H1N1- ABC- IT IS EVERYWHERE

• HINI  might sensitize about hand hygiene, other precautions,over use of oseltamavir
• see the state notification
• ABC of H1N1

H1N1 Influenza (adapted from the GoI- MoHFW guidelines)
Clinical features of an ILI (Influenza Like Illness)

(Any combination of ther following is suggestive)
– Fever > 100 deg F,
– Upper respiratory symptoms
– Cough
– Sore throat.
– Head ache, body ache, fatigue diarrhea and vomiting have also been observed
ABC GUIDELINES
1. Categorization
Category A- mild fever plus cough / sore throat with or without body ache, headache, diarrhoea and vomiting
Category-B (Bi) Category-A plus high grade fever and severe sore throat
(Bii) Category- Any mild ILI in people with co-morbidities
 Pregnant women
 Lung/ heart / liver/ kidney / neurological disease, blood disorders/ diabetes/ cancer /HIV-AIDS
 On long term steroids
 Children — mild illness but with predisposing risk factors.
 Age 65 years+.
Category-C
 · Breathlessness, chest pain, drowsiness, fall in blood pressure, haemoptysis, cyanosis
 · Children with ILI (influenza like illness) with red flag signs
 (Somnolence, high/persistent fever, inability to feed well, convulsions, dyspnoea /respiratory distress, etc).
 · Worsening of underlying chronic conditions.

2. H1N1 Testing
ILI- Cat- A- No testing needed

ILI -Cat-B- No testing for Category-B (i) and (ii)
Cat-C- Test may be needed**, but do not wait for test results .
** (Sentinel type Testing now needs to be done only for epidemiological purposes, eg.- unusual in presentation, failure to respond even after 5 days extension of Oseltamivir therapy, institutional spread, etc)
If testing is indicated –
Contact your hospital Nodal MO, DSO / Nodal MO of District Hospital
Specimen required – 1 throat swab and 1 nasal swab, using Dacron swab, and immersed in VTM (Viral Transport Medium) tube, immediately put in cold chain/ refrigerated till dispatch at 2-8 deg C .
Specimen should be dispatched through the DMO/DSO of the district. Never send parcels directly/ through bystanders.
Testing centres – Three** authorized testing centres for Kerala,
1. Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram,
2.Virology Division, MCVR, KMC Hospital, Manipal, Karnataka State.
3. NIV Unit, Medical College, Alappuzha
** At any point in time some lab may not be active due to materials /supplies issues. Details from time to time will be available with DSO/DMO of your district
3. Management:
ILI- Category- A–

No Oseltamivir required
–Symptomatic treatment
–Good supportive measures
 Plenty of warm nourishing oral fluids,
 Good food intake
 Complete rest
–Monitor progress
–Reassess , at 24 to 48 hours
–Self isolation at home, and telephone follow up for the next 2-3 days
–Any suggestion of deterioration/ failure to improve?– report in person stat.
ILI Category-B

Bi) —————– Home isolation
—Oseltamivir to be started as per clinical assessment;
(Bii) —————-Start Oseltamivir immediately
—–Self isolation at home, and telephone follow up for the next 2-3 days
–Any suggestion of deterioration/ failure to improve?– report in person stat.
ILI Category-C
Hospitalization stat
Start Oseltamivir immediately, without waiting for test results
Intensive supportive management is usually necessary.

Oseltamivir dosage schedule
 Dose for treatment is as follows:
 By Weight:
– For weight <15kg 30 mg BD for 5 days
– 15-23kg 45 mg BD for 5 days
– 24-<40kg 60 mg BD for 5 days
– >40kg 75 mg BD for 5 days
 For infants:
– < 3 months 12 mg BD for 5 days
– 3-5 months 20 mg BD for 5 days
– 6-11 months 25 mg BD for 5 days
– It is also available as syrup (12mg per ml )
– If needed dose & duration can be modified as per clinical condition.
– In case suspension is not in stock, the contents of the capsule can be divided and administered in powdered sugar, sugar syrup, or honey

***Dose by weight for chemoprophylaxis (only in special circumstances-see section 2) is similar, except that it is Once daily, for 10 days

Kerala already has community spread
Implications
(i) To assess Influenza like illness in the patient
(ii) Categorization into A, B and C categories,
(iii) home isolation for category A and B
(iv) hospitalization for Category C.
(v) Treatment with Oseltamivir indicated for Category B and Category C (refer to patient categorization guidelines ).
Chemoprophylaxis to family, school and social contacts of a positive case-
 No mass contact prophylaxis advised
 For those with high risk Eg. pregnancy/ diabetes/ Asthma/immuno-suppressed/ very low or high age– Start OD dose Oseltamivir x 10 days
 Others – assess category, if and when symptomatic, then treat as per ABC guidelines