swine flu dr reji jose.md. consultant physician taluk hospital thodupuzha
Post on 15-Jan-2016
228 views
TRANSCRIPT
SWINE SWINE FLUFLU
DR REJI JOSE.MD.DR REJI JOSE.MD.CONSULTANT PHYSICIANCONSULTANT PHYSICIAN
TALUK HOSPITALTALUK HOSPITALTHODUPUZHATHODUPUZHA
DEFINITIONDEFINITION
SWINE FLU IS A HIGHLY CONTAGEOUS SWINE FLU IS A HIGHLY CONTAGEOUS ACUTE RESPIRATORY DISEASE OF ACUTE RESPIRATORY DISEASE OF PIGS CAUSED BY INFLUENZA A PIGS CAUSED BY INFLUENZA A VIRUS, CAN CAUSE ILLNESS IN MAN VIRUS, CAN CAUSE ILLNESS IN MAN ALSOALSO
SWINE FLU IN MANSWINE FLU IN MAN
IN MAN THE DISEASE PRESENT AS AN IN MAN THE DISEASE PRESENT AS AN ABRUPT ONSET OF HIGH FEVER WITH ABRUPT ONSET OF HIGH FEVER WITH FEATURES OF ACUTE LOWER FEATURES OF ACUTE LOWER PESPIRATORY INFECTION RAPIDLY PESPIRATORY INFECTION RAPIDLY PROGRESSING, HIGHLY CONTAGEOUS PROGRESSING, HIGHLY CONTAGEOUS AND IF NOT TREATED IN TIME MAY AND IF NOT TREATED IN TIME MAY LEAD TO SERIOUS CMPLICATIONS OR LEAD TO SERIOUS CMPLICATIONS OR DEATHDEATH
PANDEMIC HISTORYPANDEMIC HISTORY
1918-SPANISH FLU-50 MILL 1918-SPANISH FLU-50 MILL DEATHS.H1N1DEATHS.H1N1
1957-ASIAN FLU-1-4 MILL DEATHS.1957-ASIAN FLU-1-4 MILL DEATHS.
1968-HONG KONG FLU-1-4 MILL 1968-HONG KONG FLU-1-4 MILL DEATHS.DEATHS.
NEXT????????????????????????NEXT????????????????????????
IMPENDING FLU IMPENDING FLU PANDEMICPANDEMIC
WE HAVE TO BE PREPARED TO MEET WE HAVE TO BE PREPARED TO MEET THE CHALLENGE, WHICH CAN OCCUR THE CHALLENGE, WHICH CAN OCCUR AT ANY TIME.AT ANY TIME.
SWINE INFLUENZA-THE SWINE INFLUENZA-THE AGENTAGENT
It is a RNA virus,It is a RNA virus, Influenza A virus,Influenza A virus,Natural reservoir-pigsNatural reservoir-pigsCan infect man,Can infect man,Shifted virus may cause pandemicShifted virus may cause pandemic
Influenza virus A- antigenic variationsInfluenza virus A- antigenic variations
ANTIGENIC DRIFTANTIGENIC DRIFT: Gradual : Gradual antegenic change over a periodantegenic change over a period
Involves “point mutations" in genes Involves “point mutations" in genes owing to selection pressure by owing to selection pressure by immunity in host populationimmunity in host population
Responsible for frequent influenza Responsible for frequent influenza epidemics;necessiates reformulation epidemics;necessiates reformulation of influenza vaccinesof influenza vaccines
Influenza virus A- antigenic variationsInfluenza virus A- antigenic variations
ANTIGENIC SHIFTANTIGENIC SHIFT: Sudden complete : Sudden complete or major change;or major change;
Results fro genetic recombination of Results fro genetic recombination of human with animal/avian virushuman with animal/avian virus
Leads to a novel subtype different from Leads to a novel subtype different from both parent virusesboth parent viruses
If novel subtype has sufficient genes from If novel subtype has sufficient genes from H1 viruses which make it readily H1 viruses which make it readily transmissible from person to person, it transmissible from person to person, it may cause pandemicmay cause pandemic
SWINE INFLUENZA-THE SWINE INFLUENZA-THE AGENTAGENT
2 surface antigens2 surface antigens
HAEMAGGLUTININSHAEMAGGLUTININS(HA)-16 Nos(HA)-16 Nos Initiates infection following Initiates infection following
attachment of virus to susceptible attachment of virus to susceptible cellscells
NEURAMINIDASENEURAMINIDASE(NA)-9 Nos(NA)-9 NosDifferent combinations eg Different combinations eg
H1N1,N5N2 etcH1N1,N5N2 etc
SWINE INFLUENZA-THE SWINE INFLUENZA-THE AGENTAGENT
THE VIRUS THE VIRUS RESPONSIBLE FOR RESPONSIBLE FOR CURRENT PANDEMIC IS CURRENT PANDEMIC IS
H1N1H1N1
SEASONAL INFLUENZA -HOST FACTORSSEASONAL INFLUENZA -HOST FACTORS
Age & sexAge & sex All ages, both sexesAll ages, both sexesAttack rates more among young Attack rates more among young
adultsadultsHigh CFR during in high risk cases High CFR during in high risk cases
like old and very young, DM cases like old and very young, DM cases and with other diseases like COPDand with other diseases like COPD
SWINE INFLUENZA –HIGH RISK SWINE INFLUENZA –HIGH RISK GROUPSGROUPS
Infants and young children,Infants and young children,Elderly,Elderly,Persons of any age with chronic Persons of any age with chronic
conditionsconditions >COPD>COPD >CVA,>CVA, >Renal diseases,>Renal diseases, >Immunocompromised,>Immunocompromised, >Pregnant women.>Pregnant women.
SEASONAL INFLUENZA -HOST FACTORSSEASONAL INFLUENZA -HOST FACTORS
ImmunityImmunityAntibody to H neutralizes the virus Antibody to H neutralizes the virus Antibody to N modifies the infectionAntibody to N modifies the infectionAntibody appear 7 days after the Antibody appear 7 days after the
infection, max in 2 weeks, drops to infection, max in 2 weeks, drops to pre infection level in 8-12 months pre infection level in 8-12 months
INFLUENZA -ENVIORNMENTAL INFLUENZA -ENVIORNMENTAL FACTORSFACTORS
SeasonalitySeasonalityTemperate zone: epidemics occur in Temperate zone: epidemics occur in
winterwinterTropics: epidemics occur in rainy Tropics: epidemics occur in rainy
seasonseasonSporadic cases: any monthSporadic cases: any month OvercrowdingOvercrowdingEnhances transmissionEnhances transmissionHigher attack rates in closed populationHigher attack rates in closed population
SWINE INFLUENZA -TRANSMISSIONSWINE INFLUENZA -TRANSMISSION
Mainly airborneMainly airborneDroplet infectionDroplet infectionDroplet nucleiDroplet nuclei
Through direct contactThrough direct contactFomites alsoFomites also
PATHOGENESISPATHOGENESIS
VIRUS INFECT WHOLE OF THE VIRUS INFECT WHOLE OF THE RESPIRATORY TRACT FROM NASAL RESPIRATORY TRACT FROM NASAL MUCOSA TO ALVEOLIMUCOSA TO ALVEOLI
Local inflammatory reaction->nasal Local inflammatory reaction->nasal congestion, cough, breathlessnesscongestion, cough, breathlessness
Systemic body reaction-> Systemic body reaction-> Fever,myalgia etcFever,myalgia etc
Features of ac lower respiratory Features of ac lower respiratory infection,infection,
COMMUNICABILITYCOMMUNICABILITY
1 DAY BEFORE TO 7 DAYS AFTER THE 1 DAY BEFORE TO 7 DAYS AFTER THE INFECTION, MORE IN CHILDRENINFECTION, MORE IN CHILDREN
SYMPTOMSSYMPTOMSAbrupt onset of fever body Abrupt onset of fever body
aches,head ache and fatigueaches,head ache and fatigueCough, rhinitis, sore throatCough, rhinitis, sore throatGI symptoms and myositis common GI symptoms and myositis common
in young,in young,
FEVERFEVERABRUPT ONSETABRUPT ONSETABOVE 38° CABOVE 38° CASSOCIATED BODY PAIN ALSOASSOCIATED BODY PAIN ALSOCONTINUE FOR FEW DAYS AND CONTINUE FOR FEW DAYS AND
GRADUALLY DIMINISHGRADUALLY DIMINISHCHILLS AND RIGOR ALSOCHILLS AND RIGOR ALSOHEAD ACHE HEAD ACHE
COUGHCOUGHTYPICAL OF LOWER RESPIRATORY TYPICAL OF LOWER RESPIRATORY
INFECTIONINFECTIONFEATURES OF UPPER RESPIRATORY FEATURES OF UPPER RESPIRATORY
INFECTION IN THE FORM OF NASAL INFECTION IN THE FORM OF NASAL CONGESTION,RHINORRHOEA, SORE CONGESTION,RHINORRHOEA, SORE THROAT. THROAT.
GIT SYMPTOMSGIT SYMPTOMS
USUALLY SEEN AS DIARRHOEA, USUALLY SEEN AS DIARRHOEA, NAUSEA AND VOMITINGNAUSEA AND VOMITING
SIGNSSIGNS
Elevated temperatureElevated temperatureTachycardiaTachycardiaTachypnoeaTachypnoeaCrepitations Crepitations
TEMPERATURETEMPERATURE
USUALLY ABOVE 38° CUSUALLY ABOVE 38° CCHILLS AND RIGOR CAN OCCURCHILLS AND RIGOR CAN OCCUR
INCREASED RESPIRATORY INCREASED RESPIRATORY RATERATE
DUE TO LOWER RESPIRATORY DUE TO LOWER RESPIRATORY INFECTIONINFECTION
CREPITATIONS AND RONCHI ALSOCREPITATIONS AND RONCHI ALSO
SWINE INFLUENZA -SWINE INFLUENZA -COMPLICATIONSCOMPLICATIONS
Sinus and ear infections,Sinus and ear infections,Pneumonia, bacterial and viral,Pneumonia, bacterial and viral,Myocarditis,Myocarditis,Pericarditis,Pericarditis,Encephalitis,Encephalitis,Febrile seizures in young,Febrile seizures in young,Worsening of underlying chronic Worsening of underlying chronic
diseasedisease
SWINE INFLUENZA –HIGH RISK SWINE INFLUENZA –HIGH RISK GROUPSGROUPS
Infants and young children,Infants and young children,Elderly,Elderly,Persons of any age with chronic Persons of any age with chronic
conditionsconditions >COPD>COPD >CVA,>CVA, >Renal diseases,>Renal diseases, >Immunocompromised,>Immunocompromised, >Pregnant women.>Pregnant women.
PROVISIONAL DIAGNOSISPROVISIONAL DIAGNOSIS
HISTORY OF CONTACTHISTORY OF CONTACTCOMING FROM AN ENDEMIC AREACOMING FROM AN ENDEMIC AREASYMPTOMS AND SIGNS OF ACUTE SYMPTOMS AND SIGNS OF ACUTE
RESPIRATORY INFECTION WITH HIGH RESPIRATORY INFECTION WITH HIGH GRADE FEVERGRADE FEVER
INVESTIGATIONSINVESTIGATIONS
INVESTIGATIONS TO EXCLUDE OTHER INVESTIGATIONS TO EXCLUDE OTHER CAUSES OF FEVER WITH SIMILAR CAUSES OF FEVER WITH SIMILAR CLINICAL PICTURECLINICAL PICTURE
CONFIRMATIONCONFIRMATION
>REAL TIME PCR>REAL TIME PCR
>ISOLATION OF VIRUS IN CULTURE>ISOLATION OF VIRUS IN CULTURE
>FOUR FOLD RISE IN VIRUS SPECIFIC >FOUR FOLD RISE IN VIRUS SPECIFIC NEUTRILISING ANTEBODIESNEUTRILISING ANTEBODIES
CONFIRMATORY TESTSCONFIRMATORY TESTS
The samples are to be tested in BSL-The samples are to be tested in BSL-3 laboratory. At present the following 3 laboratory. At present the following laboratories are the identified laboratories are the identified laboratories for this purpose:laboratories for this purpose:
National Institute of Communicable National Institute of Communicable Diseases, 22, Sham Nath Marg, Delhi Diseases, 22, Sham Nath Marg, Delhi [Tel. Nos. Influenza Monitoring Cell: [Tel. Nos. Influenza Monitoring Cell: 011-23921401; Director: 011-011-23921401; Director: 011-23913148] 23913148]
CONFIRMATORY CONFIRMATORY TESTS(CONT)TESTS(CONT)
National Institute of Virology, 20-A, National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune-411001 Dr. Ambedkar Road, Pune-411001 [Tel.No. 020-26124386][Tel.No. 020-26124386]
SPECIMEN COLLECTIONSPECIMEN COLLECTION
For confirmation of diagnosis, clinical For confirmation of diagnosis, clinical specimens such as nasopharyngeal specimens such as nasopharyngeal swab, throat swab, nasal swab, wash swab, throat swab, nasal swab, wash or aspirate, and tracheal aspirate (for or aspirate, and tracheal aspirate (for intubated patients) are to be intubated patients) are to be obtained. obtained.
The sample should be collected by a The sample should be collected by a trained physician / microbiologist trained physician / microbiologist preferably before administration of preferably before administration of the anti-viral drug the anti-viral drug
STORAGE AND STORAGE AND TRANSPORTTRANSPORT
Keep specimens at 4°C in viral Keep specimens at 4°C in viral transport media until transported for transport media until transported for testing. The samples should be testing. The samples should be transported to designated transported to designated laboratories with in 24 hours laboratories with in 24 hours
If they cannot be transported then it If they cannot be transported then it needs to b stored at -70°C. Paired needs to b stored at -70°C. Paired blood samples at an interval of 14 blood samples at an interval of 14 days for serological testing should days for serological testing should also be collected. also be collected.
DIFERENTIAL DIAGNOSISDIFERENTIAL DIAGNOSIS
OTHER EFVERS LIKE TYPHOID, OTHER EFVERS LIKE TYPHOID, COMMON RESPIRATORY INFECTIONS COMMON RESPIRATORY INFECTIONS LIKE AC BRONCHITIS, CAP, LIKE AC BRONCHITIS, CAP, LEPTOSPIROSIS ETCLEPTOSPIROSIS ETC
COMMON COLDCOMMON COLDAVIAN FLUAVIAN FLUSEASONAL INFLUENZASEASONAL INFLUENZA
SWINE INFLUENZA V/S COMMON COLDSWINE INFLUENZA V/S COMMON COLD
SYMPTOMSSYMPTOMS
FeverFever
Head acheHead ache
FatigueFatigue
Stuffy noseStuffy nose
CoughCough
Chest Chest discomfortdiscomfort
ComlicationsComlications
INFLUENZAINFLUENZA
High 3-4 daysHigh 3-4 days
YesYes
2-3 weeks 2-3 weeks
SometimesSometimes
YesYes
Yes, may be Yes, may be severe severe
CommonCommon
COLDCOLD
UnusualUnusual
UnusualUnusual
MildMild
CommonCommon
UnusualUnusual
MildMild
RareRare
SWINE INFLUENZA V/S SWINE INFLUENZA V/S INFLUENZA A INFLUENZA A
SYMPTOMSSYMPTOMS SWINE INFLUENZASWINE INFLUENZA INFLUENZA AINFLUENZA A
FEVERFEVER
HEAD ACHEHEAD ACHE
FATIGUEFATIGUE
COUGHCOUGH
GIT SYMPTOMGIT SYMPTOMCOMPLICATIONCOMPLICATIONSS
HIGHHIGH
SEVERESEVERE
>2 WEEKS>2 WEEKS
YESYES
MOREMORE
MORE CHANCEMORE CHANCE
LESSERLESSER
MILDERMILDER
2 WEEKS2 WEEKS
YESYES
NONO
LESSLESS
SWINE INFLEUNZA VS AVIANSWINE INFLEUNZA VS AVIAN
CLINICAL PICTURE SIMILAR BUT CLINICAL PICTURE SIMILAR BUT MORE SEVERE IN AVIAN INFLEUNZAMORE SEVERE IN AVIAN INFLEUNZA
TREATMENTTREATMENT
EARLY IMPLEMENTATION OF EARLY IMPLEMENTATION OF INFECTION CONTROLINFECTION CONTROL
PROMPT DRUG TREATMENT TO PROMPT DRUG TREATMENT TO PREVENT SEVERITY AND DEATHPREVENT SEVERITY AND DEATH
EARLY IDENTIFICATION OF PERSONS EARLY IDENTIFICATION OF PERSONS AT RISK AND PROTECT THEMAT RISK AND PROTECT THEM
INFECTION CONTROL INFECTION CONTROL INFRASTRUCTUREINFRASTRUCTURE
ISOLATION FACILITIESISOLATION FACILITIESMANPOWER,MEDICAL, NURSING & MANPOWER,MEDICAL, NURSING &
PARAMEDICAL STAFFPARAMEDICAL STAFFEQUIPMENTS- VENTELATORS ETCEQUIPMENTS- VENTELATORS ETCSUPPLIES-PPE, DRUGSSUPPLIES-PPE, DRUGS
INFECTION CONTROLINFECTION CONTROL
Effective Infection Control Effective Infection Control Prevents Transmission Prevents Transmission From.From.
Patients to health care Patients to health care workersworkers
Patients to patientsPatients to patients
Patients to family members Patients to family members providing careproviding care
Droplet Droplet precautionsprecautions
Swine Influenza Swine Influenza PrecautionsPrecautions
Contact Contact precautionsprecautions
Airborne PrecautionsAirborne Precautions
Precautions for Suspected or Precautions for Suspected or Confirmed CasesConfirmed Cases
Place patient in a negative air pressure room Place patient in a negative air pressure room
To create a negative air pressure room:To create a negative air pressure room: Install exhaust fan and direct air from Install exhaust fan and direct air from
inside to an outside area with no person inside to an outside area with no person movementmovement
If no air conditioning, open windows in If no air conditioning, open windows in isolation areas but keep doors closedisolation areas but keep doors closed
Place patients in rooms alonePlace patients in rooms alone Alternative: cohort patients away from Alternative: cohort patients away from
other patient care areas with beds > 1 other patient care areas with beds > 1 meter apartmeter apart
Precautions for Suspected or Precautions for Suspected or Confirmed CasesConfirmed Cases
Limit number of health care workers, Limit number of health care workers, family members and visitorsfamily members and visitors
Designate experienced staff to Designate experienced staff to provide careprovide care
Limit designated staff to swine Limit designated staff to swine influenza patient careinfluenza patient care
Teach family and visitors to use PPE Teach family and visitors to use PPE
PERONAL PROTECTION PERONAL PROTECTION EQUIPMENTS(PPE)EQUIPMENTS(PPE)
THOSE ENTERING ROOM SHOULD THOSE ENTERING ROOM SHOULD WEAR PPEWEAR PPE
Use of PPEUse of PPE
The medical, nurses and paramedics The medical, nurses and paramedics attending the suspect/ probable / confirmed attending the suspect/ probable / confirmed case should wear full complement of PPE . case should wear full complement of PPE .
Use N-95 masks during aerosol-generating Use N-95 masks during aerosol-generating procedures. procedures.
Perform hand hygiene before and after Perform hand hygiene before and after patient contact and following contact with patient contact and following contact with contaminated items, whether or not gloves contaminated items, whether or not gloves are worn. are worn.
Sample collection and packing should be Sample collection and packing should be done under full cover of PPE.done under full cover of PPE.
PERSONAL PROTECTIVE PERSONAL PROTECTIVE EQUIPMENTSEQUIPMENTS
INCLUDEINCLUDEHIGH EFFICIENCY MASKHIGH EFFICIENCY MASKGOWNGOWNGOGGLESGOGGLESGLOVESGLOVESCAP ANDCAP ANDSHOE COVERSHOE COVER
Correct procedure for Correct procedure for applyingapplying
Follow thorough hand washFollow thorough hand wash Wear the coverall.Wear the coverall. Wear the goggles/ shoe cover/and Wear the goggles/ shoe cover/and
head cover in that order.head cover in that order. Wear face maskWear face mask Wear glovesWear gloves The masks should be changed after The masks should be changed after
every six to eight hours.every six to eight hours.
Remove PPE in the following Remove PPE in the following order:order:
• • Remove gown (place in rubbish bin).Remove gown (place in rubbish bin). • • Remove gloves (peel from hand and discard into rubbish Remove gloves (peel from hand and discard into rubbish
bin).bin). • • Use alcohol-based hand-rub or wash hands with soap and Use alcohol-based hand-rub or wash hands with soap and
water.water. • • Remove cap and face shield (place cap in bin and if Remove cap and face shield (place cap in bin and if
reusable place face shield in container for decontamination).reusable place face shield in container for decontamination). • • Remove mask - Remove mask - by grasping elastic behind ears – do by grasping elastic behind ears – do
not touch front of mask not touch front of mask • • Use alcohol-based hand-rub or wash hands with soap and Use alcohol-based hand-rub or wash hands with soap and
water.water. • • Leave the room.Leave the room. • • Once outside room use alcohol hand-rub again or wash Once outside room use alcohol hand-rub again or wash
hands with soap and water hands with soap and water UUsed PPE should be handled as waste as per waste sed PPE should be handled as waste as per waste
management protocol management protocol
Neuraminidase InhibitorsNeuraminidase InhibitorsOseltamivir and Zanamivir Oseltamivir and Zanamivir
belongs to this group.belongs to this group.
Mode of action:Mode of action:
These drugs block release of These drugs block release of newly formed virus particles by newly formed virus particles by inhibiting neuraminidase of inhibiting neuraminidase of virus.virus.
Cont…Cont… Oseltamivir:Oseltamivir:It is given by oral route.It is given by oral route.The drug is excreted unchanged The drug is excreted unchanged
by kidney. Therefore dose needs by kidney. Therefore dose needs to be reduced if creatin clearance to be reduced if creatin clearance is less than 30 ml per minute.is less than 30 ml per minute.
No specific drug interaction has No specific drug interaction has been reported, although been reported, although probenecid reduces its excretion probenecid reduces its excretion by 50%. by 50%.
DOSAGEDOSAGE
Dose for treatment is as followsDose for treatment is as follows::By Weight: By Weight:
For weight <15kg 30 mg BD for 5 daysFor weight <15kg 30 mg BD for 5 days15-23kg 45 mg BD for 5 days15-23kg 45 mg BD for 5 days24-<40kg 60 mg BD for 5 days24-<40kg 60 mg BD for 5 days>40kg 75 mg BD for 5 days>40kg 75 mg BD for 5 days
DOSAGEDOSAGE
For infants:For infants:< 3 months< 3 months 12 mg BD for 5 days12 mg BD for 5 days3-5 months3-5 months 20 mg BD for 5 days20 mg BD for 5 days6-11 months6-11 months 25 mg BD for 5 days25 mg BD for 5 days
ADVERSE REACTIONSADVERSE REACTIONS
gastrointestinal side effects gastrointestinal side effects (transient nausea, vomiting) may (transient nausea, vomiting) may increase with increasing doses increase with increasing doses
cause bronchitis, insomnia and cause bronchitis, insomnia and vertigo. Less commonly angina, vertigo. Less commonly angina, pseudo membranous colitis and pseudo membranous colitis and peritonsillar abscess have also been peritonsillar abscess have also been reported. There have been rare reported. There have been rare reports of anaphylaxis and skin reports of anaphylaxis and skin rashes. rashes.
ADVERSE REACTIONSADVERSE REACTIONS
Infrequently, abdominal pain, Infrequently, abdominal pain, epistaxis, bronchitis, otitis media, epistaxis, bronchitis, otitis media, dermatitis and conjunctivitis have dermatitis and conjunctivitis have also been observed. also been observed.
Though rare reporting of fatal neuro-Though rare reporting of fatal neuro-psychiatiric illness in children and psychiatiric illness in children and adolescents have been linked to adolescents have been linked to oseltamivir oseltamivir
Other Drugs under Other Drugs under EvaluationEvaluation
Peramivir and other cyclopentane Peramivir and other cyclopentane derivatives:derivatives:A Single injection in mice strongly A Single injection in mice strongly suppreses influenza virus.suppreses influenza virus.
Dimeric Neuraminidase InhibitorsDimeric Neuraminidase Inhibitors:: 100 times more potent than Zanamivir, 100 times more potent than Zanamivir,
opens possibility of once a week dose opens possibility of once a week dose possibility.possibility.
Ribavarine and Interferon alpha.Ribavarine and Interferon alpha. Sialidase fusion proteins & siRNAs.Sialidase fusion proteins & siRNAs.
Supportive therapySupportive therapy
IV Fluids.IV Fluids.Parentral nutrition. Parentral nutrition. Oxygen therapy/ ventilatory support.Oxygen therapy/ ventilatory support.Antibiotics for secondary infection.Antibiotics for secondary infection.Vasopressors for shock Vasopressors for shock
Supportive therapySupportive therapy
Paracetamol or ibuprofen is Paracetamol or ibuprofen is prescribed for fever, myalgia and prescribed for fever, myalgia and headache. Patient is advised to drink headache. Patient is advised to drink plenty of fluids. Smokers should plenty of fluids. Smokers should avoid smoking. For sore throat, short avoid smoking. For sore throat, short course of topical decongestants, course of topical decongestants, saline nasal drops, throat lozenges saline nasal drops, throat lozenges and steam inhalation may be and steam inhalation may be beneficial. beneficial.
Supportive therapySupportive therapy
Salicylate / aspirin is strictly contra-Salicylate / aspirin is strictly contra-indicated in any influenza patient indicated in any influenza patient due to its potential to cause Reye’s due to its potential to cause Reye’s syndrome.syndrome.
The suspected cases would be The suspected cases would be constantly monitored for clinical / constantly monitored for clinical / radiological evidence of lower radiological evidence of lower respiratory tract infection and for respiratory tract infection and for hypoxia (respiratory rate, oxygen hypoxia (respiratory rate, oxygen saturation, level of consciousness). saturation, level of consciousness).
Supportive therapySupportive therapy
oxygen therapyoxygen therapy Patients with signs of tachypnea, Patients with signs of tachypnea,
dyspnea, respiratory distress dyspnea, respiratory distress and oxygen saturation less than and oxygen saturation less than 90 per cent should be 90 per cent should be supplemented with oxygen supplemented with oxygen therapy.therapy.
Supportive therapySupportive therapy
mechanical ventilation mechanical ventilation Patients with severe pneumonia and Patients with severe pneumonia and
acute respiratory failure (SpO2 < acute respiratory failure (SpO2 < 90% and PaO2 <60 mmHg with 90% and PaO2 <60 mmHg with oxygen therapy) must be supported oxygen therapy) must be supported with mechanical ventilation with mechanical ventilation
Supportive therapySupportive therapy
ABC, Maintain airway, breathing and ABC, Maintain airway, breathing and circulation circulation
Maintain hydration, electrolyte Maintain hydration, electrolyte balance and nutrition balance and nutrition
Supportive therapySupportive therapy
mechanical ventilation mechanical ventilation Patients with severe pneumonia and Patients with severe pneumonia and
acute respiratory failure (SpO2 < acute respiratory failure (SpO2 < 90% and PaO2 <60 mmHg with 90% and PaO2 <60 mmHg with oxygen therapy) must be supported oxygen therapy) must be supported with mechanical ventilation with mechanical ventilation
STEROIDSSTEROIDS
High dose corticosteroids in High dose corticosteroids in particular have no evidence of particular have no evidence of benefit and there is potential for benefit and there is potential for harm. harm.
Low dose corticosteroids Low dose corticosteroids (Hydrocortisone 200-400 mg/ day) (Hydrocortisone 200-400 mg/ day) may be useful in persisting septic may be useful in persisting septic shock (SBP < 90). shock (SBP < 90).
ANTEBIOTICSANTEBIOTICS
Suspected case not having pneumonia Suspected case not having pneumonia do not require antibiotic therapy. do not require antibiotic therapy. Antibacterial agents should be Antibacterial agents should be administered, if required, as per locally administered, if required, as per locally accepted clinical practice guidelines accepted clinical practice guidelines
Patient on mechanical ventilation Patient on mechanical ventilation should be administered antibiotics should be administered antibiotics prophylactically to prevent hospital prophylactically to prevent hospital associated infections.associated infections.
Adults Need attention if Adults Need attention if Present withPresent with
Difficulty breathing or shortness of Difficulty breathing or shortness of breath breath
Pain or pressure in the chest or Pain or pressure in the chest or abdomen abdomen
Sudden dizziness Sudden dizziness Confusion Confusion Severe or persistent vomiting Severe or persistent vomiting
Seek emergency medical care.Seek emergency medical care.IF -IF - in Childrenin Children
In children emergency warning signs that In children emergency warning signs that need urgent medical attention include: need urgent medical attention include:
Fast breathing or trouble breathing Bluish Fast breathing or trouble breathing Bluish skin color.Not drinking enough fluids skin color.Not drinking enough fluids
Not waking up or not interacting Not waking up or not interacting Being so irritable that the child does not Being so irritable that the child does not
want to be held want to be held Flu-like symptoms improve but then return Flu-like symptoms improve but then return
with fever and worse cough with fever and worse cough Fever with a rash Fever with a rash
DISCHARGEDISCHARGE
Adult patients should be discharged 7 Adult patients should be discharged 7 days after symptoms have subsided days after symptoms have subsided
Children should be discharged 14 days Children should be discharged 14 days after symptoms have subsided after symptoms have subsided
The family of patients discharged The family of patients discharged earlier should be educated on personal earlier should be educated on personal hygiene and infection control measures hygiene and infection control measures at home; children should not attend at home; children should not attend school during this period school during this period
EARLY IDENTIFICATION OF EARLY IDENTIFICATION OF PERSONS AT RISK AND PERSONS AT RISK AND PROTECTION OF THEMPROTECTION OF THEM
CHEMOPROPHYLAXIS-CHEMOPROPHYLAXIS-INDICATIONSINDICATIONS
All close contacts of suspected, All close contacts of suspected, probable and confirmed cases. Close probable and confirmed cases. Close contacts include household /social contacts include household /social contacts, family members, workplace contacts, family members, workplace or school contacts, fellow travelers or school contacts, fellow travelers etc.etc.
All health care personnel coming in All health care personnel coming in contact with suspected, probable or contact with suspected, probable or confirmed cases confirmed cases
CHEMOPROPHYLAXIS-CHEMOPROPHYLAXIS-DURATIONDURATION
Prophylaxis should be provided till 10 Prophylaxis should be provided till 10 days after last exposure (maximum days after last exposure (maximum period of 6 weeks period of 6 weeks
CHEMOPROPHYLAXIS- DRUGCHEMOPROPHYLAXIS- DRUG
Oseltamivir is the drug of choice.Oseltamivir is the drug of choice.For weight <15kg 30 mg OD For weight <15kg 30 mg OD 15-23kg 45 mg OD15-23kg 45 mg OD24-<40kg 60 mg OD24-<40kg 60 mg OD>40kg 75 mg OD>40kg 75 mg OD
OseltamivirOseltamivir
For infants:For infants:< 3 months< 3 months not recommended not recommended
unless situation judged critical due to unless situation judged critical due to limited data on use in this age grouplimited data on use in this age group
3-5 months3-5 months 20 mg OD20 mg OD6-11 months6-11 months 25 mg OD25 mg OD
Infection control measures Infection control measures at Individual levelat Individual level
Hand HygieneHand Hygiene Hand hygiene is the single most important Hand hygiene is the single most important
measure to reduce the risk of transmitting measure to reduce the risk of transmitting infectious organism from one person to infectious organism from one person to other.other.
Hands should be washed frequently with Hands should be washed frequently with soap and water / alcohol based hand rubs/ soap and water / alcohol based hand rubs/ antiseptic hand wash and thoroughly dried antiseptic hand wash and thoroughly dried preferably using disposable tissue/ paper/ preferably using disposable tissue/ paper/ towel.towel.
Respiratory Hygiene/Cough Respiratory Hygiene/Cough EtiquetteEtiquette
Cover the nose/mouth with a Cover the nose/mouth with a handkerchief/ tissue paper when handkerchief/ tissue paper when coughing or sneezing;coughing or sneezing;
Use tissues to contain respiratory Use tissues to contain respiratory secretions and dispose of them in the secretions and dispose of them in the nearest waste receptacle after use;nearest waste receptacle after use;
Cover your mouth and nose.Cover your mouth and nose.
Cover your mouth Cover your mouth and nose with a and nose with a tissue when tissue when coughing or coughing or sneezing. It may sneezing. It may prevent those prevent those around you from around you from getting sick getting sick
Simple measures carry get Simple measures carry get good Benefitsgood Benefits
Cover your Cover your mouth and nose. mouth and nose. Use a tissue when Use a tissue when you cough or you cough or sneeze and drop it sneeze and drop it in the trash. If you in the trash. If you don’t have a tissue, don’t have a tissue, cover your mouth cover your mouth and nose as best and nose as best you can.you can.
Staying awayStaying away
Stay away from pigs. Keep them Stay away from pigs. Keep them secure in cages. Keep children out of secure in cages. Keep children out of reach. reach.
Wash hands if in contact with pig or Wash hands if in contact with pig or pig products.pig products.
Stay at least one metre away from a Stay at least one metre away from a person having cough or sneeze person having cough or sneeze
Stay home when you are Stay home when you are sick.sick.
If possible, stay If possible, stay home from work, home from work, school, and errands school, and errands when you are sick. when you are sick. You will help You will help prevent others prevent others from catching your from catching your illness. illness.
Use of maskUse of mask
Persons under investigations / Persons under investigations / suspected cases managed at home suspected cases managed at home and there family contacts are trained and there family contacts are trained on using three layered surgical on using three layered surgical masks.masks.
Guidelines for waste Guidelines for waste disposaldisposal
All the waste has to be treated as All the waste has to be treated as infectious waste and decontaminated infectious waste and decontaminated as per standard proceduresas per standard procedures
Articles like swabs/gauges etc are to Articles like swabs/gauges etc are to be discarded in the Yellow coloured be discarded in the Yellow coloured autoclavable biosafety bags after autoclavable biosafety bags after use, the bags are to be autoclaved use, the bags are to be autoclaved followed by incineration of the followed by incineration of the contents of the bag.contents of the bag.
CARRY HOME MESSAGECARRY HOME MESSAGE
SWINE FLU IN MAN IS A HIGHLY SWINE FLU IN MAN IS A HIGHLY CONTAGEOUS DISEASECONTAGEOUS DISEASE
IF DIAGNOSED IN TIME, TREATED IF DIAGNOSED IN TIME, TREATED PROPERLY, AND PROTECTING HEALTH PROPERLY, AND PROTECTING HEALTH CARE STAFF AND CONTACTS, CARE STAFF AND CONTACTS, PANDEMIC MAY BE CONTAINEDPANDEMIC MAY BE CONTAINED