Swine Flu: Guideline, treatment & management protocol
M3 India Newsdesk Aug 31, 2018
Adding to the list of seasonal diseases this year is Swine Flu, which has once again made an appearance in 2018, with patients being diagnosed in Maharashtra and West Bengal. This article details on the guideline and management protocol for Swine Flu in India.
After the regular dengue, malaria scare, there was scrub typhus which rapidly spread in Himachal Pradesh and more recently in Nagpur, Hand Foot and Mouth (HFMD) which is rattling Bangaluru, and now finally H1N1 Swine flu which emerging in Maharashtra.
More cases of swine flu are being detected and reported in the state, with eleven people already having succumbed to the disease. Swine flu so far, has 79 new cases in August 2018, compared to only 40 reported the previous month.
Besides being directed to step up vaccination programs in the state, health officials have also been instructed to treat every symptomatic case. Here’s a look at diagnosis, treatment, and management protocol for H1N1.
Categorizing patients as per ABC guideline
The last swine flu outbreak in India led the Centre to devise guidelines to be followed by all states during a swine flu outbreak. Health officials were asked to separate cases under 3 categories- screening, hospitalisation, and isolation.
Category A- Patients not requiring H1N1 testing
These patients usually present with influenza-like illness, symptoms of which are mild fever, body ache, headache, nausea, diarrhoea, cough, and sore throat. Category A patients should be sent home after assessing symptoms or be kept on observation for 24 to 48 hours. Patients should not be tested for the virus and should not be put on Oseltamivir.
Category B- Symptomatic with high grade fever & high-risk patients
Patients presenting with all symptoms of category A, but also having high-grade fever, plus high risk patients should be treated with Oseltamivir and must be confined at home. High risk populations include- children presenting with mild illness, pregnant women, people older than 65 years of age, patients with co-morbidities (lung, kidney, liver, heart, neurological diseases), patients on cortisone therapy, and HIV positive patients.
Category C- Symptomatic, extremely sick, and very high patients
Under category C would be patients presenting all the symptoms of categories A & B, along with other symptoms like- breathlessness, low BP, chest pains, haemoptysis, and cyanosis. Apart from this, children exhibiting influenza-like illness (ILI) with persistent high grade fever, breathing difficulty, somnolence, convulsions, and an inability to feed should also be hospitalised immediately and started on treatment.
Testing for H1N1
- Category A- No testing required
- Category B- Only test for high risk, symptomatic patients. Patients having only have high grade fever and sore throat OR mild ILI with co-morbidities need not be tested.
- Category C- Patients definitely require testing, but treatment should not be put off until then.
Sentinel tests are usually done for epidemiological purposes or in cases where the patient presents with unusual symptoms or does not show improvement after 5-day Oseltamivir treatment.
If testing is needed, doctors should order specimens (throat and nasal swabs) and should be transported to a state authorised testing centre through DMO/DSO. Nodal medical officer (MO), DSO / Nodal MO of the district hospital should also be informed.
Management protocol
Category A: Only symptomatic treatment should be followed and Oseltamivir should not be prescribed. Patients should be advised to take plenty fluids, good food, and rest. Additionally, they should also be told to monitor symptoms and appear for follow up after 24 to 48 hours.
Category B: Patients should be put on Oseltamivir and ordered home isolation and follow up in 24 to 48 hours. Any worsening of conditions would require patients to be hospitalised immediately.
Category C: Patients should be hospitalised immediately and started on Oseltamivir without waiting for testing. Dose and duration should be managed on an individual patient basis and as per clinical condition.
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