There is an ongoing outbreak of Swine flu (H1N1) in India. Government has devised a comprehensive strategy to contain the evolving epidemic. Individuals with symptoms suggestive of swine flu have been categorized based on the severity of symptoms and background previous illnesses. Testing and treatment guidelines have been advised accordingly. Please refer to the below links for Govt. guidelines for detailed information regarding evaluation, categorization, testing and treatment.
Clinical Management Protocol and Infection Control Guidelines
Dr. Subramanian Swaminathan is a Senior Consultant in Infectious Diseases at Global Hospitals, Chennai. He graduated from CMC, Vellore and is Board certified in Internal Medicine and Infectious Diseases. He is also a consultant to WHO for the '3 by 5' initiative. Following is a brief interview with him regarding the ongoing swine flu outbreak.
What are the symptoms of Swine flu?
Swine flu is usually an upper respiratory illness very much like any other viral infection like the common cold. Some patients may have severe manifestations like high fever, severe sore throat or evidence of lung infection (pneumonia)
Should all patients with suggestive symptoms be tested? How sensitive is the throat swab test? How soon do we get the results?
Testing all patients is not necessary. It is usually suggested for those with severe illness only. The swab test is a PCR test, which is quite accurate, and can only be done in some labs. The results are usually available in one business day.
When would you recommend a doctor to initiate Tamiflu for a patient presenting with fever, cough, sore throat and nasal symptoms? Should all patients who tested positive be treated?
Symptomatic treatment should be offered to all patients like decongestants, paracetamol etc. Oseltamivir should be used in those with severe infection (Category B and C). If testing is done by guidelines, then those with confirmed infection should be treated. The physician should decide on treatment clinically and not wait for the PCR result to be the guide to start therapy.
Since the drug is effective if only taken in the earliest stages of infection, how do you to identify patients who are likely to have severe illness?
It is impossible to predict who will develop severe illness. However, the medicine is not without side effects, and of limited benefit. There is no evidence to suggest that it reduces hospitalizations or complications.
Currently it is only advised for those with significant illness as outlined earlier.
What precautions should the family members of Swine flu suspected or confirmed individuals adopt? Should they be vaccinated or should they take Tamiflu as prophylaxis?
Vaccination still remains the best strategy. All household members of a patient with possible flu should be offered vaccination. Oseltamivir is suggested for those with high risk- extremes of age, immune suppression and respiratory disorders.
How much protection does the flu vaccine offer? Does the vaccine available cover the agent responsible for the current outbreak? Would it be prudent to vaccinate all high risk individuals?
The vaccine is quite effective, and there is not much Indian data. One study in patients with COPD concluded an efficacy of more than 70%. The vaccine does cover the strain in the outbreak, and should help. It is advisable to vaccinate as many people as possible.
Regarding the masks available for personal protection, how effective are the N95 masks in reducing the transmission?
N95 masks are only recommended in a clinical setting, especially for the care givers of patients with H1N1.
Do the ordinary surgical masks have any role in personal protection?
Protection is inadequate in the clinical setting where aerosol spray from the patient is a concern.
Is there something which an ordinary individual can do to protect himself and his family from Swine flu?
• Encourage Vaccination
• Avoid close contact with people who are having respiratory illness.
• H1N1 Diagnosed persons should keep distance from others. If possible, stay at home, away from work,school, and public places when you are sick.
• Cover the mouth and nose with a tissue when coughing or sneezing and immediately discard the tissue properly.
• Wash hands often with soap or alcohol based hand wash to protect from germs.
• Get adequate sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
• Persons who have difficulty breathing or shortness of breath should seek immediate medical attention and report to the nearby hospital.
• Persons in home isolation and their household members should be given infection control instructions like frequent hand washing with soap and water use of alcohol-based hand gels (containing at least 60%alcohol).
• When the ill person is within 6 feet of others at home, the ill person should wear a face mask, if available or handkerchief or tissues.
What is the reason for the significant difference is the course of illness in patients, with most infected individuals having milder course while a few become critically ill?
It is impossible to predict who will develop severe illness. As is evident from the news items, it is young healthy people with no underlying illnesses who may get severe illness.
Health care providers have high risk of acquiring flu. What precautions do they need to take to protect themselves?
Vaccinate. Vaccinate. Vaccinate.
• Education to all staff in the hospital regarding H1N1 transmission and prevention .
• Educate all levels of staff –nurses, housekeeping, health workers, ward assistance, pharmacist and other non clinical staffs.
• Immediate alert to all relevant staff of possible diagnosis of HINI.
• Admit patients with suspected H1N1 only to appropriate pre determined areas of the hospital, without exposing other patients and staff to risk.
• Vaccination of staff.
What do you anticipate the course of the current epidemic likely to be? Is it going to resolve in a couple of weeks or are we going to have significant outbreak?
Optimism is nice. Pragmatism is critical. Plan, protect and persevere.