ABCD of Swine Flu

swine flu

Before the onset of winter season, the discussions and rumours on spread of flu, especially swine flu, are on a high, more so after the 2009 pandemic. Due to the lack of proper education and awareness, a threatened environment is created, causing undue panic!

The simple thing to be remembered is that swine flu is just like any other simple flu. People don’t need to fear; rather, just follow some precautions and be aware of the facts as to what exactly is to be worried for.

Suspicion of swine flu:

 Any person with symptoms of respiratory infection plus any two of the following :

  • Fever
  • Cough
  • Sore throat
  • Chills and fatigue
  • Diarrhea
  • Rinorrhea
  • Bodyache /headache

Incubation period

  • 1-7 days and peak shedding occurs on day 1
  • patient is infectious from 1 day before onset of symptoms to 7 days after
  • Antibodies appear after 7 days, reaching the peak at 2 weeks, and return to pre-infection level within one year.

Clinical presentation and management:

The patients are categorized into 3 categories( A/ B/ C) and management depends on the type of category of the patient.

Category A:

  • mild fever and cough/ sore throat with /without bodyache, diarrhoea or vomiting.
  • No laboratory testing (H1N1), no medication (tamiflu), no hospitalisation required.
  • Home confinement and home treatment.

Category B:

  •  Patients with Category A symptoms along with high grade fever, sore throat and /or high risk conditions.
  • No H1N1 testing,no Hospitalization
  • Home treatment with isolation
  • Tamiflu should be started.

High risk conditions- immunocompromised patients, patients on long term steroids, asthmatics, diabetics, patients with renal failure.

Category C:

  • This is the most serious category of swine flu
  • Symptoms of Category A + Category B + breathlessness, chest pain, drowsiness, hypotension, bloody sputum and cyanosis.
  • Testing of H1N1 required.
  • Hospitalization
  • Tamiflu to be started.

Monitoring:

Monitoring for progression of symptoms should be done. The following people needs special attention:

  • Young children(<5 years)
  • Pregnant mothers
  • Health workers
  • Individuals with co-morbid conditions – heart disease, lungs disease, liver or kidney disease.
  • Immunocompromised individuals.

Investigations:

  • Real time PCR for H1N1
  • Isolation of virus

Dosing of Tamiflu: 

It should be given (after due prescription) two times in a day for 5 days according to weight. Tamiflu (Ostelmavir) is available as tablets and suspension( 5 ml/12 mg).

  • < 15 kg       –        30 mg/day
  • 15-23 kg     –      45 mg/day
  • 24- < 40 kg  –    60 mg/day
  • > 40 kg        –    75 mg/day

Prevention of flu:

  • Education of family and close contacts on personal hygiene like hand washing.
  • Home isolation for around 7 days in adults and 14 days in children. Even those in close contact should also confine themselves to home for this duration.
  • Monitoring of fever for 7 days.
  • Vaccination

Vaccination:

 Vaccines available have around 80% efficacy. It is available every year after August with the prevalent strain. Hence, vaccination with the most recent vaccine should be done .Although mass vaccination is not necessary but a group of individuals who are more prone should take up the vaccine. Those who are more prone include:

  • old age individuals
  • children with cardiac, pulmonary, liver or kidney diseases
  • patients on long term steroids
  • health workers

Being aware is the best means of prevention. So the takeaway here is, don’t create or get panic, set your facts right and stay healthy.

-Dr. Anu Sharma

Dr Anu Sharma