DR.S.M.JOSHI

Sr.MEDICAL OFFICER,

GOVT.Of MAHARSTRA

Influenza like illness by Influenza H1N1 areassorted virus was reported from Mexicoon 18th March 2009 .and later spread tounited states and Canada from year 2009.andsubsequently spread to all the continents. InIndia first case reported on 13th May2008.due to travel from affected countries.Substantial no. Of cases were found inMaharashtra(Mumbai,and Pune),

Karnataka(Bangluru),Tamilnadu(Chhenai)areindigenous cases. Majority cases of deathwere due to some underlying diseases orreported late to healthcare facility.

Agent:-New subtype of Influenza A H1N1 virus

with segments from 4 influenza viruses. North

American swine, viruses. North American avian,

Human infuenza,Urassian Swine.

Host:-Majority in healthy young adults

Transmission:- by droplet infection and fomites.

Incubation Period:-1-7 days.

Communicability:-1 day before and 7 days after

the onset of symtoms and if illness persist >7

days then till resolution of illness .children may

spread the virus for longer period.

Fever, upper respiratory symtoms,i.e.cough,

running nose sore throat,headache,bodyache,

fatigue,diarrhea,and vomiting.

Possible complications:-Sinusitis,Otitis Media,

croup,Pneumonia,Bronchiolitis,status

asthmaticus

,Myocarditis,pericarditis,myositis,enchephelitis

,Seizures,Toxic shock syndrome and

secondary bacterial Pneumonia with or

without sepsis

Routineinvestigations`like

Heamatology,Biochemistry,Radiology,Microbiology tests are required.

For Confirmation of diagnosis:-

Real time PCR,Isolation of Virus culture, Fourfold rise in virus specific neutralising antibodies.Are required.

Clinical specimens of nasopharyngeal swab,nasal swab, wash or aspirate,treacheal aspirateare to be obtained samples should be collectedbefore giving antiviral drug. At 4 ⃰ C in viraltransport medium to designated lab within 24hours. if not possible then kept store under -70 ⃰C.Paired blood samples at an interval of 14 daysfor sero.testing also to be collected.

Suspect case:- a person with acute febrilerespiratory illness (fever ≥38*C) within 7 dayscontact with a person who is confirmed case .orwithin 7 days contact with a person where there is one or

more is confirmed cases. or resides in a community whereone or more confirmed cases.

Probable case:- a person with acute febrile respiratoryillness is positive for influenza A but not to H1.H3 byRTPCR.

Is positive for influenza rapid test, or immunofloroscentassay. And meets the criteria of suspect case.

Individual with clinically compatible illness died due

to unexplained acute respiratory illness andepidemiologically linked with probable or confirmedcase.

Confirmed case:- :- a person with acute

febrile respiratory illness (fever ≥38*C) with

lab. Confirmed pandemic influenza virus A at

WHO approved Lab. By one or following

tests.

Real time PCR

Viral Culture

Four fold rise in virus specific neutralising

antibodies.

Implementation of infection controlprecautions, prompt treatment to preventsevere illness and death, early identificationand follow up of persons at risk.

1. Isolation.

2. Dedicated Doctors, Nurses, Paramedicalworkers

Portable X-ray machine ventilators ,oxygencylinders, pulse ox meters.

3 Adequate quantities of PPE,disinfectants,andmedications ( oseltamivir, and othermedications)

A. Reinforce standard infection control

precautions

B. Restrict no. Of visitors and provide them

PPE

C. Provide antiviral prophylaxis to health

care personnel .

D. Dispose waste properly by placing it in

sealed impermeable bage labelled as Bio

Hazard.

Dose for treatment as follows.

By weight:-

For weight <15 kg = 30mgBD for 5 days

15-23kg = 45mgBD for 5 days

224< 40kg = 60mgBD for 5 days

>40kg = 75mgBD for 5 days

For infants:-

<3 months = 12 mg BD for 5days

3 -5months = 20mg BD for 5days

6-11 months = 25mg BD for 5days

If needed dose and duration can be modified as per clinical condition.

Transient nausea, vomiting in increasing doses

,occasionally it may cause bronchitis, insomnia,

vertigo

.less commonly angina,pseudomembranous

colitis,peritonsilar abscess

,anaphylaxis and skin rashes.

IV fluids

Parenteral nutrition.

Oxygen therapy.

Antibiotics for secondary infection

Vasopressors for shock.

Paracetamol for fever.

Plenty of fluids orally.

Abstain from smoking

Topical decongestants, nasal drops, lozenges,

steam inhalation.

PPE reduces the risk of infection if usedcorrectly.

It includes:-

Gloves.(nonsterile)

Mask, high efficiency mask, three layeredsurgical mask,

Long sleeved cuffed gown,

Protective eyewear(goggles.visors,faceshields)

Cap

Plastic apron.