Who needs anti viral drugs in swine flu

Facts

1.    In Us 0.3% of all cases require admissions

2.    The mortality rate of flu pandemic is 0.12 deaths per 100,000 population

3.    Total number of deaths caused by pandemic H1N1 influenza A in the United States was lower than the number of deaths caused by seasonal influenza during non-pandemic years

4.     Early and prompt initiation of antiviral therapy is recommended for children, adolescents, or adults with suspected or confirmed swine flu with any of the following features

a)    Flu requiring hospitalization

b)    Progressive, severe, or complicated flu

c)    Severely immunosuppressed patients (receiving treatment for malignancies, hematopoietic or solid organ transplant recipients)

d)    Swine flu at high risk for complications:

·         Children <5 years particularly those <2 years

·         Elderly ≥65 years

·          Pregnant women

·         Women up to two weeks postpartu

·         Residents of nursing homes and other chronic care facilities

·         Individuals with chronic medical conditions including: lung disease, including asthma (particularly if steroids have been required during the past year); heart disease, except isolated hypertension; active malignancy; chronic kidney disease, chronic liver disease, diabetes, sickle cell disease, other chronic disabling diseases  and morbid obesity.

5. Severity of flu

·         Asymptomatic swine flu:

            Many contact illnesses may pass off without symptoms. In all  19 percent had                         serologically confirmed infection and 28 percent of those who were infected may                      remain asymptomatic.

·         Mild or uncomplicated Swine Flu ( require no treatment, no hospitalization, no investigations)

            Fever, cough, sore throat, nasal discharge, muscle pain, headache, chills,                               malaise, and sometimes diarrhea and vomiting

            No shortness of breath

            Little change in chronic health conditions.

·         Progressive illness. Requires hospitalization

            Above symptoms plus

            Chest pain

            Poor oxygenation (high respiratory rate, hypoxia, labored breathing in children)

            Low blood pressure

            Confusion, altered mental status

            Severe dehydration

            Exacerbations of asthma, chronic bronchitis, chronic renal failure, diabetes, or                       other cardiovascular conditions

·         Severe or complicated illness requires hospitalization

            Signs of lower respiratory tract disease

            Low oxygen requiring supplemental oxygen

            Pneumonia on X ray

            Brain involvement

            BP lower than 80, organ failure

            Heart involvement

            Persistent high fever and other symptoms beyond three days