IMA Guideline: Whom to give oral oseltamivir in flu?

IMA Guideline: Whom to give oral oseltamivir in flu? People with confirmed influenza or with influenza symptoms who are very sick or who are at high risk for influenza complications require rapid treatment. Hence, doctors are advised to quickly treat suspected influenza with antiviral drugs in high-risk outpatients, those with progressive disease and all hospitalized patients, regardless of a negative rapid influenza diagnostic test (RIDT) and without waiting for results of reverse-transcriptase polymerase chain reaction (PCR). Treatment should not be withheld on the basis of results of RIDTs, as these tests have a high potential for false-negative results. Tamiflu, oral oseltamivir, known as neuraminidase inhibitor has activity against both influenza A and B viruses. Early antiviral treatment can shorten the duration of fever and illness symptoms, reduce the risk for complications from influenza, including otitis media in young children and pneumonia requiring antibiotics in adults and also reduce the mortality among hospitalized patients. Clinical benefit is greatest with early administration of oseltamivir. When indicated, oseltamivir should be started as soon as possible after illness begins, ideally within 48 hours of onset of symptoms. However, antiviral treatment might still provide some benefit in hospitalized patients when started after 48 hours of illness onset. Guideline Treatment with oseltamivir is recommended as early as possible for any patient with confirmed or suspected influenza who is (1) hospitalized, (2) has severe, complicated, or progressive illness, or (3) is at higher risk for influenza complications, including the following: • Children aged younger than 2 years • Adults aged 65 years and older • Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematologic (including sickle cell disease), and metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle, such as cerebral palsy, epilepsy, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury) • Persons with immunosuppression, including that caused by medications or by HIV infection • Women who are pregnant or postpartum (within 2 weeks after delivery) • Persons aged younger than 19 years who are receiving long-term aspirin therapy • Persons who are morbidly obese (BMI ≥ 40 kg/m2) • Residents of nursing homes and other chronic-care facilities. [Source Medscape] Arrange school lectures Prevention of Swine flu mainly involves implementation of respiratory hygiene, cough etiquettes and hand hygiene. • Respiratory hygiene: Maintain a distance of at least 3 feet from the person who is coughing and sneezing. • Cough etiquettes: Cover the mouth and nose with a tissue when you cough and sneeze and put the used tissue in a waste basket. If you do not have a tissue, then cough and sneeze into the upper sleeves and not hands or handkerchief. • Hand hygiene: This should be frequently performed including before and after every patient contact; contact with potential infectious material and before putting on and after taking of personal protective equipment including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol based hand rubs. If hands are visibly soiled, then wash with soap and water. In a survey conducted by Heart Care Foundation of India, of 63 schools, both Public and Govt., involving 6047 students (2817 girls and 3230 boys), 76% of the students (4576) did not know about the role of cough etiquettes in preventing flu. They answered that the best way to cough was either in the hands or in the handkerchief. Flu is diagnosed when the person suffers from cough and cold. Only sore throat is not a sign of flu. Flu patients do not require antibiotics. Unless cough and cold is associated with breathlessness, it does not require hospital admission. Treat swine flu like ordinary flu • Swine flu is like ordinary flu, symptoms of which are fever, coryza, cough, sore throat, bodyache and malaise. Occasionally, nausea, vomiting, diarrhea and rash may also be present. • Severe breathlessness, blood on coughing are ominous signs and need investigation and/or hospitalization. Symptoms ordinarily last for 1-2 weeks. • Cases of fever with coryza and breathlessness should not be neglected, and need admission in isolation and investigation for influenza (swine or otherwise). Influenza normally has its outbreaks intermittently especially seasonal outbreaks are common. • Influenza vaccines can prevent flu caused by human strains, which is recommended for children above 6 months; adults > 50 years of age; patients with pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic disorders and diabetes mellitus; pregnant females and health care providers. • The inactivated vaccine can be given to the above groups. The Live attenuated influenza vaccine (intranasal spray) can be given only to persons aged 2-49 years (not to pregnant females). • Current seasonal influenza vaccines are not expected to provide protection against human infection with avian or swine influenza A viruses. However, reducing seasonal influenza risk via influenza vaccination of persons who might be exposed to nonhuman influenza viruses (e.g. H5N1 viruses) might reduce the theoretical risk for recombination of influenza A viruses of animal origin and human influenza A viruses by preventing seasonal influenza A virus infection within a human host.

Flu in children

Flu in children With the onset of winter, children become increasingly prone to influenza infections highlighting the importance of preventive measures and good hygiene practices. New Delhi, Dec 26, 2016: Influenza is a viral illness and it often manifests in a mild form in children. Influenza infections are most frequent in winter and children are especially susceptible to infection due to weaker immune system. The classical features of uncomplicated flu in children include abrupt onset of fever, headache, muscle pain and malaise affected by manifestation of respiratory tract illness – sore throat, sough and nasal discharge. Flu symptoms in children are usually very similar to the symptoms of a cold, or upper respiratory tract infection. It might also cause nausea, vomiting and diarrhoea in occasional cases. Padma Shri Awardee Dr. K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Elect Indian Medical Association (IMA), adds “ Flu is highly contagious, particularly when kids stay in close vicinities like they do in school classrooms. The spread of influenza occurs when children inhale droplets that are coughed up or sneezed by an infected person, or when they come in direct contact with mucus or spit from someone who has the disease. The best way to avoid flu in children is to get a yearly vaccination. Parents should consult a physician for the same. ” Ear discharge, development into asthma and pneumonia are common complications in children. Complicated pneumonia may be severe and rapidly fatal, especially if the bacterium is Staph. However, it is not necessary that all the mentioned symptoms be present in all children, individual variations do occur. Moreover, the duration of fever can also last from a week to upto ten days. “During winter, flu should be considered in all children with fever; children with fever and acute onset of respiratory illness; children with fever and exhilaration of underlying chest condition; children with pneumonia and children with fever of more than 100, with severe cough or sore throat. In 95% of the cases, more than 39oC fever is present and about 77% of the cases present with cough and nasal discharge. The treatment is often symptomatic. Paracetamol should be given in recommended doses upto 48 hours and encourage your child to rest and drink lots of fluids, preferably warm fluids. One important point to remember is that flu is caused by a virus, so antibiotics won’t help and can even cause stomach upsets and diarrhoea.”, adds Dr. K.K Aggarwal.