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Home > Swine Flu
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Swine Flu - Indian Guide Lines |
Swine Flu: Clinical management Protocol and Infection Control Guidelines
Directorate General of Health Services Ministry of Health and Family Welfare Government of India
Swine Influenza Clinical Management Protocol.
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1. Introduction
As on August 4, 2009. World Health Organization (WHO) regions have reported 162,380 laboratory-confirmed cases of novel influenza A (H1N1) and 1,154 deaths. The laboratory-confirmed cases represent an underestimation of total cases in the world as many countries have shifted to strategies of clinical confirmation and prioritization of laboratory testing for only persons with severe illness and/or high risk conditions. More than 300 of the new deaths were in the Americas, bringing the death toll in that region to 1,008 since the virus first emerged in Mexico and the United States, and developed into the global epidemic.
The outbreak started in Mexico on 18th March, 2009 and spread to USA and Canada and then to other countries.
WHO raised the influenza pandemic alert to the highest level, Phase 6 on June 11, 2009.
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2. Epidemiology
2.1 The agent
Genetic sequencing shows a new sub type of influenza A (H1N1) virus with segments from four influenza viruses: North American Swine, North American Avian, Human Influenza and Eurasian Swine.
2.2 Host factors
The majority of these cases have occurred in otherwise healthy young adults.
2.3 Transmission
The transmission is by droplet infection and fomites.
2.4 Incubation period
1-7 days.
2.5 Communicability
From 1 day before to 7 days after the onset of symptoms. If illness persist for more than 7 days, chances of communicability may persist till resolution of illness. Children may spread the virus for a longer period.
There is substantial gap in the epidemiology of the novel virus which got re-assorted from swine influenza.
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3. Clinical features
Important clinical features of swine influenza include fever, and upper respiratory symptoms such as cough and sore throat. Head ache, body ache, fatigue diarrhea and vomiting have also been observed.
There is insufficient information to date about clinical complications of this variant of swine origin influenza A (H1N1) virus infection. Clinicians should expect complications to be similar to seasonal influenza: sinusitis, otitis media, croup, pneumonia, bronchiolitis, status asthamaticus, myocarditis, pericarditis, myositis, rhabdomyolysis, encephalitis, seizures, toxic shock syndrome and secondary bacterial pneumonia with or without sepsis. Individuals at extremes of age and with preexisting medical conditions are at higher risk of complications and exacerbation of the underlying conditions.
The reporting of cases is to be based on the case definition provided (Annexure-I).
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4. Investigations
Routine investigations required for evaluation and management of a patient with symptoms as described above will be required. These may include haematological, biochemical, radiological and microbiological tests as necessary.
Confirmation of influenza A(H1N1) swine origin infection is through:
- Real time RT PCR or
- Isolation of the virus in culture or
- Four-fold rise in virus specific neutralizing antibodies.
For confirmation of diagnosis, clinical specimens such as nasopharyngeal swab, throat swab, nasal swab, wash or aspirate, and tracheal aspirate (for intubated patients) are to be obtained. The sample should be collected by a trained physician / microbiologist preferably before administration of the anti-viral drug. Keep specimens at 4°C in viral transport media until transported for testing. The samples should be transported to designated laboratories with in 24 hours. If they cannot be transported then it needs to b stored at -70°C. Paired blood samples at an interval of 14 days for serological testing should also be collected.
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