aug 12th, 2009
INFLUENZA 'A' (H1N1) – CONSOLIDATED INSTRUCTIONS
(Courtesy – Govt. of India, Min of Health & Family Welfare)
What is Influenza A (H1N1)?
Influenza 'A' H1N1 is a circulating seasonal influenza virus that caused pandemic in 1918-1919. The present pandemic is being caused by a new sub type of Influenza 'A' H1N1 which has re-assorted with antigenic segments from American swine, Eurasian Swine, avian and human influenza virus. The majority of these cases have occurred in otherwise healthy young adults. The incubation period is from 1-7 days. The virus is spreading from human to human through droplet infection. The period of communicability is from 1 day before to 7 days after the onset of symptoms. It may be longer in children (up to 3 weeks). The virus is currently sensitive to Oseltamivir.
First detected in Mexico in March, 2009, it has spread to many countries in the World. Swine flu is basically a misnomer. This was originally referred to as "swine flu" because laboratory testing showed that many of the genes in this new virus were very similar to those found in pigs in North America. Scientists call this a 'quadruple reassortant' virus and hence this new (novel) virus is christened "influenza-A (H1N1) virus." It has caused an epidemic among humans in Mexico and spread to Argentina, Australia, Austria, Belgium, Brazil, Canada, Chile, China, Colombia, Costa Rica, Cuba, Denmark, Ecuador, El Salvador, Finland, France, Germany, Guatemala, India, Ireland, Israel, Italy, Japan, Republic of Korea, Malaysia, Netherlands, New Zealand, Norway, Panama, Peru, Poland, Portugal, Spain, Sweden, Switzerland, Thailand, Turkey, UK and USA.
Various international agencies (US Centers for Disease Control & Prevention, World Health Organization) have determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human.
World Health Organization has officially designated the present outbreak as public health emergency of international concern and has raised the pandemic alert phase to level -5 (on a 1 to 6 scale) implying widespread human transmission. WHO has stated that containment may not be possible at this stage and is advocating mitigation measures. It has recommended against closing borders and restricting or banning air travel from affected countries.
As of now, India has a stock of 10 million capsules of oseltamivir. Some stocks are also committed by pharmaceutical companies for exclusive use by the Government. This drug is only available through the public health system and its retail sale is banned as indiscriminate use may lead to development of resistance. If there is widespread infection, MOHFW would review this decision.
The currently available information suggests that seasonal influenza vaccine is found not effective against the re-assorted virus. It takes about six months to manufacture a vaccine against a novel virus. Hence, a vaccine may not be available during the first wave of the pandemic. If the candidate vaccine strains are made available by WHO or synthesized in our labs, the vaccine would be manufactured. Depending upon the availability, the at-risk population would be prioritized for vaccination.
Non pharmaceutical interventions would include measures that would need to be instituted at individual, community and national level in case India gets severely affected by the pandemic.
At individual level there would be isolation of the patient and quarantine of those exposed. Individuals should follow simple public health measures for infection control such as hand washing, respiratory etiquettes, staying away from those having respiratory symptoms and by using masks. At individual level, self recognition of illness and self reporting to identified health facility would be encouraged.
At the community level, during phase 5, community wide quarantine (restricting entry/ exit of population from a defined geographic area) is only advocated if the virus is not efficiently transmitting, mass chemoprophylaxis could be achieved and resources are available to implement and maintain quarantine. Essential services also need to be ensured with in the quarantined community.
For phase 5/6, social distancing measures would need to be imposed such as closure of school, college, business, cinemas, theatres and markets. School closure is especially useful if high morbidity among children is seen and should be implemented early. Mass gatherings such as festivals, weekly markets, sporting events, religious and social congregations, funerals etc need to be discouraged or cancelled. Public transportation need to be restricted and should also be achieved by voluntary or involuntary work holidays.
At the national level, Indian citizens would be advised to defer non essential travel. Information would be provided to travelers regarding the disease. Entry screening would be imposed at all international airports, ports and international checkpoints. If India gets affected with community outbreaks, then exit screening would be considered.
Symptoms of H1N1 Virus.
The symptoms of H1N1 (swine) flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 (swine) flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with H1N1 (swine) flu infection in people. Like seasonal flu, H1N1 (swine) flu may cause a worsening of underlying chronic medical conditions. In children emergency warning signs that need urgent medical attention include:
· Fast breathing or trouble breathing.
· Cough, fever, sore throat.
· Diarrhea.
· Bluish or gray skin color.
· Not drinking enough fluids.
· Severe or persistent vomiting.
· Not waking up or not interacting.
· Being so irritable that the child does not want to be held.
· Flu-like symptoms improve but then return with fever and worse cough.
In adults, emergency warning signs that need urgent medical attention include:
· Difficulty breathing or shortness of breath.
· Pain or pressure in the chest or abdomen.
· Cough, fever, sore throat.
· Sudden dizziness.
· Confusion.
· Severe or persistent vomiting.
· Flu-like symptoms improve but then return with fever and worse cough.
How does the H1N1 virus spread?
H1N1 (swine) flu can spread in the following ways:
· Through contact with infected pigs or environments contaminated with swine flu viruses.
· Through contact with a person with H1N1 (swine) flu. Human-to-human spread of H1N1 (swine) flu occurs in the same way as seasonal flu. Influenza spreads mainly from person-to-person through coughing or sneezing by infected people. Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
· Droplets from a cough or sneeze of an infected person move through the air. Germs can spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.
· Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick.
· That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.
· People with H1N1 virus infection should be considered potentially contagious as long as they are symptomatic and possibly for up to 7 days following illness onset.
· Children, especially younger children, might potentially be contagious for longer periods.
Protection from the Infection.
· Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
· Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
· Avoid touching your eyes, nose or mouth. The virus can spread this way.
· Try to avoid close contact with sick people.
· If you get sick with influenza, stay home from work or school and limit contact with others to keep from infecting them.
How to prevent the virus from spreading.
· If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill.
· Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket.
· Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.
Technique for washing hands.
• Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner.
• Wash your hands -- with soap and warm water -- for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores.
• If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.
Household Cleaning, Laundry, and Waste Disposal.
• Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste.
• Keep surfaces (especially bedside tables, surfaces in the bathroom, children's toys, phone handles, and door knobs) clean by wiping them down with a household disinfectant according to directions on the product label.
• Linen, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
• Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid "hugging" laundry prior to washing it to prevent contaminating yourself. Clean your hands with soap and water or alcohol-based hand rub right after handling dirty laundry.
• Eating utensils should be washed either in a dishwasher or by hand with water and soap.
Do:
· Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
· Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
· Avoid touching your eyes, nose or mouth. Germs spread this way.
· Try to avoid close contact with sick people. Keep yourself at least a meter away from people who show symptoms.
· Stay home from work or school if you get sick with influenza, and limit contact with others to keep from infecting them.
· Make sure you seek medical advice immediately if in any doubt.
· Avoid crowded places.
· Sleep well, stay physically active and manage stress.
· Drink plenty of water and eat nutritious food.
· Get enough sleep.
· Keep yourself informed on measures being taken by the Govt. to tackle the disease.
· Avoid alcohol.
Don't:
· Shake hands, hug or kiss as a form of greetings.
· Take medicines without the advice of a Doctor.
· Panic.
· Sneeze or cough directly into bare hands.
· Smoke, since smokers are more prone to catch the infection.
How are infections of H1N1 virus diagnosed?
• To diagnose influenza Type 'A' H1N1 infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus).
• However, some persons, especially children, may shed virus for 10 days or longer.
• Identification as an influenza 'A' virus requires sending the specimen to a hospital laboratory for testing.
GUIDELINES ON INFLUENZA A/H1N1
FOR SCHOOLS/COLLEGES/INSTITUTIONS
There have been some cases of Influenza 'A' H1N1 virus among students and staff in certain schools in the country. There has been considerable speculation over the need for closure of schools to control the outbreak. This matter has been considered by the Joint Monitoring Group in the Ministry of Health and Family Welfare. All schools and colleges are advised to observe the following guidelines for managing cases of infection of Influenza AH1N1.
(i) Any student or staff member showing flu like symptoms such as fever, cough, running nose and difficulty in breathing should be allowed to stay at home for a period of 7 to 10 days.
(ii) Educational institutions should not insist on production of medical certificate by the student/staff.
(iii) Educational institutions should monitor the health status of such students/staff that might have come in contact with a suspected case of Influenza 'A' H1N1 to see whether they develop flu like symptoms. In case they do so, they should be allowed to stay home, as outlined at (i) above.
(iv) In case of students staying in Hostels, the educational institutions would not only monitor the health status of the students, but also that of care providers. It has to be ensured that the care providers wear face mask and wash hands regularly. It might not be advisable to send the boarders back home, as it would spread infection further.
(v) Educational institutions are further encouraged to report such cases to local health officers for further monitoring.
(vi) Given the current magnitude of the spread of AH1N1 infection and the fact that the current virus is fairly mild, closure of educational institutions on account of any student/staff member falling ill with flu like symptoms is not recommended.
(vii) Institutions should avoid travel of students to affected countries.
(viii) In case students have proceeded to affected countries on unavoidable tours, then on their return, if some students show flu like symptoms of fever, sore- throat , cough , body ache, running nose, difficulty breathing etc, they should be advised to abstain from attending classes and be allowed to stay at home for a period of 7 to 10 days.
FAQs.
· What about using a mask? What does WHO recommend?
If you are not sick you do not have to wear a mask. If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards. If you are sick and must travel or be around others, cover your mouth and nose. Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.
· How do I know if I have influenza A (H1N1)?
You will not be able to tell the difference between seasonal flu and influenza A (H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A (H1N1).
· Should I take an antiviral now just in case I catch the new virus?
No. You should only take an antiviral, such as oseltamivir or zanamivir, if your health care provider advises you to do so. Individuals should not buy medicines to prevent or fight this new influenza without a prescription, and they should exercise caution in buying antivirals over the Internet.
· What about breastfeeding? Should I stop if I am ill?
No, not unless your health care provider advises it. Studies on other influenza infections show that breastfeeding is most likely protective for babies - it passes on helpful maternal immunities and lowers the risk of respiratory disease. Breastfeeding provides the best overall nutrition for babies and increases their defense factors to fight illness.
· When should someone seek medical care?
A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).
Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.)
· Should I go to work if I have the flu but am feeling OK?
No. Whether you have influenza A (H1N1) or a seasonal influenza, you should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your work colleagues and others.
· Can I travel?
If you are feeling unwell or have symptoms of influenza, you should not travel. If you have any doubts about your health, you should check with your health care provider. Govt. of India has issued an advisory to avoid travel to affected countries.
Govt. authorized hospitals for Screening and treatment of H1N1 (at present).
Sl. Nos.Hospitals Names
1Rajeev Gandhi Institute of Chest Diseases
2Victoria Hospital Vani Villas Road,
3Lakeside Medical Centre & Hospital, Ulsoor
4Manipal Hospital, Airport Road, B,lore
5St. John's Hospital, Sarjapura Road
6St. Martha's Hospital, Nrupathunga Road
7Vaidehi Hospital, Whitefield
8Mallya Hospital, Vittal Mallya Road
9Dr. Ambedkar Hospital 100 ft Ring Road
10Mahabodhi Mallige Hospiotal, 1st Blcok, Jayanagar
11Mallige Medical Centre, Crescent Road
12City Hospital, Rajajinagar
13MS Ramaiah Hospital MSR Nagar
14Pristine Hospital, Modi Hospital Road
15Fortis Hospital,
16Columbia Asia Hospital, Hebbal
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