Transcript H1N1 information

H1N1 information
Dr Sangeeta Joshi
Consultant Microbiologist
Manipal Hospital
Bangalore
Govt guidelines
• OPD case with symptoms of flu – if testing
necessary – refer to RGICD/ NIMHANS/VICTORIA/
Lakeside.
• Need not admit if it is not severe. Can be sent
home
• IP and ICU cases – throat swab to be collected
and sent to NIMHANS along with requisition
• Tamiflu can be given (tablets to be prescribed by
the consultant and issued directly by Dayanand of
Pharmacy.) Tablets are to be accounted for.
Transmission
• Incubation period: 1-7 days
• Communicability : From 1 day before to 7 days
after the onset of symptoms / or until cure
• Best time to collect is when the patient
presents. Day 1 has maximum shedding of the
virus
Diagnosis
Specimens
. Full personal protective equipment – mask, gown, cap, goggles – to
be worn while collecting. Samples to be sent in cold .
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throat swab
nasal swab, wash or aspirate
Tracheal aspirate / BAL
Specimens kept at 4°C in viral transport media until transport
The samples should be transported to NIMHANS, within 24 hours. If
they cannot be transported then it needs to be stored at -70°C.
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Prioritisation of the samples to be done before
sending:
Category A –
Referred from airport
Children with rapidly worsening symptoms
Pregnancy with symptoms of flu
Elderly (>65 years) with symptoms
Symptoms with h/o chronic pulmonary disease,
COPD, asthma
Symptoms in a k/c/o diabetes and HIV
Category A
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Admission, isolation
Routine investigations
Treat secondary infection
Chemoprophylaxis till results arrive 75 mg OD
10 days Treatment 75 mg BD 5 days
• Category B
• Children with h/o contact with minimal
symptoms
• Adults with h/o contact with minimal
symptoms
• Symptoms in Health care worker
• Category C – flu like symptoms but does not fit
into A and B criteria
Category B
• Home quarantine
• Restrict movement outdoors
• Chemoprophylaxis
Category C
• No prophylaxis
• Stay at home till symptoms subsides
• Wait and watch
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The tests will be done as per the priority status.
Results for category A – 24-36 hours
Category B – 3-4 days
Category C 4-5 days
All samples to be accompanied by H1N1 requisition form
Each test costs Rs 10,000/- (done free of cost )
Cost of special swab and transport medium to patient Rs
250/-
• Blood test for antibodies not done at
NIMHANS
• Rapid test sensitivity varies from 10 to 70%.
• Specificity is 50-70%
• The rapid tests detect influenza A and B
How long do viruses survive outside
the body?
• Some viruses can survive upto 2 to 8 hrs on
surfaces.
• Frequent handwashing is the solution to
prevent infection after touching the surfaces
Hand Hygiene
• It is the single most important measure to reduce the
risk of transmitting infectious organism from one
person to other.
• Hands should be washed frequently with soap and
water / alcohol based hand rubs/ antiseptic hand
wash and thoroughly dried preferably using disposable
tissue/ paper/ towel.
• After contact with respiratory secretions or such
contaminated surfaces.
• Any activity that involves hand to face contact such as
eating/ normal grooming / smoking etc.
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HCW’s attending to patients with suspected
H1N1 to wear triple layer mask or N95 mask.
Can be worn for 4 hours , needs to be changed
later.
Adequate handwashing facilities and
handrub to be provided to the HCW’s
Chemoprophylaxis
• All close contacts of confirmed cases. Close
contacts include household /social contacts,
family members, workplace or school
contacts, fellow travelers etc.
• Oseltamivir is the drug of choice.
• Prophylaxis should be provided till 10 days
after last exposure (maximum period of 6
weeks)
Resources
• http://www.cdc.gov/h1n1flu/
• http://www.cdc.gov/h1n1flu/espanol/
• 1-800-CDC-INFO (1-800-232-4636)
• http://www.who.int/csr/disease/swineflu/en/
index.html