Transcript Slide 1

INFLUENZA A H1N1
PREVENTIVE & CONTROL GUIDELINES
25 Jan 2015
National Scenario - 2015
Situational Update- Maharashtra
District Wise Cases & Deaths
Short
Incubation
Period
Large number
of subclinical
cases
Absence of
cross-immunity
WHY
INFLUENZA
SPREADS
FASTER?
Short lived
immunity
High Proportion
of susceptible
population
Influenza Surveillance
INFLUENZA H1N1
• Incubation Period- 1 to 7 days.
• Infectious Period- 1 day prior to the onset of
illness to 7 days after onset.
• Close Contact -Close Contact is defined within
6 feet of an ill person who is a confirmed,
probable or suspected case of influenza A
H1N1 virus infection during the infectious period.
Case Definition
• Suspected Case of Influenza -
A person with an acute febrile respiratory illness
commonly in the form of-High grade fever ( >38 degree C)
-Severe Pharyngitis
-Running nose & cough
-Body ache
-Head ache
INFLUENZA SURVEILLANCE
INLUENZA LIKE ILLNESS
(ILI)
SEVERE ACUTE RESP INF
(SARI)
is defined as:
• Sudden onset of a fever over
38°C, AND
• Cough or sore throat, AND
• An absence of other
diagnoses.
> 5 YEARS
 Sudden onset of fever over
38°C, &
 Cough or sore throat, &
 Shortness of breath or
difficulty in breathing, &
 Requiring hospital admission
< 5 YEARS
 Pnumonia
 Requires hospitalization
Surveillance Guidelines
• Active surveillance for ILI at all levels.
• Focus on – Schools, Hostels,Anganwadis
Ashramshalas, Orphanages, madarasas.
• Report clusters of ILI to district/divisional &
state authority immediately.
• ANMs should screen pregnant mothers for
ILI during routine check up in ANC clinic.
• Tackle clusters effectively to avoid further
spread.
CATEGORIES OF PATIENTS
Sr
No
Categ
ory
Chief Symptoms
Swab Collection
Treatment
1
C
Mild Fever(<38 C),Cough, Throat
irritation, body
ache,headache,diarrhoea & vomiting
Not Recommended
No Oseltamivir
Symptomatic t/t,
Review after 24
hrs,
Home isolation
2
B
In addition to above symptoms Fever
>38 C, severe sore throat, running
nose
Swabs of selected
patients belonging to
high risk group
Oseltamivir
needed
3
A
In addition to above symptoms
breathlessness, Chest
pain,hemoptysis,hypotension,bluish
discoloration of nails, and in children
irritation & drowsiness.
Swabs of all patients
Oseltamivir and
hospitalization
High Risk Patients
•
•
•
•
Children below 5 years of age.
Persons above 65 years of age.
Pregnant Women.
Persons having lung,heart,liver,kidney
diseases. Persons with blood &
neurological disorders.
• HIV/AIDS patients.
• Patients on long term steroid treatment.
Surveillance of ILI & SARI
by PHC & Subcenters
Treatment of Mild (C)
cases at PHC level as per
Categories
Referral of Category B &
A ( Moderate & Severe)
cases to identified
SDH/MC/ ID/DH
Treatment of Positive
cases at these facilities &
symptomatic treatment of
Negative cases
Lab sample collection at
identified
SDH/DH/IDH/MC
Contact Tracing by PHCs
& treatment of
symptomatic contacts.
Referral of critical cases
to TERTIARY CENTER
having Physician &
ventilator support
Action Plan
Civil Surgeon
District Health Officer
 District Nodal Officer of H1N1  Surveillance of ILI & SARI by
 Establish SDH 50 & 100 bed
PHC staff.
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hospitals and DH as Lab sample
collection & Treatment centers.
Isolation ward of 4 beds at each
hospital - Ventilator
Ensure logistics.
Training of MO,LT & Nursing
staff.
Workshop for private doctors &
coordination with pvt hospitals
Coordination with FDA
 Contact tracing & treatment of
symptomatic treatment.
 Treatment of mild ILI cases (
Category C)
 Referral of Cat B & A cases to
identified hospital. ( Referral Centers
for each Taluka should be identified by CS &
DHO)
 Training of MO & Paramedicals
 IEC
ISOLATION WARD GUIDELINES
Guidelines For IIWs-1
• Separate ward for positive & suspected patients.
• Distance of 6 feet between two beds.
• Isolation ward should have following facilities1. Oxygen cylinders with accessories.
2.Pulse Oxymeter.
3.Electric & foot suction machine.
4.Emergency tray
5.Ventilators with trained staff.
Guidelines For IIWs-2
• Well ventilated ward with exhaust fan.
• Disinfection measures & Biomedical waste
management according to standard guideline.
• One separate on road ambulance.
• Sufficient stock of Tamiflu,PPE,VTM.
• Trained staff & doctors to operate all
instruments.
• At least one on call physician available for 24
hours.
LAB SAMPLE COLLECTION
IDENTIFIED LABS
SN
NAME
PLACE
1
NIV
PUNE
2
HAFFKINE INSTITUTE
MUMBAI
3
KASTURBA HOSPITAL
MUMBAI
4
IGMC
NAGPUR
ACCREDITED PRIVATE LABS
5
6
SRL RELIGARE
DR LAL PATOLOGY LAB
COLLECTION CENTERS AT
VARIOUS CITIES
Guidelines About Sample Collection
 Swab should be accompanied with detailed clinical history of
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patient.
Preferably prior to giving Oseltamivir.
No swab collection on OPD basis.
Swabs of admitted patients only.
In clusters of ILI, send only 5% samples.
Do not take samples of asymptomatic contacts.
Do not collect swabs after more than 8 days of onset of illness.
If required do other tests also – eg Dengue, Malaria, Lepto etc.
Sample Collection & Laboratory
Diagnosis-1
•
•
•
•
•
What sample to be collected?
Nasopharyngeal/oropharyngeal swabs.
Brochoalveolar lavage.
Tracheal aspirates.
Nasopharyngeal/oropharyngeal aspirates
as washes.
Samples should be collected in VTM.
Sample Collection & Laboratory
Diagnosis-2
When to collect Specimens
-As soon as possible after symptoms begin
-Before administration of antiviral
medications.
• Full complement of PPE should be worn
before initiating sample collection.
Transportation of Samples
• All samples should be kept at 2-8 degree
Celsius until they can be placed at -70 C.
• Samples transported on dry ice in triple
packaging.
• Clear labels with patient’s complete
information.
• Samples should be sent to NIV,Pune,
IGMC Nagpur, Kasturba Hospital Mumbai
or Haffkine Mumbai within 24 hrs.
TREATMENT PROTOCOL
PEDIATRIC DOSES- TAMIFLU
AGE
DOSE
 < 3 months
 12 mg bid for 5 days
 3-5 months
 20 mg bid for 5 days
 6-11 months
 25 mg bid for 5 days
No Need of
chemoprophylaxis.
.
Guidelines for Close Contacts
• Search meticulously for all close contacts of every
positive case of Influenza A H1N1 case.
• Start Oseltamivir in therapeutic dose to all close contacts
with Influenza like symptoms.
• Keep asymptomatic contacts under surveillance for 10
days, if any one of them develop Influenza like
symptoms within that period start Oseltamivir in
therapeutic dose.
• Don’t give Oseltamivir to close contacts who are
asymptomatic during the entire period of observation.
Treatment of Serious Patients
Sr.
No
Particulars
Treatment
Duration
1
Normal H1N1 Patient
Cap. Oseltamivir 75 mg
BD
5 days
2
Signs & symptoms of
Pneumonia
Cap. Oseltamivir 150 mg
BD
10 days
Continue Oseltamivir
3
After 10 days treatment, X ray
shows signs of Pneumonia
OR
Replace Oseltamivir with
Zanamivir
7 days
Antiviral drugs in Pregnancy
• Category C medication.
• No clinical studies to assess safety.
• It should be used when potential benefit
justifies the potential risk to the
embryo/fetus.
• So far no adverse effects have been
reported.
• Some prefer Zanamivir over Oseltamivir
as systemic absorption is minimal.
Warning Signs- Children
•
•
•
•
•
Fast breathing/trouble breathing.
Bluish skin colour.
Not drinking enough fluids/eating food.
Increased irritability.
Flu like symptoms improve but later return
with fever and worse cough.
• Fever with rash.
EMERGENCY WARNING SIGNS NEED URGENT MEDICAL ATTENTION.
Warning Signs- Adults
•
•
•
•
•
Difficulty breathing/shortness of breath.
Pain /pressure in the chest or abdomen.
Sudden dizziness.
Confusion.
Severe or persistent vomiting.
EMERGENCY WARNING SIGNS NEED URGENT MEDICAL ATTENTION.
Pregnant Women
• Active Screening of pregnant women
during routine ANC check up by MOs &
paramedical staff for ILI.
• Timely initiation of Oseltamivir in
symptomatic pregnant women.
Influenza- Educating the Public
• Covering nose & mouth with a tissue/handkerchief when coughing /
sneezing Dispose the tissue in the trash after use.
• Hand
washing
with
soap
&
water-especially
after
coughing/sneezing.
• Cleaning hands with alcohol based hand cleaners.
• Avoiding close contact with sick people.
• Avoiding touching eyes ,nose or mouth with unwashed hands.
• Avoid hand shaking & spitting.
• If sick with Influenza staying home away from work/school & limit
contact with others to keep from infecting them.
• No need to use mask by common public.
• If you found more people suffering from Flu like symptoms from your
area, inform concerned health authority.
Use of Masks
• No need of mask for common people.
• Tissue or handkerchief is sufficient to cover
nose/mouth while sneezing or coughing.
• Improper use of disposable mask spreads
infection.
Guidelines for Educational
Institutions
• Avoid large gatherings.
• Active screening of flu like symptoms by teacher.
• Students, teaching/non teaching staff with ILI- ask for
medical consultation & home isolation.
• No need of medical certificate for such preventive
absentees.
• Identify students with high risk condition.
• Regular cleaning of area with ordinary cleaner.
• Hostel- regular check up of students & staff. Closure of
school not advised.
• Local district administration can take decision after
reviewing the situation.
• Display Do’s and Don’ts prominently.
Ensure ….
 Surveillance of ILI & SARI
 Special focus on pregnant women & children
 Contact tracing & treatment of symptomatic contacts.
 Functional screening centers & IIWs
 Stock position
 Coordination with FDA for availability of Oseltamivir in private

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medical stores.
Coordination with private hospitals & labs.
Death investigation
Coordination with educational institutions
Sharing of H1N1 prevention & control guidelines with all stake
holders
Health Education