INFLUENZA A (H1N1)

The situation in India : Since the declaration of the first H1N1 influenza case by Indian Health Ministry, 17 196 confirmed cases and 560 deaths have been reported in India as on 25th November 2009.

Precautionary measures:

H1N1 influenza is extremely contagious, but is usually not virulent. However, it does sometimes appear in a more severe form, which could necessitate hospitalization.

The following hygienic measures should be adopted:

 wash your hands regularly with soap and water or with an alcohol-based solution;

 regularly wipe surfaces that you touch (e.g. remote control or door knobs);

 cover your mouth and nose when you cough or sneeze;

 ensure that used tissues are thrown in dustbins;

 regularly ventilate the rooms you use and avoid contact with sick persons;

 limit visits to places of public gathering that are not ventilated;

 be careful about the most vulnerable persons, particularly children and frail persons.

H1N1 influenza symptoms:

 Its symptoms akin to those of seasonal flu, but similar to the latter, H1N1 influenza can aggravate other chronic underlying illnesses:

— fever higher than 38° C and exhaustion;
— two or more of the following symptoms: headache, cold, cough, stiffness or aches in limbs or joints.

What to do if you have these symptoms:

 consult a doctor, who will tell you whether you need to proceed to a mucus or blood test in one of the government hospitals designated by the Indian authorities;

 stay at home and restrict contact with others.

Incubation period:

The period between the moment a person gets infected and develops symptoms is between 1 to 7 days; in most cases, it appears that the incubation period is between 1 and 4 days.

When does one become contagious?

According to what is currently known, an infected person can pass on the infection to others from the day preceding the appearance of symptoms till seven days after their appearance. Children – particularly very young children – can remain contagious for longer.

Follow-up of the situation by the Government of India:

 New Guidelines for Screening, Testing, and Isolation for H1N1

Union Minister of Health and Family Welfare, Shri Ghulam Nabi Azad chaired a meeting late last night in connection with the various actions taken by the Government for containment and mitigation of H1N1 cases in India. The meeting lasted for more than five hours from 4.30 pm to 10.00 pm in Nirman Bhawan. The meeting was attended by various eminent experts from public and private hospitals/ organizations besides the senior officers of Health Ministry Directorate General of Health Services.

During the meeting various guidelines and protocols developed by the World Health Organization Geneva, Centre for Disease Prevention and Control, Atlanta, USA and National Health Service, United Kingdom were also discussed threadbare.

After long discussion with the experts the following guidelines for India were finalized.

In order to prevent and contain outbreak of Influenza-A H1N1 virus for screening, testing and isolation following guidelines are to be followed:

At first all individuals seeking consultations for flu like symptoms should be screened at healthcare facilities both Government and private or examined by a doctor and these will be categorized as under:

Category- A

* Patients with mild fever plus cough / sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised as Category-A. They do not require Oseltamivir and should be treated for the symptoms mentioned above. The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor.

* No testing of the patient for H1N1 is required.

* Patients should confine themselves at home and avoid mixing up with public and high risk members in the family.

Category-B

(i) In addition to all the signs and symptoms mentioned under Category-A, if the patient has high grade fever and severe sore throat, may require home isolation and Oseltamivir;

(ii) In addition to all the signs and symptoms mentioned under Category-A, individuals having one or more of the following high risk conditions shall be treated with Oseltamivir:

• Children less than 5 years old;

• Pregnant women;

• Persons aged 65 years or older;

• Patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS;

• Patients on long term cortisone therapy.

• No tests for H1N1 is required for Category-B (i) and (ii).

Category-C

In addition to the above signs and symptoms of Category-A and B, if the patient has one or more of the following:

• Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails;

• Irritability among small children, refusal to accept feed;

• Worsening of underlying chronic conditions.

All these patients mentioned above in Category-C require testing, immediate hospitalization and treatment.

These guidelines will be reviewed and revised from time to time as per need and on the basis of spread of the disease.