as we opened our eyes and widened up our ears about health issues. we'll only hear constant word for nowadays and it is the term H1N1 a pandemic disease who killed many througout the 4 corners of our world.
but then, H1N1 or Influenza A is a common topic in our class (esp. for us who were under the field of medicine)but rarely been a case in our field of duty. thus we are not that knowledgeable about the disease proper and we are very surprise with its transpirancy esp. to the unexpected spread here in our own nation.
hence, we shall be aware of the disease and as well of its clinical manifestation, prevention and treatment..
Influenza A virus subtype H1N1, also known as A(H1N1), is a subtype of influenzavirus A and the most common cause of influenza (flu) in humans.
Some strains of H1N1 are endemic in humans, including the strain(s) Less virulent H1N1 strains still exist in the wild today, worldwide, causing a small fraction of all influenza-like illness and a large fraction of all seasonal influenza.
H1N1 strains caused roughly half of all flu infections in 2006.[1] Other strains of H1N1 are endemic in pigs (swine influenza) and in birds (avian influenza).
CLINICAL MANIFESTATION
There is no documented information on clinical interactions between HIV and influenza A(H1N1) virus, whose transmission, incubation period and clinical manifestations have generally been similar to those of seasonal influenza viruses.
but it is believed that we should be cautious of usual flu signs such as high grade fever, cough and colds,
Prevenetion
* Avoid Close contact to patient who had the signs and symptoms of the alleged disease
* Be healthy, eat nutritious food to boost immune system as well as exercise regularly
* Consult your physician for appearance of certain signs
* Vaccine is already out.. you may have it for better
TREATMENT
Not all individuals with suspected H1N1 influenza A infection need to be seen by a health care provider or treated [8,12]. Patients with severe illness and those at high risk of complications from influenza should contact their health care provider or seek medical care. (See "High risk groups" above).
ANTIVIRAL THERAPY — The strain of H1N1 influenza A virus circulating in Mexico and other countries in the spring of 2009 appears sensitive to the neuraminidase inhibitors, oseltamivir and zanamivir, in vitro but resistant to amantadine and rimantadine [4,13,14]. However, there are no reported studies yet on the clinical benefits of antiviral therapy.
The United States Centers for Disease Control and Prevention (CDC) has released guidelines for the use of antivirals for patients with confirmed or suspected H1N1 influenza A virus infection and close contacts [4]. Our recommendations reflect those of the CDC. Guidelines may change as more information becomes available. See the CDC's website for updated recommendations (http://www.cdc.gov/h1n1flu/). Clinicians in other countries should consult with their ministries of health and/or the World Health Organization for specific recommendations.
Therapy should be started as soon as possible, since evidence of benefit is strongest for seasonal influenza when treatment is started within 48 hours of illness onset [4,11]. Some studies of hospitalized patients have demonstrated benefit even when therapy for seasonal influenza is started >48 hours after onset of illness. In patients who are more than mildly ill, we would initiate therapy even past 48 hours of symptoms [4]. (See "Antiviral drugs for the treatment of influenza in adults" and see "Antiviral drugs for the prevention and treatment of influenza in children").
Adults — We recommend antiviral therapy for [4]:
* All hospitalized patients with confirmed, probable, or suspected H1N1 influenza A virus infection (see "Case definitions" above) and
* Patients at increased risk for complications (see "High risk groups" above).
During the current epidemic, patients with mild illness do not need to be tested or treated unless they have risk factors for complications [4,12]. However, the decision of whether to initiate antiviral therapy for each patient should be based upon the clinician's judgment and on what is known about the benefits of therapy for seasonal influenza. (See "Medical care for suspected cases" above and see "Antiviral drugs for the treatment of influenza in adults").
In areas with limited antiviral availability, local public health officials might provide additional guidance regarding their prioritization [4].
Choice of antiviral — For patients requiring treatment, we recommend either zanamivir or oseltamivir [4]. Zanamivir is contraindicated in patients with asthma or chronic obstructive pulmonary disease. (See "Pharmacology of antiviral drugs for influenza").
During this epidemic, in patients suspected to have influenza but who have no epidemiologic link to swine H1N1 influenza A, we recommend treatment with a neuraminidase inhibitor. However, in locations where oseltamivir-resistant seasonal influenza A (H1N1) virus is still circulating, we suggest that the neuraminidase inhibitor be zanamivir rather than oseltamivir. In such a setting, for patients who are unable to take zanamivir, we suggest the addition of an adamantane (rimantadine or amantadine) to oseltamivir [4]. (See "Antiviral drugs for the treatment of influenza in adults").
The dosing of antivirals for the treatment of swine H1N1 influenza A infection in adults is the same as for seasonal influenza (show table 1). (See "Antiviral drugs for the treatment of influenza in adults" and see "Pharmacology of antiviral drugs for influenza").
Antiviral therapy should be continued for five days, as with seasonal influenza [4].
Pregnancy — Seasonal and pandemic strains of influenza cause more severe disease and an increased rate of mortality among pregnant women [7]. Cases of severe swine H1N1 influenza A have been reported in pregnant women, including a fatal case in a woman with psoriasis and mild asthma who was diagnosed at 35 weeks' gestation [15]. (See "Epidemiology, clinical manifestations, and diagnosis of swine H1N1 influenza A").
Oseltamivir, zanamivir, amantadine, and rimantadine are Pregnancy Category C drugs, reflecting that clinical studies have not been done to assess the safety of their use during pregnancy [4]. Both amantadine and rimantadine have been found to be teratogenic and embryotoxic when given at high doses in animal studies. No adverse events have been shown to be caused by oseltamivir or zanamivir among women who received these agents during pregnancy or among infants who were exposed while in utero. (See "Pharmacology of antiviral drugs for influenza", section on Pregnancy).
Pregnant women who meet current case definitions for confirmed, probable, or suspected H1N1 influenza A infection should receive antiviral therapy with either oseltamivir or zanamivir, since the potential benefit outweighs the theoretical risk to the fetus [7]. (See "Choice of antiviral" above).
Children — Oseltamivir is approved in the United States for the treatment of influenza A and B viral infections in individuals ≥1 year of age. Zanamivir is approved for the treatment of influenza A and B viral infections in individuals ≥7 years of age. However, the US Food and Drug Administration has issued an emergency use authorization for clinicians to use oseltamivir or zanamivir in younger children, when indicated, during the current epidemic [11]. Limited safety data on oseltamivir treatment in infants <1 year of age suggest that severe adverse reactions are rare [4].
We recommend antiviral therapy for [4]:
* All hospitalized patients with confirmed, probable, or suspected H1N1 influenza A virus infection (see "Case definitions" above) and
* Patients at higher risk of complications. In addition to patients with underlying illnesses, all children younger than 5 years of age, particularly those less than 2 years of age, are at increased risk for complications of influenza. (See "High risk groups" above).
During the current epidemic, patients with mild illness do not need to be tested or treated unless they have risk factors for complications [12]. However, the decision of whether to initiate antiviral therapy in each patient should be based upon the clinician's judgment and on what is known about the benefits of therapy for seasonal influenza. (See "Medical care for suspected cases" above).
For children <1 year of age, oseltamivir is the recommended antiviral [11]. Therapy should be started as soon as possible.
The dosing of antivirals for swine H1N1 influenza A infection in children is the same as that for seasonal influenza (show table 2). Treatment should be continued for five days. (See "Antiviral drugs for the prevention and treatment of influenza in children" and see "Pharmacology of antiviral drugs for influenza").
For infants younger than 1 year of age, the oseltamivir dose depends upon the age of the infant:
* Age <3 months — 12 mg twice daily
* Age 3 to 5 months — 20 mg twice daily
* Age 6 to 11 months — 25 mg twice daily
Antiviral therapy should be continued for five days, as with seasonal influenza [11].
Postmarketing reports have identified rare, but serious neuropsychiatric events in children with influenza who are taking oseltamivir. (See "Antiviral drugs for the prevention and treatment of influenza in children", section on Rare adverse events).
Children who may have influenza infection should not take aspirin or aspirin-containing products, such as bismuth subsalicyclate (PeptoBismol), due to the increased risk of Reye syndrome [4].
ANTIBACTERIAL THERAPY — Patients with H1N1 influenza A who develop pneumonia should be treated empirically for community-acquired pneumonia (CAP) [8]. In hospitalized patients with severe CAP requiring intensive care unit admission who also have either necrotizing/cavitary infiltrates or empyema, methicillin-resistant Staphylococcus aureus (MRSA) infection should be suspected and treated in addition to other potential causes. (See "Treatment of community-acquired pneumonia in adults who require hospitalization" and see "Inpatient treatment of pneumonia in children").
ANTIVIRAL PROPHYLAXIS — While awaiting further data, we suggest following the United States Centers for Disease Control and Prevention guidelines in deciding who should or should not receive antiviral prophylaxis of H1N1 influenza A virus infection [4,11]. See the CDC's website for updated recommendations (http://www.cdc.gov/h1n1flu/). Clinicians in other countries should consult with their ministries of health and/or the World Health Organization for specific recommendations.
BE HEALTHY! FUTURE HEALTH SAVER!
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