Prevent Swine Flu - Good Advice

Prevent Swine Flu - Good Advice

Dr. Vinay Goyal is an MBBS,DRM,DNB (Intensi invist and Thyroid specialist) having clinical experience of over 20 years. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital, Tata Memorial etc. Presently, he is heading our Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W).

The following message given by him, I feel makes a lot of sense and is important for all to know

The only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it's almost impossible to avoid coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. * Gargle twice a day with warm salt water (use Listerine if you don't trust salt)... * H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, * clean your nostrils at least once every day with warm salt water. * Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but * blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population. *

5. * Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). * If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. * Drink as much of warm liquids (tea, coffee, etc) as you can. * Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

I suggest you pass this on to your entire e-list. You neve know 20 who might pay attention to it - and STAY ALIVE because of it...

Influenzenum 200 single dose for 3 days with Arsenicum Album 200 single dose for 3 days

INFLUENZA A H1N1
PREVENTIVE & CONTROL GUIDELINES
25 Jan 2015
National Scenario -
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
Category
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.
Action Plan
Civil Surgeon
District Health Officer
- District Nodal Officer of H1N1
- Establish SDH 50 & 100 bed 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
- Surveillance of ILI & SARI by PHC staff.
- 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
facilities-
1. 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.in govt hosp..
LAB SAMPLE COLLECTION
IDENTIFIED hosp..

COLLECTION CENTERS  at Govt hosp n then testing fr virus at KGMU or SGPGI lko...free of cost ..

Guidelines About Sample Collection
- Swab should be accompanied with detailed
clinical history of 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.।

TREATMENT PROTOCOL
PEDIATRIC DOSES- TAMIFLU
AGE
DOSE
- < 3 months
- 3-5 months
- 6-11 months
- 12 mg  bid for 5 days
- 20 mg bid for 5 days
- 25 mg bid for 5 days
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.
No Need of chemoprophylaxis..
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
3
After 10 days treatment, X ray shows signs of
Pneumonia
Continue Oseltamivir
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
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