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WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses - including Signs & Symptoms of Novel H1N1 Flu

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  • WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses - including Signs & Symptoms of Novel H1N1 Flu

    WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses

    Publication date: 20 August 2009

    The purpose of this document is to provide a basis for advice to clinicians on the use of the currently available antivirals for patients presenting with illness due to influenza virus infection as well the potential use of the medicines for chemoprophylaxis. The document addresses specifically the two neuraminidase inhibitors oseltamivir and zanamivir, and the two M2 inhibitors amantadine and rimantadine. It includes recommendations on the use of some other potential pharmacological treatments. While the focus of the document is on management of patients with pandemic influenza (H1N1) 2009 virus infection, the document includes guidance on the use of the antivirals for other seasonal influenza virus strains, and for infections due to novel influenza A virus strains. WHO recommends that country and local public health authorities issue local guidance for clinicians from time to time that places these recommendations in the context of epidemiological and antiviral susceptibility data on the locally circulating influenza strains.

    This guidance expands on the recommendations published in May 2009 titled "Clinical management of human infection with new influenza A (H1N1) virus: Initial guidance". The recommendations are based on a review of data obtained with previously circulating strains, and treatment of human H5N1 influenza virus infections. It is anticipated that as the prevalence and severity of the current epidemic changes, further information will become available that may warrant revision of the recommendations.

    Download the document [pdf 984kb]

  • #2
    Re: WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses

    ..some excepts;

    .....on an individual patient basis, initial treatment decisions should be based on clinical presentation and epidemiological data and should not be delayed pending laboratory confirmation

    Seems the Labs on a stable H1N1 just have to stamp it Duly Corroborated

    Uncomplicated influenza
    – Influenza‐like illness symptoms: fever, cough, sore throat, rhinorrhea, headache, muscle pain, malaise, but no shortness of breath, no dyspnoea. Patients may present with some or all of these symptoms.
    – Gastrointestinal illness may also be present, such as diarrhoea and/or vomiting, especially in children, but without evidence of dehydration.
    Via of course Lactic Cultures, Yougourt capsules or as in Slavic language Kayfir.

    Complicated or severe influenza

    – Presenting clinical (shortness of breath, dyspnoea, tachypnea, hypoxia) and/or radiological signs of lower respiratory tract disease (e.g. pneumonia), CNS findings (e.g. encephalopathy), severe dehydration or presenting secondary complications, renal failure, multi‐organ failure, and septic shock. Other complications can include musculoskeletal (rhabdomyolysis) and cardiac (myocarditis).

    – Exacerbation of underlying chronic disease, including asthma, chronic obstructive pulmonary disease, chronic hepatic or renal failure, diabetes or other cardiovascular conditions.
    – Any other condition or clinical presentation requiring hospital admission for clinical management.
    – Any of the signs of disease progression listed below.
    Wich of course would exclude Ibuprofen used in suspected H1N1 infected person but instead Tynelol (Acetaminopphene)
    Confer to surprising beneficial results in Japan via the Nihon Pharmaco-Vigilance
    Japan Institute of Pharmacovigilance raises a potentially significant question, is the use of NSAIDs such as ibuprofen safe, in influenza.

    NSAIDs such as diclofenac, mefenamic acid, and ibuprofen are still used as antipyretics in many countries, albeit less often than aspirin.
    Since the use of diclofenac and mefenamic acid was restricted in children in Japan in 2000, the case fatality of so called flu associated encephalopathy has fallen dramatically
    Acute encephalopathy is the most serious complication of pediatric viral infections, such as influenza and exanthem subitum. It occurs worldwide, but is most prevalent in East Asia, and every year several hundreds of Japanese children are affected by influenza-associated encephalopathy.

    Mortality has recently declined, but is still high. Many survivors are left with motor and intellectual disabilities, and some with epilepsy. This article reviews various syndromes of acute encephalopathy by classifying them into three major categories.
    The first group caused by metabolic derangement consists of various inherited metabolic disorders and the classical Reye syndrome. Salicylate is a risk factor of the latter condition.

    CONCLUSIONS: We identified patients who had factors associated with a poor prognosis, and these findings might be clinically useful for the management of this illness.

    Now, there is no indication from media reports that any of the deaths so far had influenza-associated encephalopathy. OTOH, given this is a novel virus, the mechanism of disease may be different. There is some concern, from the age distribution of fatal cases, that this current H1N1 may be more similar to 1918 than 1957 or 68. We don't know that to be true, but if it is, the current generation of physicians have ZERO experience in treating primary influenza disease in patients totally immunologically naive to this virus.
    What may be safe in regular seasonal flu may or may not be safe in this context


    • #3
      Re: WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses


      Signs and symptoms of progressive disease

      Patients who present initially with uncomplicated influenza may progress to more severe disease. Progression can be rapid.

      The following are some of the indicators of progression, which would necessitate an urgent review of patient management:

      ? Symptoms and signs suggesting oxygen impairment or cardiopulmonary insufficiency: 3

      WHO Rapid Advice Guidelines on Pharmacological

      Management of Influenza Virus

      ? shortness of breath (with activity or at rest), difficulty in breathing, turning blue, bloody or coloured sputum, chest pain, low blood pressure;

      ? in children, fast or laboured breathing.

      ? Hypoxia as indicated by pulse oximetry
      ? Symptoms and signs suggesting CNS complications:

      ? altered mental status, unconscious, drowsiness, or difficult to awaken; recurring or persistent convulsions (seizures), confusion, severe weakness or paralysis.
      ? Evidence of sustained virus replication or invasive secondary bacterial infection:

      ? based on laboratory testing or clinical signs (e.g. persistent high fever and other symptoms beyond three days).
      ? Severe dehydration:

      ? decreased activity, dizziness, decreased urine output, lethargy.


      • #4
        Re: Swine flu, H1N1 Signs and symptoms of progressive disease

        Please see this post regarding selenium and viruses.