The Star Online
http://thestar.com.my/news/story.asp?file=/2009/8/13/ah1n1flu/4506179&sec=ah1n1flu
Thursday August 13, 2009
Don?t withhold anti-virals
THE current situation with regard to A(HINI) has compelled me to write this letter. The A (HINI) flu is a viral disease that is amenable to treatment if anti-virals are administered early. However, I feel that the recommendations for treatment by the Health Ministry are too tight.
A number of households within the past two weeks, especially those that are in contact with the public such as medical personnel, students and teachers, have had members of the family down with flu.
Any flu-like illness, especially among those already vaccinated with flu vaccine, within the last two weeks is most probably HINI unless proven otherwise.
The disease has become too widespread to be contained, and steps taken to prevent the spread may prove ineffective. Hence, the next option is to deal with the situation in the most appropriate manner. And that is to administer treatment to the appropriate group early.
Those who get the infection will become immune, and when enough of the population has acquired the infection and become immune, then we get herd immunity and the disease can be contained.
Looking at the symptoms, they are fairly consistent. Most of them start with sore throat and dry cough associated with fatigue and cold intolerance for a few days followed by cyclical fever which usually occurs in the evening. Watery runny nose occurs about one day after the onset of fever and is usually transient unless there is a secondary bacterial infection.
Some patients may have diarrhoea at this stage. Some have milder disease with low grade fever. Note that there is no bone or joint pain or severe headache as opposed to dengue, and that in dengue, there is usually no symptoms of runny nose.
While a nasal swab is helpful with the diagnosis, it has a high false negative rate, hence patients may be wrongly diagnosed. Therefore, clinical judgement is more important.
As we are all aware, the disease does not only cause fatality among the immuno-suppresed, but also healthy individuals, and if we follow closely, we will see that some of those who died had received outpatient treatment for flu prior to their death.
The current recommendation for treatment with anti-virals (http://h1n1.moh.gov.my/caseManagement.php) is too rigid and may be too late because the anti-viral is most effective if given within 48 hours of the onset of symptoms. Often, those who came early for treatment with flu-like illnesses were sent home with antibiotics which gave a false sense of security not only to the patient but also to the doctor.
According to the Health Ministry?s recommendations, if patients have no risk factor, they have to become moderately ill before they can be admitted and receive treatment with anti-virals. By that time it may be too late or the anti-viral may not be as effective or they may already be dead!
A few fatal cases were in fact relatively well at presentation but deteriorated very fast. Within hours the patient succumbed to the illness.
Patients who have high grade fever and are unwell for more than one day associated with flu-like illness should be given the option of receiving treatment with anti-virals.
The British Medical Journal research is correct to say that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them.
?But for those who experience severe symptoms, the best scientific advice tells us that anti-virals should still be taken as soon as possible ? and to suggest otherwise is potentially dangerous?.
No doubt, there are concerns about side effects and resistance to anti-virals, but at this point in time, it is not justified whatsoever to let them run the risk of fatal complications since more than 10% of mortality were from among previously healthy individuals. I repeat, the mistake is withholding anti-viral treatment for patients who deserve it. We have to be less stringent in our criteria to treat.
DR SAADIAH SULAIMAN,
Dermatologist,
Hospital Pakar Annur, Bangi.
http://thestar.com.my/news/story.asp?file=/2009/8/13/ah1n1flu/4506179&sec=ah1n1flu
Thursday August 13, 2009
Don?t withhold anti-virals
THE current situation with regard to A(HINI) has compelled me to write this letter. The A (HINI) flu is a viral disease that is amenable to treatment if anti-virals are administered early. However, I feel that the recommendations for treatment by the Health Ministry are too tight.
A number of households within the past two weeks, especially those that are in contact with the public such as medical personnel, students and teachers, have had members of the family down with flu.
Any flu-like illness, especially among those already vaccinated with flu vaccine, within the last two weeks is most probably HINI unless proven otherwise.
The disease has become too widespread to be contained, and steps taken to prevent the spread may prove ineffective. Hence, the next option is to deal with the situation in the most appropriate manner. And that is to administer treatment to the appropriate group early.
Those who get the infection will become immune, and when enough of the population has acquired the infection and become immune, then we get herd immunity and the disease can be contained.
Looking at the symptoms, they are fairly consistent. Most of them start with sore throat and dry cough associated with fatigue and cold intolerance for a few days followed by cyclical fever which usually occurs in the evening. Watery runny nose occurs about one day after the onset of fever and is usually transient unless there is a secondary bacterial infection.
Some patients may have diarrhoea at this stage. Some have milder disease with low grade fever. Note that there is no bone or joint pain or severe headache as opposed to dengue, and that in dengue, there is usually no symptoms of runny nose.
While a nasal swab is helpful with the diagnosis, it has a high false negative rate, hence patients may be wrongly diagnosed. Therefore, clinical judgement is more important.
As we are all aware, the disease does not only cause fatality among the immuno-suppresed, but also healthy individuals, and if we follow closely, we will see that some of those who died had received outpatient treatment for flu prior to their death.
The current recommendation for treatment with anti-virals (http://h1n1.moh.gov.my/caseManagement.php) is too rigid and may be too late because the anti-viral is most effective if given within 48 hours of the onset of symptoms. Often, those who came early for treatment with flu-like illnesses were sent home with antibiotics which gave a false sense of security not only to the patient but also to the doctor.
According to the Health Ministry?s recommendations, if patients have no risk factor, they have to become moderately ill before they can be admitted and receive treatment with anti-virals. By that time it may be too late or the anti-viral may not be as effective or they may already be dead!
A few fatal cases were in fact relatively well at presentation but deteriorated very fast. Within hours the patient succumbed to the illness.
Patients who have high grade fever and are unwell for more than one day associated with flu-like illness should be given the option of receiving treatment with anti-virals.
The British Medical Journal research is correct to say that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them.
?But for those who experience severe symptoms, the best scientific advice tells us that anti-virals should still be taken as soon as possible ? and to suggest otherwise is potentially dangerous?.
No doubt, there are concerns about side effects and resistance to anti-virals, but at this point in time, it is not justified whatsoever to let them run the risk of fatal complications since more than 10% of mortality were from among previously healthy individuals. I repeat, the mistake is withholding anti-viral treatment for patients who deserve it. We have to be less stringent in our criteria to treat.
DR SAADIAH SULAIMAN,
Dermatologist,
Hospital Pakar Annur, Bangi.
