NZ - Swine flu teenager 'needs a miracle'

[dr kockosh]

Swine flu teenager 'needs a miracle'


KATE NEWTON | 13th July 2009

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A Havelock North teenager with swine flu is fighting for life in Starship Children's Hospital but will need a miracle to survive, her parents say.
Claudia Teague, a Year 9 student from Woodford House, is in a critical condition after being put in a drug-induced coma in Hawke's Bay Hospital on Wednesday.
Claudia first felt unwell last Saturday, the first day of the school holidays, and on Monday had a sore chest so her mother, Caroline Teague, made an appointment with the family's GP for the next day.
By the time of that appointment Claudia's condition had deteriorated and the doctor diagnosed her with influenza and prescribed Tamiflu, but that night she had difficulty breathing so on Wednesday saw her GP again.
She was given oxygen and taken by ambulance to Hawke's Bay Hospital where she was admitted to the intensive care unit and that night put in the drug-induced coma.
Early Thursday morning the family was told Claudia needed to be flown by air ambulance to Starship so she could be put on ECMO life support _ a machine that keeps a patient alive when their own heart and lungs are too stressed to do the job.
Claudia's parents, Caroline and Roger, and sisters, Harriet and Georgia, are staying at Ronald McDonald house.
They say in the blog which they have set up to track Claudia's progress that had she not been put on the ECMO machine that day she would not have survived.
Swine flu has been confirmed and it's thought that while her body was trying to fight the new virus a secondary bacterial infection attacked her heart and lungs.
Claudia is also on dialysis because her kidneys are failing.
``It will be a long battle and as we start this new day Claudia needs a miracle to survive this,'' they wrote on the blog.
* Hawke's Bay has 132 confirmed cases of swine flu and three people in Hawke's Bay Hospital have the virus, including the young woman in intensive care whose condition has improved from critical to serious but stable.

A very sad story and a prime example of why nz needs to get antiviral medication to the sick before day 4 ( every family should be given one pack on hand and instructed when to take it if necessary by help line - far too much delay defeats antiviral efficacy

 

[tropical]

Re: NZ - Swine flu teenager 'needs a miracle'

Sorry for Claudia health state.

#1:
"Saturday, the first day of the school holidays, and on Monday had a sore chest so her mother, Caroline Teague, made an appointment with the family's GP for the next day.
By the time of that appointment Claudia's condition had deteriorated and the doctor diagnosed her with influenza and prescribed Tamiflu, but that night she had difficulty breathing so on Wednesday saw her GP again."


Tamiflu administered 3-4 days after - is this a product of the "mild cases non Tamiflu somministration" policy, or there was not opened a flu call center by the weekend(?)

 

[german-docter]

Re: NZ - Swine flu teenager 'needs a miracle'

Sorry for Claudia health state.

#1:
"Saturday, the first day of the school holidays, and on Monday had a sore chest so her mother, Caroline Teague, made an appointment with the family's GP for the next day.
By the time of that appointment Claudia's condition had deteriorated and the doctor diagnosed her with influenza and prescribed Tamiflu, but that night she had difficulty breathing so on Wednesday saw her GP again."


Tamiflu administered 3-4 days after - is this a product of the "mild cases non Tamiflu somministration" policy, or there was not opened a flu call center by the weekend (?)

Sad story about that 9 year old girl Claudia.
WHY couldn't Tamiflu be administered EARLY ???

Excerpt:

http://www.moh.govt.nz/moh.nsf/pagesmh/5180/$File/part-c-h-l-update.pdf
New Zealand Influenza Pandemic Action Plan (page 168 -173)
(?)
The National Reserve of antiviral medication
The New Zealand government is maintaining a National Reserve of neuraminidase inhibitor medication treatment courses. Each treatment course is a sealed packet containing a blister pack of 10 x 75 mg oseltamivir (Tamiflu) capsules. (?)
Supplies are stored in several locations in New Zealand, with ready-use supplies available to support a rapid response anywhere in the country within a few hours. Larger volumes could be available anywhere in New Zealand within 24 hours.

Pandemic plan strategy: outline
(?) The primary objective is to prevent or mitigate the spread of pandemic influenza in New Zealand until the population at large is protected by vaccination, or the pandemic abates.
A secondary objective is to maintain capacity in some identified sectors or services that directly reduce morbidity and mortality among the general population.

Anticipated progression through operational phases
(?) In the pandemic management phase it will have been recognised that the pandemic disease is spreading widely in a district or region, and that elimination of the disease is no longer a practical goal. The focus will shift to preventing or slowing further spread through public health measures, and mitigating the impact of the disease on the affected population. (?)


National Reserve overview
(?) In general, it is anticipated that National Reserve medication will be used for the early treatment of people who become ill, rather than for prophylaxis.
This aligns with World Health Organization (WHO) advice that ?early treatment is a more efficient use of resources than prophylaxis, which requires a prohibitively large stockpile?. The New Zealand Pandemic Influenza Technical Advisory Group concurs with the WHO opinion that pre-exposure prophylaxis for the population at large, or for the workforce in general, is neither practical nor possible because of the very large volume of medication required. The use of National Reserve stocks in this way would unreasonably deprive many people of any chance of treatment should they become ill. Apart from the resource issue, pre-exposure prophylaxis of large numbers of well people is unsound on clinical grounds, and also risks the development of viral resistance which could reduce or eliminate the effectiveness of the medication.
(?)
National Reserve medication provision
It is anticipated that National Reserve medication will be provided free of charge to people meeting the criteria for provision.
In the border management and cluster control phases, provision is likely to be principally through public health units. In the pandemic management phase, provision to the general population is likely to be through community-based assessment centres or other non-traditional methods or facilities still to be advised.

Usage: border management phaseAppendix I: Antiviral Medication Interim Guidelines
Notes (?)
? Treatment, post-exposure prophylaxis and other measures will be started without waiting for laboratory confirmation.
(?)

Usage: cluster control phase
(?)
? Because relatively small numbers of individuals will be involved cluster control operations need not be constrained by antiviral resource issues.

Usage: pandemic management phase
(?)
Provision: As long as stocks last, it is anticipated that medication will be provided for people who meet the clinical case criteria and any other prioritisation criteria advised by the Ministry of Health.

Appendix I: Antiviral Medication Interim Guidelines
Anticipated prioritisation in a large pandemic wave
The following section is a placeholder for draft purposes. Final prioritisation guidelines may differ.

Should pandemic influenza spread widely within New Zealand very large numbers of people may become ill. The supply of antiviral medication may need to be prioritised to ensure the most effective use of the National Reserve. Prophylactic use is unlikely to be possible because the very large amount of medication used in this way would unreasonably deprive many people of the chance of treatment.
Normal seasonal influenza tends to impact most heavily on the very young and the elderly, but pandemic influenza may not follow this pattern. Prioritisation policies and criteria cannot be predicted or developed until the size, course, epidemiology and nature of the pandemic disease in New Zealand become apparent.
As it may take some time to understand the epidemiology of the disease in New Zealand it is likely that the practical approach will be to supply medication to all people who meet the case criteria for at least the first week or two of a large pandemic wave before establishing further prioritisation criteria.Should prioritisation become necessary, medication will be prioritised towards population groups that are suffering poorer outcomes in terms of morbidity and/or mortality AND who appear to be able to benefit most from antiviral medication, and to people who provide certain identified services and functions essential for effective direct pandemic responses.
(?)
An overview of Tamiflu
Tamiflu (oseltamivir) is a neuraminidase inhibitor medication. It is effective against influenza A and B viruses (avian influenza viruses are type A). It acts to prevent the influenza virus in an infected person?s respiratory tract from spreading from the infected cells, so reducing the symptoms of influenza in an infected person. It can also reduce the amount of virus an infected person sheds into the environment, so helping to prevent infection of other people.
Appendix I: Antiviral Medication Interim Guidelines
Tamiflu can be used either for treatment of people who become ill, or prophylactically to prevent people from developing a symptomatic influenza infection. At present in New Zealand Tamiflu is available only on prescription, and is not subsidised.
When used for treatment of seasonal influenza the entire treatment course is taken as one capsule twice a day for five days. Treatment should be started as early as possible after the development of symptoms, up to a maximum of 48 hours. Tamiflu treatment started more than 48 hours after symptoms develop provides no benefit. The use of Tamiflu by an infected person does not prevent the development of immunity to the strain of influenza causing the illness. There is evidence that, when used correctly, Tamiflu can reduce illness and secondary complications due to seasonal influenza.Tamiflu can be used for pre-or post-exposure prophylaxis. Current registration of the medicine in New Zealand enables pre-exposure prophylaxis for up to six weeks, at the rate of one capsule per day. Protection against influenza ceases at the end of the prophylaxised period unless infection occurs during this time. Both pre-exposure and post-exposure prophylaxis courses are one capsule a day for 10 days. In both cases Tamiflu can be about 80 percent effective in preventing the development of symptoms in exposed people.


http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/aug2405who.html
Roche to give flu drug to WHO to fight pandemic
Aug 24, 2005 (CIDRAP News) ? The Swiss drug company Roche has pledged to give the World Health Organization (WHO) enough doses of the antiviral drug oseltamivir (Tamiflu) to treat 3 million people, in the hope that it could help to stave off or delay an influenza pandemic.

The 30 million doses will be used to build up an international stockpile of antivirals, the WHO said in announcing the gift today. (...)

Countries aiming to buy enough of the drug to cover 20% to 40% of their people include France, Finland, Iceland, Ireland, Luxembourg, Netherlands, New Zealand, Norway, Switzerland, and the United Kingdom.​

 

[dr kockosh]

Re: NZ - Swine flu teenager 'needs a miracle'

The new policy is not helping - at the beginning they treated evryone and contacts with anti virals - now only those with more sever symptoms - it definatly causes critical hesitation.
A better strategy would be to issue at least one pack of antiviral per family and get green light from health line based on symptoms when necessary.
at the moment the public thinks it's mostly mild and not concerned unless worse symptoms develop. this is media and govt fault.If the virus jumps in severity a lot of people will be caught out - at the moment its only the unlucky few. change in system needed and co ordinated message to go with it.

 

[pinkfrost]

Re: NZ - Swine flu teenager 'needs a miracle'

Another option that would have been available to them is to have had it prescribed by a pharmacist. She would have met the criteria to have it prescribed by a pharmacist and there would be no need to wait for an appointment.

 

[tropical]

Re: NZ - Swine flu teenager 'needs a miracle'

Another option that would have been available to them is to have had it prescribed by a pharmacist. She would have met the criteria to have it prescribed by a pharmacist and there would be no need to wait for an appointment.

The suggestion #4 is better, but even this (but queues will forms by infected patients shed it at the farmacies) is better than nothing until is late, as now.

 

[tropical]

Re: NZ - Swine flu teenager 'needs a miracle'

I agree.

Does it exists there legal ways through population health laws which can by claim derogate such policy decision which now induct late antiviral somministration?

The new policy is not helping - at the beginning they treated evryone and contacts with anti virals - now only those with more sever symptoms - it definatly causes critical hesitation.
A better strategy would be to issue at least one pack of antiviral per family and get green light from health line based on symptoms when necessary.
at the moment the public thinks it's mostly mild and not concerned unless worse symptoms develop. this is media and govt fault.If the virus jumps in severity a lot of people will be caught out - at the moment its only the unlucky few. change in system needed and co ordinated message to go with it.