german-docter
New member
WHY did a 6-year-old Brampton girl with swine flu die in Ontario, Canada ?
WHY NOT to CHANGE recommendations of antiviral treatment by PHAC ?
Read the following quotes and then decide by yourself: What would YOU do ?
Part # 1:
Credits to: theforeigner.
http://www.flutrackers.com/forum/showthread.php?t=112153
Swine flu kills Brampton girl, 6, in 24 hrs
A 6-year-old Brampton girl with swine flu died only a day after she began showing flu-like symptoms. The child (?) passed away a week ago and it was only discovered after she died that she had the H1N1 influenza virus. (?) The child got a fever and began vomiting on Sunday, June 14, and died the following day. An autopsy was performed and lab results revealed last Friday she did indeed have the virus. She is the fourth Ontarian with the virus to die.(?) The deaths of the two Quebecers and the Brampton girl bring to 16 the number of Canadians to die after contracting swine flu. (?)
http://www.thestar.com/article/655062
H1N1 flu victim collapsed on way to hospital
Within minutes, six-year-old Rubjit Thindal went from happily chatting in the back seat of the car to collapsing and dying in her father's arms.(?) Rubjit was pronounced dead at hospital barely 24 hours after showing signs of a fever. Later, doctors told her parents she had the H1N1 influenza virus. She is believed to be the youngest person in Canada with the virus to have died. On the evening of June 14, Rubjit had a bit of a fever and complained that her legs and arms hurt. The next morning, Kuldip took her to a walk-in clinic and the doctor prescribed the pain reliever Advil. By the afternoon, the little girl's fever was gone but she was complaining of astomach ache. Kuldip again took her to the clinic at about 2 p.m. The doctor gave her pills and told the Grade 1 student at Roberta Bondar School in Brampton to take it easy. (?) In the evening, when Rubjit said her stomach was still hurting, Kuldip and her husband, Gurmukh, decided to take her immediately to the Georgetown Hospital.Kuldip was driving. It was about 8 p.m. and they were five minutes from the hospital. (?) A minute later, Rubjit suddenly put her hand on her chest and said it was hurting. The next minute, her body went limp and she stopped breathing. (?) It was about 8:05 p.m. when they arrived, Kuldip remembers. Two hours later, doctors confirmed their little girl was dead.(?) Rubjit's parents say they don't know where the little girl contracted the virus. The entire family has been tested and Kuldip said doctors have told them no one else has it. (?) "She was so lively, never sat still for a minute and was always laughing,'' said Kuldip, who admits she keeps wondering if Rubjit would still have been alive had she taken her directly to the hospital instead of the walk-in clinic.
Part # 2:
http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/hp-ps-info_amb-eng.php
(PHAC-) Interim Guidance for Clinicians in ambulatory Care Settings
Screening for Influenza-Like Illness (ILI)
As noted in detail below, to determine if a patient may have a human case of swine influenza A (H1N1), clinicians need to ask about fever and cough, other ILI symptoms and conduct a detailed travel and contact history.
Influenza Like Illness (ILI) Screening Criteria
Acute onset of respiratory illness with fever and cough
Note: in children under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent.
AND one or more of the following:
Sore throat, arthralgia, myalgia, or prostration which could be due to influenza virus.
AND one or more of the following:
Travel/contact exposure: (?)
REPORTING RESPONSIBILITIES
If, based on the above criteria, you suspect that your patient may have swine influenza A (H1N1), contact your local/regional public health authorities. If it is off hours, call your Medical Officer of Health. Local/regional public health authorities will report any suspect cases to the province/territory; these will be reported to the Public Health Agency of Canada. As this outbreak progresses, guidance may change. Initially, it is important to know if and how the infection is spreading in Canada. In the initial response phase, public health will be taking detailed information on cases and contacts.
LABORATORY BEST PRACTICES
It is vital to get a laboratory sample in order to confirm or rule out the diagnosis of swine influenza A (H1N1).
(?)
CLINICAL MANAGEMENT
To date, most cases of swine influenza have been mild; however, the experience in Mexico suggests a spectrum of disease. Mild cases can be treated in the same way as other influenza-like illnesses, with an emphasis on staying at home to prevent spread of the disease. Review good respiratory and hand hygiene practices. Encourage patients to recuperate away from others. As with other types of influenza, an ill person may want to wear a surgical mask when in close contact with others (less then 2 metres). Others may want to wear a mask if in close contact with an ill person. Medications to ease fever and myalgias may be indicated. Rest, fluids, and instructions on when they need to be reassessed would be helpful. If an ill person must go out in public (e.g., to seek medical care) he/she should wear a face mask to reduce the risk of spreading the virus in the community.
Mild cases do not require antiviral treatment. Moderately ill people who are at high risk of influenza-related complications (such as those with chronic health conditions) 2 may benefit from antiviral therapy. Severely ill patients will need to be hospitalized. You may wish to confer with public health or an infectious disease specialist. If you decide to transfer the patient to hospital, ensure that the ambulance personnel and the hospital are notified ahead of time of the possible diagnosis and the need for Routine Practices with Contact Precautions.
Oseltamivir (Tamiflu?) or zanamivir (Relenza?) are the treatments of choice for influenza. These antiviral medications can reduce the severity of the illness and may reduce the risk of complications in at-risk persons. Antiviral treatment should be started as soon as possible, i.e. within 12-48 hours after onset of symptoms.
(?)
Part # 3:
http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/faq_rg_swine-eng.php
Q. What are PHAC's recommendations for the use of antivirals?
PHAC's recommendation is that antivirals be used to treat H1N1 Flu Virus when the illness is moderate to severe and the patient is at a great risk for complications.
PHAC is not recommending that antivirals be given for a mild disease or on a preventive basis at this time.
The reasons for this are:
We do not have sufficient information to suggest that this influenza virus requires the use of antivirals. Most patients in Canada are recovering well on their own.
There is a risk that the virus could be resistant to antiviral treatment if antivirals are overused to treat mild illness.
The antiviral stockpile is a finite resource. We want to be sure not to run out before they are really needed.
Part # 4:
http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/antiviral-antiviraux05-01-eng.php
PHAC-recommodation:
Use of antivirals to treat H1N1 flu virus (Human Swine Flu)
(?)
Antivirals are drugs that can treat the symptoms of an influenza virus infection and reduce the spread of the illness to others, but only if they are administered early. These drugs have to be administered within 48 hours of the beginning of symptoms in order to be optimally effective. (?)
Additionally, some people are wondering if they should take antivirals to prevent them from getting sick. This is called prophylaxis. At this point, the Agency has not changed its recommendations for the use of antivirals as prophylaxis for influenza. PHAC recommends that antivirals be used to prevent the spread of illness in closed settings, such as hospitals and long-term care facilities. PHAC does not recommend that family members and other close contacts of people who are sick with the H1N1 flu virus take antivirals as a preventative measure. (?)
All medications should be used judiciously and only when needed. (?)
Part # 5:
http://content.nejm.org/cgi/content/full/360/25/2605
Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans
Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team
Background: On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identified from the rapidly evolving U.S. outbreak. (?)
In the United States to date, most confirmed cases of S-OIV infection have been characterized by self-limited, uncomplicated febrile respiratory illness and symptoms similar to those of seasonal influenza (cough, sore throat, rhinorrhea, headache, and myalgia), but approximately 38% of cases have also involved vomiting or diarrhea, neither of which is typical of seasonal influenza. (?)
As of May 5, 2009, the CDC has recommended that given the severity of illness observed among some patients with S-OIV infection, therapy with neuraminidase inhibitors should be prioritized for hospitalized patients with suspected or confirmed S-OIV infection and for patients who are at high risk for complications from seasonal influenza. (?)
Part # 6
http://www.phac-aspc.gc.ca/cpip-pclcpi/s04-eng.php#phase6
The Canadian Pandemic Influenza Plan for the Heath Sector
(?)
Canadian Phases 6.1 and 6.2:
Pandemic virus detected in Canada (Phase 6.1 ? single case(s) occurring, Phase 6.2 ? localized or widespread activity occurring)
Antivirals: Strategic and controlled use of antivirals:
If not previously completed in Phase 6.0, review and if necessary revise national recommendations on antiviral use based on available epidemiological data
Part # 7
Now, it?s time to make your own decision !
If you were a member of the PHAC staff, would you urge to change Guidance for Clinicians in ambulatory Care Settings or recommendations for the use antiviral treatment of novel Influenza in Canada ?
WHY NOT to CHANGE recommendations of antiviral treatment by PHAC ?
Read the following quotes and then decide by yourself: What would YOU do ?
Part # 1:
Credits to: theforeigner.
http://www.flutrackers.com/forum/showthread.php?t=112153
Swine flu kills Brampton girl, 6, in 24 hrs
A 6-year-old Brampton girl with swine flu died only a day after she began showing flu-like symptoms. The child (?) passed away a week ago and it was only discovered after she died that she had the H1N1 influenza virus. (?) The child got a fever and began vomiting on Sunday, June 14, and died the following day. An autopsy was performed and lab results revealed last Friday she did indeed have the virus. She is the fourth Ontarian with the virus to die.(?) The deaths of the two Quebecers and the Brampton girl bring to 16 the number of Canadians to die after contracting swine flu. (?)
http://www.thestar.com/article/655062
H1N1 flu victim collapsed on way to hospital
Within minutes, six-year-old Rubjit Thindal went from happily chatting in the back seat of the car to collapsing and dying in her father's arms.(?) Rubjit was pronounced dead at hospital barely 24 hours after showing signs of a fever. Later, doctors told her parents she had the H1N1 influenza virus. She is believed to be the youngest person in Canada with the virus to have died. On the evening of June 14, Rubjit had a bit of a fever and complained that her legs and arms hurt. The next morning, Kuldip took her to a walk-in clinic and the doctor prescribed the pain reliever Advil. By the afternoon, the little girl's fever was gone but she was complaining of astomach ache. Kuldip again took her to the clinic at about 2 p.m. The doctor gave her pills and told the Grade 1 student at Roberta Bondar School in Brampton to take it easy. (?) In the evening, when Rubjit said her stomach was still hurting, Kuldip and her husband, Gurmukh, decided to take her immediately to the Georgetown Hospital.Kuldip was driving. It was about 8 p.m. and they were five minutes from the hospital. (?) A minute later, Rubjit suddenly put her hand on her chest and said it was hurting. The next minute, her body went limp and she stopped breathing. (?) It was about 8:05 p.m. when they arrived, Kuldip remembers. Two hours later, doctors confirmed their little girl was dead.(?) Rubjit's parents say they don't know where the little girl contracted the virus. The entire family has been tested and Kuldip said doctors have told them no one else has it. (?) "She was so lively, never sat still for a minute and was always laughing,'' said Kuldip, who admits she keeps wondering if Rubjit would still have been alive had she taken her directly to the hospital instead of the walk-in clinic.
Part # 2:
http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/hp-ps-info_amb-eng.php
(PHAC-) Interim Guidance for Clinicians in ambulatory Care Settings
Screening for Influenza-Like Illness (ILI)
As noted in detail below, to determine if a patient may have a human case of swine influenza A (H1N1), clinicians need to ask about fever and cough, other ILI symptoms and conduct a detailed travel and contact history.
Influenza Like Illness (ILI) Screening Criteria
Acute onset of respiratory illness with fever and cough
Note: in children under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent.
AND one or more of the following:
Sore throat, arthralgia, myalgia, or prostration which could be due to influenza virus.
AND one or more of the following:
Travel/contact exposure: (?)
REPORTING RESPONSIBILITIES
If, based on the above criteria, you suspect that your patient may have swine influenza A (H1N1), contact your local/regional public health authorities. If it is off hours, call your Medical Officer of Health. Local/regional public health authorities will report any suspect cases to the province/territory; these will be reported to the Public Health Agency of Canada. As this outbreak progresses, guidance may change. Initially, it is important to know if and how the infection is spreading in Canada. In the initial response phase, public health will be taking detailed information on cases and contacts.
LABORATORY BEST PRACTICES
It is vital to get a laboratory sample in order to confirm or rule out the diagnosis of swine influenza A (H1N1).
(?)
CLINICAL MANAGEMENT
To date, most cases of swine influenza have been mild; however, the experience in Mexico suggests a spectrum of disease. Mild cases can be treated in the same way as other influenza-like illnesses, with an emphasis on staying at home to prevent spread of the disease. Review good respiratory and hand hygiene practices. Encourage patients to recuperate away from others. As with other types of influenza, an ill person may want to wear a surgical mask when in close contact with others (less then 2 metres). Others may want to wear a mask if in close contact with an ill person. Medications to ease fever and myalgias may be indicated. Rest, fluids, and instructions on when they need to be reassessed would be helpful. If an ill person must go out in public (e.g., to seek medical care) he/she should wear a face mask to reduce the risk of spreading the virus in the community.
Mild cases do not require antiviral treatment. Moderately ill people who are at high risk of influenza-related complications (such as those with chronic health conditions) 2 may benefit from antiviral therapy. Severely ill patients will need to be hospitalized. You may wish to confer with public health or an infectious disease specialist. If you decide to transfer the patient to hospital, ensure that the ambulance personnel and the hospital are notified ahead of time of the possible diagnosis and the need for Routine Practices with Contact Precautions.
Oseltamivir (Tamiflu?) or zanamivir (Relenza?) are the treatments of choice for influenza. These antiviral medications can reduce the severity of the illness and may reduce the risk of complications in at-risk persons. Antiviral treatment should be started as soon as possible, i.e. within 12-48 hours after onset of symptoms.
(?)
Part # 3:
http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/faq_rg_swine-eng.php
Q. What are PHAC's recommendations for the use of antivirals?
PHAC's recommendation is that antivirals be used to treat H1N1 Flu Virus when the illness is moderate to severe and the patient is at a great risk for complications.
PHAC is not recommending that antivirals be given for a mild disease or on a preventive basis at this time.
The reasons for this are:
We do not have sufficient information to suggest that this influenza virus requires the use of antivirals. Most patients in Canada are recovering well on their own.
There is a risk that the virus could be resistant to antiviral treatment if antivirals are overused to treat mild illness.
The antiviral stockpile is a finite resource. We want to be sure not to run out before they are really needed.
Part # 4:
http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/antiviral-antiviraux05-01-eng.php
PHAC-recommodation:
Use of antivirals to treat H1N1 flu virus (Human Swine Flu)
(?)
Antivirals are drugs that can treat the symptoms of an influenza virus infection and reduce the spread of the illness to others, but only if they are administered early. These drugs have to be administered within 48 hours of the beginning of symptoms in order to be optimally effective. (?)
Additionally, some people are wondering if they should take antivirals to prevent them from getting sick. This is called prophylaxis. At this point, the Agency has not changed its recommendations for the use of antivirals as prophylaxis for influenza. PHAC recommends that antivirals be used to prevent the spread of illness in closed settings, such as hospitals and long-term care facilities. PHAC does not recommend that family members and other close contacts of people who are sick with the H1N1 flu virus take antivirals as a preventative measure. (?)
All medications should be used judiciously and only when needed. (?)
Part # 5:
http://content.nejm.org/cgi/content/full/360/25/2605
Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans
Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team
Background: On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identified from the rapidly evolving U.S. outbreak. (?)
In the United States to date, most confirmed cases of S-OIV infection have been characterized by self-limited, uncomplicated febrile respiratory illness and symptoms similar to those of seasonal influenza (cough, sore throat, rhinorrhea, headache, and myalgia), but approximately 38% of cases have also involved vomiting or diarrhea, neither of which is typical of seasonal influenza. (?)
As of May 5, 2009, the CDC has recommended that given the severity of illness observed among some patients with S-OIV infection, therapy with neuraminidase inhibitors should be prioritized for hospitalized patients with suspected or confirmed S-OIV infection and for patients who are at high risk for complications from seasonal influenza. (?)
Part # 6
http://www.phac-aspc.gc.ca/cpip-pclcpi/s04-eng.php#phase6
The Canadian Pandemic Influenza Plan for the Heath Sector
(?)
Canadian Phases 6.1 and 6.2:
Pandemic virus detected in Canada (Phase 6.1 ? single case(s) occurring, Phase 6.2 ? localized or widespread activity occurring)
Antivirals: Strategic and controlled use of antivirals:
If not previously completed in Phase 6.0, review and if necessary revise national recommendations on antiviral use based on available epidemiological data
Part # 7
Now, it?s time to make your own decision !
If you were a member of the PHAC staff, would you urge to change Guidance for Clinicians in ambulatory Care Settings or recommendations for the use antiviral treatment of novel Influenza in Canada ?