Download - Dr.joshi 2015
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DR.S.M.JOSHI
Sr.MEDICAL OFFICER,
GOVT.Of MAHARSTRA
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Influenza like illness by Influenza H1N1 areassorted virus was reported from Mexicoon 18th March 2009 .and later spread tounited states and Canada from year 2009.andsubsequently spread to all the continents. InIndia first case reported on 13th May2008.due to travel from affected countries.Substantial no. Of cases were found inMaharashtra(Mumbai,and Pune),
Karnataka(Bangluru),Tamilnadu(Chhenai)areindigenous cases. Majority cases of deathwere due to some underlying diseases orreported late to healthcare facility.
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Agent:-New subtype of Influenza A H1N1 virus
with segments from 4 influenza viruses. North
American swine, viruses. North American avian,
Human infuenza,Urassian Swine.
Host:-Majority in healthy young adults
Transmission:- by droplet infection and fomites.
Incubation Period:-1-7 days.
Communicability:-1 day before and 7 days after
the onset of symtoms and if illness persist >7
days then till resolution of illness .children may
spread the virus for longer period.
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Fever, upper respiratory symtoms,i.e.cough,
running nose sore throat,headache,bodyache,
fatigue,diarrhea,and vomiting.
Possible complications:-Sinusitis,Otitis Media,
croup,Pneumonia,Bronchiolitis,status
asthmaticus
,Myocarditis,pericarditis,myositis,enchephelitis
,Seizures,Toxic shock syndrome and
secondary bacterial Pneumonia with or
without sepsis
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Routineinvestigations`like
Heamatology,Biochemistry,Radiology,Microbiology tests are required.
For Confirmation of diagnosis:-
Real time PCR,Isolation of Virus culture, Fourfold rise in virus specific neutralising antibodies.Are required.
Clinical specimens of nasopharyngeal swab,nasal swab, wash or aspirate,treacheal aspirateare to be obtained samples should be collectedbefore giving antiviral drug. At 4 ⃰ C in viraltransport medium to designated lab within 24hours. if not possible then kept store under -70 ⃰C.Paired blood samples at an interval of 14 daysfor sero.testing also to be collected.
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Suspect case:- a person with acute febrilerespiratory illness (fever ≥38*C) within 7 dayscontact with a person who is confirmed case .orwithin 7 days contact with a person where there is one or
more is confirmed cases. or resides in a community whereone or more confirmed cases.
Probable case:- a person with acute febrile respiratoryillness is positive for influenza A but not to H1.H3 byRTPCR.
Is positive for influenza rapid test, or immunofloroscentassay. And meets the criteria of suspect case.
Individual with clinically compatible illness died due
to unexplained acute respiratory illness andepidemiologically linked with probable or confirmedcase.
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Confirmed case:- :- a person with acute
febrile respiratory illness (fever ≥38*C) with
lab. Confirmed pandemic influenza virus A at
WHO approved Lab. By one or following
tests.
Real time PCR
Viral Culture
Four fold rise in virus specific neutralising
antibodies.
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Implementation of infection controlprecautions, prompt treatment to preventsevere illness and death, early identificationand follow up of persons at risk.
1. Isolation.
2. Dedicated Doctors, Nurses, Paramedicalworkers
Portable X-ray machine ventilators ,oxygencylinders, pulse ox meters.
3 Adequate quantities of PPE,disinfectants,andmedications ( oseltamivir, and othermedications)
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A. Reinforce standard infection control
precautions
B. Restrict no. Of visitors and provide them
PPE
C. Provide antiviral prophylaxis to health
care personnel .
D. Dispose waste properly by placing it in
sealed impermeable bage labelled as Bio
Hazard.
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Dose for treatment as follows.
By weight:-
For weight <15 kg = 30mgBD for 5 days
15-23kg = 45mgBD for 5 days
224< 40kg = 60mgBD for 5 days
>40kg = 75mgBD for 5 days
For infants:-
<3 months = 12 mg BD for 5days
3 -5months = 20mg BD for 5days
6-11 months = 25mg BD for 5days
If needed dose and duration can be modified as per clinical condition.
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Transient nausea, vomiting in increasing doses
,occasionally it may cause bronchitis, insomnia,
vertigo
.less commonly angina,pseudomembranous
colitis,peritonsilar abscess
,anaphylaxis and skin rashes.
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IV fluids
Parenteral nutrition.
Oxygen therapy.
Antibiotics for secondary infection
Vasopressors for shock.
Paracetamol for fever.
Plenty of fluids orally.
Abstain from smoking
Topical decongestants, nasal drops, lozenges,
steam inhalation.
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PPE reduces the risk of infection if usedcorrectly.
It includes:-
Gloves.(nonsterile)
Mask, high efficiency mask, three layeredsurgical mask,
Long sleeved cuffed gown,
Protective eyewear(goggles.visors,faceshields)
Cap
Plastic apron.
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