SWINE FLU 2#

By Dr Himanshu Gul Mirani

Emergncy Physician

-          Prevention

-          Treatment

PREVENTION:

A. Sanitation related recommendations:

Breaking the transmission cycle is the simplest key to prevent infection. Some useful tips are as below:-

1.       Since it’s transmitted by droplet mode – covering the nose and mouth while sneezing / coughing into a tissue and discarding the same at the earliest is important prevention tip.

2.       Practice good hand hygiene standards like washing hands after sneezing into them, after touching things that are possibly infected by droplets like table tops/ toys/ door knobs etc.

3.       Wash hands preferably with soaps or alcohol based hand sanitizers.

4.       Kids who are suspected to have flu like symptoms should take off from school (duration to be based on the individual case basis) to prevent spread to other vulnerable populace of school kids.

B. Vaccination:

There are special vaccines for HINI strain of influenza virus and they are available in 2 forms, viz.                                       1.) Inactivated virus vaccine, as an intramuscular injectable drug                                                                                                            2.) Live attenuated (weakened) vaccine  which is given as an intranasal preparation.

Parameter	Killed vaccine (injection form)	Live vaccine (intranasal form)
Target age group	Above 6 months of age	Between 2-49 years only
Safety in pregnancy	Safe	Contraindicated

Dose: Before 9 years of age 2 doses are recommended, 4 weeks apart. For others one dose would suffice. For citizens over 65yrs of age, special ‘high dose’ vaccines are available.

The quantity of drug dose is age dependent and varies with the manufacturer and hence needs to be cross checked prior to administration every time.

Site of injections: For kids up to 1 yr of age – anterolateral aspect of thigh is preferred, for others deltoid is the preferred site.

Targets populace:  Ideally everyone should get the vaccination at the earliest possible opportunity. Still the ‘high risk category’ of people has been defined -

-patients with lung/kidney/ heart disease;                                                                                                                              -people with compromised immunity;                                                                                                                                   -pregnant women;                                                                                                                                                                                                        -health care personnel;                                                                                                                                                                        -children and old people above 65yrs

Action: Immunity takes about 2 weeks to get established and lasts for 1 year

Contraindications:

- For killed virus vaccine (injectable): Egg allergy or previous allergic reactions to flu vaccine or its constituents; previous history of Gullian Barre syndrome.

Mildfebrile illness is not a contraindication for injectable vaccine.

- For live virus vaccine (intranasal) : kids below 2 yrs and adults over 50 yrs of age; pregnant women; patients with severe active febrile illness or compromised immunity with asthma/lung/kidney/heart disease; Egg allergy or previous allergic reactions to flu vaccine or its constituents; previous history of Gullian Barre syndrome.

Side effects: Usually there are very mild side effects which subside in a day or two.

Vaccine type	Side effect
Injectable form	Injection site pain, mild fever, mild abdomen pain
Intranasal form	Headache, running nose dizziness, sore throat, nausea

But very rarely there can be life threatening allergic reactions also.

Reasons for flu like complaints despite vaccination:

Swine flu vaccine does not protect against the other viral strains or viruses. The symptoms might be because the patient develops flu from some other strain of influenza or is infected with some other virus like rhinoviruses or the vaccine did not induce adequate immunity in the individual or the individual go infected within the 2 week period post vaccination.

TREATMENT:

1. Symptomatic medications: Paracetamol group of medicines for pain relief and fever management and OTC nasal decongestants are advocated for the patients with mild flu symptoms.

Adequate hydration status needs to be ensured.

2. Antivirals: Its recommended for high risk patients who present with flu-like symptoms; patients who have had contact with a known case and present with symptoms and are not previously immunized or are not have supposed to have had developed the required immunity post vaccination and have viral levels sufficient to cause their symptoms are advised to take antivirals.

The recommended antivirals are OSELTAMIVIR & ZANAMIVIR.

3.  In case of superimposed infections and sepsis, antibiotic cover may be needed.