Swine flu : Treatment

Oseltamivir under trade name of "Tamiflu" is recommended for children above 1 year. Zanamavir is another drug under thetrade name of "Relenza" which can be used above 7 yrs. These drugs have to be used within 48 hrs of onset of symptoms to be effective for 5 - 7 days. Adverse drug reactions include nervousness, poor concentration, nausea, vomiting. Zanamavir is not recommended in asthmatic patients. Osteltamivir is more accepted in treatment. 

Oselatmivir phosphate ( Tamiflu ) is available in tablets of 30, 45 and 75 mg for oral use and can be taken with or without food. For children, Tamiflu oral suspension is available at a strength of 15mg/ml. Dosage for adults and children above 40 kgs is 75 mg BD for 5 days.

Dosage of Oseltamivir in children is as follows ( for 5 days ):

• 15 - 23 kgs : 45 mg BD
  
• 24 - 40 kgs : 60 mg BD
• > 40 kgs : 75 mg BD
  

Oseltamivir is not recommended for infants below 3 months. Dosage for infants (> 3 months):

• between 3 - 5 months : 20 mg OD
  
• 6 - 11 months: 25 mg OD 
  

The recommended dose for prophylaxis is 75 mg OD ( for adults and children above 40 kg ) to be started within 2 days of exposure following close contact with infected individual. For children below 40 kg, the dosage is OD dose of the therapeutic dose given above according to body weight. Oseltamivir prophylaxis is provided till 10 days after last exposure (maximum of 6 weeks). 

Supportive treatment is given with Paracetamol / Brufen for fever, myalgia and headache. Salicylates / Aspirin are contraindicated.
Patients are monitored for clinical / radiological evidence of LRTI, hypoxia ( with level of conciousness, SPO2 levels, Respiratory rate )

Close contacts are adviced voluntary home quarantine for at least 7 days after last contact with case.

Adult patients are discharged at 7 days after their symptoms decrease and children after 14 days of relief of symptoms as they shed the virus for longer periods.

More details regarding Tamiflu is found at http://www.rxlist.com/tamiflu-drug.htm

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Swine Flu: Lab tests, info to Lab workers

Lab tests for Swine flu include :

• Rapid antigen test (less sensitive)
• RT - PCR
• Virus isolation
• Virus genome sequencing
• 4 -fold rise in H1N1 virus specific neutralising antibody

The sample is collected from suspected cases by treating physician within first 4-5 days. The swabs have to be kept at 2-8 degree Celcius until they are placed at -70 degree Celcius. They are transported in dry ice in triple packages. In India, at present, samples are sent to NIV, Pune or NICD, Delhi within 24 hours. 

Information for lab workers / staff: Tests should be performed only in BSL2 LAB with BSL3 practices.

Additional requirements:

• Respirator protection - N-95 respirator or higher
• Shoe cover
• Closed front gown
• Double gloves
• Eye protection with goggles / face shield
  

Disinfectants used:

• 70% Ethanol
• 5% Lysol
• 10% Bleach
  
  
  

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Swine Flu - General information

Swine Flu, caused by influenza virus A, subtype H1N1, is a new type of Flu which causes illness in people all around the world. First detected in US (April 2009). It spreads from person to person like any other flu. If you eat cooked pork, you won't get it.  'Swine Flu' got it's name due to resemblance of the virus to that found in pigs in the North America. Further studies have shown that the virus is really different from that found in North America's pigs, but contain two genes from flu viruses that normally circulate in pigs in Europe and Asia, avian genes and human genes.

Symptoms of H1N1 (See the video below). Just remember that it starts like any other Flu, but later affects all systems of your body. There is no specific symptom by which you can say a person has swine flu.   Children below 5 yrs, pregnant ladies and elderly people (above 65 yrs) are at higher risk of getting the infection.

Diagnosis is by taking nasopharyngeal and throat swabs.

Ordinary masks will not give from swine flu. N-95 Respirator or higher is required if you are in close contact with an infected person.

Drugs used in treatment, other than supportive measures are Oseltamivir and Zanamavir.

For more details on the diagnosis and treatment see the posts that follow.

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