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WHO Releases Revised H1N1 Clinical Management Guidance

 

 

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The World Health Organization has released revised guidance on the diagnosis and treatment of the H1N1 virus.  

 

It may be downloaded from the WHO site:

 

Clinical management of human infection with new influenza A (H1N1) virus: revised guidance

Publication date: November 2009
Download the document [pdf 228kb]

 

This 15 page PDF document covers a wide range of issues.  I’ve excerpted a few sections below, but download and read the whole document.

 

Risk factors for severe disease from pandemic (H1N1) 2009 virus infection reported to date  are  considered  similar  to  those  risk  factors  identified  for  complications  from seasonal influenza.

  • These include the following groups:
    •  Infants and young children, in particular <2 years
    •  Pregnant women
    •  Persons of any age with chronic pulmonary disease (e.g. asthma, COPD) 
    •  Persons of any age with chronic cardiac disease (e.g. congestive cardiac failure) 
    •  Persons with metabolic disorders (e.g. diabetes) 
    •  Persons with chronic  renal disease,  chronic hepatic disease, certain neurological conditions  (including  neuromuscular,  neurocognitive,  and  seizure  disorders), hemoglobinopathies,  or  immunosuppression,  whether  due  to  primary immunosuppressive  conditions,  such  as HIV  infection,  or  secondary  conditions, such as immunosuppressive medication or malignancy
    •  Children receiving chronic aspirin therapy 
    •  Persons aged 65 years and older


A higher  risk of  severe  complications  from pandemic  (H1N1) 2009 virus  infection has also been  reported  in  individuals who are obese  (particularly  in  those who are morbidly obese) and among disadvantaged and indigenous populations.


On average, about 1/2 of hospitalized patients have had at  least one or more underlying medical conditions1


.  However, about 1/3 of patients with very severe illness admitted to ICU were previously healthy persons. 

 

Infection control

Evidence  to date  suggests  that pandemic  (H1N1) 2009 virus  is  transmitted  similarly  to seasonal  influenza A  and  B  viruses. Appropriate  infection  control measures  (Standard plus Droplet Precautions) should be adhered  to at all  times. Whenever performing high-risk  aerosol-generating  procedures  (for  example,  bronchoscopy  or  any  procedure involving  aspiration  of  the  respiratory  tract)  use  a  particulate  respirator  (N95,  FFP2  or equivalent),  eye  protection,  gowns,  and  gloves  and  carry  out  the  procedure  in  an adequately ventilated room, either naturally or mechanically, as per WHO guidance 3

 

The duration of  isolation precautions  for hospitalized patients with  influenza  symptoms should be continued  for 7 days after onset of  illness or 24 hours after  the  resolution of fever and  respiratory symptoms, whichever  is  longer, while a patient  is  in a health-care facility.  For  prolonged  illness  with  complications  (i.e.  pneumonia),  control  measures should  be  used  during  the  duration  of  acute  illness  (i.e.  until  the  patient  has  improved clinically). Special attention is needed in caring for immunosuppressed patients who may shed  virus  for  a  longer  time  period  and  are  also  at  increased  risk  for  development  of antiviral-resistant virus

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