1. H1N1 information Dr Sangeeta Joshi Consultant Microbiologist Manipal Hospital Bangalore

2. Govt guidelines OPD case with symptoms of flu – if testing necessary – refer to RGICD/ NIMHANS/VICTORIA/ Lakeside. Need not admit if it is not severe. Can be sent home IP and ICU cases – throat swab to be collected and sent to NIMHANS along with requisition Tamiflu can be given (tablets to be prescribed by the consultant and issued directly by Dayanand of Pharmacy.) Tablets are to be accounted for.

3. Transmission Incubation period: 1-7 days Communicability : From 1 day before to 7 days after the onset of symptoms / or until cure Best time to collect is when the patient presents. Day 1 has maximum shedding of the virus

4. Diagnosis Specimens. Full personal protective equipment – mask, gown, cap, goggles – to be worn while collecting. Samples to be sent in cold. throat swab nasal swab, wash or aspirate Tracheal aspirate / BAL Specimens kept at 4°C in viral transport media until transport The samples should be transported to NIMHANS, within 24 hours. If they cannot be transported then it needs to be stored at -70°C.

5. Prioritisation of the samples to be done before sending: Category A – Referred from airport Children with rapidly worsening symptoms Pregnancy with symptoms of flu Elderly (>65 years) with symptoms Symptoms with h/o chronic pulmonary disease, COPD, asthma Symptoms in a k/c/o diabetes and HIV

6. Category A Admission, isolation Routine investigations Treat secondary infection Chemoprophylaxis till results arrive 75 mg OD 10 days Treatment 75 mg BD 5 days

7. Category B Children with h/o contact with minimal symptoms Adults with h/o contact with minimal symptoms Symptoms in Health care worker Category C – flu like symptoms but does not fit into A and B criteria

8. Category B Home quarantine Restrict movement outdoors Chemoprophylaxis

9. Category C No prophylaxis Stay at home till symptoms subsides Wait and watch

10. The tests will be done as per the priority status. Results for category A – 24-36 hours Category B – 3-4 days Category C 4-5 days All samples to be accompanied by H1N1 requisition form Each test costs Rs 10,000/- (done free of cost ) Cost of special swab and transport medium to patient Rs 250/-

11. Blood test for antibodies not done at NIMHANS Rapid test sensitivity varies from 10 to 70%. Specificity is 50-70% The rapid tests detect influenza A and B

12. How long do viruses survive outside the body? Some viruses can survive upto 2 to 8 hrs on surfaces. Frequent handwashing is the solution to prevent infection after touching the surfaces

13. Hand Hygiene It is the single most important measure to reduce the risk of transmitting infectious organism from one person to other. Hands should be washed frequently with soap and water / alcohol based hand rubs/ antiseptic hand wash and thoroughly dried preferably using disposable tissue/ paper/ towel. After contact with respiratory secretions or such contaminated surfaces. Any activity that involves hand to face contact such as eating/ normal grooming / smoking etc.

14. HCW’s attending to patients with suspected H1N1 to wear triple layer mask or N95 mask. Can be worn for 4 hours, needs to be changed later. Adequate handwashing facilities and handrub to be provided to the HCW’s

15. Chemoprophylaxis All close contacts of confirmed cases. Close contacts include household /social contacts, family members, workplace or school contacts, fellow travelers etc. Oseltamivir is the drug of choice. Prophylaxis should be provided till 10 days after last exposure (maximum period of 6 weeks)

16. Resources http://www.cdc.gov/h1n1flu/ http://www.cdc.gov/h1n1flu/espanol/ 1-800-CDC-INFO (1-800-232-4636) http://www.who.int/csr/disease/swineflu/en/ index.html http://www.who.int/csr/disease/swineflu/en/ index.html