IMA circular against creating panic on Swine flu

Who needs anti-viral drugs in swine flu? 

Facts Published by IMA – Indian Medical Association

1. In the United States, 0.3% of all cases require admissions.
2. The mortality rate of flu pandemic is 0.12 deaths per 100,000 population.
3. Total number of deaths caused by pandemic H1N1 influenza A in the United States was lower than the number of deaths caused by seasonal influenza during non-pandemic years
4. Early and prompt initiation of antiviral therapy is recommended for children, adolescents, or adults with suspected or confirmed swine flu with any of the following features:
   • Flu requiring hospitalization
   • Progressive, severe, or complicated flu
   • Severely immunosuppressed patients (receiving treatment for malignancies, hematopoietic or solid organ transplant recipients)
   • Swine flu at high risk for complications:
     • Children <5 years particularly those <2 years
     • Elderly =65 years
     • Pregnant women
     • Women up to 2 weeks postpartum
     • Residents of nursing homes and other chronic care facilities
     • Individuals with chronic medical conditions including: lung disease, including asthma (particularly if steroids have been required during the past year); heart disease, except isolated hypertension; active malignancy; chronic kidney disease, chronic liver disease, diabetes, sickle cell disease, other chronic disabling diseases and morbid obesity.

5. Severity of flu
   • Asymptomatic swine flu: Many contact illnesses may pass off without symptoms. In all 19 percent had serologically confirmed infection and 28 percent of those who were infected may remain asymptomatic.
   • Mild or uncomplicated swine flu (require no treatment, no hospitalization, no investigations)
     • Fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting
     • No shortness of breath
     • Little change in chronic health conditions.
   • Progressive illness. Requires hospitalization
     • Above symptoms plus
     • Chest pain
     • Poor oxygenation (high respiratory rate, hypoxia, labored breathing in children)
     • Low blood pressure
     • Confusion, altered mental status
     • Severe dehydration
     • Exacerbations of asthma, chronic bronchitis, chronic renal failure, diabetes, or other cardiovascular conditions
   • Severe or complicated illness requires hospitalization
     • Signs of lower respiratory tract disease
     • Low oxygen requiring supplemental oxygen
     • Pneumonia on x-ray
     • Brain involvement
     • BP lower than 80, organ failure
     • Heart involvement
     • Persistent high fever and other symptoms beyond 3 days