H1N1 General Information Update

Karen Dahl, MDPediatric Infectious Diseases

Symptoms of Influenza

fever of 100° F or greater (measured orally) cough runny or stuffy nose sore throat headache chills muscle aches vomiting and diarrhea

Fever is not always present

Not Everyone Needs Treatment

Most people ill with influenza will recover without complications or treatment

However, some patients are at high risk of complications and should receive antiviral treatment

High Risk for Complication

Children less than 2 years old Hospitalized patients

High Risk for Complications

Neurological disorders Epilepsy Cerebral palsy, especially when accompanied by

neurodevelopmental disabilities Moderate to profound mental retardation or

developmental delay Brain or spinal cord injuries Neuromuscular disorders (e.g., muscular

dystrophy), especially when associated with impairment in respiratory functioning

High Risk for Complications

Chronic respiratory diseases such as Asthma Conditions associated with impaired pulmonary

function and/or difficulty handling secretions Technology dependent children (e.g., those

requiring oxygen, tracheostomy, or a ventilator)

High Risk for Complications

Deficiencies in immune function Chemotherapy HIV infection Other treatments that result in significant immune

deficiencies Primary immunodeficiency

Cardiovascular disease including congenital heart disease

High Risk for Complications

Significant metabolic (e.g., mitochondrial) disorders

Significant (e.g., diabetes) endocrine disorders

Renal, hepatic, hematological (including sickle cell disease) disorders

Receiving chronic aspirin therapy Pregnant or within 2 weeks post partum

Treatment Considerations

Treatment may be given even if presenting after 48 hours of symptom onset

Influenza testing is not necessary as the rapid tests are not highly sensitive and waiting for results may delay treatment

Treatment should be initiated based on clinical suspicion

Antiviral Treatment

Antiviral treatment is recommended for patients with influenza who are at high risk of complications

Tamiflu or Relenza is appropriate treatment Confirmation of influenza/H1N1 infection is

not necessary to begin treatment Sending the patient to Urgent Care or ED not

necessary unless worrisome symptoms

Worrisome SymptomsAge 12 weeks to <5 years

Fast breathing or difficulty breathing or retractions present Dehydration (no urine output in 8 hours, decreased tears or no

tears when child is crying, or not drinking enough fluids).. Severe or persistent vomiting/unable to keep fluids down.. Lethargy (excessive sleepiness, significant decrease in activity

level, and/or diminished mental status).. Irritability (cranky, restless, does not want to be held or wants to

be held all the time).. Flu-like symptoms improved but then returned or worsened

within one to a few days.. Pain in chest or abdomen (for children who can reliably report)

Worrisome SymptomsAge > 5 years

Fast breathing or difficulty breathing Dizziness or lightheadedness Severe or persistent vomiting/unable to keep

fluids down Flu-like symptoms improved but then returned

or worsened within one to a few days Pain in the chest or abdomen

Clinical Judgment

Children and adults presenting with suspected influenza who have symptoms of lower respiratory tract illness or clinical deterioration should also receive prompt empiric antiviral therapy, regardless of previous health or age.

Physicians may also decide not to treat some people in these groups and/or treat people who are not in these groups based on their clinical judgment.