GUIDELINES FOR CLINICAL MANAGEMENT OF BIRD FLU (AVIAN INFLUENZA)

1. Symptoms / Signs:

Rapid onset of Flu symptoms like severe nasal and oral irritation with profuse watery secretions followed by immediate high grade fever with throbbing headache and generalized muscular aches. The syndrome if not controlled with medical treatment and nursing care is liable to progress in the subsequent complications e.g. wide spread pneumonia which can lead to acute respiratory failure in a short span of time.

2. Treatment:

i). Isolation ward: gowns, masks, gloves, goggles, for aerosol producing procedures

ii). Immediate maintenance of IV line for Infusion / Antibiotics

iii). Immediate commencement of Oral Capsules of Oseltamivir 75mg BD up to 5 days.

iv). Analgesics / antipyretic (Paracetamol-Tablet / Syrup or Broufen Tablet / Syrup or Injection diclofenac 75-150mg IM which ever is clinically necessary.

v). Antibiotics (Quinolone Tablets / Injection / Infusion Ciprofloxacin BD) for 7-10 days in case of super added infection and emergence and complication like Pneumonia.

vi). Putting patient on ventilators if patient has developed respiratory failure on the segregated be of intensive care unit under the supervision of trained physician and medical staff.

3. Prophylaxis for Health Workers or other Associates of Patients:

Capsule Oseltamivir 75mg once a day for 7 days past last exposure. Health worker means exposed physician, nurse / nurses and other staffs.

4. Criteria for Distribution of Oseltamivir:

i). Positioning Oseltamivir at provincial level:

Same to each province 4 provinces, AJK, FANA, ICT in order to treat within 48 hours.

ii). Rapid response teams: Observe for fever

Treat 2 tablets / day 5-10 days if fever develops.

iii). Patients:

According to Case Definitions (explained below) treat 2 tablets / day 5-10 days.

iv) Contacts and Heath Care Workers (HCWs):

Observe for fever: Treat 2 tablets / day 5-10 days if fever develops.

V) Reserve: 10%

NOTE:

1. This is a provisional Plan and should be reviewed every week/as and when required.

2. Resources should be diverted according to the emergency and the need of hour.

3. Estimate 30% of the Oseltamivir would be used for each group 2, 3, 4 above and 10% shall be kept as reserve.

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CASE DEFINITIONS

(In an area where bird flu has been identified or suggested by live stock experts)

Possible case

Any person hospitalized with pneumonia who has not improved within 24 hours of hospitalization OR

Person hospitalized with Pneumonia AND having

1. Recently (less than 1 week) visited a poultry farm in an area known to have an outbreak of highly pathogenic avian influenza (HPAI)

2. OR worked in a laboratory that is processing samples from persons or animals that are suspected for HPAI virus infection

3. OR contact with a confirmed case of influenza A (H5N1) during the infectious period.

Probable Case

Possible case AND limited laboratory evidence for Influenza A (H5N1) (such as IFA + using HF5 monoclonal antibodies) OR no evidence for another cause of disease.

Confirmed Case

A confirmed case of influenza A/H5 infection is an individual with an acute respiratory febrile illness for whom laboratory testing demonstrates one or more of the following:

· Positive viral culture for influenza A/5H;

· Positive polymerase chain reaction (PCR) for influenza A/H5;

· Positive immunofluorescence antibody (IFA) test to H5 antigen using H5 monoclonal antibodies;

· 4-fold rise in H5 specific antibody titre in paired serum samples.