Guideline for Preparedness on H1N1 Influenza in Govt Sector
GOVERNMENT OF WEST BENGAL
Directorate of Health Services
Swasthyabhavan
GN 29, Sector V, Salt Lake, Kolkata 700 091
Memo No. HF/SPSRe/42/2013/45, Dated: 18th April 2013
To
1–25) CMOH of all districts (including health districts)
26–37) MSVP of all Medical Colleges
Subject: Guidelines for preparedness on H1N1 influenza in the government sector
Three confirmed cases of Influenza A H1N1 have been reported in the state in the last 10 days. As part of preparedness, the undersigned issued a letter on 08/04/13. Now, a comprehensive guideline is forwarded for your ready reference.
A report on action taken is to be sent to the undersigned with a copy to Addl. DHS (PH&CD).
Enclosure: Guideline for preparedness on H1N1 influenza in govt. sector
Sd/-
Director of Health Services &
Ex Officio Secretary, West Bengal
Memo No. HF/SPSRe/42/2013/45
Copy forwarded to:
- Principal Secretary, Dept of Health & Family Welfare, Govt of West Bengal
- DME, West Bengal
- Secretary (PHP)
- Director EMR, Ministry of Health, Govt of India
- Director, NICED, Kolkata
- Addl. DHS (PH&CD) & SPO, IDSP
- JS (PHP)
- Regional Director, ROHFW, Kolkata
- MSVP, ID&BG Hospital, Kolkata
- DDHS (E&S)
- ADHS (EC, NS & ES)
- Dr. Asit Biswas, TO SPSRC & Nodal Officer, Influenza
- IT Coordinator for website posting
Sd/-
Director of Health Services &
Ex Officio Secretary, West Bengal
Date: 18th April 2013
Guideline for preparedness on H1N1 influenza in government sector
Screening
At present, there is no need to start a separate influenza OPD for screening of patients. Screening is to be done at the general OPD until further direction.
Patients who need to undergo swab collection:
- Patient with high fever (101.4°F) & severe sore throat (may or may not have other associated symptoms like diarrhoea, vomiting, headache, body ache, etc.)
- Symptoms of fever and sore throat in a patient of the following categories:
- a) Age <5 years
- b) Age >60 years
- c) Pregnancy
- d) Patient having other comorbidity (lung disease, heart disease, liver disease, kidney disease, blood disorder, diabetes, cancer, HIV/AIDS)
- e) Patient on long-term steroid therapy
- Patient with fever, sore throat along with one or more of the following:
- Breathing difficulty
- Drowsiness
- Chest pain
- Low pressure
- Children having influenza-like illness with drowsiness, inability to drink & feed, breathing difficulty, increased rate of breathing, persistent fever, convulsion.
Throat & nasopharyngeal swab collection
- Swab collection arrangement is to be developed at OPD of ID&BG hospital, all district hospitals (including new health districts), and Medical Colleges.
- Separate space at OPD to be earmarked for sample collection.
Transportation of sample, laboratory testing, and reporting
- Throat swab in VTM (virus transport media) with properly filled lab request form to be sent to ID&BG hospital (Sister in-charge, IB-6, 3rd floor isolation ward) preferably during working hours.
- Lab request form should mention: name, age, sex, address, contact no. (mobile), date of onset of fever, and clinical features of the patient.
- Sample to be transported maintaining cold chain (vaccine carrier).
- NICED is the designated laboratory for testing samples.
- NICED will send report only to the Nodal Officer & State IDSP cell. Institutes will get lab test results from the Nodal Officer/IDSP Cell via email or SMS.
- No sample is to be sent directly to NICED, Kolkata.
- All samples from periphery are to be sent to ID&BG hospital (Sister in-charge, IB-6, 2nd floor isolation ward).
Procurement of drugs, logistics & transport media
Drugs & logistics:
CMS is the nodal agency for supply of drugs & logistics.
All DH & MCH to collect the following from CMS:
- Tamiflu (75 mg) – 1000 tablets
- Tamiflu (45 mg) – 100 tablets
- Tamiflu (30 mg) – 100 tablets
- N95 mask – 50 pcs
- PPE kit & overall – 10 pcs
VTM collection:
- VTM will be supplied by NICED, to be collected maintaining cold chain and kept between 2–8°C.
- Each DH & MCH to collect 10 VTM from NICED initially.
- Requisition for VTM to be signed by CMOH/Deputy CMOH II or MSVP of Medical Colleges and forwarded to Dr. Mamata Chawla Sarkar, Scientist-C, Virology, NICED, Kolkata.
Management
Categorization of patients
Category A:
Patient with mild fever and sore throat, with or without other symptoms like diarrhoea, vomiting, headache, body ache, etc.
Category B:
- Patient with clinical features of Category A but having high fever and severe sore throat.
- Symptoms of fever and sore throat in a patient of the following groups:
- a) Age <5 years
- b) Age >60 years
- c) Pregnancy
- d) Patient having other comorbidity (lung disease, heart disease, liver disease, kidney disease, blood disorder, diabetes, cancer, HIV/AIDS)
- e) Patient on long-term steroid therapy
Category C:
- Children having influenza-like illness with drowsiness, inability to drink & feed, breathing difficulty, increased rate of breathing, persistent fever, convulsion.
- Patient with fever, sore throat along with one or more of the following:
- Breathing difficulty
- Drowsiness
- Chest pain
- Low pressure
Treatment protocol
- Category A: No diagnostics or specific treatment. Patients should confine themselves at home and avoid mixing with the public and high-risk family members during illness.
- Category B & C: Need diagnostic test and specific treatment.
- Patient tested positive for H1N1 should be kept in isolation ward.
Oseltamivir therapy
Doses (based on body weight):
- >40 kg – 75 mg BD for 5 days
- 24–<40 kg – 60 mg BD for 5 days
- 15–23 kg – 45 mg BD for 5 days
- <15 kg – 30 mg BD for 5 days
For infants:
- <3 months – 12 mg BD for 5 days
- 3–5 months – 20 mg BD for 5 days
- 6–11 months – 25 mg BD for 5 days
Chemoprophylaxis
Half of the above-mentioned dose for 10 days
(e.g., for adult weighing >45 kg: 75 mg Tamiflu OD for 10 days)
Healthcare providers and family members who come in close contact with confirmed H1N1 patients should receive prophylaxis treatment.
Preventive measures
- Hygienic practices relating to respiration and cough
- Repeated hand wash
Isolation ward
All District Hospitals (including new health districts) and Medical Colleges should prepare to have an isolation ward with 5–10 beds for treatment of H1N1 patients. Patients testing positive for H1N1 are to be admitted to the isolation ward. These are to be made operational on need.
ID&BG Hospital is identified for management of H1N1 patients in Kolkata, except for management of H1N1 patients in the 3rd trimester of pregnancy, who will be treated at NRSMCH.
Guideline for using protective equipment (may change as per situation)
- OPD – No mask
- Isolation ward (when functional) – 3-layer mask
- N95 mask – when one has to come in close contact with patient (clinical examination)
- Sample collection – PPE kit
Critical care support
ID&BG Hospital will provide critical care support to H1N1 patients for both adults and children.