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Human Swine Influenza: information for health professionals

Slowing the spread in the early stages of the influenza A/H1N1v (swine flu) pandemic has given the HPA and the health service time to learn more about the new virus, build up antiviral and antibiotic stockpiles, and start to develop a pandemic specific vaccine.

The focus is now on treating those affected by the virus.

This section contains advice and information for healthcare professionals.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_100941

Clinical diagnostic criteria
Clinicians are now encouraged to diagnose influenza A/H1N1v cases on the basis of symptoms.

The clinical diagnostic criteria are:

Fever [pyrexia ≥38°C] or a history of fever,
AND

influenza-like illness (TWO OR MORE of the following symptoms: cough; sore throat; rhinorrhoea; limb or joint pain; headache; vomiting or diarrhoea) OR
severe and/or life-threatening illness suggestive of an infectious process
More information can be found in the Department of Health’s swine flu clinical package.

Testing
There is no need to test patients in primary care or emergency departments where admission is not required.

Testing should only be considered if patients are hospitalised, for the control of infection in hospitals, as part of ‘spotter’ surveillance schemes, or if there are unusual syndromes that are considered to have an infectious basis.

Treatment
All those who have contracted swine flu will continue to be offered antiviral drugs. However, it will remain a matter of clinical discretion as to whether antivirals should be prescribed in individual cases. It is vital that those in higher-risk groups get antivirals and start using them as soon as possible – within 48 hours of the onset of symptoms. This includes those with long-term lung, kidney, neurological, liver or heart disease; children under five; people over 65; those with diabetes mellitus; the immunosuppressed (whether caused by disease or treatment); patients who have had drug treatment for asthma within the past three years; and pregnant women.

The Chief Medical Officer for England has written to healthcare professionals with the latest information and guidance.

The HPA has produced detailed prescribing guidance for oseltamivir (Tamiflu) and zanamivir (Relenza)
Prescribing guidance for antiviral drugs (PDF, 167 KB)

http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1243581475043

Clinicians who feel prophylaxis for contacts of cases may be needed should consult the current HPA guidance

http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1247038677052

Guidance on use of prophylaxis in the treatment phase of the H1N1v pandemic (PDF, 36 KB)

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_100941

Decisions to admit
The Department of Health’s swine flu clinical package contains detailed guidance on hospital admission criteria for adults and children, along with a referral form.

Flu response centres
Flu Response Centres:contact details for use by health professionals (PDF, 239 KB

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_100941