H1N1 Update: Symptoms, Risks, and Treatment Guidelines

1. H1N1 General Information Update Karen Dahl, MD Pediatric Infectious Diseases

2. 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

3. 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

4. High Risk for Complication • Children less than 2 years old • Hospitalized patients

5. 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

6. 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)

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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.