# 3655
The World Health Organization (WHO) released updated guidelines on the use of antivirals for the treatment of the novel H1N1 virus today, with a strong recommendation to withhold the drug from healthy people seeing uncomplicated influenza symptoms.
Whether individual countries will actually heed this advice remains to be seen.
I’ve only excerpted part of the document. Follow the link to read the guidance, and its associated files, in their entirety.
Recommended use of antivirals
Pandemic (H1N1) 2009 briefing note 8
Related link:
WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses
20 August 200921 AUGUST 2009 | GENEVA -- WHO is today issuing guidelines for the use of antivirals in the management of patients infected with the H1N1 pandemic virus.
The guidelines represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs. Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalization, and reduce the duration of hospital stays.
The pandemic virus is currently susceptible to both of these drugs (known as neuraminidase inhibitors), but resistant to a second class of antivirals (the M2 inhibitors).
Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals.
On an individual patient basis, initial treatment decisions should be based on clinical assessment and knowledge about the presence of the virus in the community.
In areas where the virus is circulating widely in the community, clinicians seeing patients with influenza-like illness should assume that the pandemic virus is the cause. Treatment decisions should not wait for laboratory confirmation of H1N1 infection.
This recommendation is supported by reports, from all outbreak sites, that the H1N1 virus rapidly becomes the dominant strain.
<SNIP>
Danger signs in all patients
Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:
- shortness of breath, either during physical activity or while resting
- difficulty in breathing
- turning blue
- bloody or coloured sputum
- chest pain
- altered mental status
- high fever that persists beyond 3 days
- low blood pressure.
In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.
The Catch-22 in all of this is that 40% of those who develop severe illness from this virus have no underlying medical conditions, and that they often develop severe symptoms only after several days into what starts off looking like a `normal’ flu.
From the guidance document:
. . . the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness. Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years.
Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day 5 or 6 following the onset of symptoms.
Based on these guidelines, they would not be offered antivirals until after their symptoms worsened.
Since antivirals are most effective when taken within 48 hours of contracting the virus, by the time it becomes obvious that they would benefit from the drug, it may be too late to derive much benefit.
A genuine dilemma. And one I haven’t a good answer to.
