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Influenza A(H1N1) Swine Flu
Dr. Tjatur Winarsanto SpPD 2012
CHOTANI © 2009.
OUTLINE 1. 2. 3. 4. 5. 6. 7. 8.
Influenza Virus Definitions Introduction History in the US Spread/Transmission Timeline/Facts Response Status Update • • • • •
9. 10.
Case-Definitions Guidelines • • •
11. 12. 13. 14. 15. 16.
CHOTANI © 2009.
Mexico US Canada European Union Globally
Clinicians Laboratory Workers General Population
Treatment Other Protective Measures Summary Timeline of Emergence Lessons Learned from Past Pandemics Conclusion & Recommendations
Virus • RNA, enveloped • Viral family: Orthomyxoviridae • Size: 80-200nm or .08 – 0.12 μm (micron) in diameter
• Three types • A, B, C
• Surface antigens • H (haemaglutinin) • N (neuraminidase)
CHOTANI © 2009.
Credit: L. Stammard, 1995
Haemagglutinin subtype
H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 H16
Neuraminidase subtype
N1 N2 N3 N4 N5 N6 N7 N8 N9
Swine Influenza A(H1N1) Introduction • Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs • Most commonly, human cases of swine flu happen in people who are around pigs • Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-tohuman spread of swine flu viruses have been documented
CHOTANI © 2009.
Swine Influenza A(H1N1) History in US •
A swine flu outbreak in Fort Dix, New Jersey, USA occurred in 1976 that caused more than 200 cases with serious illness in several people and one death • •
More than 40 million people were vaccinated However, the program was stopped short after over 500 cases of Guillain-Barre syndrome, a severe paralyzing nerve disease, were reported • 30 people died as a direct result of the vaccination
•
In September 1988, a previously healthy 32year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later.
•
From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States
CHOTANI © 2009.
Swine Influenza A(H1N1) Transmission to Humans
• Through with infected pigs or environments contaminated with swine flu viruses • Through with a person with swine flu • Human-to-human spread of swine flu has been documented also and is thought to occur in the same way as seasonal flu, through coughing or sneezing of infected people
CHOTANI © 2009.
Swine Influenza A(H1N1) Transmission Through Species
Human Virus Avian Virus
Avian/Human Reassorted Virus
Swine Virus
Reassortment in Pigs CHOTANI © 2009.
Swine Influenza A(H1N1) March 2009 Timeline •
In March and early April 2009, Mexico experienced outbreaks of respiratory illness and increased reports of patients with influenza-like illness (ILI) in several areas of the country
•
April 12, the General Directorate of Epidemiology (DGE) reported an outbreak of ILI in a small community in the state of Veracruz to the Pan American Health Organization (PAHO) in accordance with International Health Regulations
•
April 17, a case of atypical pneumonia in Oaxaca State prompted enhanced surveillance throughout Mexico
•
April 23, several cases of severe respiratory illness laboratory confirmed as influenza A(H1N1) virus infection were communicated to the PAHO
•
Sequence analysis revealed that the patients were infected with the same strain detected in 2 children residing in California •
CHOTANI © 2009.
Samples from the Mexico outbreak match swine influenza isolates from patients in the United States
Source: CDC
Swine Influenza A(H1N1) March 2009 Facts •
Virus described as a new subtype of A/H1N1 not previously detected in swine or humans
•
CDC determines that this virus is contagious and is spreading from human to human
•
The virus contains gene segments from 4 different influenza types: • • • •
CHOTANI © 2009.
North American swine North American avian North American human and Eurasian swine
Swine Influenza A(H1N1) US Response •
The Strategic National Stockpile (SNS) is releasing one-quarter of its • • •
Anti-viral drugs Personal protective equipment and Reparatory protection devices
•
President Obama today asked Congress for an additional $1.5 billion to fight the swine flu
•
On April 27, 2009, the CDC issued a travel advisory that recommends against all nonessential travel to Mexico
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) US Case Definitions •
A confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests: • •
•
A probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness who is: • •
•
real-time RT-PCR viral culture
positive for influenza A, but negative for H1 and H3 by influenza RT-PCR, or positive for influenza A by an influenza rapid test or an influenza immunofluorescence assay (IFA) plus meets criteria for a suspected case
A suspected case of swine influenza A (H1N1) virus infection is defined as a person with acute febrile respiratory illness with onset • • •
CHOTANI © 2009.
within 7 days of close with a person who is a confirmed case of swine influenza A (H1N1) virus infection, or within 7 days of travel to community either within the United States or internationally where there are one or more confirmed swine influenza A(H1N1) cases, or resides in a community where there are one or more confirmed swine influenza cases.
Source: CDC
Swine Influenza A(H1N1) US Case Definitions • Infectious period for a confirmed case of swine influenza A(H1N1) virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset • Close is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine influenza A(H1N1) virus infection during the case’s infectious period • Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness) • High-risk groups: A person who is at high-risk for complications of swine influenza A(H1N1) virus infection is defined as the same for seasonal influenza (see Reference)
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Guidelines for Clinicians
• Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who • live in areas where human cases of swine influenza A(H1N1) have been identified or • have traveled to an area where human cases of swine influenza A(H1N1) has been identified or • have been in with ill persons from these areas in the 7 days prior to their illness onset
• If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer) • once collected, the clinician should their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Guidelines for Clinicians
• Signs and Symptoms • Influenza-like-illness (ILI) • Fever, cough, sore throat, runny nose, headache, muscle aches. In some cases vomiting and diarrhea. (These cases had illness onset during late March to mid-April 2009)
• Cases of severe respiratory disease, requiring hospitalization including fatal outcomes, have been reported in Mexico • The potential for exacerbation of underlying chronic medical conditions or invasive bacterial infection with swine influenza virus infection should be considered
• Non-hospitalized ill persons who are a confirmed or suspected case of swine influenza A (H1N1) virus infection are recommended to stay at home (voluntary isolation) for at least the first 7 days after illness onset except to seek medical care CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Guidelines for Clinicians FDA Issues Authorizations for Emergency Use (EUAs) of Antivirals •
On April 27, 2009, the U.S. Food and Drug istration (FDA) issued EUAs in response to requests by the Centers for Disease Control and Prevention (CDC) for the swine flu outbreak
•
One of the reasons the EUAs could be issued was because the U.S. Department of Health and Human Services (HHS) declared a public health emergency on April 26, 2009
•
The swine influenza EUAs aid in the current response:
CHOTANI © 2009.
•
Tamiflu: Allow for Tamiflu to be used to treat and prevent influenza in children under 1 year of age, and to provide alternate dosing recommendations for children older than 1 year. Tamiflu is currently approved by the FDA for the treatment and prevention of influenza in patients 1 year and older.
•
Tamiflu and Relenza: Allow for both antivirals to be distributed to large segments of the population without complying with federal label requirements that would otherwise apply to dispensed drugs and to be accompanied by written information about the emergency use of the medicines.
Source: FDA
Swine Influenza A(H1N1) Biosafety Guidelines for Laboratory Workers •
Diagnostic work on clinical samples from patients who are suspected cases of swine influenza A (H1N1) virus infection should be conducted in a BSL-2 laboratory •
All sample manipulations should be done inside a biosafety cabinet (BSC)
•
Viral isolation on clinical specimens from patients who are suspected cases of swine influenza A (H1N1) virus infection should be performed in a BSL-2 laboratory with BSL-3 practices (enhanced BSL-2 conditions)
•
Additional precautions include: • • • • • •
•
recommended personal protective equipment (based on site specific risk assessment) respiratory protection - fit-tested N95 respirator or higher level of protection shoe covers closed-front gown double gloves eye protection (goggles or face shields)
Waste •
CHOTANI © 2009.
all waste disposal procedures should be followed as outlined in your facility standard laboratory operating procedures
Source: CDC
Swine Influenza A(H1N1) Biosafety Guidelines for Laboratory Workers • Appropriate disinfectants • 70 per cent ethanol • 5 per cent Lysol • 10 per cent bleach
• All personnel should self monitor for fever and any symptoms. Symptoms of swine influenza infection include diarrhea, headache, runny nose, and muscle aches • Any illness should be reported to your supervisor immediately • For personnel who had unprotected exposure or a known breach in personal protective equipment to clinical material or live virus from a confirmed case of swine influenza A (H1N1), antiviral chemoprophylaxis with zanamivir or oseltamivir for 7 days after exposure can be considered
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Biosafety Guidelines for Laboratory Workers FDA Issues Authorizations for Emergency Use (EUAs) of Diagnostic Tests •
On April 27, 2009, the U.S. Food and Drug istration (FDA) issued EUAs in response to requests by the Centers for Disease Control and Prevention (CDC) for the swine flu outbreak
•
One of the reasons the EUAs could be issued was because the U.S. Department of Health and Human Services (HHS) declared a public health emergency on April 26, 2009
•
The swine influenza EUAs aid in the current response: •
CHOTANI © 2009.
Diagnostic Test: Allow CDC to distribute the rRT-PCR Swine Flu diagnostic test to public health and other qualified laboratories that have the equipment and personnel to perform and interpret the results.
Source: CDC
Swine Influenza A(H1N1) Guidelines for General Population
• Covering nose and mouth with a tissue when coughing or sneezing • Dispose the tissue in the trash after use.
• Handwashing with soap and water • Especially after coughing or sneezing.
• Cleaning hands with alcohol-based hand cleaners • Avoiding close with sick people • Avoiding touching eyes, nose or mouth with unwashed hands • If sick with influenza, staying home from work or school and limit with others to keep from infecting them CHOTANI © 2009.
Swine Influenza A(H1N1) Treatment
• No vaccine available • Antivirals for the treatment and/or prevention of infection: • Oseltamivir (Tamiflu) or • Zanamivir (Relenza)
• Use of anti-virals can make illness milder and recovery faster • They may also prevent serious flu complications • For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms)
• Warning! Do NOT give aspirin (acetylsalicylic acid) or aspirincontaining products (e.g. bismuth subsalicylate – Pepto Bismol) to children or teenagers (up to 18 years old) who are confirmed or suspected ill case of swine influenza A (H1N1) virus infection; this can cause a rare but serious illness called Reye’s syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Treatment Oseltamivir (Tamiflu) Treatment
Prophylaxis
Zanamivir (Relenza) Treatment
Prophylaxis
Adults
75 mg capsule twice per day for 5 days
75 mg capsule once per day
Two 5 mg inhalations (10 mg total) twice per day
Two 5 mg inhalations (10 mg total) once per day
Children
15 kg or less: 60 mg per day divided into 2 doses
30 mg once per day
Two 5 mg inhalations (10 mg total) twice per day (age, 7 years or older)
Two 5 mg inhalations (10 mg total) once per day (age, 5 years or older)
15–23 kg: 90 mg per day divided into 2 doses
45 mg once per day
24–40 kg: 120 mg per day divided into 2 doses
60 mg once per day
>40 kg: 150 mg per day divided into 2 doses
75 mg once per day
Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatment dose for 5 days. <3 months: 12 mg twice daily; 3-5 months: 20 mg twice daily; 6-11 months: 25 mg twice daily Dosing recommendations for antiviral chemoprophylaxis of children younger than 1 year using oseltamivir. Recommended prophylaxis dose for 10 days. <3 months: Not recommended unless situation judged critical due to limited data on use in this age group; 3-5 months: 20 mg once daily; 6-11 months: 25 mg once daily CHOTANI © 2009.
Source: CDC
Dr. Tjatur Winarsanto SpPD 2012
CHOTANI © 2009.
OUTLINE 1. 2. 3. 4. 5. 6. 7. 8.
Influenza Virus Definitions Introduction History in the US Spread/Transmission Timeline/Facts Response Status Update • • • • •
9. 10.
Case-Definitions Guidelines • • •
11. 12. 13. 14. 15. 16.
CHOTANI © 2009.
Mexico US Canada European Union Globally
Clinicians Laboratory Workers General Population
Treatment Other Protective Measures Summary Timeline of Emergence Lessons Learned from Past Pandemics Conclusion & Recommendations
Virus • RNA, enveloped • Viral family: Orthomyxoviridae • Size: 80-200nm or .08 – 0.12 μm (micron) in diameter
• Three types • A, B, C
• Surface antigens • H (haemaglutinin) • N (neuraminidase)
CHOTANI © 2009.
Credit: L. Stammard, 1995
Haemagglutinin subtype
H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 H16
Neuraminidase subtype
N1 N2 N3 N4 N5 N6 N7 N8 N9
Swine Influenza A(H1N1) Introduction • Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs • Most commonly, human cases of swine flu happen in people who are around pigs • Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-tohuman spread of swine flu viruses have been documented
CHOTANI © 2009.
Swine Influenza A(H1N1) History in US •
A swine flu outbreak in Fort Dix, New Jersey, USA occurred in 1976 that caused more than 200 cases with serious illness in several people and one death • •
More than 40 million people were vaccinated However, the program was stopped short after over 500 cases of Guillain-Barre syndrome, a severe paralyzing nerve disease, were reported • 30 people died as a direct result of the vaccination
•
In September 1988, a previously healthy 32year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later.
•
From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States
CHOTANI © 2009.
Swine Influenza A(H1N1) Transmission to Humans
• Through with infected pigs or environments contaminated with swine flu viruses • Through with a person with swine flu • Human-to-human spread of swine flu has been documented also and is thought to occur in the same way as seasonal flu, through coughing or sneezing of infected people
CHOTANI © 2009.
Swine Influenza A(H1N1) Transmission Through Species
Human Virus Avian Virus
Avian/Human Reassorted Virus
Swine Virus
Reassortment in Pigs CHOTANI © 2009.
Swine Influenza A(H1N1) March 2009 Timeline •
In March and early April 2009, Mexico experienced outbreaks of respiratory illness and increased reports of patients with influenza-like illness (ILI) in several areas of the country
•
April 12, the General Directorate of Epidemiology (DGE) reported an outbreak of ILI in a small community in the state of Veracruz to the Pan American Health Organization (PAHO) in accordance with International Health Regulations
•
April 17, a case of atypical pneumonia in Oaxaca State prompted enhanced surveillance throughout Mexico
•
April 23, several cases of severe respiratory illness laboratory confirmed as influenza A(H1N1) virus infection were communicated to the PAHO
•
Sequence analysis revealed that the patients were infected with the same strain detected in 2 children residing in California •
CHOTANI © 2009.
Samples from the Mexico outbreak match swine influenza isolates from patients in the United States
Source: CDC
Swine Influenza A(H1N1) March 2009 Facts •
Virus described as a new subtype of A/H1N1 not previously detected in swine or humans
•
CDC determines that this virus is contagious and is spreading from human to human
•
The virus contains gene segments from 4 different influenza types: • • • •
CHOTANI © 2009.
North American swine North American avian North American human and Eurasian swine
Swine Influenza A(H1N1) US Response •
The Strategic National Stockpile (SNS) is releasing one-quarter of its • • •
Anti-viral drugs Personal protective equipment and Reparatory protection devices
•
President Obama today asked Congress for an additional $1.5 billion to fight the swine flu
•
On April 27, 2009, the CDC issued a travel advisory that recommends against all nonessential travel to Mexico
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) US Case Definitions •
A confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests: • •
•
A probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness who is: • •
•
real-time RT-PCR viral culture
positive for influenza A, but negative for H1 and H3 by influenza RT-PCR, or positive for influenza A by an influenza rapid test or an influenza immunofluorescence assay (IFA) plus meets criteria for a suspected case
A suspected case of swine influenza A (H1N1) virus infection is defined as a person with acute febrile respiratory illness with onset • • •
CHOTANI © 2009.
within 7 days of close with a person who is a confirmed case of swine influenza A (H1N1) virus infection, or within 7 days of travel to community either within the United States or internationally where there are one or more confirmed swine influenza A(H1N1) cases, or resides in a community where there are one or more confirmed swine influenza cases.
Source: CDC
Swine Influenza A(H1N1) US Case Definitions • Infectious period for a confirmed case of swine influenza A(H1N1) virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset • Close is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine influenza A(H1N1) virus infection during the case’s infectious period • Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness) • High-risk groups: A person who is at high-risk for complications of swine influenza A(H1N1) virus infection is defined as the same for seasonal influenza (see Reference)
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Guidelines for Clinicians
• Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who • live in areas where human cases of swine influenza A(H1N1) have been identified or • have traveled to an area where human cases of swine influenza A(H1N1) has been identified or • have been in with ill persons from these areas in the 7 days prior to their illness onset
• If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer) • once collected, the clinician should their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Guidelines for Clinicians
• Signs and Symptoms • Influenza-like-illness (ILI) • Fever, cough, sore throat, runny nose, headache, muscle aches. In some cases vomiting and diarrhea. (These cases had illness onset during late March to mid-April 2009)
• Cases of severe respiratory disease, requiring hospitalization including fatal outcomes, have been reported in Mexico • The potential for exacerbation of underlying chronic medical conditions or invasive bacterial infection with swine influenza virus infection should be considered
• Non-hospitalized ill persons who are a confirmed or suspected case of swine influenza A (H1N1) virus infection are recommended to stay at home (voluntary isolation) for at least the first 7 days after illness onset except to seek medical care CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Guidelines for Clinicians FDA Issues Authorizations for Emergency Use (EUAs) of Antivirals •
On April 27, 2009, the U.S. Food and Drug istration (FDA) issued EUAs in response to requests by the Centers for Disease Control and Prevention (CDC) for the swine flu outbreak
•
One of the reasons the EUAs could be issued was because the U.S. Department of Health and Human Services (HHS) declared a public health emergency on April 26, 2009
•
The swine influenza EUAs aid in the current response:
CHOTANI © 2009.
•
Tamiflu: Allow for Tamiflu to be used to treat and prevent influenza in children under 1 year of age, and to provide alternate dosing recommendations for children older than 1 year. Tamiflu is currently approved by the FDA for the treatment and prevention of influenza in patients 1 year and older.
•
Tamiflu and Relenza: Allow for both antivirals to be distributed to large segments of the population without complying with federal label requirements that would otherwise apply to dispensed drugs and to be accompanied by written information about the emergency use of the medicines.
Source: FDA
Swine Influenza A(H1N1) Biosafety Guidelines for Laboratory Workers •
Diagnostic work on clinical samples from patients who are suspected cases of swine influenza A (H1N1) virus infection should be conducted in a BSL-2 laboratory •
All sample manipulations should be done inside a biosafety cabinet (BSC)
•
Viral isolation on clinical specimens from patients who are suspected cases of swine influenza A (H1N1) virus infection should be performed in a BSL-2 laboratory with BSL-3 practices (enhanced BSL-2 conditions)
•
Additional precautions include: • • • • • •
•
recommended personal protective equipment (based on site specific risk assessment) respiratory protection - fit-tested N95 respirator or higher level of protection shoe covers closed-front gown double gloves eye protection (goggles or face shields)
Waste •
CHOTANI © 2009.
all waste disposal procedures should be followed as outlined in your facility standard laboratory operating procedures
Source: CDC
Swine Influenza A(H1N1) Biosafety Guidelines for Laboratory Workers • Appropriate disinfectants • 70 per cent ethanol • 5 per cent Lysol • 10 per cent bleach
• All personnel should self monitor for fever and any symptoms. Symptoms of swine influenza infection include diarrhea, headache, runny nose, and muscle aches • Any illness should be reported to your supervisor immediately • For personnel who had unprotected exposure or a known breach in personal protective equipment to clinical material or live virus from a confirmed case of swine influenza A (H1N1), antiviral chemoprophylaxis with zanamivir or oseltamivir for 7 days after exposure can be considered
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Biosafety Guidelines for Laboratory Workers FDA Issues Authorizations for Emergency Use (EUAs) of Diagnostic Tests •
On April 27, 2009, the U.S. Food and Drug istration (FDA) issued EUAs in response to requests by the Centers for Disease Control and Prevention (CDC) for the swine flu outbreak
•
One of the reasons the EUAs could be issued was because the U.S. Department of Health and Human Services (HHS) declared a public health emergency on April 26, 2009
•
The swine influenza EUAs aid in the current response: •
CHOTANI © 2009.
Diagnostic Test: Allow CDC to distribute the rRT-PCR Swine Flu diagnostic test to public health and other qualified laboratories that have the equipment and personnel to perform and interpret the results.
Source: CDC
Swine Influenza A(H1N1) Guidelines for General Population
• Covering nose and mouth with a tissue when coughing or sneezing • Dispose the tissue in the trash after use.
• Handwashing with soap and water • Especially after coughing or sneezing.
• Cleaning hands with alcohol-based hand cleaners • Avoiding close with sick people • Avoiding touching eyes, nose or mouth with unwashed hands • If sick with influenza, staying home from work or school and limit with others to keep from infecting them CHOTANI © 2009.
Swine Influenza A(H1N1) Treatment
• No vaccine available • Antivirals for the treatment and/or prevention of infection: • Oseltamivir (Tamiflu) or • Zanamivir (Relenza)
• Use of anti-virals can make illness milder and recovery faster • They may also prevent serious flu complications • For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms)
• Warning! Do NOT give aspirin (acetylsalicylic acid) or aspirincontaining products (e.g. bismuth subsalicylate – Pepto Bismol) to children or teenagers (up to 18 years old) who are confirmed or suspected ill case of swine influenza A (H1N1) virus infection; this can cause a rare but serious illness called Reye’s syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.
CHOTANI © 2009.
Source: CDC
Swine Influenza A(H1N1) Treatment Oseltamivir (Tamiflu) Treatment
Prophylaxis
Zanamivir (Relenza) Treatment
Prophylaxis
Adults
75 mg capsule twice per day for 5 days
75 mg capsule once per day
Two 5 mg inhalations (10 mg total) twice per day
Two 5 mg inhalations (10 mg total) once per day
Children
15 kg or less: 60 mg per day divided into 2 doses
30 mg once per day
Two 5 mg inhalations (10 mg total) twice per day (age, 7 years or older)
Two 5 mg inhalations (10 mg total) once per day (age, 5 years or older)
15–23 kg: 90 mg per day divided into 2 doses
45 mg once per day
24–40 kg: 120 mg per day divided into 2 doses
60 mg once per day
>40 kg: 150 mg per day divided into 2 doses
75 mg once per day
Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatment dose for 5 days. <3 months: 12 mg twice daily; 3-5 months: 20 mg twice daily; 6-11 months: 25 mg twice daily Dosing recommendations for antiviral chemoprophylaxis of children younger than 1 year using oseltamivir. Recommended prophylaxis dose for 10 days. <3 months: Not recommended unless situation judged critical due to limited data on use in this age group; 3-5 months: 20 mg once daily; 6-11 months: 25 mg once daily CHOTANI © 2009.
Source: CDC
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