Health care aspects

Session 6
• By administration of prophylaxis / anti-viral 1. Neuraminidase inhibitors
Oseltamivir* (Tamiflu)
Zanamivir (Relenza)
2. Adamantanes
Amantadine
Rimantadine
* Most relevant in treating human cases of avian influenza.
• Active against influenza A and B
– Against H5N1 and other AI viruses
• Oseltamivir: (Tami flu)
– Antiviral resistance may occur
– Antiviral for pandemic containment
– WHO has rapid response stockpile
Route of Administration
• Administer orally
For Treatment
• Administer within 48 hours of
symptom onset
For Prophylaxis
• Give to close contacts within
48 hours of exposure
Capsules 75 mg each
Liquid Suspension
– 10 capsules per box
– White powder mixed with
– Manufacturer: Roche
23 mL of drinking water
– Brand name—Tamiflu®
– Fruit flavored
– Store at room
– Refrigeration required
temperature (15 - 300C)
– Use within 10 days
– Oral dispenser included
Treatment with Oseltamivir
• Active against H5N1 viruses in the laboratory
and in experimental animals
• No proof of effectiveness against human
H5N1 disease
• Optimal dose and duration of treatment yet
to be determined
• Use Oseltamivir dosing for seasonal
influenza per WHO recommendations
Oseltamivir Treatment Regimen
• Adults: 75 mg two times a day for 5 days
• Not approved for children less than 1 year of
• Children > 1 year old:
<15 kg:
30 mg twice daily
15 - <23 kg:
45 mg twice daily
23 - <40 kg:
60 mg twice daily
> 40 kg:
75 mg twice daily
Patient Age
Prophylactic Dose
> 13 years
1 capsule (75 mg) once a day
1 to 12 years < 15 kg: 30 mg once a day
15-<23 kg: 45 mg once a day
23-<40 kg: 60 mg once a day
> 40 kg: 75 mg once a day
*Duration of prophylaxis depends on epidemiologic
setting. Post-exposure use is typically for 7 to 10 days.
• Headache (20%)*
• Nausea (10%)
• Vomiting (9%)
• Fatigue (8%)*
• Diarrhea (7%)
• Cough (6%)*
• Bronchitis, abdominal pain, dizziness (2%)
• Insomnia, vertigo (1%)
*In study of Oseltamivir as prophylaxis, treatment % is lower.
Serious Adverse Events*
Allergic reactions
Skin rash (sometimes severe)
Facial swelling
Dizziness
Hepatitis
*A causal relationship has not been established for
many of these
ƒ School closuresƒ Business and market ƒ Cancellation of eventsƒ Movement restrictions • Limited evidence to evaluate NPI for influenza • Tailor NPI to each locality’s situation • NP interventions likely useful in delaying spread of disease, and should be used in coordination with other interventions ƒ School closuresƒ Business and market ƒ Cancellation of eventsƒ Movement restrictions – Separation and restricted movement of ill persons – Often in a hospital setting– Primarily individual level – Separation and restricted movement of well – Often at home, may be designated residential – Applied at the individual or community level • Location of isolation (eg home, hospital) • Plan for large number of severe cases – Separation and restricted movement of ill persons – Often in a hospital setting– Primarily individual level – Separation and restricted movement of well – Often at home, may be designated residential – Applied at the individual or community level • Used when resources are available to – Provide essential services and care for those in • Used in combination with other interventions – Surveillance, diagnosis, treatment, and preventive • Does not have to be absolute to be effective • Implementation requires clear understanding of • Implementation requires coordinated planning – Public health authorities, health-care providers, emergency response teams, law enforcement, and transportation authorities • Implementation requires trust and participation – Effective risk communication, support and – Becomes difficult as case load increases – Essential during rapid response phase • Regular health monitoring is essential part – Conduct frequent health checks for high risk groups (e.g. household contacts of suspected cases) – Self-health monitoring and reporting – Fever telephone hotlines and clinics – Cleaning and disinfection of surfaces Infection Control Practices and Personal – Destroys the influenza (eg, H5N1) virus, when – Results in fewer upper respiratory infections – Hand washing stations in public places References: WHO Writing Group. Emerg Inf Dis 2006;12:88-94 *WHO SEARO: Simple public health interventions for Avian Influenza Infection Control Practices and Personal Infection Control Practices and Personal – Recommended for symptomatic persons and persons seeking care for respiratory illness in high risk areas (waiting rooms) – Consider use when caring for ill persons in the – Consider use among high risk populations, and exposed persons (poultry workers, market workers) • PPE should be used in health care facilities • Use household cleaning products such as alcohol • In hospitals clean rooms daily or more ƒ School closuresƒ Business and market ƒ Cancellation of eventsƒ Movement restrictions – Evidence or suspicion of human-to-human – Monitor for illness and provide essential services and – Barrier that restricts travel in and out of an area – Helpful in closed settings (military barracks, – Especially useful if high morbidity among – Access to and availability of necessities • Population measures to increase social – Discourage mass gatherings such as festivals • Another population measure to increase social – Restrictions on public transportation and public – Voluntary or involuntary work holidays – Effectiveness– Implementation– Alternative infrastructure • Early, rapid response may be key to successful • Health officials have legal authority – Review existing laws prior to pandemic – Under what conditions can authority be used? – How is quarantine/isolation enforced? Note: Please adapt this content to your country
• Administrative communication & coordination – Define who will make decisions about which NPI to – Define who will be responsible for implementation and – Rapid response teams, MOH and WHO should communicate regularly and coordinate activities Note: Please adapt this content to your country
– Compensation for mandatory isolation and Protocol for demobilization for RRT and
subsequent precautions
• Minimum of 7 days’ Quarantine for members of • Disinfection of bags, spectacles, cap, valet etc.

Source: http://nandurbar.nic.in/html_docs/animalhusb/birdflu/Important.pdf