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Swine Flu

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Manal:

--- Quote --- i agree that one thals situation is different to anothers.  i don't compare my youngest to my oldest son.  the way they are with their thal is not the same....and yes people should be careful....but not too scared ...
--- End quote ---


I really do agree :wink

I hope that you can soon see your mum :hugfriend

manal

Narendra:
Not sure if any one you read the comment of Dr. Ellis Neufeld in regards with Swine Flu (H1N1 virus) in the CAF Medical Update - June 2009. I think his words were from Feb 2009, so it might be a little out of date.

From:- http://www.cooleysanemia.com/updates/MUJune09.pdf


--- Quote ---Several people have contacted CAF asking if there are any special precautions that people with thalassemia need to consider in terms of the current swine flu situation. We forwarded this question to Dr. Ellis Neufeld, the Chair of the CAF Medical Advisory Board.

This is his response: “First, a few disclaimers: I am not an infectious disease expert, and the scope of the problem is
not clear yet. This will need to be reevaluated over coming days/weeks. The fact that there are 100 deaths can’t be evaluated until it is clear how many folks had mild disease. If 1000 people had the disease, this is a high fatality rate and worrisome. If 100,000 people had the disease, the death rate is lower and the concern would be
lower, but more people would be affected.

“(At the moment), it’s a national health “emergency” because this allows the government to distribute anti-flu drugs in stockpiles. If it becomes a genuine emergency, it’s vital to follow official public health evaluations.
“Here are some general comments.
a. Evaluation of fever: thalassemia patients without ports/central lines should be evaluated like anybody else. CALL your physician if you have symptoms of fever, muscle aches. Don’t just go in.
b. Patients with no spleen or central lines need to be evaluated for fever even if flu is prevalent (as in February).
c. Good handwashing is the best way to stay safe!
d. Thalassemia patients will be in a unique position if this proves to be a serious epidemic because they will need to go to the hospital for transfusions, regardless. But see the disclaimers above; we need to wait.”
--- End quote ---

Andy Battaglia:
How simple, but true. If people remember to wash their hands after being exposed to other people or after touching surfaces, there will be much fewer colds and flu. And never rub your eyes if your hands aren't clean. It's one of the quickest ways to get sick.

Sharmin:
Thank you for the information Narendra and Andy. 

Two women have died in our city in recent weeks - one was fifty years old, the other was a 25 year old mom who had no prior history of illness.  It is so hard to know, this virus is so illusive and it is hard to know who will be affected how with it. 

Stay safe all and wash your hands!

Sharmin

jade:
HI guys

H1N1 finally got into the country.  On 29 infected cases, there is already 3 deaths, a lady aged 54 yrs, a girl aged 4 yrs and a young man aged 30 yrs.  I find this quite alarming.  I am freaking out, i am afraid of sending my children to school, particularly with my son ongoing cough(with mucus).  From what I have been reading, the most common complication of the flu is pneumonia.  The patients develop very large quantities of mucus.

I believe that it is good to educate children on the various precautions to take but children being children, they just forget that they should avoid certain things.  For example, at school, they may go downstairs to wash their hands before eating but when coming up they may forget not to touch the hand rail, the door knob, the table, the pencil of their friend etc.

i have found something on antiviral for the flu and hope it will be helpful.

Quote from Centers for Disease Control and Prevention.

Antiviral Resistance

This novel (H1N1) influenza virus is sensitive (susceptible) to the neuraminidase inhibitor antiviral medications, zanamivir and oseltamivir. It is resistant to the adamantane antiviral medications, amantadine and rimantadine.
Antiviral Treatment for Novel (H1N1) Influenza

For antiviral treatment of novel influenza (H1N1) virus infection, either oseltamivir or zanamivir are recommended Table 1. Recommendations for use of antivirals may change as data on antiviral effectiveness, clinical spectrum of illness, adverse events from antiviral use, and antiviral susceptibility data become available.

Clinical judgment is an important factor in treatment decisions. Persons with suspected novel H1N1 influenza who present with an uncomplicated febrile illness typically do not require treatment unless they are at higher risk for influenza complications, and in areas with limited antiviral mediation availability, local public health authorities might provide additional guidance about prioritizing treatment within groups at higher risk for infection.

Treatment is recommended for:

   1. All hospitalized patients with confirmed, probable or suspected novel influenza (H1N1).
   2. Patients who are at higher risk for seasonal influenza complications (see above).

If a patient is not in a high-risk group or is not hospitalized, healthcare providers should use clinical judgment to guide treatment decisions, and when evaluating children should be aware that the risk for severe complications from seasonal influenza among children younger than 5 years old is highest among children younger than 2 years old. Many patients who have had novel influenza (H1N1) virus infection, but who are not in a high-risk group have had a self-limited respiratory illness similar to typical seasonal influenza. For most of these patients, the benefits of using antivirals may be modest. Therefore, testing, treatment and chemoprophylaxis efforts should be directed primarily at persons who are hospitalized or at higher risk for influenza complications.

Once the decision to administer antiviral treatment is made, treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Evidence for benefits from antiviral treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of oseltamivir treatment of hospitalized patients with seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset. Recommended duration of treatment is five days. Antiviral doses recommended for treatment of novel H1N1 influenza virus infection in adults or children 1 year of age or older are the same as those recommended for seasonal influenza (Table 1). Oseltamivir use for children <1 year old was recently approved by the U.S. Food and Drug Administration (FDA) under an Emergency Use Authorization (EUA), and dosing for these children is age-based (Table 2) (See Emergency Use Authorization of Tamiflu (oseltamivir)).

Note: Areas that continue to have seasonal influenza activity, especially those with circulation of oseltamivir-resistant seasonal human influenza A (H1N1) viruses, might prefer to use either zanamivir or a combination of oseltamivir and rimantadine or amantadine to provide adequate empiric treatment or chemoprophylaxis for patients who might have seasonal human influenza A (H1N1) virus infection.
Antiviral Chemoprophylaxis for Novel (H1N1) Influenza

For antiviral chemoprophylaxis of novel (H1N1) influenza virus infection, either oseltamivir or zanamivir are recommended (Table 1). Duration of antiviral chemoprophylaxis post-exposure is 10 days after the last known exposure to novel (H1N1) influenza. The indication for post-exposure chemoprophylaxis is based upon close contact with a person who is a confirmed, probable or suspected case of novel influenza A (H1N1) virus infection during the infectious period of the case. The infectious period for persons infected with the novel influenza A (H1N1) virus is assumed to be similar to that observed in studies of seasonal influenza. With seasonal influenza, studies have shown that people may be able to transmit infection beginning one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be infectious for longer periods. However, for this guidance, the infectious period is defined as one day before until 7 days after the case’s onset of illness. If the contact occurred with a case whose illness started more than 7 days before contact with the person under consideration for antivirals, then chemoprophylaxis is not necessary. For pre-exposure chemoprophylaxis, antiviral medications should be given during the potential exposure period and continued for 10 days after the last known exposure to a person with novel (H1N1) influenza virus infection during the cases infectious period. Oseltamivir can also be used for chemoprophylaxis under the EUA for children less than 1 year of age (see Children Under 1 Year of Age).

Post exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following:

   1. Close contacts of cases (confirmed, probable, or suspected) who are at high-risk for complications of influenza
   2. Health care personnel, public health workers, or first responders who have had a recognized, unprotected close contact exposure to a person with novel (H1N1) influenza virus infection (confirmed, probable, or suspected) during that person’s infectious period. Information on appropriate personal protective equipment is available at: Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting and might be updated frequently as additional information on transmission becomes available.

Pre-exposure antiviral chemoprophylaxis should only be used in limited circumstances, and in consultation with local medical or public health authorities. Certain persons at ongoing occupational risk for exposure who are also at higher risk for complications of influenza (e.g., health care personnel, public health workers, or first responders who are working in communities with influenza A H1N1 outbreaks) should carefully follow guidelines for appropriate personal protective equipment or consider temporary reassignment.



Antiviral Agents for Seasonal Influenza: Side Effects and Adverse Reactions

    * Drug Interactions

When considering use of influenza antiviral medications (i.e., choice of antiviral drug, dosage, and duration of therapy), clinicians must consider the patient's age, weight, and renal function (See Table); presence of other medical conditions; indications for use (i.e., chemoprophylaxis or therapy); and the potential for interaction with other medications.
Zanamivir

Limited data are available about the safety or efficacy of zanamivir for persons with underlying respiratory disease or for persons with complications of acute influenza, and zanamivir is licensed only for use in persons without underlying respiratory or cardiac disease. In a study of zanamivir treatment of ILI among persons with asthma or chronic obstructive pulmonary disease in which study medication was administered after use of a B2-agonist, 13% of patients receiving zanamivir and 14% of patients who received placebo (inhaled powdered lactose vehicle) experienced a greater than 20% decline in forced expiratory volume in 1 second (FEV1) after treatment. However, in a phase-I study of persons with mild or moderate asthma who did not have ILI, one of 13 patients experienced bronchospasm after administration of zanamivir. In addition, during postmarketing surveillance, cases of respiratory function deterioration after inhalation of zanamivir have been reported. Because of the risk for serious adverse events and because efficacy has not been demonstrated among this population, zanamivir is not recommended for treatment for patients with underlying airway disease. Allergic reactions, including oropharyngeal or facial edema, also have been reported during postmarketing surveillance.

In clinical treatment studies of persons with uncomplicated influenza, the frequencies of adverse events were similar for persons receiving inhaled zanamivir and for those receiving placebo (i.e., inhaled lactose vehicle alone). The most common adverse events reported by both groups were diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections. Each of these symptoms was reported by less than 5% of persons in the clinical treatment studies combined. Zanamivir does not impair the immunologic response to TIV.
Oseltamivir

Nausea and vomiting were reported more frequently among adults receiving oseltamivir for treatment (nausea without vomiting, approximately 10%; vomiting, approximately 9%) than among persons receiving placebo (nausea without vomiting, approximately 6%; vomiting, approximately 3%). Among children treated with oseltamivir, 14% had vomiting, compared with 8.5% of placebo recipients. Overall, 1% discontinued the drug secondary to this side effect, and a limited number of adults who were enrolled in clinical treatment trials of oseltamivir discontinued treatment because of these symptoms. Similar types and rates of adverse events were reported in studies of oseltamivir chemoprophylaxis. Nausea and vomiting might be less severe if oseltamivir is taken with food. No published studies have assessed whether oseltamivir impairs the immunologic response to TIV.

Transient neuropsychiatric events (self-injury or delirium) have been reported postmarketing among persons taking oseltamivir; the majority of reports were among adolescents and adults living in Japan. FDA advises that persons receiving oseltamivir be monitored closely for abnormal behavior.


Has anyone been using these drugs?

Jade

( sorry for the earlier post, I don't know where the information went earlier)

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