WHO issue antiviral flu recommendations
receive antiviral treatment as soon as possible after symptom onset.
At the same time, 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.
Clinical deterioration is characterized by primary viral pneumonia, which destroys the lung tissue and does not respond to antibiotics, and the failure of multiple organs, including the heart, kidneys, and liver. These patients require management in intensive care units using therapies in addition to antivirals.
Clinicians, patients, and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir.
In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.
Antiviral use in children
Following the recent publication of two clinical reviews, [1,2] some questions have been raised about the advisability of administering antivirals to children.
The two clinical reviews used data that were considered by WHO and its expert panel when developing the current guidelines and are fully reflected in the recommendations.
WHO recommends prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness. This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness.
Otherwise healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens.
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 colored 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.
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[1] Shun-Shin M., Thompson M., Heneghan C., et al., “Neuraminidase Inhibitors for Treatment and Prophylaxis of Influenza in Children: Systematic Review and Meta-analysis of Randomized Controlled Trials,” BMJ 2009;339:b3172; doi:10.1136/bmj.b3172
[2] Burch J., Stock C., et al., “Prescription of Anti-influenza Drugs for Healthy Adults: A Systemic Review and Meta-analysis,” Lancet Infect Dis 2009; doi:10.1016/S1473-3099(09)70199-9
