The World Health Organization said Friday that worldwide, around 40% of severe cases of persons with swine flu or the H1N1 virus are now occurring in previously healthy children and adults, usually under the age of 50 years. This means that the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness. Therefore, clinicians, patients, and home-based care givers needed to be alert to danger signs.
In issuing additional guidelines today, the Organization said that, those persons who initially present with severe illness or whose conditions begin to deteriorate should be treated with oseltamivir, one of the antivirals, as soon as possible, with the view to preventing severe illness and deaths, or to reduce the need for hospitalization. Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given, says WHO.
This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.
WHO guidelines also recommend that for those persons with underlying medical conditions that increase the risk of more severe disease, treatment should be started as soon as possible, without waiting for the results of laboratory tests.
As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset.
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.
WHO points out that progression of illness can be very rapid and clinicians, patients and those providing home-based care need to be alert to danger signs.
Medical attention should be sought in persons with confirmed or suspected H1N1 infection who displayed the following symptoms:
* 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.
According to WHO, in children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.
