eWellness: Who needs anti-viral drugs in swine flu?


Dr KK Aggarwal    03 September 2017


  1. In the United States, 0.3% of all cases require admissions.
  2. The mortality rate of flu pandemic is 0.12 deaths per 100,000 population.
  3. Total number of deaths caused by pandemic H1N1 influenza A in the United States was lower than the number of deaths caused by seasonal influenza during non-pandemic years
  4. Early and prompt initiation of antiviral therapy is recommended for children, adolescents, or adults with suspected or confirmed swine flu with any of the following features:
    • Flu requiring hospitalization
    • Progressive, severe, or complicated flu
    • Severely immunosuppressed patients (receiving treatment for malignancies, hematopoietic or solid organ transplant recipients)
    • Swine flu at high risk for complications:
      • Children <5 years particularly those <2 years
      • Elderly =65 years
      • Pregnant women
      • Women up to 2 weeks postpartum
      • Residents of nursing homes and other chronic care facilities
      • Individuals with chronic medical conditions including: lung disease, including asthma (particularly if steroids have been required during the past year); heart disease, except isolated hypertension; active malignancy; chronic kidney disease, chronic liver disease, diabetes, sickle cell disease, other chronic disabling diseases and morbid obesity.
  1. Severity of flu
  • Asymptomatic swine flu: Many contact illnesses may pass off without symptoms. In all 19 percent had serologically confirmed infection and 28 percent of those who were infected may remain asymptomatic.
  • Mild or uncomplicated swine flu (require no treatment, no hospitalization, no investigations)
    • Fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting
    • No shortness of breath
    • Little change in chronic health conditions.
  • Progressive illness. Requires hospitalization
    • Above symptoms plus
    • Chest pain
    • Poor oxygenation (high respiratory rate, hypoxia, labored breathing in children)
    • Low blood pressure
    • Confusion, altered mental status
    • Severe dehydration
    • Exacerbations of asthma, chronic bronchitis, chronic renal failure, diabetes, or other cardiovascular conditions
  • Severe or complicated illness requires hospitalization
    • Signs of lower respiratory tract disease
    • Low oxygen requiring supplemental oxygen
    • Pneumonia on x-ray
    • Brain involvement
    • BP lower than 80, organ failure
    • Heart involvement
    • Persistent high fever and other symptoms beyond 3 days

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