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INFLUENZA A H1N1 Dr.P.Gopinathan DSO, Kasaragod

Present Status : 

Present Status Kerala Confirmed cases 1120 Deaths 16 Total Screened 21,943 Throat Swab taken 3691 ICU Care 88 Kasaragod No. of Confirmed cases 11( 5 from other districts) No. of Deaths NIL Total Screened 57 Throat Swab taken 30

Centres : 

Centres Details of Screening, Treatment & Tertiary centres for H1N1 NAME OF DISTRICT : KASARAGOD I) SCREENING CENTERS

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DETAILS OF INFLUENZA A H1N1 IN EDUCATIONAL INSTITUTIONS Name of the District : Kasaragod No.Of schools affected : 1 Name of School : St.Mary’s English Medium school, Chittarikkal (PRIVATE SCHOOL) No. of cases Confirmed : 2 Details of cases Total No. of throat swab taken From the school : 8 ( 1 from DH Kannur)

Testing Facility : 

Testing Facility Rajiv Gandhi Centre for Bio-Technology TVM KMC , Manipal Co- Operation by Indian Railways !!

New Updates from MOHFW, GOI : 

New Updates from MOHFW, GOI Kerala fulfils ‘Community Spread’ criteria ( If there is 25 or more epidemiologically linked cases of Pandemic Influenza A H1N1 of which at least one or more are laboratory confirmed for Pandemic Influenza A H1N1, in two or more cities , over a period of two weeks, then the state would be considered to be having community spread.) Therefore , mass chemoprophylaxis for school, family, and social contacts not recommended Prophylaxis only for high risk persons No Contact tracing

Approach : 

Approach To screen ILI in designated health facilities Categorization to A, B & C Home Isolation of A& B Hospitalization of C Treatment for B & C Prophylaxis only for high risk contacts. Prophylaxis to Medical personnel attending to cases in treatment facilities to a maximum of 42 days.

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Category- A Patients with mild fever plus cough / sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised as Category-A. They do not require Oseltamivir and should be treated for the symptoms mentioned above. The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor. No testing of the patient for H1N1 is required. Patients should confine themselves at home and avoid mixing up with public and high risk members in the family.

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Category-B (i) In addition to all the signs and symptoms mentioned under Category-A, if the patient has high grade fever severe sore throat, may require home isolation and Oseltamivir;

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Category-B (ii) In addition to all the signs and symptoms mentioned under Category-A, individuals having one or more of the following high risk conditions shall be treated with Oseltamivir: Children less than 5 years old; Pregnant women; Persons aged 65 years or older; Patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS; Patients on long term cortisone therapy.

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No tests for H1N1 is required for Category-B (i) and (ii). All patients of Category-B (i) and (ii) should confine themselves at home and avoid mixing with public and high risk members in the family.

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Category-C In addition to the above signs and symptoms of Category-A and B, if the patient has one or more of the following: Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails; Children with ILI who had severe disease as manifested by the red flag sign.(Somnolence, High & Persistent fever , Inability to feed well, difficulty in breathing , convulsions) Worsening of underlying chronic conditions. All these patients mentioned above in Category-C require testing, immediate hospitalization and treatment.

Advisory to Physicians/obstetricians : 

Advisory to Physicians/obstetricians If a pregnant woman in the first, second or third trimester presents with ILI ,it is advisable to start treatment with Tamiflu after taking specimens for lab test. If the test comes as negative treatment may be discontinued. If the disease spreads widely treatment without lab confirmation is recommended.

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Effect of the disease on the fetus In mild cases no adverse effect reported If the Disease is severe enough to effect Oxygen saturation , fetal compromise is possible . There is no recommendation for termination of pregnancy Effect of the Drug on the fetus Experience is limited. There are no data available. Start drug after counseling the patient.

Broad Guidelines for Schools/Educational Institutions : 

Broad Guidelines for Schools/Educational Institutions The primary responsibility of prevention of the illness rests with the HMs/Principals. To this effect any students/staffs who have influenza like illness should be asked to take leave and get advice of a doctor. A medical certificate should not be insisted upon for granting leave to such cases. All class teachers should begin their class with active screening of each student in the class so as to detect any student who is having influenza like symptoms.

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Students/staff are advised to stay at home if they develop flu like symptoms. Students should be daily reminded about the general preventive and supportive measures for H1N1 influenza. Students /staff who are advised rest at home should strictly follow the isolation and avoid going to tuition/coaching centers etc Schools are advised to avoid any large gathering of students during the course of the day in the school.

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In case of large number of ILI are noticed in the school a medical camp may be arranged with cooperation of the DMO. If the no. of cases in class or in an institution are significant, the class/school may be closed for a week by the school authorities in consultation with the DMO. Excursions /tours should be discouraged as far as possible. Students/staffs are advised to wash their hands frequently with soap and water.

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All schools should observe regular cleaning. All schools should display Do’s and Don’ts for H1N1 Influenza at all important places. IEC materials should be displayed.

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IF YOU THINK YOU HAVE H1 N1 FLU: Stay at home or in your hotel room if traveling, except to seek medical care. Do not travel or go to work or school. Avoid close contact with others for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer.

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EVERYONE SHOULD: Cover your mouth and nose with a tissue when you cough or sneeze Wash your hands often with soap and water or use an alcohol-based hand gel. Avoid touching your eyes, nose or mouth. Avoid contact with ill persons.

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Look for these symptoms: FEVER AND Other symptoms may include: Body aches Headache Fatigue Cough Sore throat Runny or stuffy nose Chills Diarrhea Vomiting

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