Microsoft word - 2 garispanduan pengendalian influenza a h1n1 090909

Algorithm for Treatment of ILI in Paediatric Patients
In An Outpatient Setting
Paediatric patients presenting
mptoms # within 48
Assessed by He alth Care Provider
(Clinical as
sessment Tool**)
co-mobidities @ ?
Oseltamivir treatment
***Home Assessment Tool,
and
Patient Home Care Advice
If patient develops moderate to
severe symptoms at home
Assessment Tool,
Patient Home Care

# Definition of Influenza-like Illness (ILI)

History of high fever with temperature > 38°C AND one or more of the following
respiratory symptoms: cough, shortness of breath, body ache, sore throat.

* Treatment with influenza antivirals
Treatment with the antiviral drugs should be started as soon as possible after symptom onset. As the benefits are greatest when administered within 48 hours after symptom onset, clinicians should initiate treatment immediately and not wait for the results of laboratory tests. While treatment within 48 hours of symptom onset brings the greatest benefits, later initiation of treatment may also be beneficial. This decision should be made on a case-by-case basis. If the symptoms are improving beyond the first 48 hours, treatment may not be necessary. Clinical benefits associated with oseltamivir treatment include a reduced risk of pneumonia (one of the most frequently reported causes of death in infected people) and a reduced need for hospitalization.
**Clinical Assessment Tool for Moderate to Severe Symptoms

1. Severe respiratory distress
Lower chest wall indrawing, sternal recession, grunting or noisy breathing when calm. 2. Increased respiratory rate
Measured over at least 30 seconds. ≥50 breaths per minute if under 1 year, or ≥40 breaths per minute if ≥1 year. 3. Oxygen saturation ≤92% on pulse oximetry, breathing air or on
Absence of cyanosis is a poor discriminator for severe illness. 4. Respiratory exhaustion or apnoeic episode
Apnoea defined as a ≥20 second pause in breathing. 5. Evidence of severe clinical dehydration or clinical shock
Sternal capillary refil time >2 seconds, reduced skin turgor, sunken eyes or fontanelle. 6. Altered conscious level
Strikingly agitated or irritable, seizures, or floppy infant. Source: Disease Control Division Ministry of Health Malaysia
@ List of Co-Morbidities In Paediatric Patients

1. Cardiac disease 2. Chronic respiratory disease (e.g. asthma, bronchopulmonary dysplasia) 3. Other chronic diseases (e.g., diabetes mellitus, chronic metabolic diseases, chronic renal failure, haemoglobinopathies) 4. Chronic neurological disorders e.g. muscular dystrophies 5. Impaired immunity, including HIV infection, child with malignancy or 6. Children aged 6 months – 10 years on long-term aspirin therapy 7. Malnourished or obesity
*** Home Assessment Tool for Parents and Caregivers

Children should be brought to the nearest hospital for further assessment if they developed the fol owing symptoms and signs: 1. Lethargy or poor oral intake 2. Change in mental status or behavior eg. drowsiness , irritability 3. Signs of dehydration: sunken eyes, dry tongue, absence of tears during 4. Increasing respiratory rate: fast breathing, noisy breathing, presence of 5. Fits. 6. Cyanosis. 7. Persistent fever. Source: Disease Control Division Ministry of Health Malaysia
Antiviral Medication Dosing Recommendations
for Treatment Of Novel Influenza A (H1N1) Infection.

Oseltamivir
Children ≥ 12
Zanamivir
Children
Two 5-mg inhalations (10 mg total) twice per day (age 7 years or older)
Dosing recommendations for antiviral treatment of children younger
than 1 year using Oseltamivir.

Recommended treatment dose for 5 days
Disease Control Division Ministry of Health Malaysia

Source: http://h1n1.moh.gov.my/pengamalPerubatan/Annex1KK_090909.pdf