Sunday, July 19, 2009

Influenza A(H1N1)

Picture above is linked from the Jabatan Perkhidmatan Haiwan Perak website. Great site! Informative. Click here.

The Ministry of Health Malaysia has a new webpage just to address the issues of Influenza A(H1N1).
Click here to access. URL:

Few salient points from the webpage regarding management during the mitigation phase:

*Note: Mitigation phase of the Influenza A pandemic is a phase whereby the spread of an infection in a community is controlled by adherence to preventive measures and this applies to all industries including the health care industry.

Not all patients with suspected novel influenza (H1N1) infection need to be seen by a health care provider. For most people, the illness appears to be mild and self-limiting. Cases have been confirmed in all age groups, but children and younger people seem to be much more likely to be affected, whereas fewer cases have been confirmed to date in older adults.

Patients with ILI:

* who have moderate or severe illness


* who have significant co-morbidities and hence are at high risk for complications from influenza should seek EARLY professional medical assessment (preferably within first 2 days of illness) from the nearest hospital or health clinic (depending on the severity of symptoms

** Clinical assessment tool for moderate to severe influenza:

Patients with ILI and any of the following parameters should be considered for admission to the of nearest designated hospital

Respiratory impairment: any of the following

  • Tachypnoea, respiratory rate > 24/min
  • Inability to complete sentence in one breath
  • Use of accessory muscles of respiration, supraclavicular recession
  • Oxygen saturation <>
  • Decreased effort tolerance since onset of ILI
  • Respiratory exhaustion
  • Chest pains

Evidence of clinical dehydration or clinical shock

  • Systolic BP <>
  • Capillary refill time > 2 seconds, reduced skin turgor

Altered Conscious level (esp. in extremes of age)

  • New confusion, striking agitation or seizures

Other clinical concerns:

  • Rapidly progressive (esp. high fever > 3 days) or serious atypical illness
  • Severe & persistent vomiting

For complete management guidelines, click here and here.

*Close contact is defined as: a person who has been within a distance of 2 meters or less from an ill person who is a confirmed or suspected case of influenza A(H1N1 infection).

(**Social distancing is more than 1 m)

Three basic principles of precaution:
1. Hand hygiene
2. Droplets precaution (during coughing, sneezing, etc)
3. Mask/PPE

Hand hygiene is the single most important practice needed to reduce the transmission of infection in healthcare settings and is an essential element of standard infection control principles. In any outbreak of pandemic influenza strict adherence to hand hygiene recommendations should be enforced.

Use of Personal Protective Equipment (PPEs)

Entry to cohorted area but no contact with patients

Close Contact with patient (within 3 feet)

Aerosol generating procedures ° (see Reference 1 below)


No (1)



Plastic Apron

No (1)







Surgical mask

Yes (2)



N95 mask(3)




Eye Protection


Risk Assessment (4)


° Wherever possible, aerosol-generating procedures should be performed in side rooms or other closed single patient areas with minimal staff present. Aerosol-generating procedures include endotracheal intubation, nebulized medication administration, airway suctioning, bronchoscopy, diagnostic sputum induction, positive pressure ventilation via face mask, and high frequency oscillatory ventilation. These procedures should preferably be performed in a single room with the door closed.
1. Gloves and apron should be worn during certain cleaning procedures.
2. Surgical masks (3-ply) are recommended for use at all times in cohorted areas for practical purposes.
3. Formal Fit Testing for N95 masks is recommended where available.
4. Use eye protection if splashes can be expected during that particular procedure

For complete information, go to the MOH website at:

Updates 15 August 2009:

Dr. David Quek, president of MMA has written two excellent and insightful comments on A(H1N1). Click here:


and here:


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