pandemic influenza




Mild cases

• Mild cases do NOT require confirmatory laboratory testing and should NOT be admitted to hospital. They should be advised to isolate themselves at home for 7 days after the onset of symptoms and managed symptomatically.

• Supportive care at home is adequate for recovery. Provide the patient with advice which should include: resting, drinking plenty of fluids and keeping warm and dry. Use a pain reliever for head and muscle aches. Non-aspirin pain relievers should be used by children and young adults due to the risk of Reye’s syndrome.

• Antiviral medication is NOT recommended for mild cases or contacts not at risk for development of severe disease unless these patients are at high risk for serious complications of influenza.

• Patients at high risk for serious complications of influenza should be offered antiviral therapy at the discretion of the attending physician.

• The patient and their contacts should be given infection control guidance as follows:
o Regular hand washing with soap and water
o Cover nose and mouth with a tissue when coughing and sneezing (or use the upper part of your sleeve). Dispose of used tissues in a dustbin, and then wash hands with soap and water.

• Contacts of cases should stay at home at the first sign of illness and follow guidelines as above. They should seek medical care only if required.


Moderate to severe cases

• Cases with moderate to severe illness (based on a clinical assessment) that require hospital admission should be managed as follows:
o Where possible these cases should be isolated in their own room with the door closed for the duration of hospital stay. If discharged prior to day 7 of onset of illness, they can complete home isolation as outlined above.
o Droplet and contact precautions should be instituted.
o Health workers should wear a properly fitting N95 mask on entry into the patient’s room (if available).
o The patient should wear a standard surgical mask whenever he/she is required to leave the isolation room.
o Where separate isolation rooms are not available, suspected cases should be cohorted in a designated ward and the above precautions instituted.
o Oseltamivir should be used for treatment of moderate to severe cases.


Use of antiviral agents should be limited to persons with the following indications:
• Individuals with moderate or severe influenza-related illness, OR
• Any individual at high risk for serious complications of influenza and in whom treatment can be commenced within 2 days of onset of illness.

The pandemic influenza A(H1N1) 2009 virus is currently sensitive (susceptible) to the neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. It is resistant to the adamantane antiviral medications, amantadine and rimantadine. Note that recommendations for use of antivirals may change as data on antiviral susceptibilities become available. Oseltamivir (Tamiflu®) and zanamivir (Relenza®) are neuraminidase inhibitor (NI) antivirals registered for use in South Africa and active against influenza A and B viruses. Oseltamivir (Tamiflu®) is orally administered and is registered for use in individuals aged ≥1 year of age. Zanamivir (Relenza®) is administered through an inhaler and is registered for use in individuals aged ≥ 12 year of age.

Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Although benefit is likely to be greatest when therapy is initiated within 48 hours, some benefit may still be obtained in patients whose therapy is started later in the course of illness. Recommended duration of treatment is five days. Antiviral doses recommended for treatment of pandemic influenza A(H1N1) 2009 virus infection in adults or children 1 year of age or older are similar to those for seasonal influenza and are described in Table 1.

Table 1: Recommended dosage of antiviral agents for treatment of confirmed, probable or suspected pandemic influenza A(H1N1) 2009 cases*

tabel influenza


Source :
The National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS) In collaboration with: The South African National Department of Health and World Health Organisation (WHO).

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