Fw: H1N1 lecture

[Guest guest]

Dear Atul,

Following are my observations:

1. How useful is the surgical mask - does a pediatrician need to wear a

mask?

All medical staff who are at risk of infections with H1N1 should wear N95

mask. Triple layer surgical mask is not enough. However surgical mask can be

used by patients/people when in a close surroundings (and not when in open

spaces). N95 masks are difficult to tolerate for long time. Surgical masks

if not properly worn can be counter-productive. Practically it is better to

get exposed to H1N1 and be immune than to worry about it. Personally I am

NOT wearing mask in my clinic. (Remember H1N1 is a mild diseae unlike H5N1)

2. Is it mandatory that we wash our hands with alcohol based cleanser - and

how often

Yes, after touching every patient. (It is also the standard of care to

prevent nosocomial infections) If you see 100 patients a day, it will be

practically difficult to do so.

3. Is the respiratory complications directly due to A(H1N1) or does sec

bacterial infection (like in the 1918 epidemic , Klugman et al) play a part?

1918-19 flu pandemic did show evidence of secondary bacterial infection with

Pneumo or Staph in those who developed pneumonia following flu. However data

from H5N1 flu (Bird flu) did not show any role of such super-infection and

that is why antibiotics could not prevent mortality which was nearly 55%.

There is no evidence currently to suggest super-infection with bacteria for

H1N1 either as on now. In any case I don't think so any child with H1N1 who

develops pneumonia ot gets sick enough will not receive antibiotics which

will take care of super-infection if it has occurred (unlike 1918-19 when

antibiotics were not available)

4. Is it any use therefore taking a Pneumo 23 vaccine? Will the children who

have had PCV 7 be better off?

Current CDC guidelines recommend to strengthen use of PPV23 for elderly and

any age group with high risk including giving a repeat dose if more than 5

years have lapsed since the last immunization. It does not recommend use of

PPV23 routinely for the entire population. I personally think it does not

make sense in giving this vaccine to every one unless more data comes in. .

5. Has bacterial cultures been done in the post mortems this time in India?

No idea. In most tertiary care hospitals cultures are any one done for all

pneumonia cases.

6. Was mortality in countries using PCV 7 in their national schedule less

this time round or was it because the A(HINI) is less virulent?

No it same all over the world. It has more to do with case management (which

will be more precise and aggressive in developed countries and cities)

rather than use or otherwise of PCV7.

7. What use is Tamiflu given beyond 48hrs of illness?

Data suggests that Tamiflu in H1N1 will benefit when the virus replication

is still on (as is expected in cases who deteriorate to merit testing and

Tamiflu) Hence the current policy of offering Tamiflu to only those with red

flag signs (with or without testing for H1N1) seems reasonable and will not

chock the limited resources of testing and availability of Tamiflu.

8. Is seasonal flu vaccine any use at all for A(HINI)? Then why is the new

vaccine being tested?

Seasonal flu vaccine has no role in the new H1N1 as the new H1N1 virus is

antigenically totally different than the endemic H1N1 Vaccine against

the new H1N1 is in phase # trials and may be available by end of this year

(Pandemic vaccines always come too little and too late). In any case even if

the new vaccine is available, where is the public health program of offering

this vaccine to mass in India in place? From e-mail of Dr. Panna, it seems

GoI is now thinking of evolving a national program for flu! (Dig a well

after fire breaks out!)

With Warm Regards,

Yours sincerely,

Dr. Nitin K. Shah

* President, Indian Academy of Pediatrics 2006

* Consultant Pediatrician, PD Hinduja National Hospital, Mumbai

* Hon Hematologist Oncologist, BJ Wadia Hospital for Children, Mumbai

* Hon Pediatric Hematologist Oncologist, Lion's Hospital, Mumbai

Tel: (Off) +91-22-24080606 (Res) +91-22-24075063 Mobile: +91-98210 37201

E-mail: drnitinshah@...

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