CLINICIANS
Case Definition | Testing Update | Participating in the NSW Health response: The ‘PROTECT’ phase | Treatment Guidance | Infection control resourcesCase Definition
Current clinical case definition for influenza NSW: 27 June 09
Patients should be considered likely to have influenza if they present with fever ≥38ºC or a good history of fever, and either a cough or sore throat.
Testing Update
With the move to the 'PROTECT' phase, GPs are asked to revert to their normal practices for testing for influenza and other respiratory viruses.
Laboratory testing advice for respiratory virues: 22 July 2009 update
Treatment for H1N1 influenza should be based on the clinical case definition. Patients do not need to be tested to be eligible for treatment.
Testing for influenza should only be performed in those who are admitted to hospital for an influenza-related illness, or where test results could alter clinical management. Testing may also be performed where an outbreak of influenza occurs in an institutional setting.
Asymptomatic patients presenting with a request for testing for H1N1 Influenza 09 human swine influenza should not be tested.
Participating in the NSW Health response: The 'PROTECT' phase
What does the 'Protect' phase involve?
• As the H1N1 influenza 09 virus is mild in most people, health system efforts will focus on protecting vulnerable people by providing them with early oseltamivir (Tamiflu®) or zanamivir (Relenza®) treatment, and controlling outbreaks in high-risk institutional settings.
• To allow this to occur, NSW Health will distribute free anti-influenza medicine to participating GPs and AMSs.
What should I do if I would like to participate?
• Order stocks of anti-influenza medicine through the State Vaccine Centre using the order form provided. Initial stocks of anti-influenza medicine (60 courses) and surgical masks will then be distributed to your practice
• Assess patient eligibility using the Australian Government criteria described under 'treatment guidance'
• Provide free treatment to eligible patients only using the stocks provided, and re-order as required
• Record the details of all patients given free medication using the treatment record form attached
• Strongly encourage all patients with influenza-like illness to stay at home until symptoms resolve (or for 3 days if treated), minimise contact with other people and practice good hand hygiene and cough etiquette.
• Notify your local public health unit of suspected influenza outbreaks in high-risk settings.
Treatment Guidance
Who is eligible for free treatment?
Patients are eligible for free treatment if they:
1.
a) present with fever ≥38ºC or a good history of fever, and either a cough or sore throat, and
b) are at risk of severe illness because they are pregnant, have underlying chronic disease or immunosuppression, are of Aboriginal or Torres Strait Islander background or are morbidly obese, and
c) present within 48 hours of symptom onset.
OR
2. present with moderate or severe acute febrile respiratory illness, or are rapidly deteriorating.
People considered to be at higher risk of severe illness from H1N1 influenza 09 include those with:
• Chronic respiratory disease, including asthma
• Chronic cardiac conditions (except simple hypertension)
• Chronic kidney or liver disease
• Haemoglobinopathies
• Chronic neurological conditions
• Metabolic disorders (such as diabetes)
• Weakened immune systems (caused by medications, malignancy or viruses such as HIV).
Laboratory testing for influenza is not required for patients to receive free anti-influenza treatment. Free anti-influenza medication should not be routinely provided for prophylaxis of household members or other contacts. Vulnerable contacts should be advised to monitor themselves for symptoms of influenza, and to present for early treatment if symptoms develop. Prophylaxis can be considered for those at very high risk of severe illness (e.g. bone marrow suppression).
Patients who require urgent medical attention should be referred to the nearest emergency department where they will be assessed and treated if indicated.
What are the arrangements for treatment of children?
Oseltamivir (Tamiflu®) 75 mg capsules can be used in children weighing over 40kg. Zanamivir (Relenza®) inhaler can be used in children aged 5 years and over. More advice on the treatment of children will be provided upon delivery of anti-influenza medication.
As there is limited supply of oseltamivir (Tamiflu) suspension in NSW, GPs and Aboriginal Medical Services will not receive their own supply of suspension.
For eligible children, or for those who can't swallow capsules, suspension is available from selected community pharmacies in Sydney, Newcastle and Wollongong and from major hospital pharmacies in other areas. If a patient requires oseltamivir suspension, you need to:
1. provide a prescription for the patient
2. indicate on the attached eligibility form:
a) whether the patient is eligible for free oseltamivir, and
b) the child's weight (for children under 13 years).
3. ask the patient/parent to call the pharmacy to check that suspension is available - see the list of selected metropolitan community pharmacies on the attached eligibility form.
Do not provide free anti-influenza medicine to patients who do not meet the eligibility criteria.
If the patient is ineligible but you wish to prescribe anti-influenza treatment, issue a private script and advise the patient to obtain the medicine from their local community pharmacy. Indicate clearly on the script the patient's eligibility status.
Resources for Clinicians
- H1N1 influenza 09 update 7 - ED & Clinics [PDF, 70KB]
- H1N1 influenza 09 update 7 - GPs and Aboriginal Medical Services [PDF, 103KB]
- H1N1 influenza 09 update 8 - GPs and Aboriginal Medical Services [PDF, 97KB]
- H1N1 influenza 09 update 9 - GPs and Aboriginal Medical Services [PDF, 61KB]
- H1N1 influenza 09 update 10 - GPs and Aboriginal Medical Services [PDF, 95KB]
- Update for Aboriginal Medical Services - 10 July
- Flow chart for influenza assessment in general practice settings- 'protect' phase [PDF, 68KB]
- H1N1 Flu GP and AMS Order Form [PDF, 117KB]
- GP Treatment Record Form [PDF, 115KB]
- Eligibility declaration form [PDF, 121KB]
- Clinical Management of H1N1 influenza 09 Cases (prepared by DoHA) [PDF, 142KB]