Category Based Management of Swine Flu H1N1

Current Guidelines for Management of Seasonal Influenza based on their clinical categories was issued Ministry of Health & Family Welfare in April 2016

Category- A

Patients with mild fever plus cough / sore throat with or without bodyache, headache, diarrhoea and vomiting.
No testing of the patient for Influenza is required.
They do not require Oseltamivir
Should be treated symptomatically only
Should be confined to home and should be reassessed at 24 to 48 hours by the doctor.

Category-B : This category has 2 groups-

Category B(i) – Category-A symptoms PLUS high grade fever and severe sore throat
- Oseltamivir may be given in this group as per clinical discretion of the physician

Category B(ii)- Category-A symptoms PLUS individuals having one or more of the following high risk conditions

Pregnant women
Persons aged 65 years or older
Patients with lung diseases, heart disease, liver disease
Kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS
- Patients on long term systemic steroids therapy(not Inhaled steroids)
- Oseltamivir should be given in this group
No tests for Influenza is required for Category-B (i) and (ii).
Category-B patients should confine themselves at home and avoid mixing with high risk members in the family.
Broad Spectrum antibiotics as per the Guideline for Community- acquired pneumonia (CAP) may be prescribed in Category B(ii) patients

Category-C

Category-A or B patients PLUS has one or more of the following:

Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolorationof nails
Children with red flag signs (Somnolence, high and persistent fever, inability to feed well, convulsions, shortness of breath, difficulty in breathing, etc).
Worsening of underlying chronic conditions.

All these patients mentioned above in Category-C require testing, immediate hospitalization in isolation wards and treatment with Oseltamivir.

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