Communicable Diseases and Health Analysis
Washington, D.C., 12 November 2009 (PAHO) — The World Health Organization (WHO) has issued new healthcare guidance for the H1N1 influenza pandemic that encourages early treatment with antiviral drugs of ill people in high-risk categories and of anyone who has rapidly progressing symptoms.
The guidance reflects a more aggressive approach to the use of the main antiviral treatment, oseltamivir (Tamiflu). It is based on discussions with doctors from around the globe who have cared for severely ill H1N1 patients.
The updated recommendations emphasize three points:
- People in high-risk groups—pregnant women, children under 2, and people with underlying conditions such as asthma and other respiratory diseases—should be treated with antivirals as soon as possible when they begin to have flu symptoms. Physicians should not wait for laboratory confirmation of H1N1.
- People who are not in high-risk groups should be treated with antivirals if they have persistent or rapidly worsening symptoms. Danger signs include difficulty breathing or a high fever that lasts more than three days.
- People who have already developed pneumonia should be given both antivirals and antibiotics, because many severe cases develop bacterial infections.
People with milder flu symptoms need not be treated with antivirals unless they are in high-risk groups.
In announcing the new guidance, Dr. Nikki Shindo of WHO’s Global Influenza Program, said many doctors involved in caring for very sick patients in intensive care units regretted that the patients had arrived too late for even the most sophisticated medical procedures to save their lives.
“When we asked what could have been done differently to avoid the tragic outcomes, all of them answered, without exception, that things may have been very different it they had been treated with an antiviral drug earlier,” said Shindo.
Most people infected with H1N1 recover without medication, Shindo emphasized, but the virus can cause severe pneumonia even in healthy young people and can claim a life within a week.
“The window of opportunity is very narrow to reverse the progression of the disease. The medicine needs to be administered before the virus destroys the lungs,” she said.
WHO is also encouraging countries to decentralize the distribution of antivirals so that general practitioners, not just hospitals, have access to these medicines for their patients.
“Patients should not need to visit a hospital in order to get antivirals prescribed,” said Shindo. “This should help ensure that individuals get the care they need faster, and that the burden on hospitals is reduced. This will leave hospitals freer to treat the most severe cases.”
Shindo said WHO is also recommending that countries with limited supplies of antivirals should prioritize their distribution, with an emphasis on early use for members of high-risk groups and in progressive and severe cases.
WHO and its regional offices, including the Pan American Health Organization (PAHO), have stockpiles of antivirals to help supply low-income countries. In addition, PAHO is pooling purchases of antivirals and vaccines for its member countries through the PAHO Revolving Fund.
PAHO was established in 1902 and is the world’s oldest public health organization. It works with all the countries of the Americas to improve the health and the quality of life of the people of the Americas and serves as the Regional Office for the Americas of the World Health Organization (WHO).