H1N1 Influenza Australian Task Force Position Paper: Update

Just a brief update on the A (H1N1) 09 (swl) Influenza Pandemic, from the Position Paper of the Australian Swine Influenza Task Force, reported in eMJA: ASID/TSANZ guidelines: treatment and prevention of H1N1 influenza 09 (human swine influenza) with antiviral agents: http://www.mja.com.au/public/rop/cheng/che10661_fm.html

Abstract
● To date, there have been thousands of cases of H1N1 influenza 09 (human swine influenza) worldwide, with established community transmission in parts of Australia.

● Timely diagnostic tests can enable targeted antiviral treatment early in the course of the pandemic. Rapid antigen tests will be less useful once the pandemic is established.

● Recommendations for use of antiviral treatment for influenza:
1. Neuraminidase inhibitors (oseltamivir and zanamivir) are the antiviral agents of choice for H1N1 influenza 09.

2. In otherwise healthy children and adults with confirmed or suspected influenza, antiviral treatment is of greatest benefit when given within 48 hours of symptom onset.

3. Treatment should be prioritised for patients with risk factors for severe disease, such as older people (> 65 years), pregnant women, patients with chronic disease (eg, asthma, cardiorespiratory disease, diabetes and renal failure) or immunosuppression, and young children.

4. Antiviral treatment can be given to children as young as 1 year. However, animal studies suggest central nervous system accumulation of oseltamivir in infants <> 48 hours after symptom onset. Antibiotics should be given to such patients according to established guidelines for community-acquired pneumonia.

● Recommendations for use of antiviral prophylaxis:
1. Antiviral prophylaxis can be given to health care workers and close contacts of patients with influenza following exposure, and to residents of institutions to terminate outbreaks. Contacts not provided with prophylaxis should have access to early treatment with antiviral agents.

2. Long-term prophylaxis can be given to “first responder” health care workers for durations of up to 6 weeks for oseltamivir and 4 weeks for zanamivir. Use of antiviral prophylaxis for these groups should be in the context of agreement to use the national stockpile.

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