Sunday, August 23, 2009


A crowded traffic
Ever since the Influenza A (H1N1) pandemic erupted, I haven't bother to read the guidelines for handlings of patients issued by WHO or the MOH, because I am not even directly involved in it.

Anyway, the guidelines keep changing and many doctors are confused as the Health Minister and DG kept giving inconsistent views over the media.

Part of the reasons I believe is, as this strain of mutated virus is new, nobody could actually predict how virulence or severe the disease can be. Different countries have different patterns of involvement as well as incidence and mortality rate, depending on how the disease is diagnosed and treated.

Well, our MOH has dedicated a website on Influenza A (H1N1) at

It has listed out algorithm on how to handle paediatric as well as adult groups presenting with influenza-like illness (ILI) in the out-patient setting.

It has also a list of high risk groups for severe illness.

Well, I am particlularly interested to know if the health care workers and their family, and particularly, those who deals with or has had contact with patients with influenza A (H1N1), are at RISK as well, so that anti-viral treatment could be considered when neccessary.

By the way, I suppose the handling of health care workers is of no difference as with the general public.

Here is the latest guideline dated 13 th August 2009:

Indications for anti-viral:

1. Patients with ifluenza-like illness (ILI) and at risk (Appendix 1).
2. Patients with ILI, but NOT in the high risk groups, BUT have fever (>38°C) and prolonged more than 2 days.
3. Patients other than the above mentioned 1 and 2, who have ILI with a "Rapid test positive" AND worsening within 48 hours (as mentioned in Appendix 2).

By the way, what particularly upset me recently was, a doctor friend's child was down with ILI and was seen by the specialist. The child was given symptomatic treatment and sent home. However, the child deteriorated the next day and has to be intubated, currently still fighting for his life in ICU, with the prognosis I heard, not good. He was confirmed H1N1.

I am a bit upset because the doctor friend is a contact of a confirmed A (H1N1) patient and was quarantined at home before. I presumed, anti-viral was not started on the child initially because he did not fulfil the criteria for anti-viral treatment.

A lot of queries struck my mind, but then, there is no point dwelling into that issue again because it has become academic and I am very upset because a health care worker and his family members were affected.

It seems to me that health care workers and their immediate family are at RISK, and I wonder if there is a specific guidelines to deal with this category.

And by the way, I am still upset because tomorrow I am 'forced' to have a new job, that is to be in-charged of the A (H1N1) ward.

Must read:
Garispanduan Pengendalian Influenza A (H1N1) di Klinik Kesihatan.
Influenza A Prevention Guidelines for Health Care Workers.


sbanboy said...

Please take k and take all the pre cautions when you are in charge of the h1n1 wards.

aktarar said...

Standard precaution. Hygeine, hygeine and hygeine. Anyhow, the virus will mutate anyway. To worst or doom. That's life bro. Don't b upset. Just keep up the good work!

little_daisy said...

Keep cool...