Accessing Antivirals from Pandemic Stockpile' Vital Swine Flu Management for GPs and Practice staff'

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Accessing Antivirals from Pandemic
Stockpile.Vital Swine Flu Management for GPs and
Practice staff.

• Prepared By
• Dr Lesley Stainkey
• General Practice Liaison Officer
• Townsville General Practice Network

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Patient Access to GP

• Must really have same day access due to the need
  to start antivirals within 48 hours of onset of
  symptoms

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Definitions

• Case Definition
• ARI (acute respiratory illness)
• Fever 38 degrees or well documented history
• Cough
• Sore throat
• Flu Definition
• If H1N1 Influenza 09 is in the local
  community (i.e. Swine Flu) then anyone with ARI
  is considered to have H1N1 Influenza 09.

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H1N1 influenza 09 (Human Swine Influenza HSI)
Decision Tree for Management of Influenza-like
illnessGuidance for medical practitioners to
prescribe stockpile antivirals for patient
treatment during the PROTECT phase (effective
22/06/09)
Patient with an Febrile Influenza-like
illness (Recent onset fever (38 C or greater,
or good history of fever) with a cough and/or
sore throat
NO
YES
Present in the first 48 hours of
symptoms Beyond 48 hours antiviral medication
may still be indicated on clinical grounds
NO
YES

• Patient is a member of at least one of the
  following groups
• Those with chronic respiratory conditions
  (including asthma or COPD)
• Pregnant women (particularly 2nd and 3rd
  trimester)
• Persons with morbid obesity
• Indigenous people of any age
• Persons with conditions predisposing to severe
  influenza such as
• - cardiac disease (excluding simple
  hypertension)
• - Other chronic diseases such as
  Diabetes mellitus, chronic metabolic, chronic
  renal disease,
• haemoglobinopathies, immunosuppressed (including
  cancers, HIV/AIDS infection, drugs) chronic
  neurological conditions

NO
NO
Patient has moderate/severe disease, Particularly
those who are deteriorating or experiencing
respiratory difficulties.
YES
YES
Supportive Treatment Only Medication to assist
with alleviating symptoms NOT including
antiviral treatment e.g.paracetamol
CONSIDER antiviral treatment through access to
the antiviral stockpile and consider Testing1
plus provide supportive treatment as indicated.

• TESTING
• Laboratory testing should only be considered for
  those who have an acute, febrile, respiratory
  illness AND are either
• a member of a vulnerable group OR
• a health care worker OR
• have moderate or severe disease including those
  requiring hospitalisation
• OR
• Laboratory testing is required on public health
  grounds, such as to determine the cause of an
  outbreak in closed environment
• ONE SWAB INTO BOTH NOSTRILS IS ALL THAT IS
  REQUIRED FOR VIRAL TESTING FOR THIS CONDITION

In the PROTECT phase antivirals SHOULD NOT be
provided for prophylaxis of household members or
to other contacts. Public Health Physicians may
prescribe/recommend antivirals for contacts in
high risk settings on public health grounds.
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Vulnerable Groups

• High Risk for complications

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Sick Patients

• Moderate/Severe Illness
• Deteriorating
• Respiratory Difficulties

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Active Monitoring

• Smokers
• Children under 5 years
• Obstructive Sleep Apnoea
• Pregnant women 1st Trimester (Relenza)

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Personal Protective Equipment

• Changes
• Gowns and P2 mask only needed for nebulized
  medication administration
• At all other times
• Surgical Mask
• Protective eyewear
• Gloves

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Who gets tested?

• Swabs (Right Left same swab)
• Sick patients
• Vulnerable groups
• Health Care workers
• Testing in closed environments
• (e.g. Nursing homes, Schools, Prisons for public
  health reasons)

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What Tests?

• One Nasopharyngeal swab- now called Deep Nasal
  Right and Left (same swab)

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Room Cleaning Waste

• Rooms can be used immediately after cleaning
• Used tissues are disposed of in general waste

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Antiviral Prescription

• ARI Vulnerable group
• ARI Moderate/Severe
• ARI Healthcare workers with either
• Vulnerable Group status
• Moderate/severe illness
• SCRIPT MUST BE ENDORSED

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Antiviral Prescriptions Endorse Script

• Extract from Medical Practitioner Update PROTECT
  phase 19 June 2009
• In order to access the antiviral stockpile,
  your prescription MUST contain the following
  information
• The patient has an acute febrile ILI AND
• The patient is a member of a vulnerable group
  (specify which group) OR has moderate/severe
  disease AND
• THIS SCRIPT IS TO BE FILLED FROM THE ANTIVIRAL
  STOCKPILE

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Townsville solution to Endorse Script

• Pandemic Stockpile on script PLUS faxback

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Who doesnt get Antivirals?

• Mild illness
• Mild illness greater than 48 hours
• Non-vulnerable group
• Well household contacts

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Who does get Antivirals?
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Dosage Schedule
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Other Dosing Information

• Dosing information available for children aged
  less than 1 year via the TGPN website.
• Precribing
• Pregnancy breastfeeding
• Renal impairment
• Warfarin

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Notification to TPHU

• Notification to TPHU is no longer necessary
• TPHU is notified from swab results
• TPHU may distribute antivirals to others consult
  if outside of guidelines especially if patient
  lives in closed environment.

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H1N1 influenza 09 (Human Swine Influenza HSI)
Decision Tree for Management of Influenza-like
illnessGuidance for medical practitioners to
prescribe stockpile antivirals for patient
treatment during the PROTECT phase (effective
22/06/09)
Patient with an Febrile Influenza-like
illness (Recent onset fever (38 C or greater,
or good history of fever) with a cough and/or
sore throat
NO
YES
Present in the first 48 hours of
symptoms Beyond 48 hours antiviral medication
may still be indicated on clinical grounds
NO
YES

• Patient is a member of at least one of the
  following groups
• Those with chronic respiratory conditions
  (including asthma or COPD)
• Pregnant women (particularly 2nd and 3rd
  trimester)
• Persons with morbid obesity
• Indigenous people of any age
• Persons with conditions predisposing to severe
  influenza such as
• - cardiac disease (excluding simple
  hypertension)
• - Other chronic diseases such as
  Diabetes mellitus, chronic metabolic, chronic
  renal disease,
• haemoglobinopathies, immunosuppressed (including
  cancers, HIV/AIDS infection, drugs) chronic
  neurological conditions

NO
NO
Patient has moderate/severe disease, Particularly
those who are deteriorating or experiencing
respiratory difficulties.
YES
YES
Supportive Treatment Only Medication to assist
with alleviating symptoms NOT including
antiviral treatment e.g.paracetamol
CONSIDER antiviral treatment through access to
the antiviral stockpile and consider Testing1
plus provide supportive treatment as indicated.

• TESTING
• Laboratory testing should only be considered for
  those who have an acute, febrile, respiratory
  illness AND are either
• a member of a vulnerable group OR
• a health care worker OR
• have moderate or severe disease including those
  requiring hospitalisation
• OR
• Laboratory testing is required on public health
  grounds, such as to determine the cause of an
  outbreak in closed environment
• ONE SWAB INTO BOTH NOSTRILS IS ALL THAT IS
  REQUIRED FOR VIRAL TESTING FOR THIS CONDITION

In the PROTECT phase antivirals SHOULD NOT be
provided for prophylaxis of household members or
to other contacts. Public Health Physicians may
prescribe/recommend antivirals for contacts in
high risk settings on public health grounds.
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The END