Health Professionals (updated 21st January 2010)

• Introduction

• Diagnosis and treatment

• Critical Care

• Treatment of high risk groups after exposure

• Vaccination

• Surveillance and research

Introduction

Influenza in young children may present differently to adults, with symptoms similar to those of other serious treatable illnesses such as meningitis. Care should be taken not to confuse the presentation of this and other conditions with the symptoms of flu.

Good Medical Practice, responsibilities of doctors in a national pandemic, published by the GMC outlines the standards of practice expected of doctors if their work is affected by a pandemic.

General information is available:

• for England go to DH
• for Scotland go to the Scottish Government 
• for Wales go to the Welsh Assembly

Swine flu information for asylum seekers, refugees and foreign nationals in the UK

A summary of current information on swine flu can now be accessed for or by people who cannot speak or read English and who may not have access to a regular flow of news, i.e, an asylum seeker or refugee, a temporary worker in the UK or even a member of an established migrant group.

Specific information is available:

• for England refer to the Health Protection Agency,
• for Scotland refer to the Health Protection Scotland 
• for Wales refer to the National Public Health Service for Wales.

Disclaimer: Please note that unless there is explicit endorsement of a document, RCPCH takes no responsiblity for the content of guidance from an external site.

Diagnosis and treatment

The following resources are available for diagnosis and treatment:

•  RCPCH consensus statement on the use of anti-virals for children and young people with swine flu:  Oseltamivir under 1 Consensus Statement Jan2010 (last updated Jan 2010). The DH has also published guidance, stating the same dosage regime.
• Babies between 0 and 6 months are potentially at high risk where flu symptoms are not immediately apparent. It is essential that other potential diagnoses are considered.
• Pandemic H1N1 2009 influenza: clinical management guidelines for adults and children
   (DH) updates provisional guidance for the clinical management of adults and children with symptoms of influenza-like illness, severe influenza and complications, provided in 2007 by the British Thoracic Society.
• DH Clinical package, is a set of tools for use by frontline healthcare professionals in severe and exceptional circumstances during a pandemic situation. Note that this guidance was revised in October 2009 to reflect changes in guidance on the use of empirical antibotics and oseltamivir prescribing in young children.
• The World Health Organisation has guidance on the clinical management of Swine Flu.
• Specialist advice from DH for pregnancy and breastfeeding during the pandemic.
• The Children's Cancer and Leakeumia Group have developed practice notes on the treatment, prophylaxis and self-isolation of haematology/oncology children with immunosuppression. Please note that this document was reviewed via the RCPCH Quality of Practice Committee rapid appraisal process.
• Guidance has been developed regarding symptom management and end of life care for children during pandemic influenza. Sympton Management and End of Life Care. Please note that this document was reviewed via the RCPCH Quality of Practice Committee rapid appraisal process.
• Guidance has been developed by BAPN for specialists and renal units on prescribing antiviral medicine to children with renal failure during the swine flu pandemic.
  Antivirals_and_advice_for_children_with_renal_failure. Please note that this document was reviewed via the RCPCH Quality of Practice Committee rapid appraisal process

Critical Care

• RCPCH have developed, with support from the HPA and DH, the   Joint Paediatric Critical Care Practice Note for H1N.
• DH has published a critical care strategy, of which paragraphs 57 to 68 specifically relate to children.
• The Intensive Care Society, Paediatric Intensive Care Society and the Association of Paediatric Anaesthetists have developed a briefing statement:  ICS-PICS-APA Pandemic Briefing
• DH have published prophylaxis guidance which outlines when it may be appropriate to offer antivirals after exposure to Swine Flu.

Treatment of the high risk case after exposure

DH have published prophylaxis guidance which outlines when it may be appropriate to offer antivirals after exposure to Swine Flu. 

Vaccination

DH has outlined the priority groups for vacination:

• individuals aged six months and up to 65 years in the current seasonal flu vaccine
• clinical at-risk groups
• all pregnant women, subject to licensing considerations on trimesters
• household contacts of immunocompromised individuals
• people aged 65 and over in the current seasonal flu vaccine clinical at-risk groups

There is further operational advice regarding vaccination from DH

Surveillance and research

BPSU  has commenced surveillance of Guillain Barré syndrome/Fisher syndrome (GBS/FS).  Funded by the Department of Health the study aims to identifying new paediatric GBS/FS cases in the UK. There is information available on the BPSU surveillance protocol  and general HPA information on GBS and guidance on serology collection  .

Patients and carers

• If you are a patient or carer and are wanting further information regarding swine flu, the following should provide useful information NHS Choices has general information about swine flu and also has a page of question and answers.
• If you are concerned that you, or someone you care for has swine flu, you can go to the National Pandemic Flu Service for more information about the symptoms.
• RCPCH, in conjunction with the Royal College of Obstetrics and Gynaecology have developed the following a question and answers sheet : Swine Flu Questions and Answers for parents of newborn babies
• Swine flu information for asylum seekers, refugees and foreign nationals in the UK

A summary of current information on swine flu can now be accessed for or by people who cannot speak or read English and who may not have access to a regular flow of news, i.e, an asylum seeker or refugee, a temporary worker in the UK or even a member of an established migrant group.