A: Treatment is largely supportive and consists of bed rest, increased fluid consumption, cough suppressants, and antipyretics and analgesics (eg. Acetaminophen, non steroidal anti-inflammatory drugs) for fever and myalgias. Aspirin should be avoided in pediatric patients to avoid Reye’s sundrome. Severe cases may require intravenous hydration and other supportive measures. Antiviral agents may also be considered for treatment or prophylaxis. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine flu virus. Antiviral drugs may reduce the symptoms and duration of illness, just as they do for seasonal influenza. They also may contribute to preventing severe disease and death.

Immediate care to be provided at home includes the following :-

•	Do not allow the child to go to school while ill. Also, try to keep them away, maybe in a separate bedroom, from others in the family as far as possible. This is to prevent others from being exposed.
•	Make sure they get plenty of rest.
•	Make sure that they drink clear fluids (such as water, broth, electrolyte beverages for infants) to keep them from being dehydrated.
•	Remind them to cover coughs and sneezes. Also, remind them to clean hands with soap and water often and especially after using tissues and after coughing or sneezing into hands
•	Try to make your child wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza.

It is important to be watchful for any emergency warning signs that might indicate you need to seek immediate medical attention. These include

•	Difficulty in breathing.
•	Purple or bluish discoloration of lips
•	Frequent vomiting, and inability to keep liquids down.
•	Signs of dehydrations such as dizziness, absence of tears when infants cry or absence of urination.
•	Seizures (uncontrolled convulsions)
•	Decreased responsiveness and confusion.

Tamiflu (Oseltamivir phosphate) is not 100% curative. However, a very high survival rate is noted in patients receiving Tamiflu treatment if the treatment has been started within 48 hours. It can be safely concluded that although not a perfect cure, it is an excellent drug for the treatment of influenza.

In most cases, it is self-limiting and requires only symptomatic and supportive therapy like fever-reducing medicines (Paracetamol, etc), bed rest and good hydration. However in a confirmed case of H1N1 influenza it is always appropriate to treat with oseltamivir. All hospitalized patients with confirmed, probable or suspected novel influenza (H1N1) and patients who are at higher risk for seasonal influenza should receive oseltamivir.

A new study carried out by Dr Aileen Kitching from the European Programme for Intervention Epidemiology Training and colleagues from the Health Protection Agency (HPA) in London claims that “more than half of children taking Tamiflu to combat swine flu suffer side effects such as nausea, insomnia and nightmares. The study suggests that one in five children who took part reported having a neuropsychiatric side effect, such as poor concentration, inability to think clearly, problems sleeping, and feeling dazed or confused. This online survey looked at schoolchildren’s adherence to Tamiflu and any side effects they experienced. It had a low response rate, and no control group against which to compare the symptoms. As such, it is not possible to say for sure that this frequency of side effects is precise. No serious or long-term side effects of the drug were reported.

For additional references : Kitching A, Roche A, Balasegaram S, Heathcock R, Maguire H. Oseltamivir adherence and side effects among children in three London schools affected by influenza A(H1N1)v, May 2009 - an internet-based cross-sectional survey. Euro Surveill. 2009 Jul 30;14(30):19287.

There can be mutations in the neuraminidase of the virus, which is the principle target of the antivirals in use today, being oseltamivir. H274Y gene mutation causes viruses to be resistant to oseltamivir and this is observed in some areas today. Indiscriminate use of Tamiflu will result in more and more genetic mutations leading to resistance to the drug. Hence caution is advised before prescribing Tamiflu unless it is recommended.

Swine flu poses added risks for pregnant women such as increased chances of pneumonia and in some cases premature delivery. Risks from the virus are greater than the unknown risks to the fetus from the drug oseltamivir. It is, therefore, accepted to give oseltamivir to treat pregnant women with swine flu.

While Tamiflu is a good drug to control the severity of swine flu in most patients, a recent study has found that it may not be as useful in children under the age of 12. This is because it is found to decrease, on average, the duration of illness by 0.5 to 1.5 days. Its use does not have a clinically significant effect on reducing asthma exacerbations or on overall use of antibiotics, but oseltamivir is associated with an increased risk of vomiting.Hence, it is believed that Tamiflu treatment in children should be restricted to severe cases only.

Tamiflu can presently (as of 12th August, 2009) be procured only through the governmental health set up. If you are a confirmed case of swine flu, the government will provide you with Tamiflu. Chemoprophylaxis for certain healthcare professionals with Tamiflu is also provided for by the Government.

There is no vaccine available right now to protect against the swine flu virus. The usual vaccine for influenza administered at the beginning of the flu season is not effective for this viral strain. The Serum Institute in Pune is actively involved in producing a vaccine against Swine Flu along with several institutes and pharmaceutical companies worldwide. The first vaccine is reportedly going to be ready for a trial in September, though it could be 6 months longer before it is ready for mass use.

http://www.bmj.com/cgi/content/abstract/339/aug10_1/b3172