Clinical Guidance on Swine Flu

Swine Flu: CDC Offers Clinical Guidance, WHO Raises Alert Level Again

The CDC has released a series of flu-related interim clinical guidance documents. They include one on the care of infected children and pregnant women, another for emergency medical services, and a case-definition document.

With regard to infected children, the advisory says the signs of severe disease include apnea, tachypnea, dyspnea, cyanosis, dehydration, altered mental status, and extreme irritability. Pregnant women suspected of being infected "should receive empiric antiviral treatment."

The CDC clarified case-definition terms as follows:

• An acute febrile respiratory illness is characterized by a temperature of 100.4 degrees or higher and recent onset of one of the following: rhinorrhea, nasal congestion, sore throat, or cough.
• Cases are "confirmed" only by PCR or viral culture.
• "Probable" cases include those with acute febrile respiratory illness, positive for influenza A, but negative for H1 and H3 by PCR.
• "Suspected" cases include symptomatic patients with recent (within 7 days) travel to infected areas or contact with a known case.

WHO raised its pandemic alert level from 4 to 5 (on a 6-level scale), reflecting confirmed person-to-person spread and the imminence of the threat. Earlier on Wednesday, the CDC confirmed the first death in the U.S.

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Dr Marwah