Wednesday, July 22, 2009

H1N1: ALERT!!!

Awalnya,mungkin ramai tak menyedari betapa bahayanya wabak ini yang bermula di Mexico termasuk saya sendiri. Namun,walaupun setelah beberapa ketika, ternyata virus yang telah menjadi pandemik hampir ke seluruh dunia ini semakin membimbangkan.

Saya juga sebelum ini agak diburu resah memandangkan demam, sakit tekak dan selsema yang agak kronik. Sehinggakan ada sahabat yang mengesyorkan, "Pergilah periksa kat PPUM tu. Tak lama pun." Alhamdulillah, ketika berjumpa doktor di klinik pelajar, doktor mengatakan saya tidak perlu menjalani saringan H1N1.


Fenomena ini agak kritikal sebenarnnya walaupun ada pihak mendakwa kerajaan sengaja menyembunyikan fakta kes sebenar supaya tidak `kehilangan` pelancong asing.

Masakan tidak, pelajar-pelajar baru terpaksa dikuarantin sehingga suasana Minggu Haluansiswa di beberapa universiti berubah wajah, kaunter saringan di hospital-hospital juga tak menang tangan dibuatnya dan termasuk juga suasana memakai topeng penutup di tempat-tempat awam.


Memandangkan masih ramai lagi yang tidak endah mengenai penularan virus ini,maka, sedikit perkongsian maklumat mengenai virus pandemik ini:


Guidelines for H1N1 in Malaysian Government Hospital setting (as presented in Hosp Sungai Buloh on 10th July 2009)



Case definition for Novel Influenza (H1N1) virus
A confirmed Case: person with an influenza like illness (ILI) with laboratory confirmed novel influenza

A (H1N1) virus infection by one or more of the following tests:
1. Real time RT-PCR
2. Viral culture

Not all with suspected novel influenza (H1N1) infection need to be seen by a health care provider (doctors)

For most people, the illness appears to be mild and self-limiting. Cases have been confirmed in all ages group but children and younger age group seem to be much more higher groups that easily affected. Only few cases for older adult.

For a minority people, H1N1 caused severe illness with complications. In many but not all of these cases underlying risk factors or comorbidities.

Complications of H1N1

1. Respiratory
a. Pneumonia
b. Upper Resp: Otitis Media, sinusitis, conjunctivitis
c. Croup
d. Bronchiolitis
e. AEBA/AECOAD

2. CVS
a. Myocarditis
b. pericarditis

3. Muscular
a. Rhabdomyositis
b. Rhabdomyolisis with myoglobinuria and ARF

4. Neuro
a. Encephalitis
b. Reye’s Syndrome
c. Guillian Barre Syndrome
d. Transverse Myelitis

5. Systemic
a. Toxic shock syndrome
b. Sudden death

Risk Factors @ co-morbidities
1. Chronic respiratory condition COAD, Asthma, OSA
2. Pregnancy (2nd to 3rd trimester)
3. Morbid Obesity
4. Chronic diseases eg DM, CCF, CRF (NOT simple hypertension-need 2 anti hypertension)
5. Immunosuppression including Chemo patient, Transplant patient, HIV, long term steroid,
6. haemoglobinopathies e.g Thalassemia,
7. > 65 years old
8. <>Who need to seek health care provider?
Patients with ILI (definition for ILI: fever > 38 and a cough and / or sore throat in the absence of a known cause other than influenza)
AND
Moderate to severe illness ( based on Home Assessment Tool)
or
significant co-morbidities
need to seek within first 2 days of illness

Patient Home Assessment Tool
1. Respiratory difficulties i.e SOB, rapid breathing, purple/blue discoloration of lips
2. Coughing out blood or blood streaked sputum
3. Persistent chest pain
4. Persistent diarrhea and / or vomiting
5. Fever > 3 days or recurring after 3 days
6. Abnormal behavior ie confusion, fit
7. Dizziness while standing or reduce urine production


Clinical assessment for moderate to severe illness (Need to consider admission)

1. Respiratory impairment
a. Tachypnoea RR> 24
b. Inability to complete sentence in one breath
c. Use of accessory muscle
d. SPO2 <>2. Clinical dehydration or clinical shock
a. SBP <90> 2 sec
c. Reduce skin turgor

3. Altered conscious level
a. Confusion, seizure and agitation

4. Others
a. Severe and persistent vomiting
b. Rapidly progressive (high temperature > 3 days)

Akhir sekali, sebagai muhasabah bersama, tidak mustahil wabak ini juga satu peringatan dari ALLAH dalam dunia pada hari ini sudah cukup ralit dengan menghadapi kemelut yang tidak berkesudahan.

"Dan apabila Kami berikan kesenangan kepada manusia, nescaya dia berpaling dan menjauhkan diri dengan sombong; dan apabila dia ditimpa kesusahan, nescaya dia berputus asa."
(Al-Isra`:83)

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