Children with H1N1 should be promptly treated with with available antivirals like oseltamivir (Tamiflu) and zanmivir (Relenza) as there are no safety concerns with use of these drugs in children.
WHO recommends prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness. This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness.
No additional safety concerns have been identified so far with use of the anti flu drugs osetamivir or zanamivir in children.
Some questions have been raised about the advisability of administering antivirals to children, following the recent publication of two clinical reviews.
The two clinical reviews used data that were considered by WHO and its expert panel when developing the current guidelines.
Otherwise healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens.
Evidence on the efficacy and safety of oseltamivir for use in influenza other than seasonal influenza is based on case reports of its use in humans infected with avian H5N1 and emerging reports of its use in H1N1.
Use of oseltamivir in children aged less than one year has been described in retrospective reports or those that have been provided to regulatory authorities but are currently unpublished.
There are no publicly available data describing the use of zanamivir in children aged less than one year.Although no studies assessing use of zanamivir during lactation are available, this study concludes that the amount of zanamivir that would be ingested by a 5 kg infant is much lower than the recommended dose for children.
Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease.
As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in children with confirmed or suspected H1N1 infection:
–fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.
Presentation of influenza virus infection can vary from asymptomatic infection through to serious complicated illness that may include exacerbation of other underlying conditions and severe viral pneumonia with multi?organ failure.
Since a wide range of pathogens can cause influenza?like illness, a clinical diagnosis of influenza will be guided by epidemiologic data and confirmed by laboratory tests. However, on an individual patient basis, initial treatment decisions should be based on clinical presentation and epidemiological data and should not be delayed pending laboratory confirmation.
In uncomplicated influenza the symptoms may include fever, cough, sore throat, rhinorrhea, headache, muscle pain, malaise, but no shortness of breath, no dyspnoea. Patients may present with some or all of these symptoms.
Gastrointestinal illness may also be present, such as diarrhoea and/or vomiting, especially in children, but without evidence of dehydration.
Patients who present initially with uncomplicated influenza may progress to more severe disease. Progression can be rapid. In complicated or severe influenza, the symptoms can aggravate to shortness of breath (dyspnoea, tachypnea, hypoxia) and/or radiological signs of lower respiratory tract disease (e.g. pneumonia), CNS findings (e.g. encephalopathy), severe dehydration or presenting secondary complications, renal failure, multi?organ failure, and septic shock. Other complications can include musculoskeletal (rhabdomyolysis) and cardiac (myocarditis).
Symptoms and signs suggesting oxygen impairment or cardiopulmonary insufficiency are fast and laboured breathing, shortness of breath (with activity or at rest), difficulty in breathing, turning blue, bloody or coloured sputum, chest pain, low blood pressure; Hypoxia as indicated by pulse oximetry.
Altered mental status, unconscious, drowsiness, or difficult to awaken; recurring or persistent convulsions (seizures), confusion, severe weakness or paralysis, are the signs suggesting CNS complications.
Persistent high fever and other symptoms beyond three days and severe dehydration, decreased activity, dizziness, decreased urine output, lethargy are evidence of sustained virus replication or invasive secondary bacterial infection.