Kerala - Thiruvananthapuram   

Delayed referral hits flu management

THIRUVANANTHAPURAM: As the case load of Influenza A (H1N1) infection slowly mounts in the State, the Health Department officials are worried that delayed reporting and referral of severe respiratory infection cases, especially from small private hospitals and clinics in the State, could affect the management of cases in the community.

While major private hospitals may be up to date with the latest Ministry of Health and Family Welfare guidelines and the WHO statements, it is likely that the small private hospitals and clinics in the State are not quite familiar with the treatment guidelines or protocols.

The Health Department woke up to this problem after it came to its notice that many cases of respiratory distress with high fever were being referred to major health centres by small hospitals at a much later stage. This has been making it difficult for doctors to manage the disease and also, if at all the patient had contracted A(H1N1) virus, he would have spread the infection to several other people.

The Health Department had thus proposed last week that Influenza A (H1N1) infection be made a notifiable disease under the Travancore Public Health Act. The government had accepted this in principle and the GO is expected to be released soon.

This makes it mandatory for all health-care facilities in the State, including private hospitals, to report all cases of severe respiratory illness handled by these institutions to the government.

“The Health Department put forth this proposal as we found that some cases of acute pneumonia or respiratory illnesses in the community, which might turn out to be A(H1N1) infection, had not been reported promptly to the department. As community-level spread of A(H1N1) has become a reality in the country, missing A(H1N1) cases could be very dangerous,” a senior Health official said.

The Health Department has thus advised all private health-care facilities to refer all cases of high fever and respiratory illness to the nearest taluk headquarters or General Hospital promptly as delayed referrals could affect the management of the disease.

But this is easier said than done, as usually, almost three-fourth of the cases that come to General Medicine OP clinics in hospitals might be cases of cold and fever with headache, a senior doctor in the department pointed out.

“The first stage of frantic testing for all flu-like cases is over and we are in the second stage where the Ministry of Health and Family Welfare has advised that testing be restricted to cases where symptoms are severe and the patient needs to be admitted (category C). We have asked all doctors to follow the latest guidelines but we would add that some amount of clinical discretion should also be applied,” he added.

In a nutshell, community-level spread of A(H1N1) infection is a reality now and with increased travel of people across State borders, every case of acute respiratory distress/asthma/pneumonia in the community should be treated as a suspect case and dealt with accordingly.

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