Dr Attila Danko has posted a fascinating comment about the Victorian Government’s approach to managing Swine Flu in its “Modified Sustain” phase. Attila is worried about the broad case definition now being used, which may lead to over-prescribing of Tamiflu, increasing the risk of Tamiflu resistance.
The comment is under this post. I’ve reproduced the relevant parts below:
The recent change in Victoria to treatment of case definitions and limited testing
is deeply troubling to me. I am a busy GP in a walk-in clinic in Ballarat, so I have a high proportion of my patients presenting with acute illness. What I have found is that there is a lot of “flu-like illness” around that meets the case definition; but despite testing dozens of people I have yet to pick up even one case of true influenza, swine or otherwise. In other words, they all have colds. But a severe cold can look like influenza. Yes, they have had fevers too, often measured in my surgery. My feeling is that they have jumped the gun. This influenza is not widespread in my community yet. If I followed the guidelines strictly I will be prescribing Tamiflu in large numbers to people with a cold where it is useless.
Lets say that some of these people then catch swine flu at the end of their Tamiflu course. They will then have low levels of Tamiflu in their blood which will encourage the development of Tamiflu resistance.
I’ve had a look at the “case definition” in the link supplied by Attila. It does look very broad. Here is what it says:
Current case definition
Children and Adolescents > 12 months old – 18 years
Acute onset of illness with a measured temperature of ≥ 38.5°C or significant history of fever (rigors, sweating chills) plus two or more of cough, sore throat, body aches, fatigue/tiredness or shortness of breath.
Adults (over 18 years)
as above except a measured temperature of 38°C may be used.
Or Laboratory confirmed Influenza A
It is important to check the DHS Human Swine Flu website regularly as the case definition may change over time.