WHO lists warning signs for severe H1N1 disease

Jul 31, 2009 (CIDRAP News) – The World Health Organization (WHO) today issued a list of warning signs of possible severe disease in H1N1 flu patients, while adding its voice to the recent warnings about the virus's threat to pregnant women.

The WHO said signs that can signal a progression to severe disease include shortness of breath, difficulty breathing, turning blue, bloody or colored sputum, chest pain, altered mental status, high fever lasting more than 3 days, and low blood pressure.

In addition, particular danger signs in children include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play, the agency said.

Because a patient's condition can worsen very quickly, medical attention should be sought when any of the warning signs appear, the WHO advised.

The agency noted that most patients continue to have mild symptoms and recover fully within a week, but a few people, usually younger than 50, rapidly progress to severe and often fatal illness. "No factors that can predict this pattern of severe disease have yet been identified, though studies are under way," the statement said.

Regarding pregnant women, the WHO noted a US study published this week in The Lancet that showed an increased risk of severe or fatal H1N1 disease in this group. Several other countries also have noted an increased risk for pregnant women and a higher risk of fetal death or spontaneous abortion, the agency said.

"WHO strongly recommends that, in areas where infection with the H1N1 virus is widespread, pregnant women, and the clinicians treating them, be alert to symptoms of influenza-like illness," the statement said.

The agency said pregnant women should be treated with oseltamivir as soon as possible after symptom onset and should be a priority group for immunization.

In other comments, the WHO said monitoring of viruses from multiple outbreaks has revealed no evidence of a change in the virus's ability to spread or cause severe illness.

See also:

Jul 31 WHO statement
http://www.who.int/csr/disease/swineflu/notes/h1n1_pregnancy_20090731/en/index.html

Jul 29 CIDRAP News story "Study on pandemic flu risks in pregnancy finds antiviral treatment delays"