The Health Ministry has been monitoring the H1N1 situation over the last few months and we acknowledge the significant community transmission of the virus in the country. The number of patients requiring hospital care has increased, including ICU admissions.

With the evolution of the pandemic, the ministry has also adjusted its management guidelines to keep in tandem with the situation. There should also be coverage for those with influenza-like illness who do not have co-morbidities (risk factors) as they make up 20% to 25% of all H1N1 hospital admissions. Nonetheless, we recognise that more than 90% of patients infected with H1N1 will have a mild and self-limiting disease lasting one to three days. Treatment with influenza anti-virals for these individuals may not be necessary.

Hence, to balance the concerns of widespread overuse and the need to get treatment to a proportion of those with no co-morbidities, the ministry recommends using clinical assessment to assist decision making, with fever being a good indicator of disease activity.

Our current updated guidelines recommend the usage of influenza anti-virals for the following:

> All patients admitted for influenza-related complications. H1N1 confirmation is not required for commencement of therapy in these cases.

> All patients with high risk co-morbidities who present with influenza-like illness (ILI).

> All patients with ILI (but do not have co-morbidities) who present with fever of 38°C after 48 hours of fever. However, any patient with ILI who is experiencing rapidly progressive symptoms in the first two days of illness may also be started on therapy. This will be the clinical purview of the attending doctor.

Rapid influenza diagnostic testing is not a requirement for commencement of therapy but, if available, may be used to assist in clinical assessment, which remains the crux of clinical decision-making.

The ministry will continue to monitor the situation on the ground, including reviewing all mortalities and identifying potential areas of weakness. We believe there is still much to learn from this pandemic, which is still evolving.

We continue to be flexible in our strategies in dealing with this pandemic and will not hesitate to make changes in our approach to safeguard the health and well-being of our people.


Director General of Health.