Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic

Correspondence to:
Dr W S Lim
Department of Respiratory Medicine, Nottingham University Hospitals, City Hospital Campus, Nottingham NG5 1PB, UK; weishen.lim{at}nuh.nhs.uk

SYNOPSIS OF MAIN RECOMMENDATIONS

This document is intended for use in the UK in the event that the World Health Organization declares that an influenza pandemic has started,¹ and the Department of Health in England (UK-wide lead agency on pandemic influenza, including the devolved administrations) has declared UK Pandemic Alert Level 2 (cases of pandemic influenza identified within the UK).
These guidelines are not relevant for the management of patients affected by seasonal/interpandemic influenza, lower respiratory tract infections, community acquired pneumonia or exacerbations of chronic obstructive pulmonary disease (COPD).
Once an influenza pandemic is under way, users are strongly urged to ensure that they refer to the most up-to-date version of these guidelines (from web-based access points).

Patients with uncomplicated influenza infection would be expected to make a full recovery and do not require hospital care.
In uncomplicated infection, the illness usually resolves in seven days although cough, malaise and lassitude may persist for weeks.
Patients with worsening of pre-existing comorbid medical conditions should be managed according to best practice for that condition with reference to published disease-specific guidelines, if available, for example the National Institute for Health and Clinical Excellence’s COPD guidelines.

In hospital, patients with influenza-related pneumonia and who have a CURB-65 score of 3, 4 or 5 (see Box A) are at high risk of death and should be managed as having severe pneumonia.
Patients with bilateral lung infiltrates on chest radiography consistent with primary viral pneumonia should be managed as having severe pneumonia regardless of CURB-65 score.
Patients who have a CURB-65 score of 2 are at increased risk of death. They should be considered for short stay inpatient treatment or hospital supervised outpatient treatment. This decision is a matter of clinical judgment.
Patients who have a CURB-65 score of 0 or 1 are at low risk of death. …

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