One must be cautious to recognise symptoms of Flu A and know the steps to take for you or your family. You need to ensure that you have a thermometer to take your child’s temperature. You need to consult your GP if your child has a temperature of 38° C or above or any of these symptoms: Headache, tiredness, runny nose and sneezing, sore throat, shortness of breath, loss of appetite, vomiting and diarrhoea, aching muscles, limb and joint pain or even if your child is younger than one year.

What to do?
If your child is confirmed to have Influenza A by your GP, they should stay at home and treated like any other cold. They must drink plenty of liquids, take adequate rest and paracetamol for controlling their temperature. Your GP will prescribe your child the appropriate antiviral drugs like Oseltamivir. This can shorten the duration of symptoms and reduce the risk of complications. If symptoms are mild and do not wish to give them antivirals, you need to ask your GP for advice. Oseltamivir is suggested based on the review on seasonal flu in children but not swine flu. Hence, authors consider it as uncertain to apply these findings to swine flu as its behaviour is different from usual seasonal flu. ³¹

Special Considerations:
Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) are contraindicated in confirmed or suspected ill cases of novel influenza A virus, among 18 years old and younger due to the risk of Reye syndrome. Anti-pyretic medications such as acetaminophen or non- steroidal anti-inflammatory drugs are recommended instead. Children younger than 4 years of age should not be given over-the-counter as cold medications without doctor’s prescription. ¹⁷

Risk of Influenza A:
The pandemic might reach its height in the autumn when 1 in 3 people may be affected and pregnant women with Flu A will have a higher risk of developing complications with even mild symptoms. Complications of the infection (including pneumonia) can cause a risk to the mother as well as the baby’s health. This risk is more in the second and third trimesters of pregnancy but these risks can not be quantified in early pandemic. However, most of them make an uncomplicated recovery.

Effects on pregnancy:
The major adverse effect of H1N1 is attributed to maternal hyperthermia during the first trimester doubling the risk of neural tube defects and other adverse outcomes including neonatal seizures, encephalopathy, cerebral palsy, and neonatal death. This might be treated with the use of antipyretic medications like Acetaminophen and/or multivitamins containing folic acid.

Precautions:
Bearing these risks in mind, pregnant women are advised to take the following measures to reduce their risk of flu and its complications:

• Avoid normal activities like going to work, travelling in public transport, or attending family gatherings and other events. Avoid large densely populated gatherings with little control over personal contact.
• Follow good hand hygiene and avoid contact with suspected cases with flu-like symptoms,
• Contact General physician for treatment advise with antiviral drugs

Treatment Recommendations:
It is better not to waste time in waiting for viral test results and must initiate treatment as medications are beneficial if started after onset of symptoms within 48 hours. Oseltamivir and Zanamivir treatment and chemoprophylaxis recommended similar to those for adults with seasonal influenza. The drug of choice for treatment in pregnant women is Oseltamivir due to its systemic activity. It is to be administered for five days. However, research data suggests that treatment for hospitalized patients is beneficial even if started after 48 hours after onset.

Post exposure antiviral chemoprophylaxis with Zanamivir is recommended for pregnant women if they are on close contacts with suspected or confirmed H1N1 cases due to its limited systemic absorption. However, its limitation is its associated risk of respiratory complications due to its inhaled route of administration. Hence, must not be considered for those with respiratory problems where Oseltamivir can be an alternative. Chemoprophylaxis is to be given for 10 days following exposure to H1N1. Both are considered safe during breastfeeding your baby. ³¹

Use of Antivirals during Pregnancy:

• Oseltamivir, Zanamivir, Amantadine and Rimantadine are both "Pregnancy Category C" medications i.e. no clinical studies were conducted to assess the safety of these medications for pregnant women. Only two cases of Amantadine use during last trimester were reported for severe influenza illness. However, both Amantadine and Rimantadine have been demonstrated to be teratogenic and embryotoxic in animal studies at substantially high doses.
• Since, the effects of influenza antiviral drugs on pregnant women and their fetuses are unknown; these four drugs should be used during pregnancy only if the potential benefit outweighs potential risk to embryo or fetus. The manufacturers' package inserts should be read carefully. However, no adverse effects have been reported with Oseltamivir or Zanamivir among pregnancy women or among infants born to such women. ¹⁷

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