A/H1N1 flu pandemic: By any maths would be as weakBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4048 (Published 05 October 2009) Cite this as: BMJ 2009;339:b4048
All rapid responses
Unfortunately, swine flu cases have increased again from 3000 to 5000 new cases per week during 2nd week of September1. Patients can either call a dedicated Swine Flu information line on 08001513513 or go to www.pandemicflu.direct.gov.uk for more information and advice. Often the advice given to patients is that they have swine flu if they have two or more of the symptoms from table (I) along with high temperature2and commenced on antivirals3.
Table (I) sore throat headache runny nose unusual tiredness shortness of breath or cough loss of appetite aching muscles diarrhoea or vomiting Cannot stop crying (only children)
However the above symptoms are common with other serious illness and a wrong diagnosis without a clinician’s assessment could be fatal.
Up to 9th of September, 16 patients, with no underlying medical conditions, were admitted under the ENT department of Princess Royal University Hospital at Farnborough. These patients were previously diagnosed through the dedicated helpline or visiting the website as having swine flu and treated with Tamiflu (Table II). All these patients were later seen by ENT Surgeons of the Princess Royal University Hospital when they did not improve with the antiviral medication.
Table (II) Age Diagnosis 17 Peritonsillar Abscess 28 Orbital Cellulitis 35 Sub Mandibular Abscess 25 Peritonsillar Abscess 33 Acute Suppurative Tonsillitis 5 Mastoid Abscess 38 Peritonsillar Abscess 43 Parapharyngeal abscess 35 Peritonsillar Abscess 21 Peritonsillar Abscess 41 Acute Laryngopharyngitis 38 Peritonsillar Abscess 3 Neck Abscess 43 Peritonsillar Abscess 33 Acute Suppurative Tonsillitis 28 Peritonsillar Abscess
Patients admitted with non-potential life threatening infections, previously diagnosed and treated as swine flu are common and usually are either acute tonsillitis or peritonsillar abscess in our experience. However we are more worried about those potentially morbid conditions, such as Orbital Cellulitis and Para-pharyngeal abscess that are misdiagnosed as swine flu because of the presence of two of the commonest symptoms.
Wilson et al 4 report that only two out of 28 patients admitted to James Cook University hospital with suspected swine flu had positive H1N1 virus. Electronic or telephonic triage is not reliable and even experienced clinicians may not be able to diagnose electronically5. So to prevent wrong diagnosis of fatal conditions such as the above mentioned and meningitis, we recommend a clinician assessment of suspected swine flu patients.
1) BBC news 17th September : http://news.bbc.co.uk/1/hi/health/8261496.stm
2) Information about swine flu on NHS website: www.nhs.uk/Conditions/Pandemic-flu/Pages/Symptoms.aspx
3) Royal College of General Practitioners, authorisation of anti-viral treatment, URL: www.rcgp.org.uk/pdf/assessment_algorithim_updated.pdf (18.09.2009).
4) Wilson, E.J., Williams, J and McCarron, B. A/H1N1 influenza update, Case definition is too loose BMJ 2009; 339:b3365.
5) Bravata D, Sundaram V, McDonald K, et al. Evaluating detection and diagnostic decision support systems for bioterrorism response. Emerging Infectious Diseases 2004; 10:100-8.
Competing interests: Table (I)sore throatheadache runny noseunusual tirednessshortness of breath or cough loss of appetite aching muscles diarrhoea or vomiting Cannot stop crying (only children)