Since July 23, the management of patients is assigned to general practitioners and not just to hospitals. What changes for patients? Who to contact in case of flu symptoms? When to go to the hospital? ... Doctissimo answers your questions.
Here are 10-point change on the management of pandemic influenza A/H1N1, following the press conference the Ministry of Health July 22, 2009 1:
1. The doctor becomes the first contact
Since July 23, sick of influenza A should not call the 15 but through their doctor. In cases of high fever (> 38.5 ° C), cough, fatigue, you should no longer pass by the UAS but directly call your family doctor. The latter decide the course of treatment. Most often, it is limited to paracetamol and rest.
The prevention recommendations are still valid: washing hands several times a day with soap or a hydro-alcoholic solution, using a tissue to cough or sneeze and put used tissues in a garbage can followed by a handwashing.
2. An organization set up to study
How will GPs be able to accommodate these cases of influenza without risk of infecting others see patients? Ideally, two different waiting rooms would be required but for most firms, such an organization is difficult or impossible. "Everything depends on the number of patients: 5 or 45 patients per day? If premises do not adapt, time slots dedicated to patients with influenza will be to provide and use barriers that the measures we recommend to our patients : clean doorknobs, wear masks ... We will adapt to the reality that will change every day, "said Dr. Martial Koehret Olivier, president of the union MG France.
Spatial Location, time slots, capacity management support during the summer months ... "This will require adjustments along the water."
3. GPs sufficiently informed and prepared?
The Minister responsible initiatives have multiplied of information to GPs: 300 000 training kits and information sent two years ago, 450 of 000 kits including protective masks and protective Splash, training sessions in 2006 and 2007 in all regions, direct information to subscribers of DGS Urgent, two preparatory meetings with unions in early July and a letter sent to the 80 000 general practitioners, pulmonologists and pediatricians July 15. Finally, according to the Minister, the Prefect will meet with doctors from July 23 and before August 10 at a briefing. These meetings should also help to adapt the management of the epidemic through the "mountain land" professionals. A site dedicated to health professionals to provide medical information but also regional national epidemic.
Large stocks of FFP2 masks (to protect themselves from viruses) and Splash masks (for those infected) are distributed from a single point in the region since early May Today, 16 distribution centers are operational. "They should cover tomorrow all departments," says Thierry Coudert, Managing Director of the Institution of preparation and response to health emergencies.
4. No systematic Tamiflu ®
Only cases potentially most serious benefit of Tamiflu ®, the famous new antiviral available in pharmacies and reimbursed by the National Health Insurance. No indication for preventive medication is recommended, since the contrary view that such use might encourage the emergence of resistance to antiviral drugs.
In a pandemic, stockpiles made by the Government will be sufficient, according to Health Minister Roselyne Bachelot, which invites the public not to provide Personal Reserve: "We have enough antiviral treatments to address a wide pandemic. No effect medicine cabinet! Doctors are the guarantors of a good use of antivirals and I know I can count on them.
5. The hospital reserved for severe cases
Only children under 1 year (through their parents) or victims of complications of influenza should contact the 15 or go directly to the hospital. Hospitals have antivirals pediatric use.
Where appropriate, the physician can guide the serious cases to hospital. But because of the less formidable profile of the virus and its active movement throughout the territory, the hospital is no longer the centerpiece of the national plan of care for patients.
6. Masks Free Pharmacy
As of July 23, the repellent masks to be worn by the patient (to avoid contaminating the environment in cases of infection and not to protect the virus) will be issued free pharmacy if they have been prescribed by the doctor. Director General of the establishment of preparedness and response to health emergencies, and Thierry Coudert said that "the deployment of masks to the metropolitan territory of pharmacies will be completed July 23 in the afternoon. For Reunion and New Caledonia the transaction will be completed July 27.
7. More systematic research of the virus
Given the spread of the virus (and its relative harmfulness), the naso-pharyngeal sampling to search the H1N1 virus is no longer mandatory. They now share the principle that symptoms necessarily reflect confirmed influenza infection with influenza A.
This also means that the procedures related to localized foci of infection (isolation of sick children in summer camps for example) will be triggered without infection by the H1N1 influenza virus is confirmed by analysis laboratory.
8. Vaccine against pneumococcal recommended for some people
The Society of Infectious Pathology (SPILF), the SFLS (French Society for the Fight against AIDS) and ESC (GP's National College of Teachers) recommend increased pneumococcal vaccination in some people fragilisées2. Must be vaccinated: respiratory insufficiency, cardiac insufficiency, alcoholic patients with chronic liver disease, persons with a history of invasive lung infection or pneumonia, patients with functional asplenia or splenectomy, patients with homozygous sickle cell disease the patients with nephrotic syndrome and patients with HIV infection and with CD4> 200/mm3. The aim is to prevent the population in this pneumococcal superinfection of influenza.
9. Vaccines available at best in October
94 million doses ordered were ordered by the government in three different laboratories (Sanofi-Pasteur: 28 million doses, GlaxoSmithKline: 50 Novartis 16). Based laboratories, the doses should be delivered between October and December 2009. Given that vaccination require two injections three weeks apart and a time of incubation before being protected, some fear that the first doses arrive after the peak of the pandemic ...
If England is planning to ignore the permissions on the market (AMM) European (via emergency procedures), France seems more prudent. The epidemiological situation in France is less cause for concern. If the virus retains a moderate virulence, France could expect to obtain the European marketing authorization prior to vaccination.
Today, the vaccination strategy is not adopted, but no compulsory vaccination is now considered. Depending on the evolution of the epidemic, mass vaccination could be achieved in immunization clinics or by physicians.
10. The management of drug stocks and masks to improve
It is the establishment of preparedness and response to health emergencies (Eprus) who manages a stock valued at 845 million euros, including 33 million antiviral 1 billion surgical masks and 537 million protective masks FFP
His action was pinned by a report of centrist Senator Jean-Jacques the criticisms made, we note: dispersion and heterogeneity of the 72 storage sites, uncertainty related to exceeding the expiry date of products, storage products in places sometimes just adequate, a lack of clarity between the roles attributed to the public, health agencies and various departments ... Without putting into question the creation of Eprus, the report estimates that these findings could "pose difficulties in coordinating emergency health" ...
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