Swine flu revised guidelines - India

So far, the present guidelines stipulate that a person suspected of influenza A H1N1 need to be referred to an identified govt. health facility. He/she needs to be kept in an isolation facility in that hospital and if found positive, is treated accordingly. 

In order to make the testing facility for H1N1 more accessible at large and due to the onset of the Influenza season in the country, it has been decided to revise the existing guidelines.

Under the new guidelines, any person with flu like symptoms such as fever, cough, sore throat, cold, running nose etc. should go to a designated Government facility for giving his/her sample for testing for the H1N1 virus.  After clinical assessment, the designated medical officer would decide on the need for testing. Except for cases that are severe, the patient would be allowed to go home (This was not allowed under the existing guidelines).    

The sample of the suspect case would be collected and sent to the notified laboratory for testing. If tested as positive for H1N1 and in case the symptoms are mild, the patient would be informed and given the option of admission into the hospital or isolation and treatment at his own home.

In case the patient opts for home isolation and treatment, he/she would be provided with detailed guidelines / safety measures to be strictly adhered to by the entire household of the patient.  He/ she would have to provide full contact details of his entire household. The house hold and social contacts would be provided with the preventive treatment.

Notwithstanding the above guidelines, the decision of the doctor of the notified hospital about admitting the patient would be final.

In case the test is negative, the patient will accordingly be informed.

These guidelines have been issued by the Government in public interest and shall be reviewed from time to time depending on the spread of the pandemic and its severity in the country.  These guidelines would however not apply to passengers who are identified through screening at the points of entry.  The existing policy of isolating passengers with flu like symptoms would continue.

TB: Why you should not discriminate

Impact of Stigma and Discrimination

Tuberculosis is an infectious disease caused by bacteria that any person can get. It is not a hereditary disease or a curse of God. It can be completely cured by taking regular and complete treatment. Stigma and discrimination against people diseased with TB can occur in many settings at the workplace, health care facilities, or within the community. Its manifestation can be as dramatic as physical violence or as subtle as avoidance. However, it is totally unnecessary and primarily based on myths. Stigma is as old as history. Stigma and discrimination against people infected with TB can occur in many settings at the workplace, healthcare facilities, or within the community. Its manifestation can be as dramatic as physical violence or as subtle as avoidance. However, it is totally unnecessary and primarily based on myths. Beyond the economic consequences, stigma and discrimination against people with TB have a devastating social and psychological impact. Such attitudes obstruct health care providers in delivering effective treatment. Stigma often prevents people from seeking health care attention, which constitutes a direct public health threat to the community. Even when patients attend treatment, social disapproval of their family or community members decreases compliance with treatment. Proper adherence, however, is critical to avoid the development of multi-drug resistant TB (MDR-TB). Social isolation, experienced rejection, shame and blame due to TB diagnosis can lead to psychosomatic stress, loneliness and feelings of hopelessness.



                                 

                                                                                                                                          

Some of the causes of stigma & discriminationinclude:
•Lack of knowledge about TB transmission, diagnosis and treatment.
•Association with conditions already stigmatized particularly HIV/AIDS, poverty, malnutrition, migration and poor hygienic living conditions.
•People with TB are often seen as being responsible for becoming infected.
• People living with TB are seen as guilty of infecting others.
• Lack of protective equipment for health care workers.
• Lack of access to treatment.

                                                                         
TB related stigma and discrimination can be minimized!

                                                     
It is important that employees and healthcare professionals understand the determinants and dynamics of stigma to ensure that they prevent the violation of human rights, that patients seek timely advice and achieve good treatment adherence. It is suggested that company management implement the following strategies to minimize TB related stigma and discrimination at the workplace:

•Provide a supportive work environment, where people can disclose their TB status without the threat of being stigmatized and risk losing their jobs. Have in place a policy that addresses this so that workers don’t lose their jobs because of being diagnosed as TB; rather such TB patients are provided proper care and access to DOTS services.

• Influence people’s attitudes through awareness about TB, to provide up to date information on TB epidemiology, diagnosis, transmission, treatment and address TB related stigma and discrimination. Increasing factual knowledge should be followed by experiential learning, which helps employees reflect their own attitude about TB and understand individuals affected by TB stigma and discrimination.

•Involve those with personal experience with TB and set up “Support Groups”. Such groups can encourage the exchange of experiences related to TB and address issues concerning social and workplace support.

• Initiate workplace campaigns to change attitudes. The aim of these campaigns is to provide accurate, up-to date information on TB (‘TB is curable’).

• Develop sustainability of TB anti-stigma campaigns through partnerships with private and public national and international companies.

• Respect confidentiality. Risks of disclosure might include negative responses, such as rejection, isolation and loss of employment. This can result in poor treatment adherence and/or the spread of TB to other employees.

•Link with existing HIV/AIDS anti-stigma workplace initiatives.

•Ensure occupational safety for health care staff and appropriate working conditions for all, e.g. ensuring good ventilation of premises and/ or applying air filtration. TB anti-stigma interventions should be in place in every company.

Source: Adapted from ICN Document: TB/MDR TB Related Stigma and Discrimination.