TTSH releases clinical data of first 50 H1N1 patients in Singapore
By Satish Cheney, Channel NewsAsia | Posted: 24 June 2009 1923 hrs

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SINGAPORE: The World Health Organisation uses a temperature benchmark of 37.8 degrees Celsius as one of the factors to determine if someone is a suspect H1N1 case, but experts at the Tan Tock Seng Hospital warn that doctors should not overlook those with low fever as well.

92 per cent of H1N1 patients in Singapore had respiratory infections, but 46 per cent had mild fever of less than 37.8 degrees Celsius when they sought medical treatment.

This is according to Tan Tock Seng Hospital, which released its clinical findings on the first 50 H1N1 patients on Wednesday.

Professor Leo Yee Sin, clinical department head at Tan Tock Seng Hospital, said: "We do come across many patients where the fever may not be very high. It's important to be able to add several symptoms together that would include fever and respiratory symptoms that would include running nose, cough, sore throat and other clinical symptoms like headache and muscle ache."

The professor continued to say that it is possible for general practioners to miss out on diagnosing some of their patients as having the H1N1 virus because their symptoms could be very mild.

There is also the possibility that some patients may not show any symptoms at all.

According to the hospital, about 20 per cent of the first 50 H1N1 cases who are on Tamiflu were still infectious on the fifth day of treatment.

It was found that patients who started Tamiflu earlier (for example on the second day instead of the third day of infection) tend to recover faster.

One of the bigger concerns for medical authorities now involves the higher risk group – people with asthma, very young children, the elderly and anyone with major underlying medical problems.

The high risk group also includes those with chronic lung disease, heart disease, liver disease, renal disease, immuno-compromised patients such as those on chemotherapy, radiotherapy or patients who are required to be on long-term steroids and pregnant women.

Professor Leo said: "How the disease is going to behave in the high risk population is yet to be seen and to be determined in the local situation.

"However, we know from overseas data and understanding of seasonal influenza, that high risk groups tend to have a higher frequency of complications and they may have adverse outcomes and we may not be surprised that there may be deaths among the risky individuals."

The hospital said high risk patients may need more medical attention while on antiviral medication.

Another concern is the mutation of the H1N1 virus as it mixes with other types of flu viruses. Professor Leo said this is something the authorities are keeping track of.

The hospital said it will be doing more clinical research to help authorities understand the nature of the disease better. It has urged the public to remain vigilant and not to be complacent.

Professor Leo said Singaporeans must change their mindsets about donning face masks when they are sick and that they should adopt a life-long approach to improve their personal hygiene to ward off flu viruses.

- CNA/yb