H1N1 is now spreading within the local communities of Singapore. Most patients do recover from the infection with only basic symptomatic treatment and rest. The estimated case fatality rate is around 0.16 to 0.3% ie out of 1000 thousand infected only about 1-3 people will die from complications. The Ministry of Health has identified several groups of patients that are considered high risk for developing complications when infected with H1N1. These are :

• Persons >= 65 yrs old
• Children <= 5 yrs old
• History of chronic lung disease such as chronic obstructive lung disease or chronic asthma
• History of heart disease

Anyone with regular follow-up in the last one year on :

• Chronic metabolic diseases such as diabetes
• Kidney impairment
• Haemoglobinopathies such as Thalassaemic patients
• Immunosuppression from medication or infection such as HIV infection

• Children and teenagers 6 months to 18 years who are on long term aspirin treatment
• Pregnant women

Ministry of Health has advised the public that anyone who has come down with influenza-like-illness should excuse themselves from work or school and present themselves to a doctor at the Pandemic Preparedness Clinics (PPC) or polyclinics or to see their own family doctors. Ministry of Health has defined influenza-like-illness (ILI) as anyone coming down with fever (>38) + two out of any of these symptoms (sore throat, cough, body aching, running nose). Patients with ILI will be assessed by the doctors regarding their risk of developing influenza complications according to the list given above. Patients who fit into the list will be treated with Tamiflu. Adult patients with ILI will be given 7 days of medical leave from onset of symptoms and for children, 10 days of medical leave. The medical leave is given so that the patients can be isolated at home and avoid further spread to the people around them.

Patients with ILI should be socially responsible by :

1. Avoiding crowed places
2. Avoid taking public transport
3. Isolation at home especially if there are young children, elderly or patients with chronic diseases
4. Avoiding visitation
5. Avoid going to work places
6. Wearing a mask if there is a chance of contact with other people in close proximity

With the presence of local spread, patients should also highlight to the doctors if they develop flu symptoms that do not fit into the ILI definitions, when they have been to the local clusters. This is because some patients with H1N1 will not present with typical ILI symptoms.

Due to the high risk of influenza related complications, it is advisable for patients to seek consultation with their specialist if they are pregnant, on kidney dialysis, on chemotherapy, or if age <1 year old.