Chinese guidelines for influenza management

Sir, the recent publication on Chinese guideline for influenza management is very interesting (1). Indeed, there are many recent publications on regional guideline for management of influenza such as recent publications for Eastern Mediterranean Region (2) and European (3). It is wise to set a specific guideline for different region with different underlying geographical pathology pattern. An important thing to be considered is the attachment to the guideline by the health practitioners. Some specific groups of practitioners might have the problems in implementation. It is reported that the young internists is the group that have the problem of practice and there might be reasonable to add a specific guideline for them (4). Also, another study reports that generalists are more frequent to recommend vaccination to risk patients comparing to the specialist (5). Hence, there must be the system to reassure the success of implementation of the proposed guideline. As Rickert et al. noted, "research is needed to assist in putting support strategies into practice (6)". The other concern is on the generalization of this atypical influenza such as swine flu. It should be noted that swine is presently re-emerging in Southeast Asia and might expand to China (7). The effectiveness of the present guideline to correspond the emerging of atypical influenza is a challenging issue.

Acknowledgements

Disclosure: The authors declare no conflict of interest.

References

1. Zhong NS, Li YM, Yang ZF, et al. Chinese guidelines for diagnosis and treatment of influenza (2011). J Thorac Dis 2011;3:274-89.
2. Al Hajjar S, Malik MR, Hallaj Z, et al. Clinical management guidelines for pandemic (H1N1) 2009 virus infection in the Eastern Mediterranean Region: technical basis and overview. East Mediterr Health J 2011;17:342-8.
3. Stephenson I, Clark TW, Pareek M. Antiviral treatment and prevention of seasonal influenza: a comparative review of recommendations in the European Union. J Clin Virol 2008;42:244-8.
4. Rothberg MB, Bonner AB, Rajab MH, et al. Do pediatricians manage influenza differently than internists? BMC Pediatr 2008;8:15.
5. Nichol KL, Zimmerman R. Generalist and subspecialist physicians’ knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for elderly and other high-risk patients: a nationwide survey. Arch Intern Med 2001;161:2702-8.
6. Rickert D, Santoli J, Shefer A, et al. Influenza vaccination of high-risk children: what the providers say. Am J Prev Med 2006;30:111-8.
7. Wiwanitkit V. New bird flu death, new pandemic and new public health issue. Adv Trop Med Pub Health Int 2012;2:30-1.