Quyết định 528/QD-BYT

DECISION

GUIDELINES ON HOME TREATMENT OF CHILDREN WITH COVID-19 INFECTION

THE MINISTER OF HEALTH

Pursuant to the Law on Prevention and Control of Infectious Diseases 2007;

Pursuant to the Law on Medical Examination and Treatment 2009

Pursuant to the Government’s Decree No.75/2017/ND-CP dated June 20, 2017 on functions, duties, powers and organizational structure of the Ministry of Health; 

According to the minutes of meeting dated March 1, 2022 of the Council for the development of documents, professional guidelines and regulations on assurance about the diagnosis and treatment of COVID-19 established in accordance with Decision No. 4026/QD-BYT August 20, 2021 of the Minister of Health;

At the request of the Director of the Vietnam Administration of Medical Services and the Ministry of Health.

HEREBY DECIDES:

Article 1. The “Guidelines on home treatment of children with covid-19 infection” is promulgated with this Decision.

Article 2. The “Guidelines on home treatment of children with covid-19 infection” applies to grassroots level and households

Article 3. Departments of Health of provinces or centrally affiliated cities shall, in consideration of COVID-19 situation in their provinces, provide guidelines on home treatment children with covid-19 infection in order to develop and implement this document in their provinces. 

Article 4. This Decision takes effect from the date on which it is signed.

Article 5. Chiefs of the Ministry Offices, Chief Inspectors of Ministries, General Directors and Directors of Departments affiliated to the Ministry of Health, Directors of Departments of provinces and centrally affiliated cities, Directors of Hospitals affiliated to the Ministry of Health, Healthcare Directors of Authorities shall implement this Decision ./.

GUIDELINES

ON HOME TREATMENT OF CHILDREN WITH COVID-19 INFECTION
(Issued together with Decision No. 528/QD-BYT dated March 03, 2022 of the Minister of Health) 

LIST OF EDITORS
“GUIDELINES ON HOME TREATMENT OF CHILDREN WITH COVID-19 INFECTION”

APPENDIX

I. CRITERIA FOR HOME TREATMENT OF CHILDREN WITH COVID-19 INFECTION

II. HEALTH DECLARATION

III. NECESSARY PREPARATION FOR HOME TREAMENT OF CHILDREN

1. Necessary items

2. Medicine

3. Isolation, infection prevention

4. Means of communication

IV. GUIDELINES ON HOME TREATMENT OF CHILDREN WITH COVID-19 INFECTION

1. Guidelines on monitoring the health of children with COVID-19 infection

2. Medicine

3. Implement measures for preventing infection

4. Test COVID -19 to end isolation and start home treatment

V. DUTIES OF HEALTH STATIONS AND HOME TREATMENT MANAGEMENT FACILITIES

GUIDELINES

ON HOME TREATMENT OF CHILDREN WITH COVID-19 INFECTION

I. CRITERIA FOR HOME TREATMENT OF CHILDREN WITH COVID-19 INFECTION

1. Clinical criteria

- Is a child who is ≤ 16 years old and confirmed cases of SARS-CoV-2 infection by real-time RT-PCR method or rapid antigen test that is done at home by caregivers; healthcare workers or medical facilities.

- Do not have clinical symptoms or hypoxia; have mild clinical symptoms; SpO2 > 96% when breathing normally; normal breathing

- Do not have underlying conditions, or such conditions are under stable treatment.

2. Caregivers

Are parents, relatives, etc. who have the ability to take care of and monitor the health of children (hereinafter referred to as “caregivers”) and contact medical staffs (via phone, computer…) to be monitored and treated in case of emergency.

II. HEALTH DECLARATION

1. Rapid assessment of home treatment of children: Health workers, medical facilities or caregivers shall assess children who are subject to home treatment specified in Section I above.

2. Caregivers shall notify health stations of districts, communes or facilities that manage COVID-19 patients at home... according to guidelines of local authorities of personal information, time of being confirmed cases of COVID-19 infection, ability to treat children at home, at the end of isolation and home treatment.

3. The health stations of communes or facilities that manage children with COVID-19 infection shall collect information and make a list of COVID-19 patients at home according to the form specified in Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health on the promulgation of the “guidelines on management of covid-19 patients at home”

III. NECESSARY PREPARATION FOR HOME TREAMENT OF CHILDREN

1. Necessary items at home:

a) Thermometer;

b) SpO2 Pulse Oximeter for personal use (if any);

c) Medical mask;

d) Hand sanitizer;

d) Necessary personal items;

e) Container containing infectious waste with lids.

2. Medicine

a) Paracetamol (powders; granules for suspensions or tablets with content of 80mg, 100mg, 150mg or 250mg that are sufficient for use within 5-7 days).

b) Oresol and other electrolytes

c) Cough suppressants (herbal medicine which is preferable) that are sufficient for use within 5-7 days.

d) Nasal sparys: 0.9% natriclorua that are sufficient for use within 5-7 days.

dd) Medicine for treatment of underlying conditions (if any, that are sufficient for use within 01-02 week (s))

3. Isolation, infection prevention

a) Create a separate space for the purpose of isolation of children, especially when they are able to take care of themselves. The isolation area shall have good ventilation, no central air conditioner. The windows of the isolation area shall always be opened.

b) The children with COVID-19 infection ( ≥ 2 years old), caregivers, family members and children who are  ≥ 2 years old shall wear medical masks.

c) Keep a distance that is at least 2 meters between a child with COVID-19 infection and others (if possible).

4. Means of communication

Telephones, phone numbers of medical facilities (medical stations, health centers of districts, emergency transportation centers, doctors, community consultation teams, rapid response teams, etc.).

GUIDELINES ON HOME TREATMENT OF CHILDREN WITH COVID-19 INFECTION

1. Guidelines on monitoring the health of children with COVID-19 infection

1.1. Children who are under 5 years old

a) Monitor symptoms, including: mental signs, breathing rate, pulse, skin color, mucous membranes, digestive disorders, breastfeed and eating; measure SpO2 (if any) and body temperature at least 2 times/day

b) Report abnormal symptoms to medical staffs or take the children to the nearest medical facility for medical examination and treatment when they have one of the following abnormal symptoms:

 (1) Mental health: children are withdrawn, convulsive or hard to wake up.

 (2) Continuous fever >39◦C. It is difficult to lower body temperature by antipyretic drugs + applying warm water The fever does not improve after 48 hours

 (3) Rapid breathing rate

- Children under 2 months old: ≥ 60 times/minute

- Children from 2 to 12 months old: ≥ 50 times/minute

- Children from 1 to 5 years old: ≥ 40 times/minute

 (4) Children with abnormal breathing: dyspnea, nose flaring, intercostal retractions, abdominal external oblique muscles

 (5) Signs of dehydration: dry lips, sunken eyes, thirst, little or no urination<0}

 (6) Cyanosis

 (7) SpO2 < 96%

 (8) Nausea

 (9) Drinking, eating and breast refusal

 (10) Children with underlying conditions: Dengue fever; Hand, foot and, mouth disease….

 (11) Other abnormal symptoms that are serious

1.2. Children who are above 5 years old

a) Monitor symptoms, including: mental signs, breathing rate, pulse, skin color, mucous membranes, digestive disorders, eating, stomachache, chest pain, smell and taste; measure SpO2 (if any) and body temperature at least 2 times/day

b) Report abnormal symptoms to medical staffs or take the children to the nearest medical facility for medical examination and treatment when they have one of the following abnormal symptoms:

 (1) Dyspnea;   

 (2) Continuous cough

 (3) Drinking/eating refusal

 (4)  The fever that does not go down or improve after 48 hours

 (5) Nausea

 (6) Chest pain

 (7) Diarrhea

 (8) Withdrawal from interaction

 (9) SpO2 < 96%

 (10) Rapid breathing rate: children from 5 to under 12 years old: ≥ 30 times/minute; children above 12 years old: ≥ 20 times/minute

 (11) Abnormal breathing: intercostal retractions, abdominal external oblique muscles

 (12) Other abnormal symptoms that are serious

2. Medicine

a) Antipyretic drugs in case of fever ≥ 38,5◦C: Paracetamol with a dose of 10-15 mg/kg/time (orally or rectally administered at least 4-6 hours in case of repetition (or according to age, detailed in the Appendix).  Note: the total dose shall not exceed 60 mg/kg/day.

b) Electrolyte replacement in case of dehydration (due to fever, diarrhea, fatigue): Encourage children to drink a lot of water, juice or Oresol (use according to instructions). If children do not want drink Oresol, thay can drink cooled boiled water or juice. Do not use industrial soda that is not produced from fruit for the purpose of rehydration;

c) Eat nutrient rich food, fresh fruits and vegetables     

d) Use symptomatic drugs (if necessary)

- Cough: cough suppressants (herbal medicine which is preferable)

- Nasal congestion, runny nose: nasal sprays, nasal drops with 0.9% natriclorua.

- Diarrhea: probiotics and digestive enzymes

dd) Continue to use medicines for outpatient treatment for underlying conditions according to instruction.

e) Note:

- Do not use antiviral drugs, antibiotics, anti-inflammatory drugs... without the direction of medical staffs

- Do not steam children.

3. Measures for prevention of infection          

a) Children with COVID-19 infection

- Do not leave the isolation area during the isolation time.

- Do not share items with other people.

- Do not eat or drink with other people.

- Do not have close contact with other people or pets.

b) Caregivers

- Regularly wash or disinfect hands . Disinfect objects and contact surfaces, including countertops, doorknobs, toilets, sinks...

- Classify and collect infectious waste according to regulations.

- Wear masks, face shields (if any), wash their hands before and after taking care of children.

4. COVID-19 test for the purpose of ending the medical isolation and home treatment:

a) The time of isolation and treatment shall be 7 days. The rapid antigen test that is done by medical staff or the caregiver and the child at home shall have negative result of SARS-CoV-2 virus.

b) In case the test result is still positive after 7 days, the children who are fully vaccinated shall continue to isolate within 10 days according to regulations.

V. DUTIES OF HEALTH STATIONS, FACILITIES THAT MAGEMENT HOME TREATMENT OF CHILDREN

1. Manage a list of children with COVID-19 infection at home according to the form specified in Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health on the promulgation of the “guidelines on management of covid-19 patients at home”

2. Assess and classify home management of children with COVID-19 infection.

3. Direct caregivers to monitor the health of children with COVID-19 infection

4. Implement emergency and direct caregivers to transfer the children to the nearest medical facilities in case of abnormal signs and symptoms.

5. Confirm the recovery of chilldren according to applicable regulations

6. Perform other duties according to applicable regulations. 

APPENDIX

GUIDELINES ON PARACETAMOL DOSAGE FOR CHILDREN ACCORDING TO AGE
(only use in case of unknown weight– Calculation of a paracetamol dose in children should be based on body weight)

Note: Take paracetamol in case of high fever (> 38.5⁰C). If the children still have fever, they can take paracetamol every 4 to 6 hours.