SWINE FLU

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SWINE FLUNOVEL H1N1 : 

SWINE FLUNOVEL H1N1 DR.ZAHOOR AHMAD MBBS,FCPS,MRCP[UK] QILWAH GENERAL HOSPITAL,ALBAHA,KSA

Influenza ABC’s : 

Influenza ABC’s There are three types of Influenza viruses, Influenza A, B, and C [Matrix&NP]. Influenza C: Causes mild disease in humans and is not associated with epidemics. Influenza B: Causes disease in humans, but it is usually mild. It occurs during annual epidemics, but has not been associated with pandemics. Influenza A is associated with annual epidemics and with prior pandemics. “Bird Flu” and “Swine Flu” are influenza A viruses.

SWINE FLUActual : 

SWINE FLUActual A respiratory disease of pigs, caused by type A&C influenza viruses.[H1N1,H1N2,H3N1,H3N2,H2N3] They cause regular outbreaks in pigs. People do not normally get swine flu, but human infections can happen. Swine flu viruses can spread from person-to-person. Recent H1N1 has 2 genes similar to swine flu virus.

Influenza H’s and N’s : 

Influenza H’s and N’s These are two surface proteins They affect viral spread. H = Hemagglutinin: it helps the virus get into cells. 16 different H proteins have been identified. N = Neuraminidase: it facilitates the release of new viral particles from the infected cells. 9 different N proteins have been identified. Circulating strains are identified by the H and N proteins present, for example: H1N1 or H2N3.

Slide 5: 

An example of an Influenza A virus and its official name.

Influenza AREAL PROBLEM : 

Influenza AREAL PROBLEM Antigenic shift, Antigenic drift, Reassortment.

Antigenic Driftminor : 

Antigenic Driftminor Changes in H and N proteins occur continuously. These small changes make you susceptible to the new virus that’s circulating each year. Called “Seasonal Influenza” That’s why you need a new influenza vaccine each year, to protect you from the new circulating strain.

Antigenic Shiftmajor : 

Antigenic Shiftmajor This is a larger change in the H and N surface proteins. When Antigenic Shift occurs, there may be little or no protection from prior infections. For example, infection with H1N1 virus confers little resistance to infection with an H3N2 virus. These larger changes, or shifts, may result in influenza pandemics, infecting much larger numbers of people than the annual epidemics.

Reassortment : 

Reassortment Mix between species. Most dangerous. Bad farming habits. Pandemic potential. H5N1,H7N2 in recent past. Many pandemics since 1889-90. Quadruple Reassortant.[NOVEL H1N1] Segmented 8 single stranded RNA

Infectious Period : 

Infectious Period In general, persons should be considered potentially infectious from one day before to 7 days following illness onset. Children, especially younger children, might be infectious for up to. 10 days. Incubation period 18—72 hours

How do virus types get mixed together? : 

How do virus types get mixed together? Large swine breeding farms. Large chicken ranches. Families with pigs or chickens/ducks/geese. Close relationships between animals and humans.

Pandemic Influenzapast,present&future : 

Pandemic Influenzapast,present&future 1918 - Spanish Flu, H1N1 1957 - Asian Flu, H2N2 1968 - Hong Kong Flu, H3N2 1977 – Russian Flu An H1N1 influenza strain that had not been seen since 1957 re-emerged. Older people were less frequently affected by it. They had been exposed to H1N1 before. Younger people who had not been previously exposed to the H1N1 strain were more frequently infected.

Swine Flu - Where is it Now? : 

Swine Flu - Where is it Now?

Clinical FeaturesUncomplicated NOVEL H1N1 : 

Clinical FeaturesUncomplicated NOVEL H1N1 Fever Headache Upper respiratory tract symptoms cough, sore throat, runny nose Sore muscles Fatigue Vomiting, or diarrhea.

Mild Influenza Sounds a Lot like the Common Cold! : 

Mild Influenza Sounds a Lot like the Common Cold!

Influenza vs. the Common Cold : 

Influenza vs. the Common Cold Onset Fever Sore Muscles Fatigue Sore Throat Headache Sneezing Stuffy Nose Cough Nasal Discharge Cause Abrupt Virtually always, >101oF often Common, often severe Severe, near exhaustion Sometimes Prominent Sometimes Sometimes Dry, nonproductive, may be severe Clear, modest amounts Inf.viruses. Gradual Practically never Mild, or nonexistent Mild Common Rare Usually Usually Hacking, possibly productive Clear or green/yellow, possibly Lots Rhino,Corona,RSV,Parainf,Adeno Influenza Common Cold

Complicated Swine FluExpect complications to be similar to seasonal influenza. : 

Complicated Swine FluExpect complications to be similar to seasonal influenza. Worsening of underlying chronic medical conditions[CCF.BA,COPD] Upper respiratory tract disease sinusitis, otitis media, croup Lower respiratory tract disease pneumonia, bronchiolitis, status asthmaticus Cardiac myocarditis, pericarditis

Complicated Swine FluExpect complications to be similar to seasonal influenza : 

Complicated Swine FluExpect complications to be similar to seasonal influenza Musculoskeletal myositis, rhabdomyolysis, Neurologic acute and post-infectious encephalopathy, encephalitis, febrile seizures, status epilepticus Toxic shock syndrome Secondary bacterial pneumonia with or without sepsis. Renal ARF

Groups at higher risk for seasonal influenza complications. : 

Groups at higher risk for seasonal influenza complications. Children less than 5 years old; Persons aged 65 years or older; Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s syndrome after influenza virus infection; Pregnant women; Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders; Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV); Residents of nursing homes and other chronic-care facilities.

Warning signs in children : 

Warning signs in children Fast breathing or trouble breathing Bluish or gray skin color Not drinking enough fluids Severe or persistent vomiting Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms improve but then return with fever and worse cough

Warning signs in adults : 

Warning signs in adults Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Flu-like symptoms improve but then return with fever and worse cough

Swine Flu - Is there a treatment or vaccine? : 

Swine Flu - Is there a treatment or vaccine?

Treatment : 

Treatment Bed rest Analgesics&Antipyretics Antihistamines&Decongestants Anti Tussives Antiviral therapy Antibacterial ICU care

Swine Flu – Treatment? : 

Swine Flu – Treatment? This swine flu virus is susceptible to oseltamivir and zanamivir. Tamiflu® and Relenza® TAMIFLU CAP 75mg BID FOR 5 DAYS FOR TREATMENT. TAMIFLU CAP 75mg OD FOR 7 DAYS TO 6 WK FOR PREVENTION IN EPIDEMIC. ZANAMIVIR 10 mg INHALATION BID FOR 5 DAYS.

Treatment of influenza does no good if started more than 48 hours after onset of symptoms.Don’t waste the drug or the expense!!! : 

Treatment of influenza does no good if started more than 48 hours after onset of symptoms.Don’t waste the drug or the expense!!!

Prevention : 

Prevention General measures Chemoprophylaxis Vaccine

Prevention / Avoidance of the Flu : 

Prevention / Avoidance of the Flu Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Avoid touching your eyes, nose or mouth. Try to avoid close contact with sick people. If you get sick with influenza, stay home from work or school and limit contact with others to keep from infecting them.

Human Influenza Transmission : 

Human Influenza Transmission Influenza viruses are spread from person to person through respiratory droplets. The virus infects through the nose and throat, and is expelled by coughing and sneezing. Droplets are believed to fall to the ground within 3 ft from an infected person. More distant spread is unlikely.

If you are doing this – STAY HOME !! : 

If you are doing this – STAY HOME !!

Slide 33: 

Helena girls wearing flu masks, winter of 1918-19.

Swine Flu - Vaccine : 

Swine Flu - Vaccine Work is already under way. Making a completely new influenza vaccine can take five to six months. The seasonal vaccines will confer little or no protection against this swine flu virus.

Happy New YearRamadan Kareem : 

Happy New YearRamadan Kareem

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