Swine Flu

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SWINE FLU : 

SWINE FLU Dr. Naila Naeem House officer Medical Unit V CIVIL Hospital Karachi, PAKISTAN

What Is Swine Flu?? : 

What Is Swine Flu?? Swine influenza, or “Swine Flu” or “Hog Flu” or “H1N1 Influenza” is a highly contagious acute respiratory disease caused by any strain of the influenza virus endemic in pigs (swine) that regularly cause outbreaks of influenza among pigs. Strains endemic in swine are called swine influenza virus (SIV). .

Swine Influenza Virus : 

Swine Influenza Virus The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.It causes high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year,but most outbreaks occur during the late fall & winter months similar to outbreaks in humans.

Classification : 

Classification SIV strains isolated to date have been classified either as: Influenza virus A (common): various subtypes H1N1, H1N2,H3N1,H3N2, & H2N3 In pigs, three influenza A virus subtypes (H1N1, H3N2, & H1N2) are the most common strains worldwide. . Influneza virus C (rare): Due to its limited host range and the lack of genetic diversity, this form of influenza does not cause pandemics in humans.

Cause By Reassortment Of Different Strains : 

Cause By Reassortment Of Different Strains Like all influenza viruses, swine flu viruses change constantly. Pigs are distinct from other species in that their cells possess receptors that can bind to swine, human & avian influenza viruses; therefore two or more types of viruses may co-infect swine cells and combine to produce a novel virus.When influenza viruses from different species infect pigs, the viruses can reassot (i.e swap genes ) and a new viruses that are a mix of swine, human and/or avian influenza viruses can emerge.

Present Swine Flu Strains : 

Present Swine Flu Strains The 2009 flu outbreak is due to a new strain of influenza, an apparent reassortment of at least four strains of influenza A virus subtype H1N1, including one strain endemic in humans, one endemic in birds & two endemic in swine.

How Swine Flu Spread Among Pigs? : 

How Swine Flu Spread Among Pigs? Close contact among pigs particularly common during animal transport and possibly from contaminated objects moving between infected & uninfected pigs,by pigs touching noses or through dried mucus. Airborne transmission through aerosols produced by pigs e.g. coughing or sneezing. The virus usually spreads quickly through a herd, infecting all the pigs within just a few days. Transmission may also occur through wild animals, such as wild boar, which can spread the disease between farms.

Transmission To Human : 

Transmission To Human Direct Transmission Pigs to Human (people are in close proximity to infected pigs, such as in pig barns & livestock exhibits housing pigs at fairs) Human to Pigs .

Indirect Transmission : 

Indirect Transmission Human to Human: (via aerosolized respiratory secretions for e.g. coughing ,sneezing of infected person, touching contaminated inanimate objects & then touching nose or mouth)

Is Eating Pork Save? : 

Is Eating Pork Save? Swine influenza viruses are not transmitted from eating pork or pork products. Cooking pork to an internal temperature of 160°F kills the swine flu virus.

Incubation Period : 

Incubation Period It is usually one to three days Pigs begin excreting the virus within 24 hours of infection, and may shed the virus for seven to ten days.

Infectious Period : 

Infectious Period Defined as 1 day prior to the case’s illness onset to 7 days after onset.Younger children, might potentially be contagious for longer periods up to 10 days.A carrier state can exist for up to 3 months.The viruses can live 2 hours or longer outside body.

Who Are At Risk ?? : 

Who Are At Risk ?? Children aged 6 months up to their 19yrs Pregnant women People 50 years of age and older People of any age with certain medical conditions, such as heart or lung disease (Asthma, COPD, Emphysema ), Diabetes or those with weakened immune systems e.g. HIV

Pathophysiology : 

Pathophysiology Influenza viruses enters the respiratory tract bind through Hemagglutinin onto Sialic acid sugars on the surfaces of epithelial cells; typically in the nose, throat and lungs of mammals. The respiratory tract becomes swollen & inflamed .From the tract it then enters the blood streams and symptoms begins to show .

Symptoms : 

Symptoms Fever with or without chills Lethargy Lack of appetite Sore throat Cough Running nose Body ache Headache Nausea Vomiting Diarrhea 1 According to Center for disease control & prevention (CDC), symptoms of swine flu resembles seasonal influenza and other acute upper respiratory tract infections.

Seek Emergency Medical CareIF - in Children : 

Seek Emergency Medical CareIF - in Children In children emergency warning signs that need urgent medical attention include: Bluish skin colour Not drinking enough fluids 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 Fever with a rash

Adults Need Attention If Present With : 

Adults Need Attention If Present With Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting

Outbreak Of Flu Pandemics : 

Outbreak Of Flu Pandemics Flu pandemics occur whenever a new strain of the virus arises to which most people have no natural immunity Experts believe they have been occurring at irregular intervals since at least the 16th-century. Swine flu has been reported numerous times as a Zoonosis in humans, usually with limited distribution rarely with a widespread distribution.

Swine Flu 2009 : 

Swine Flu 2009 From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States. The new strain of swine flu was first recognized as such when the CDC received a sample on April 14 from a patient who fell ill on March 30 in San Diego Country, California.

Swine Flu Present Status : 

Swine Flu Present Status According to WHO it is currently a “Phase 5” outbreak, that is one level below an official pandemic. 22 countries have now reported laboratory confirmed cases. Uptil date, there are 1124 confirmed cases worldwide. 590 in Mexico, 286 confirmed U.S cases in 38 states, 140 in Canada, 54 in Spain, 20 in Britain, 8 in Germany, 6 in New Zealand, 4 in France & Israel, 2 in Italy, in Asia 1 in Hong Kong other in South Korea & 1 case in Austria, Costa Rica, Colombia, Denmark, El Salvador, Ireland, Netherlands, Portugal & Switzerland. There have been 26 confirmed deaths, 25 in Mexico & one in the United State.

Diagnosis : 

Diagnosis To diagnose swine influenza A infection ,a respiratory specimen (nasopharyngeal swab/aspirate or nasal wash/aspirate, combined nasal swab with an oropharyngeal swab, endotracheal aspirate) would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer Specimen should be placed into sterile viral transport media (VTM) and immediately placed on ice or cold packs or at 4°C (refrigerator) for transport to the laboratory.

Diagnosis : 

Diagnosis CDC helps in diagnosing cases by performing following test in laboratory Real-time RT-PCR Viral culture

Real-time RT-PCR : 

Real-time RT-PCR Also called quantitative real time polymerase chain reaction is a laboratory technique based on the polymerase chain reaction, which is used to amplify & simultaneously quantify a targeted DNA molecule. The CDC currently recommends real-time RT-PCR for influenza A, B, H1, H3. A positive test result from the rRT-PCR indicates that the patient is presumably an infected with swine influenza virus. The test does not indicate the stage of infection.

Viral Culture : 

Viral Culture Isolation of swine-origin influenza A (H1N1) virus is diagnostic of infection, but may not yield timely results for clinical management. It provides results in 3-10 days. A negative viral culture does not exclude infection with swine-origin influenza A (H1N1) virus.

Rapid Influenza Diagnostic Tests & Immunofluroscence : 

Rapid Influenza Diagnostic Tests & Immunofluroscence These tests can distinguish between influenza A and B viruses. A patient with a positive for influenza A may meet criteria for a suspected case. But they cannot distinguish between seasonal influenza A and swine influenza, which is a subtype of A.

Drugs Effective In Swine Flu : 

Drugs Effective In Swine Flu Influenza antiviral drugs work best when started soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications. There are four different antiviral drugs that are licensed for use for the treatment of influenza: ? Amantidine ? Rimantadine ? Oseltamivir ? Zanamivir While most swine influenza viruses have been susceptible to all four drugs

Drugs Proved Resistant At Present : 

Drugs Proved Resistant At Present Most recent swine influenza viruses isolated from humans are resistant to Amantidine and Rimantadine

CDC recommends at Present : 

CDC recommends at Present CDC recommends the use of Oseltamivir (Tamiflu) or Zanamivir (Relenza) for the treatment and/or prevention of infection with swine influenza viruses.

Prevention In Humans : 

Prevention In Humans

Prevention From Swine To Human Transmission : 

Prevention From Swine To Human Transmission Use of vaccines on pigs to prevent their infection is a major method of limiting swine to human transmission. Farmers & veterinarians are encouraged to use a face mask when dealing with infected animals.

Prevention Of Human To Human Transmission : 

Prevention Of Human To Human Transmission Avoid Close Contact Aerosols spread the virus in any environment. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

Stay Home When You Are Sick : 

Stay Home When You Are Sick If possible, stay home from work, school & errands when you are sick. You will help prevent others from catching your illness.

Cover Your Mouth & Nose : 

Cover Your Mouth & Nose Cover your mouth and nose with a tissue when coughing or sneezing. If you don’t have a tissue, cover your mouth and nose as best you can. It may prevent those around you from getting sick

Clean Your Hands : 

Clean Your Hands Clean your hands often. Clean your hands every time you cough or sneeze. Hand washing stops germs .It is the best procedure in prevention of majority of communicable diseases. Use alcohol based gels & wipes also worked well .

Avoid Touching Your Eyes, Nose or Mouth : 

Avoid Touching Your Eyes, Nose or Mouth Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

Healthy Habits Reduces The Attacks : 

Healthy Habits Reduces The Attacks Get plenty of sleep,be physically active, manage your stress, drink plenty of fluids, and eat nutritious. Unnecessary Migration of people from epidemic and endemic areas to be reduced.

No Vaccines To HumansBut Available To Pigs : 

No Vaccines To HumansBut Available To Pigs Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses as the H1N1 swine flu viruses are antigenically very different from human H1N1 viruses But CDC is working on making vaccines for it and hoping that 600 million doses will be achievable in next four- six month timeframe.

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