Slide 2: Influenza A (H1N1) A/California/7/2009 (H1N1) DR. MUHAMMAD ALAUDDIN SARWAR
Sindh Government Qatar Hospital Karachi Influenza A Viruses : Influenza A Viruses Influenza A viruses categorized by subtype
Classified according to two surface proteins
Hemagglutinin (H) – 16 known
Site of attachment to host cells
Antibody to HA is protective
Neuraminidase (N) – 9 known
Helps release virions from cells
Antibody to NA can help modify disease severity National Center for Disease Prevention and Control, DOH Slide 4: SWINE FLU VIRUS A/California/7/2009 (H1N1) Slide 5: GENESIS OF SWINE FLU VIRUS Slide 6: SWINE FLU PANDEMIC Slide 7: WORLDWIDE SWINE FLU PANDEMIC Slide 8: WHO 9 jan 2010 WORLDWIDE SWINE FLU PANDEMIC Slide 9: WORLDWIDE SWINE FLU PANDEMIC http://www.flucount.org/ and Wikipedia
23/01/10 Slide 10: 219 cases of swine flu have so far been detected in the country.
Health Minister Makhdoom Shahabuddin
12 january 2010.
THE DAILY DAWN History of Swine Flu in Pakistan First case of swine flu was detected in August, 2009 Slide 11: A Suspected Case of Influenza A / H1N1 virus infection is defined as an individual presenting with
High fever >38°C, AND
One or more of the following respiratory symptoms: cough, shortness of breath, body ache, difficulty in breathing, AND
One or more of the following: close contact with a person diagnosed as Influenza A/H1N1 OR recent travel to an area reporting cases of confirmed Influenza A/H1N1 Case Definitions for Influenza A H1N1 Cases (Acute febrile respiratory illness (fever > 38 °C) with the spectrum of disease from influenza-like illness to pneumonia) WHO and The U.S. Centers for Disease Control and Prevention Slide 12: A Probable Case of Influenza A/H1N1 infection is defined as an individual that fulfill the criteria for a suspected case,
with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection
An individual with a clinically compatible illness or who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case. Case Definitions for Influenza A H1N1 Cases WHO and The U.S. Centers for Disease Control and Prevention Slide 13: A Confirmed Case of Influenza A/H1N1 infection is defined as an individual with laboratory confirmed Influenza A/H1N1 virus infection by one or more of the following tests:
4-fold rise in swine influenza A(H1N1) virus specific neutralizing antibodies Case Definitions for Influenza A H1N1 Cases WHO and The U.S. Centers for Disease Control and Prevention Slide 14: Clinical Signs & Symptoms of Influenza A (H1N1) WHO, Wikipedia and The U.S. Centers for Disease Control and Prevention Slide 15: DIFFERENCE B/W FLU, COLD & ALLERGY Slide 16: Close contact is defined as: within about 3 feet of an ill person who is a confirmed or suspected case of influenza A H1N1 virus infection during the case’s infectious period. Complications:viral and bacterial pneu monia, febrile seizures, cardiomyopathy, encephalopathy/encephalitis, worsening underlying chronic conditions WHO and The U.S. Centers for Disease Control and Prevention FEATURES OF H1N1 INFECTION Slide 17: Infectious period for a confirmed case of swine influenza A (H1N1) virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset.
Time from exposure to onset of symptoms
1 to 4 days (average = 2 days)
In temperate zones, sharp peaks in winter months
In tropical zones, circulates year-round with seasonal increases. FEATURES OF H1N1 INFECTION WHO and The U.S. Centers for Disease Control and Prevention Slide 18: Through large-particle respiratory droplets which do not remain suspended in air & travel only short distances (<1m ).
Contact with respiratory-droplet contaminated surfaces is another possible source of transmission.
As data from influenza viruses H1N1 are limited, potential for ocular, conjunctival, or GI infection is unknown.
Being a novel influenza A virus, transmission from infected persons to close contacts maybe common. All respiratory secretions & bodily fluids (diarrheal stool) of H1N1 cases should be considered infectious. TRANSMISSION OF SWINE FLU VIRUS WHO and The U.S. Centers for Disease Control and Prevention Slide 19: Elderly > 65 years
Children less than two years
Certain chronic diseases
Heart or lung disease, including asthma
Metabolic disease, including diabetes
HIV/AIDs, other immuno-suppression
Conditions that can compromise respiratory function or the handling of respiratory secretions
Pregnant women Individuals at Increased Risk for Hospitalizations and Death WHO and The U.S. Centers for Disease Control and Prevention Slide 20: Oseltamivir & zanamivir can be given for suspected, probable & confirmed H1N1 cases
Current approach :
Use for probable & confirmed cases
In suspected cases:
-Empirical treatment if patients present with complications of influenza eg. Pneumonia, mental confusion, metabolic derangement, etc
- If patient is clinically comfortable (no complications), treatment deferred till virology results
Duration of treatment: 5 days Antiviral Therapy WHO and The U.S. Centers for Disease Control and Prevention Slide 21: It is also available as syrup (12mg per ml ) OSELTAMIVIR (Cap.Tamiflu) WHO and The U.S. Centers for Disease Control and Prevention http://www.cdc.gov/H1N1flu/recommendations.htm Slide 22: ZANAMIVIR (Relenza Diskhaler) WHO and The U.S. Centers for Disease Control and Prevention http://www.cdc.gov/H1N1flu/recommendations.htm Slide 23: The patients can be discharged with the following criteria:
When PCR results are negative
If patient is still unwell, he can be transferred out of isolation ward
Probable & Confirmed cases:
At least 7 days from onset of illness and
Completed at least 5 days of antiviral therapy and
Well / asymptomatic
If the patient has fulfilled the first 2 criteria but is still recovering, he can be transferred out of isolation ward DISCHARGE OF PATIENTS WHO and The U.S. Centers for Disease Control and Prevention Slide 24: ALGORITHM FOR MANAGEMENT (H1N1) The University of North Carolina, 23 September 2009 Updates at http://intranet.unchealthcare.org/intranet_news/empnews/fluYesNoNo Slide 25: Vaccines are available. (CELVAPAN & PANDEMRIX)
They are made just like seasonal flu vaccines.
They are expected to be as safe and effective as seasonal flu vaccines.
They will not prevent “influenza-like” illnesses caused by other viruses.
They will not prevent seasonal flu.
You should also get seasonal influenza vaccine, if you want to be protected against seasonal flu. PANDEMIC FLU VACCINATION Contraindication: Severe (life-threatening) allergy to eggs, or to any other substance in the vaccine. The U.S. Centers for Disease Control and Prevention, 10/2/09 Slide 26: PANDEMIC FLU VACCINATION Groups recommended to receive 2009 H1N1 vaccine first are:
People who live with or care for infants younger than 6 months of age.
Health care and emergency medical personnel.
Anyone from 6 months through 24 years of age.
Anyone from 25 through 64 years of age with certain chronic medical conditions or a weakened immune system.
As more vaccine becomes available, these groups should also be vaccinated:
Healthy 25 through 64 year olds
Adults 65 years and older Children through 9 years of age should get two doses of vaccine, about a month apart. Older children and adults need only one dose. The U.S. Centers for Disease Control and Prevention, 10/2/09 Slide 27: SEASONAL FLU VACCINATION Influenza vaccine is the best prevention for seasonal influenza.
Inactivated viruses in the vaccine developed from three circulating strains (generally 2 Type A and 1 Type B strain)
Therefore, seasonal “flu shot” only works for 3 influenza subtypes and will not work on pandemic strains (H1N1). Slide 28: Pakistan Vs Australia Series PANDEMIC FLU VACCINATION Slide 29: Frequent hand washing
Covering coughs and sneezes
Avoidance of crowded settings when possible
advising ill persons to stay home (except to seek medical care) and minimize contact with others in household
voluntary home quarantine of members of households with confirmed or probable swine influenza cases GENERAL PRECAUTIONS Slide 30: * consider Facemasks (disposable, single use masks) for persons who enter crowded settings
* consider Respirators (N95 or higher filtering facepiece respirator) for persons who have unavoidable close contact with infectious person
No clear scientific evidence regarding the effectiveness of facemasks and respirators in protecting against influenza WHEN CONTACT IS UNAVOIDABLE Slide 31: Serious Public Health Impact
Unusual or Unexpected
International disease spread
Interference with inter-
national travel or trade **WHO Recommends intensifying and enhancing national surveillance systems for Influenza-like Illnesses and atypical pneumonia National Center for Disease Prevention and Control, DOH WHO Raise the Pandemic Alert level to 5-6 Influenza A (H1N1) is a Public Health Emergency of International Concern (PHEIC) ?? Slide 33: Unusual combination of genetic material from pigs (of North America and Euroasia), birds & humans which have re-assorted??? Only fewer companies has the permission to produce vaccine??? Mortality is far less not only from previous Pandemics but also from yearly seasonal flu !!!!!!! Is it an attempt to control World population ??? Or just an experimentation ???? Influenza A (H1N1) is a Public Health Emergency of International Concern (PHEIC) ?? Slide 34: firstname.lastname@example.org