H1 N1 Diagnosis and Vaccination current Trends

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H1 N1 Diagnosis and Vaccination current Trends by Dr.T.V.Rao MD

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H1 N1 Current Diagnostic and Prevention Trends 2018 - 2019:

H1 N1 Current Diagnostic and Prevention Trends 2018 - 2019 Dr.T.V.Rao MD 1/5/2019 Dr.T.V.Rao MD 1

What is Swine Flu ( H1 N1 ):

What is Swine Flu ( H1 N1 ) Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs, resulting in nasal secretions, a barking cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. 1/5/2019 Dr.T.V.Rao MD 2

Influenza Virus a Complex Virus :

Influenza Virus a Complex Virus 1/5/2019 Dr.T.V.Rao MD 3

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H1 N1 is a Pandemic Infection many regions in the world are infected with the virus :

H1 N1 is a Pandemic Infection many regions in the world are infected with the virus In the temperate zone of the northern hemisphere influenza activity continued to increase, although overall influenza activity remained low. Increased influenza detections were reported in some countries of Southern and South-East Asia. 1/5/2019 Dr.T.V.Rao MD 6

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The main swine flu viruses in pigs in the recent years are swine triple reassortant (tr; it means a viral strain with genes from three different organisms) H1N1, trH3N2, and trH1N2. However, in August 2018, China first reported a new swine flu outbreak in pigs in Liaoning province. The pig flu strain known as African swine flu (although some researchers think it originated in Russia), 1/5/2019 Dr.T.V.Rao MD 7

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In the temperate zones of the southern hemisphere, influenza activity returned to inter-seasonal levels. Worldwide, seasonal influenza A viruses accounted for the majority of detections. 1/5/2019 Dr.T.V.Rao MD 8

Tropical Asia :

Tropical Asia In Southern Asia, decreased influenza activity of predominately A(H1N1)pdm09 virus was reported in India. Influenza activity continued to increase in Iran (Islamic Republic of) with influenza A(H3N2) viruses most frequently detected. ILI and SARI levels appeared to increase in Afghanistan with increased detections of influenza A(H1N1)pdm09 virus. ▪ 1/5/2019 Dr.T.V.Rao MD 9

Transmission to humans:

Transmission to humans The main route of transmission is through direct contact between infected and uninfected animals. These close contacts are particularly common during animal transport and intensive farming. Transmission may also occur through wild animals, such as wild boar. 1/5/2019 Dr.T.V.Rao MD 10

People at Great Risk :

People at Great Risk People who work with poultry and swine, especially those with intense exposures, are at increased risk of zoonotic infection with influenza virus endemic in these animals, and constitute a population of human hosts in which zoonosis and reassortment can co-occur. 1/5/2019 Dr.T.V.Rao MD 11

Others at Risk of Influenza :

Others at Risk of Influenza Other professions at particular risk of infection are veterinarians and meat processing workers, although the risk of infection for both of these groups is lower than that of farm worker. 1/5/2019 Dr.T.V.Rao MD 12

Spread:

Spread One can get infected by the droplets from a cough and the sneeze of the infected person. When an infected person sneezes or coughs, they release multiple tiny droplets. If you come in contact with these drops or touch a surface where the drops landed you’ll be exposed to the infection 1/5/2019 Dr.T.V.Rao MD 13

Population at risk:

Population at risk People who are 65 yrs.' and older. Chronic conditions like Asthma, Diabetes, Heart and other Respiratory problems Pregnant women Young children are at high risk. Children with lethargy, low appetite, breathing difficulty are also considered in the high risk category. 1/5/2019 Dr.T.V.Rao MD 14

Signs and Symptoms:

Signs and Symptoms Some people are at higher risk for becoming seriously ill if they are infected with swine flu. High grade fever with chills Headache Body ache Cough and cold Sore throat Running nose Vomiting Severe tiredness. Stuffy nose/running nose Fatigue 1/5/2019 Dr.T.V.Rao MD 15

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Who needs a Test for H1 N1:

Who needs a Test for H1 N1 Swine flu symptoms resemble those found in the regular and elderly people or people with other illnesses have a chance of dying from this infection. Reports from the U.S Center of Disease Control And Prevention (CDC) reveal that 556 deaths and 8,843 hospitalisations have occurred in the U.S. alone due to this disease. 1/5/2019 Dr.T.V.Rao MD 19

How Is Swine flu Test Done?:

How Is Swine flu Test Done? Specimen type: nasopharyngeal swab Specimen collection procedure A dry swab would be inserted through one nostril straight back (not upwards), along the floor of the nasal passage until it reaches the wall of the nasopharynx. The distance from the nose to the ear would give an estimate of the distance the swab should be inserted. The swab is gently rotated and left in its place for up to 10 seconds. The swab is placed immediately into the transport container. 1/5/2019 Dr.T.V.Rao MD 20

Diagnosis:

Diagnosis The detection is done through nasal and throat swabs. Theses swabs are then analyzed using various laboratory techniques to identify the specific type of virus. Routine blood test is also done to differentiate between bacterial and viral infection 1/5/2019 Dr.T.V.Rao MD 21

Influenza Diagnostic Tests:

Influenza Diagnostic Tests A number of different laboratory diagnostic tests can be used for detecting the presence of influenza viruses in respiratory specimens, including direct antigen detection tests, virus isolation in cell culture, or detection of influenza-specific RNA by real-time reverse transcriptase-polymerase chain reaction ( rRT -PCR). 1/5/2019 Dr.T.V.Rao MD 22

Testing for H1 N1:

Testing for H1 N1 These tests differ in their sensitivity and specificity in detecting influenza viruses as well as in their commercial availability, the amount of time needed from specimen collection until results are available, and the tests’ ability to distinguish between different influenza virus types (A versus B) and influenza A subtypes (e.g. novel H1N1 versus seasonal H1N1 versus seasonal H3N2 viruses). 1/5/2019 Dr.T.V.Rao MD 23

Traditional Serological Tests for Influenza:

Traditional Serological Tests for Influenza Serologic tests on paired acute (within 1 week of illness onset) and convalescent (collected 2-3 weeks later) sera can help to establish a retrospective diagnosis of influenza virus infection for epidemiological and research studies 1/5/2019 Dr.T.V.Rao MD 24

Rapid Influenza Diagnostic Tests:

Rapid Influenza Diagnostic Tests Rapid influenza diagnostic tests (RIDTs) are antigen detection tests that detect influenza viral nucleoprotein antigen. The commercially available RIDTs discussed in this document can provide results within 30 minutes or less. Thus, results are available in a clinically relevant time period to inform clinical decisions. These assays may be referred to as “point-of care” tests since CLIA-waived RIDTs (not all RIDTs are CLIA waived) may be used in facilities with a certificate of waiver or in locations outside a central laboratory. 1/5/2019 Dr.T.V.Rao MD 25

H1N1 (SWINE FLU) QUALITATIVE, REAL TIME PCR:

H1N1 (SWINE FLU) QUALITATIVE, REAL TIME PCR This test is intended for the detection of Influenza A H1N1 virus (Swine Flu). Real Time PCR assay is based on the detection of 4 targets in the sample namely influenza A, H1 Influenza A, H1 Influenza A ( Subtype H1) & Human RNase P gene which serves as a positive control for the presence of human nucleic acids. 1/5/2019 Dr.T.V.Rao MD 26

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Influenza in Children :

Influenza in Children Even children are susceptible to this and suffer from respiratory diseases like asthma and COPD, and anyone with immunocompromised systems are at risk of several complications. People who are in the advanced stages of swine flu virus infection may not be protected despite receiving immediate vaccinations. This is why you need this test to receive appropriate vaccinations on-time or early on before it becomes too late. 1/5/2019 Dr.T.V.Rao MD 28

What Do My Test Results Mean?:

What Do My Test Results Mean? Your test results will indicate whether you've been clinically diagnosed as positive for swine flu or negative. If all four targets are negative in your lab report, then a repeat sample analysis will be recommended. 3 out of 4 positive targets is considered inconclusive evidence and requires repeat testing. 1/5/2019 Dr.T.V.Rao MD 29

Recommended Vaccination for Influenza:

Recommended Vaccination for Influenza Vaccination is recommended each year for protection against seasonal influenza. Antiviral drugs for influenza given early (within 48 hours of symptom onset) may reduce severe complications and deaths. 1/5/2019 Dr.T.V.Rao MD 30

What kinds of flu vaccines are available?:

What kinds of flu vaccines are available? CDC recommends use of any licensed, age-appropriate influenza vaccine during the 2018-2019 influenza season, including inactivated influenza vaccine [IIV], recombinant influenza vaccine [RIV], or live attenuated influenza vaccine (LAIV). No preference is expressed for any influenza vaccine over another. Both trivalent (three-component) and quadrivalent (four-component) flu vaccines will be available. 1/5/2019 Dr.T.V.Rao MD 31

Trivalent flu vaccines include::

Trivalent flu vaccines include: One standard-dose trivalent flu shot (IIV3) manufactured using virus grown in eggs. This shot (Afluria) can be given either with a needle (for people aged 5 years and older) or with a jet injector (or people aged 18 through 64 years only). Dr.T.V.Rao MD 1/5/2019 32

High-dose trivalent flu shot :

High-dose trivalent flu shot 33 A high-dose trivalent flu shot ( Fluzone High-dose), approved for people 65 years and older. A trivalent flu shot made with adjuvant ( Fluad ), approved for people 65 years and older. 1/5/2019 Dr.T.V.Rao MD

Quadrivalent flu vaccines include::

Quadrivalent flu vaccines include: Standard-dose quadrivalent flu shots that are manufactured using virus grown in eggs. These include Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, and Fluzone Quadrivalent. Different flu shots are approved for different age groups. Some are approved for children as young as 6 months of age. Most flu shots are given in the arm (muscle) with a needle. One quadrivalent flu shot (Afluria Quadrivalent) can be given either with a needle (for people aged 5 years and older) or with a jet injector (for people aged 18 through 64 years only). 1/5/2019 Dr.T.V.Rao MD 34

quadrivalent cell-based flu shot :

quadrivalent cell-based flu shot A quadrivalent cell-based flu shot ( Flucelvax Quadrivalent) containing virus grown in cell culture (that is egg-free), which is approved for people 4 years and older. A recombinant quadrivalent flu shot ( Flublok Quadrivalent) approved for people 18 years and older. 1/5/2019 Dr.T.V.Rao MD 35

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Are any of the available flu vaccines recommended over others?:

Are any of the available flu vaccines recommended over others? For the 2018-2019 flu season, the Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for everyone 6 months and older with any licensed age-appropriate flu vaccine including inactivated influenza vaccine (IIV), recombinant influenza vaccine (RIV4) or live attenuated influenza vaccine (LAIV4) with no preference expressed for any one vaccine over another. Dr.T.V.Rao MD 1/5/2019 37

Update: February 10, 2018 from CDC .:

Update: February 10, 2018 from CDC . From CDC 1/5/2019 Dr.T.V.Rao MD 38

Update: On Influenza Vaccine:

Update: On Influenza Vaccine The current quadrivalent flu vaccines contain antigens for 4 flu viruses — two types of influenza A, H1N1 and H3N2, and two types of influenza B, B/Phuket/3073/2013 — like virus (Yamagata lineage) and B/Brisbane/60/2008 — like virus (Victoria lineage). Dr.T.V.Rao MD 1/5/2019 39

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40 The vaccine is highly effective against all but influenza A H3N2 virus. It is very important to be protected against all circulating flu viruses. The CDC estimated that the vaccine is over 70% effective against the two influenza B viruses, and over 60% effective against the H1N1 variant. 1/5/2019 Dr.T.V.Rao MD

Who should get vaccinated this season?:

Who should get vaccinated this season? Dr.T.V.Rao MD Everyone 6 months of age and older should get a flu vaccine every season. This recommendation has been in place since February 24, 2010 when CDC’s Advisory Committee on Immunization Practices (ACIP) voted for “universal” flu vaccination in the United States to expand protection against the flu to more people. 1/5/2019 41

High Risk Groups Vaccination is a Priority :

High Risk Groups Vaccination is a Priority 42 Vaccination to prevent influenza is particularly important for people who are at high risk of serious complications from influenza. See People at High Risk of Developing Flu-Related Complications for a full list of age and health factors that confer increased risk. 1/5/2019 Dr.T.V.Rao MD

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Who Should Not Be Vaccinated?:

Who Should Not Be Vaccinated? Different flu vaccines are approved for use in different age groups. In addition, some vaccines are not recommended for certain groups. Factors that can determine a person’s suitability for vaccination, or vaccination with a particular vaccine, include a person’s age, health (current and past) and any allergies to flu vaccine or its components. 1/5/2019 Dr.T.V.Rao MD 44

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References :

References Key Facts About Seasonal Flu Vaccine Influenza (Flu) Current updates on Influenza from CDC and WHO 1/5/2019 Dr.T.V.Rao MD 46

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Program File Created by Dr.T.V.Rao MD for benefit of Medical Nursing and Health care Professionals in the Developing world Email doctortvrao@gmail.com 1/5/2019 Dr.T.V.Rao MD 47

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