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Dept. of community medicine GR Medical college Gwalior(MP) India Slide 2: Introduction- Highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses: – Morbidity tends to be high and – Low mortality (1-4%) • Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans Swine flu in Pigs : Swine flu in Pigs Virus spreads among pigs by aerosols, direct and indirect contact, and asymptomatic carrier pigs Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1,H3N2) Slide 4: Cont.. Pigs can also be infected with avian influenza viruses and human seasonal influenza viruses as well as swine influenza viruses The H3N2 swine virus was thought to have been originally introduced into pigs by humans Many countries routinely vaccinate swine populations against swine influenza Swine flu in Humans : Swine flu in Humans Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons having direct exposure to pigs. In addition, there have been sporadic cases of one person spreading swine flu to others. Current Situation : Current Situation World: WHO has reported 29669 laboratory confirmed cases of influenza A/H1N1 infection from74 countries. There have been 146 deaths. India: 15 laboratory confirmed cases. No Death Pandemic Alert: We are now in Phase 6 WHO Pandemic Influenza reparedness and Response Guidance 2009 : WHO Pandemic Influenza reparedness and Response Guidance 2009 Slide 8: Epidemiology The agent Influenza A (H1N1) virus with segments from four influenza viruses: North American Swine, North American Avian, Human Influenza and Eurasian Swine. Host factors Healthy young adults. Transmission Droplet infection and fomites. Incubation period 1-7 days. Communicability From 1 day before to 7 days after the onset of symptoms. Slide 9: Case Definition- A suspected case of swine influenza A (H1N1) virus infection is defined as a person with acute febrile respiratory illness with onset within 7 days of close contact with a person who is a confirmed case of swine influenza A (H1N1) virus infection, or . within 7 days of travel to areas where there are one or more confirmed swine influenza A(H1N1) cases, or . resides in a community where there are one or more confirmed swine influenza cases. Slide 10: A probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness who: -is positive for influenza A, but unsubtypable for H1 and H3 by influenza RT-PCR or reagents used to detect seasonal influenza virus infection, or -is positive for influenza A by an influenza rapid test or an influenza immunofluorescence assay (IFA) plus meets criteria for a suspected case, or -individual with a clinically compatible illness who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case. Slide 11: A confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at WHO approved laboratories by one or more of the following tests: . Real Time PCR . Viral culture . Four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies. Close contact is defined within 6 feet of an ill person who is a confirmed, probable or suspected case of swine influenza A (H1N1) virus infection during the infectious period. Slide 12: Acute respiratory illness is defined as illness of recent onset with least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever). High-risk group for complications of influenza is defined as a person such as: . resident of institutions for elderly people and the disabled; . people with certain chronic health conditions (chronic heart or lung disease, metabolic or renal disease or immunodeficiency); . elderly people and very young children. Diagnosis : Diagnosis Respiratory specimen would generally need to be collected within the first 4 to 5 days of illness . Sample Collection & Laboratory Diagnosis Sample Collection: Should be done by the treating doctor who is managing the case. Preferred respiratory samples : Nasopharyngeal swab and throat swab . Storage of Samples: 2-8 degreeC . Slide 15: Transportation of Samples: samples should be transported on dry ice in triple packaging. . Laboratory biosafety measures should be followed for collection, storage, packaging and shipping of influenza samples. . Available Laboratory tests: . Rapid Antigen Tests: not as sensitive as other available tests. . RT-PCR . Virus isolation . Virus Genome Sequencing . Four-fold rise in swine influenza A(H1N1) virus specific neutralizing antibodies. Prevention : Prevention There is currently no vaccine available against human swine influenza. One has to follow proper hand hygiene and respiratory etiquettes. Do’s and Don’ts: : Do’s and Don’ts: Avoid close contact with people who are having respiratory illness. Sick persons should keep distance from others. If possible, stay at home, away from work,school, and public places when you are sick. Cover your mouth and nose with a tissue or handkerchief when coughing or sneezing. If you have no tissue or handkerchief you should not clean the nose with the hands but with the cuff of your shirt or clothes. Slide 18: . Washing your hands often with soap or alcohol based hand wash will help protect from germs. . Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. .Persons who develop influenza-like-illness (ILI) (fever with either cough or sore throat) should be strongly encouraged to self isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer. Slide 19: . Persons who experience ILI and wish to seek medical care should contact their health care providers to report illness. . Persons who have difficulty breathing or shortness of breath should seek immediate medical attention and report to the nearby hospital. . If ill persons must go into the community (e.g., to seek medical care) they should wear a face mask to reduce the risk of spreading the virus in the community. . Slide 20: If a face mask is unavailable, ill persons needing to go into the community should use a handkerchief or tissues to cover any coughing and sneezing. Persons in home isolation and their household members should be given infection control instructions like frequent hand washing with soap and water; use of alcohol-based hand gels (containing at least 60%alcohol). When the ill person is within 6 feet of others at home, the ill person should wear a face mask, if available or handkerchief or tissues. Slide 21: Household contacts who are well should: o remain home at the earliest sign of illness; o minimize contact in the community to the extent possible; o designate a single household family member as the ill person’s caregiver to minimize interactions with asymptomatic persons. Slide 22: Precautions for School children: o Schools with a confirmed or a suspected case should be considered for closure. o All school or childcare related gatherings should be cancelled and encourage parents and students to avoid congregating outside of the school. o Schools and childcare facilities should bar students for a time period to be evaluated on an ongoing basis depending upon epidemiological findings. Slide 23: o Schools and childcare facilities should consult with their local or state health departments for guidance on reopening. If no additional confirmed or suspected cases are identified among students (or school-based personnel) for a period of 7 days, schools may consider reopening. o Schools and childcare facilities in unaffected areas should begin to prepare for the possibility of school or childcare facility closure Treatment- : Treatment- Oseltamivir is the recommended drug both for prophylaxis and treatment. Supportive therapy: - IV Fluids. - Parentral nutrition. - Oxygen therapy/ ventilatory support. - Antibiotics for secondary infection. - Vasopressors for shock. Slide 25: -Paracetamol or ibuprofen is prescribed for ever,myalgia and headache. -Patient is advised to drink plenty of fluids. -Smokers should avoid smoking. For sore throat, short course of topical decongestants, saline nasal drops, throat lozenges and steam inhalation may be beneficial. - Salicylate / aspirin is strictly contra-indicated in any influenza patient due to its potential to cause Reye’s syndrome. Slide 26: The suspected cases would be constantly monitored for clinical / radiological evidence of lower respiratory tract infection and for hypoxia (respiratory rate, oxygen saturation, level of consciousness). Adult patients should be discharged 7 days after symptoms have subsided. Children should be discharged 14 days after symptoms have subsided. Prophylaxis : Prophylaxis Given to: All close contacts of suspected, probable and confirmed cases. All health care personnel coming in contact with suspected, probable or confirmed cases Drug of choice: Oseltamivir Time period: Prophylaxis should be provided till 10 days after last exposure (maximum period of 6 weeks) . Slide 28: By Weight: For weight <15kg: 30 mg OD 15-23kg: 45 mg OD 24-<40kg: 60 mg OD >40Kg: 75 mg OD . For infants: . < 3 months: not recommended unless situation judged critical due to limited data on use in this age group . 3-5 months: 20 mg OD . 6-11 months: 25 mg OD . Slide 29: Close Contacts of suspected, probable and confirmed cases should be advised to remain at home (voluntary home quarantine) for at least 7 days after the last contact with the case. Monitoring of fever should be done for at least 7 days. Prompt testing and hospitalization must be done when symptoms are reported. All suspected cases, clusters of ILI/SARI cases need to be notified to the State Health Authorities and the Ministry of Health & Family Welfare, Govt. of India (Director, EMR and Director, NICD) Slide 30: Thank you You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.