Novel H1 N1 Influenza Pandemic

Novel H1 N1 Influenza Pandemic: 

Novel H1 N1 Influenza Pandemic DR.MAULIK SHAH MD.(PED) ASSOCIATE PROFESSOR DEPARTMENT OF PEDIATRICS M.P.S.M.C – JAMNAGAR(GUJARAT-INDIA)

What should we call ?: 

What should we call ? SWINE FLU ?? H 1 N1 ?? NOVEL H1 N1 ??

WHAT is H1 & N1 ?: 

WHAT is H1 & N1 ? H 1 N 1

The VIRUS Parichay: 

The VIRUS Parichay RNA, enveloped Viral family: Orthomyxoviridae Size: 80-200nm or .08 – 0.12 μm (micron) in diameter Three types A, B, C Surface antigens H ( haemaglutinin ) N (neuraminidase)

The VIRUS Parichay: 

The VIRUS Parichay AVIAN or HUMAN POLYMERASE AVIAN POLYMERASE HUMAN or SWINE POLYMERASE HUMAN or SWINE POLYMERASE SWINE POLYMERASE

How did it originate ?: 

How did it originate ? Concept of ANTIGENIC shIFT video

Pathophysiology: 

Pathophysiology Video.1

How does Swine Flu spread?: 

How does Swine Flu spread? Human-to-human transmission DIRECT DROPLET TRANSMISSION (Usually within 6-10 feet). Coughing or sneezing of infected people. Touching droplets & then touching mouth or nose (moist mucous membranes).

Communicability : 

Communicability ADULTS- From 1 day before to 7 days after the onset of symptoms CHILDREN- From 1 day before to 10 days after the onset of symptoms.

Why are we worried about…: 

Why are we worried about… Because of past experience of INFLUENZA PANDEMIC S & present warnings by WHO/CDC

What is current situation ?: 

What is current situation ?

Oh NO its in INDIA…!!: 

Oh NO its in INDIA…!!

Origin –Duration- Progress !: 

Origin –Duration- Progress ! COURTESY: http://www.swineflu-india.org/

Current Pandemic in Phase 6: 

Current Pandemic in Phase 6

Interesting Facts in this NOVEL H1N1: 

Interesting Facts in this NOVEL H1N1 Affects young ones… Most cases have been milder one… Less cases in tropics- hot climates…

Affects young ones…(5-50yrs) : 

Affects young ones…(5-50yrs)

Most cases have been milder one…!!?? WHY?? : 

Most cases have been milder one…!!?? WHY?? Video Swine Flu Cases for India (last 5 days) Date New Total Cured 19-Aug-2009 216 2242 758 18-Aug-2009 99 2026 708 17-Aug-2009 220 1927 703 16-Aug-2009 152 1707 694 15-Aug-2009 165 1555 689

Less cases in tropics- hot climates… : 

Less cases in tropics- hot climates…

FIGHTING BACK: 

FIGHTING BACK Identify the CASE Isolate DIGNOSE TREAT PREVENT

Case deffination(as per GOI): 

Case deffination (as per GOI) A confirmed case s/s + one or more following test Real Time PCR Viral culture Four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies.

ISOLATION : 

ISOLATION Whom ? Where ? How Long ? Why ? Things to look for ?

Isolation -Whom ? : 

Isolation -Whom ? All who have FEBRILE viral respiratory infection like symptoms – COUGH/ RUNNING NOSE/SORE THROAT/BODY ACHE/ DIARRHOEA/ VOMITTING etc. Category A – MILDER symptoms. Category B- MODERATE symptoms without Respiratory Distress. & HIGH RISK GROUP Category C- with RESPIRATORY DISTRESS with or without hemodynamic instability

High Risk Group: 

High Risk Group Children less than 5 years old; Pregnant women; Persons aged 65 years or older; Patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS; Patients on long term cortisone therapy.

Isolation: 

Isolation WHERE ? HOME – category A & category B b) HOSPITAL ISOLATION- category C

Isolation Precautions : 

Isolation Precautions

AT HOME: 

AT HOME Well ventilated - Clean – hyginic space . Avoid meeting people. Rest & adequate sleep. Keep handkerchief or cloth while sneeze or cough. Or wear a mask. To wash hands frequently with soap & water. Do not hug or shake hands with others if possible. Avoid sharing things & utensils. Linen & cloths to be washed & decontaminated.

Isolation-At hospital : 

Isolation-At hospital Written-Informed policy. Well ventilated / air conditioned room. Facilities for management of respiratory distress and supportive intensive care. Personal Protection Gears or equipments. Trained and Informed team. Hand washing facility. Sample collection & transport establishment. Facility for waste management. Security personnel for restricted enteries .

Personal Protection : 

Personal Protection Gown & plastic wrap Mask or Respirator Gloves Goggles or face shield Shoe cover

Application Sequence: 

Application Sequence

Wearing Respirator or MASK: 

Wearing Respirator or MASK

Respirators or MASK: 

Respirators or MASK Protection value an ordinary mask with single layer- 68 % Tripple layer or N-95 MASK - 95 % N 95 SINGLE LAYERED

What is N95 Mask is Made of : 

What is N95 Mask is Made of Three layers of electrostatically charged microfibers that prevent 95 percent of particulates from penetrating them. Inner Layer -a non-woven polypropylene cloth that is hypoallergenic and comfortable against the face. The middle one- Filter Layer --a blown web of fabric that blocks 95 percent of particulates. Outer Layer -active carbon that absorbs harmful vapors .

Removal Sequence: 

Removal Sequence

Areas - often contaminated: 

Areas - often contaminated

HAND WASHING: 

HAND WASHING Soap & water Alcohol based solutions

MEDICAL MANAGEMENT: 

MEDICAL MANAGEMENT SUPPORTIVE CARE Rest Nutrition Hydration Anti histaminics , cough supressant Paracetamol (no nsaids /ibuprofen) Saline gargles Steam inhalation

DRUG THERAPY: 

DRUG THERAPY PROPHYLACTIC THERAPEUTIC DRUGS OSELTAMIVIR ZANAMIVIR

MECHANISM OF ACTION: 

MECHANISM OF ACTION BOTH inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell's receptor for viral hemagglutinin . By inhibiting viral neuraminidase, this agent decreases the release of viruses from infected cells and, thus, viral spread.

DRUG THERAPY: 

DRUG THERAPY Presently Only OSELTAMIVIR is available for use in INDIA & as recommended by GOI Prophylaxis for: CATEGORY -B (Moderate symptom – no distress) High Risk Groups of CATEGORY – B CATEGORY -C THERAPEUTIC for: ONLY CONFIRMED CASES

OSELTAMIVIR: 

OSELTAMIVIR Must be administered within 48 hours of symptom onset to provide optimal treatment. Reduces the length of illness by an average of 1.5 -2.5 days. In addition, the severity of symptoms is also reduced.

The present CDC Recommendation in Children (revised – dec.09): 

The present CDC Recommendation in Children ( revised – dec.09 ) Agent, age group Treatment (5 days) Chemoprophylaxis (10 days) Oseltamivir 1,2 ( Tamiflu ®) Children < 3 3 months 3 mg/kg/dose twice daily Not recommended unless situation judged critical due to limited data on use in this age group Children ≥ 3 months 3 mg/kg/dose twice daily 3 mg/kg/dose once per day Children ≥ 12 months ≤15 kg 30 mg twice daily 30 mg once per day 16-23 kg 45 mg twice daily 45 mg once per day 24-40 kg 60 mg twice daily 60 mg once per day >40 kg 75 mg twice daily 75 mg once per day Zanamivir ( Relenza ®) 4 Children 10 mg (two 5 mg inhalations) twice daily (for 7 years or older) 10 mg (two 5-mg inhalations) once daily (for 5 years or older) Adapted from CDC Guidelines

Drug treatment: 

Drug treatment Duration of administration for treatment is 5 days. Postexposure prophylaxis should be initiated within 7 d of exposure and continued for at least 10 days. Pre-exposure prophylaxis should be initiated during potential exposure period and continue for 10 days after last known exposure.

DRUG THERAPY: 

DRUG THERAPY SPECIAL CONSIDERATION Pediatric population Pregnant mothers

PREVENTION: 

PREVENTION Common Measures. VACCINE

Common Measures: 

Common Measures

Vaccines for -H1N1 : 

Vaccines for -H1N1 Currently there is commercially available vaccine to protect humans against this H1N1 virus.(available in INDIA) Two forms : Inactivated vaccine - I.M. route Live intranasal vaccine.

Vaccine for 2009 -H1N1 : 

Vaccine for 2009 -H1N1 Dose: Children (<9 years of age) : two doses a month apart. Older children and adults : only one dose. Side effects: Mild local Rarely severe.

Groups recommended to receive 2009 -H1N1 vaccine first are: : 

Groups recommended to receive 2009 -H1N1 vaccine first are: Pregnant women 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 Then as supply is available for rest of persons.

Useful websites: 

Useful websites http://mohfw-h1n1.nic.in/ http://www.flu.gov/ http://www.swineflu-india.org/ http://www.whoindia.org/EN/Index.htm Download - freely my GUJARATI/HINDI/ENGLISH presentation on swineflu -link: http://www.scribd.com/doc/19011905/GUJARATI-Novel-H1-N1-Influenza-Pandemic http://www.scribd.com/doc/19100849/SWINE-FLUH1N1-INFORMATIVE-POSTERS

Share your views please:: 

Share your views please: DR.MAULIK SHAH MD.(PED) ASSOCIATE PROFESSOR DEPARTMENT OF PEDIATRICS M.P.S.M.C – JAMNAGAR(GUJARAT-INDIA) maulikdr@gmail.com http://matrutvanikediae.blogspot.com/