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Premium member Presentation Transcript 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 1The 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 POLYMERASEHow did it originate ?: How did it originate ? Concept of ANTIGENIC shIFT videoPathophysiology: Pathophysiology Video.1How 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/CDCWhat 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 6Interesting 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 689Less cases in tropics- hot climates… : Less cases in tropics- hot climates…FIGHTING BACK: FIGHTING BACK Identify the CASE Isolate DIGNOSE TREAT PREVENTCase 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 instabilityHigh 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 CIsolation Precautions : Isolation PrecautionsAT 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 coverApplication Sequence: Application SequenceWearing Respirator or MASK: Wearing Respirator or MASKRespirators or MASK: Respirators or MASK Protection value an ordinary mask with single layer- 68 % Tripple layer or N-95 MASK - 95 % N 95 SINGLE LAYEREDWhat 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 SequenceAreas - often contaminated: Areas - often contaminatedHAND WASHING: HAND WASHING Soap & water Alcohol based solutionsMEDICAL MANAGEMENT: MEDICAL MANAGEMENT SUPPORTIVE CARE Rest Nutrition Hydration Anti histaminics , cough supressant Paracetamol (no nsaids /ibuprofen) Saline gargles Steam inhalationDRUG THERAPY: DRUG THERAPY PROPHYLACTIC THERAPEUTIC DRUGS OSELTAMIVIR ZANAMIVIRMECHANISM 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 CASESOSELTAMIVIR: 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 GuidelinesDrug 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 mothersPREVENTION: PREVENTION Common Measures. VACCINECommon Measures: Common MeasuresVaccines 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) email@example.com http://matrutvanikediae.blogspot.com/ You do not have the permission to view this presentation. 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