swine flu

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By: ddy2j (116 month(s) ago)

presentation is nice.. . . i like to download it . .

By: erayren (119 month(s) ago)

Hellow Dr, Sosale, I like your presentation very much, can you allow me to download it or e-mail to me at erayren@yahoo.com.cn thanks lot

By: vich (119 month(s) ago)

Hello Dr.Sosale i'd like to download your presentation ,

By: pooja_bissa (120 month(s) ago)

hello sir, i would like to download this presentation

By: pooja_bissa (120 month(s) ago)

hello sir, i want to download this presentation

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H1N1 FLU(SWINE FLU) Department of pediatrics, G.M.C, Miraj & Affiliated hospital PVPGH, Sangli,(MH). DR.SHIVAPRAKASH SOSALE,C 8/17/2009 pediatrics ,GMC,Miraj

DEDICATED TO……. : 

DEDICATED TO……. “INNOCENT PEOPLE OF ENTIRE WORLD WHO DIED DUE TO THIS H1N1 INFECTION” 8/17/2009 pediatrics ,GMC,Miraj

Influenza is unpredictable. : 

Influenza is unpredictable. Who is next? Where is next? 8/17/2009 pediatrics ,GMC,Miraj

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MAP of affected countries and deaths as of 6 August 2009 *Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases U P D A T E 8/17/2009 pediatrics ,GMC,Miraj

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Phase 1 – animal to animal transmission. Phase 2 – an animal influenza virus is capable of human infection. Phase 3 - small outbreaks among close populations but not through human to human contact . Phase 4 - Human to human transmission Phase 5 - spread across two countries or more in one of the WHO regions (continents ) Phase 6 – spread across two countries or more in one of the WHO regions plus spread to another WHO region. WHO PANDEMIC ALERT: 8/17/2009 pediatrics ,GMC,Miraj

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8/17/2009 pediatrics ,GMC,Miraj

April 24: 2009 H1N1 first disease outbreak notice. April 25: WHO Director General declares a formal “Public health emergency of international concern” April 27: “containment of the outbreak is not feasible” pandemic alert raised from phase 3 to phase 4. April 29: phase 4 to phase 5. June 11: phase 5 to phase 6. WHO 8/17/2009 pediatrics ,GMC,Miraj

INFLUENZA A : 

INFLUENZA A The influenza A virus, carrying the designation H1N1. It is a hybrid reassorted virus. Contains DNA typical to avian, swine and human viruses, including elements from European and Asian swine viruses. 8/17/2009 pediatrics ,GMC,Miraj

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O I N F L U E N Z A 8/17/2009 pediatrics ,GMC,Miraj

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Pigs provide an excellent 'melting pot' for these viruses to mix and match with each other. : 

Pigs provide an excellent 'melting pot' for these viruses to mix and match with each other. Different species shelter different strains of flu virus 8/17/2009 pediatrics ,GMC,Miraj

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A) Host factors: Presence of target receptors on host cells Availability of enzymes - for viral entry and replication State of immunocompetence Specific immunity -host and target group Immune system - control the viral replication - without serious collateral damage P A T H O G E N E S I S 8/17/2009 pediatrics ,GMC,Miraj

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B)Viral factors: Ability to bind to host cells Ability of virus shedding Restriction of cytopathogenic effects to allow for an appropriate balance between viral replication and control by the host Escape from the immunosurveillance Immune response modulation P A T H O G E N E N E S I S 8/17/2009 pediatrics ,GMC,Miraj

Droplet infection: : 

Droplet infection: sneeze/cough Single sneeze -20000 particle Nasal secretion-millions of virus particle/ml Single HID(Human Infectious Dose)-100-1000particle 8/17/2009 pediatrics ,GMC,Miraj

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8/17/2009 pediatrics ,GMC,Miraj

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IInfection through respiratory system: 8/17/2009 pediatrics ,GMC,Miraj

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PATHOGENESIS; Pediatrics GMC Miraj 8/17/2009 pediatrics ,GMC,Miraj

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Viral replication 8/17/2009 pediatrics ,GMC,Miraj

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8/17/2009 pediatrics ,GMC,Miraj

HIGH RISK PATIENTS: : 

HIGH RISK PATIENTS: CHILDREN LESS THAN 5 YEARS PATIENT WITH CHRONIC MEDICAL CONDITION ASTHMA DIABETIS MELLITUS CHRONIC RENAL FAILURE OBESITY PATIENT WITH IMMUNOSUPRESSION/HIV SICKEL CELL ANEAMIA 8/17/2009 pediatrics ,GMC,Miraj

SYMPTOMS IN CHILDREN: : 

SYMPTOMS IN CHILDREN: FEVER COUGH HEADACHE SORE THROAT BODY ACHES CHILLS FATIGUE DIARRHEA & VOMITING IN SOME PATIENTS 8/17/2009 pediatrics ,GMC,Miraj

EMERGENCY WARNING SIGNS IN CHILDREN: : 

EMERGENCY WARNING SIGNS IN CHILDREN: FAST BREATHING BLUISH SKIN COLOUR NOT ACCEPTING FEED HIGH OR PROLONGED FEVER NOT WAKING UP EXTREME IRRITABILITY LETHARGIC Flu-like symptoms improve but then return with fever and worse cough 8/17/2009 pediatrics ,GMC,Miraj

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The suspected cases – Monitor for clinical / radiological evidence of LRTI For hypoxia Respiratory rate, Oxygen saturation, Level of Consciousness. W A T C H F O R 8/17/2009 pediatrics ,GMC,Miraj

COMPLICATIONS: : 

COMPLICATIONS: SECONDARY BACTERIAL PNEUMONIAARDS PRIIMARY VIRAL PNEUMONIA EXACEREBRATION OF CH.PULMONARY DISEASE CROUP SINUSITIS,OTITIS MEDIA CARDIAC COMPLICATION TOXIC SHOCK SYNDROME ENCEPHALITIS 8/17/2009 pediatrics ,GMC,Miraj

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SUPPORTIVE: MEDICATIONS: ANTI –FEVER: TEPID SPONGING ONLY PARACETAMOL ANTI –VIRAL:OSELTAMIVIR(TAMIFLU/FLUVIR) ZANAMIVIR(RELANZA) ADEQUATE CONTROLE PRECATIONS: Cough etiquette Hand hygiene Natural ventilation 8/17/2009 pediatrics ,GMC,Miraj

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Supportive therapy includes: -IV Fluids -Parental nutrition. -Oxygen therapy - ventilatory support.-SpO2 <90% PaO2<60mm with O2 -Antibiotics for secondary infection. -Vasopressors for shock.-Dopamine,dobutamine -Paracetamol or ibuprofen -Advised to drink plenty of fluids. --For sore throat, short course of topical decongestants, saline nasal drops, throat lozenges and steam inhalation - 8/17/2009 pediatrics ,GMC,Miraj

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Salicylate / aspirin is strictly contra-indicated in any influenza patient due to its potential to cause Reye’s syndrome NO ASPIRIN PLEASE W A R N I N G 8/17/2009 pediatrics ,GMC,Miraj

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Cat C :mild fever + cough/sore throat +/- bodyache, headache, diarrhoea,vomiting do not require Oseltamivir Cat B: IB+ high grade fever and severe sore throat . They may require home isolation and Oseltamivir.   IIB +high risk conditions Treated with Oseltamivir No tests for both  confine themselves at home Cat A: breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails, irritability among small children, refusal to accept food, worsening of underlying chronic conditions require testing, immediate hospitalisation and treatment. New guidelines according to Govt.of India 8/17/2009 pediatrics ,GMC,Miraj

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NOT RECOMMANDED USUALY 8/17/2009 pediatrics ,GMC,Miraj

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Chemo prophylaxis: : 

Chemo 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 Time period: Prophylaxis should be provided till 10 days after last exposure (maximum period of 6 weeks) 10 day 8/17/2009 pediatrics ,GMC,Miraj

OSELTAMIVIR: : 

OSELTAMIVIR: PRO-DRUG esterases OSELTAMIVIR CARBOXYLASE & ELEMINATED BY KIDNEY PLEASE ASK ABOUT 1.ANY FRUCTOSE INTOLERANCE 2.RENAL PROBLEMS PREFERABLY TO BE TAKEN WITH FOOD ACTION: NEURAMINIDASE INHIBITOR This drug is only available through the public health system and its retail sale is banned as indiscriminate use may lead to development of resistance 8/17/2009 pediatrics ,GMC,Miraj

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8/17/2009 pediatrics ,GMC,Miraj

ADVERSE EFFECT: : 

ADVERSE EFFECT: NAUSIA VOMITING HEADACHE BRONCHITIS URTI NEUROPSYCHIATRIC DISORDERS: hallucination ,insomnia, O S E L T A M I V I R 8/17/2009 pediatrics ,GMC,Miraj

Can be used these drugs in pregnancy? : 

Can be used these drugs in pregnancy? Category “C” medication No adverse effects have been reported during pregnancy or among infants born to that mother. Pregnancy should not be considered a contraindication to use these drugs Oseltamivir is preferred because of its systemic activity 8/17/2009 pediatrics ,GMC,Miraj

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No vaccine available at present to protect humans from H1N1 flu Vaccine for human seasonal influenza does not protect against H1N1 flu viruses due to antigenic differences, but may provide partial protection against swine H3N2 virus Vaccination 8/17/2009 pediatrics ,GMC,Miraj

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seasonal influenza vaccine is found not effective against the re-assorted virus. It takes about six months to manufacture a vaccine against a novel virus. Hence, a vaccine not available during the first wave of the pandemic. If the candidate vaccine strains are made available by WHO or synthesized in our labs, the vaccine would be manufactured. Depending upon the availability, the at-risk population would be prioritized for vaccination. V A C C I N A T I O N 8/17/2009 pediatrics ,GMC,Miraj

Discharge policy : 

Discharge policy Adult patients should be discharged 7 days after symptoms have subsided. Children should be discharged 14 days after symptoms have subsided. 8/17/2009 pediatrics ,GMC,Miraj

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Do’s and Don’ts for the Community DO: * Wash your hands * Avoid crowded places * Stay more than an arm's length from persons afflicted with flu * Get plenty of sleep * Drink plenty of water and eat nutritious food 8/17/2009 pediatrics ,GMC,Miraj

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For people who are sick: * Stay home and limit contacts with others as much as possible * Rest and take plenty of liquids * Cover your mouth and nose when you cough or sneeze * Seek medical advice if needed. 8/17/2009 pediatrics ,GMC,Miraj

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DO NOT: * Shake hands or hug/kiss in greeting * Spit in public * Take medicines without consulting a physician 8/17/2009 pediatrics ,GMC,Miraj

Follow general infection control practices, that are, : 

Follow general infection control practices, that are, Frequent hand washing Covered sneezes and coughs Using a tissue Disposing the tissue or handkerchief properly. Wearing mask while nursing or caring for someone infected. 8/17/2009 pediatrics ,GMC,Miraj

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PARENTS ROLE:TEACH CHILDREN : 

PARENTS ROLE:TEACH CHILDREN FIND OUT WHAT THEY KNOW EXPLAIN THE FACTS IN SIMPLE WORDS TALK ABOUT HYGINE A)FREQUENT HAND WASHING—20MIN B)TEACH COUGH ETIQETTE SOCIAL DISTANCING-6 FFET TEACH GENERAL HEALTH HABITS STAY HOME FROM SCHOOL IF SICK, AND STAY AWAY FROM SICK PEOPLE UNTIL THEY ARE BETTER. IF ANY FLU LIKE SYMPTOMS CONSULT PEDIATRICIAN 8/17/2009 pediatrics ,GMC,Miraj

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“Children always need to feel safe and loved. When they are uncertain about situations and afraid they may need even more affection and attention”. REMEMBER….. 8/17/2009 pediatrics ,GMC,Miraj

CAN MOTHER WITH H1N1 FLU CAN BREAST FEED? : 

CAN MOTHER WITH H1N1 FLU CAN BREAST FEED? YES. INFLUENZA VIRUS IS NOT TRANSMITTED WITH THE BREAST MILK. BUT, AGAIN MAINTAIN HYGINE….. S P E C I A L S I T U A T I O N S 8/17/2009 pediatrics ,GMC,Miraj

CAN PEOPLE CATCH THE H1N1 FLU FROM EATING PORK? : 

CAN PEOPLE CATCH THE H1N1 FLU FROM EATING PORK? NO. H1N1 VIRUS NOT TRANSMITTED BY FOOD YOU CANNOT GET THE H1N1 FLU FROM EATING THE COOKED PORK OR PORK PRODUCTS 8/17/2009 pediatrics ,GMC,Miraj

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How long someone with the flu infect someone else? Infected people may be able to infect others beginning one day before symptoms develop and up to ten or more days after becoming sick. 8/17/2009 pediatrics ,GMC,Miraj

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8/17/2009 pediatrics ,GMC,Miraj

Drinking water? : 

Drinking water? No completed research for novel H1N1 virus. Free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. 8/17/2009 pediatrics ,GMC,Miraj

Swimming Pools: : 

Swimming Pools: No completed research for novel H1N1 virus. Free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. 8/17/2009 pediatrics ,GMC,Miraj

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“Avoid adopting any misconceptions and stay informed about the Do’s and Don’ts while the prevalence of any kind of flu” 8/17/2009 pediatrics ,GMC,Miraj

MANY WASHES A DAY KEEPS THE FLU AWAY : 

MANY WASHES A DAY KEEPS THE FLU AWAY LET THE SWINE FLY BY IN THE BLUE AND NOT DESCEND ON ME AND YOU, 8/17/2009 pediatrics ,GMC,Miraj

Summary; : 

Summary; WHO raised alert level to 6 on june 11,2009 There is disparity b/w % of case fatality rate b/w countries No vaccive available Anti-virals availble Prevention is the best medicine 8/17/2009 pediatrics ,GMC,Miraj

Lessons learnt frompast pandemics: : 

Lessons learnt frompast pandemics: Pandemics are unpredictable Most of people do not have immunity A sudden ,sharp increase in the need for medical care will always occur Capacity to cause severe disease in nontraditional groups –pandemic impact Epidemiology reveals waves of infection ages/areas not infected initially –vulnerable in future waves Subsequent wave may be more sever 8/17/2009 pediatrics ,GMC,Miraj

Each locality/jurisdiction needs to; : 

Each locality/jurisdiction needs to; Have enhanced surveillance capability Develop a plan to house large no of severely sick Healthcare facilities /hospitals need to focus on increasing surge capacity &stringent infection prevention /control General population need to follow basic precautions 8/17/2009 pediatrics ,GMC,Miraj

Remember ; : 

Remember ; Public interventions delay, but do not stop pandemic spread Quarantine ,travel restriction shows little effect Temporary banning of public gatherings, closing schools –effective in severe disease and high mortality 8/17/2009 pediatrics ,GMC,Miraj

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As the best treatment of any disease is PREVENTION 8/17/2009 pediatrics ,GMC,Miraj

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“Sense,not scare is the key to stay safe” 8/17/2009 pediatrics ,GMC,Miraj

So, Stay Alert, Stay Safe 8/17/2009 pediatrics ,GMC,Miraj

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“BE CONTAGIOUS IN SPREADING AWARENESS” 8/17/2009 pediatrics ,GMC,Miraj

INFORMATION SOURCES; : 

INFORMATION SOURCES; WHO ) Ministry of Health & Family Welfare GOVERNAMENT OF INDIA AND Website: www.nicd.nic.in 8/17/2009 pediatrics ,GMC,Miraj

References : 

References Nelson textbook of pediatrics 18th ed Text book of Influenza today ECDC 8/17/2009 pediatrics ,GMC,Miraj

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THANK YOU DEPARTMENT OF PEDIATRICS ,G.M.C ,MIRAJ 8/17/2009 pediatrics ,GMC,Miraj

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8/17/2009 pediatrics ,GMC,Miraj

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