Post on 21-Apr-2017
BIRD FLUAVIAN INFLUENZA
essential learning Dr.T.V.Rao MD
An acute respiratory illness resulting from infection with an Influenza virus
Highly infectious and can spread rapidly from person to person
Some strains cause more severe illness than others
What is influenza?
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History of influenza
412 BC - first
mentioned by
Hippocrates
1580 - first
pandemic described
1580-1900 - 28
pandemics
Pandemic influenza in the
20th Century
1920 1940 1960 1980 2000
H1N1 H2N2 H3N2
1918 “Spanish Flu” 1957 “Asian Flu”1968 “Hong Kong Flu”
20-40 million deaths 1 million deaths 1 million deaths
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1918
Pandemic
Highest mortality in people 20-40 years of age
- 675,000 Americans died of influenza
- 43,000 U.S. soldiers died of influenza
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Emergency hospital, Camp Funston, Kansas 1918 Courtesy of National Museum of Health and Medicine
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Types of influenza viruses
Influenza viruses are divided into three main types: influenza A, B, and C
A viruses – infect birds and other animals, as well as humans
A viruses – source of seasonal influenza epidemics and all pandemics
B and C viruses – infect humans only and do not cause pandemics
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Avian InfluenzaAvian influenza refers to the disease caused by infection with avian (bird) influenza (flu) Type A viruses. These viruses occur naturally among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species. Avian flu viruses do not normally infect humans. However, sporadic human infections with avian flu viruses have occurred.
Migratory
water birdsDomestic birds
Where does influenza
A virus come from?
Humans
and other
animals
Human influenza A viruses start as avian (bird) influenza viruses
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Avian Influenza in Birds
Avian influenza refers to infection of birds with avian influenza Type A viruses. These viruses occur naturally among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species. Wild aquatic birds can be infected with avian influenza A viruses in their intestines and respiratory tract, but usually do not get sick. However, avian influenza A viruses are very contagious among birds and some of these viruses can sicken and even kill certain
domesticated bird species including chickens, ducks, and turkeys.
Avian Influenza
A Viral disease of Domestic and Wild Birds characterized by the full range of responses from almost no signs of the disease to very high mortality. The incubation period is also highly variable, and ranges from a few days to a week ( 3 to 7 days).
Spread of H5 N1
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Highly Pathogenic Avian InfluenzaWorldwide Occurrences
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Intercontinental Spread of Avian Flu
Transport of live poultry,
frozen poultry meat and
untreated hatching eggs
over long distances. Trade
of poultry by-products
unheated and egg
products and possibly
frozen poultry semen.
Least importance are free
living migrating birds
International Spread of Avian Flu
Trade of commercial poultry including liv birds, vehicles, crates, containers. Also, international exhibitions, shows, bird markets and similar events. Least important are birds which displays seasonal migration pattern.
Local
Local Spread of
Avian Flu Farm personnel, technical
crew
(debeaker, vaccinators,
catchers, etc.). Also,
contaminated poultry
manure and waste stuff as
well as airborne particle
and dust. Significant are
live birds in close vicinity
to poultry houses
Infected Birds Can Spread the Virus
Infected birds can shed avian influenza A viruses
in their saliva, nasal secretions, and feces.
Susceptible birds become infected when they
have contact with the virus as it is shed by
infected birds. They can also become infected by
coming in contact with surfaces that are
contaminated with virus from infected birds.
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Avian Influenza in Wild Birds
Avian influenza A viruses have been isolated from more than 100 different species of wild birds.. The majority of the wild birds from which these viruses have been recovered represent gulls, terns and shorebirds or waterfowl such as ducks, geese and swans. These wild birds are often viewed as reservoirs (hosts) for avian influenza A viruses.
Avian Influenza in Poultry
(Domesticated Birds)Domesticated birds (chickens, turkeys, etc.) may become infected with avian influenza A viruses through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces that have been contaminated with the viruses.
depopulation (or culling,
also called “stamping out”) When H5 or H7 avian influenza outbreaks occur in poultry, depopulation (or culling, also called “stamping out”) of infected flocks is usually carried out. In addition surveillance of flocks that are nearby or linked to the infected flock(s), and quarantine of exposed flocks with culling if disease is detected, are the preferred control and eradication methods
Avian influenza outbreaks are of concern in
domesticated birds for several reasons:
The potential for low pathogenic H5 and H7 viruses to evolve into highly pathogenic viruses
The potential for rapid spread and significant illness and death among poultry during outbreaks of highly pathogenic avian influenza
The economic impact and trade restrictions from a highly pathogenic avian influenza outbreak
The possibility that avian influenza A viruses could be transmitted to humans
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How influenza spreadsSpreads easily from person to person through coughing and sneezing
Transmitted by:
inhaling respiratory aerosols containing the virus, produced when infected person talks, coughs, or sneezes
touching an infected person or an item contaminated with the virus and then touching your eyes, nose, or mouth
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Disease containment measures
Isolation: restriction of movement/separation of illinfected persons with a contagious disease
Quarantine: restriction of movement/separation of wellpersons presumed exposed to a contagious disease
Self-shielding: self-imposed exclusion from infected persons or those who may be infected
Social distancing: reducing interactions between people to reduce the risk of disease transmission
Snow days: days on which offices, schools, transportation systems are closed or cancelled, as if there were a major snowstorm
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How can someone with the flu infect
someone else?
Infected people may be able to
infect others beginning 1 day
before symptoms develop and
up to 7 or more days after
becoming sick.
That means that you may be able
to pass on the flu to someone
else before you know you are
sick, as well as while you are
sick.
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In adults, emergency warning signs that
need urgent medical attention include:
Difficulty breathing or
shortness of breath
Pain or pressure in the
chest or abdomen
Sudden dizziness
Confusion
Severe or persistent
vomiting
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DiagnosisTo diagnose swine or Birds influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus Dr.T.V.Ra
o MD
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Specimen Collection for
DiagnosisSample Collection and handling is same as
for human avian flu or seasonal influenza
like illness (Refer CD Alert on AI). Sample
Collection: should be labelled clearly and
include patient’s complete information and
should be sent to designated Laboratory.
Laboratory biosafety measures
should be followed for collection,
storage, packaging and shipping of
influenza samples.Dr.T.V.Rao MD 29
Currently Available 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. It is important to note that samples from all cases, once the Pandemic starts, are not required to be tested.
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Diagnosis of FluFor diagnosis of swine influenza A
infection, respiratory specimen (NP
(nasopharyngeal swab), throat swab
, nasal aspirate, nasal washing)
would generally need to be collected
within the first 4 to 5 days of illness
(when an infected person is most
likely to be shedding virus). However,
some persons, especially children,
may shed virus for 10 days or longer.Dr.T.V.Rao MD 31
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Rapid Diagnosis
RT PCR
can make
rapid
Diagnosis
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How we control Health
care Associated Spread
Combination of infection control strategies
is recommended to decrease transmission
of influenza in health-care settings. These
include placing influenza patients in
private rooms when possible and having
health-care personnel wear masks for
close patient contact (i.e., within 3 feet)
and gowns and gloves if contact with
respiratory secretions is likely .
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Slide 6-
35
Recommendation for all individuals with
respiratory symptoms
Cover the nose/mouth when coughing or sneezing
Perform hand hygiene if contact
respiratory secretions and
contaminated objects
Put on a surgical mask
Respiratory hygiene and cough etiquette
• Use tissue paper to contain
respiratory secretions and
dispose in the waste receptacle
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Use of Mask by Patients
and Health care WorkersThe use of surgical or
procedure masks by infectious
patients may help contain their
respiratory secretions and
limit exposure to others.
Likewise, when a patient is not
wearing a mask, as when in an
isolation room, having health-
care personnel mask for close
contact with the patient may
prevent nose and mouth
contact with respiratory
droplets
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Can the Mask Prevent the
Spread of Flu ???
However, no studies
have definitively
shown that mask use
by either infectious
patients or health-
care personnel
prevents influenza
transmission
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Prevention is best option
Covering your
nose and mouth
with a tissue
when you cough
or sneeze. Throw
the tissue in the
trash after you
use it.
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Using N95 mask reduces the Risk
You can cut your
risk of contracting
the flu or other
respiratory viruses
by as much as 80
percent by wearing a
mask over your
nose and mouth,
according to a new
study.
Emerging Infectious Diseases, the journal of
the Centres for Disease Control and
Prevention (CDC) . Dr.T.V.Ra
o MD
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Health Care Personal
Should Protect WithDuring a surgical or procedure mask
should be worn by health-care personnel
who are in close contact (i.e., within 3 feet)
with a patient who has symptoms of a
respiratory infection, particularly if fever is
present, as recommended for standard and
droplet precautions. These precautions
should be maintained until the patient has
been determined to be non infectious or
for the duration recommended for the
specific infectious agent.Dr.T.V.Rao MD 40
Slide 6- 41
Isolation
Precautions
Patient
Transport
Linen & laundry Waste Management
Decontamination
PPE
Hand hygiene
Patient
placement
Isolation Precautions
Strategy of Patient Placement
1. Isolate suspected or confirmed cases in a negative pressure isolation room
2. When single rooms are fully occupied
Cohort patients with same confirmed diagnosis in same cubicles, maintaining a minimum of 1 metre distance from each other
3. Confirmed and suspected cases should be nursed in separate cubicle
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Slide 6-
43
Waste
Management
1. All waste generated from room/ area housing suspected or confirmed avian influenza patients should be treated as clinical waste
2. Biohazard labeling
3. Wear appropriate PPE when handling clinical waste
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Institutional Measures
Use of antiviral drugs for treatment and chemoprophylaxis of influenza is a key component of influenza outbreak control in institutions that house patients at higher risk for influenza complications. In addition to antiviral medications, other outbreak-control measures include instituting droplet and contact precautions and establishing cohorts of patients with confirmed or suspected influenza, re-offering influenza vaccination (if available) to unvaccinated staff and patients, restricting staff movement between wards or buildings, and restricting contact between ill staff or visitors and patients.
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Dealing Patients with suspected Influenza
1. Follow Respiratory Hygiene and Cough Etiquette precautions
2. Triage: Fever, Travel history, Occupational exposure, Contact history and Cluster of persons with fever and pneumonia symptoms.
3. Designated areas for suspected patients while waiting for referral and arrange speedy consultation and management
4. Wear appropriate PPE
5. Environment and equipment cleaning and disinfection
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Antiviral Drugs Can Be Used
to Treat Illness
For treatment (and
prevention) of human
infection with avian
influenza A viruses, CDC
and WHO currently
recommend oseltamivir
or zanamivir, two of four
prescription antiviral
medications currently
licensed for use in the
United States.
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Control with Antiviral DrugsBoth adamantine and neuraminidase inhibitors have been used successfully to control outbreaks caused by susceptible strains when antiviral medications are combined with other infection-control measures.
Currently Oseltamivir has gained importance as safe and effective Antiviral agent.
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• No Visitors• A sign-in log
• Clean clothing and sanitized footwear• Properly maintained foot pans with
disinfectant solution• Rodent and insect control
• No other animals, esp. wild birds • Vaccination • All in, all out• Sanitize hands
MINIMUM BIOSECURITY
STANDARDS
HAND WASHING REDUCES
SPREAD OF INFLUENZA
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Clean Hands – Safe Hands
Even Reduces Influenza
Washing your
hands often with
soap and water,
especially after you
cough or sneeze.
You can also use
alcohol-based
hand cleaners.
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Avian influenza A(H7N9) virus
An Emerging Strain
The latest avian influenza
virus strain added to the
list of agents causing "bird
flu" is called avian
influenza A(H7N9) virus -
a colourfully exciting
reference to its key
surface proteins
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References
Centre for Disease Control (CDC)
World Health Organization ( WHO)
Google Images
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