2009 swine flu outbreak 2009 swine flu outbreak

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PengenalanPengenalan Prior to breakPrior to break Recent influenza outbreakRecent influenza outbreak

INTRODUCTIONINTRODUCTION The The 2009 swine flu outbreak2009 swine flu outbreak is the spread of a new strain is the spread of a new strain

of of H1N1H1N1 influenzainfluenza virus that was first detected by public virus that was first detected by public health agencies in March 2009. health agencies in March 2009.

Localized outbreaks of Localized outbreaks of influenza-like illnessinfluenza-like illness (ILI) were (ILI) were detected in three areas initially in detected in three areas initially in MexicoMexico and soon after in and soon after in the the United StatesUnited States and and CanadaCanada. .

Following the discovery of the new strain in the United Following the discovery of the new strain in the United States, its presence was quickly suspected in several States, its presence was quickly suspected in several continents, with over 1,600 candidate cases by April 27.continents, with over 1,600 candidate cases by April 27.

Because it is not possible to confirm every one of such Because it is not possible to confirm every one of such cases as being caused by an influenza virus, the cases as being caused by an influenza virus, the World Health OrganizationWorld Health Organization (WHO) refers to them (WHO) refers to them collectively as influenza-like illnesses (ILI). collectively as influenza-like illnesses (ILI).

The new strain is derived in part from human The new strain is derived in part from human influenzavirusinfluenzavirus A A (subtype H1N1), and in part from two strains of (subtype H1N1), and in part from two strains of swine influenzaswine influenza as as well as an avian influenzawell as an avian influenza

In April both the WHO and the United States In April both the WHO and the United States Centers for Disease Control and PreventionCenters for Disease Control and Prevention (CDC) expressed (CDC) expressed serious concerns about this novel strain, because it apparently serious concerns about this novel strain, because it apparently transmits from human to human, has had a relatively high transmits from human to human, has had a relatively high mortality ratemortality rate in Mexico, and because it has the potential to become in Mexico, and because it has the potential to become a a flu pandemicflu pandemic..

On April 25, 2009, the WHO determined the situation to be a formal On April 25, 2009, the WHO determined the situation to be a formal "public health emergency of international concern", with knowledge "public health emergency of international concern", with knowledge lacking in regard to "the lacking in regard to "the clinical featuresclinical features, , epidemiologyepidemiology, and , and virologyvirology of reported cases and the appropriate responses".of reported cases and the appropriate responses".

Government health agencies around the world also expressed Government health agencies around the world also expressed concerns over the outbreak and are monitoring the situation closely.concerns over the outbreak and are monitoring the situation closely.

As of April 26, 2009, Mexico City schools remained closed while As of April 26, 2009, Mexico City schools remained closed while dozens of other schools and school districts in the US closed due to dozens of other schools and school districts in the US closed due to confirmed cases in students.confirmed cases in students.

     Confirmed cases followed by death     

Confirmed cases    

  Unconfirmed or suspected

CountryCountry Laboratory Laboratory confirmed confirmed casecase

Other Other possible possible casescases

Confirmed Confirmed deathsdeaths(unconfirmed)(unconfirmed)

MexicoMexico 1818 1,6141,614 22 (103)22 (103)United StatesUnited States 2020 100+100+ 00CanadaCanada 66 18+18+ 00New ZealandNew Zealand 00 25+25+ 00ColombiaColombia 00 1212 00SpainSpain 11 1717 00UKUK 00 66 00FranceFrance 00 44 00Israel 0Israel 0 11 00TotalsTotals 4444 1,768+1,768+ 22(103)22(103)

US Human cases of Swine Flu US Human cases of Swine Flu infection (total 20)infection (total 20)

StateState # of laboratory confirmed # of laboratory confirmed casecase

CaliforniaCalifornia 77

KansasKansas 22

New York CityNew York City 88

OhioOhio 11

TexasTexas 22

As of Apr 26,2009

WASHINGTON (AFP) – The United States declared a WASHINGTON (AFP) – The United States declared a swine flu outbreak a as officials confirmed 20 cases in swine flu outbreak a as officials confirmed 20 cases in five US states and warned that they expected more in five US states and warned that they expected more in the coming days. is monitoring the spreading virus and the coming days. is monitoring the spreading virus and has reviewed US capabilities to counter the deadly flu has reviewed US capabilities to counter the deadly flu outbreak, which has killed up to 81 people in , homeland outbreak, which has killed up to 81 people in , homeland security advisor John Brennan told reporters.security advisor John Brennan told reporters.

Obama has ordered a "very active, aggressive, and Obama has ordered a "very active, aggressive, and coordinated response," Brennan said.coordinated response," Brennan said.

Richard Besser, the acting head of the Centers for Richard Besser, the acting head of the Centers for Disease Control and Prevention (CDC), told a that there Disease Control and Prevention (CDC), told a that there were eight confirmed US cases in , seven in , two in were eight confirmed US cases in , seven in , two in Texas, two in Kansas and one in Texas, two in Kansas and one in

Published: Monday April 27, 2009 MYT 11:52:00 AMPublished: Monday April 27, 2009 MYT 11:52:00 AMUpdated: Monday April 27, 2009 MYT 3:31:34 PMUpdated: Monday April 27, 2009 MYT 3:31:34 PM

Swine flu: Health Ministry advises against travel to Canada, Swine flu: Health Ministry advises against travel to Canada, Mexico and US states (Update 3)Mexico and US states (Update 3)

By SIM LEOI LEOI and BEH YUEN HUIBy SIM LEOI LEOI and BEH YUEN HUI

KUALA LUMPUR:KUALA LUMPUR: The Health Ministry has advised Malaysians against travelling to The Health Ministry has advised Malaysians against travelling to Canada, Mexico and selected US states where there have been reports of swine flu Canada, Mexico and selected US states where there have been reports of swine flu infection.infection.

Its minister Datuk Seri Liow Tiong Lai said the United States had recorded 20 cases of Its minister Datuk Seri Liow Tiong Lai said the United States had recorded 20 cases of influenza-like illness in New York (eight cases), California (seven), Texas (two), influenza-like illness in New York (eight cases), California (seven), Texas (two), Kansas (two) and Ohio (one).Kansas (two) and Ohio (one).

Mexico has reported 1,149 cases with 71 deaths, out of which 18 cases were Mexico has reported 1,149 cases with 71 deaths, out of which 18 cases were confirmed to be caused by the swine influenza A/H1N1 virus. Canada has reported confirmed to be caused by the swine influenza A/H1N1 virus. Canada has reported four swine flu cases.four swine flu cases.

“ “So far, no deaths have been reported in these two countries,” he said, referring to So far, no deaths have been reported in these two countries,” he said, referring to Canada and the United States.Canada and the United States.

“ “Although the World Health Organisation (WHO) has not called for any sanction in Although the World Health Organisation (WHO) has not called for any sanction in travel or trade with those affected countries, I would like to advise all Malaysians travel or trade with those affected countries, I would like to advise all Malaysians against travelling to these places,” he told reporters after witnessing the presentation against travelling to these places,” he told reporters after witnessing the presentation of the Joint Commission International award to Prince Court Medical Centre here of the Joint Commission International award to Prince Court Medical Centre here Monday.Monday.

Liow said the ministry had also alerted both public and private medical practitioners to Liow said the ministry had also alerted both public and private medical practitioners to report to the district health office any patient they might have treated for influenza-like report to the district health office any patient they might have treated for influenza-like illness or severe pneumonia symptoms and who had a history of travelling to the illness or severe pneumonia symptoms and who had a history of travelling to the above destinations after April 17.above destinations after April 17.

Background of breakBackground of breakPrior influenza seasonPrior influenza season

Nouthern Hemisphere winter 2008-2009 Nouthern Hemisphere winter 2008-2009 mild season for flu infection -250,000-mild season for flu infection -250,000-500,000 death yearly (elderly, very young, 500,000 death yearly (elderly, very young, chronic illness)chronic illness)

Up to Apr 8,2009 – CDC reported death of Up to Apr 8,2009 – CDC reported death of 43 chlidren from seasonal flu (prev 68)- 43 chlidren from seasonal flu (prev 68)- vaccine H1N1,H3N2vaccine H1N1,H3N2

Dec 2005-Febr 2009, total 12 human Dec 2005-Febr 2009, total 12 human infection with swine influenzainfection with swine influenza

Recent Influenza outbreakRecent Influenza outbreak The outbreak was first detected in the Federal District of Mexico, The outbreak was first detected in the Federal District of Mexico,

where surveillance began picking up a surge in cases of ILI starting where surveillance began picking up a surge in cases of ILI starting March 18.March 18.

The surge was assumed by Mexican authorities to be "late-season flu" The surge was assumed by Mexican authorities to be "late-season flu" (which usually coincides with a mild (which usually coincides with a mild InfluenzavirusInfluenzavirus B B peak until April peak until April 21, when a CDC alert concerning two isolated cases of a novel swine 21, when a CDC alert concerning two isolated cases of a novel swine flu was reported in the media.flu was reported in the media.

The first two cases identified (and confirmed) as swine flu were two The first two cases identified (and confirmed) as swine flu were two children living in the United States, in children living in the United States, in San Diego CountySan Diego County and and Imperial County, CaliforniaImperial County, California, who became ill on March 28 and 30., who became ill on March 28 and 30.

This new strain was promptly confirmed in Mexico, connecting the new This new strain was promptly confirmed in Mexico, connecting the new strain to the ongoing outbreak of ILI. strain to the ongoing outbreak of ILI.

The first deadly case seems to go back to the 13 April, some samples The first deadly case seems to go back to the 13 April, some samples being sent to the US based CDC the 18being sent to the US based CDC the 18thth..

News of the connection was broadcast live in Mexico on April 23, News of the connection was broadcast live in Mexico on April 23, 2009.2009.

In March and April 2009, over 1000 cases of suspected swine flu in In March and April 2009, over 1000 cases of suspected swine flu in humans were detected in humans were detected in MexicoMexico and the and the southwestern United Statessouthwestern United States. . The strain appears to be unusually lethal in Mexico, causing 103 The strain appears to be unusually lethal in Mexico, causing 103 deaths (20 confirmed) so far, mostly in Mexico City.deaths (20 confirmed) so far, mostly in Mexico City.

There have also been cases reported in the states of There have also been cases reported in the states of San Luis San Luis PotosíPotosí, , HidalgoHidalgo, , QuerétaroQuerétaro and and Mexico StateMexico State, all in central Mexico, all in central Mexico

Some cases in Mexico and the United States have been confirmed by Some cases in Mexico and the United States have been confirmed by the the World Health OrganizationWorld Health Organization to be a never-before-seen strain of to be a never-before-seen strain of H1N1.H1N1.

The Mexican fatalities are mainly young adults of 25 to 45, a hallmark The Mexican fatalities are mainly young adults of 25 to 45, a hallmark of of pandemic flupandemic flu..

A new swine flu strain was confirmed in 16 of the deaths and at least A new swine flu strain was confirmed in 16 of the deaths and at least 100 others were being tested as of April 24, 2009.100 others were being tested as of April 24, 2009.

Mexican Health Minister Mexican Health Minister José José ÁngelÁngel CórdovaCórdova on April 24, said "We’re on April 24, said "We’re dealing with a new flu virus that constitutes a respiratory epidemic that dealing with a new flu virus that constitutes a respiratory epidemic that so far is controllable."so far is controllable."

MEXICO:

Theory…Theory… The origins of the new virus strain remain The origins of the new virus strain remain

unknown. One theory is that Asian and European unknown. One theory is that Asian and European strains traveled to Mexico in migratory birds or in strains traveled to Mexico in migratory birds or in people, then combined with North American people, then combined with North American strains in Mexican pig strains in Mexican pig factory farmsfactory farms before before jumping over to farm workers. jumping over to farm workers.

The Mexican health agency acknowledged that The Mexican health agency acknowledged that the original disease vector of the virus may have the original disease vector of the virus may have been flies multiplying in manure lagoons of pig been flies multiplying in manure lagoons of pig farms near farms near PerotePerote, , VeracruzVeracruz, owned by Granjas , owned by Granjas Carroll, a subsidiary of Smithfield Foods.Carroll, a subsidiary of Smithfield Foods.

Genetic and effectsGenetic and effects Dr. Anne Schuchat, interim Deputy Director for CDC Science Dr. Anne Schuchat, interim Deputy Director for CDC Science

and Public Health, and Public Health, the American cases were found to be made up of genetic the American cases were found to be made up of genetic

elements from four different flu viruses — North American swine elements from four different flu viruses — North American swine influenza, North American avian influenza, human influenza, influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe - and swine influenza virus typically found in Asia and Europe - "an unusually mongrelised mix of genetic sequences."an unusually mongrelised mix of genetic sequences.

"Pigs have been shown to act as a potential "mixing vessel" in "Pigs have been shown to act as a potential "mixing vessel" in which reassortment can occur between flu viruses of several which reassortment can occur between flu viruses of several species.species.

This new strain appears to be a result of reassortment of human This new strain appears to be a result of reassortment of human influenza and swine influenza viruses, presumably due to influenza and swine influenza viruses, presumably due to superinfection in an individual human. Influenza viruses readily superinfection in an individual human. Influenza viruses readily undergo reassortment because their genome is packaged in 8 undergo reassortment because their genome is packaged in 8 pieces pieces

Women wear masks as they walk past a closed school in Mexico City April 24, 2009. A Women wear masks as they walk past a closed school in Mexico City April 24, 2009. A deadly strain of swine flu never seen before has killed as many as 61 people in Mexico deadly strain of swine flu never seen before has killed as many as 61 people in Mexico and has spread into the United States, where several people were reported ill. and has spread into the United States, where several people were reported ill. (REUTERS/Henry Romero)(REUTERS/Henry Romero)

Train commuters in Mexico City wearing surgical masks

Mexican soldiers distributing protective masks to citizens

Mexican police officers

Pandemic concernPandemic concern The U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO) The U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO)

are concerned that this outbreak may become a are concerned that this outbreak may become a pandemicpandemic, for the following reasons., for the following reasons.[73][73] New strain  New strain 

– The virus is a new strain of influenza, from which human populations have not been The virus is a new strain of influenza, from which human populations have not been vaccinatedvaccinated or or naturally immunizednaturally immunized..[74][74]

Human transmission  Human transmission  – The virus appeared to infect by human-to-human transmission. Investigations of infected The virus appeared to infect by human-to-human transmission. Investigations of infected

patients indicated no direct contact with swine, such as at a farm or agricultural fair.patients indicated no direct contact with swine, such as at a farm or agricultural fair. [37][37] The The strain was later confirmed to have been transmitted between humans.strain was later confirmed to have been transmitted between humans. [75][75] However, at least one However, at least one other strain of swine flu has previously been transmitted between humans without wider other strain of swine flu has previously been transmitted between humans without wider community infection.community infection.[76][76] In contrast, for example, disease transmission in the last severe human In contrast, for example, disease transmission in the last severe human outbreak of influenza, the outbreak of influenza, the bird flubird flu that peaked in 2006, was determined to be almost entirely that peaked in 2006, was determined to be almost entirely from direct contact between humans and birds.from direct contact between humans and birds.[77][77]

Virulence  Virulence  – The virus has produced severe disease in Mexico, and some deaths. Furthermore, in Mexico The virus has produced severe disease in Mexico, and some deaths. Furthermore, in Mexico

(but not in the United States) the illness has primarily struck young, healthy adults, much like the (but not in the United States) the illness has primarily struck young, healthy adults, much like the deadly Spanish Flu of 1918. Most other influenza strains produce the worst symptoms in young deadly Spanish Flu of 1918. Most other influenza strains produce the worst symptoms in young children, elderly adults, and others with weaker immune systems.children, elderly adults, and others with weaker immune systems.[78][78][37][37]

Geography  Geography  – The virus has been detected in multiple areas, indicating that containment is unlikely.The virus has been detected in multiple areas, indicating that containment is unlikely. [71][71][38][38]

This is exacerbated by the incubation and infectious periods of influenza. This is exacerbated by the incubation and infectious periods of influenza. Other points Other points

– Some other specificities which are also important to rate, such as the Some other specificities which are also important to rate, such as the contagiousnesscontagiousness setting setting the percentage of a population susceptible to this virus, are data which are not yet known. the percentage of a population susceptible to this virus, are data which are not yet known.

Prevention and treatmentPrevention and treatment SStandard personal precautionstandard personal precautions against influenza. against influenza. This includes frequent washing of hands with soap This includes frequent washing of hands with soap

and water or with alcohol-based hand sanitizers, and water or with alcohol-based hand sanitizers, especially after being out in-public.especially after being out in-public.

People should avoid touching their mouth, nose or People should avoid touching their mouth, nose or eyes with their hands unless they've washed their eyes with their hands unless they've washed their hands. hands.

If people do cough, they should either cough into a If people do cough, they should either cough into a tissue and throw it in the garbage immediately or, tissue and throw it in the garbage immediately or, if they cough in their hand, they should wash their if they cough in their hand, they should wash their hands immediately.hands immediately.[79][79]

Prevention and treatmentPrevention and treatment

Some physicians in the US are recommending the use of Some physicians in the US are recommending the use of masks when in public.masks when in public.

The purpose of a face mask is to effectively cover a The purpose of a face mask is to effectively cover a person's mouth and nose so that if a person is around person's mouth and nose so that if a person is around someone who is infected, there is a decreased likelihood of someone who is infected, there is a decreased likelihood of transmission.transmission.

Recommendations to protect against the avian flu indicated Recommendations to protect against the avian flu indicated that using a face mask with a rating of N99, N100 or P100 that using a face mask with a rating of N99, N100 or P100 in the United States or a rating of FFP3 in Europe should in the United States or a rating of FFP3 in Europe should be effective in protecting against transmission.[88] While be effective in protecting against transmission.[88] While face masks with these ratings provide 99% or greater face masks with these ratings provide 99% or greater efficiency in protecting against flu transmission, N95 or efficiency in protecting against flu transmission, N95 or FFP2 face masks provide about 94% efficiency.[89] N95 FFP2 face masks provide about 94% efficiency.[89] N95 and FFP2 rated face masks may therefore also be effective and FFP2 rated face masks may therefore also be effective

The previously recommended influenza vaccines for the southern and The previously recommended influenza vaccines for the southern and northern hemispheres, including that for the 2009/2010 flu season, are northern hemispheres, including that for the 2009/2010 flu season, are ineffective against the new strain.ineffective against the new strain.[80][80] Current development, large- Current development, large-scale manufacturing, distribution and delivery of a new vaccine takes scale manufacturing, distribution and delivery of a new vaccine takes several months.several months.[71][71]

US based medical product company US based medical product company Baxter InternationalBaxter International has has requested a virus sample from the WHO in order to begin development requested a virus sample from the WHO in order to begin development of a new vaccine.of a new vaccine.[81][81] Baxter has patented a cell-based technology that Baxter has patented a cell-based technology that may allow the company to develop a vaccine in half the time it usually may allow the company to develop a vaccine in half the time it usually takes, possibly cutting development time from six months to three.takes, possibly cutting development time from six months to three.[82][82]

Of the available Of the available antiviral treatmentsantiviral treatments for influenza, the WHO stated that for influenza, the WHO stated that the viruses obtained from the human cases with swine influenza in the the viruses obtained from the human cases with swine influenza in the United States were sensitive to United States were sensitive to oseltamiviroseltamivir (Tamiflu) (Tamiflu)[83][83] and and zanamivirzanamivir (Relenza) but resistant to (Relenza) but resistant to amantadineamantadine and and remantadineremantadine..[84][84]

Tamiflu and Relenza also have a preventative effect against Tamiflu and Relenza also have a preventative effect against InfluenzavirusInfluenzavirus A A..[85][85] Roche and the US government have extended Roche and the US government have extended the shelf-life of stock-piled Tamiflu from the original five years to seven the shelf-life of stock-piled Tamiflu from the original five years to seven years because studies indicated that the medication continues to years because studies indicated that the medication continues to maintain its effectiveness.maintain its effectiveness.[[

Vaccine?

National responses National responses Many countries confirmed that inbound international passengers will be screened. Many countries confirmed that inbound international passengers will be screened.

Typical airport health screening involves asking passengers which countries they have Typical airport health screening involves asking passengers which countries they have visited and checking whether they feel or look particularly unwell. visited and checking whether they feel or look particularly unwell. ThermographicThermographic equipment equipment was put into use at a number of airports to screen passengers. In the USA, was put into use at a number of airports to screen passengers. In the USA, two confirmed cases were detected through their "border infectious disease two confirmed cases were detected through their "border infectious disease surveillance".surveillance".[71][71] A number of countries advised against travel to known affected A number of countries advised against travel to known affected regions.regions.

According to the According to the MalaysianMalaysian Health Ministry, health screenings will be carried out on Health Ministry, health screenings will be carried out on passengers traveling to and from Mexico beginning on April 17.passengers traveling to and from Mexico beginning on April 17.[107][107] The Health The Health Ministry’s disease control division has activated its operations room to monitor the swine Ministry’s disease control division has activated its operations room to monitor the swine flu situation and informed medical practitioners who are treating cases with symptoms of flu situation and informed medical practitioners who are treating cases with symptoms of influenza-like illness or severe pneumonia and persons had visited Mexico, California or influenza-like illness or severe pneumonia and persons had visited Mexico, California or Texas, to inform the district health office immediately for preventive and control Texas, to inform the district health office immediately for preventive and control measures.measures.[108][108]

United StatesUnited States The United States of America has declared a state of The United States of America has declared a state of Public Health EmergencyPublic Health Emergency. .

According to the According to the New York TimesNew York Times, "the emergency declaration frees resources to be , "the emergency declaration frees resources to be used toward diagnosing or preventing additional cases and releases money for more used toward diagnosing or preventing additional cases and releases money for more antiviral drugs," including the transfer of approximately 12 million influenza medications antiviral drugs," including the transfer of approximately 12 million influenza medications from a federal stockpile to states.from a federal stockpile to states.[122][122][129][129] The U.S. plans to follow a guidebook The U.S. plans to follow a guidebook developed over the past five years to fight a pandemic flu, such as H5N1.developed over the past five years to fight a pandemic flu, such as H5N1.

Residents of States with Swine Residents of States with Swine Influenza CasesInfluenza Cases

Cover your nose and mouth with a tissue when you cough Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. or sneeze. Throw the tissue in the trash after you use it.

Wash your hands often with soap and water, especially Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners after you cough or sneeze. Alcohol-based hands cleaners are also effective. are also effective.

Try to avoid close contact with sick people. Try to avoid close contact with sick people. If you get sick, CDC recommends that you stay home from If you get sick, CDC recommends that you stay home from

work or school and limit contact with others to keep from work or school and limit contact with others to keep from infecting them. infecting them.

Avoid touching your eyes, nose or mouth. Germs spread Avoid touching your eyes, nose or mouth. Germs spread that way. that way.

CliniciansClinicians Clinicians should consider the possibility of swine influenza virus Clinicians should consider the possibility of swine influenza virus

infections in patients presenting withinfections in patients presenting with 1. febrile respiratory illness who live in an area where human cases of 1. febrile respiratory illness who live in an area where human cases of

swine influenza A (H1N1) has been identified or swine influenza A (H1N1) has been identified or 2. Have traveled to an area where human cases of swine influenza A 2. Have traveled to an area where human cases of swine influenza A

(H1N1) has been identified or (H1N1) has been identified or 3. Have been in contact with ill persons from these areas in the 7 days 3. Have been in contact with ill persons from these areas in the 7 days

prior to their illness onset. prior to their illness onset.

If swine flu is suspected, clinicians should obtain a respiratory swab for If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public department to facilitate transport and timely diagnosis at a state public health laboratory.health laboratory.

INFLUENZA LIKE ILLNESS (ILI)INFLUENZA LIKE ILLNESS (ILI) Definitions of Respiratory IllnessDefinitions of Respiratory Illness Acute respiratory illness Acute respiratory illness

Recent onset of at least two of the following: Recent onset of at least two of the following: – rhinorrhea or nasal congestion rhinorrhea or nasal congestion – sore throat sore throat – cough cough – fever or feverishnessfever or feverishness

Influenza-like illnessInfluenza-like illness: fever >37.8°C (100°F) plus : fever >37.8°C (100°F) plus cough or sore throat cough or sore throat

Case Definitions for Infection with Swine Influenza A (H1N1) Virus Case Definitions for Infection with Swine Influenza A (H1N1) Virus A Confirmed case A Confirmed case of swine influenza A (H1N1) virus infection is defined as a of swine influenza A (H1N1) virus infection is defined as a

person with an acute respiratory illness with laboratory confirmed swine person with an acute respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests: influenza A (H1N1) virus infection at CDC by one or more of the following tests: – real-time RT-PCR real-time RT-PCR – viral culture viral culture – four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodiesfour-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies

A Probable caseA Probable case of swine influenza A (H1N1) virus infection is defined as a of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with an influenza test that is positive for person with an acute respiratory illness with an influenza test that is positive for influenza A, but H1 and N1 negative.influenza A, but H1 and N1 negative.

A Suspected case A Suspected case of swine influenza A (H1N1) virus infection is defined as: of swine influenza A (H1N1) virus infection is defined as: – A person with an acute respiratory illness who was a close contact to a confirmed A person with an acute respiratory illness who was a close contact to a confirmed

case of swine influenza A (H1N1) virus infection while the case was ill case of swine influenza A (H1N1) virus infection while the case was ill OROR – A person with an acute respiratory illness with a recent history of contact with an A person with an acute respiratory illness with a recent history of contact with an

animal with confirmed or suspected swine influenza A (H1N1) virus infection animal with confirmed or suspected swine influenza A (H1N1) virus infection OROR – A person with an acute respiratory illness who has traveled to an area where there are A person with an acute respiratory illness who has traveled to an area where there are

confirmed cases of swine influenza A (H1N1) within 7 days of suspect case's illness confirmed cases of swine influenza A (H1N1) within 7 days of suspect case's illness onset. onset.

Infectious period for confirmed cases = Infectious period for confirmed cases = 1 day before onset to 7 days after onset of 1 day before onset to 7 days after onset of

illnessillnessDay before onset = Day -1Day before onset = Day -1Onset day = Day 0Onset day = Day 0Days after onset = Days 1-7Days after onset = Days 1-7

  

State Public Health LaboratoriesState Public Health Laboratories Laboratories should send all unsubtypable Laboratories should send all unsubtypable

influenza A specimens as soon as possible to the influenza A specimens as soon as possible to the Viral Surveillance and Diagnostic Branch of the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division for further diagnostic CDC’s Influenza Division for further diagnostic testing.testing.

Public Health /Animal Health OfficialsPublic Health /Animal Health Officials Officials should conduct thorough case and Officials should conduct thorough case and

contact investigations to determine the source of contact investigations to determine the source of the swine influenza virus, extent of community the swine influenza virus, extent of community illness and the need for timely control measures.illness and the need for timely control measures.

KESIAPSIAGAAN BAGI KESIAPSIAGAAN BAGI MENANGANI “SWINE FLU”MENANGANI “SWINE FLU”

Melakukan saringan ke atas mereka yang datang dari Melakukan saringan ke atas mereka yang datang dari Carlifornia, Texas dan Mexico.Carlifornia, Texas dan Mexico.

Sila ambil sejarah pergerakan mereka untuk 7 hari masa Sila ambil sejarah pergerakan mereka untuk 7 hari masa pengeraman sebelum keluar dari kawasan negara pengeraman sebelum keluar dari kawasan negara tersebut.tersebut.

Melakukan diagnosa ke atas mereka dengan mengikut Melakukan diagnosa ke atas mereka dengan mengikut definisi kes ILIdefinisi kes ILI

Bagi mereka yang sakit dengan tanda-tanda ILI hendaklah Bagi mereka yang sakit dengan tanda-tanda ILI hendaklah dirujuk ke Hospital Batu Pahatdirujuk ke Hospital Batu Pahat

Bagi mereka yang tiada tanda-tanda ILI hendaklah di ber Bagi mereka yang tiada tanda-tanda ILI hendaklah di ber HEALTH ALERT CARD untuk di bawa bersama-sama HEALTH ALERT CARD untuk di bawa bersama-sama sebagai panduan pemegang kad dan pengamal perubatan sebagai panduan pemegang kad dan pengamal perubatan masa akan datang.masa akan datang.

KESIMPULANKESIMPULAN

WHO : amaran tahap wabak swine influenzaWHO : amaran tahap wabak swine influenza

TAHAP 4TAHAP 4