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Swine fu (Swine infuenza,H1N1 FLU)

BYBY

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Outline

• Introduction

• Historical Perspective of Swine Flu

• Inuenza viruses-virology

• Mode of transmissions

• Other informations

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Introduction

! "here is glo#al evidence of inuenza $%H& causingmor#idity and mortality!

'! (HO has raised the level of inuenza pandemic alertto )!

*! Inuenza must #e ta+en seriously, precisely #ecauseof their capacity to spread to every country!

! Most cases seem to #e mild and self limited howeversevere illness and death have #een reported in a

small proportion of cases!

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O#.ectives

!  "o detect and con/rm cases of newInuenza $%H&virus infection!

'!  "o esta#lish and monitor the e0tend ofspread of new Inuenza $%H& contacts!

*! "o esta#lish treatment protocols!! "o assist the hospitals sta1 in infection

control!

2! "o use the personal protective e3uipmentand removal and disposal with safely!

)! "o train medical personnel in collectingsamples and to store them and safely

transport to the national la#! 

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 "IM4 5I&4 OF 464&"S

April 12: An out#rea+ of inuenza-li+e illness in Veracruz, Mexico,

reporte to !H"• April 1#$1%: two ca&e& o' a new $7H&8 virus infection

ientie in two &outern 9alifornia countie& in U*S*A*

• April 2+: new inuenza $ 7H&8 virus infection conre in&e-eral patient& in Me0ico

• April 2.: !H" eclare& a pu/lic ealt e-ent o'international concern (PH4I9)*

•  0une 11: !H" eclare& paneic phase ) (&prea to 2 !H"reion&)

• n 3 wee4&, all !H" reion& reportin ca&e& o' paneic

(H1N1) 2553

6rea4in New&

• 7lo/al &wine fu eat& pa&& 15,555 wit ore tan +2#555conre ca&e& e8ectin ore tan 259 countrie&*

•

Accorin to unocial &ource, 93 ca&e& in ;un

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Mode of spread

! "he virus is spread from person to person #ye0posure to infected droplet e0pelled #ycoughing or sneezing7*: ;8!

'! 9ontaminated hands and surfaces7

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HumanHuman

 virusvirus

ReassortantReassortant

virusvirus

Non-Non-

humanhuman

virusvirus

Mecani&& o' nfuenza Viru&Mecani&& o' nfuenza Viru&

Aaptation to Huan nfuenza -iru&Aaptation to Huan nfuenza -iru&

(>&i't?)(>&i't?)

 D I R E C T

 D I R E C T

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6irology

INFLUENZA VIRUSESINFLUENZA VIRUSES

Family orthomyxoviridaeFamily orthomyxoviridae Influenza A H1N1, and H1N2,Influenza A H1N1, and H1N2,

H3N2 may beH3N2 may be RNA virus segmented genomesRNA virus segmented genomes a!h segment en!odes a differenta!h segment en!odes a different

 "rotein "rotein #$o ma%or surfa!e "roteins#$o ma%or surfa!e "roteins

&Hemagglutining &HA',&Hemagglutining &HA',nuraminidase &NA'nuraminidase &NA' that determinthat determinthe seroty"esthe seroty"es

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9ase =e/nition

Su&pecte ca&e o' paneic (H1N1) 251=! $ suspected case is de/ned as an individual

with acute respiratory illness and fever7reported or documented fever 7more than

*>?98 and one of the following@ cough, sorethroat, shortness of #reath, diAculty in#reathing or chest pains with onset@

- (ithin seven days of close contact with aperson who is pro#a#le or con/rmed case!

- (ithin seven days of travel to acountry%community where there is one or more

con/rmed cases of pandemic!

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Pro#a#le case of pandemic

! $ pro#a#le case is de/ned as an individual withan inuenza li+e illness who is positive forinuenza $ that unsu#typea#le #y P9B

individual with a clinically compati#le illness orwho died of an une0plained acute respiratoryillness who is considered to #eepidemiologically lin+ed to a pro#a#le or

con/rmed case!

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9on/rmed case of pandemic7H&8 ':)

! $ con/rmed case is de/ned as an individualwith an inuenza li+e illness with la#oratorycon/rmed pandemic $%H& '::C virus

infection #y one more of the following testD- P9B

- 4lisa

- 6iral culture- Four fold rise in pandemic 7H&8 ':) virus

speci/c neutralizing anti#odies!

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=anger Signs

• Shortness of #reath, either during physicalactivity or while resting!

• =iAculty in #reathing

• "urning #lue

• Eloody coloured sputum

• 9hest pain

•

$ltered mental status• High fever that persists #eyond * days

• 5ow #lood pressure!

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=anger signs in 9hildren

• Fast or diAcult #reathing

• 5ac+ of alertness

• =iAculty in wa+ing up

• 5ittle or no desire

• convulsions

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$verage age of cases

• Occurring in younger people with the medianage reported to #e '-< years

• $verage age of cases now increasing from :-

2 years• $ge group #elow 2-' years also suscepti#le

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Bis+ factors

• 9ardiovascular disease

• Bespiratory disease i!e! $sthma etc!

• =ia#etes

• 9ancer

• Immunosuppressant illnesses

• Hepatic and renal diseases

• (ith poor socioeconomics status

• pregnancy

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Proposed Strategy for 9ontrol ofPandemic H&

• 9ontainment PhaseD $lmost over, so airportsurveillance has limited e1ect

• Out#rea+ management PhaseD "hrough

awareness 7li+e social distancing8, improveddiagnosis, updated u response centres, stoc+pilling drugs, plan to manage socialdistur#ances, monitor /rst case contacts

•  "reatment PhaseD Eased on clinical diagnosis!

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9linical scenario

Varia/le& "ccurrenceS@pto&

9hilly sensation GGGG

9ough GGG

Headache GGGSore throat GGG

Prostration GG

&asal stuAness GG

=iarrhea GG=izziness G

4ye irritation or pain G

6omiting G

Myalgia G

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Sin&

Fever GGGG

Pharyngitis GGG

9on.unctivitis 7mild8 GG

Bhinitis GG9ervical lymphadenopathy G

Pulmonary rales, wheezes, or rhonchi

G

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 in the assessment of persons withmild or uncomplicated inuenza

illness

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$ntiviral =rugs for "reatment ofInuenza

•  "he neuraminidase inhi#itors are the drugs ofchoice

1*"&eltai-ir  - $s capsules or oral suspension

7"amiu82*anai-ir - For oral inhalation 7Belenza8

+*;erai-ir  - $ third neuraminidase inhi#itor

peramivir formulated for intravenous 7I68administration is an investigational product

Speci/c Begimens for "reatment and 9hemoprophyla0is of

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Speci/c Begimens for "reatment and 9hemoprophyla0is of'::C H& Inuenza $

 "reatment and 9hemoprophyla0is Begimens for $dultsand 9hildren #y $ge and (eight

#able 1( Antiviral medi!ation dosing re!ommendations#able 1( Antiviral medi!ation dosing re!ommendations

for treatment or !hemo"ro"hylaxis of 2))* Hfor treatment or !hemo"ro"hylaxis of 2))* H11 N N11 

infe!tioninfe!tion

+edi!ation+edi!ation #reatment#reatment& days'& days'

-hemo"ro"hylaxis-hemo"ro"hylaxis&1) days'&1) days'

.seltamivir .seltamivir 11

AdultsAdults/ mg/ mg

t$i!et$i!e

dailydaily

/ mg on!e daily/ mg on!e daily

-hildren-hildren 00 12 months12 months

d i h d i ht d i h d i ht

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ody eightody eight

&g'&g'ody eightody eight

&lbs'&lbs'

441 g1 g 4433lbs33lbs 3) mg t$i!e3) mg t$i!e

dailydaily

3) mg on!e3) mg on!e

dailydaily

0 1 g to 230 1 g to 23

gg0 33 lbs to 10 33 lbs to 1

lbslbs5 mg t$i!e5 mg t$i!e

dailydaily5 mg on!e5 mg on!e

dailydaily

0 23 g to 5)0 23 g to 5)gg

0 1 lbs to 660 1 lbs to 66lbslbs

7) mg t$i!e7) mg t$i!edailydaily

7) mg on!e7) mg on!edailydaily

0 5) g0 5) g 0 66 lbs0 66 lbs / mg t$i!e/ mg t$i!e

dailydaily/ mg on!e/ mg on!e

dailydaily

-hildren 3 months to 0 12 months-hildren 3 months to 0 12 months22

3 mg8g8dose3 mg8g8dose

t$i!e dailyt$i!e daily3 mg8g8dose3 mg8g8dose

on!e "er dayon!e "er day

-hild ) t 3 th-hild ) t 4 3 th 33

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-hildren ) to 4 3 months-hildren ) to 4 3 months33

3 mg8g8dose3 mg8g8dose

t$i!e dailyt$i!e daily

 Not re!ommended Not re!ommended

unless situationunless situation %udged !riti!al due to %udged !riti!al due to

limited data on uselimited data on use

in this age grou"in this age grou"

9anamivir 9anamivir 55

AdultsAdults

1) &t 1) &t 1) &t 1) &t

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1) mg &t$o :1) mg &t$o :

mgmg

inhalations'inhalations'

t$i!e dailyt$i!e daily

1) mg &t$o :mg1) mg &t$o :mg

inhalations' on!e dailyinhalations' on!e daily

-hildren &-hildren &00 / years or older for treatment,/ years or older for treatment, 00  years for years for

!hemo"ro"hylaxis'!hemo"ro"hylaxis'

1) mg &t$o :1) mg &t$o :

mgmg

inhalations'inhalations'

t$i!e dailyt$i!e daily

1) mg &t$o :mg1) mg &t$o :mg

inhalations' on!e dailyinhalations' on!e daily

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Preventive tips

ash hands fre;uently $ith soa" and $ater ash hands fre;uently $ith soa" and $ater  -over mouth < nose $hen !oughing or sneezing-over mouth < nose $hen !oughing or sneezing Avoid tou!hing your eyes, nose and mouthAvoid tou!hing your eyes, nose and mouth =eo"le $ho are si! $ith an influenza:lie illness &I>I'=eo"le $ho are si! $ith an influenza:lie illness &I>I'

&fever "lus at least !ough or sore throat and "ossibly other&fever "lus at least !ough or sore throat and "ossibly othersym"toms lie runny nose, body a!hes, heada!hes, !hills,sym"toms lie runny nose, body a!hes, heada!hes, !hills,fatigue, vomiting and diarrhea' should stay homefatigue, vomiting and diarrhea' should stay home

?ee" a$ay from others@ avoid travel, for at least 25 hours?ee" a$ay from others@ avoid travel, for at least 25 hours

after fever is gone( &Fever should be gone $ithout the useafter fever is gone( &Fever should be gone $ithout the useof fever:redu!ing medi!ine'(of fever:redu!ing medi!ine'( Avoid !lose !onta!t &i(e( being $ithin about 7 feet' $ithAvoid !lose !onta!t &i(e( being $ithin about 7 feet' $ith

 "ersons $ith I>I( "ersons $ith I>I(

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Indications for vaccination

;er&on& at i ri&4 'or coplication 'ro te fu

• $ll children )-2C months of age• Person )2 yr of age

• $dults and children ) mo of age with chronic heart orlung conditions, including asthma

•

$dults and children ) mo of age who needed regularmedical care or were in a hospital during the previousyear #ecause of a meta#olic disease 7li+e dia#etes8,chronic +idney disease, or immune system, includingimmune system pro#lems caused #y medicines or #y

infection with HI6%$I=S!• 9hildren ) months to > yr of age who are on long term

aspirin therapy #ecause of the increased ris+ for Beyesyndrome!

• (omen who will #e pregnant during the inuenza season

;er&on& #5$=. @r o' ae

;er&on& wo can tran&it fu to oter&

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;er&on& wo can tran&it fu to oter&

"his includes all health care wor+ers, householdcontacts and out of home caregivers of children

:-'* mo of age, and close contact of persons )2 yr of age!

6 i il #l

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6accines availa#le;anerix: 7Monovalent Inuenza $ H& ':)8

Healt@ cilren ae o-er &ix ont& an /elow15 @ear&D- $ single dose of :!'2ml!

uno coproi&e cilren ae o-er &ixont& an /elow 15 @ear&:- "wo doses of :!'2ml given at least three wee+sapart!

Healt@ cilren ae 15 @ear& an o-er orealt@ ault&:- $ single dose of :!2ml!

uno coproi&e cilren ae 15 @ear& ano-er or iuno coproi&e ault&:- "wo doses of :!2ml given at least three

  wee+s apart!

C l 7Mono alent Inuen a $ H&

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Cel-apan: 7Monovalent Inuenza $ H&':)8

All cilren ae o-er &ix ont& an/elow 15 @ear&:- "wo doses of :!2ml given at least threewee+s apart!

All cilren ae 15 @ear& an o-er orault&: - "wo doses of :!2ml given at least three

wee+s apart6accine manufacturers are Sonoo/ Pasteur,

&ovartis, Intranasal #y MedImmune, 559,

9S5 5imited!

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Levels of Prevention

! Health Promotion

'! Speci/c Protection

*! 4arly diagnosis and prompttreatment

! =isa#ility limitation

2! Beha#ilitation

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MDEH"S "F C"NEG"L

1* ;re-enti-e ea&ure&• Health 4ducation for pu#lic and health personnel

• Immunoprophyla0is

• 9hemoprophyla0is

2* Control o' patient, contact& an teieiate en-ironent

• Beport to local health authority

• Isolation

• 9oncurrent disinfection

• Kuarantine

• Protection of contencts

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• Investigation of contacts

• Speci/c treatment

+*Dpieic Mea&ure&

.*i&a&ter iplication&#*nternational ea&ure&

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Non CommunicableDiseases

1* ;ro/le& wit natural i&tor@ o'i&ea&e

• $#sence of a +nown agent• Multifactorial causation

• 5ong latent period

• Inde/nite onset

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Burden of Disease-Measurement

! Proportional mortality ratio

'! 5oss of life e0pectancy

*! 9H= incidence rate

! $ge-speci/c death rates prevalence rate

2! 9ase fatality rate

)! Measurement of ris+ factor levels

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PREVEN!VE "R#E$!E"1* ;opulation Strate@

• Prevention in whole populations

"%eci&c !nterventions e'(

i8 =ietary changes

ii8 Smo+ingiii8 Elood pressure

iv8 Physical activity

• Primordial prevention in whole populations

2* Hi Gi&4 Strate@

+* Seconar@ pre-ention

Darl@ iano&i& An Ereatent