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Influenza 2009Influenza 2009

2009.7.102009.7.10

Keelung General HospitalKeelung General HospitalChang Cheng-LongChang Cheng-Long

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1918 Pandemic influenza1918 Pandemic influenza

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NewsNews

April 29 2009 WHO Elevates Swine

April 29 2009 WHO Elevates SwineInfluenza Pandemic Alert Level To Phase 5Influenza Pandemic Alert Level To Phase 5

18:00 GMT, 29 April 2009, nine countries18:00 GMT, 29 A

pril 2009, nine countrieshave officially reported 148 cases of swinehave official

ly reported 148 cases of swineinfluenza A/H1N1 infection. The Unitedinfluenza A/H1N1 infection. The UnitedStates Government has reported 91States Government has r

eported 91laboratory confirmed human cases, with onelaborator

y confirmed human cases, with onedeath. Mexico has reported 26 confirmeddeath. Mexico has r

eported 26 confirmedhuman cases of infection including sevenhuman cases of infection includin

g sevendeaths.deaths.

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Mexico City under the grip of the swine fluoutbreak in April, 2009

@cnnbrk is CNNs breaking news account onTwitter

http://www.flickr.com/photos/benedictedesrus/3475742790/

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20092009 33 44 H1N1H1N1 H1N1H1N1

H1N1H1N1..

http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/

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A1A1

A2A2 A3A3

A4A4

Antigenic Shift

http://www3.niaid.nih.gov/topics/Flu/Research/basic/AntigenicShiftIllustration.htm

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RELENZA'sRELENZA'sMechanism of ActionMechanism of Action

Tamiflu

Relenza

http://changturtle.blogspot.com/2009/05/relenzas-mechanism-of-action.htmlhttp://changturtle.blogspot.com/2009/05/relenzas-mechanism-of-action.htmlhttp://changturtle.blogspot.com/2009/05/relenzas-mechanism-of-action.htmlhttp://changturtle.blogspot.com/2009/05/relenzas-mechanism-of-action.htmlhttp://www.relenza.com/hcp/relenza-action-mechanism.htmlhttp://changturtle.blogspot.com/2009/05/relenzas-mechanism-of-action.htmlhttp://changturtle.blogspot.com/2009/05/relenzas-mechanism-of-action.htmlhttp://changturtle.blogspot.com/2009/05/relenzas-mechanism-of-action.html

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Cytokine StormCytokine Storm http://changturtle.blogspot.com/2009/05/cytokine-

storm.html

http://changturtle.blogspot.com/2009/05/cytokine-storm.htmlhttp://changturtle.blogspot.com/2009/05/cytokine-storm.html

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Epidemic and Pandemic Alert and RespEpidemic and Pandemic Alert and Resp

(EPR)(EPR) :::: 66

20092009 66 1111 ---- 55 66 ::::

::::

55 :: 66 ::

http://changturtle.blogspot.com/2009/05/epidemic-and-pandemic-alert-and.htmlhttp://changturtle.blogspot.com/2009/05/epidemic-and-pandemic-alert-and.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://www.who.int/entity/csr/disease/swineflu/assess/disease_swineflu_assess_20090511/zh/index.htmlhttp://www.who.int/entity/csr/disease/swineflu/assess/disease_swineflu_assess_20090511/zh/index.htmlhttp://www.who.int/entity/csr/disease/swineflu/3rd_meeting_ihr/zh/index.htmlhttp://www.who.int/entity/csr/disease/swineflu/3rd_meeting_ihr/zh/index.htmlhttp://www.who.int/entity/csr/disease/swineflu/3rd_meeting_ihr/zh/index.htmlhttp://www.who.int/entity/csr/disease/swineflu/assess/disease_swineflu_assess_20090511/zh/index.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/zh/index.htmlhttp://changturtle.blogspot.com/2009/05/epidemic-and-pandemic-alert-and.html

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Tracking the progress of H1N1 swine fTracking the progress of H1N1 swine f

http://changturtle.blogspot.com/2009/05/tracking-progress-of-h1n1-swine-flu.htmlhttp://changturtle.blogspot.com/2009/05/tracking-progress-of-h1n1-swine-flu.htmlhttp://changturtle.blogspot.com/2009/05/tracking-progress-of-h1n1-swine-flu.html

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H1N1 - pandemic influenzaH1N1 - pandemic influenza

phasesphases

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,, ` ,, ..

` ` ` ,, ,, ::

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* Fever* Fever* Cough* Cough* Sore throat* Sore throat

* Body aches* Body aches* Headache* Headache* Chills and fatigue* Chills and fatigue* Diarrhea and vomiting (possible)* Diarrhea and vomiting (possible)

Phase 5 is characterized by human-to-Phase 5 is characterized by human-to-human spread...human spread...

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ProphylaxisProphylaxis

H1N1 influenza in pregnancyH1N1 influenza in pregnancy

Prophylaxis with antiviral agents shouldProphylaxis with antiviral agents should

also be considered in the followingalso be considered in the followingindividuals (pre-exposure orindividuals (pre-exposure or

postexposure):postexposure):

o Close household contacts of a confirmedo Close household contacts of a confirmed

or suspected case who are at high risk foror suspected case who are at high risk forcomplications (eg, chronic medicalcomplications (eg, chronic medical

conditions, persons >65 y or 65 y or 65 y,conditions, persons >65 y or 65 y or 65 y,

pregnant women)pregnant women)

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Reverse GeneticsReverse Genetics

http://www.flickr.com/photos/turtle5001tw/3511994094/in/photostream/

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ReassortmentReassortment

http://www.flickr.com/photos/turtle5001tw/3511198667/in/photostream/

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Antigenic DriftAntigenic Drift

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FDA Approves New Influenza Vaccine Production FacilityFDA Approves New Influenza Vaccine Production Facility

ScienceDaily (May 7, 2009) The U.S.ScienceDaily (May 7, 2009) The U.S.Food and Drug Administration (FDA) hasFood and Drug Administration (FDA) hasannounced that it has approved a newannounced that it has approved a new

manufacturing facility used to producemanufacturing facility used to produceinfluenza virus vaccines. The facility isinfluenza virus vaccines. The facility isapproved for seasonal influenza vaccineapproved for seasonal influenza vaccineproduction and could be used for theproduction and could be used for the

production of vaccine against the newproduction of vaccine against the new2009 H1N1 influenza strain.2009 H1N1 influenza strain.

http://www.sciencedaily.com/releases/2009/05/090507175916.htm

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Pandemic Virus geneticPandemic Virus genetic ReassortmentReassortment

http://changturtle.blogspot.com/2009/05/pandemic-virus.htmlhttp://changturtle.blogspot.com/2009/05/pandemic-virus.htmlhttp://changturtle.blogspot.com/2009/05/pandemic-virus.htmlhttp://changturtle.blogspot.com/2009/05/pandemic-virus.htmlhttp://changturtle.blogspot.com/2009/05/pandemic-virus.htmlhttp://www.flickr.com/photos/turtle5001tw/3516639187/in/photostream/http://changturtle.blogspot.com/2009/05/pandemic-virus.htmlhttp://changturtle.blogspot.com/2009/05/pandemic-virus.htmlhttp://changturtle.blogspot.com/2009/05/pandemic-virus.htmlhttp://changturtle.blogspot.com/2009/05/pandemic-virus.html

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18891889 19181918 19571957 19681968

http://www.flickr.com/photos/turtle5001tw/3517466050/in/photostream/

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H5N1 outbreak in Afghanistan , Feb 2006H5N1 outbreak in Afghanistan , Feb 2006

http://www.blogger.com/H5N1%20Afghanistan%20since%20Feb%2027%202006http://www.flickr.com/photos/turtle5001tw/3518663211/http://changturtle.blogspot.com/2009/05/h5n1-outbreak-in-afghanistan-feb-2006.htmlhttp://changturtle.blogspot.com/2009/05/h5n1-outbreak-in-afghanistan-feb-2006.html

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Qinghai , China on May 30, 2005 , H5N1Qinghai , China on May 30, 2005 , H5N1

http://changturtle.blogspot.com/2009/05/qinghai-china-on-may-30-2005.html

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http://www.flickr.com/photos/23562155@N00/69018604

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How Bird Flu Has Spread Jul Oct 26 2005 HHow Bird Flu Has Spread Jul Oct 26 2005 H

http://www.flickr.com/photos/changturtle/110163250/http://changturtle.blogspot.com/2009/05/how-bird-flu-has-spread-jul-oct-26-2005.htmlhttp://changturtle.blogspot.com/2009/05/how-bird-flu-has-spread-jul-oct-26-2005.htmlhttp://changturtle.blogspot.com/2009/05/how-bird-flu-has-spread-jul-oct-26-2005.html

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How Bird Flu Has Spread , Jul-Oct 26 2005 HHow Bird Flu Has Spread , Jul-Oct 26 2005 H

Up to date Map of H5N1 Outbreaks (JanuaryUp to date Map of H5N1 Outbreaks (January

http://changturtle.blogspot.com/2009/05/how-bird-flu-has-spread-jul-oct-26-2005.htmlhttp://changturtle.blogspot.com/2009/05/how-bird-flu-has-spread-jul-oct-26-2005.htmlhttp://www.flickr.com/photos/quiplash/56893419/in/pool-influenzahttp://changturtle.blogspot.com/2009/05/how-bird-flu-has-spread-jul-oct-26-2005.html

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Up-to-date Map of H5N1 Outbreaks (JanuaryUp-to-date Map of H5N1 Outbreaks (January

2006)2006)

Russia says bird flu may spread to Europe Aug 15Russia says bird flu may spread to Europe Aug 15

http://www.flickr.com/photos/quiplash/86125728/in/pool-influenza

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Russia says bird flu may spread to Europe , Aug 15,Russia says bird flu may spread to Europe , Aug 15,

20052005

http://www.flickr.com/photos/quiplash/34291595/in/pool-influenza

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Crossroads of bird flu , AlaskaCrossroads of bird flu , Alaska

http://changturtle.blogspot.com/2009/05/crossroads-of-bird-flu.htmlhttp://changturtle.blogspot.com/2009/05/crossroads-of-bird-flu.htmlhttp://www.latimes.com/news/printedition/la-102106-sci-kipnuk-g,1,1144213.graphichttp://changturtle.blogspot.com/2009/05/crossroads-of-bird-flu.html

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Probing the Mysterious Migration of SwansProbing the Mysterious Migration of Swans

Suspected in Spread of Avian FluSuspected in Spread of Avian Flu

http://www.nytimes.com/2006/09/12/science/12bird.html?_r=1&ref=sciencehttp://www.flickr.com/photos/hlthenvt/361078906/in/set-72157594189834822/

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http://www.latimes.com/news/printedition/front/la-sci-kipnuk22oct22,1,47557,full.story?coll=la-headlines-frontpage

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TackingTacking birdflubirdflu 20082008

http://news.bbc.co.uk/2/hi/in_depth/world/2005/bird_flu/default.stmhttp://changturtle.blogspot.com/2009/05/tacking-birdflu-2008.htmlhttp://changturtle.blogspot.com/2009/05/tacking-birdflu-2008.htmlhttp://changturtle.blogspot.com/2009/05/tacking-birdflu-2008.html