H1n1

Swine Flu(H1N1) Dr Sujnanendra Mishra MD (O&G)

H1N1 Influenza • last influenza pandemic in 1917 that accounted for 20 million deaths worldwide. • This time first cases of human infection with novel H1N1 influenza virus were detected in April 2009 in San Diego. • The virus is spreading rapidly. • The virus is widespread in the United States at this time and has been detected internationally including INDIA

The Virus H1N1 Influenza

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RNA, enveloped

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Viral family: Orthomyxoviridae

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Size: 80-200nm or .08 – 0.12 μm (micron) in diameter

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Three types

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Surface antigens

• A, B, C • A, associated worldwide epidemics. B & C, not severe, no animal reservoir • H (haemaglutinin) 16 Subtypes (H1,to H16 ) • N (neuraminidase) 9 Subtypes (N1 toN9 )

Signs and symptoms Symptoms of H1N1 flu are similar to those with seasonal flu. • Running or stuffy nose • Cough •

Sore throat

• Fever ,

Chills

• Body aches • Headache •

Fatigue

• vomiting (25%) and diarrhea (25%) have also with beenfebrile reported. Acute Onset respiratory illness

How does H1N1 Influenza spread? • This virus spreads the way seasonal flu spreads • Primarily through respiratory droplets – Coughing – Sneezing – Touching respiratory droplets on yourself, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing hands

How is A/H1N1 diagnosed?  1. Clinical diagnosis. This involves physically examining the patient and taking a clinical history that may serve to determine if there are any signs and symptoms and if there was any close contact with any infected person(s) including family members.  2. Pathological diagnosis. This involves laboratory confirmation first of the A type influenza and then confirmation of H1N1 strain of virus. A/H1N1 is diagnosed by taking nasopharyngeal swabs of the suspected person(s). Swab samples are then subjected to Polymerase Chain Reaction analysis for RNA amplification, followed by RNA sequencing and typing.

H1N1 A GLOBAL ISSUE

Swine Influenza A(H1N1) US Case Definitions

 1. Confirmed cases

a. Influenza like illness b. Confirmation of flu like infection i. RT-PCR ii. Viral culture  2. Probable cases a. Influenza like illness b. Positive for influenza A c. Negative for H1 and H3 d. Confirmation by RT-PCR  3. Possible cases a. Previously healthy b. Less than 65 years c. Hospitalized for influenza like illness

Swine Influenza A(H1N1) US Case Definitions

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Infectious period for a confirmed case of swine influenza A(H1N1) virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset

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Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine influenza A(H1N1) virus infection during the case’s infectious period

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Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness)

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High-risk groups: A person who is at high-risk for complications of swine influenza A(H1N1) virus infection is defined as the same for seasonal influenza (see Reference)

Swine Influenza A(H1N1) • Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who – live in areas where human cases of swine influenza A(H1N1) have been identified or – have traveled to an area where human cases of swine influenza A(H1N1) has been identified or – have been in contact with ill persons from these areas in the 7 days prior to their illness onset

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

Swine Influenza A(H1N1) • Covering nose and mouth with a tissue when coughing or sneezing – Dispose the tissue in the trash after use. – or, Sneeze on to your

sleeve above elbow • Handwashing with soap and water

– Especially after coughing or sneezing.

• Cleaning hands with alcohol-based hand cleaners • Avoiding close contact with sick people • Avoiding touching eyes, nose or mouth with unwashed hands • If sick with influenza, staying home from work or school and limit contact with others to keep from infecting them

Swine

Influenza

A(H1N1)

Treatment

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No vaccine available

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Antivirals for the treatment and/or prevention of infection: – Oseltamivir (Tamiflu) or – Zanamivir (Relenza)

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Use of anti-virals can make illness milder and recovery faster

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They may also prevent serious flu complications

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For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms)

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Warning! Do NOT give aspirin (acetylsalicylic acid) or aspirincontaining products (e.g. bismuth subsalicylate – Pepto Bismol) to children or teenagers (up to 18 years old) who are confirmed or suspected ill case of swine influenza A (H1N1) virus infection; this can cause a rare but serious illness called Reye’s syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.

Swine Influenza A(H1N1) Treatment Oseltamivir (Tamiflu)

Zanamivir (Relenza)

Treatment

Prophylaxis

Treatment

Prophylaxis

Adults

75 mg capsule twice per day for 5 days

75 mg capsule once per day

Two 5 mg inhalations (10 mg total) twice per day

Two 5 mg inhalations (10 mg total) once per day

Children

15 kg or less: 60 mg per day divided into 2 doses

30 mg once per day

15–23 kg: 90 mg per day divided into 2 doses

45 mg once per day

Two 5 mg inhalations (10 mg total) twice per day (age, 7 years or older)

Two 5 mg inhalations (10 mg total) once per day (age, 5 years or older)

24–40 kg: 120 mg per day divided into 2 doses

60 mg once per day

>40 kg: 150 mg per day divided into 2 doses

75 mg once per day

Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatment dose for 5 days. <3 months: 12 mg twice daily; 3-5 months: 20 mg twice daily; 6-11 months: 25 mg twice daily Dosing recommendations for antiviral chemoprophylaxis of children younger than 1 year using oseltamivir. Recommended prophylaxis dose for 10 days. <3 months: Not recommended unless situation judged critical due to limited data on use in this age group; 3-5 months: 20 mg once Source: CDC

Swine Influenza A(H1N1) Other Protective Measures

Defining Quarantine vs. Isolation vs. Social-Distancing – Isolation: Refers only to the sequestration of symptomatic patents either in the home or hospital so that they will not infect others – Quarantine: Defined as the separation from circulation in the community of asymptomatic persons that may have been exposed to infection – Social-Distancing: Has been used to refer to a range of nonquarantine measures that might serve to reduce contact between persons, such as, closing of schools or prohibiting large gatherings

Source: CDC

Swine Influenza A(H1N1) Other Protective Measures

Infection Control of Ill Persons in a Healthcare Setting •

Standard, Droplet and Contact precautions should be used for all patient care activities, and maintained for 7 days after illness onset or until symptoms have resolved. Maintain adherence to hand hygiene by washing with soap and water or using hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions.

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Personnel providing care to or collecting clinical specimens from suspected or confirmed cases should wear disposable non-sterile gloves, gowns, and eye protection (e.g., goggles) to prevent conjunctival exposure.

Source: CDC

Swine Influenza A(H1N1) Other Protective Measures

Infection Control of Ill Persons in a Healthcare Setting  Patients with suspected or confirmed case-status should be placed in a single-patient room with the door kept closed.  If available, an airborne infection isolation room (AIIR) with negative pressure air handling with 6 to 12 air changes per hour can be used. Air can be exhausted directly outside or be recirculated after filtration by a high efficiency particulate air (HEPA) filter. For suctioning, bronchoscopy, or intubation, use a procedure room with negative pressure air handling.  The ill person should wear a surgical mask when outside of the patient room, and should be encouraged to wash hands frequently and follow respiratory hygiene practices. Cups and other utensils used by the ill person should be washed with soap and water before use by other persons. Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of swine influenza. Source: CDC

What can you do to stop spreading….

Stay Safe……

• Wash your hands frequently and thoroughly. Use soap and warm water when available; use hand sanitizer between hand washings. • Avoid close contact with sick people. Close contact means getting within 6 feet of a sick person. • Use the face mask properly and throw it away after use. Though It's not known whether face masks protect 100% against infection.

Avoid spreading the swine flu virus:

• Stay home if you are sick. • Don't cough or sneeze into your hands. Instead Cough/sneeze into a tissue -- or, your sleeve above elbow. • If you can do so comfortably, wear a face mask if you come into contact with others. • Allow Special leave for workers for staying home if sick or for caring for sick children. • Encourage Hand washing at home and workplace

Have it everywhere

NO HANDSHAKE PLEASE !!

SAY NAMASTE !!

Wash your hands frequently and thoroughly

wear a face mask, if available and tolerable,

NAMASKAR