The Global Killer

h1n1 The global killer

• •

•

•

What is a PANDEMIC ?

A Pandemic is an epidemic of infectious disease that is spreading through human populations across a large region; for instance a continent, or even worldwide. According to the World Health Organization (WHO), a pandemic can start when three conditions have been met: (1)Emergence of a disease new to a population; (2)Agents infect humans, causing serious illness; (3)Agents spread easily and sustainably among humans. A disease or condition is not a pandemic merely because it is widespread or kills many people; it must also be infectious. For instance, cancer is responsible for many deaths but is not considered a pandemic because the disease is not infectious or contagious. Dr Margaret Chan, Director-General of the World Health Organization (WHO), gave a statement on 11 June 2009 confirming that the H1N1 strain was indeed a pandemic, having nearly 30,000 confirmed cases worldwide.

The Difference • GENERAL IDEA OF INFLUENZA VIRUS (H1N1): It is a type of influenza virus A and the most common cause of FLU in humans. H1N1 strains caused roughly half of all human flu infections in 2006. Other strains of H1N1 are endemic in pigs (swine influenza) and in birds (avian influenza).

• In the 2009 FLU PANDEMIC, the virus isolated from patients in the United States was found to be made up of genetic elements from four different flu viruses – North American Mexican influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe.

A Brief Introduction •

•

•

•

The 2009 flu pandemic is a global outbreak of a new strain of an Influenza “A” virus subtype H1N1, referred to as the "novel H1N1", first identified in April 2009, and commonly called "swine flu“. It is thought to be a GENETIC MIXTURE of four known strains of Influenza “A” virus : One normally infecting HUMANS, one endemic in BIRDS, and two endemic in PIGS (SWINE). The outbreak began in Mexico, with evidence that Mexico was already in the midst of an epidemic for months before the outbreak was recognized. The virus has since spread to the Southern Hemisphere which entered its winter flu season, and to many less developed countries with limited healthcare systems. The virus typically spread via coughing, sneezing or touching contaminated surfaces and then touching the nose or mouth. Symptoms, which could last up to a week, were similar to those of Seasonal Flu, and may have included fever, sneezes, sore throat, coughs, headache, and muscle or joint pains.

Introduction [CONTD.] •

•

As the virus spreads easily between people, through the air or surface contact, those who get the flu are recommended to stay home from school or work and avoid crowds to avoid spreading the infection further. Wearing facial masks is of limited benefit as they are designed for industrial use and do not filter out viral or other biological agents. In an attempt to slow the spread of the illness, a number of countries, especially in Asia, quarantined airline passengers with flu symptoms, while some also pre-screened passengers.

Detection : March 2009 • Mexico In La Gloria, Veracruz, 60% of the town's population is sickened by a respiratory illness of unknown provenance. On March 17, the earliest known onset of a case that is later to be confirmed as Swine-Origin Influenza A (H1N1) Virus Infection. Within days of the outbreak Mexico City was "effectively shut down." Some countries canceled flights to Mexico while others halted trade.

H1N1 in India • Soon after the outbreak of H1N1 virus in the United States and Mexico in March, the Government of India started screening people coming from the affected countries at airports for swine flu symptoms. The first case of the flu in India was found on the Hyderabad airport on 13 May, when a man traveling from US to India was found H1N1 positive. Subsequently, more confirmed cases were reported and as the rate of transmission of the flu increased in the beginning of August, with the first death due to swine flu in India in Pune. • 4738 cases of swine flu have been confirmed with 131 deaths. (latest)

Medical Terminology •

CATEGORY A: Patients with mild fever plus cough / sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised as Category-A. They do not require Oseltamivir.

•

CATEGORY B: In addition to the signs and symptoms mentioned under Category-A, if the patient has high grade fever and severe sore throat, may require home isolation and Oseltamivir;

•

CATEGORY C: if the patient has one or more of the following: (1)Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails; (2)Irritability among small children, refusal to accept feed; (3)Worsening of underlying chronic conditions.

View Animation

Standard Operating Procedures • • • • • • • •

PPE reduces the risk of infection if used correctly. It includes: Gloves (nonsterile), Mask (high-efficiency mask) / Three layered surgical mask, Long-sleeved cuffed gown, Protective eyewear (goggles/visors/face shields). Cap (may be used in high risk situations where there may be increased aerosols). Plastic apron if splashing of blood, body fluids, excretions and secretions is anticipated. Avoid Shaking Hands.

N-95 Mask

Goggles and Mask

Avoid Shaking Hands

Prevention is Better than CURE •

•

•

Oseltamivir is an antiviral drug that slows the spread of influenza (flu) virus between cells in the body by stopping the new virus from chemically cutting ties with its host cell. The drug is sold under the trade name Tamiflu. There are concerns that oseltamivir may cause dangerous psychological, neuropsychiatric side effects including self harm in some users. These dangerous side effects occur more commonly in children than in adults. Oseltamivir is a Neuraminidase inhibitor, serving as a competitive inhibitor towards Sialic Acid, found on the surface proteins of normal host cells. By blocking the activity of the neuraminidase, Oseltamivir prevents new viral particles from being released by infected cells.

M o r e ……… •

• • •

• •

Schools, Colleges are advised to avoid any large gathering of students during the course of the day in the school. This would reduce the possibility of the spread of the infection. Large Public gatherings should be avoided. Students, teachers and other employees working in schools/educational institutions are advised to stay at home if they develop flu like symptoms. It should be made mandatory by the school authorities that all class teachers should begin their class with active screening of each student in the class so as to detect any student who is having symptoms of flu (mild fever with cough/ sore throat with or without body ache, headache, diarrhea and vomiting). Students, teachers and other employees working in schools/educational institutions are advised to wash their hands frequently with soap and water. All the schools should display “DO’S AND DON’TS” for H1N1 infection at all important places.