ali hassoun, md alabama infectious diseases center huntsville, al h1n1 2009 pandemic what you need...
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ALI HASSOUN, MDALABAMA INFECTIOUS DISEASES CENTER
HUNTSVILLE, AL
H1N1 2009 pandemicWhat you need to Know
What is ‘the flu’?
An illness caused by influenza virusA sudden onset respiratory illness with fever
Affects nose, throat, air passages, and lung Yearly epidemics Occurs worldwide causing significant illness
How are viruses different from other germs?
Much smaller than animal cells or bacteriaViruses need to get a life!
Need to be inside our cells to live
Our cells become virus factoriesInfluenza virus kills cells in breathing
passages
What does an influenza virus look like?
Hemagglutinin protein Allows virus to stick to
cells of some animals and not others
Neuraminidase protein Helps release new virus
from cells
Genes (RNP) divided into 8 parts Allows 2 or more viruses
to mix and match genes
Fig.1 Electron micrograph
Fig.2 Schematic of influenza virus
Why are the numbered “H” and “N” important?
Used to subtype influenza A strains 16 different H’s 9 different N’s
Current human subtypes A(H1N1) and A(H3N2) primarily
Antibodies against H’s and N’s made by our immune system protect usH and N subtypes are basis for flu vaccines
How is influenza spread?
Patients with pandemic H1N1 influenza A virus infection are likely to be contagious from one day prior to the development of signs and symptoms until resolution of fever.
Incubation– Typically 2 days Range 1 to 4 days
Viral shedding Can begin 1 day before the onset of symptoms Peak shedding first 3 days of illness
Correlates with fever Subsides usually by 7 days
Can be 10+ days in children
Is flu only spread through the air?
Large droplet mostly Generated by coughing,
sneezing, talking “spitting distance”
Contact with contaminated hands or surfaces, sometimes
Microscopic droplets less common
Certain other bodily fluids (eg, diarrheal stool) should also be considered potentially infectious
the consequences of yearly epidemics in U.S.A?
> 36,000 die and 200,000 are hospitalized5 to 20% of general population infectedNursing home attack rates of up to 60%85% of flu-related deaths in ages > 65Over $10 billion lost
What about past flu pandemics?
A(H1N1) A(H2N2) A(H3N2)1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
20-40 m deaths
675,000 US deaths
1-4 m deaths
70,000 US deaths
1-4 m deaths
34,000 US deaths
Credit: US National Museum of Health and Medicine
H1N1 2009 pandemic
In March and April 2009, an outbreak of respiratory illnesses was first noted in Mexico, which was eventually identified as being related to H1N1 influenza A. The outbreak spread rapidly to the United States, Canada, and throughout the world as a result of airline travel
As of July 31, 2009, over 162,000 laboratory-confirmed cases had been reported in over 160 countries
In the United States, as of July 24, 2009, over 43,000 confirmed cases had been reported from 55 states and territories.
In Alabama as of August 19, 1587 confirmed cases and madison county had 115 cases
Novel H1N1 Confirmed and Probable Case Rate in the United States, By Age Group
What are symptoms of H1N1 flu?
Fever, usually > 101oF, and chillsSore throatNasal congestion and runny noseHeadacheBody and muscle achesDry coughTiredness and weaknessNausea, vomiting, diarrhea. gastrointestinal
manifestations appear to be more common
the most common risk factors for influenza complications
1.Chronic lung disease (asthma or chronic obstructive pulmonary disease)
2.Immunosuppressive conditions 3.Cardiac disease 4.Pregnancy 5.Diabetes mellitus 6.Obesity
Who is at risk for severe infection with H1N1 virus?
Treatment is mostly supportive with rest, fluids, cough medicine, and antipyretics such as Tylenol. Aspirin should be avoided.
It can be treated with antivirals. Mainly for at risk population and hospitalized patients with more than mild symptoms. Oseltamivir (Tamiflu)–
capsules and oral liquid Zanamivir (Relenza)–
Inhaled powder
How is H1N1 influenza treated?
No protection from current flu vaccine H1N1 vaccine will be available mid October,
initially will be indicated:1. Pregnant women,2. People who live with and care for children younger
than 6 months of age,3. Healthcare and emergency medical services
personnel,4. People between the ages of 6 months and 24 years5. People ages 25–64 years of age who have chronic
health conditions (such as asthma, heart disease, or diabetes) or compromised immune systems.
Will a regular flu vaccine protect me?
When should I call my healthcare provider?
Call if you get concerned about your symptoms especially if you or a family member are high risk.
If you have a fever and two or more other flu symptoms especially if symptoms are severe Your provider may recommend tests or treatment with
antivirals
If unable to drink fluids, have dark urine, or feel dizzy when standing (signs of dehydration)
If you have a fever for more than 3 to 5 days even if you have already been treated
If you start to recover from the flu symptoms and you get fever again.
When to Seek Emergency Medical Care
has difficulty breathing or chest pain has purple or blue discoloration of the lips is vomiting and unable to keep liquids down has signs of dehydration such as dizziness
when standing, absence of urination, or in infants, a lack of tears when they cry
has seizures (for example, uncontrolled convulsions)
is less responsive than normal or becomes confused
What should I do if I’m exposed to someone with H1N1 influenza?
Anti-viral prophylaxis is recommended for certain groups of people.
Household close contacts who are at high-risk of complications of a confirmed or probable case Your healthcare provider can tell you if you need
preventative medication If you are not in a high-risk group you should:
Limit your contact with others in the community Stay home at the earliest sign of flu symptoms
For updates see: http://www.cdc.gov/h1n1flu/recommendations.htm
What should People with novel H1N1 flu do ?
Check with their health care provider about whether they should take antiviral medications
Keep away from others as much as possible. Do not go to work or school while ill
Stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.)
Drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
Cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands
Wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others.
be watchful for emergency warning signs that might indicate you need to seek medical attention.
Placement of the sick person
Keep the sick person in a room separate from the common areas of the house. Keep the sickroom door closed.
Unless necessary for medical care or other necessities, people who are sick with an influenza-like-illness should stay home and keep away from others as much as possible
If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant.
Protect other persons in the home
The sick person should not have visitors other than caregivers. If possible, have only one adult in the home take care of the sick person. If you are in a high risk group for complications from influenza, you should
attempt to avoid close contact (within 6 feet) with household members who are sick with influenza.
Avoid having sick family members care for infants and other groups at high risk for complications of influenza.
All persons in the household should clean their hands frequently, including after every contact with the sick person or the person’s room or bathroom.
Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
Antiviral medications can be used to prevent the flu, so check with your health care provider to see if some persons in the home should use antiviral medications.
What about masks in a pandemic?
Masks outside a healthcare setting can be considered in some circumstances.
Facemasks considered for crowded settings (avoid if possible and minimize time) Protect wearer from others’ cough and protect others from
wearer’s cough Single use
Respirators (N95) considered when close contact with infected person is unavoidable Care of sick person at home Requires fit-testing to be effective Single use
What about household cleaning, laundry, and waste disposal?
Throw away tissues and other disposable items used by sick person in the trash (wash hands)
Keep surfaces clean by wiping down with a household disinfectant according to label
Eating utensils and dishes of sick person Do not need to be cleaned separately; wash thoroughly in
dishwasher or with soap and waterLinens and towels
Household laundry soap and tumble dry on hot Avoid “hugging” laundry prior to washing to prevent
contaminating yourself Clean hands with soap and water or alcohol-based hand
rub right after handling dirty laundry
THANK YOU