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Mohamed M. B. Alnoor
CHP400COMMUNITY HEALTH PROGRAM-II
Novel H1N1 (Swine)
Epidemiology
& Control
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Content
• Previous influenza pandemics• Definitions• Transmission Through Species• Transmission to humans• Pandemic-Alert Levels and WHO Regions• The Global H1N1 Pandemic
• Lessons Learned form Past Pandemics• Prevention of H1N1 infection
• Antiviral Protection
• Who Should Be Vaccinated?
• Summary
Swine Influenza A (H1N1)
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PandemicDeaths
WorldwidePopulation
Affected
Spanish Flu (H1N1)
1918-191940 million
Persons 20-40 years
Asian Flu (H2N2)
1957-581-2 million Infants, elderly
Hong Kong Flu (H3N2)
1968-69700,000 Infants, elderly
Previous influenza pandemics
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Swine Influenza (swine flu) is a respiratory disease of pigs
caused by Type A influenza viruses
causing regular outbreaks in pigs.
What is swine flu?
Definition:
They do not normally infect humans
Swine Influenza A (H1N1)
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Swine flu viruses have been reported to
spread from person-to-person but in the past
this transmission was limited and not sustained beyond
three people.
What is swine flu?
Definition:Swine Influenza A (H1N1)
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This swine influenza A (H1N1) virus is contagious
and is spreading from
human to human.
What is swine flu?
Definition:Swine Influenza A (H1N1)
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Swine Influenza A (H1N1) Transmission Through Species
Reassortment in Pigs
Avian Virus
Human Virus
Swine Virus
Avian/HumanReassorted Virus
Swine/
North American swineNorth American avianNorth American human Eurasian swine
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How does swine flu spread?
Transmission to humans:
Contact with: - infected pigs - contaminated environments
- a person with swine flu
Airborne(from infected people)- coughing - sneezing
Swine Influenza A (H1N1)
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Swine Influenza A (H1N1) Pandemic-Alert Levels
Phase 1: Animals viruses, no humans infections.Phase 2: Virus in domesticated/wild animals, caused infection in humans: a potential pandemic threat.”Phase 3: Reassortant v: sporadic cases or small clusters in humans.Phase 4: Reassortant v:community-level outbreaks. Phase 5: There is human-to-human spread of the virus into at least two countries in one WHO region. Phase 6: Phase 5 + community-level outbreaks in at least one other country in a different WHO region. A global pandemic is occurring.
African Region
Region of the Americas
South East Asia RegionEast Mediterranean Region
European Region Western Pacific Region
WHO Regions
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• Pandemics are unpredictable: - Mortality - severity of illness - pattern of spread
• Capacity to cause severe disease in nontraditional groups is a major determinant of pandemic impact
Lessons Learned formPast Pandemics
• Epidemiology reveals waves of infection: Ages/areas not initially infected likely vulnerable in future waves
• Subsequent waves may be more severe
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Lessons Learned formPast Pandemics
Public health interventions delay, but do not stop pandemic spread
• Temporary banning of public gatherings, potentially effective
• Quarantine, travel restriction show little effect
• Delaying spread is desirable:
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Prevention and control of H1N1
Swine Influenza A (H1N1)
General prevention and control measures
The H1N1 Vaccine
Antiviral treatment
Antiviral Prophylaxis
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Prevention of H1N1 INFECTION
Swine Influenza A (H1N1)
General prevention and control measures
• Tips to Reduce the Infection
• Respiratory hygiene and cough etiquette
• Social-Distancing
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Prevention of H1N1 INFECTION
Tips to Reduce the H1N1 Influenza Infection
•Use a tissue when coughing or sneezing.
•Frequently wash hands with warm water and soap .
•Try not to touch your eyes, nose or mouth .
•Wipe down kitchen and bathroom countertops, home and office phones, keyboards , etc
•If exhibiting symptoms, stay home.
•If coworkers or family members become ill, consider taking anti-viral medication .
Swine Influenza A (H1N1)
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Prevention of H1N1 INFECTION
vaccineThe H1N1 Inactivated Vaccine (the shot)
The H1N1 Live Attenuated Vaccine (the nasal spray)
Swine Influenza A (H1N1)
Specific preventive measures
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Pregnant women Contacts and caregivers <6 months Healthcare and emergency personnel All people from 6 mo - 24 years
Persons 25 - 64 years (higher risk of complications from influenza)
Children from 6 mo - 18 years Young adults 19 - 24 years
The groups recommended to receive the 2009 H1N1 influenza vaccine include:
Who Should Be Vaccinated?
Swine Influenza A (H1N1)
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People with allergy to chicken eggs or had a severe reaction to an influenza vaccination.
Children younger than 6 months of age
People who have a moderate-to-severe illness with a fever (delay vaccination.)
History of Guillain–Barré Syndrome.
Who Should NOT Be Vaccinated?
Swine Influenza A (H1N1)
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Make illness milder and recovery faster
May prevent serious flu complications
Work best if started within 2 days of symptoms.
Warning! Do NOT give aspirin: Reye’s syndrome.
Swine Influenza A(H1N1) Antiviral Protection
Treatment (Antiviral drugs )
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2 days 3 days1 day >4 daysDays from onset till initiation of treatment
mRecovered
Dead
Tota
l n
um
ber
Prognosis and days before treatment
Importance of the Early Treatment
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Swine Influenza A(H1N1) Antiviral Protection
Treatment (Antiviral drugs )Who to treat
Suspected or confirmed influenza with: Illness requiring hospitalizationProgressive, severe, or complicated illness,
regardless of previous statusPatients at risk for severe disease
Children <2, 2-4 Adults > 65 Pregnancy & 2wks postpartum
Persons with certain conditions:
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Swine Influenza A(H1N1) Antiviral Protection
Prophylaxis (Antiviral drugs )
Who may be considered:
Close contact of a person with H1N1 : Persons at high risk for complications
of influenza; Health care workers and emergency
medical personnel; Pregnant women.
• Vaccine takes 10 – 14 days to act
• When the vaccine is not available
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The health authorities of Saudi Arabia has advised certain populations against attending Hajj
The hajj Season
Children younger than 10 Adults older than 65 Pregnant women Those with chronic health conditions
That was the position of many countries Vaccination against H1N1 required
Swine Influenza A (H1N1)
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• Meeting of Arab health ministers(In July) working very closely with
To ensure pilgrim and resident safety, Saudi Arabia has set up:
• Health screenings at all ports of entry• H1N1 vaccine secured• Antiviral medication is available
• Schools started by mid-October
World Health Organization Other international experts
The hajj SeasonSwine Influenza A (H1N1)