health care workers safety in influenza
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Circulating Influenza Strains and
Pandemics in The 20th Century
1920 1940 1960 1980 2000
H1N1
H2N2H3N2
1918: Spanish Flu1957: Asian Flu1968: Hong Kong Flu20-40 million deaths 1-4 million deaths 1-4 milliondeaths
Dr.T.V.Rao MD 2
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What is Swine Flu?
Swine flu (also called swine influenza) is outbreaksin pigs.
People do not normally get swine flu, but humaninfections can and do happen. Swine flu viruses have
been reported to spread from person-to-person, butin the past, this transmission was limited and notsustained beyond three people.
The 2009 swine fluoutbreak (began in April) in
humans is due to a new strain of influenza A virussubtype H1N1 that derives in part from humaninfluenza, avian influenza, and two separate strains ofswine influenza.
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HOW DOES SWINE FLU SPREAD?
Coughing orsneezing of people
with influenza
Touching somethingwith flu viruses to
yourmouth ornose
Spqeadof theswineinfluenza A(H1N1)viqus[the same as seasonal fluspreads]
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Viral Re-assortment
Reassortment in pigs
Reassortment in
humans
Pandemic InfluenzaVirus
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PIG THE CREATOR
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EPIDEMIOLOGY
Incubation period- 1-7 days Transmission
PRIMARY CASEdirect contact with pigs
SECONDARY CASESsneezing, coughing
respiratory droplets
body fluids(diarroeal stool)contact surfaces
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Transmission
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Spread of Influenza Virus
This virus is not transmitted from eating porkor pork products
Contagiousness:
1 day onset of symptoms
7 days
Children are contagious for longer periods.
. Majority of patients were previously healthy.
Clinical course mild in PCR negative influenza.
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EARTH LIVING SPACE FOR ALL
Including Influenza Virus
n Epidemic: An increase in disease above what is normally expected
n Pandemic: A worldwide epidemic
A pandemic begins when: there is person-to-person
sustained transmission on multiple continents
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Signs and Symptoms
Human Influenza
Type of infection Upper and lower respiratory
Fever Yes
Headache Yes
Cough Yes
Respiratory symptoms Varies; sore throat to difficulty breathing
Gastrointestinal symptoms Uncommon, except children, elderly
Recovery 2-7 daysDr.T.V.Rao MD 13
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Swine flu
A Acute respiratory infection Swine flu is an infection caused by a virus. It's
named for a virus that pigs can get. People donot normally get swine flu, but human
infections can and do happen. The virus iscontagious and can spread from human tohuman. Symptoms of swine flu in people aresimilar to the symptoms of regular human flu
and include fever, cough, sore throat, bodyaches, headache, chills and fatigue.
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Swine flu spreads through
Respiratory route
The main way that
influenza viruses
are thought tospread is from
person to person
in respiratorydroplets of coughs
and sneezes.
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Swine flu can begin with
Fever
with Sudden
symptoms of Aches
Chills Tiredness
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May Preset with more severe
Symptoms Fever (usually high) Headache Muscle aches Chills Extreme tiredness Dry cough Runny nose may also occur but is more common in
children than adults
Stomach symptoms, such as nausea, vomiting, anddiarrhea, may also occur but are more common inchildren than adults
Donot self Diagnose Visit a Health Centre
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Collection of Specimens
Nasopharyngeal swab, nasal swab, throatswab, combined oropharyngeal/
nasopharyngeal swab, or nasal aspirate
Swabs with a synthetic tip (eg, polyester orDacron) and an aluminum or plastic shaft
should be used. Swabs with cotton tips and
wooden shafts are not recommended. The collection vial in which the swab is placed
should contain 1 to 3 mL of viral transport
media. Dr.T.V.Rao MD 18
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Collection and Transportation
Respiratory specimen should be collected
within 4 to 5 days of illness or at the
earliest Specimens should be placed in viral
transport media and placed on ice (4C)
or refrigerated immediately fortransportation to the laboratory
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Whom to test
Testing for pandemic H1N1 influenza A
should be considered in individuals with
an acute febrile respiratory illness( temperature of 100F or higher and
recent onset of at least one of the
following: rhinorrhea, nasal congestion,sore throat, or cough) or sepsis-like
syndrome
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Priority and Recommendations in
Testing
Priority for testing should be given to :
Those who require hospitalization and
Those who are at high risk for severecomplications
No testing if illness is mild or the personresides in an area with confirmed cases
Recommended test for suspected cases is real-time reverse transcriptase (RT)-PCR forinfluenza A, B, H1, and H3
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Diagnosis To diagnose swine influenza A
infection, a respiratory specimenwould generally need to be
collected within the first 4 to 5 daysof illness (when an infected personis most likely to be shedding virus).
However, some persons, especiallychildren, may shed virus for 10 daysor longer. Identification as a swine
flu influenza A virusDr.T.V.Rao MD 23
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Rapid Diagnosis
RT PCR can
make rapid
Diagnosis
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Frequent hand washing Covering coughs and sneezes
Avoidance of crowded settings when possible
advising ill persons to stay home (except toseek medical care) and minimize contact
with others in household
voluntary home quarantine of members ofhouseholds with confirmed or probable swine
influenza cases
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Hand Washing
Method Wet hands with clean (not hot) water
Apply soap
Rub hands together for at least 20seconds
Rinse with clean water
Dry with disposable towel or air dry
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Isolation Precautions
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Care for common materials used by
Swine flu patients
Linens, eatingutensils, and dishesbelonging to those
who are sick do notneed to be cleanedseparately, butimportantly these
items should not beshared withoutwashing thoroughlyfirst.
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Antivirals- Oseltamivir Treatment is 75 mg twice a day for 5 days.
Prophylaxis is 75 mg once a day for 7 days
after last exposure. Prophylaxis:
High risk exposure (household contacts)
Moderate risk (unprotected very close exposure tosick animals; HCW with unprotected exposure topatients)
Low risk exposure: no need for prophylaxis unless
activation of exceptional measures.Dr.T.V.Rao MD 32
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* household close contacts (of confirmed, probable, or
suspected case) at high-risk for complications of influenza
+ chronic medical conditions
+ aged 65 years
+ aged 5 years+ pregnant women
* school children or children in daycare at high-risk for
complications of influenza (certain chronic medicalconditions) who had close contact (face-to-face) with
confirmed, probable, or suspected case
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*Any healthcare worker at high-risk for
complications of influenza (persons with certain
chronic medical conditions, elderly) working in area
with confirmed swine influenza A (H1N1) cases, orwho is caring for patients with any acute febrile
respiratory illness
* Non-high risk travelers to Mexico, first
responders, or border workers who are working in
areas with confirmed cases of swine influenza A
(H1N1) virus infection Dr.T.V.Rao MD 34
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Pre-exposure
Treat during exposure period and for 10 days
after last known exposure to ill confirmed
case of swine influenza A (H1N1) virus
infection
Post-exposure
Treat for 10 days after last known exposure
to ill confirmed case of swine influenza A(H1N1) virus infection
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Can the Mask Prevent the Spread
of Flu ???
However, no studies
have definitively
shown that mask
use by eitherinfectious patients
or health-care
personnel preventsinfluenza
transmission
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Prevention is best option
Covering your
nose and mouth
with a tissue
when you cough
or sneeze. Throw
the tissue in thetrash after you
use it.
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Using N95 mask reduces the Risk
You can cut your risk of
contracting the flu or
other respiratory
viruses by as much as80 percent by wearing a
mask over your nose
and mouth, according
to a new study.Emerging Infectious Diseases, the
journal of the Centres for Disease
Control and Prevention (CDC) .
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Why do we need vaccine
COST EFFECTIVETARGET AT RISK
PEOPLE
VACCINE
WINTER SEASON
TO COME(LOW
HUMIDITY,TEMP)
RAPID GLOBAL
SPREAD
SEASONAL
VACCINE
PROTECTION?
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"flu shot
The "flu shot" aninactivated vaccine(containing killed virus)that is given with a
needle, usually in thearm. The flu shot isapproved for use inpeople older than 6
months, includinghealthy people andpeople with chronicmedical conditions.
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Nasal Vaccination
The nasal-spray flu
vaccine a vaccine made
with live, weakened flu
viruses that do not causethe flu (sometimes called
LAIV for "live attenuated
influenza vaccine" or
FluMist). LAIV
(FluMist) is approved
for use in healthy*
people 2-49 years of age
who are not re nant.Dr.T.V.Rao MD 43
How to Keep Away from Swine Flu?
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How to Keep Away from Swine Flu?
A,B,C,D of Prevention
A. Wash your hands with soap or hand cleaners.B. Avoid touching your eyes, nose or mouth.C. Drink plenty of fluids and eat nutritious food.D. Cover your nose and mouth with a tissue.
E. Try to stay in good general health.F. Get plenty of sleep to be physically active.G. Manage your stress.H. Try not touch surfaces that may be contaminated
with the flu virus.I. Avoid close contact with people who are sick.J. Get treatment and/or prevention of the infection
with antiviral drugs.
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Transport of deceased persons in a transport bag.
Hand hygiene should be performed after
completing transport.
For deceased persons with confirmed, probable, orsuspect novel influenza A (H1N1):
o limit contact with the body in health care
settings to close family memberso Direct contact with the body is discouraged
o Necessary contact may occur as long as hands
are washed immediately with soap and water.
Dealing with the Deceased
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Stop Spreading Virus
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Stop Spreading Virus
Promote Prevention
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d hi i b
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Your Hand Washing Practices are best
contribution to Hospital Safety
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The Programme Created by Dr.T.V.Rao MD as
Public Health Message on Prevention and
Control of Swine Flu among the Health Care
Workers
Email