SWINE FLU SWINE FLU OUTBREAKOUTBREAK

20092009

Dr.T.V.Rao MDDr.T.V.Rao MD

SWINE FLU 2009SWINE FLU 2009

2009 swine flu outbreak2009 swine flu outbreak is the is the epidemic spread of a new strain of epidemic spread of a new strain of influenza virus that was clinically influenza virus that was clinically identified in April 2009 The new virus identified in April 2009 The new virus strain is a type of strain is a type of influenza A influenza A (H1N1)(H1N1) virus, commonly called the virus, commonly called the swine flu. The outbreak has also been swine flu. The outbreak has also been called the called the H1N1 influenzaH1N1 influenza, , 2009 2009 H1N1 fluH1N1 flu, , Mexican fluMexican flu, or , or swine-swine-origin influenzaorigin influenza. .

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WHO alerts it as PhaseWHO alerts it as Phase 55

WHO to change its WHO to change its pandemic alert pandemic alert phase to "Phase 5", phase to "Phase 5", which is defined as which is defined as "...human-to-"...human-to-human spread of human spread of the virus into at the virus into at least two countries least two countries in one WHO region in one WHO region

Qualifies as Phase 5Qualifies as Phase 5 By April 28, the new By April 28, the new

strain was confirmed to strain was confirmed to have spread to Spain, have spread to Spain, the United Kingdom, the United Kingdom, New Zealand, and New Zealand, and Israel, and the virus Israel, and the virus was suspected in many was suspected in many other nations, with a other nations, with a total of over 4,400 total of over 4,400 candidate cases, candidate cases, prompting the WHO to prompting the WHO to change its pandemic change its pandemic alert phase to "Phase alert phase to "Phase 5" 5"

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Early cases - MexicoEarly cases - Mexico Although the exact Although the exact

time and location of the time and location of the outbreak is unknown, it outbreak is unknown, it is believed to have is believed to have been first detected been first detected when an influenza-like when an influenza-like illness was reported by illness was reported by both health agencies both health agencies and local news media and local news media in in Mexico Mexico

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A New Strain of Influenzae A New Strain of Influenzae VirusVirus

The virus The virus responsible was responsible was clinically clinically identified as a identified as a new strain on new strain on April 24, 2009 April 24, 2009

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A serious Concern to Health A serious Concern to Health AuthoritiesAuthorities

In late April officials In late April officials from both from both World World Health OrganizationHealth Organization (WHO) and the (WHO) and the CDC CDC expressed serious expressed serious concern about the concern about the situation, stating that situation, stating that the virus had the the virus had the potential to become a potential to become a flu pandemic.flu pandemic.

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Virologists OptimisticVirologists Optimistic

By late April, By late April, however, some however, some virologists believed virologists believed that this strain was that this strain was unlikely to cause as unlikely to cause as many fatalities as many fatalities as earlier pandemics, earlier pandemics, and may not even and may not even be as damaging as be as damaging as a typical flu season. a typical flu season.

New virus is a New virus is a ReassortmentReassortment

The new strain is an apparent reassortment The new strain is an apparent reassortment of four strains of influenza A virus subtype of four strains of influenza A virus subtype H1N1 Analysis at the United States Centers H1N1 Analysis at the United States Centers for Disease Control and Prevention (CDC) for Disease Control and Prevention (CDC) identified the four component strains as one identified the four component strains as one endemic in humans, one endemic in birds, endemic in humans, one endemic in birds, and two endemic in pigs (swine). One swine and two endemic in pigs (swine). One swine strain was widespread in the United States, strain was widespread in the United States, the other in Euras the other in Euras

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Why Called as Swine FluWhy Called as Swine Flu

Although called Although called swine swine fluflu due to it due to it predominantly predominantly containing swine containing swine strains, the World strains, the World Organisation for Organisation for Animal Health have Animal Health have proposed the name proposed the name North American North American influenzainfluenza..

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Flu in Pigs IdentifiedFlu in Pigs Identified By May 2, some pigs By May 2, some pigs

in Canada were in Canada were diagnosed with diagnosed with H1N1.H1N1.

The Canadian Food The Canadian Food Inspection Agency Inspection Agency (CFIA) indicates that (CFIA) indicates that it has found H1N1 it has found H1N1 flu virus in a swine flu virus in a swine herd in Alberta. herd in Alberta.

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Proper Handling of Pig Proper Handling of Pig meat a Prioritymeat a Priority

Influenza viruses do not Influenza viruses do not affect the safety of affect the safety of pork, according to the pork, according to the World Health World Health Organization (WHO) and Organization (WHO) and the Food and the Food and Agriculture Organization Agriculture Organization of the United Nations of the United Nations (FAO). As with any raw (FAO). As with any raw meat, pork should meat, pork should always be properly always be properly handled and cooked to handled and cooked to eliminate a range of eliminate a range of food safety concerns. food safety concerns.

New Virus a New New Virus a New combinationcombination

The CDC determined The CDC determined that the strain that the strain contained genes from contained genes from four different flu viruses four different flu viruses – North American swine – North American swine influenza, North influenza, North American avian American avian influenza, human influenza, human influenza, and swine influenza, and swine influenza virus typically influenza virus typically found in Asia and found in Asia and Europe – "an unusually Europe – "an unusually mongrelised mix of mongrelised mix of genetic sequences. genetic sequences.

The pig strains carry The pig strains carry several other genesseveral other genes

But the North But the North American pig strain American pig strain was itself the product was itself the product of previous of previous reassortments, and reassortments, and has carried an avian has carried an avian PB2 gene for at least PB2 gene for at least ten years and a ten years and a human PB1 gene since human PB1 gene since 1993. These genes 1993. These genes were passed on to the were passed on to the new virus. new virus.

Pigs a Mixing vesselPigs a Mixing vessel

Pigs can catch Pigs can catch human and avian or human and avian or bird flu. When flu bird flu. When flu viruses from viruses from different species different species infect pigs, they can infect pigs, they can mix inside the pig mix inside the pig and new, mixed and new, mixed viruses can emerge. viruses can emerge.

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Pigs infect HumansPigs infect Humans Pigs can pass Pigs can pass

mutated viruses mutated viruses back to humans, back to humans, and these can be and these can be passed from human passed from human to human. to human. Transmission Transmission among humans is among humans is thought to occur in thought to occur in the same way as the same way as with seasonal flu.with seasonal flu.

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Case Definitions for Infection with Case Definitions for Infection with Swine-origin Influenza A (H1N1) Virus Swine-origin Influenza A (H1N1) Virus

(S-OIV)(S-OIV)

A A confirmed caseconfirmed case of of S-OIV infection is S-OIV infection is defined as a person defined as a person with an acute febrile with an acute febrile respiratory illness respiratory illness with laboratory with laboratory confirmed S-OIV confirmed S-OIV infection at CDC by infection at CDC by one or more of the one or more of the following tests.following tests.

Real-time RT-PCRReal-time RT-PCR Viral cultureViral culture

A A probable caseprobable case of S-OIV of S-OIV A A probable caseprobable case of of

S-OIV infection is S-OIV infection is defined as a person defined as a person with an acute febrile with an acute febrile respiratory illness respiratory illness who is positive for who is positive for influenza A, but influenza A, but negative for H1 and negative for H1 and H3 by influenza RT-H3 by influenza RT-PC PCRPC PCR

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A A suspected casesuspected case of S-OIV of S-OIV suspected casesuspected case of S-OIV infection is defined as a of S-OIV infection is defined as a

person with acute febrile respiratory illness with person with acute febrile respiratory illness with onset onset

Within 7 days of close contact with a person who Within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or is a confirmed case of S-OIV infection, or

Within 7 days of travel to community either within Within 7 days of travel to community either within the United States or internationally where there the United States or internationally where there are one or more confirmed cases of S-OIV are one or more confirmed cases of S-OIV infection, or infection, or

Resides in a community where there are one or Resides in a community where there are one or more confirmed cases of S-OIV infection. more confirmed cases of S-OIV infection.

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Simple Measures HelpSimple Measures Help By touching By touching

something something contaminated with contaminated with flu viruses and then flu viruses and then touching one's touching one's mouth or nose, and mouth or nose, and through coughing or through coughing or sneezing. One of the sneezing. One of the most effective most effective prevention prevention measures is measures is regular regular hand washinghand washing. .

Eating Pork Safe?Eating Pork Safe? People cannot catch People cannot catch

swine flu from eating swine flu from eating pork or pork products. pork or pork products. Cooking pork to an Cooking pork to an internal temperature internal temperature of 160 degrees of 160 degrees Fahrenheit (71 Fahrenheit (71 degrees Celsius) kills degrees Celsius) kills the swine flu virus the swine flu virus along with other along with other bacteria and virusesbacteria and viruses

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Yet no fully protective Yet no fully protective VaccineVaccine

Vaccines are available Vaccines are available to be given to pigs to to be given to pigs to prevent swine prevent swine influenza. There is no influenza. There is no vaccine to protect vaccine to protect humans from swine flu, humans from swine flu, although the CDC is although the CDC is formulating one. The formulating one. The seasonal influenza seasonal influenza vaccine may help to vaccine may help to provide partial provide partial protection against protection against swine H3N2, but not swine H3N2, but not against swine H1N1 against swine H1N1 viruses like the one viruses like the one circulating now. circulating now.

Past Vaccines proved not Past Vaccines proved not safesafe

In 1976 a new strain of swine flu started In 1976 a new strain of swine flu started infecting people and worried U.S. health infecting people and worried U.S. health officials started widespread vaccination. officials started widespread vaccination. More than 40 million people were More than 40 million people were vaccinated. But several cases of vaccinated. But several cases of Guillain-Guillain-Barré syndromeBarré syndrome, a severe and sometime , a severe and sometime fatal condition that can be linked to come fatal condition that can be linked to come vaccines, caused the U.S. government to vaccines, caused the U.S. government to stop the program. The incident led to stop the program. The incident led to widespread distrust of vaccines in general widespread distrust of vaccines in general

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Prevention is best optionPrevention is best option

Covering your nose Covering your nose and mouth with a and mouth with a tissue when you tissue when you cough or sneeze. cough or sneeze. Throw the tissue in Throw the tissue in the trash after you the trash after you use it. use it.

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Clean Hands – Safe Clean Hands – Safe HandsHands

Washing your hands Washing your hands often with soap and often with soap and water, especially water, especially after you cough or after you cough or sneeze. You can also sneeze. You can also use alcohol-based use alcohol-based hand cleaners. hand cleaners.

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Avoid Unnecessary Avoid Unnecessary ActionsActions

Avoiding touching Avoiding touching your eyes, nose or your eyes, nose or mouth. Germs mouth. Germs spread this way spread this way

Trying to avoid Trying to avoid close contact with close contact with sick people. sick people.

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Staying at home if sickStaying at home if sick

Staying home from Staying home from work or school if work or school if you are sick you are sick

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Several countreis effectedSeveral countreis effected WHOWHO

The following countries The following countries have reported laboratory have reported laboratory confirmed cases with no confirmed cases with no deaths - Austria (1), Canada deaths - Austria (1), Canada (34), China, Hong Kong (34), China, Hong Kong Special Administrative Special Administrative Region (1), Denmark (1), Region (1), Denmark (1), France (1), Germany (4), France (1), Germany (4), Israel (2), Netherlands (1), Israel (2), Netherlands (1), New Zealand (4), Republic New Zealand (4), Republic of Korea (1), Spain (13), of Korea (1), Spain (13), Switzerland (1) and the Switzerland (1) and the United Kingdom (13). United Kingdom (13).

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Prompt to seek Medical Prompt to seek Medical AttentionAttention

There is also no risk of There is also no risk of infection from this virus infection from this virus from consumption of from consumption of well-cooked pork and well-cooked pork and pork products. pork products. Individuals are advised Individuals are advised to wash hands to wash hands thoroughly with soap thoroughly with soap and water on a regular and water on a regular basis and should seek basis and should seek medical attention if medical attention if they develop any they develop any symptoms of symptoms of influenza-like illnessinfluenza-like illness

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Drug options in Swine Drug options in Swine FluFlu

There are four influenza antiviral drugs approved for There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir, use in the United States (oseltamivir, zanamivir, Amantidine and rimantadine). The swine influenza A Amantidine and rimantadine). The swine influenza A (H1N1) viruses that have been detected in humans in (H1N1) viruses that have been detected in humans in the United States and Mexico are resistant to the United States and Mexico are resistant to Amantidine and rimantadine so these drugs will not Amantidine and rimantadine so these drugs will not work against these swine influenza viruses. work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1) Laboratory testing on these swine influenza A (H1N1) viruses so far indicate that they are susceptible viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir (sensitive) to oseltamivir and zanamivir

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Drugs are Highly Drugs are Highly BeneficialBeneficial

If you get sick, antiviral drugs can make If you get sick, antiviral drugs can make your illness milder and make you feel your illness milder and make you feel better faster. They may also prevent better faster. They may also prevent serious influenza complications. Influenza serious influenza complications. Influenza antiviral drugs work best when started antiviral drugs work best when started soon after illness onset (within two 2 soon after illness onset (within two 2 days), but treatment with antiviral drugs days), but treatment with antiviral drugs should still be considered after 48 hours of should still be considered after 48 hours of symptom onset, particularly for symptom onset, particularly for hospitalized patients or people at high risk hospitalized patients or people at high risk for influenza-related complications.for influenza-related complications.

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CDC RecommendsCDC Recommends

CDC recommends CDC recommends the use of the use of oseltamivir or oseltamivir or zanamivirzanamivir for the for the treatment and/or treatment and/or prevention of prevention of infection with swine infection with swine influenza viruses. influenza viruses.

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OseltamivirOseltamivir

Oseltamivir (brand Oseltamivir (brand name name TamifluTamiflu ®) ®) is approved to both is approved to both treat and prevent treat and prevent influenza A and B influenza A and B virus infection in virus infection in people one year of people one year of age and older age and older

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ZanamivirZanamivir ZanamivirZanamivir (brand (brand

name Relenza ®) is name Relenza ®) is approved to treat approved to treat influenza A and B virus influenza A and B virus infection in people 7 infection in people 7 years and older and to years and older and to prevent influenza A and prevent influenza A and B virus infection in B virus infection in people 5 years and people 5 years and older. older.

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Spread the Message of Flu Spread the Message of Flu to Everyoneto Everyone

A good health A good health preparednesspreparedness

Possible Option in Possible Option in PreventionPrevention

Updates on Swine Updates on Swine FluFlu

20092009Doctortvrao's ‘e’ learning seriesDoctortvrao's ‘e’ learning series

Dr.T.V.Rao MDDr.T.V.Rao MD

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