swine flu.ppt
TRANSCRIPT
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CHOTANI 2009.
1. Influenza Virus2. Definitions3. Introduction4. History in the US5. Spread/Transmission6. Timeline/Facts7. Response8. Status Update
Mexico
US Canada European Union Globally
9. Case-Definitions10. Guidelines
Clinicians Laboratory Workers General Population
11. Treatment12. Other Protective Measures13. Summary14. Timeline of Emergence15. Lessons Learned from Past Pandemics16. Conclusion & Recommendations
OUTLINE
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Credit: L. Stammard, 1995
RNA, enveloped
Viral family: Orthomyxoviridae
Size:80-200nm or .08 0.12 m(micron) in diameter
Three types A, B, C
Surface antigens
H (haemaglutinin) N (neuraminidase)
Virus
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H1 N1
H2 N2
H3 N3
H4 N4H5 N5
H6 N6
H7 N7
H8 N8
H9 N9
H10
H11
H12
H13
H14
H15
H16
Haemagglutinin subtype Neuraminidase subtype
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Swine Influenza A(H1N1)Introduction
Swine Influenza (swine flu) is a respiratory
disease of pigs caused by type A influenzathat regularly cause outbreaks of influenzaamong pigs
Most commonly, human cases of swine fluhappen in people who are around pigs
Swine flu viruses do not normally infecthumans, however, human infections withswine flu do occur, and cases of human-to-human spread of swine flu viruses havebeen documented
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Swine Influenza A(H1N1)History in US
A swine flu outbreak in Fort Dix, New Jersey,
USA occurred in 1976 that caused morethan 200 cases with serious illness in severalpeople and one death More than 40 million people were vaccinated However, the program was stopped short
after over 500 cases of Guillain-Barresyndrome, a severe paralyzing nerve disease,were reported 30 people died as a direct result of the
vaccination
In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin washospitalized for pneumonia after beinginfected with swine flu and died 8 days later.
From December 2005 through February2009, a total of 12 human infections withswine influenza were reported from 10 statesin the United States
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Swine Influenza A(H1N1)Transmission to Humans
Through contact with infected pigs orenvironments contaminated withswine flu viruses
Through contact with a person with
swine flu
Human-to-human spread of swine fluhas been documented also and isthought to occur in the same way asseasonal flu, through coughing orsneezing of infected people
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Swine Influenza A(H1N1)Transmission Through Species
Avian Virus
Human Virus
Swine Virus
Avian/Human
Reassorted Virus
Reassortment in Pigs
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Swine Influenza A(H1N1) March 2009Timeline
In March and early April 2009, Mexico experiencedoutbreaks of respiratory illness and increased
reports of patients with influenza-like illness (ILI) inseveral areas of the country
April 12, the General Directorate of Epidemiology(DGE) reported an outbreak of ILI in a smallcommunity in the state of Veracruz to the Pan
American Health Organization (PAHO) inaccordance with International Health Regulations
April 17, a case of atypical pneumonia in OaxacaState prompted enhanced surveillance throughoutMexico
April 23, several cases of severe respiratory illnesslaboratory confirmed as influenza A(H1N1) virusinfection were communicated to the PAHO
Sequence analysis revealed that the patients wereinfected with the same strain detected in 2 childrenresiding in California Samples from the Mexico outbreak match swine
influenza isolates from patients in the United States
Source: CDC
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Swine Influenza A(H1N1) March 2009Facts
Virus described as a new subtype ofA/H1N1 not previously detected in
swine or humans
CDC determines that this virus iscontagious and is spreading fromhuman to human
The virus contains gene segments from
4 different influenza types: North American swine North American avian North American human and Eurasian swine
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Swine Influenza A(H1N1)US Response
The Strategic National Stockpile (SNS) isreleasing one-quarter of its Anti-viral drugs Personal protective equipment and Reparatory protection devices
President Obama today asked Congress foran additional $1.5 billion to fight the swine flu
On April 27, 2009, the CDC issued a traveladvisory that recommends against all non-essential travel to Mexico
Source: CDC
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Swine Influenza A(H1N1)USCase Definitions
A conf i rmed caseof swine influenza A (H1N1) virus infection is defined as a
person with an acute febrile respiratory illness with laboratory confirmed swineinfluenza A (H1N1) virus infection at CDC by one or more of the following tests: real-time RT-PCR viral culture
A probable caseof swine influenza A (H1N1) virus infection is defined as aperson with an acute febrile respiratory illness who is: positive for influenza A, but negative for H1 and H3 by influenza RT-PCR, or positive for influenza A by an influenza rapid test or an influenza
immunofluorescence assay (IFA) plus meets criteria for a suspected case
A suspected caseof swine influenza A (H1N1) virus infection is defined as aperson with acute febrile respiratory illness with onset within 7 days of close contact with a person who is a confirmed case of swine
influenza A (H1N1) virus infection, or
within 7 days of travel to community either within the United States or internationallywhere there are one or more confirmed swine influenza A(H1N1) cases, or resides in a community where there are one or more confirmed swine influenza
cases.
Source: CDC
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Swine Influenza A(H1N1)USCase Definitions
Infectious period for a confirmed case of swine influenza A(H1N1)
virus infection is defined as 1 day prior to the cases illness onset to7 days after onset
Close contact is defined as: within about 6 feet of an ill person who isa confirmed or suspected case of swine influenza A(H1N1) virusinfection during the cases infectious period
Acute respiratory illness is defined as recent onset of at least two ofthe following: rhinorrhea or nasal congestion, sore throat, cough (withor without fever or feverishness)
High-risk groups:A person who is at high-risk for complications ofswine influenza A(H1N1) virus infection is defined as the same forseasonal influenza (see Reference)
Source: CDC
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Swine Influenza A(H1N1)Guidelines for Clinicians
Clinicians should consider the possibility of swineinfluenza virus infections in patients presenting withfebrile respiratory illness who live in areas where human cases of swine influenza A(H1N1)
have been identified or have traveled to an area where human cases of swine influenza
A(H1N1) has been identified or have been in contact with ill persons from these areas in the 7
days prior to their illness onset
If swine flu is suspected, clinicians should obtain arespiratory swab for swine influenza testing and place it
in a refrigerator (not a freezer) once collected, the clinician should contact their state or local
health department to facilitate transport and timely diagnosis ata state public health laboratory
Source: CDC
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Swine Influenza A(H1N1)Guidelines for Clinicians
Signs and Symptoms Influenza-like-illness (ILI)
Fever, cough, sore throat, runny nose, headache, muscle aches. Insome cases vomiting and diarrhea. (These cases had illness onsetduring late March to mid-April 2009)
Cases of severe respiratory disease, requiring hospitalizationincluding fatal outcomes, have been reported in Mexico The potential for exacerbation of underlying chronic medical
conditions or invasive bacterial infection with swine influenza virusinfection should be considered
Non-hospitalized ill persons who are a confirmed or
suspected case of swine influenza A (H1N1) virusinfection are recommended to stay at home (voluntaryisolation) for at least the first 7 days after illness onsetexcept to seek medical care
Source: CDC
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FDA Issues Authorizations for Emergency Use (EUAs) of Antivirals
On April 27, 2009, the U.S. Food and Drug Administration (FDA) issuedEUAs in response to requests by the Centers for Disease Control andPrevention (CDC) for the swine flu outbreak
One of the reasons the EUAs could be issued was because the U.S.Department of Health and Human Services (HHS) declared a public healthemergency on April 26, 2009
The swine influenza EUAs aid in the current response: Tamiflu: Allow for Tamiflu to be used to treat and prevent influenza in children
under 1 year of age, and to provide alternate dosing recommendations forchildren older than 1 year. Tamiflu is currently approved by the FDA for thetreatment and prevention of influenza in patients 1 year and older.
Tamiflu and Relenza: Allow for both antivirals to be distributed to large segments
of the population without complying with federal label requirements that wouldotherwise apply to dispensed drugs and to be accompanied by writteninformation about the emergency use of the medicines.
Swine Influenza A(H1N1)Guidelines for Clinicians
Source: FDA
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Swine Influenza A(H1N1)Biosafety Guidelines for Laboratory Workers
Diagnostic work on clinical samples from patients who are suspectedcases of swine influenza A (H1N1) virus infection should be conducted in
a BSL-2 laboratory All sample manipulations should be done inside a biosafety cabinet (BSC)
Viral isolation on clinical specimens from patients who are suspectedcases of swine influenza A (H1N1) virus infection should be performed ina BSL-2 laboratory with BSL-3 practices (enhanced BSL-2 conditions)
Additional precautions include: recommended personal protective equipment (based on site specific risk
assessment) respiratory protection - fit-tested N95 respirator or higher level of protection shoe covers closed-front gown double gloves
eye protection (goggles or face shields)
Waste all waste disposal procedures should be followed as outlined
in your facility standard laboratory operating procedures
Source: CDC
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S i I fl A(H1N1)
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FDA Issues Authorizations for Emergency Use (EUAs) of Diagnostic
Tests On April 27, 2009, the U.S. Food and Drug Administration (FDA) issued
EUAs in response to requests by the Centers for Disease Control andPrevention (CDC) for the swine flu outbreak
One of the reasons the EUAs could be issued was because the U.S.Department of Health and Human Services (HHS) declared a public healthemergency on April 26, 2009
The swine influenza EUAs aid in the current response: Diagnostic Test: Allow CDC to distribute the rRT-PCR Swine Flu Panel
diagnostic test to public health and other qualified laboratories that have theequipment and personnel to perform and interpret the results.
Swine Influenza A(H1N1)Biosafety Guidelines for Laboratory Workers
Source: CDC
S i I fl A(H1N1)
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Swine Influenza A(H1N1)Guidelines for General Population
Covering nose and mouth with a
tissue when coughing or sneezing Dispose the tissue in the trash after
use.
Handwashing with soap and water Especially after coughing or sneezing.
Cleaning hands with alcohol-basedhand cleaners Avoiding close contact with sick
people Avoiding touching eyes, nose or
mouth with unwashed hands If sick with influenza, staying home
from work or school and limitcontact with others to keep frominfecting them
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Swine Influenza A(H1N1)Treatment
No vaccine available
Antivirals for the treatment and/or prevention of infection: Oseltamivir (Tamiflu) or Zanamivir (Relenza)
Use of anti-virals can make illness milder and recovery faster
They may also prevent serious flu complications
For treatment, antiviral drugs work best if started soon after gettingsick (within 2 days of symptoms)
Warning!Do NOTgive aspirin (acetylsalicylic acid) or aspirin-containing products(e.g. bismuth subsalicylate Pepto Bismol) tochildren or teenagers (up to 18 years old) who are confirmed orsuspected ill case of swine influenza A (H1N1) virus infection; thiscan cause a rare but serious illness called Reyes syndrome. Forrelief of fever, other anti-pyretic medicationsare recommended suchas acetaminophen or non steroidal anti-inflammatory drugs.
Source: CDC
S f ( 1 1)
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Swine Influenza A(H1N1)Treatment
S CDC
Oseltamivir (Tamiflu) Zanamivir (Relenza)
Treatment Prophylaxis Treatment Prophylaxis
Adults 75 mg capsule twiceper day for 5 days
75 mg capsule onceper day
Two 5 mg inhalations(10 mg total) twice perday
Two 5 mg inhalations(10 mg total) once perday
Children 15 kg or less: 60 mgper day divided into 2doses
30 mg once per day Two 5 mg inhalations(10 mg total) twice perday (age, 7 years or
older)
Two 5 mg inhalations(10 mg total) once perday (age, 5 years or
older)1523 kg: 90 mg perday divided into 2doses
45 mg once per day
2440 kg: 120 mg perday divided into 2doses
60 mg once per day
>40 kg: 150 mg perday divided into 2doses
75 mg once per day
Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatmentdose for 5 days.