Case study of the 2009 pandemic

SWINE INFLUENZA

SOME THINGS TO KNOW BEFORE WE BEGIN…• Caused by a reassorted strain of the H1N1 A virus.

• The term ‘Swine flu’ originated as a result of the fact that the H1N1 virus is a

mixture of the strains of bird, swine and human flu viruses.

• Called the pandemic H1N1/09 virus by the WHO and as the novel influenza A

(H1N1) or 2009 H1N1 flu by the CDC of the USA.

• Second pandemic caused by a H1N1 virus, the first being in 1918.

ORIGIN• First recognised in Veracruz, Mexico.

• Initially thought to be an ‘outbreak’, the virus was present for months before it was officially declared an epidemic.

• Continued to spread globally despite efforts.

• In late April 2009, WHO declared it as a ‘public health emergency of international concern’ or PHEIC.

• In June, CDC stopped counting cases and declared it as a pandemic.

• However, recent studies (2011) show that the outbreak could have been China and not Mexico

SYMPTOMS

• Symptoms vary in adults and kids.

• Most symptoms are similar to other influenzas

In kids, symptoms include

• Fast breathing• Bluish skin colour• Inadequate fluid intake• Easily irritable• Not interacting• Cough• Fever with a rash• Unable to eat• No tears while crying

TRANSMISSION• Reassorted virus

• Children had no pre existing immunity but some adults over 60 did.

• Spread from person to person by droplets or fomites.

• The basic reproduction rate(R-nought) was estimated at 1.75

• Does not spread by eating pork.

DIAGNOSIS• Mostly diagnosed based on symptoms.

• Testing of nasopharyngeal, nasal or oropharyngeal tissue swab from the patient.

• Real time PCR is the recommended test. It can differentiate between H1N1 and seasonal influenza.

• Usually the differentiating test is not done, unless the patients are high risk, as it does not alter the course of treatment.

• For the mere diagnosis of influenza, RIDT(Rapid Influenza Diagnostic Tests) are used, which yield results in 30 minutes.

TREATMENT• To treat symptoms, adequate rest and fluid intake are

recommended.

• Pain medicines such as acetaminophen and ibuprofen may help ease the symptoms. They do not kill the virus.

• At-risk people must be administered antivirals.

• To help reduce shortage of drugs, CDC recommended to use antivirals primarily for hospitalised people.

• In patients with pneumonia, both antibiotics and antivirals are used.

PREVENTION• Basic hygiene habits like frequent handwashing, adequate liquid

intake… etc.,

• N-95 masks were recommended to prevent spread through droplet infection.

• Vaccines were made available in both injection and nasal spray forms.

PROPHYLAXIS• The CDC recommended the administering antivirals for people

hospitalised with pandemic flu.

• This was to avoid the shortage of the drugs.

• Vaccines were first given to the at-risk individuals like children and pregnant women.

• Affected patients were isolated and healthcare personnel protected themselves from exposure by various protective equipment.

CONTROL• In spite of control measures of the Mexican Government and the

CDC, the disease became a pandemic.

• Elimination of potential exposures

• Engineering controls

• Administrative controls

• Personal Protective Equipment(PPE)

• Educating the masses on hygiene procedures and limiting exposure.

HOTSPOTS• The swine flu of 2009 was a pandemic, which means the wide

spread of a disease over a large geographical area.

• The virus spread almost throughout the entire world.

THANK YOU