2009 H1N1 Info gathered by Mona Youss
2009 H1N1
Info gathered by Mona Youssef
Study has shown virus to be different from the normally circulating North American pig virus.
It has two genes from flu viruses that normally circulate in pigs in Europe and Asia , avian genes and human genes.
"quadruple reassortant" virus
How is it then that it made its first appearance in Mexico and the US?
Genomic mapping of the virus revealed that it has been present and circulating in pigs for the past 7.5 to ten years (obviously undetected due to laxity in surveillance of pigs).
Charecteristics
• Influenza virus can survive on environmental surfaces and remain infectious for up to 2-8 hours after being deposited on the surface.
• Virus is destroyed by:o heat 75-100 degrees Celcius.o chemical germicides: chlorine, hydrogen peroxide, detergents
(soap), iodophors (iodine-based antiseptics), and alcohols.
*wipes or gels with alcohol in them should be rubbed into hands
until they are dry.
A person can sneeze on someone’s luggage in an airport, and start an outbreak in a country without even entering it!
Swine flu virus(Not novel H1N1)
• Like all influenza viruses, swine flu viruses change constantly.
• Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses.
• When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge.
• Over the years, different variations of swine flu viruses have emerged. There are currently four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1.
• Most of the recently isolated influenza viruses from pigs have been H1N1 viruses.
H3 subtypes infect older population and tend to be more severe.
Drinking waterSwimming Pools and Spas
No completed research for novel H1N1 virus.
Research on H5N1 has shown:
• Free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza.
• Free chlorine levels recommended by CDC to disinfect avian influenza A (H5N1) virus:
for swimming pools :1–3 parts per million
(ppm or mg/L)
spas: 2–5 ppm
It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination.
Dealing with the Deceased
• Transport of deceased persons does not require any additional precautions when bodies have been secured in a transport bag. Hand hygiene should be performed after completing transport.
• For deceased persons with confirmed, probable, or suspect novel influenza A (H1N1):o limit contact with the body in health care settings to close family
memberso Direct contact with the body is discouragedo Necessary contact may occur as long as hands are washed
immediately with soap and water.
NO need for mass burials yet….
• Autopsy:o Standard Precautions.o Additional respiratory protection is needed procedures that
generate aerosols (e.g., use of oscillating saws). o minimize the number of personnel participating in post mortem
examinations.o Follow standard safety procedures for preventing percutaneous
injuries during autopsy.
He says ice-cream made
him feel better, and Thank God
has now recovered full health.But the rest of the planet has a quick –
paced pandemic marching
on….'Patient Zero' in Swine Flu Outbreak Identified as 5-Year-Old Mexican Boy:
Edgar Hernandez
Timeline
April 23 : S-OIV (swine origin influenza virus) confirmed, same strain detected in two California children as in Mexico. PAHO informed of Mexico cluster of S-OIV
MidMarch: La Gloria,Veracruz, 60% of the town's population is sickened by a respiratory illness of unknown provenance.
Mexico
April 16 : Mexico Authorities notify the PAHO (Pan American Health Organization) of the atypical pneumonia.
Canadian labs
WHO• April 24: 2009 H1N1 first disease outbreak notice.
• April 25: WHO Director General declares a formal “Public health emergency of international concern”
• April 27: “containment of the outbreak is not feasible” pandemic alert raised from phase 3 to phase 4.
• April 29: phase 4 to phase 5.
• June 11: phase 5 to phase 6.
During this time interim, the WHO was vastly criticized for not announcing
phase 6
WHO Report 95 AFFECTED COUNTRIES
Nothing’s holding this virus back…….!!!
keyword
A pandemic means an epidemic of an infectious disease, that spreads throughout a large number of people and can spread worldwide.
A pandemic begins when: there is person-to-person sustained transmission on multiple continents.
The World Health Organization uses a six stage phase for alerting the general public to an outbreak
Phase 1 – animal to animal transmission.
Phase 2 – an animal influenza virus is capable of human infection.
Phase 3 - small outbreaks among close populations but
not through human to human contact.
Phase 4 - Human to human transmission
Phase 5 - spread across two countries or more in one of the WHO regions (continents).
Phase 6 – spread across two countries or more in one of the WHO regions plus spread to another WHO region.
W.H.O. identifies the following six epidemiological sub-regions.
- African Region- Eastern Mediterranean Region- European Region- Region of the Americas- South-East Asian Region- Western Pacific Region
Even an island in the middle of the ocean isn’t out of its reach….
June 15/2009
Who asked him to deny?
Any closer we’ll probably find him in
the living room watching TV
In one week, the United Nations agency raised the alert level twice,
from phase 3 to phase 5, in response to the sustained transmission
of H1N1 in Mexico and the United States.
( 1976 swine flu Hsw1N1 outbreak never passed phase 3.
The vaccine developed caused 10 per million Guillain Barre
syndrome as compared to the 1-2 per million with the seasonal
flu vaccine and was banned.)
Graveness of the situation
Clippings from the
past
19/6/2009WHO report
19/6/2009WHO reportCountry
Cumulative total
Newly confirmed since the last reporting period
Cases Deaths
Cases Deaths
Country Cumulative total
Newly confirmed since the last reporting period
Cases Deaths
Cases Deaths
Country Cumulative total
Newly confirmed since the last reporting period
Cases Deaths
Cases Deaths
Argentina 918 4 185 3
Australia 2199 0 87 0
Austria 8 0 1 0
Bahamas 2 0 0 0
Bahrain 12 0 0 0
Barbados 4 0 1 0
Belgium 19 0 0 0
Bermuda, UKOT 1 0 0 0
Bolivia 11 0 0 0
Brazil 96 0 17 0
British Virgin Islands, UKOT 1 0 0 0
Bulgaria 2 0 0 0
Canada 4905 12 856 5
Cayman Islands, UKOT 4 0 0 0
Chile 3125 2 790 0
China 519 0 137 0
Colombia 60 1 7 0
Costa Rica 149 1 0 0
Cuba 15 0 8 0
Cyprus 1 0 0 0
Czech Republic 5 0 1 0
Denmark 22 0 7 0
Dominica 1 0 0 0
Dominican Republic 93 1 0 0
Ecuador 86 0 0 0
Egypt 29 0 3 0
El Salvador 160 0 35 0
Estonia 5 0 1 0
Finland 13 0 1 0
France 131 0 13 0
French Polynesia, FOC 1 0 0 0
Martinique, FOC 1 0 0 0
Germany 238 0 43 0
Greece 31 0 8 0
Guatemala 153 1 25 0
Honduras 108 0 8 0
Hungary 7 0 3 0
Iceland 4 0 0 0
India 30 0 0 0
Ireland 16 0 4 0
Israel 219 0 67 0
Italy 88 0 16 0
Jamaica 14 0 2 0
Japan 690 0 24 0
Jordan 2 0 0 0
Korea, Republic of 84 0 19 0
Kuwait 18 0 0 0
Laos 1 0 1 0
Lebanon 12 0 1 0
Luxembourg 2 0 0 0
Malaysia 23 0 6 0
Mexico 7624 113 1383 5
Morocco 8 0 5 0
Netherlands 87 0 19 0
Netherlands Antilles, Curaçao * 3 0 2 0
Netherlands Antilles, Sint Maarten 1 0 1 0
New Zealand 216 0 89 0
Nicaragua 144 0 26 0
Norway 17 0 4 0
Oman 3 0 3 0
Panama 272 0 0 0Papua New Guinea 1 0 1 0
Paraguay 27 0 2 0
Peru 141 0 29 0
Philippines 311 0 118 0
Poland 7 0 0 0
Portugal 5 0 2 0
Qatar 3 0 0 0
Romania 18 0 2 0
Russia 3 0 0 0
Samoa 1 0 0 0
Saudi Arabia 22 0 5 0
Singapore 77 0 28 0
Slovakia 3 0 0 0
South Africa 1 0 1 0
Spain 512 0 13 0
Sri Lanka 1 0 0 0
Suriname 11 0 11 0
Sweden 43 0 6 0
Switzerland 27 0 0 0
Thailand 518 0 208 0
Trinidad and Tobago 18 0 13 0
Turkey 20 0 4 0
Ukraine 1 0 0 0
United Arab Emirates 2 0 1 0
United Kingdom 1752 1 291 0
Isle of Man, Crown Dependency 1 0 0 0
Jersey, Crown Dependency 1 0 0 0
United States of America 17855 44 0 0
Uruguay 36 0 0 0
Venezuela 60 0 15 0
Viet Nam 27 0 0 0
West Bank and Gaza Strip 5 0 3 0
Yemen 4 0 3 0
Grand Total 44287 180 4667 13
Australia 2199 0 87 0
Chile 3125 2 790 0
Egypt 29 0 3 0
Mexico 7624 113 1383 5
United States of America 17855 44 0 0
Grand Total 44287 180 4667 13
Country 19/6/2009Cumulative total
Newly confirmed since the last reporting period (17/6)
Cases Deaths Cases Deaths
Countries of origin.
Mixing of NH1N1 with seasonal flu virus could result in a strain resistant to tamiflu (NH1N1 is already
resistant to other antivirals
Mixing with H5N1 could produce strains capable of human to human transmission (Death toll of H5N1 is app. 66%)
Any half-brain would know that
these three subgroups were the
most imortant to keep an eye on...
And then Fate has it that the first detected viral strains resistant to tamiflu would show
up in China! NOT Australia, and Not Chilli
Surprise? Just when
you think you know... You
don’t!
Consequences of a declaration of a full
pandemic
Institution of pandemic response plans, which may include measures affecting hospitals, schools or public events.
Provision of support for developing countries including: drugs, diagnostic tests, and medical staff
WHO is still expected to make an announcement to specify whether manufacturers should switch from making seasonal to pandemic flu vaccines.
June 5 CDC Report:
Testing•CDC has developed a PCR diagnostic test kit for distribution throughout U.S. as well as internationally.
Vaccine •CDC has isolated the new H1N1 virus, for use as a candidate vaccine virus (Novartis manufactures first vaccine June 11 2009)
Strategic National Stockpile•CDC has deployed 25 percent of the supplies in the Strategic National Stockpile (SNS) to all states in the continental United States and U.S. territories. •This included antiviral drugs, personal protective equipment, and respiratory protection devices.
Previous Global Pandemics
1918 - Spanish Flu (originated in birds).
First hit soldiers in Europe during World War I, as their immune systems were weakened by war.
The mortality rate was highest between 20 to 50 year olds. There was never any vaccine developed, after about 18 months, the virus seemed to just disappear.
The final death toll was written as 40 million people worldwide.
Many of the victims who have died in Mexico have been young and otherwise healthy.
1957 - Asian FluThis flu started in birds in Asia.
In September schools and public places started closing in an effort to contain the virus.
In December the virus started to subside, but reappeared in January.
over two million people died
Reappeared
1968 - The Hong Kong Flu
This is the mildest pandemic It was first found in the early months of 1968 in Hong Kong, and was declared a global pandemic by December.
Children were out of school and were therefore not able to spread it as much.
It made a mild reappearance in 1970 and 1972.
it claimed about a million lives
Seasonal influenza normally claims app. ¼ to ½ a million lives yearly.
Reappeared…!!!
What we do know
Novel H1N1 virus tends to affect younger people just like the seasonal H1N1. (Older adults were shown to possess serum neutralizing antibodies to the new virus, most likely due to cross‐immunity with human H1N1 viruses. )
Novel H1N1 spreads just as easily as regular winter flu; ranging from very mild self-limited disease to Death.
Pandemic (H1N1) influenza virus continues to be the predominant circulating virus of influenza, both in the northern and southern hemisphere. All pandemic H1N1 2009 influenza viruses analysed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus.
Seasonal flu vaccine production is to continue as is, in an attempt to reduce the chances of the viruses mingling together in the same environment.
Seasonal H1N1 virus that we've had this past year is resistant to Tamiflu.
Influenza is unpredictable.
Characteristics of reported cases of influenza A(H1N1) by country
Of note , the prevailing clinical picture in other countries has
been GIT related.
Past Data limitations :
countries were using different surveillance methods and case definitions.
Caution must be exercised in interpreting information such as age as it may reflect patterns of travel or the occurrence of outbreaks in special settings such as schools.
Due to early stage of disease spread and the limited number of settings :
Incomplete picture of the epidemiological and clinical characteristics of the virus.
Estimates of important epidemiological parameters such as incubation period, attack rate and case fatality ratio may not be broadly applicable.
The objectives of on‐going monitoring of influenza activity throughout the pandemic
are to track:
global geographical spread
disease trend
intensity
impact of the pandemic on health‐care services
the number of deaths due to acute respiratory disease (by age group if available)
changes in viral antigenicity and antiviral sensitivity.
Reporting requirements
• National health authorities from all countries should inform WHO on a weekly basis of their qualitative assessment of the geogrphical spread, trend of cases, intensity of disease, impact on the health‐care system, and deaths.
• National health authorities from countries with established influenza surveillance systems should report on a weekly basis data on ILI and/or SARI
• National influenza centres or reporting laboratories are asked to report weekly via FluNet on the number of specimens collected and processed for influenza and the number of specimens tested that are positive for influenza by subtype.
Case definition for the reporting of pandemic (H1N1) 2009 virus infections in humans
The following case definition should be used to report confirmed cases of pandemic (H1N1) 2009 virus infection to WHO: An individual with laboratory‐confirmed pandemic (H1N1) 2009 virus infection by one or more of the following tests:
polymerase chain reaction (PCR);
viral culture;
4‐fold rise in pandemic (H1N1) 2009 virus virus‐specific neutralizing antibodies.
VACCINE
A review of 2009 production status for northern hemisphere seasonal vaccine indicates that:
Industry plans to produce approximately 480 million doses of trivalent seasonal vaccine in 2009.
Of this, 350 and 430 million doses will be available by 30 June and 31 July 2009, respectively.
For influenza A (H1N1), it is estimated that up to 4.9 billion doses could be produced over a 12‐month period IF there is initiation of a full‐scale production. In this situation, there is a potential access for the UN of supplies of up to 400 million doses.
A lot of Ifs……..
Currently available data indicate that:
• Immunization with recent or shortly to be available trivalent seasonal vaccine is unlikely to provide public health benefits in terms of protection against influenza A (H1N1).
• Unknowns: optimal antigen content, the required number of doses, the required intervals between doses and the interchangeability of different products is currently unknown for
influenza A (H1N1) vaccines. the safety profile
After considering the following issues:
1. the need for any recommendation to balance both risks and benefits,
2. the current uncertainty about the severity of influenza A (H1N1) illness,
3. the readiness of vaccine seed strains and reagents for large scale vaccine ‐production,
4. the current status of production of seasonal vaccine for the Northern hemisphere,
5. The risks associated with a premature cessation of seasonal vaccine production,
•Two doses of vaccine may be needed.
•The combination of A (H1N1) vaccine with trivalent seasonal vaccine would have significant regulatory limitations.
•Moving into production now could result in starting vaccine production with strains of lower growth potential, as was the case for H5N1 A/Vietnam/2004. The yields were less than 50% of those usually obtained with seasonal vaccine viruses. (currently NH1N1 yields are 25% to 50 % of the normal yields for seasonal influenza)
• Using a poorly growing A (H1N1) virus could reduce global supplies of A (H1N1) vaccine.
The Working Group Declares that:
•It is premature to recommend commercial‐scale production of influenza A (H1N1) vaccine.
The Working Group did make the following recommendations for immediate action:
(i)The WHO Secretariat, should recommend which vaccine viruses should be used for vaccine development as soon as possible
(ii) Essential reagents to calibrate antigenic content should be made available as a priority
(iii) The WHO Secretariat is encouraged to collaborate actively with its Collaborating Centres, Essential Regulatory Laboratories, and with industry, to assess the growth property of vaccine viruses and identify those with best growth potential, in order to maximize output of vaccine.
(iv) Manufacturers are urged to develop clinical trial batches and accelerate initiation of clinical trials of influenza A (H1N1) vaccines and to start preparing for a potential future recommendation to move to commercial‐scale production.
(v) The above activities should not interfere with the present production of the Northern hemisphere seasonal vaccines
(vi) The number of needed doses of A (H1N1) vaccine will depend on the spread of influenza A (H1N1) virus in the next few weeks and on a better definition of the groups to be targeted
(vii) An evidence‐based recommendation for the groups to be targeted for vaccination still requires more data
Medpage 7/24/2009 from an article written by Dr. Zalman S. Agus:
The FDA is likely to approve 2009 H1N1 (swine flu) vaccines before trial data can prove their safety and effectiveness against the virus.
Having a licensed vaccine doesn't mean that an immunization program will kick-off immediately -- that call has to come from the Secretary of Health and Human Services (HHS).
• Of the five companies applying for FDA approval -- Novartis, sanofi pasteur, CSL Biotherapies, GlaxoSmithKline, and MedImmune -- only CSL has already started human trials. The Australian company, which provides seasonal flu vaccines to the U.S., inoculated its first human trial participant Wednesday.
• Meanwhile, the NIH announced it was set to begin clinical trials in the United States of vaccines made by sanofi-pasteur and CSL.
If the vaccine is ineffective at stimulating an immune response, the FDA might have to issue an "emergency use authorization" for an oil-in-water adjuvant that sparks a stronger reaction in the immune system, but causes more side effects.
Two companies, GlaxoSmithKline and Novartis, are applying for approval for vaccines that contain oil-in-water adjuvants. The NIH is also conducting a trial of an adjuvant-enhanced vaccine.
Adjuvanted flu vaccines have been used for a decade in Europe and have not been shown to harm vulnerable populations, such as children.(Theodore Eickhoff).
The government has already purchased a supply of 120 million adjuvant doses that it will add to its antigen supply if it there is a shortage of the vaccine, or if the standard versions are shown to be ineffective.
Human infection with 2009 H1N1virus: clinical observations from Mexico and
other affected countries, May 2009
Presenting Manifestations:
•Fever: may be absent in one out of six hospitalized patients.•Dehydration•Shortness of breath•Myalgia•Sever malaise•Tachycardia•Tachypnoea•Low O2 sat.•Hypotension•Cyanosis•Acute myocarditis•Cardiopulmonary arrest
*Diarrhoea,nausea,vomiting: uncommon in hospitalized pts (38% of US outpatients) *NO ENCEPHALITIS TO DATE
Hospitalization :
•2-5% of confirmed cases in US and Canada
•6% of confirmed cases in Mexico (in Mexico 33% of hospitalized patients required ventilation as compared to only 13% in California)
•Fatalities are mainly from rapid progression to: ARDS Renal failure Multiorgan failure
•The highest rates of hospitalization are actually in children under 5, and the next highest rates are in those people 5 to 24.
Preparing ICUs…
Comorbidities associated with complications:
(71% of the hospitalized patients have occurred in people who have an underlying condition )
• Pregnancy:2/5 developed complications: Spontaneous abortion Premature ruptured membrane • Asthma and other lung disease
• Diabetes
• Morbid Obesity
• Autoimmune disorders
• Associated immunosuppressive therapy
• Neurological
• Cardiovascular disease
Lab:
•Leucocytosis/leucopenia
•Lymphopenia
•Elevated aminotransferases
•Elevated LDH was found (retrogradely) in 100% of 16 dead patients
•In some extremely elevated CPK
•1/2 hospitalized pts showed some degree of Renal insufficiency ( 2ry to rhabdomyolysis and myoglobinuria)
•Co-infections with strept. pneumonia and adenovirus have been reported in some Mexican cases.
Pathology (postmortem)
ARDS 2ry to 1ry viral pneumonia including :
• diffuse alveolar damage• Peribronchial and perivascular lymphoctic infiltrates• hyperplastic airway changes• bronchiolitis obliterans
Muscle biopsy: sk ms necrosis
WHO Guidance
Mild Cases:•Supportive: Paracetamol, flds… *NO SALICYLATES IN CHILDREN/ YOUNG ADULTS: REYE'S SYNDROME
•Antivirals : *best within first 48 hours *Early administration in at-risk pts ie those with co-morbidities/pregnancy… *Neuraminidase inhibitors: oral Oseltamivir Inhaled Zanamivir (N H1N1 is resistant to M2 ion channel inhibitors: Amantadine Rimantadine )
•Adequate control precautions: cough etiquette Hand hygiene Natural ventilation
Hospitalized pts:
•Antivirals • Pneumonia management like avian (antibiotics)
• Resp. Support: early detection Correction of hypoxia with supplemental O2 or mech. Vent as necessary
• when mech. vent is indicated: low volume low pressure lung protective vent. Strategy for ARDSSteroids:•Avoid routine use, no benefit was reported . •Higher doses associated with serious SE:
o evidence of increased viral replication in SARS and other resp. viral infections. o Increased mortality in Avian.
Who is prioritized for treatment with influenza antiviral drugs?
Most people ill with influenza will recover without complications. Some people are at increased risk of influenza complications and are prioritized for treatment with influenza antiviral drugs this season. They include:People hospitalized with suspected or confirmed influenza People with suspected or confirmed influenza who are at higher risk for complications:
Children younger than 5 years old (children under 2 years old are at higher risk for complications than older children) Adults 65 years and older Pregnant women People with certain chronic medical or immunosuppressive conditions
People younger than 19 years of age who are receiving long-term aspirin therapy
Physicians may also decide not to treat some people in these groups and/or treat people who are not in these groups based on their clinical judgment.
75-mg capsule once per day Treatment(5 days)
Chemoprophylaxis(10 days)
Oseltamivir
Adults 75-mg capsule twice per day 75-mg capsule once per day
Children ≥ 12 months 15 kg or less 60 mg per day divided into 2 doses
30 mg once per day
16-23 kg 90 mg per day divided into 2 doses
45 mg once per day
24-40 kg 120 mg per day divided into 2 doses
60 mg once per day
>40 kg 150 mg per day divided into 2 doses
75 mg once per day
Zanamivir
Adults Two 5-mg inhalations (10 mg total) twice per day
Two 5-mg inhalations (10 mg total) once per day
Children Two 5-mg inhalations (10 mg total) twice per day (age, 7 years or older)
Two 5-mg inhalations (10 mg total) once per day (age, 5 years or older)
Antiviral medication dosing recommendations for treatment or
chemoprophylaxis of 2009 H1N1 infection
Dosing recommendations for antiviral treatment or chemoprophylaxis of children
younger than 1 year using oseltamivir
Age Recommended treatment dose for 5 days
Recommended prophylaxis dose for 10 days
Younger than 3 months 12 mg twice daily Not recommended unless situation judged critical due to limited data on use in this age group
3-5 months 20 mg twice daily daily 20 mg once
6-11 months 25 mg twice daily 25 mg once daily
Storage of Tamiflu
At controlled room temperature; defined as temperature maintained thermostat between 20-25 degrees centigrade.
Other temperature excursions that are outside of the labeled temperature storage conditions are permitted within the 90-day period provided they do not exceed 40 degrees centigrade.
Unanswered questions:
Effect of:
• Smoking
• Air pollution
• Faeces and vomitus
Role of flies?
Roooooar!…….
Nobody’s scared of me
nomore!
Roooooar!…….
Nobody’s scared of me
nomore!
Round and round she
goes, where it stops , nobody knows…
Hey, who said that?
swine flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death
How Flu Spreads,Droplet infection
•Respiratory droplets of coughs and sneezes propelled through the air
and deposited on the mouth or nose or eyes of people nearby.
•when a person touches respiratory droplets on another person or an
object and then touches their own mouth or nose or eyes (or someone
else’s mouth or nose or eyes) before washing their hands.
People with 2009 NH1N1 who are cared for at home should:
I wish everyone
could have a
home like this
• Check with their health care provider about any special care they
might need and about antivirals if they are pregnant or have a health
condition such as diabetes, heart disease, asthma, or emphysema.
• stay home for 7 days after the start of their symptoms or until they
have been symptom-free for 24 hours, whichever is longer
• get plenty of rest.
• drink clear fluids (such as water, broth, sports drinks, electrolyte
beverages for infants) to keep from being dehydrated
• cover coughs and sneezes. Clean hands with soap and water or an
alcohol-based hand rub often and especially after using tissues and
after coughing or sneezing into hands.
• avoid close contact with others – do not go to work or school while ill
• be watchful for emergency warning signs that might indicate the need
to seek medical attention
When to Seek Emergency Medical Care Emergency Warning Signs
Get medical care right away if the sick person at home:
• has difficulty breathing, or chest pain.
• has purple or blue discoloration of the lips.
• is vomiting and unable to keep liquids down .
• has signs of dehydration such as dizziness when standing (hypovolemia),
absence of urination, or in infants, a lack of tears when they cry.
• has seizures (for example, uncontrolled convulsions) .
• is less responsive than normal or becomes confused .
• Irritable child who doesn’t want to be held.
• Flu-like symptoms improve but then return with fever and worse cough.
Medications to Help Lessen Symptoms of the Flu (fever and aches)
Acetaminophen , Ibuprofen, or other nonsteroidal anti-inflammatory drugs
(NSAIDS).
However:
• These medications will not lessen how infectious a person is.
• Could result in self-intoxication ,check the ingredients on the package
label before taking additional doses.
• Need consultation with healthcare provider if receipient has kidney or
stomach problems .
Aspirin
• Not to be given to children or teenagers who have the flu ( or any viral
infection); as it can cause Reye’s syndrome.
• Should be checked for on ingredient labels on over-the-counter cold
and flu medications to avoid accidental ingestion.
cool-mist humidifier and a suction bulb
• The safest care for flu symptoms in children younger than 2 years of
age .
• Used to clear away mucus.
Steps to Lessen the Spread of Flu in the Home
• Stay informed.
• Follow the cough etiquette and teach and model it to your children:
Cover your nose and mouth with a tissue when you cough or
sneeze.
Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after
you cough or sneeze. Alcohol-based hand cleaners are also
effective.
Avoid touching your eyes, nose or mouth. Germs spread this
way.
Try to avoid close contact with sick people.
• Stay home for 7 days after your symptoms begin or until you have
been symptom-free for 24 hours, whichever is longer.
• Keep away from other household members as much as possible. This
is to keep you from infecting others and spreading the virus further.
• Provide each family member with their own hygienic necessaties eg
towels…
Placement of the sick person
• Keep the sick person in a room separate from the common areas of
the house. For example, a spare bedroom with its own bathroom,to be
cleaned daily with household disinfectant.
• Keep the sickroom door closed.
• Have the sick person wear a surgical mask if they need to be in a
common area of the house near other persons.
Stay away from the
alien virus invasion!
Protect other persons in the home
• The sick person should not have visitors other than caregivers. A
phone call is safer than a visit.
• If possible, have only one adult in the home take care of the sick
person.
• Avoid having pregnant women care for the sick person.
• Maintain good ventilation in shared household areas (e.g., keeping
windows open in restrooms, kitchen, bathroom, etc.).
If you are the caregiver
• Avoid being face-to-face with the sick person.
• When holding small children who are sick, place their chin on your
shoulder so that they will not cough in your face.
I didn’t believe them when they said that smoking was bad for my health… a risk factor for novel H1N1!
• Avoid close contact (less than about 6 feet away) with the sick person
as much as possible.
• Spend the least amount of time possible in close contact and try to
wear a facemask (for example, surgical mask) or N95 disposable
respirator(it is harder to breathe through an N95 mask for long periods
of time)
Get in, get out…
• Clean your hands with soap and water or use an alcohol-based hand
rub after you touch the sick person or handle used tissues, or laundry.
• Talk to your health care provider about taking antiviral medication to
prevent the caregiver from getting the flu.
• Monitor yourself and household members for flu symptoms and
contact a telephone hotline or health care provider if symptoms occur.
Using Facemasks or Respirators
• Facemasks and respirators may be purchased at a pharmacy, building
supply or hardware store (not off the street).
• Used facemasks and N95 respirators should be taken off and placed
immediately in the regular trash so they don’t touch anything else.
• Avoid re-using disposable facemasks and N95 respirators if possible.
If a reusable fabric facemask is used, it should be laundered with
normal laundry detergent and tumble-dried in a hot dryer.
• After you take off a facemask or N95 respirator, clean your hands with
soap and water or an alcohol-based hand sanitizer.
Household Cleaning, Laundry, and Waste Disposal
• Throw away tissues and other disposable items used by the sick
person in the trash.
• Wash your hands after touching used tissues and similar waste.
• Keep surfaces (especially bedside tables, surfaces in the bathroom,
and toys for children) clean by wiping them down with a household
disinfectant according to directions on the product label.
• Eating utensils should be washed either in a dishwasher or by hand
with water and soap.
• Linens, eating utensils, and dishes belonging to those who are sick do
not need to be cleaned separately, but importantly these items should
not be shared without washing thoroughly first.
• Wash linens (such as bed sheets and towels) by using household
laundry soap and tumble dry on a hot setting.
• Avoid “hugging” laundry prior to washing it to prevent contaminating
yourself.
• Clean your hands with soap and water or alcohol-based hand rub right
after handling dirty laundry.
Pandemic Flu Planning Checklist for Individuals and Families
• To plan for a pandemic:
– Store a two week supply of water and food.
– Periodically check your regular prescription drugs
– Have any nonprescription drugs and other health supplies on hand,
including pain relievers, stomach remedies, cough and cold
medicines, fluids with electrolytes, and vitamins.
– Volunteer with local groups to prepare and assist with emergency
response.
•
Ready-to-eat canned meats, fish, fruits, vegetables, beans, and soups
Canned juices Fluids with
electrolytes Bottled water Canned or
jarred baby food and
formula Pet food Protein or fruit
bars Dry cereal or
granola Dried fruit Peanut butter
or nuts Crackers
Cleansing
agent/soap
Soap and water, or
alcohol-based (60-
95%)
hand wash
Flashlight
Batteries
Other non-
perishable items
Portable radio
Manual can opener
Garbage bags
Tissues, toilet
paper, disposable
diapers
Examples of food and non-perishables Examples of medical, health, and emergency supplies:
Thermometer
Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
Vitamins
Medicines for fever, such as acetaminophen or ibuprofen
Anti-diarrheal medication
Be prepared for Power failure, water
shortage….
Looks to me like he’s conquered his matador , and
has every right to fly……….