Flu and you by Dr Pruthvi Puwar (Physician, Vadodara, Guj, India)

Title pageDecember 11, 2014

FLU & You

Dr. Pruthvi Puwar

Consultant Physician

Sunshine Global Hospitals

Ph: 8866444474

The Forgotten PandemicThe 1918 Flu Epidemic

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I had a little bird,Its name was Enza,

I opened the window,And in-flew-enza.

American Skipping Rhyme (circa 1918.)

It is estimated that anywhere from 20 to 100 million people were killed worldwide. The pandemic is estimated to have affected up

to one billion people, half the world’s population at the time.

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Approximate Deaths Worldwide Samples *

India – 17 million Japan – 390,000 U.S. – 675,000 England – 250,000 France – 400,000 Canada – 50,000

* http://en.wikipedia.org/Flu_epidemic_of_1918

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This huge death toll was caused by an extremely high infection rate of up to 50%, and the extreme severity of the symptoms.

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Swine Flu 2009

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Swine Flu 2009

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Swine Flu 2009

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Swine Flu 2009

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Notable Epidemic Survivors

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Presidents Woodrow Wilson & Franklin D. Roosevelt

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Spanish Flu Survivors

Silent film super-star Mary Pickford

Famed animator Walt Disney

Spanish Flu Survivors

U.S. General John J. Pershing, WWI

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Wilhelm II, German Emperor, WWI

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Notable Flu Survivor

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Leo Szilard, Inventor Nuclear Chain Reaction

October 30, 2009 in TOI

Overview of Today’s Presentation

The important flu Basics everyone needs to know

The CDC recommends flu vaccination for everyone age 6 months and older

The flu can be life-threatening, especially in older adults– Our immune system weakens with age

What is Influenza/ Flu?

Influenza, also called the flu Common respiratory infection Symptoms: high fever, headache, fatigue,

cough, sore throat, runny or stuffy nose, and body aches

The flu is a serious disease, especially for adults age > 65

Types of Flu

Three types of influenza virus: A, B, and C

Different strains of influenza type A and B virus can circulate from year to year and cause illness

– There are many human and animal flu strains, however only a few predominate and cause human disease

Types of Flu

Scientists predict which strains will circulate and should be included in the flu vaccine each year– The 2012-13 seasonal vaccine contains 3 strains

• Two type A strains• One type B strain

The 2009 H1N1 virus was a new type A strain– It has been included in seasonal flu vaccines since its

appearance

Influenza A virus

•The type A viruses are the most virulent human pathogens among the three influenza types and cause the most severe disease. Type A flu or influenza A viruses are capable of infecting people as well as animals.

•Wild aquatic birds are the natural hosts for a large variety of influenza A.

•The influenza A virus can be subdivided into different serotypes based on the antibody response to these viruses. The serotypes that have been confirmed in humans, ordered by the number of known human pandemic deaths, are:•H1N1, which caused Spanish flu in 1918, and the 2009 flu pandemic •H2N2, which caused Asian Flu in 1957 •H3N2, which caused Hong Kong Flu in 1968 •H5N1, a current pandemic threat •H7N7, which has unusual zoonotic potential•H1N2, endemic in humans and pigs •H9N2 •H7N2 •H7N3 •H10N7

Treatment

•Treatment with oseltamivir (trade name Tamiflu®) or zanamivir (trade name Relenza®) is recommended for all people with suspected or confirmed influenza who require hospitalization.

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Why We Need Annual Flu Vaccination

Flu strains change genetically over time New vaccines are developed each flu season

to account for new strains resulting from these genetic changes

Even when there is no strain change in the vaccine, immunity to the virus gradually wanes

Common Mentality : NEEDS TO CHANGE

The Flu Season

In the United States, the flu season takes place during the fall and winter

– Flu season usually runs from October through May– Peaks in January or February

In India, season usually starts in Winter Season

How the Flu Spreads

The flu is easily passed from person to person– Transmitted through coughing, sneezing, or contact with an

infected person or surface1

• The flu can survive 24-48 hours on most surfaces– The flu can spread to others up to 6 feet away

Symptoms of the flu appear 1-4 days after infection Influenza can be spread 1 day before and as many as

7 days after symptoms begin

Preventing the Flu

Annual influenza vaccination is the best way to prevent the flu

The following hygiene measures can help prevent the spread of the flu– Cover your nose and mouth when you cough or sneeze– Use a tissue instead of a handkerchief to blow your nose– Wash hands often with soap and water– Use alcohol-based hand rubs, when soap and water are unavailable– Avoid touching your face; especially your eyes, nose, and mouth– Limit contact with others when sick

High-Risk Groups for Influenza

Older adults, young children, and pregnant women People who live in facilities, like a nursing home People with chronic health conditions like asthma,

diabetes, and heart disease American Indians and Native Alaskans Morbidly obese People with a weakened immune system due to disease

or medication, such as HIV or AIDS, or cancer

Flu in Older Adults

People 65 years of age and older are hardest hit by the flu and its complications1

– 6 out of 10 of the 226,000 flu-related hospitalizations each year1

– 9 out of 10 of the 3,000-49,000 annual flu-related deaths1

No matter how healthy or young a person looks or feels, older adults are more vulnerable to the flu because with advancing age the immune system weakens2

– The body is less able to fight infection from the virus2

– Fewer antibodies are produced in response to vaccination as compared to younger people2

Influenza Complications

Most common in older adults, people with pre-existing medical conditions and young children

Serious complications include:– Pneumonia– Inflammation of the heart

Worsening of chronic conditions:– Asthma, COPD– Heart failure, heart attack, and stroke– Diabetes– Kidney disease

Influenza Vaccination

Annual flu vaccination is the best way to help prevent the flu– Vaccination is safe and effective

– People can get immunized as vaccine becomes available

The Centers for Disease Control and Prevention (CDC) recommends annual vaccination for everyone age 6 months and older

Vaccination is especially important for adults 65 and older

You Can’t Get the Flu From the Flu Shot

The flu vaccine is made from a small piece of the killed flu virus, so it can’t cause the flu

Some people may experience flu-like or cold-like symptoms following the flu shot because: – They were exposed to the flu prior to receiving the shot– The immune response to the vaccine triggers some symptoms similar

to the disease

Some may have soreness, mild pain, swelling, fever, headache, fatigue, and muscle pain following a flu shot– Side effects vary and usually disappear in a few days

Other Things You Can Do To Stay Healthy

Getting vaccinated is the BEST way to avoid the flu.

Avoid close contact. Stay home when you are sick. Cover your mouth and nose. Clean your hands. Avoid touching your eyes, nose or mouth. Practice other good health habits.

CLEAN HANDS SAVE LIVES

Keeping our hands clean is one of the most important things we can do to save lives!

When to Wash Your Hands

Before, during, and after preparing food Before eating food Before and after caring for someone who is sick Before and after treating a cut or wound After using the toilet After changing diapers or cleaning up a child who has used

the toilet After blowing your nose, coughing, or sneezing After touching an animal or animal waste After handling pet food or pet treats After touching garbage

Proper Handwashing Technique

Wet your hands with clean, running water (warm or cold) and apply soap.

Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails.

Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.

Rinse your hands well under running water. Dry your hands using a clean towel or air dry them.

What about Hand Sanitizer?

Washing hands with soap and water is the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.

Hand sanitizers are not effective when hands are visibly dirty.

The story of Ebola virus

Ebola virus disease (EVD)

It is one of the world’s most virulent diseases. Formerly known as Ebola haemorrhagic fever. Severe, often fatal illness, with a case fatality rate of up to 90%. EVD outbreaks occur primarily in remote villages in Central and

West Africa, near tropical rainforests. All agents that cause viral hemorrhagic fever syndrome are

RNA viruses with a lipid envelope, all are considered zoonoses, all damage the microvasculature, resulting in increased vascular permeability, and all are members of one of four families: Arenaviridae, Bunyaviridae, Flaviviridae, and Filoviridae.

2014 OUTBREAK

On 8 August 2014, WHO declared the Ebola virus disease outbreak in West Africa a Public Health Emergency of International Concern (PHEIC) in accordance with the IHR 2005.

The current EVD outbreak is believed to have begun in Guinea in December 2013.

Viral sequencing shows strong homology (98%) with Zaïre Ebolavirus (EBOV)

As of August 16, 2014,

2,240 suspected or confirmed cases, including 1383 laboratory-confirmed cases and

1,229 deaths

2014 OUTBREAK

TRANSMISSION

Natural Host: Fruit bats of the Pteropodidae family

(Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata)

Source of human infection: Blood, secretions, organs, or other bodily fluids of infected animals, Bushmeat

(handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines found ill or dead or in the rainforest)

EPIDEMICEPIZOOTIC ENZOOTIC

Human-to-Human transmission Direct contact (through broken skin or mucous membranes) with the

blood, secretions, organs or other bodily fluids of infected people Indirect contact with environments contaminated with fluids. Burial ceremonies (mourners direct contact with corpse) The patients become contagious once symptoms begin. They are not

contagious during incubation period. Virus transmitted through the semen for up to 7 weeks after

recovery from illness. Health-care workers have frequently been infected

INCUBATION PERIOD: 2 to 21 daysCASE FATALITY RATE: 53%

All cases in the current outbreak- H2H

Zmapp Combination of monoclonal antibodies which binds with outer

glycoprotein of the virus and prevents its entry to the host cells

Efficacy yet to be proven, no clinical trials done till date.

In early trials- all Rhesus monkeys infected with virus survived when administered 1 hour after infection.

Produced using specific tobacco plants.

WHO authorised this treatment for a small group on 11th August,2014.

Even if successful, stocks will not be available till 2015

Tekmira, a Canadian biotech company, has begun early human trials of a new drug

Experimental treatmentExperimental treatment

Isolation and Quarantine, Notification Contact Tracing Standard Precautions–At All Times, For All Patients Barrier nursing Hand washing Personal Protective Equipment (PPE) Injection safety, Safe sex practices Concomitant & Terminal Disinfection, Sterilisation Following SOP for Blood sample collection and Transport Appropriate Hospital Waste management Enhanced Surveillance Health Education: Myths

PREVENTIONPREVENTION

PPEPPE

INDIAINDIA

No confirmed case of Ebola till date. The World Health Organisation (WHO) had informed that one

Indian passenger had travelled on the same flight in which an Ebola virus patient (a foreign national) was travelling from Monrovia to Lagos. He was tracked and found healthy.

24-hour 'Emergency Operation Centre‘:

011-23061469, 3205 and 1302 TN Helpline- 104 Rumours from Karnataka-WhatsApp message that student from

the National Institute of Technology Karnataka (NITK) in Dakshina Kannada districthad ebola and succumbed to it

PREVENTION IS THE ONLY

CURE

ADULT VACCINATION RECOMMENDATIONS

Pneumococcal (Conjugate vaccine) Hepatitis – B Influenza vaccine

Sunshine Global HospitalsSunshine Global Hospitals

Dr Pruthvi PuwarPh: 8866444474