Mmmmm Mohamed M. B. Alnoor CHP400 COMMUNITY HEALTH PROGRAM-II Novel H1N1 (Swine) Epidemiology & Control.

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Mohamed M. B. Alnoor

CHP400COMMUNITY HEALTH PROGRAM-II

Novel H1N1 (Swine)

Epidemiology

& Control

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Content

• Previous influenza pandemics• Definitions• Transmission Through Species• Transmission to humans• Pandemic-Alert Levels and WHO Regions• The Global H1N1 Pandemic

• Lessons Learned form Past Pandemics• Prevention of H1N1 infection

• Antiviral Protection

• Who Should Be Vaccinated?

• Summary

Swine Influenza A (H1N1)

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PandemicDeaths

WorldwidePopulation

Affected

Spanish Flu (H1N1)

1918-191940 million

Persons 20-40 years

Asian Flu (H2N2)

1957-581-2 million Infants, elderly

Hong Kong Flu (H3N2)

1968-69700,000 Infants, elderly

Previous influenza pandemics

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Swine Influenza (swine flu) is a respiratory disease of pigs

caused by Type A influenza viruses

causing regular outbreaks in pigs.

What is swine flu?

Definition:

They do not normally infect humans

Swine Influenza A (H1N1)

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Swine flu viruses have been reported to

spread from person-to-person but in the past

this transmission was limited and not sustained beyond

three people.

What is swine flu?

Definition:Swine Influenza A (H1N1)

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This swine influenza A (H1N1) virus is contagious

and is spreading from

human to human.

What is swine flu?

Definition:Swine Influenza A (H1N1)

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Swine Influenza A (H1N1) Transmission Through Species

Reassortment in Pigs

Avian Virus

Human Virus

Swine Virus

Avian/HumanReassorted Virus

Swine/

North American swineNorth American avianNorth American human Eurasian swine

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How does swine flu spread?

Transmission to humans:

Contact with: - infected pigs - contaminated environments

- a person with swine flu

Airborne(from infected people)- coughing - sneezing

Swine Influenza A (H1N1)

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Swine Influenza A (H1N1) Pandemic-Alert Levels

Phase 1: Animals viruses, no humans infections.Phase 2: Virus in domesticated/wild animals, caused infection in humans: a potential pandemic threat.”Phase 3: Reassortant v: sporadic cases or small clusters in humans.Phase 4: Reassortant v:community-level outbreaks. Phase 5: There is human-to-human spread of the virus into at least two countries in one WHO region. Phase 6: Phase 5 + community-level outbreaks in at least one other country in a different WHO region. A global pandemic is occurring.

African Region

Region of the Americas

South East Asia RegionEast Mediterranean Region

European Region Western Pacific Region

WHO Regions

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Swine Influenza A (H1N1)

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• Pandemics are unpredictable: - Mortality - severity of illness - pattern of spread

• Capacity to cause severe disease in nontraditional groups is a major determinant of pandemic impact

Lessons Learned formPast Pandemics

• Epidemiology reveals waves of infection: Ages/areas not initially infected likely vulnerable in future waves

• Subsequent waves may be more severe

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Lessons Learned formPast Pandemics

Public health interventions delay, but do not stop pandemic spread

• Temporary banning of public gatherings, potentially effective

• Quarantine, travel restriction show little effect

• Delaying spread is desirable:

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Prevention and control of H1N1

Swine Influenza A (H1N1)

General prevention and control measures

The H1N1 Vaccine

Antiviral treatment

Antiviral Prophylaxis

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Prevention of H1N1 INFECTION

Swine Influenza A (H1N1)

General prevention and control measures

• Tips to Reduce the Infection

• Respiratory hygiene and cough etiquette

• Social-Distancing

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Prevention of H1N1 INFECTION

Tips to Reduce the H1N1 Influenza Infection

•Use a tissue when coughing or sneezing.

•Frequently wash hands with warm water and soap .

•Try not to touch your eyes, nose or mouth .

•Wipe down kitchen and bathroom countertops, home and office phones, keyboards , etc

•If exhibiting symptoms, stay home.

•If coworkers or family members become ill, consider taking anti-viral medication .

Swine Influenza A (H1N1)

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Prevention of H1N1 INFECTION

vaccineThe H1N1 Inactivated Vaccine (the shot)

The H1N1 Live Attenuated Vaccine (the nasal spray)

Swine Influenza A (H1N1)

Specific preventive measures

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Pregnant women Contacts and caregivers <6 months Healthcare and emergency personnel All people from 6 mo - 24 years

Persons 25 - 64 years (higher risk of complications from influenza)

Children from 6 mo - 18 years Young adults 19 - 24 years

The groups recommended to receive the 2009 H1N1 influenza vaccine include:

Who Should Be Vaccinated?

Swine Influenza A (H1N1)

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People with allergy to chicken eggs or had a severe reaction to an influenza vaccination.

Children younger than 6 months of age

People who have a moderate-to-severe illness with a fever (delay vaccination.)

History of Guillain–Barré Syndrome.

Who Should NOT Be Vaccinated?

Swine Influenza A (H1N1)

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Make illness milder and recovery faster

May prevent serious flu complications

Work best if started within 2 days of symptoms.

Warning! Do NOT give aspirin: Reye’s syndrome.

Swine Influenza A(H1N1) Antiviral Protection

Treatment (Antiviral drugs )

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2 days 3 days1 day >4 daysDays from onset till initiation of treatment

mRecovered

Dead

Tota

l n

um

ber

Prognosis and days before treatment

Importance of the Early Treatment

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Swine Influenza A(H1N1) Antiviral Protection

Treatment (Antiviral drugs )Who to treat

Suspected or confirmed influenza with: Illness requiring hospitalizationProgressive, severe, or complicated illness,

regardless of previous statusPatients at risk for severe disease

Children <2, 2-4 Adults > 65 Pregnancy & 2wks postpartum

Persons with certain conditions:

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Swine Influenza A(H1N1) Antiviral Protection

Prophylaxis (Antiviral drugs )

Who may be considered:

Close contact of a person with H1N1 : Persons at high risk for complications

of influenza; Health care workers and emergency

medical personnel; Pregnant women.

• Vaccine takes 10 – 14 days to act

• When the vaccine is not available

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The health authorities of Saudi Arabia has advised certain populations against attending Hajj

The hajj Season

Children younger than 10 Adults older than 65 Pregnant women Those with chronic health conditions

That was the position of many countries Vaccination against H1N1 required

Swine Influenza A (H1N1)

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• Meeting of Arab health ministers(In July) working very closely with

To ensure pilgrim and resident safety, Saudi Arabia has set up:

• Health screenings at all ports of entry• H1N1 vaccine secured• Antiviral medication is available

• Schools started by mid-October

World Health Organization Other international experts

The hajj SeasonSwine Influenza A (H1N1)

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Summary

• This virus is contagious and is spreading from human to human.

• This is a NEW virus

• The disease has low fatality

• This will not be the last pandemic

Swine Influenza A (H1N1)