swine flu.ppt

8/14/2019 swine flu.ppt

1/22


2/22

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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3/22

CHOTANI 2009.

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


4/22

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


5/22

CHOTANI 2009.

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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6/22

CHOTANI 2009.

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


7/22CHOTANI 2009.

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


8/22CHOTANI 2009.

Swine Influenza A(H1N1)Transmission Through Species

Avian Virus

Human Virus

Swine Virus

Avian/Human

Reassorted Virus

Reassortment in Pigs


9/22CHOTANI 2009.

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


10/22CHOTANI 2009.

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


11/22CHOTANI 2009.

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


12/22CHOTANI 2009.

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


13/22CHOTANI 2009.

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


14/22CHOTANI 2009.

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


15/22CHOTANI 2009.


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


16/22CHOTANI 2009.

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.


Source: FDA


17/22CHOTANI 2009.

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


18/22

S i I fl A(H1N1)


19/22CHOTANI 2009.

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)


20/22CHOTANI 2009.

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


21/22CHOTANI 2009.

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

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22/22

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.

swine flu.ppt

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