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  • 1. Influenza A H1N1: Risk factors and Response Actions Mónica C. Del Moral Department of Biology University of Puerto Rico at Cayey Review Paper
  • 2. Outline  Background information  Influenza A H1N1  Strain  Relation of different strains  2009 H1N1  According to studies- Risk factors observed  Vaccine and Control measures
  • 3. Introduction
  • 4. Background information: Influenza  Influenza- contagious airborne disease that expresses febrile illness. (Derlet and Nguyen, 2013)  Symptoms range from fatigue to respiratory failure or death  Seasonal strains are common, but deadly ones have emerged (Derlet and Nguyen, 2013)  Pandemics- influenza virus + hemagglutinin (Garten et al, 2009) grama_de_s%C3%ADntomas_de_la_gripe _AH1N1.svg
  • 5. Background information: Strains  Lethal strains lead to pandemics- 1918 Spanish flu (Kilbourne, 2006)  1/3 of the world infected  50 million deaths (Taubenberger and Morens, 2006)  Strains affect animals- species specific (Derlet and Nguyen, 2013)  Avian influenza  Swine influenza 02/island-earth-audio-logo.html
  • 6. Background information: Avian, Swine and Humans (Taubenberger and Morens, 2006)  1918- relation between avian and swine was unknown  1930’s- viruses were isolated  Transmission- pigs to humans (Stuart et al. 2013) blog/long-distance-caregiving snowbirds-seagulls-and-piegons/birds-
  • 7. 2009 H1N1  Mix of swine, avian and human gene segments (Derlet and Nguyen, 2013)  Start- cases identified in Mexico (Stuart et al., 2013) (Michaelis et al. 2009)  The WHO stated that these viruses were not previously detected  Majority of cases- healthy young adults  WHO- pandemic alert level 6 June 11 2009 11226
  • 8. Vulnerability and Risk Factors  1918 Spanish flu and the First World War (Erkoreka, 2009)  Many soldiers living in poor conditions, harsh climate, wild animals, etc.  Similarity with 2009
  • 9. Vulnerability and Risk Factors  New Mexico study- relation between racial/ethnic groups and the outcome of the infection (Thompson 2011)  NMDOH- developed hospital surveillance system  Results:  American Indians- highest rate of related hospitalizations  Age- young (hospitalization), older (mechanical ventilation)  High risk medical conditions- most common were diabetes, asthma, and chronic lung diseases  Obesity (mechanical ventilation, not death)
  • 10. Vulnerability and Risk Factors  Outbreak in a Germany hospital (Grund et al. 2010)  In immunocompromised ward- 5 infected people  To identify infection- tested to see the viral RNA and virus antigen:  Nasopharyngeal swabs  Bronchoalveolar or pharyngeal lavages  Healthcare workers were also tested- if results were positive control measures would be implemented
  • 11. Vulnerability and Risk Factors  Control measures such as:  Isolation of influenza positive patients  Hand washing  and others  Results were negative for influenza, but positive for antibodies against influenza A and B  It is suggested that infection occurred within and spread through staff
  • 12. Response
  • 13. Vaccine implementation  Canadian study in 2011 (Conway et al. 2011) designed a model to visualize the transmission of Pandemic H1N1 in urban sites  Model included: demographic and behavioral factors  Strategies:  Actual coverage  Uniform Coverage  Parents and Children  Parents-and-children/Actual sequence
  • 14. Vaccine implementation  Stratified population:  Susceptible  Vaccinated  Exposed  Pre-symptomatically infectious  Infectious  Immune  Activity level and social contact
  • 15. Vaccine implementation  Assumed and confirmed: with vaccine there would be a reduction of 90% risk of infection  Diversifying campaign start dates were tested  Results confirmed vaccine efficacy and strategy used- relative to moment of campaign implementation (prior or on peak)
  • 16. Control Measures  CDC (Stuart et al. 20013) makes recommendations to manage the H1N1 virus:  Isolation for approximately 7 days  Inform and report case to a health care provider  If in social contact, wear masks  Strict hand washing*files*wordpress*com%7C2011%7 C09%7Cwash-hands-12171*jpg/
  • 17. Summary  Out of patterns studied, risk factors can be identified  Social interaction- 1918 and 2009  Age, weight, income, race/ethnicity, and high risk medical conditions  Vaccine campaign timing varies efficacy  Key control measures- isolation and hand wash and/or disinfection
  • 18. Conclusion  We can now:  identify some high risk groups to provide them help with prevention plans and treatments  identify risk factors to either avoid them or be alert of cases around and reduce chance of infection  be prepared to face the infection with common hygiene practices and proper vaccine campaigns.
  • 19. References  Anonymous. Influenza-like illness in the United States and     Mexico. World Health Organization. [Cited 2013 Nov/8]. Available source at: Brook I. Last update: April/4/2013. Pediatric Influenza. [Internet]. [Cited 2013 Nov/8]. Available source at: CDC. Interim Guidance for Clinicians on the Prevention and Treatment of Swine-Origin Influenza Virus Infection in Young Children. Centers for Disease Control and Prevention. Available source at: Conway J, Tuite A, Fisman D, Hupert N, Meza R, Davoudi B, English K, Driessche P, Brauer F, Ma J et al. 2011.Vaccination against 2009 pandemic H1N1 in a population dynamical model of Vancouver, Canada: timing is everything. BMC Public Health 11: 1-14 Derlet R, Nguyen N. Last update: Nov/4/2013. Influenza. [Internet]. [Cited 2013 Nov/8]. Available source at:
  • 20. References  Erkoreka A. 2009. Origins of the Spanish Influenza pandemic (1918–1920) and its relation to the First World War. Journal of Molecular and Genetic Medicine 3(2): 190-194. Available source at:  Garten R, Davis CT, Russell C, Shu Bo, Lindstrom S, Balish A, Sessions W, Xu X, Skepner E, Deyde V, et al. 2009. Antigenic and Genetic Characteristics of the Early Isolates of Swine-Origin 2009 A (H1N1) Influenza Viruses Circulating in Humans. Science 325(5937): 197-201. Available source at:  Grund S, Roggendorf M, Schweiger. 2010. Outbreak of influenza virus A/H1n1 in a hospital ward for immunocompromised patients. Archives of Virology 155: 1797-1802  Kilbourne E. 2006. Influenza Pandemics of the 20th Century. Emerg Infect Dis 12(1):9-14. [Cited 2013 Nov/8] Available source at: eader#!po=81.2500 .
  • 21. References  Michaelis M, Doerr HW, Cinatl J. 2009. An Influenza A H1N1 Virus Revival-Pandemic H1N1/09 Virus. Infection37 5(9): 381-389. Available source at:  Stuart M, Ross D, Wolf S. Last update: Oct/1/2013. H1N1 Influenza (Swine Flu). [Internet]. [Cited 2013 Nov/8]. Available source at:  Taubenberger JK, Morens DM. 2006. 1918 influenza: the mother of all pandemics. Emerg Infect Dis 12(1): 15–22. [Cited 2013 Nov/8]. Available source at:  Thompson D, Jungk J, Hancock E, Smelser C, Landen M, Nichols M, Selvage D, Baumbach J, Sewell M. 2011. Risk Factors for 2009 Pandemic Influenza A (H1N1)-Related Hospitalization and Death among Racial/Ethnic Groups in New Mexico. American Journal of Public Health 101 (9):1776-1784. Available source at: