H1N1 Prevention and Care


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H1N1 Prevention and Care

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H1N1 Prevention and Care

  1. 1. Dr.T.V.Rao MDDr.T.V.Rao MD 1
  2. 2.  The 1918 flu pandemic (January 1918 –December 1920) was an unusually deadlyinfluenza pandemic, the first of the twopandemics involving H1N1 influenza virus(the second being 2009 flu pandemic). Itinfected 500 million people across theworld, including remote Pacific islands andthe Arctic, and killed 50 to 100 million ofthem—3 to 5 percent of the worldspopulation at the time—making it one ofthe deadliest natural disasters in humanhistory. Dr.T.V.Rao MD 2
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  4. 4. The InfluenzaVirusDr.T.V.Rao MD 4
  5. 5. Novel H1N1 (referred to a swine flu early on)is a new influenza virus that is spreadingfrom person-to-person.The United States government has declareda public health emergency in the U.S. inresponse to the H1N1 outbreak.CDC’s response goals are to: reduce transmission and illness severity provide information to help health careproviders, public health officials, andthe public address the challenges posedby this emergency.Dr.T.V.Rao MD 5
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  7. 7.  The first cases of human infection withnovel H1N1 influenza virus were detectedin April 2009 in San Diego and ImperialCounty, California and in GuadalupeCounty, Texas. The virus has spread rapidly. The virus is widespread in the UnitedStates at this time and has been detectedinternationally as well.Dr.T.V.Rao MD 7
  8. 8.  Swine Influenza (swine flu) is arespiratory disease of pigs causedby type A influenza that regularlycause outbreaks of influenza amongpigs Most commonly, human cases ofswine flu happen in people who arearound pigs Swine flu viruses do not normallyinfect humans, however, humaninfections with swine flu do occur,and cases of human-to-humanspread of swine flu viruses havebeen documented
  9. 9. Avian VirusHuman VirusSwine VirusAvian/HumanReassorted VirusReassortment in Pigs
  10. 10. Source: Bean B, et al. JID 1982;146:47-51 Hard non-porous surfaces 24-48 hours◦ Plastic, stainless steel Recoverable for > 24 hours Transferable to hands up to 24 hours Cloth, paper & tissue◦ Recoverable for 8-12 hours◦ Transferable to hands 15 minutes Viable on hands <5 minutes only at high viral titers◦ Potential for indirect contact transmission*Humidity 35-40%, Temperature 28C (82F)
  11. 11.  This virus is thought tospread the same wayseasonal flu spreads Primarily through respiratorydroplets◦ Coughing◦ Sneezing◦ Touching respiratory dropletson yourself, another person,or an object, then touchingmucus membranes (e.g.,mouth, nose, eyes) withoutwashing handsDr.T.V.Rao MD 11
  12. 12. Big dropletsfall on peoplesurfaces bedclothesCourtesy of CDC Dr.T.V.Rao MD 12
  13. 13.  Infected people maybe able to infectothers beginning 1day before symptomsdevelop and up to 7 ormore days afterbecoming sick. That means that you maybe able to pass on the fluto someone else beforeyou know you are sick, aswell as while you are sick.
  14. 14. Symptoms of novel H1N1 flu in people are similar tothose associated with seasonal flu.• Fever• Cough• Sore throat• Runny or stuffy nose• Body aches• Headache• Chills• Fatigue• In addition, vomiting (25%) and diarrhea (25%) have beenreported. (Higher rate than for seasonal flu.)Dr.T.V.Rao MD 14
  15. 15.  Some peoplehavereporteddiarrhea andvomitingassociatedwith swineflu.Dr.T.V.Rao MD 15
  16. 16.  This virus is thought tospread the same wayseasonal flu spreads Primarily through respiratorydroplets◦ Coughing◦ Sneezing◦ Touching respiratory dropletson yourself, another person,or an object, then touchingmucus membranes (e.g.,mouth, nose, eyes) withoutwashing handsDr.T.V.Rao MD 16
  17. 17. No. The novel H1N1 influenzavirus (formerly referred to asswine flu) virus is not spread byfood.You cannot get novel H1N1 flufrom eating pork or pork products.Eating properly handled andcooked pork products is safe.Dr.T.V.Rao MD 17
  18. 18.  To diagnose swine influenza A infection, arespiratory specimen would generally needto be collected within the first 4 to 5 daysof illness (when an infected person is mostlikely to be shedding virus). However, some persons, especially children,may shed virus for 10 days or longer. Identification as a swine flu influenza Avirus requires sending the specimen to ahospital laboratory for testing.Dr.T.V.Rao MD 18
  19. 19.  People with swine influenza virusinfection should be consideredpotentially contagious as long asthey are symptomatic andpossible for up to 7 daysfollowing illness onset. Children, especially youngerchildren, might potentially becontagious for longer periods.Dr.T.V.Rao MD 19
  20. 20.  The virus can be spread when a persontouches something that is contaminatedwith the virus and then touches his or hereyes, nose, or mouth. Droplets from a cough or sneeze of aninfected person move through the air. Thevirus can then be spread when a persontouches respiratory droplets from anotherperson on a surface like a desk, doorknob,child’s toy or phone handset and thentouches their own eyes, mouth or nosebefore washing their hands.Dr.T.V.Rao MD 20
  21. 21.  Difficulty breathingor shortness ofbreath Pain or pressure inthe chest orabdomen Sudden dizziness Confusion Severe or persistentvomiting
  22. 22.  Separation and restricted movement of wellpersons presumed exposed◦ Identification of contacts Often at home, but may be designatedresidential facility or hospital Applied at the individual or communitylevel Regular health monitoring is essential partof quarantine◦ Self-health monitoring and reportingDr.T.V.Rao MD 22
  23. 23.  Cover yournose andmouth with atissue whenyou cough orsneeze.Throw thetissue in thetrash after Dr.T.V.Rao MD 23
  24. 24.  Wash your handsoften with soapand water,especially afteryou cough orsneeze. Alcohol-based handcleaners are alsoeffective.Dr.T.V.Rao MD 24
  25. 25. Avoidtouchingyour eyes,nose ormouth. Thevirus canspread thisway.Dr.T.V.Rao MD 25
  26. 26.  Covering nose and mouth with atissue when coughing or sneezing◦ Dispose the tissue in the trashafter use. Hand washing with soap and water◦ Especially after coughing or sneezing. Cleaning hands with alcohol-basedhand cleaners Avoiding close contact with sickpeople Avoiding touching eyes, nose ormouth with unwashed hands If sick with influenza, staying homefrom work or school and limitcontact with others to keep frominfecting themDr.T.V.Rao MD 26
  27. 27.  Try to avoidclose contactwith sickpeople. Dental,Ophthalmology, and ENT willbe cautiousDr.T.V.Rao MD 27
  28. 28.  If you get sickwith influenza,stay home fromwork or schooland limit contactwith others tokeep frominfecting them.Dr.T.V.Rao MD 28
  29. 29.  Potential for transmission Must educate family caregivers Fever / symptom monitoring Infection control measures◦Hand washing◦Use of available material as mask…Dr.T.V.Rao MD 29
  30. 30. Source: Rosie Sokas, MD MOH UIL atChicagoDroplet precautions:Surgical MasksDr.T.V.Rao MD 30
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  34. 34.  Utilize ObGyns toencourage and/oradministerinfluenzavaccination◦ Conduct research tobetter understandbarriers and facilitators◦ Provide information andresources◦ Partner with ACOG onevents and outreachDr.T.V.Rao MD 34
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  36. 36.  Respiratory specimens including: broncoalveolar lavage, tracheal aspirates,nasopharyngeal or oropharengeal aspiratesas washes, and nasopharyngeal ororopharengeal swabs. Swab specimensshould be collected only on swabs with asynthetic tip (such as polyester or Dacron)and aluminium or plastic shaft. Swabs withcotton and wooden shafts are notrecommended. Specimens collected withswabs made of calcium alginate areacceptable. Dr.T.V.Rao MD 36
  37. 37.  As soon as possible after symptomsbegin Before antiviral medications areadministered Even if symptoms began more thanone week ago Multiple specimens on multiple days could be collected if you have accessto patientDr.T.V.Rao MD 37
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  42. 42.  Store specimens at 4 °C before and duringtransportation within 48 hours Store specimens at -70 °C beyond 48 hours Do not store in standard freezer – keep on ice or in refrigerator Avoid freeze-thaw cycles Better to keep on ice for a week than to haverepeat freeze and thawDr.T.V.Rao MD 42
  43. 43.  Once collected, clinicians shouldcontact their state or local healthdepartment to facilitate transportand timely diagnosis at a state publichealth laboratory. State public healthlaboratories should perform testingto determine influenza type andsubtype on all submitted samplesthat are positive for influenza.Dr.T.V.Rao MD 43
  44. 44. State and local healthdepartment guidelines willdetermine which specimenscan be submitted to publichealth laboratories for rRT-PCR testingDr.T.V.Rao MD 44
  45. 45.  Diagnostic testing is recommended onsuspect cases of novel influenza AH1N1(swine flu). Active infection withswine influenza can only be confirmedby polymerase chain reaction (PCR)assays, including sub-typing andfurther characterization by otherspecial PCR assays. PCR and sub-typing is available at certain localpublic health laboratoriesDr.T.V.Rao MD 45
  46. 46.  A negative result does not exclude adiagnosis of swine influenza A. A positiveresult may be helpful, but does notdistinguish between seasonal and swineinfluenza viruses. Therefore, if a patient testsnegative for influenza by rapid antigentesting, specimens should be sent for furthercharacterization (including PCR and sub-typing) to the local public health laboratoriesDr.T.V.Rao MD 46
  47. 47.  Vaccine development◦ Usually produced in fertilized chicken eggs (H5N1 kills chicken embryos)◦ Modified seed viruses are in development usingrecombinant genetic technology to remove lethalgenes◦ Process of producing vaccine using thistechnology takes months—pandemic basicallyover when vaccine was available in quantity in1957 and 1968◦ A few companies are developing cell cultureproduction techniques WHO Avian influenza: assessing the pandemic threatDr.T.V.Rao MD 47
  48. 48.  The nasal spray flu vaccine (sometimescalled LAIV for Live Attenuated InfluenzaVaccine) is a vaccine made with live,weakened viruses that cannot grow atnormal body temperature and is given via anasal sprayer. This vaccine was approvedfor seasonal influenza viruses in 2003 andtens of millions of doses of the vaccine havebeen given in the United States.Dr.T.V.Rao MD 48
  49. 49.  Replicates primarily in the ciliatedepithelial cells of the nasopharyngealmucosa to induce immune responses. Does not replicate well in warmertemperatures found in the lowerairways and lung In adults, studied in ages 18-64.Studies evaluated the effectiveness inpreventing any febrile illness. Posthoc analysis in adults 50-64 years oldfailed to show effectiveness. As aresult, not approved for use in adults>50 in the United States.Dr.T.V.Rao MD 49
  50. 50.  The CDC’s AdvisoryCommittee on ImmunizationPractices (ACIP) hasrecommended which U.S.population groups should betargeted to receive H1N1influenza vaccine when itbecomes available.People over 65 have thelowest priority.Dr.T.V.Rao MD 50
  51. 51.  LAIV is a very good option formost health care providers whoare healthy, younger than 50years old, and not pregnant.However, health care providersshould not get LAIV if they areproviding medical care forpatients who require specialenvironments in the hospitalbecause they are profoundlyDr.T.V.Rao MD 51
  52. 52.  The 15-member ACIP says these five groupsshould be targeted: pregnant women; household contacts of infants under 6months; healthcare and emergency-services workers; young people between 6 months and 24years of age; and nonelderly adults with underlying riskconditions, such as diabetes and chronic lungdisease.Dr.T.V.Rao MD 52
  53. 53.  Consult Local HealthAuthorities as the trends in FluVaccination change as per theScientific ResearchMost Ideal to follow CDCguidelinesDr.T.V.Rao MD 53
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  55. 55.  Treatment is 75 mg twice a day for 5 days. Prophylaxis is 75 mg once a day for 7 daysafter last exposure. Prophylaxis:◦ High risk exposure (household contacts)◦ Moderate risk (unprotected very close exposure tosick animals; HCW with unprotected exposure topatients)◦ Low risk exposure: no need for prophylaxis unlessactivation of exceptional measures.Dr.T.V.Rao MD 55
  56. 56. Importance of the EarlyTreatmentDr.T.V.Rao MD 56
  57. 57. Occupational (non-health care) No novel H1N1 in community: Facemask/respirator notrecommended Facemask Novel H1N1 in community: Facemask/respirator notrecommended but could be considered under certaincircumstancesOccupational (health care) Caring for persons with known, probable orsuspected novel H1N1 or influenza-likeillness: Respirator. Use respirator and consider temporaryreassignment for employees at high risk.http://www.cdc.gov/h1n1flu/masks.htmDr.T.V.Rao MD 57
  58. 58. Infection Control of Ill Persons in a Healthcare Setting Patients with suspected or confirmed case-status should be placedin a single-patient room with the door kept closed. If available, anairborne infection isolation room (AIIR) with negative pressure airhandling with 6 to 12 air changes per hour can be used. Air can beexhausted directly outside or be recirculated after filtration by a highefficiency particulate air (HEPA) filter. For suctioning, bronchoscopy,or intubation, use a procedure room with negative pressure airhandling. The ill person should wear a surgical mask when outside of thepatient room, and should be encouraged to wash hands frequentlyand follow respiratory hygiene practices. Cups and other utensilsused by the ill person should be washed with soap and water beforeuse by other persons. Routine cleaning and disinfection strategiesused during influenza seasons can be applied to the environmentalmanagement of swine influenza.Source: CDC
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  60. 60. Indications for HandHygiene When hands are visibly dirty,contaminated, or soiled, washwith non-antimicrobial orantimicrobial soap and water. If hands are not visibly soiled,use an alcohol-based hand rubfor routinely decontaminatinghands.Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;vol. 51, no. RR-16.Dr.T.V.Rao MD 60
  61. 61. Any student or staff membershowing flu like symptomssuch as fever, cough,running nose and difficulty inbreathing should be allowedto stay at home for a periodof 7 to 10 days.Dr.T.V.Rao MD 61
  62. 62. Efficacy of Hand HygienePreparations in KillingBacteriaGood Better BestPlain Soap AntimicrobialsoapAlcohol-basedhand rubDr.T.V.Rao MD 62
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  68. 68.  Programme Created byDr.T.V.Rao MD for Awarenesson H1N1 for Mass, and HealthEducation Emaildoctortvrao@gmail.comDr.T.V.Rao MD 68