Lecture+Influenza+A+ H1 N1
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  • Module 2: ABCs of Influenza and Pandemics - Influenza (commonly called “flu”) is a respiratory infection – the virus attacks the respiratory tract (upper airways and lungs) so it causes symptoms such as cough or sore throat - The influenza virus is contagious and can easily spread from person to person - Human influenza is a respiratory infection that is thought mostly to be spread through direct contact with respiratory secretions from an infected person who is sneezing and/or coughing. - Indirect transmission from objects (such as contact with “fomites” on contaminated surfaces or clothing) is also a possible means of transmission.
  • Module 2: ABCs of Influenza and Pandemics Little information is available on the modes of influenza transmission and the data from studies has been interpreted in various ways. Contact, droplet and droplet nuclei transmission all likely occur but the relative contribution of each is unclear. Droplet transmission is thought to be the most important mode of transmission with infectious particles generated by the coughing and sneezing of infected persons. Most studies of infection transmission are either artificial human or animal experiments or outbreak investigations. In outbreaks, influenza is often also circulating in the community so the source of infection is difficult to pinpoint. The lack of clarity over modes of influenza transmission has complicated the development of some control strategies for influenza.
  • Module 2: ABCs of Influenza and Pandemics Infected adults can shed virus and possible transmit influenza from 1 day before they have symptoms to 5-7 days after the onset of symptoms. Peak viral shedding (when infected persons are most likely to infect others) is during the first 3 days of symptoms. Infants, children and immunocompromised patients (such as people with AIDS, or cancer patients on chemotherapy) may shed the virus and be infectious for longer periods of time.
  • Module 2: ABCs of Influenza and Pandemics The incubation period, the time period from exposure to the onset of symptoms, for influenza is fairly short, between 1 and 4 days. The short incubation period makes influenza outbreaks difficult to control. Human influenza usually peaks in winter months (which are December – March in the Northern Hemisphere and May – September in the Southern Hemisphere) within temperate zones but can occur year-round in tropical zones. However because of limited influenza surveillance systems in many tropical and developing countries, less is known about the epidemiology and seasonality of influenza in these settings.
  • Module 2: ABCs of Influenza and Pandemics The hallmark of influenza is the sudden , rapid onset of symptoms. Influenza symptoms may include fever, chills, body aches, sore throat, non-productive cough, runny nose and headache. Gastrointestinal symptoms and myositis occur more often in young children, and infants can present with a sepsis-like syndrome. Complications include viral and bacterial pneumonia, febrile seizures, cardiomyopathy, encephalopathy/encephalitis, and worsening underlying chronic conditions.
  • Module 2: ABCs of Influenza and Pandemics Complications of Influenza infection include pneumonia, dehydration, or worsening of chronic lung and heart problems, and even death. Groups at high risk for influenza complications are: - Persons 65 and older - Persons with other chronic medical conditions, such as lung or heart disease, or diabetes - Infants less than 2 years of age - Pregnant women - Nursing home residents - Children on long-term aspirin therapy
  • Module 2: ABCs of Influenza and Pandemics The influenza vaccine is the main way of preventing seasonal influenza infection and its serious complications. Each year, 3 virus strains are selected for the vaccine based on information about circulating strains (usually, the vaccine includes 2 type A strains and 1 type B strain). Therefore, the vaccine can only protect us from the 3 influenza subtypes selected for inclusion in the vaccine and will provide no protection for any new pandemic subtype resulting from antigenic shift. More will be discussed about influenza subtypes and the phenomenon of antigenic drift/shift later in this presentation. Live, intranasal spray vaccine is approved for use in the United States by healthy non-pregnant persons 5-49 years old. Inactivated, injectable vaccine is approved for aged persons 6 months and older.
  • Module 2: ABCs of Influenza and Pandemics While there are three types of influenza viruses—A, B, and C—only two cause significant disease in humans (A and B). Type B influenza viruses are limited to humans, whereas Type A viruses can cause severe disease in humans and affect many other species. Influenza Type A Type A influenza is considered to cause the most serious disease among the influenza viruses. Influenza A can cause severe epidemics as well as pandemics. Influenza type A infects multiple species including people, birds, pigs, cats, dogs, horses, and other animals. Wild birds are the natural hosts for these viruses. Influenza Type B Influenza B viruses are usually found only in humans. Influenza B viruses can cause some morbidity and mortality among humans, but in general are associated with less severe epidemics (chiefly among children) than influenza A viruses. Although influenza type B viruses can cause human epidemics, they do not cause pandemics. Because avian influenza and all pandemic viruses are of the Type A variety, we will focus this session on Type A influenza viruses.
  • Module 2: ABCs of Influenza and Pandemics Influenza A viruses are further subtyped by two proteins on the viral surface, called hemagglutinin (or HA) and neuraminidase (or NA). Hemagglutinin allows the virus to attach to host cells, while neuraminidase allows the virus to escape infected cells, and then go on to infect more cells. There are 16 known hemagglutinin and 9 known neuraminidase subtypes for Influenza A. Each hemagglutinin subtype is named using an “H” plus a number, such as type H1, H2, and so on. In the same way, each neuraminidase subtype is named with an “N” plus a number, such as type N1, N2, and so on. Many different combinations of HA and NA proteins are possible.
  • Module 2: ABCs of Influenza and Pandemics Influenza A viruses are named based on the type and the place that the sample originally came from. They are also labeled with a strain number by a reference laboratory, the year the virus was isolated, and the subtype of the virus. Viruses from animals would also include the type of animal.

Lecture+Influenza+A+ H1 N1 Lecture+Influenza+A+ H1 N1 Presentation Transcript

  • Influenza A (H1N1) ROMEO ALMAZAN BITUIN, MD, MHA Medical Specialist III HEMS Coordinator Dr. Jose Fabella Memorial Hospital Department of Health DISTRIBUTED BY www.medicalppt.blogspot.com National Center for Disease Prevention and Control, DOH
  • Influenza A (H1N1) Is PANDEMIC Imminent? National Center for Disease Prevention and Control, DOH
    • Influenza is usually a respiratory infection
    • Transmission
      • Regular person-to-person transmission
      • Primarily through contact with respiratory droplets
      • Transmission from objects (fomites) possible
    National Center for Disease Prevention and Control, DOH View slide
  • Transmission of Influenza
    • Limited studies, varying interpretations
    • Contact, droplet, and droplet nuclei (airborne) transmission all likely occur
      • Relative contribution of each unclear
        • Droplet thought most important
          • Coughing, sneezing, talking
      • Most studies either
        • Animals or human experiments under artificial conditions
        • Outbreak investigations
          • Unclear of infection source
    National Center for Disease Prevention and Control, DOH View slide
  • Key Characteristics
    • Communicability
      • Viral shedding can begin 1 day before symptom onset
      • Peak shedding first 3 days of illness
      • Correlates with temperature
      • Subsides usually by 5-7th day in adults
      • can be 10+ days in children
      • Infants, children and the immuno-compromised may shed the virus longer
    National Center for Disease Prevention and Control, DOH
    • Incubation period
      • Time from exposure to onset of symptoms
      • 1 to 4 days (average = 2 days)
    • Seasonality
      • In temperate zones, sharp peaks in winter months
      • In tropical zones, circulates year-round with seasonal increases.
    National Center for Disease Prevention and Control, DOH
  • Clinical Illness, Seasonal Influenza
    • Abrupt onset
    • Fever and constitutional symptoms: body aches, headaches, fatigue
    • Cough, rhinitis, sore throat
    • GI symptoms and myositis more common in young children
    • Sepsis-like syndrome in infants
    • Complications: viral and bacterial pneumonia, febrile seizures, cardiomyopathy, encephalopathy/encephalitis, worsening underlying chronic conditions
    National Center for Disease Prevention and Control, DOH
  • Individuals at Increased Risk for Hospitalizations and Death
    • Elderly > 65 years
    • Children less than two years
    • Certain chronic diseases
      • Heart or lung disease, including asthma
      • Metabolic disease, including diabetes
      • HIV/AIDs, other immuno-suppression
      • Conditions that can compromise respiratory function or the handling of respiratory secretions
    • Pregnant women
    National Center for Disease Prevention and Control, DOH
  • Vaccination
    • Influenza vaccine is the best prevention for seasonal influenza.
    • Inactivated viruses in the vaccine developed from three circulating strains (generally 2 Type A and 1 Type B strain)
      • Therefore, seasonal “flu shot” only works for 3 influenza subtypes and will not work on pandemic strains.
    • Live, intranasal spray vaccine for healthy non-pregnant persons 5-49 years
    • Inactivated, injectable vaccine for persons 6 months and older
    National Center for Disease Prevention and Control, DOH
  • Influenza Viruses
    • Classified into types A, B, and C
      • Only Types A and B cause significant disease
      • Types B and C limited to humans
      • Type A viruses
        • More virulent
        • Affect many species
    C Goldsmith, CDC National Center for Disease Prevention and Control, DOH
  • Influenza A Viruses
    • Influenza A viruses categorized by subtype
      • Classified according to two surface proteins
        • Hemagglutinin (H) – 16 known
          • Site of attachment to host cells
          • Antibody to HA is protective
        • Neuraminidase (N) – 9 known
          • Helps release virions from cells
          • Antibody to NA can help modify disease severity
    N H National Center for Disease Prevention and Control, DOH
    • A / Sydney / 05 / 97 (H3N2)
    Nomenclature Virus type Strain number Virus subtype Place virus isolated Year isolated National Center for Disease Prevention and Control, DOH
  •  
  • Influenza A (H1N1) is a novel virus
    • Unusual combination of genetic material from pigs, birds & humans which have re-assorted
    • human-to-human transmission occurs through respiratory droplets generated from sneeze or cough
    • Affects all age groups
    • Vaccines for human seasonal flu can not protect humans against the novel virus
    National Center for Disease Prevention and Control, DOH
  • Swine Influenza Viruses
    • RNA viruses
    • Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses.
    • Re-assort and new viruses that are a mix of swine, human and avian influenza viruses can EMERGE
    National Center for Disease Prevention and Control, DOH
  • SIV Genetic Re-assortment National Center for Disease Prevention and Control, DOH
  • Signs & Symptoms of Influenza A (H1N1)
    • Fever
    • Lethargy
    • Lack of appetite
    • Coughing
    • Runny Nose
    • Sore throat
    • Nausea / Vomiting
    • Diarrhea
    National Center for Disease Prevention and Control, DOH
  • Swine H1N1 vs. Human H1N1
    • swine H1N1 flu virus NOT the same as human H1N1 virus
    • antigenically very different from human H1N1 viruses
    • vaccines for human seasonal flu can not protect humans from swine H1N1
    National Center for Disease Prevention and Control, DOH
  • Transmission: Food-Borne?
    • NO
    • Influenza A (H1N1) viruses are not transmitted through food
    • Safe to eat properly handled and cooked pork and pork products
    • Cook pork at an internal temperature of 70°C (160°F)
    National Center for Disease Prevention and Control, DOH
  • Diagnosis and Laboratory Confirmation
    • Clinically diagnosed
    • Respiratory Specimen
      • first 4 to 5 days of illness
      • can shed for 10 days or longer
    • Specimens sent to US CDC
      • ONLY laboratory that can isolate and identify swine influenza type A virus
    National Center for Disease Prevention and Control, DOH
  • Treatment
    • Influenza A (H1N1) is sensitive to:
      • Oseltamivir (tamiflu)
      • Zanamivir
    • Self medication is discouraged, may induce drug resistance
    • Chemoprophylaxis
      • Oseltamivir
    National Center for Disease Prevention and Control, DOH
  • Vaccine
    • No Influenza A (H1N1) vaccine yet
    • Process of production is underway, but may take 5 – 6 months
    • Seasonal influenza vaccine provides protection against the seasonal human influenza strains only
    National Center for Disease Prevention and Control, DOH
  • Influenza A (H1N1) is a Public Health Emergency of International Concern (PHEIC)
      • Serious Public Health Impact
      • Unusual or Unexpected
      • International disease spread
      • Interference with international travel or trade
    **WHO Recommends intensifying and enhancing national surveillance systems for Influenza-like Illnesses and atypical pneumonia National Center for Disease Prevention and Control, DOH
  •  
  • Pandemic Alert Phase 5
  •  
  •  
  • Influenza A (H1N1) Preparedness Plan
    • Goal:
      • To minimize the public health & socio-economic impact of influenza pandemic in the Philippines
    • Objectives:
      • To maintain a functional command & control structure during an influenza pandemic
      • To adopt early warning system for pandemic influenza
      • To identify & monitor cases of pandemic influenza
      • To manage large numbers of ill & dying people
      • To maintain essential services during a pandemic
      • To prevent spread through public health interventions
      • To manage public anxiety & panic & ensure effective & appropriate information, education & campaign
    National Center for Disease Prevention and Control, DOH
  • What has been done?
    • Activation of the DOH Management Committee on Prevention and Control of Re-Emerging Infectious Diseases (DOHMC-PCREID) with the Secretary of Health as the Chairperson of the DOH Central Command
    • Enhanced health surveillance in hospitals, seaports, and airports which include thermal scanning of arriving passengers from affected countries
      • emergency procurement of 4 additional thermal scanners
    National Center for Disease Prevention and Control, DOH
  • What has been done?
    • Health Declaration Checklist to screen for potential signs & symptoms & possible exposure to the virus
    • Health Alert Notice (HAN) distributed to all arriving travelers who are strongly advised to monitor body temperature daily up to 10 days from date of arrival & to contact health authorities A.S.A.P. if they become ill during this period
    National Center for Disease Prevention and Control, DOH
  • National Center for Disease Prevention and Control, DOH
  • What has been done?
    • Issuance of travel advisory to the public
      • No travel ban but travelers are asked to reconsider their plans to travel to affected countries unless extremely necessary
      • The World Health Organization does not recommend any travel restrictions or closure of borders at this time
    • Activation of DOH HOTLINE (+632-7111001 / +632-7111002) for immediate reporting of suspected Influenza A (H1N1), flu-like illness and atypical pneumonia by DOH regional Offices, LGUs, hospitals, and the public
    National Center for Disease Prevention and Control, DOH
  • Influenza A (H1N1) Surveillance Reporting Flow Bureau of Quarantine Referral Hospitals Influenza-like Illness Surveillance Event-based Surveillance NEC/HOTLINE Surveillance Team Response needed? Yes Daily zero reporting No WHO Inform other offices, agencies, etc. involved in the response EXECOM Central Command Media End Cases under investigation Probable/ Confirmed Probable/ Confirmed National Center for Disease Prevention and Control, DOH
  • What has been done?
    • Firmed up national stockpile of Personal Protective Equipment (PPE) & the antiviral drug (Oseltamivir) and other logistics
      • Priority will be high-risk exposure groups consisting of frontline health workers and surveillance teams
      • Interim Guidelines on Clinical Management of Influenza A (H1N1) Virus Infection and the Use of Antivirals
      • Interim Guidelines on the Use of Personal Protective Equipments and Infection Control During Influenza A (H1N1) Outbreaks
    National Center for Disease Prevention and Control, DOH
  • Interim Guidelines on Clinical Management of Influenza A (H1N1) Virus Infection and the Use of Antivirals
    • Case definitions for infections with Influenza A (H1N1)
    • Clinical Management of Influenza A (H1N1) Virus Infection
    • Use of Antiviral Agents
      • Priority groups to receive antiviral agents for prophylaxis
        • Health workers
        • First responders
        • Workers providing essential services
      • For treatment, priority will be the patients considered at high risk of severe disease
    • Discharge guidelines
    National Center for Disease Prevention and Control, DOH
  • Interim Guidelines on the Use of Personal Protective Equipments & Infection Control During Influenza A (H1N1) Outbreaks
    • Rational use of personal protective equipments
    • Guidelines on the use of masks
    • Public health measures
    • Personal hygiene
    • Guidelines on infection control in health care setting
    National Center for Disease Prevention and Control, DOH
  • What has been done?
    • National Referral Centers for EID readied in the event of suspected or confirmed swine flu cases
      • Research Institute of Tropical Medicine (RITM)
      • Lung Center of the Philippines
      • San Lazaro Hospital
      • Vicente Sotto Memorial Medical Center
      • Davao Medical Center
    • Organized the DOH Central Command for A (H1N1) that will oversee the operations of the different components of the A(H1N1) Task Force
      • Planning, Operations, Financing, Logistics
    National Center for Disease Prevention and Control, DOH
  • Health Emergency Management Structure National Center for Disease Prevention and Control, DOH
  • What has been done?
    • Convened a meeting of all Metro Manila DOH Hospitals to orient them on the situation & come up with a response plan for hospitals
    • Secretary Francisco T. Duque IIII called for a DOH Command Conference to check the readiness plans & command & control systems of all regions nationwide
    • Secretary Francisco T. Duque III is made de facto Crisis Manager of the national Disaster Coordinating Council (NDCC) to coordinate government efforts in responding to the threat of Influenza A/H1N1
    National Center for Disease Prevention and Control, DOH
  • What has been done?
    • Request of Php 93.5 M calamity fund for the preparedness phase of a possible pandemic
    • Meeting with Metro Manila private hospitals and DOH retained hospitals on referral procedures to DOH-Designated Hospitals for the Isolation & Treatment of suspected Influenza A (H1N1) cases; as well as contingency plans for a worse case scenario
    National Center for Disease Prevention and Control, DOH
  • DOH – Medical City Joint Forum (May 4, 2009)
    • Guidance on
      • Surveillance
        • Case definitions, case reporting forms
      • Infection control
        • Will the private hospitals be allowed to admit cases? As of now, only the referral hospitals will be allowed to admit cases
      • Use of oseltamivir
        • Prophylaxis, treatment
    • Societal approach rather than health sectors only
    • Updates to be provided on a regular basis
    National Center for Disease Prevention and Control, DOH
  • Public Health Advisory
    • Cover nose and mouth with a tissue when coughing or sneezing.
    • Wash hands regularly with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective
    • Avoid close contact with sick people.
    • If sick, self-monitor and stay home from work or school and limit contact with others.
    • Consult your doctor immediately should signs and symptoms of flu persist.
    National Center for Disease Prevention and Control, DOH
  • Risk Communications Challenges
    • How to communicate with stakeholders minimizing fear and panic
    • Informing or instructing widely
    • divergent audiences
    • Minimizing / overcoming
    • misinformation, rumors and myths
    • Encouraging the adoption of
    • appropriate protective actions
    • Building trust
    National Center for Disease Prevention and Control, DOH
  • What’s next?
    • Coordination with other concerned agencies regarding national response in the event of a pandemic
      • OP, DA, DILG, DFA, NDCC
    National Center for Disease Prevention and Control, DOH
  •  
  • Thank you for listening and God Bless Us All ! DISTRIBUTED BY www.medicalppt.blogspot.com National Center for Disease Prevention and Control, DOH