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2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
2009 Influenza A(H1N1) – Human Swine FluIs this the pandemic?
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2009 Influenza A(H1N1) – Human Swine Flu Is this the pandemic?

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Allison McGeer, MSc, MD, FRCPC

Allison McGeer, MSc, MD, FRCPC

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    • 1. 2009 Influenza A(H1N1) – Human Swine Flu Is this the pandemic? Allison McGeer, MSc, MD, FRCPC Mount Sinai Hospital University of Toronto
    • 2.  
    • 3.  
    • 4. Nasal Congestion Sore Throat Muscle Pains Headache Cough Malaise Infectious Clinical Characteristics of Seasonal Influenza Infection Days After Onset 0 1 2 3 4 5 6 7 8 Nöel GE. Life-threatening “flu”? Can J Diagnosis 1999;Mar Fever
    • 5. Be an influenza virus, see the world
    • 6. Changes in Influenza Viruses <ul><li>Antigenic drift (continuous mutation) </li></ul><ul><ul><li>minor changes in A & B strains, s ame subtype </li></ul></ul><ul><ul><li>every year while virus is in humans </li></ul></ul><ul><li>Antigenic shift (recombination with non-human viruses) </li></ul><ul><ul><li>produce new subtype with changed H and/or N </li></ul></ul><ul><ul><li>population has no immunity to this new virus </li></ul></ul>
    • 7. Human virus Reassortant virus Avian virus 16 HAs 9 NAs Mechanisms of Antigenic Shift Swine virus
    • 8. 2009 H1N1 influenza A <ul><li>April 10-15 </li></ul><ul><ul><li>Mexican authorities recognize increase in acute respiratory disease/pneumonia, especially in young adults </li></ul></ul><ul><li>April 17 </li></ul><ul><ul><li>US recognizes new influenza strain, mostly derived from pigs (a “swine” flu), in two unrelated children in California </li></ul></ul>
    • 9.  
    • 10. 2009 A(H1N1) – Human Swine flu Disease <ul><li>Symptoms – typical influenza </li></ul><ul><li>Fever (>90%) </li></ul><ul><li>Cough (>90%) </li></ul><ul><li>“ Prostration” </li></ul><ul><li>Nasal congestion </li></ul><ul><li>Sore throat (66%) </li></ul><ul><li>Diarrhea (25%) </li></ul><ul><li>Vomiting (25%) </li></ul><ul><li>Provisos </li></ul><ul><li>Almost certainly, milder disease occurs </li></ul><ul><li>More severe disease likely won’t present “typically” </li></ul>
    • 11. <ul><li>How severe is it? </li></ul><ul><ul><li>WHO totals: 61 deaths / 5728 cases </li></ul></ul><ul><ul><li>Case fatality rate=1% </li></ul></ul>2009 A(H1N1) – Human Swine flu Disease
    • 12.  
    • 13. <ul><li>How severe is it? </li></ul><ul><ul><li>WHO totals: 61 deaths / 5728 cases </li></ul></ul><ul><ul><li>Case fatality rate=1% </li></ul></ul><ul><ul><li>WHO Rapid Pandemic Assessment Collaboration (Science 11 May) </li></ul></ul><ul><ul><ul><li>Case fatality rate: 0.4% (0.3-1.5%) </li></ul></ul></ul><ul><ul><ul><li>0 (U95%CL 0.6%) </li></ul></ul></ul>2009 A(H1N1) – Human Swine flu Disease
    • 14. <ul><li>No – not quite “humanized” </li></ul><ul><li>Yes – and “first wave” will start in the next few weeks </li></ul><ul><li>Yes – but “first wave” won’t start until sometime in the fall </li></ul>2009 A(H1N1) – Human Swine flu Is it the next pandemic?
    • 15. So, what are we doing in hospitals? <ul><li>Brushing off our pandemic plans, and activating phase 5 </li></ul><ul><li>Filling in the gaps </li></ul><ul><li>Recognizing that the pressure in ICUs may be less than anticipated, but the workload in ED and primary may be higher </li></ul>

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