Briefing on Swine Flu and
  Briefing on Swine Flu and
 IInfluenza Pandemic Threat
  nfluenza Pandemic Threat




WHO Count...
Overview of Influenza Pandemics

                         • Human viral respiratory infection
                         • S...
Prerequisites for Influenza Pandemic?

 A new influenza virus emerges to which
 the general population has little/no
 immu...
Review of Influenza Pandemics in the 20th Century




                2
How Many Might Die From Influenza Pandemic?


 “Spanish Flu” in 1918-19
  Total population: 2 billion
  Clinical infection...
NEJM, November 24, 2005 The Origins of Pandemic Influenza
— Lessons from the 1918 Virus. Robert B. Belshe, M.D.
Re-assortment and Direct Transmission




  Non-human           Human
    virus              virus




                   ...
Swine influenza in humans


Generally clinical symptoms are similar to seasonal
influenza from asymptomatic infection to s...
Swine Influenza A/H1N1: Virology

Reassortment - four different genes: Unique combination
that has never been seen before
...
Confirmed and Probable Cases as of 29.4.2009

Country                    Lab. confirmed &          Probable case
         ...
Confirmed and Probable Cases as of 29.4.2009

Country            Lab Confirmed &      Probable case
                   dea...
Phase 5
• Human-to-human spread of the virus into at least two countries in
one WHO region.

• While most countries will n...
Influenza Antiviral Medications
Tamiflu: (Oseltamivir)

  Prophylaxis: (adult)
     Oral: 75 mg once daily;
     initiate ...
Tamiflu Stockpiling

Stockpiling

   Global and Regional: WHO/Roche
   ASEAN/Japan: 0.5 millions located in Singapore
   N...
Public Health Measures -- Vaccines

Most effective control measure
Seasonal influenza vaccine:
Unlikely provide protection...
Medical Care Capacity

How to increase surge capacity of hospital care?

Designated Hospitals and other facilities:

Isola...
What you can do as an individual?

Avoid crowds and close contact with people who appear
unwell and who have fever and cou...
Action taken by Malaysia

No case
Active screening at ports of international entry: 125
Active surveillance in all health ...
Main Actions for Phase 5

             Planning and coordination
                 • Activate multisector coordination to m...
Suggestions for UN agencies and Staffs

Prepare for worst situation
Seek advice from UN medical services
Office stockpile ...
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A(H1N1) Flu Briefing

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A(H1N1) Flu Briefing

  1. 1. Briefing on Swine Flu and Briefing on Swine Flu and IInfluenza Pandemic Threat nfluenza Pandemic Threat WHO Country Office for Brunei, Malaysia and Singapore 30 April 2009, Kuala Lumpur
  2. 2. Overview of Influenza Pandemics • Human viral respiratory infection • Self-limiting, but can be serious & fatal in elderly, Seasonal Influenza infants & people with chronic diseases ~ 500,000 “The Flu” deaths globally / yr. • Routine vaccination available • Bird virus - different from human influenza virus Avian Influenza • Spreads from birds to birds • Can sometimes infect humans “Bird Flu” • Can sometimes mutate into human virus • Global outbreak of new human influenza (different from seasonal and avian influenza) Pandemic Influenza • Rare event “A Pandemic” • Associated with increased morbidity & mortality Three Kinds of Influenza
  3. 3. Prerequisites for Influenza Pandemic? A new influenza virus emerges to which the general population has little/no immunity The new virus must be able to replicate in humans and cause disease The new virus must be efficiently transmitted from one human to another Yes?
  4. 4. Review of Influenza Pandemics in the 20th Century 2
  5. 5. How Many Might Die From Influenza Pandemic? “Spanish Flu” in 1918-19 Total population: 2 billion Clinical infection: 400 millions (20%) Deaths: 40-50 millions (2%) High CFR in healthy young adults Global Estimate of Death In A New Pandemic WHO range: 2 to 7.4 millions
  6. 6. NEJM, November 24, 2005 The Origins of Pandemic Influenza — Lessons from the 1918 Virus. Robert B. Belshe, M.D.
  7. 7. Re-assortment and Direct Transmission Non-human Human virus virus Reassortant virus
  8. 8. Swine influenza in humans Generally clinical symptoms are similar to seasonal influenza from asymptomatic infection to severe pneumonia resulting in death. Incubation period: (Time from exposure to onset of symptoms): 1 to 6 days? Clinical Illness: abrupt onset, fever, body aches, headaches, fatigue, cough, sore throat etc
  9. 9. Swine Influenza A/H1N1: Virology Reassortment - four different genes: Unique combination that has never been seen before North America swine Asia/Europe swine Human influenza Avian (Non H5) Level of immunity in general community Unlikely Antiviral resistance Resistant to amandatines Sensitive to oseltamivir (tamiflu) and zanamivir (relenza)
  10. 10. Confirmed and Probable Cases as of 29.4.2009 Country Lab. confirmed & Probable case deaths USA 91 cases / 1 death Mexico 26 cases / 7 death: 1324 under investigation, 84 deaths Austria 1 case Canada 13 cases Germany 3 cases Note: Situation is evolving quickly. The numbers may change from this update
  11. 11. Confirmed and Probable Cases as of 29.4.2009 Country Lab Confirmed & Probable case deaths UK 5 Spain 4 New Zealand 3 in Auckland 7 in Auckland South Korea 1 Israel 2 Total 148 cases; 8 death
  12. 12. Phase 5 • Human-to-human spread of the virus into at least two countries in one WHO region. • While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
  13. 13. Influenza Antiviral Medications Tamiflu: (Oseltamivir) Prophylaxis: (adult) Oral: 75 mg once daily; initiate treatment within 2 days of contact with an infected individual; duration of treatment: 7 -10 days During community outbreaks, dosing is 75 mg once daily. May be used for up to 6 weeks; duration of protection lasts for length of dosing period. Treatment: (adult) Oral: 75 mg twice daily initiated within 2 days of onset of symptoms; duration of treatment: 5 days
  14. 14. Tamiflu Stockpiling Stockpiling Global and Regional: WHO/Roche ASEAN/Japan: 0.5 millions located in Singapore National target: 25% population Policy for use Defining priority between treatment and prophylaxis Priority groups
  15. 15. Public Health Measures -- Vaccines Most effective control measure Seasonal influenza vaccine: Unlikely provide protection as it is developed from three circulating strains Stockpiling not possible Swine flu vaccine is not available at early stage: 6-8 months lead time WHO vaccine task force Working with vaccine factories
  16. 16. Medical Care Capacity How to increase surge capacity of hospital care? Designated Hospitals and other facilities: Isolation facility: ICUs and ventilation machines: Staff training: Knowledge and skills for diagnosis, treatment and infection control
  17. 17. What you can do as an individual? Avoid crowds and close contact with people who appear unwell and who have fever and cough. No hugging and shaking of hands, wash your hands frequently and thoroughly. If you are sick, stay home, do not come to office Wear a mask when you are sick, when you visit hospitals or caring for the ill person Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active. Keep the environment clean with readily.
  18. 18. Action taken by Malaysia No case Active screening at ports of international entry: 125 Active surveillance in all health settings Stockpile of Tamiflu: 2 millions / 9 distribution centres 29 Designated hospitals, 3 for swine flu now MOH operation room activated National multisectoral committee has been activiated National Pandemic preparedness plan has been activated 200,00 frontliners be given for seasonal flu vaccine Actively communicating with WHO 778 pig farms actively monitored by Veterinary Service Department
  19. 19. Main Actions for Phase 5 Planning and coordination • Activate multisector coordination to mitigate the societal and economic impacts Situation monitoring and assessment Phase 4 • Increase surveillance • Actively monitor the evolving situation Communication • Continue communication & updates Phase 4: Reducing the spread of disease Sustained • Implement individual & community precaution H-2-H measures transmission Security of health care provision • Implement contigency plan for Health care • Ensure pharmaceutical measures
  20. 20. Suggestions for UN agencies and Staffs Prepare for worst situation Seek advice from UN medical services Office stockpile and policy for use: Tamiflu and PPE, Plan for minimum level of operation: critical staffs? Stay home, working at home? Communication between offices and staffs Health education and awareness among staffs Prepare essential stuffs for living Know how to access to local medical services AI Task Force meeting and UNCT meeting

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