Swine Flu


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  • What are pandemics? Pandemics are when a new influenza A emerges to which most or many of the population have no immunity. The result usually from an animal influenza combining some of its genes with a human influenza. To be a pandemic strain an influenza A virus needs to have three or four characteristics. They need to be able to infect humans, to cause disease in humans and to spread from human to human quite easily. An additional criteria that is often applied is that many or most of the population should be non-immune to the new virus.
    Note this animated slide was first developed by the National Institute of Infectious Disease in Japan and we are grateful to them and especially Masato Tashiro for letting us use it.
  • But remember this is idealised – and in 2009 in North America this is not putting as many people into Hospital as you would expect from the above. In the 2009 pandemic it is not clear yet what percentage are asymptomatic. Two reasonable estimates are 33% and 50% of the total infected. [Note to Uwe – can you increase the asymptomatic fraction in both to make them look about 33% of the total]
  • The three pandemics of the 20th century show how these known unknowns can result in important changes. More detail on the different pandemics are available at http://ecdc.europa.eu/en/Health_Topics/Pandemic_Influenza/stats.aspx.
  • The influenza virion is an enveloped virus that derives its lipid bilayer from the plasma membrane of a host cell. Two different varieties of glycoprotein spike are embedded in the envelope. Approximately 80 percent of the spikes are hemagglutinin, a trimeric protein that functions in the attachment of the virus to a host cell. The remaining 20 percent or so of the glycoprotein spikes consist of neuraminidase, which is thought to be predominantly involved in facilitating the release of newly produced virus particles from the host cell. On the inner side of the envelope that surrounds an influenza virion is an antigenic matrix protein lining. Within the envelope is the influenza genome, which is organized into eight pieces of single-stranded RNA (A and B forms only; influenza C has 7 RNA segments). The RNA is packaged with nucleoprotein into a helical ribonucleoprotein form, with three polymerase peptides for each RNA segment.
  • For the most current number of human cases visit the CDC H1N1flu website: http://www.cdc.gov/h1n1flu/investigation.htm.
    CDC, along with state and local health agencies, are working together to investigate this situation.
    Numbers are updated every at 11:00 AM EDT.
  • It is thought that the main way influenza viruses are spread from person to person is through transmission of respiratory droplets during coughing and sneezing. Close contact (about 3 feet or less) usually is necessary for this type of spread. Influenza viruses also can spread by touching respiratory droplets on yourself, others, or an object, then touching mucus membranes, such as the mouth, nose, or eyes, without washing contaminated hands.
  • In addition of sign and symptom of
  • contact with suspected, probable or confirmed cases
  • “If there is 25 or more epidemiologically linked suspect cases of Pandemic Influenza A H1N1 of which at least one or more are laboratory confirmed for Pandemic Influenza A H1N1, in two or more cities, over a period of two weeks, then the State would be considered to be having community spread”
  • C/I in person sufferinf from rspiratory and cardiac ds
  • Each year, experts from Food and Drug Administration (FDA), World Health Organization (WHO), U.S. Centers for Disease Control and Prevention (CDC) and other institutions study virus samples collected from around the world. They identify the influenza viruses that are the most likely to cause illness during the upcoming flu season so that people can be protected against them through vaccination.
  • Flu virus are costantly changes (Ag drift), so its not possible to predict ehich flu virus predominate during a given year
  • Children shed virus for longer duration, suspect !!!!
  • Leave the room
    Once outside room use alcohol hand-rub again or wash hands with soap & water
  • The masks have numbers beside them that indicate their filtration efficiency. For example, a N95 mask has 95% efficiency in filtering out particles greater than 0.3 micron under normal rate of respiration
    The next generation of masks use Nano-technologywhich are capable of blocking particles as small as 0.027 micron.
  • Swine Flu

    1. 1. REVIEW H1N1 Maj SK Mishra Dr Rajeev Gupta Dr Prashant Malviya Chair Person Surg Cdr Anuj Singhal
    2. 2. Introduction  Epidemiology  Sign and symptom  Diagnosis  Treatment  Prevention 
    3. 3. WHAT IS SWINE FLU  Swine influenza Refers to influenza cases that are caused by Orthomyxovirus endemic to pig populations. Is a respiratory disease of pigs caused by type A influenza Regularly cause outbreaks among pigs. Swine flu viruses do not normally infect humans
    4. 4. VIRAL INFLUENZA A - HUMAN HISTORY 1889-90 1900-03 1918-19 H2N8 H3N8 H1N1(HswN1) Severe epidemic Mod epidemic Severe epidemic 1933-35 1946-47 1957-58 H1N1(HON1) H1N1 H2N2 Mild epidemic Mild epidemic Severe epidemic 1968-69 1977-78 H3N2 H1N1 Mod epidemic Mild epidemic
    5. 5. OR Y H IS T The H1N1 form of swine flu is one of the descendants of the Spanish flu that caused a devastating pandemic in humans in 1918–1919 In 1957, an Asian flu pandemic infected some 45 million Americans and killed 70,000. It caused about 2 million deaths globally Eleven years later, lasting from 1968 to 1969, the Hong Kong flu pandemic afflicted 50 million Americans and caused 33,000 deaths In 1976, about 500 soldiers became infected with swine flu over a period of a few weeks.
    7. 7. PANDEMICS OF INFLUENZA H2N2 H2N2 H1N1 H1N1 H3N8 1895 1905 1889 Russian influenza H2N2 7 1915 1900 Old Hong Kong influenza H3N8 Pandemic H1N1 H3N2 1925 1955 1918 Spanish influenza H1N1 Reproduced and adapted (2009) with permission of Dr Masato Tashiro, Director, Center for Influenza Virus Research, National Institute of Infectious Diseases (NIID), Japan. 1965 1957 Asian influenza H2N2 1975 1985 1968 Hong Kong influenza H3N2 1995 2005 2010 2009 Pandemic influenza H1N1 Animated slide: Press space bar 2015
    8. 8. SEASONAL INFLUENZA COMPARED TO PANDEMIC — PROPORTIONS OF TYPES OF CASES Deaths Requiring hospitalisation Deaths Requiring hospitalisation Clinical symptoms Asymptomatic Seasonal influenza 8 Clinical symptoms Asymptomatic Pandemic
    9. 9. SOME OF THE 'KNOWN UNKNOWNS' IN THE 20TH CENTURY PANDEMICS Three pandemics (1918, 1957, 1968). Each quite different in shape and waves. Some differences in effective reproductive number. Different groups affected. Different levels of severity including case fatality ratio. Imply different approaches to mitigation.       9
    10. 10. INDIAN SCENARIO- 2009
    12. 12. COMPARATIVE MORTALITY Avian flu(H7N7) HK 07 Hantavirus PS China 06 SARS-CoV China 07 Swine flu(H1N1) Dengue 60 % 30-40 % 9.5 % <1 %(177457 and 1462) <1 >1 %
    13. 13. INFLUENZA VIRUS  Three types of influenza viruses: A, B and C.  A and B  seasonal epidemics of disease  C infections mild respiratory illness and are not thought to cause epidemics. 
    14. 14. ORTHOMYXOVIRUSES 80-200nm HA - hemagglutinin –attaches to sialic Acid receptor NA – neuraminidase-helps in Budding out of infected cell helical nucleocapsid (RNA plus NP protein) lipid bilayer membrane polymerase complex M1 protein type A, B, C : NP, M1 protein sub-types: HA or NA protein
    15. 15. INFLUENZA -A  Two proteins on the surface of the virus  Hemagglutinin  16 subtypes  Neuraminidase  (H) 09 subtypes (N)
    16. 16. CLASSIFICATION= The antigenic type (e.g., A, B, C)  The host of origin (e.g., swine, equine, chicken, etc. For human-origin viruses, no host of origin designation is given.)  Geographical origin (e.g., Mexico, Taiwan, etc.)  Strain number (e.g., 15, 7, etc.)  Year of isolation (e.g., 57, 2009, etc.) 
    17. 17. PATHOPHYSIOLOGY  Antigenic drift  Mutations within the virus antibody-binding sites accumulate over time  Circumvent the body's immune system  A and B  Antigenic shift  Sudden change in antigenicity  Recombination of the influenza genome  Cell becomes simultaneously infected by two different strains of type A influenza.  Humans live in close proximity swine, that human strains and bird strains, may readily infect a pig at the same time, resulting in a unique virus.
    18. 18. ANTIGENIC SHIFT H1N1
    19. 19. NOVEL H1N1 INFLUENZA  The first cases of human infection with novel H1N1 influenza virus were detected in April 2009 in San Diego and Imperial County, California and in Guadalupe County, Texas.  The virus has spread rapidly.  The virus is widespread in the United States  Has been detected internationally as well.
    20. 20. WHO CAN CATCH THE “FLU” ?
    21. 21. WHO CAN CATCH THE FLU ? As in all epidemics Children Elderly Pregnant women Immuno-suppressed or Immuno-compromised Chronic medical conditions Occupational exposure-paramedics, medics
    22. 22. HOW DOES NOVEL H1N1 INFLUENZA SPREAD?  spread the same way seasonal flu spreads  Primarily through respiratory droplets  Coughing  Sneezing  Touching respiratory droplets on yourself, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing hands
    23. 23. CAN YOU GET NOVEL H1N1 INFLUENZA FROM EATING PORK? No You cannot get novel H1N1 flu from eating pork or pork products. Eating properly handled and cooked pork products is safe.
    24. 24. DEFINITIONS- CDC
    25. 25. CDC INTERIM GUIDANCE REPORT CONFIRMED CASE is defined as a person with an acute febrile respiratory infection and a confirmed positive test for S-OIV by RT-PCR and/or viral culture. PROBABLE CASE is defined as a person with an acute febrile respiratory infection who tests positive for influenza A but negative for H1 and H3 by viral RT-PCR.
    26. 26. SUSPECTED CASE is defined as a person with an acute febrile respiratory infection with onset Within 7 days of close contact with a person who is a confirmed case of S-OIV infection. Within 7 days of travel to a community where there are one or more confirmed cases. Resides in a community where there are one or more confirmed cases of SIV infection.
    27. 27. INFECTIOUS PERIOD for a confirmed case of H1N1 is defined as 1 day prior to the cases illness onset to 7 days after onset. CLOSE CONTACT is defined as being within 6 feet of a confirmed or suspected case of H1N1 during the case’s infectious period. ACUTE ONSET OF A RESPIRATORY ILLNESS is defined as having at least 2 of the following: rhinorrhea, sore throat and cough with or without fever
    28. 28. INFECTIVITY PERIOD Should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children - might potentially be contagious for longer periods.
    29. 29. INDIVIDUALS AT INCREASED RISK Elderly > 65 years  Children less than two years  Certain chronic diseases   Heart (except HTN) or lung disease (including asthma)  Metabolic disease, including diabetes  HIV/AIDS, other immuno-suppression (drugs induced)  Chronic renal disease  chronic hepatic disease http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm,Influenza Antiviral Medications: Summary for Clinicians (Current for the 2012-2013 Influenza Season)
    30. 30. Pregnant/postpartum (2 weeks after delivery)  Hemoglobinopathies  Aged younger than 19 years, receiving long term Asprin therapy  Person who are morbidly obese (BMI >40)  Residents of nursing homes and other chronic care facilities 
    32. 32. SYMPTOMS  Mild or uncomplicated illness
    33. 33.  Progressive illness   typical symptoms  chest pain  poor oxygenation  (eg, tachypnea)  cardiopulmonary insufficiency  central nervous system (CNS) impairment (eg, confusion, altered mental status)  severe dehydration
    34. 34.  Severe illness   mechanical ventilation  CNS findings (encephalitis, encephalopathy)  complications of hypotension (shock, organ failure)  myocarditis or rhabdomyolysis  invasive secondary bacterial infection  persistent high fever and other symptoms beyond three days.
    35. 35. COMPLICATIONS   Refractory respiratory failure  Not improving on mechanical ventilator  Inhaled nitric oxide  high-frequency oscillatory ventilation  extracorporeal membrane oxygenation (ECMO)
    36. 36. COMPLICATIONS  Bacterial superinfection   Streptococcus pneumoniae  Streptococcus pyogenes  Staphylococcus aureus,  Streptococcus mitis  Haemophilus influenzae  Moraxella catarrhalis
    37. 37. BACTERIAL SUPERINFECTION  Clinical findings:  Secondary fever after a period of defervescence.  Sputum Gm stain or culture  Lobar consolidation on chest imaging (diffuse pattern in normal viral pneumonia)  Leukocytosis (normal or low white blood cell count)  Onset of respiratory compromise occurring four to seven days after initial symptoms
    38. 38. COMPLICATIONS  Neurologic   Seizure  Confusion      acute or postinfectious encephalopathy quadriparesis encephalitis severe acute disseminated encephalomyelitis stroke, and transient ischemic attack
    39. 39. COMPLICATIONS  Other   Myocarditis  Renal insufficiency  Rhabdomyolysis  Multisystem organ failure.  Hypercoagulability
    40. 40. LABORATORY FINDINGS  Elevated SGOT/SGPT  Anemia  Leukopenia  Thrombocytopenia /Thrombocytosis  Elevated total bilirubin  Elevations of CPK ,LDH 
    41. 41.  
    42. 42. DIAGNOSTIC ASSAYS  Real-time reverse transcriptase (rRT)-PCR  most  sensitive and specific test culture  too slow  A negative viral culture does not exclude pandemic H1N1 influenza A infection.
    43. 43. LIMITATIONS Analysts should be trained and familiar with testing procedures and interpretation of results prior to performing the assay.  A false negative result may occur if inadequate numbers of organisms are present in the specimen due to improper collection, transport or handling. 
    44. 44. DIAGNOSTIC ASSAYS Combined nasopharyngeal and throat swabs (CNTS)  Nasopharyngeal aspirates (NPA) 
    45. 45. DIAGNOSTIC ASSAYS  Rapid antigen tests  Distinguish between influenza A and B viruses  Cannot distinguish among different subtypes of influenza A  sensitivity -10 to 70 percent  specificity of rapid antigen testing was generally >95 percent
    46. 46. DIAGNOSTIC ASSAYS  Immunofluorescent antibody testing   Direct or indirect immunofluorescent antibody testing (DFA or IFA)  Distinguish between influenza A and B  does not distinguish among different influenza A subtypes  Low sensitivity and specificity
    47. 47. METHOD Acceptable Specimens Test Time Viral cell culture NP swab, throat swab, NP ,bronchial wash, nasal endotracheal aspirate, sputum 3-10 days Direct (DFA) or Indirect (IFA) Antibody NP swab or wash, bronchial wash, nasal or endotracheal aspirate 1-4 hours RT-PCR NP swab, throat swab, NP or bronchial wash, nasal or endotracheal aspirate, sputum 1- 6 hours Rapid Influenza Diagnostic Tests NP swab, (throat swab), nasal wash, nasal aspirate <30 min.
    48. 48. Treatment of H1N1
    49. 49. Treatment • Adamantane agents – Amantadine – Rimantadine • Neuraminidase inhibitor – Oseltamivir (oral) – Zanamivir (aerosolized) – Peramivir (intravenous)
    50. 50. CDC recommends • Treatment and prevention of H1N1/seasonal flu • Neuraminidase inhibitor – Oseltamivir (oral) – Zanamivir (aerosolized)
    52. 52. Category- A • Patients with mild fever plus cough / sore throat with or without body ache, headache, diarrhoea and vomiting • Do not require Oseltamivir • Symptomatic treatment • Monitored for their symptom progress and reassessed at 24 to 48 hours by the doctor • No testing of the patient for H1N1 • Confine themselves at home • Avoid mixing up – Public and high risk members in the family
    53. 53. Category-B i. i. • • Category-A + high grade fever & severe sore throat – Require home isolation and Oseltamivir Category-A + one or more of high risk conditions i. Shell be treated with Oseltamivir No tests required for Category-B (i) and (ii) All patients of Category-B (i) and (ii) i. should confine themselves at home ii.Avoid mixing with public and high risk members in the family
    54. 54. Category-C • Category-A and B – Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discoloration of nails – Children with red flag signs (Somnolence, high and persistent fever, inability to feed well, convulsions, shortness of breath, difficulty in breathing etc) – Worsening of underlying chronic conditions • Require testing, immediate hospitalization and treatment
    55. 55. • Treatment should be started as soon as possible after illness onset – Ideally within 48 hrs
    56. 56. Chemoprophylaxis • Drug approved – Oseltamivir is approved for prophylaxis of influenza in individual > 1 year of age – Zanamivir for > 5 years of age • 84-89% efficacious against influenza A and B
    57. 57. Guidelines on chemoprophylaxis • Healthy persons after community exposure – No chemoprophylaxis • If states qualify the criteria for community spread – Family contacts that are at high risk – Co-morbid condition • Irrespective of laboratory testing Guidelines on chemoprophylaxis, Ministry of Health & Family Welfare Pandemic Influenza A (H1N1) Govt of India
    58. 58. • States which does not qualify the criteria of community spread – Family contacts, school contacts and social contacts • Irrespective of community spread or not – Medical personnel attending to influenza A H1N1 cases Guidelines on chemoprophylaxis, Ministry of Health & Family Welfare Pandemic Influenza A (H1N1) Govt of India
    59. 59. OSELTAMIVIR (Cap.Tamiflu) TREATMENT (5 DAYS) 75 mg BD ADULTS Chemoprophylaxis (10 days) 75 mg OD Body Weight (kg) TREATMENT (5 DAYS) Chemoprophylaxis (10 days) ≤15 kg 30 mg once daily > 15 kg to 23 kg 45 mg twice daily 45 mg once daily >23 kg to 40 kg 60 mg twice daily 60 mg once daily >40 kg Children ≥ 12 months 30 mg twice daily 75 mg twice daily 75 mg once daily Children 3 months to < 12 months2 TREATMENT (5 DAYS) Chemoprophylaxis (10 days) 3 mg/kg/dose twice daily 3 mg/kg/dose once per day It is also available as syrup (12mg per ml ) WHO and The U.S. Centers for Disease Control and Prevention http://www.cdc.gov/H1N1flu/recommendations.htm http://www.cdc.gov/H1N1flu/recommendations.htm
    60. 60. ZANAMIVIR (Relenza Diskhaler) ADULTS and Children > 5 years TREATMENT (5 DAYS) Chemoprophylaxis (10 days) 10 mg (two inhalations) BD 10 mg (two inhalations) once daily WHO and The U.S. Centers for Disease Control and Prevention http://www.cdc.gov/H1N1flu/recommendations.htm http://www.cdc.gov/H1N1flu/recommendations.htm
    61. 61. Adverse effect • Oseltamivir – – – – – – • Zanamivir Nausea GI discomfort Vomiting Vertigo Insomnia Neuropsychiatric events • Delirium • Self-injury – – – – – Worsen asthma Diarrhea Nausea Sinusitis Nasal signs and symptoms – Bronchitis – Headache & dizziness – Ear, nose, and throat infections http://www.cdc.gov/flu/professionals/antivirals/antiviral-adverse-events.htm Harrison’s 18th edition, page no.1442
    62. 62. INFLUENZA SEASONAL VACCINE CDC - Seasonal Influenza (Flu) - Key Facts About Seasonal Flu Vaccine
    63. 63. Vaccination • Annually • Trivalent – 2 strain of influenza A & 1 strain of influenza B • Above the age of 6 months • Quadrivalent vaccine CDC - Seasonal Influenza (Flu) - Key Facts About Seasonal Flu Vaccine
    64. 64. “Flu shot” • The "flu shot" – Killed vaccine – Intramuscular – Usually in the arm – approved for use in people older than 6 months, including healthy people and people with chronic medical conditions. 76
    65. 65. Nasal vaccination • LAIV (Flumist) – a vaccine made with live, weakened flu viruses that do not cause the flu – LAIV (FluMist) is approved for use in healthy people 2-49 years of age who are not pregnant 77
    66. 66. Seasonal influenza vaccine 2012-13 • Influenza vaccines for 2012–13 season – A/California/7/2009 (H1N1) – A/Victoria/361/2011 (H3N2) – B/Wisconsin/1/2010 (Yamagata lineage) antigens • All individual above the age of 6 mths • 6 months to 8 years – 2 doses – Month apart (4 weeks to 1 years) CDC- Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) —United States, 2012–13 Influenza Season, August 17, 2012 / 61(32);613-618
    67. 67. Available
    68. 68. Pandemic flu vaccine • Monovalent vaccine – CELVAPAN – PANDEMRIX
    69. 69. Side effects • Flu shot • LAIV (Flumist) – Soreness, redness, or swelling where the shot was given – Fever (low grade) – Aches – Children • • • • • runny nose wheezing headache muscle aches Fever – Adults • • • • runny nose headache sore throat cough CDC - Seasonal Influenza (Flu) - Key Facts About Seasonal Flu Vaccine
    70. 70. Who should get the swine flu shot? • Pregnant women • People who live with or care for children younger than 6 months of age • Children and young people between the ages of 6 months and 24 years • Health care workers and emergency medical service providers • 25 and 64 years of age who have chronic medical disorders or compromised immune systems. CDC - Seasonal Influenza (Flu) - Key Facts About Seasonal Flu Vaccine
    71. 71. Who Should Not Be Vaccinated? • People who have a severe allergy to chicken eggs • Severe reaction to an influenza vaccination • Children younger than 6 months of age • People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated) • History of Guillain–Barré Syndrome CDC - Seasonal Influenza (Flu) - Key Facts About Seasonal Flu Vaccine
    72. 72. GUIDELINES ON INFECTION CONTROL MEASURES Clinical management Protocol and Infection Control Guidelines; Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India
    73. 73. Health facility managing the human cases of Influenza A H1N1 • During Pre Hospital Care – Three layer surgical mask – Full complement of PPE(Personal Protection Equipments ) – No Aerosol generating procedures – Three layered surgical mask for driver – Ambulance equipment sanitized using sodium hypochlorite / quaternary ammonium compounds
    74. 74. Contd • During hospital care – Isolation ward and continue to wear a three layer surgical mask – Identified medical, nursing and paramedical personnel attending the pt should wear full complement of PPE (Personal Protection Equipments) – Aerosol-generating procedures – Sample collection and packing – Hand wash • Before and after patient contact • Following contact with contaminated items
    75. 75. Contd • Infection control precautions – 7 days after resolution of symptoms for adult – 14 days after resolution of symptoms for children • Contaminated surfaces and equipments • Disinfectants – 70% ethanol, 5% benzalkonium chloride (Lysol) and 10% sodium hypochlorite
    76. 76. STANDARD OPERATING PROCEDURES ON USE OF PERSONAL PROTECTION EQUIPMENTS (PPE) Clinical management Protocol and Infection Control Guidelines; Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India
    77. 77. Personal Protection Equipments (PPE) • Reduces the risk of infection. It includes: – Gloves (nonsterile) – Mask (high-efficiency mask N95) / 3 layered surgical mask – Long-sleeved cuffed gown – Protective eyewear (goggles/visors/face shields) – Cap (may be used in high risk situations where there may be increased aerosols) – Plastic apron if splashing of blood, body fluids, excretions and secretions is anticipated
    78. 78. Contd • Correct procedure for applying PPE : – Follow thorough hand wash – Wear the coverall – Wear the goggles/ shoe cover/and head cover – Wear face mask – Wear gloves The masks should be changed after every six to eight hours
    79. 79. Remove PPE in the following order • Remove gown (place in rubbish bin) • Remove gloves (peel from hand and discard into rubbish bin) – Alcohol -based hand-rub or wash hands with soap & water • Remove cap and face shield (place cap in bin and if reusable place face shield in container for decontamination) • Remove mask - by grasping elastic behind ears – do not touch front of mask – Use alcohol-based hand-rub or wash hands with soap & water
    80. 80. INFECTION CONTROL MEASURES AT INDIVIDUAL LEVEL Clinical management Protocol and Infection Control Guidelines; Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India
    81. 81. Hand washing a Top priority • Single most important measure to reduce the risk of transmitting infectious organism from one person to other
    82. 82. Respiratory Hygiene/Cough Etiquette • Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use • Wash hand
    83. 83. Touching face regions can faster the Spread • Avoiding touching your eyes, nose or mouth. Virus can spread this way in a faster way
    84. 84. Staying home if you are sick
    85. 85. Avoid crowded places more so with young children
    86. 86. Mild cold like symptoms - Take rest
    87. 87. Using N95 mask reduces the Risk • You can cut your risk of contracting the flu or other respiratory viruses by as much as 80 percent by wearing a mask over your nose and mouth Emerging Infectious Diseases, the journal of the Centres for Disease Control and Prevention (CDC) .
    88. 88. Infection control measures at health facility • • • • Droplet Precautions Visual alerts Use of PPE Decontaminating contaminated surfaces, fomites and equipments • Guidelines for waste disposal
    89. 89. Discharge policy • Asymptomatic pt after two to three days of treatment – Should be discharged after 5 days of treatment – Repeat test not required • Continuation of symptoms of fever, sore throat etc. even on the 5th day – should continue treatment for 5 more days – Asymptomatic  discharge – No need to test further
    90. 90. Discharge policy • Symptomatic – Even after 10 days of treatment or – cases with respiratory distress – Suspected secondary infection – if patient continue to shed virus • Resistance of the patients to anti viral drug would be tested • Family should be educated on – Personal hygiene – Infection control measures at home
    91. 91. Check list • S – Stay home (if ill) and sleep well • W –Wash hands, wear masks. Wine not to be consumed • I – Imbibe fluids • N – No smoking • E – Eat well • F – Fear not ( deaths < 1 %) ,Fully treatable • L – Lessen travel and visits to crowded places • U – Uphold cleanliness and proper disposal of used masks
    92. 92. Panic and Fear are much dangerous than Swine Flu