Viral diseases.pptx- Mumps, Influenza and Polio

1. VIRAL DISEASES
Adithya Mohan

2. MUMPS

3. • INTRODUCTION
• ▸ MUMPS (EPIDEMIC PAROTITIS) IS A VIRAL DISEASE OF THE HUMAN SPECIES,
CAUSED BY THE MUMPS VIRUS.
• ▸ BEFORE THE DEVELOPMENT OF VACCINATION AND THE INTRODUCTION OF A
VACCINE, IT WAS A COMMON CHILDHOOD DISEASE WORLDWIDE.
• ▸ IT IS STILL A SIGNIFICANT THREAT TO HEALTH IN THE THIRD WORLD, AND
OUTBREAKS STILL OCCUR SPORADICALLY IN DEVELOPED COUNTRIES
• DEFINITION
• MUMPS IS AN ACUTE VIRAL INFECTION OF CHILDHOOD THAT TYPICALLY
INVOLVES SWELLING OF ONE OR BOTH PAROTID GLANDS, ALTHOUGH MANY
DIFFERENT ORGANS CAN BE INFECTED.

4. MUMPS IS AN ACUTE VIRAL INFECTION OF THE PARAMYXOVIRUSES FAMILY. AS
ITS ALTERNATIVE NAME (INFECTIOUS PAROTITS) SUGGESTS, THE INFECTION IS
CHARACTERIZED BY SWELLING MORE COMMONLY BILATERAL THAN UNILATERAL
OF THE PAROTID SALIVARY GLANDS. THE INCUBATION PERIOD IS 14-21 DAYS
AND IS COMMUNICABLE FROM 6 DAYS BEFORE TO 9 DAYS AFTER FACIAL
SWELLING IS APPARENT. IT CAN LEAD TO BRAIN INFLAMMATION, DEAFNESS OR
STERILITY.

5. • CAUSE
• ▸ MUMPS IS A CONTAGIOUS DISEASE THAT IS SPREAD FROM PERSON TO
PERSON THROUGH CONTACT WITH RESPIRATORY SECRETIONS SUCH AS
SALIVA FROM AN INFECTED PERSON.
• ▸ MUMPS CAN ALSO BE SPREAD BY SHARING FOOD AND DRINKS.
• ▸ A PERSON INFECTED WITH MUMPS IS CONTAGIOUS FROM APPROXIMATELY 6
DAYS BEFORE THE ONSET OF SYMPTOMS UNTIL ABOUT 9 DAYS AFTER
SYMPTOMS START.
• ▸ THE INCUBATION PERIOD (TIME UNTIL SYMPTOMS BEGIN) CAN BE FROM 14-
25 DAYS BUT IS MORE TYPICALLY 16-18 DAYS

6. • PATHOGENESIS
• VIRUS ENTERS THROUGH THE RESPIRATORY TRACT. PROLIFERATION TAKES
PLACE IN EITHER THE PAROTID GLAND OR THE SUPERFICIAL EPITHELIUM OF
THE RESPIRATORY TRACT. THIS IS FOLLOWED BY VIREMIA, VIRUS IS
LOCALIZED IN THE SALIVARY GLANDS OR CENTRAL NERVOUS SYSTEM. THE
PAROTID GLAND IS MOST OFTEN INVOLVED.
• MUMPS VIRUS HAS BEEN ISOLATED FROM HUMAN SALIVA, BLOOD, URINE, AND
CEREBROSPINAL FLUID (CSF) DURING THE ACUTE PHASE OF THE ILLNESS.
• THE INTERSTITIAL TISSUE SHOWS EDEMA AND INFILTRATION WITH
LYMPHOCYTES.

8. • SIGNS AND SYMPTOMS
• ▸ THE MORE COMMON SYMPTOMS OF MUMPS ARE:
• ▸ PAROTID INFLAMMATION (OR PAROTITIS) IN 60-70% OF INFECTIONS AND 95%
OF PATIENTS WITH SYMPTOMS.[2] PAROTITIS CAUSES SWELLING AND LOCAL
PAIN, PARTICULARLY WHEN CHEWING. IT CAN OCCUR ON ONE SIDE
(UNILATERAL) BUT IS MORE COMMON ON BOTH SIDES (BILATERAL) IN ABOUT
90% OF CASES.[6]
• ► FEVER
• ▸ HEADACHE
• PANCREATITIS, REFERRING TO INFLAMMATION OF THE AFFECTED PANCREAS.
• ▸ ORCHITIS, REFERRING TO PAINFUL INFLAMMATION OF THE TESTICLES

9. • TREATMENT
• THERE IS NO SPECIFIC TREATMENT FOR MUMPS. SYMPTOMS MAY BE RELIEVED BY
THE APPLICATION OF INTERMITTENT ICE OR HEAT TO THE AFFECTED
NECK/TESTICULAR AREA AND BY ACETAMINOPHEN/PARACETAMOL (TYLENOL) FOR
PAIN RELIEF.
• ▸ WARM SALT WATER GARGLES, SOFT FOODS, AND EXTRA FLUIDS MAY ALSO HELP
RELIEVE SYMPTOMS.
• ACCORDING TO THE DEPARTMENT OF HEALTH OF MINNESOTA THERE IS NO
EFFECTIVE POST-EXPOSURE RECOMMENDATION TO PREVENT SECONDARY
TRANSMISSION, AS WELL AS THE POST-EXPOSURE USE OF VACCINE OR
IMMUNOGLOBULIN IS NOT EFFECTIVE.
• ▸ PATIENTS ARE ADVISED TO AVOID ACIDIC FOODS AND BEVERAGES, SINCE THESE
STIMULATE THE SALIVARY GLANDS, WHICH CAN BE PAINFUL

10. • PREVENTION:
• MMR IMMUNIZATION (VACCINE) PROTECTS AGAINST MEASLES, MUMPS, AND
RUBELLA. IT SHOULD BE GIVEN TO CHILDREN 12 – 15 MONTHS OLD. THE
VACCINE IS GIVEN AGAIN BETWEEN AGES 4 – 6, OR BETWEEN AGES 11 – 12, IF
IT WASN’T GIVEN BEFORE.
• RECENT OUTBREAKS OF THE MUMPS HAVE REINFORCED THE IMPORTANCE
OF HAVING ALL CHILDREN VACCINATED

11. • SUMMARY
• MUMPS IS AN ACUTE VIRAL INFECTION PAROTID GLANDS
• INVOLVES SWELLING OF ONE OR BOTH
• MUMPS IS AN RNA VIRUS OF THE GENUS RUBULAVIRUS IN THE PARAMYXOVIRIDAE
FAMILY
• SPREAD FROM HUMAN RESERVOIR BY: DIRECT CONTACT, AIRBORNE DROPLETS
FOMITES CONTAMINATED BY SALIVA AND POSSIBLY BY URINE
• TRANSMISSION DOES NOT SEEM TO OCCUR MORE THAN 24 HR BEFORE THE
APPEARANCE OF THE SWELLING OR LATER THAN 3 DAYS AFTER IT HAS SUBSIDED
• THE INCUBATION PERIOD RANGES FROM 14-24 DAYS, WITH A PEAK AT 17-18 DAYS.
• APPROXIMATELY 30-40% OF INFECTIONS ARE SUBCLINICAL
• COMMON COMPLAINTS ARE: EARACHE DISCOMFORT WITH EATING OR DRINKING ACIDIC
FOOD PAROTID PAIN IS MOST PRONOUNCED DURING THE FIRST FEW DAYS OF
SWELLING

12. POLIOMYELITIS

13. • POLIO WAS ONE OF THE MOST DREADED CHILDHOOD DISEASES OF THE 20TH
CENTURY
• POLIO MAINLY AFFECTS CHILDREN UNDER FIVE YEARS OF AGE
• ONE IN 200 INFECTIONS LEADS TO IRREVERSIBLE PARALYSIS
• AMONG THOSE PARALYZED, 5% TO 10% DIE WHEN THEIR RESPIRATORY
MUSCLES BECOME PARALYZED
• THIS IS A DISEASE OF DIGESTIVE TRACT BUT SINCE IT CAN CAUSE PARALYSIS
AND DEFORMITY.

14. • IT IS VIRAL INFECTION CAUSED BY POLIOMYELITIS VIRUS
• POLIOVIRUSES ARE NONENVELOPED, POSITIVE- STRANDED RNA VIRUSES
• BELONGING TO THE GENUS ENTEROVIRUS, IN THE PICORNAVIRIDAE FAMILY
• 3 ANTIGENICALLY DISTINCT SEROTYPES (TYPES 1, 2, AND 3)
• A) TYPE I: “LEON”; THE COMMONEST IN EPIDEMICS
• B) TYPE II: “BERLINHIDE”; THE PREVAILING TYPE IN ENDEMIC AREAS.
• C) TYPE III: “LANSING”; OCCASIONALLY CAUSES EPIDEMICS.
• SPREAD FROM THE INTESTINAL TRACT TO THE CENTRAL NERVOUS SYSTEM (CNS), WHERE THEY CAUSE
ASEPTIC MENINGITIS AND POLIOMYELITIS, OR POLIO
• MOST OF THE CHILDREN SHOW MINOR SYMPTOMS BUT AS MANY AS 1 IN 200 CHILDREN WILL BE
PARALYSEDTHE VIRUS IS EXCRETED IN THE STOOLS FOR THREE TO SIX WEEKS.
• IT IS MORE STABLE THAN MOST VIRUSES.CAN STAY ALIVE FOR SEVERAL WEEKS IN CONTAMINATED FOOD
OR WATER.
• IT IS ONE OF THE MOST CONTAGIOUS VIRUSES.
• IF ONE FAMILY MEMBER IS INFECTED, NEARLY ALL THE REST OF THE FAMILY BECOMES INFECTED.

15. • ▸ ALSO CALLED POLIO, INFANTILE PARALYSIS.
• THE WORD POLIOMYELITIS COMES FROM TWO GREEK WORDS: POLIO, WHICH MEANS
GRAY, AND MYELITIS MEANS INFLAMMATION OF THE SPINAL CORD.
• POLIOMYELITIS IS A HIGHLY INFECTIOUS DISEASE CAUSED BY POLIO VIRUS I, II, III(OR
P1,P2,P3)
• P1 MOST TYPICALLY CAUSES OUTBREAKS-IS THE MOST LIKELY VIRUS TO CAUSE
PARALYSIS.
• P2 IS THE EASIEST TO ERADICATE FOLLOWED BY P3.
• POLIO VIRUS MAINLY AFFECTS YOUNG CHILDREN. THE VIRUS IS TRANSMITTED
THROUGH CONTAMINATED FOOD AND WATER, AND MULTIPLIES IN THE INTESTINE,
FROM WHERE IT CAN INVADE THE NERVOUS SYSTEM.
• POLIOVIRUSES ARE RELATIVELY RESISTANT AND SURVIVE FOR A LONG TIME UNDER
SUITABLE ENVIRONMENTAL CONDITIONS, BUT ARE READILY DESTROYED BY HEAT (E.G.
PASTEURIZATION OF MILK, AND CHLORINATION OF WATER.

16. • TYPES OF POLIOMYELITIS:
• INAPPERENT SUB CLINICAL) INFECTION; THIS OCCURS APPROXIMATELY IN 95 PER
CENT OF POLIOVIRUS INFECTION. THERE ARE NO PRESENTING SYMPTOMS.
RECOGNITION ONLY BY ISOLATION.
• ABORTIVE POLIO OR MINERNESS; OCCURS APPROXIMATELY IN 4-8 PER CENT OF
THE INFECTION. IT CAUSES ONLY A MILD OR SELF LIMITING ILLNESS DUE TO
VIRAEMIA. THE PATIENT RECOVERS QUICKLY.
• NON PARALYTIC POLIO: OCCURS APPROXIMATELY IN ONE PER CENT OF ALL
INFECTIONS. THE PRESENTING FEATURES ARE STIFFNESS AND PAIN IN NECK AND
BACK. THE DISEASE LASTS FOR TWO TO TEN DAYS. RECOVERY IS RAPID.
• PARALYTIC POLIO OCCURS IN LESS THEN ONE PER CENT OF INFECTIONS. THE
VIRUS ENTERS THE BRAIN AND CAUSES VARYING DEGREE OF DISABILITY.

18. • TRANSMISSION OF POLIOVIRUS
• POLIOMYELITIS CAUSED BY POLIOVIRUS USUALLY OCCURS IN SUMMER.
WHEN A PERSON IS INFECTED WITH POLIOVIRUS, THE VIRUS RESIDES IN THE
INTESTINAL TRACT AND MUCUS IN THE NOSE AND THROAT. POLIOVIRUS
TRANSMISSION MOST OFTEN OCCURS THROUGH CONTACT WITH STOOL OF
THIS INFECTED PERSON (KNOWN AS FECAL- ORAL TRANSMISSION). LESS
FREQUENTLY, POLIO TRANSMISSION CAN OCCUR THROUGH CONTACT WITH
INFECTED RESPIRATORY SECRETIONS OR SALIVA (ORAL-ORAL
TRANSMISSION).

19. • PATHOGENESIS
• POLIOVIRUS REPLICATES IN CELLS OF HUMAN GASTROINTESTINAL TRACT AND
IS EXCRETED IN FECES. IN RARE CASES IT INVADES CENTRAL NERVOUS
SYSTEM(CNS) AND CAUSES PARALYTIC DISEASE CALLED POLIOMYELITIS.
INCUBATION PERIOD IS 7 TO 14 DAYS. FOLLOWING INGESTION. THE VIRUS
MULTIPLIES IN OROPHARYNGEAL AND INTESTINAL MUCOSA. THE LYMPHATIC
SYSTEM, IN PARTICULAR, THE TONSILS AND PAYER’S PATCH OF THE ILEUM IS
INVADED. THE VIRUS ENTERS THE BLOOD RESULTING IN VIREMIA.

21. • SYMPTOMS:-
• 1. ACUTE STAGE:-
• GENERALLY LAST FOR 7 TO 10 DAYS.
• MANY INCLUDES FEVER, PHARYNGITIS, HEADACHE, ANOREXIA, NAUSEA, AND
VOMITING.
• THESE PATIENTS DEVELOP A HIGHER FEVER & SEVER HEADACHE WITH
STIFFNESS OF THE NECK AND BACK.
• PARALYSIS OF THE RESPIRATORY MUSCLES OR FROM CARDIAC ARREST IF
THE NEURONS IN THE MEDULLA OBLONGATA ARE DESTROYED.

22. • SYMPTOMS OF POLIO
• • POLIO, IN ITS MOST DEBILITATING FORMS, DISPLAYS SYMPTOMS SUCH AS PARALYSIS
AND DEATH.
• HOWEVER, MOST PEOPLE WITH POLIO DON’T ACTUALLY DISPLAY ANY SYMPTOMS OR
BECOME NOTICEABLY SICK. WHEN SYMPTOMS DO APPEAR, THERE ARE DIFFERENCES
DEPENDING ON THE TYPE OF POLIO.
• • NONPARALYTIC POLIO (ABORTIVE POLIOMYELITIS) LEADS TO FLU-LIKE SYMPTOMS
THAT LAST FOR A FEW DAYS OR WEEKS, SUCH AS FEVER, SORE THROAT, HEADACHE,
VOMITING, FATIGUE, BACK AND NECK PAIN, ARM AND LEG STIFFNESS, MUSCLE
TENDERNESS, MUSCLE SPASMS, AND MENINGITIS.
• • PARALYTIC POLIO WILL OFTEN BEGIN WITH SYMPTOMS SIMILAR TO NONPARALYTIC
POLIO, BUT WILL PROGRESS TO MORE SERIOUS SYMPTOMS SUCH AS A LOSS OF
MUSCLE REFLEXES, SEVERE MUSCLE PAIN AND SPASMS, AND LOOSE OR FLOPPY
LIMBS THAT IS OFTEN WORSE ON ONE SIDE OF THE BODY.

23. • HIGH FEVER HEADACHE
• STIFFNESS (BACK AND NECK)
• WEAKNESS OF VARIOUS MUSCLES
• SENSITIVITY TO TOUCH
• DIFFICULTY SWALLOWING
• MUSCLE PAIN
• LOSS OF REFLEXES
• IRRITABILITY
• CONSTIPATION
• DIFFICULTY URINATING
• PARALYSIS DEVELOPS 1-10 DAYS AFTER EARLY SYMPTOMS BEGIN USUALLY CONTINUES FOR 2-3
DAYS, AND COMPLETE SOON AFTER

24. • DIAGNOSIS OF POLIO
• POLIO IS OFTEN RECOGNIZED BECAUSE OF SYMPTOMS SUCH AS NECK AND
BACK STIFFNESS, ABNORMAL REFLEXES, AND TROUBLE WITH SWALLOWING
AND BREATHING.
• A PHYSICIAN WHO SUSPECTS POLIO WILL PERFORM LABORATORY TESTS THAT
CHECK FOR POLIOVIRUS USING THROAT SECRETIONS, STOOL SAMPLES, OR
CEREBROSPINAL FLUID.

25. • TREATMENT:
• THERE IS NO CURE FOR POLIO
• TREATMENT IS LESSENING SEVERITY OF THE SYMPTOMS (OF WEAKNESS, PARALYSIS)
• SOME EXAMPLES:
• ANTIBIOTICS TO PREVENT INFECTIONS IN WEAKENED MUSCLES
• PAIN-RELIEVING DRUGS
• MODERATE EXERCISE AND A NUTRITIOUS DIET
• LONG-TERM REHABILITATION; PHYSICAL THERAPY
• BRACES (BODY)
• CORRECTIVE SHOES
• ORTHOPEDIC SURGERY
• IRON LUNGS (PORTABLE VENTILATORS)

26. • PREVENTION
• THE BEST PREVENTIVE MEASURE FOR POLIOMYELITIS IS ENSURING HYGIENE
AND ENCOURAGING GOOD SANITATION PRACTICES. BUT, POLIO PREVENTION
BEGINS WITH POLIO VACCINATION. POLIO VACCINE HAS BEEN DEVELOPED
AGAINST ALL 3 SUBTYPES OF THE POLIOVIRUS AND IS VERY EFFECTIVE IN
PRODUCING PROTECTIVE ANTIBODIES THAT INDUCES IMMUNITY AGAINST THE
POLIOVIRUS AND PROVIDES PROTECTION FROM PARALYTIC POLIO.

27. INFLUENZA
SYMPTOMS
CAUSES
TREATMENT
PREVENTION

28. • ALSO KNOW AS “SEASONAL FLU”
• INFLUENZA IS AN ACUTE RESPIRATORY TRACT INFECTION CAUSED BY INFLUENZA
VIRUS CHARACTERIZED BY SUDDEN ONSET OF CHILLS, MALAISE, FEVER, MUSCULAR
PAIN AND COUGH. CAN OCCUR AS
• -SPORADIC CASE / SEASONAL CASE
• - EPIDEMIC CASE
• -PANDEMIC CASE
• INFLUENZA PANDEMICS HAVE BEEN ASSOCIATED WITH HIGH MORBIDITY AND
MORTALITY WORLDWIDE.
• INFLUENZA A(H1N1) VIRUS IS A SUBTYPE OF INFLUENZA A VIRUS AND THE MOST
COMMON CAUSE OF INFLUENZA(FLU) IN HUMANS.
• IN 2009, THE WHO DECLARED THE NEW STRAIN OF SWINE ORIGIN H1N1 AS A PANDEMIC
WHICH IS OFTEN REFERRED AS “SWINE FLU”.

29. •
• INFLUENZA, COMMONLY REFERRED TO AS THE FLU, IS AN INFECTIOUS VIRAL
DISEASE CAUSED BY RNA VIRUSES OF THE FAMILY ORTHO-MYXOVIRIDAE (THE
INFLUENZA VIRUSES). AFFECTS BIRDS AND MAMMALS.
• COMMON SYMPTOMS ARE CHILLS, FEVER, SORE THROAT, MUSCLE PAINS,
SEVERE HEADACHE, COUGHING, FATIQUE AND GENERAL DISCOMFORT
• ALTHOUGH CONFUSED WITH OTHER INFLUENZA-LIKE ILLNESSES, ESPECIALLY
THE COMMON COLD, INFLUENZA IS A MORE SEVERE DISEASE.

30. • THERE ARE THREE TYPES OF INFLUENZA VIRUSES: A, B, C
• THE VIRUS’S GENETIC MATERIAL IS SINGLE STRANDED RNA
• •THE INFLUENZA VIRUS CONTAINS SSRNA IN ITS CORE
• THIS IS SURROUNDED BY A MATRIX PROTEIN MEMBRANE
• A LIPID BILAYER ENVELOPES THE VIRUS
• THE OUTER LAYER(VIRAL ENVOLOPE) IS STUDDED WITH PROMINENT GLYCOPROTEIN SPIKES
• WHICH CAN BE USED TO IDENTIFY EACH VIRUS AND PUT THEM INTO GROUPS: HEMAGGLUTININ AND
NEURAMINIDASE
• A IS MOST SERIOUS AND IT CAN GENETICALLY CHANGE RAPIDLY AND . IS THE ONE THAT CAUSED THE
PANDEMICS (WORLDWIDE SPREAD)
• - INFLUENZA A IS ASSOCIATED WITH ANNUAL EPIDEMICS AND WITH PRIOR PANDEMICS.
• - “BIRD FLU” AND “SWINE FLU” ARE INFLUENZA A VIRUSES. BOTH HUMANS AND OTHER ANIMALS
• INFLUENZA B: CAUSES DISEASE IN HUMANS, BUT IT IS USUALLY MILD. IT OCCURS DURING ANNUAL
EPIDEMICS, BUT HAS NOT BEEN ASSOCIATED WITH PANDEMICS.
• - INFLUENZA C: CAUSES MILD DISEASE IN HUMANS AND IS NOT ASSOCIATED WITH EPIDEMICS.RARELY
REPORTED IN HUMANS.

32. • WHAT ARE THE SYMPTOMS OF INFLUENZA IN HUMANS?
• THE SYMPTOMS OF DIFFERENT FORMS OF INFLUENZA IN PEOPLE TEND TO BE
SIMILAR AND INCLUDE
• FEVER > 37.8°C
• SORE THROAT
• COUGH
• RUNNY NOSE
• CHILLS
• HEADACHE AND BODY ACHES
• FATIGUE
• SOME PEOPLE HAVE REPORTED NAUSEA, VOMITING AND DIARRHEA.

34. PATHOPHYSIOLOGY:-
INFLUENZA VIRUS
ENTERS THE RESPIRATORY SYSTEM FROM AN INFECTED INDIVIDUAL THROUGH RESPIRATORY DROPLETS
↓
THE VIRUS ATTACHES TO AND REPLICATES IN COLUMNAR EPITHELIAL CELLS THE VIRUS REPLICATES IN CELLS OF
BOTH UPPER AND LOWER RESPIRATORY TRACT
THE VIRAL REPLICATION COMBINES WITH THE IMMUNE RESPONSE (BOTH HUMORAL AND CELL MEDIATED )TO
INFECTION
LEADS TO DESTRUCTION AND LOSS OF CELLS LINING OF THE RESPIRATORY TRACT
RELEASE OF CYTOKINES
SYMPTOMS SUCH AS SORE THROAT, RUNNY NOSE, COUGH.

36. • INFLUENZA DIAGNOSIS
• CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS
• ISOLATION OF INFLUENZA VIRUS FROM CLINICAL SPECIMEN (E.G.,
NASOPHARYNX, THROAT, SPUTUM)
• SIGNIFICANT RISE IN INFLUENZA IGG BY SEROLOGIC ASSAY
• DIRECT ANTIGEN TESTING FOR TYPE A VIRUS

37. • TREATMENT OF INFLUENZA
• MOST PEOPLE WITH INFLUENZA WHO ARE OTHERWISE HEALTHY DO NOT NEED
SPECIAL DRUGS OR TREATMENTS. IF YOU HAVE INFLUENZA, YOU SHOULD:
REST
• DRINK LOTS OF FLUIDS
• EAT A LIGHT DIET
• STAY AT HOME
• TAKE APPROPRIATE MEDICINES
• ANTIVIRAL MEDICATION
• ANTIVIRAL DRUGS
• ANTIVIRAL TREATMENT LAST FOR 3-5 DAYS AND MUST BE STARTED WITH IN
THE FIRST 2 DAYS OF ILLNESS.

38. • PREVENTING THE FLU
• ANNUAL INFLUENZA VACCINATION IS THE BEST WAY TO PREVENT THE FLU
• THE FOLLOWING HYGIENE MEASURES CAN HELP PREVENT THE SPREAD OF
THE FLU
• COVER YOUR NOSE AND MOUTH WHEN YOU COUGH OR SNEEZE
• USE A TISSUE INSTEAD OF A HANDKERCHIEF TO BLOW YOUR NOSE
• WASH HANDS OFTEN WITH SOAP AND WATER
• USE ALCOHOL-BASED HAND RUBS, WHEN SOAP AND WATER ARE
UNAVAILABLE2
• AVOID TOUCHING YOUR FACE; ESPECIALLY YOUR EYES, NOSE, AND MOUTH
• LIMIT CONTACT WITH OTHERS WHEN SICK

39. THANK YOU