The content of the slide is taken by referencing various textbook of social and preventive pharmacy.

1. 1. SEVEREACUTE RESPIRATORYSYNDROME
2. EBOLAVIRUS
3. INFLUENZA
Social and Preventive Pharmacy

2. SEVEREACUTE RESPIRATORYSYNDROME
Social and Preventive Pharmacy

3. Severe acute respiratory syndrome (SARS) is a viral respiratory illness in which the lungs inflamed and
there is difficulty in breathing and has been associated with infection of one of the corona virus named as
SARS CoV.
The disease first emerged in china in November 2002. SARS infections are not occurring now, although
they could reappear any time. Seven different kinds of coronavirus can infect humans.
Four of these are common; the three other coronaviruses are highly infectious and contagious which can
cause: SARS, Middle East Respiratory Syndrome (MERS) and Covid-19.
Transmission of SARS
1. By Large droplet transmission
2. By Saliva exchange (Sharing drinks)
3. By skin to skin contacts (Handshake)
4. By touching a contaminated surface
5. By airborne droplets of respiratory tract
6. Sharing utensils for eating and drinking
7. Speaking to others within 3 feet distance
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4. Most people suffering from SARS developed symptoms which mimic pneumonia while very less chances of
having long term organ damage such as kidney, liver, lung and heart damage.
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Fig.:1 Factors affecting and symptoms of SARS

5. Diagnostic tests for SARS
Diagnostic Test Characteristic
Blood tests - CBC: Leukopenia ( reduction in WBC count) is common in most of SARS patients
- Lactate dehydrogenase level elevated ( used to screen tissue damage)
- Creatine kinase level elevated
Blood and sputum
cultures
- Blood culture: Negative for a bacterial infection
- Sputum culture: Negative for growth of streptococcus pneumonia and for influenza virus.
- Immuno-fluorescent antibody staining Test-This test is for nasopharyngeal virus and it
would be negative.
Chest X-ray - 20% to 25% of cases have a normal chest X-ray.
- Viral pneumonia has no typical imaging patterns.
-Small or large patchy shadows with intensive density in both lungs were observed in X-ray
observations.
Pulse Oximetry - For a healthy person, SpO2 values usually fall between 94-96%.
- If a person is infected with SARS, the oxygen carrying capacity decreases and so this
value falls below 90.
Arterial Blood Gas -Performed when the SpO2 measured with pulse oximetry is <90%.
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6. Prevention
1. Quick and accurate identification of SARS positive persons, their exposure and contacts.
2. Isolation of the individual travelling from affected countries or potential carriers.
3. Restriction of traveling from affected country.
4. Effective isolation of SARS patients in hospitals.
5. Appropriate protection of medical staff with all precautionary measurement treating these patients.
6. Simple hygienic measures such as hand-washing after touching patients, use of appropriate and well-
fitted masks, and introduction of infection control measures.
7. Timely and accurate reporting and sharing of information with other authorities and/or governments.
8. Spreading awareness among public.
9. Special care must be given to the immunocompromised and other disease affected persons.
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7. Some specific measures can be followed to prevent spread of SARS:
a. Washing of hands
b. Wash/clean hadns frequently with soap and hot water or use an alcohol-based hand sanitiser containing
at least 60% alcohol.
c. Wear hand gloves
d. Wear disposable hand gloves before contact with the person's body fluids or feces.
e. Wear a surgical mask
f. Wear surgical mask to cover mouth and nose and wearing eyeglasses may also offer some protection.
g. Wash personal items
h. Use soap and hot water to wash the utensils, towels, bedding and clothing of someone with SARS.
i. Wash/clean surface with Disinfect
j. Use a household disinfectant to clean any suspected surfaces.
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8. Control
1. SARS spread can be controlled by following standard guidelines for the communicable diseases. There
is no confirmed treatment that works for every person who has SARS. Antiviral medications and
steroids are sometimes given to reduce lung swelling, but aren’t effective for everyone.
2. Oxygen supplement or a ventilator may be prescribed as per the need.
3. In severe cases, blood plasma of the SARS recovered patient may also be administered.
4. Maintenance of good immunity, consumption of nutrient diet, consumption of vitamins especially C
and E with yoga and exercises help in fighting with SARS.
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9. EBOLA
Social and Preventive Pharmacy

10. Ebola Virus Disease (EVD) is also known as Ebola haemorrhagic fever, it’s a rarely occurring deadly disease in people
and nonhuman primates. The first occurrence of Ebola was noted in Zaire and Sudan in 1976. Ebola belongs to Filoviridae
family that consists of 5 distinct species-Zaire ebolavirus; Reston ebolavirus; Sudan ebolavirus; Tai ebolavirus; and
Bundibugyo ebolavirus.
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11. Sign and Symptoms of Ebola
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12. Mode of Transmission:
It can be transmitted through:
1. Direct contact with patients’ blood and body fluids
2. Use of the items such as clothes, bedding, needles, and medical equipment that are in contact with the
patient.
3. Direct contact with or consumption of food in contact with bats, forest antelopes, and nonhuman
primate blood, fluids, or raw meat prepared from these or unknown animals (bushmeat).
Diagnosis
Ebola virus disease (EVD) symptoms are similar with the malaria and typhoid fever so symptomatic
diagnosis may not be concrete. Hence some additional investigations are required to perform Polymerase
chain reaction which is effective method to detect Ebola virus in small amount of blood sample.
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13. Other less known laboratorial diagnosis tests for EVD are:
1. Antigen- capture detection tests
2. Serum neutralization test
3. Reverse transcriptase polymerase chain reaction (RT-PCR) assay
4. Electron microscopy
5. Virus isolation by cell culture
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14. Preventive measures
1. Avoid any direct contact with patients’ blood and body fluids (such as urine, feces, saliva, sweat, vomit,
breast milk, amniotic fluid, semen, and vaginal fluids).
2. Do not use items such as clothes, bedding, needles, and medical equipment that are in contact with the
patient.
3. Avoid funeral or burial practices that involve touching the body of someone who died from EVD or
suspect EVD.
4. Avoid contact with bats, forest antelopes, and nonhuman primates blood, fluids, or raw meat prepared
from these or unknown animals (bushmeat).
5. Avoid visits to the EVD affected area. If visited to affected area or came in contact with EVD patient,
should monitor their health for 21 days and seek medical care immediately.
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15. Treatment of Ebola
No specific treatment available for the treatment of Ebola virus disease. There are so many supportive
care and treatment available for this disease but any no one is accurate and precise method of treatment.
Some suggested supportive treaments includes:
Frequent dehydration and oral rehydration should be done with a view to remove infectious matter from
body by using electrolytes or IV fluids.
Replacing lost blood.
Maintaining oxygen status and blood pressure.
Experimental serum injection into IV which helps to destroy the infected cells.
Treating other complicating infections if they occur.
Timely treatment of Ebola is difficult to diagnosed at early stage. Ebola has complicated symptoms
which can be confused with other infectious disease.
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16. Treatment of Ebola
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Some treatments are recommended for the disease are shown in the table:

17. Control
Therapeutic approach, Currently Food and Drug Administration (FDA) approved two treatments are
available to treat EVD caused by the Ebola virus. The first drug Inmazeb™, a combination of three
monoclonal antibodies approved in October 2020. The second drug, Ebanga™, is a single monoclonal
antibody approved in December 2020.
Supportive Care
1. Oral or intravenous fluid and electrolyte supplementation.
2. Use of antihypertensive for lowering elevated blood pressure, antiemetic-reduce vomiting and anti-
diarrhoeal, analgesic-pain killer and antipyretics-reduce fever.
3. Treating other infections, if they occur.
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18. INFLUENZA
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19. Influenza is an acute respiratory tract infection caused by influenza virus (strain A, B and C), All known
pandemics were caused by influenza A strains. Worldwide, these annual epidemics are estimated to result in
about 3 to 5 million cases of severe illness and about 290 000 to 650 000 respiratory deaths. The incubation
period is 1-4 days (average 2days).
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20. 20
Common signs and symptoms of the flu include:
1. Chills, fever, and sweat
2. Headache, muscles ache
3. Dry, persistent cough
4. Shortness of breath
5. Tiredness and weakness
6. Sore throat, runny or stuffy nose
7. Eye pain
8. Vomiting and diarrhoea (children)

21. People at higher risk of developing flu complications include:
1. Age
Children under age 5yrs of ag (especially under 6 months) and Adults older than age 65
2. Occupation
Health care worker or persons with residents of nursing homes and other long-term care facilities
3. Pregnancy
Pregnant women (2nd and 3rd Trimester) and women up to two weeks after giving birth
4. Immune system
People with weakened immune systems
5. Disease state
Patient with chronic illnesses, such as asthma, AIDS, heart disease, kidney disease, liver disease, and diabetes can
tremendously increase risk of influenza infection.
6. Life style disorders
It includes obesity, person with a body mass index (BMI) of 40 or higher, Illnesses range from mild to severe and
even death. Hospitalization and death occur mainly among high risk groups. Worldwide, these annual epidemics
are estimated to result in about 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory
deaths
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22. Mode of transmission
Coughing or sneezing by infected person disperse infectious droplets into the air and can infect person
breathe under 1 meter area. It can also transmit through the contaminated hands with influenza.
Diagnosis
1. Symptomatic diagnosis is the predominant mean of diagnosis of human influenza. However, co-existing
infection of other respiratory viruses like rhinovirus, respiratory syncytial virus, parainfluenza and
adenovirus may show Influenza-like Illness (ILI) which makes diagnosis ambiguous.
2. Then confirmation is done by analysis of appropriate sample collected from throat, nasal and
nasopharyngeal secretions or tracheal aspirate or washings.
3. Sample can be used for direct antigen detection, virus isolation, or detection of influenza-specific RNA
by reverse transcriptase-polymerase chain reaction (RT-PCR). A specific rapid influenza diagnostic test
(RIDTs) is available which less sensitive than RT-PCR method.
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Diagnosis Characteristics
Serological Complement Fixation Test and Haemagglutination Inhibition
Assessing antibody (IgG) level in serum samples
Virus Isolation Isolation of virus from nasopharynx, throat or sputum
Rapid Diagnosis by
immunofluorescence
Antigen detection tests by using methods such as Direct fluorescent assay,
Indirect Fluorescent assay and Rapid Immunofluorescence Assay (RIDT)
Moderate sensitive and high specificity.

23. Prevention
1. Regular hand washing with proper drying of the hands
2. To prevent transmission a good respiratory hygiene–covering mouth and nose when coughing or
sneezing, using tissues and disposing of them correctly
3. Early self-isolation of those feeling unwell, feverish and having other symptoms of influenza
4. Avoiding close contact with sick people
5. Avoiding touching one’s eyes, nose or mouth.
6. Good ventilation of public buildings, the avoidance of crowded places during epidemics Wearing mask
at least by sufferer, encouraging them to use handkerchief while coughing and sneezing.
7. Stay home stay safe.
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24. 1. Vaccination is the most effective way to prevent the disease. An annual dose of inactivated influenza
vaccine is recommended to protect against influenza.
2. In elderly vaccine may be ineffective in preventing illness but reduces severity of disease and incidence
of complications and deaths while healthy adults become immune after vaccination. Vaccination is
especially important for people at high risk of influenza complications.
3. Vaccination may or may not be much successful because of the continuous mutation in influenza virus
strain hence WHO recommend adding the new strain in the vaccine to provide the better protection.
Vaccination is 70-90% effective only when taken before 2-3 month of influenza.
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25. Patients with uncomplicated seasonal influenza
1. Symptomatic treatment can be given to the patients focusing on symptoms like fever. Symptomatic
patients are advised to stay at home to avoid the further community spread. Patient from high risk
category or with chances of developing the severe illness provide with special care and are treated with
antivirals in addition to symptomatic treatment as soon as possible.
2. Neuraminidase inhibitors (i.e. oseltamivir) must be given within 48 hours of symptom onset, to
maximize therapeutic benefits. The treatment suggested for a minimum of 5 days, but can be extended
as per the need.
3. WHO- Global Influenza Surveillance and Response System (GISRS) monitors resistance to antivirals
among circulating influenza viruses to provide timely guidance for antiviral use in clinical management
and potential chemoprophylaxis.
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26. THANK YOU
ANY QUERY?
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