H1 N1 Influenza A virus, its Transmission Indoor Air & Role of HVAC

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2003 outbreak

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H1 N1 Influenza A virus, its Transmission Indoor Air & Role of HVAC

  1. 1. H1N1 Influenza A Virus,H1N1 Influenza A Virus, It's Transmission in Indoor AirIt's Transmission in Indoor Air & Role of HVAC& Role of HVAC By Dr Anjum Hashmi MBBS,CCS(USA),MPH Infection Control Director Maternity & Children’s Hospital Najran KSA
  2. 2. Airborne Germ Bacteria vs. Viruses
  3. 3. Influenza A virus & the way it kills • Influenza A causes disease primarily in lungs as it infects the lower respiratory system. It multiply at 98.6o F which is the temperature of LRT. • It is not a Rhinovirus which primarily causes infection in nose and upper respiratory system. Rhinovirus multiply at 93o F which is the temperature of URT. • Influenza A virus infects and destroys lung tissue leading to pneumonia or massive bacterial infection. • Victim may die from staph infections like MRSA.
  4. 4. Manifestations of H1N1 Influenza (swine flu) • These are similar to those of seasonal influenza. • Patients present with symptoms of acute respiratory illness, including at least 2 of the following: • Fever • Cough • Sore throat • Body aches • Headache • Chills and fatigue • Diarrhea and vomiting (possible)
  5. 5. Manifestations of H1N1 Influenza (swine flu) • In children, signs of severe disease include apnea, tachypnea, dyspnea, cyanosis, dehydration, altered mental status, and extreme irritability. • Influenza should be considered as a diagnosis in children with neurologic symptoms, even when few or even no respiratory symptoms are noted. • The duration of illness is typically 4-6 days. • The infectious period is form 1 day prior to the onset of symptoms to 7 days after onset.
  6. 6. CDC criteria for suspected H1N1 Influenza • Onset of acute febrile respiratory illness within 7 days of close contact with a person who is a confirmed case of H1N1 influenza A virus infection. or • Onset of acute febrile respiratory illness within 7 days of travel to a community (locally/internationally) where one or more H1N1 influenza A cases have been confirmed. or • Acute febrile respiratory illness in a person who resides in a community where at least one H1N1 influenza case has been confirmed.
  7. 7. Toilet water Viral Aerosolization • Since 1959, many studies have documented how a toilet flush aerosolizes bacteria and viruses into the air above the bowl…. • British Scientist John Barker in 2005, replicated the viral load and consistency of diarrhea. He flushed the toilet and took air samples to capture the aerosolized droplets. • Samples were full of thousands of viruses. • He was surprised by the fact that samples taken after 30 minutes of each flush contains more viruses, means porcelain is porous enough to harbor viruses (and bacteria also.)
  8. 8. Toilet water Viral Aerosolization • The 2003 SARS epidemic has showed the lethality of toilet water aerosolization in following conformed & published accounts: • 1. Liu Jianlun was the Chinese Doctor who initiated the worldwide SARS epidemic when he stayed in Hong Kong at The Metropole Hotel in February 2003. • Infected with SARS and having diarrhea, he probably infected 12 fellow hotel guests through toilet water aerosolization. • These travelers flew around the world and one brought SARS to Toronto thereby devastating the city.
  9. 9. Airborne SARS Transmission at The Metropole Hotel 22 Feb.2003
  10. 10. Toilet water Viral Aerosolization • 2. Wang Kaixi was infected with SARS at the same hospital which was treating a SARS infected patient who visited a hotel guest’s whose room was on the same floor where Dr Liu Jianlun stayed at the Metropole hotel. • Infected with SARS and having diarrhea, he probably infected over 200 fellow residents through toilet water aerosolization. • Many were over 160 feet away from his apartment but on same floor.
  11. 11. Airborne SARS Transmission at Amoy Gardens Apartments 19-20 March 2003
  12. 12. WHY IS THERE A FLU SEASON?? • Does Flu take a vacation in each summer? • Are there Flu epidemics in Summer? • What changes in late spring & summer occur which reduces flu morbidity and mortality? • Is indoor Humidity goes in winter Up! • NO
  13. 13. Low Indoor Humidity Increases Droplet Nuclei Levels (winter) ● Viruses Evaporate faster in Low Humidity levels thus creating More Droplet Nuclei. ● Low humidity allows droplet nuclei to stay airborne longer. ● Indoor Air currents both created by HVAC systems and people movement assure that droplet nuclei will remain airborne Indefinitely. ● This allows HVAC systems to remove and redistribute droplet nuclei throughout the building to infect more occupants.
  14. 14. Correlation between low indoor humidity & increased influenza morbidity & mortality in winter • 1. Indoor humidity levels in the Northern Hemisphere especially in North America and Europe are between 15-35%. • 2. Studies have showed that there is no “flu season” in the tropics where indoor humidity levels stay above 40% year long. • 3. This logic gives the correlation of airborne droplet nuclei creation and available contagion.
  15. 15. WHAT SYSTEMS ARE AVAILABLE TO STERILIZE, CAPTURE AND/OR KILL AIRBORNE FLU VIRUSES? • 1. MERV Rated Filters, H.E.P.A. • 2. Germicidal UV Lights • 3. Cold Plasma Bi-Polar Ionization. • 4. Photo-Catalytic Oxidation(PCO).
  16. 16. Mechanical Filters Used in our Home/office HVAC system • MERV 1 or 2 filters which used in our home/offices are nearly worthless in capturing airborne human germs. • The higher the MERV rating, like a MERV 13 than, a mechanical filter really reduce airborne viruses.
  17. 17. Mechanical Air Filters can trap this % of Swine Flu Viruses
  18. 18. Ultraviolet Light and How does it work? • Ultraviolet Germicidal (germ-killing) light at “C”band (254 nanometers) frequency kills germs. • UV-C light sterilizes germs by destroying the A to T bond in their DNA. • This prevents them from replicating and they die.
  19. 19. Airborne Flu viruses can be captured & sterilized with a combination of MERV Filter & UV-C Light • Adding filters and UV together in successive layers can provide a lethal force to prevent distribution of airborne viruses. • A MERV 16 alone can get 76% capture /sterilize rate. • Adding UV lamps we can achieve a total single pass capture/sterilize of 99.9%.
  20. 20. Proactive Droplet Nuclei Infection Prevention
  21. 21. Photocatalytic Oxidation (PCO) and Bi-Polar Ionization & How do they work? • Photcatalytic Oxidation is created when Ultraviolet light photons strike Titanium Di-Oxide to create Hydroxyl radicals. These airborne Hydroxyl radicals destroys the cellular material of any virus/germs. • Bi-Polar Ionization is creates positively and negatively charged oxygen molecules which destroy the virus/germs by damaging their cell wall and inner cellular material.
  22. 22. Air Filters, UV Lights, Photocatalytic Oxidation (P.C.O.) & Bi-Polar Ionization Can Kill, Sterilize & Capture Viral Droplet Nuclei
  23. 23. Preventive measures for Health Care Personnel • Place patients in a single-patient room with the door kept closed & air should be exhausted directly outside. • An isolation room with negative-pressure. • Patients should wear a surgical mask when outside their room. • Encourage patients to wash their hands frequently and to follow respiratory hygiene practices.
  24. 24. Preventive measures for Health Care Personnel • Standard, airborne, droplet, and contact precautions should be used for all patient care activities and maintained for 7 days after illness onset or until symptoms have resolved. • Health care personnel should wash their hands with soap and water or use hand sanitizer. • Routine environmental cleaning and disinfection strategies should be applied.
  25. 25. NEW STRAIN OF BIRD FLUNEW STRAIN OF BIRD FLU • In China a new strain of bird flu previously unknown in humans has emerged, this new strain of H7N9 bird flu is likely to be able to spread swiftly among human populations. • 18 cases of H7N9 bird flu confirmed in China, including six deaths until 7th April 2013. • Scientist said H7N9 virus is harder to track because of its ability to spread among poultry without showing any signs.
  26. 26. LL Ori and the Orion Nebula THANK YOU

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