H1 N1


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The new virus has made the jump from pigs to humans and has demonstrated it can also pass from human to human. This is why it is demanding so much attention from health authorities. The virus passes from human to human like other types of flu, either through coughing, sneezing, or by touching infected surfaces, although little is known about how the virus acts on humans.

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  • 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.
  • Influenza primarily infects the respiratory tract (nose, throat, and lungs). The disease can cause severe illness and lead to life-threatening complications, such as pneumonia, in many people.
  • 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.
  • Pregnant Women Oseltamivir and zanamivir are "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers' package inserts should be consulted. However, no adverse effects have been reported among women who received oseltamivir or zanamivir during pregnancy or among infants born to women who have received oseltamivir or zanamivir. Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Because of its systemic activity, oseltamivir is preferred for treatment of pregnant women.  The drug of choice for prophylaxis is less clear.  Zanamivir may be preferable because of its limited systemic absorption; however, respiratory complications that may be associated with zanamivir because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems. Adverse Events: http://www.cdc.gov/flu/professionals/antivirals/side-effects.htm
  • More information can be found at http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html
  • H1 N1

    1. 1. Swine Flu(H1N1) Dr Sujnanendra Mishra MD (O&G )
    2. 2. H1N1 Influenza <ul><li>last influenza pandemic in 1917 that accounted for 20 million deaths worldwide. </li></ul><ul><li>This time first cases of human infection with novel H1N1 influenza virus were detected in April 2009 in San Diego. </li></ul><ul><li>The virus is spreading rapidly. </li></ul><ul><li>The virus is widespread in the United States at this time and has been detected internationally including INDIA </li></ul>
    3. 3. The Virus H1N1 Influenza <ul><li>RNA, enveloped </li></ul><ul><li>Viral family: Orthomyxoviridae </li></ul><ul><li>Size: </li></ul><ul><li>80-200nm or .08 – 0.12 μm (micron) in diameter </li></ul><ul><li>Three types </li></ul><ul><ul><li>A, B, C </li></ul></ul><ul><ul><li>A, associated worldwide epidemics. B & C, not severe, no animal reservoir </li></ul></ul><ul><li>Surface antigens </li></ul><ul><ul><li>H (haemaglutinin) 16 Subtypes (H1,to H16 ) </li></ul></ul><ul><ul><li>N (neuraminidase) 9 Subtypes (N1 toN9 ) </li></ul></ul>
    4. 4. Signs and symptoms <ul><li>Symptoms of H1N1 flu are similar to those with seasonal flu. </li></ul><ul><ul><li>Running or stuffy nose </li></ul></ul><ul><ul><li>Cough </li></ul></ul><ul><ul><li>Sore throat </li></ul></ul><ul><ul><li>Fever , Chills </li></ul></ul><ul><ul><li>Body aches </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>vomiting (25%) and diarrhea (25%) have also been reported. </li></ul></ul>Acute Onset with febrile respiratory illness
    5. 5. How does H1N1 Influenza spread? <ul><li>This virus spreads the way seasonal flu spreads </li></ul><ul><li>Primarily through respiratory droplets </li></ul><ul><ul><li>Coughing </li></ul></ul><ul><ul><li>Sneezing </li></ul></ul><ul><ul><li>Touching respiratory droplets on yourself, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing hands </li></ul></ul>
    6. 6. How is A/H1N1 diagnosed? <ul><li>1. Clinical diagnosis. This involves physically examining the patient and taking a clinical history that may serve to determine if there are any signs and symptoms and if there was any close contact with any infected person(s) including family members. </li></ul><ul><li>2. Pathological diagnosis. This involves laboratory confirmation first of the A type influenza and then confirmation of H1N1 strain of virus. A/H1N1 is diagnosed by taking nasopharyngeal swabs of the suspected person(s). Swab samples are then subjected to Polymerase Chain Reaction analysis for RNA amplification, followed by RNA sequencing and typing. </li></ul>
    7. 7. H1N1 A GLOBAL ISSUE
    8. 8. <ul><li>1. Confirmed cases a. Influenza like illness b. Confirmation of flu like infection i. RT-PCR ii. Viral culture </li></ul><ul><li>2. Probable cases a. Influenza like illness b. Positive for influenza A c. Negative for H1 and H3 d. Confirmation by RT-PCR </li></ul><ul><li>3. Possible cases a. Previously healthy b. Less than 65 years c. Hospitalized for influenza like illness </li></ul>Swine Influenza A(H1N1) US Case Definitions
    9. 9. Swine Influenza A(H1N1) US Case Definitions <ul><li>Infectious period for a confirmed case of swine influenza A(H1N1) virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset </li></ul><ul><li>Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine influenza A(H1N1) virus infection during the case’s infectious period </li></ul><ul><li>Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness) </li></ul><ul><li>High-risk groups: A person who is at high-risk for complications of swine influenza A(H1N1) virus infection is defined as the same for seasonal influenza (see Reference) </li></ul>
    10. 10. Swine Influenza A(H1N1) <ul><li>Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who </li></ul><ul><ul><li>live in areas where human cases of swine influenza A(H1N1) have been identified or </li></ul></ul><ul><ul><li>have traveled to an area where human cases of swine influenza A(H1N1) has been identified or </li></ul></ul><ul><ul><li>have been in contact with ill persons from these areas in the 7 days prior to their illness onset </li></ul></ul><ul><li>If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer) </li></ul><ul><ul><li>once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory </li></ul></ul>
    11. 11. <ul><li>Covering nose and mouth with a tissue when coughing or sneezing </li></ul><ul><ul><li>Dispose the tissue in the trash after use . </li></ul></ul><ul><ul><li>or, Sneeze on to your sleeve above elbow </li></ul></ul><ul><li>Handwashing with soap and water </li></ul><ul><ul><li>Especially after coughing or sneezing. </li></ul></ul><ul><li>Cleaning hands with alcohol-based hand cleaners </li></ul><ul><li>Avoiding close contact with sick people </li></ul><ul><li>Avoiding touching eyes, nose or mouth with unwashed hands </li></ul><ul><li>If sick with influenza, staying home from work or school and limit contact with others to keep from infecting them </li></ul>Swine Influenza A(H1N1)
    12. 12. Swine Influenza A(H1N1) Treatment <ul><li>No vaccine available </li></ul><ul><li>Antivirals for the treatment and/or prevention of infection : </li></ul><ul><ul><li>Oseltamivir (Tamiflu) or </li></ul></ul><ul><ul><li>Zanamivir (Relenza) </li></ul></ul><ul><li>Use of anti-virals can make illness milder and recovery faster </li></ul><ul><li>They may also prevent serious flu complications </li></ul><ul><li>For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms) </li></ul><ul><li>Warning! Do NOT give aspirin ( acetylsalicylic acid ) or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) to children or teenagers (up to 18 years old) who are confirmed or suspected ill case of swine influenza A (H1N1) virus infection; this can cause a rare but serious illness called Reye’s syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs . </li></ul>
    13. 13. Swine Influenza A(H1N1) Treatment Source: CDC Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatment dose for 5 days. <3 months: 12 mg twice daily; 3-5 months: 20 mg twice daily; 6-11 months: 25 mg twice daily Dosing recommendations for antiviral chemoprophylaxis of children younger than 1 year using oseltamivir. Recommended prophylaxis dose for 10 days. <3 months: Not recommended unless situation judged critical due to limited data on use in this age group; 3-5 months: 20 mg once daily; 6-11 months: 25 mg once daily Oseltamivir (Tamiflu) Zanamivir (Relenza) Treatment Prophylaxis Treatment Prophylaxis Adults 75 mg capsule twice per day for 5 days 75 mg capsule once per day Two 5 mg inhalations (10 mg total) twice per day Two 5 mg inhalations (10 mg total) once per day Children 15 kg or less: 60 mg per day divided into 2 doses 30 mg once per day Two 5 mg inhalations (10 mg total) twice per day (age, 7 years or older) Two 5 mg inhalations (10 mg total) once per day (age, 5 years or older) 15–23 kg: 90 mg per day divided into 2 doses 45 mg once per day 24–40 kg: 120 mg per day divided into 2 doses 60 mg once per day >40 kg: 150 mg per day divided into 2 doses 75 mg once per day
    14. 14. Swine Influenza A(H1N1) O ther Protective Measures <ul><li>Defining Quarantine vs. Isolation vs. Social-Distancing </li></ul><ul><ul><li>Isolation : Refers only to the sequestration of symptomatic patents either in the home or hospital so that they will not infect others </li></ul></ul><ul><ul><li>Quarantine : Defined as the separation from circulation in the community of asymptomatic persons that may have been exposed to infection </li></ul></ul><ul><ul><li>Social-Distancing : Has been used to refer to a range of non-quarantine measures that might serve to reduce contact between persons, such as, closing of schools or prohibiting large gatherings </li></ul></ul>Source: CDC
    15. 15. Swine Influenza A(H1N1) O ther Protective Measures <ul><li>Infection Control of Ill Persons in a Healthcare Setting </li></ul><ul><li>Standard, 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.  Maintain adherence to hand hygiene by washing with soap and water or using hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions. </li></ul><ul><li>Personnel providing care to or collecting clinical specimens from suspected or confirmed cases should wear disposable non-sterile gloves, gowns, and eye protection (e.g., goggles) to prevent conjunctival exposure. </li></ul>Source: CDC
    16. 16. <ul><li>Infection Control of Ill Persons in a Healthcare Setting </li></ul><ul><li>Patients with suspected or confirmed case-status should be placed in a single-patient room with the door kept closed.  If available, an airborne infection isolation room (AIIR) with negative pressure air handling with 6 to 12 air changes per hour can be used. Air can be exhausted directly outside or be recirculated after filtration by a high efficiency particulate air (HEPA) filter. For suctioning, bronchoscopy, or intubation, use a procedure room with negative pressure air handling. </li></ul><ul><li>The ill person should wear a surgical mask when outside of the patient room , and should be encouraged to wash hands frequently and follow respiratory hygiene practices. Cups and other utensils used by the ill person should be washed with soap and water before use by other persons. Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of swine influenza. </li></ul>Swine Influenza A(H1N1) O ther Protective Measures Source: CDC
    17. 17. What can you do to stop spreading…. <ul><li>Wash your hands frequently and thoroughly. Use soap and warm water when available; use hand sanitizer between hand washings. </li></ul><ul><li>Avoid close contact with sick people. Close contact means getting within 6 feet of a sick person. </li></ul><ul><li>Use the face mask properly and throw it away after use. Though It's not known whether face masks protect 100% against infection. </li></ul>Stay Safe……
    18. 18. Avoid spreading the swine flu virus: <ul><li>Stay home if you are sick. </li></ul><ul><li>Don't cough or sneeze into your hands. Instead Cough/sneeze into a tissue -- or, your sleeve above elbow. </li></ul><ul><li>If you can do so comfortably, wear a face mask if you come into contact with others. </li></ul><ul><li>Allow Special leave for workers for staying home if sick or for caring for sick children. </li></ul><ul><li>Encourage Hand washing at home and workplace </li></ul>Have it everywhere
    19. 19. NO HANDSHAKE PLEASE !! SAY NAMASTE !! Wash your hands frequently and thoroughly. wear a face mask, if available and tolerable,
    20. 20. NAMASKAR