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Novel H1 N1 Flu Infection


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Novel H1 N1 Flu Infection

  1. 1. Novel Influnza A H1N1 virus Infection
  2. 2. Swine Flu Background <ul><li>Contageous respiratory disease with mild to severe symptoms. </li></ul><ul><li>Human to human transmission like seasonal influenza via sneezing coughing, etc. </li></ul><ul><li>The first outbreak in 1918 called “Spanish influenza pandemic affecting 1/3 of world population (500 million) with 50 million deaths. </li></ul>
  3. 3. Swine Flu Background <ul><li>Second outbreak in 1976 in New Jersey </li></ul><ul><li>Vaccination halted after 40 million vaccination due to appearance of Guillain-Barre Syndrome and 25 deaths. </li></ul><ul><li>Increased flu risk in pregnant women, particularly during the second and third trimesters. </li></ul><ul><li>Increased risk of fetal death or spontaneous abortions in infected pregnant women. </li></ul>
  4. 4. Novel H1N1 flu infection <ul><li>From April 15, 2009 to July 24, 2009, it is estimated that more than one million people became ill with novel H1N1 flu in the United States. </li></ul><ul><li>From April 15, 2009 to July 24, 2009, a total of 43,771 confirmed and probable cases of novel influenza A (H1N1) infection were reported. </li></ul><ul><li>Of these cases reported, 5,011 people were hospitalized and 302 people died. </li></ul><ul><li>In India 782 cases reported 511 cured 4 deaths. </li></ul>
  5. 5. Novel H1N1 flu Global Map    confirmed death and infections    confirmed infections    unconfirmed infections
  6. 6. Swine Flu Features <ul><li>Duration 4 – 6 days. </li></ul><ul><li>Infectious period – 1 day prior to onset of symptoms to 7 days after onset. </li></ul><ul><li>Suspect in pt who present with febrile respiratory illness </li></ul><ul><li>Onset within 7 days of close contact with confirmed infection. </li></ul><ul><li>Onset within 7 days of travel to areas where sustained human transmission exists </li></ul><ul><li>Acute illness in person who resides in community where atleast 1 confirmed case. </li></ul>
  7. 7. Symptoms and Complications <ul><li>Symptoms of swine flu are similar to influenza infections. </li></ul><ul><li>Strong immune response may cause some collateral tissue damage. </li></ul><ul><li>Majority (about 90%-95%) of people feel terrible but recover with no problems. </li></ul><ul><li>Some patients develop severe respiratory symptoms and need respiratory support. </li></ul><ul><li>Patients may get pneumonia (bacterial secondary infection) if the viral infection persists, and some develop seizure. </li></ul><ul><li>Death often occurs from secondary bacterial infection of the lungs; appropriate antibiotics need to be used in these patients. Mortality Rate – 1% - 6% </li></ul>
  8. 8. Novel Influenza A H1N1 virus <ul><li>Novel H1N1 virus is also called “swine flu” because many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine). </li></ul><ul><li>It has two genes from flu viruses that normally circulate in pigs, bird (avian) genes and human genes. </li></ul><ul><li>Scientists call this a &quot;quadruple reassortant&quot; virus. </li></ul>
  9. 9. Symptoms in hospitalized novel H1N1 flu patients Symptom Number (%) Fever* 249 (93%) Cough 223 (83%) Shortness of breath 145 (54%) Fatigue/Weakness 108 (40%) Chills 99 (37%) Myalgias 96 (36%) Rhinorrhea 96 (36%) Sore Throat 84 (31%) Headache 83 (31%) Vomiting 78 (29%) Wheezing 64 (24%) Diarrhea 64 (24%)
  10. 10. Signs of Emergency <ul><li>Novel H1N1 swine flu can progress rapidly. </li></ul><ul><ul><li>Shortness of breath, either during physical activity or while resting, difficulty in breathing, turning blue, bloody or colored (not clear) sputum, chest pain. </li></ul></ul><ul><ul><li>Altered mental status. </li></ul></ul><ul><ul><li>High fever that persists beyond three days. </li></ul></ul><ul><ul><li>Low blood pressure. </li></ul></ul><ul><ul><li>In children, danger signs include fast or difficult breathing,. </li></ul></ul>
  11. 11. Emergency in Children <ul><li>In children, emergency warning signs are: </li></ul><ul><ul><li>Fast breathing or trouble breathing </li></ul></ul><ul><ul><li>Bluish or gray skin color </li></ul></ul><ul><ul><li>Not drinking enough fluids </li></ul></ul><ul><ul><li>Severe or persistent vomiting </li></ul></ul><ul><ul><li>Not waking up or difficulty in waking up, not interacting , lack of alertness, little or no desire to play. </li></ul></ul><ul><ul><li>Being so irritable that the child does not want to be held </li></ul></ul><ul><ul><li>Flu-like symptoms improve but then return with fever and worse cough </li></ul></ul>
  12. 12. Emergency in Adults <ul><li>In adults, emergency warning signs are: </li></ul><ul><ul><li>Difficulty breathing or shortness of breath </li></ul></ul><ul><ul><li>Pain or pressure in the chest or abdomen </li></ul></ul><ul><ul><li>Sudden dizziness </li></ul></ul><ul><ul><li>Confusion </li></ul></ul><ul><ul><li>Severe or persistent vomiting </li></ul></ul><ul><ul><li>Flu-like symptoms improve but then return with fever and worse cough </li></ul></ul>
  13. 13. Care for Swine Flu <ul><li>Sick patient </li></ul><ul><li>Bed rest, increased fluid consumption, cough supressants, analgesic antipyretics, avoid close contact, wash hands after contact, avoid touching eyes, nose and mouth. </li></ul><ul><li>Self isolate in home for 7 days or more if flu like symptom. </li></ul><ul><li>Wear face mask, if going out. </li></ul><ul><li>Seek medical help if breathing difficulty or severe illness. </li></ul>
  14. 14. Care for Swine Flu <ul><li>Household not sick </li></ul><ul><li>Remain at home at the earliest signs of sicknes. </li></ul><ul><li>Minimize contact with community </li></ul><ul><li>Designate single family member as care taker. </li></ul><ul><li>Wash hands with soap and water frequently. </li></ul><ul><li>Do not use utensils and linen used by patient, without washing. </li></ul>
  15. 15. Novel H1N1 flu infection <ul><li>Estimated community rate of influenza-like-illness approximately 6% - 6.9% of the population. </li></ul><ul><li>Causes greater disease burden on people younger than 25 years of age than older people . </li></ul><ul><li>Greater risk of serious flu-related complications in pts of asthma, diabetes, heart disease, kidney disease, suppressed immune system, neurocognitive, neuromuscular disorder, obesity, age group <5 and >65 yr and pregnancy. </li></ul><ul><li>The generation time </li></ul><ul><ul><li>acute respiratory illness (ARI) - 2.0-3.1 days </li></ul></ul><ul><ul><li>influenza like illness (ILI) - 2.4-3.1 days . </li></ul></ul><ul><li>A secondary attack rate in household contacts </li></ul><ul><ul><li>For acute-respiratory-illness (ARI) - 18 % to 19% </li></ul></ul><ul><ul><li>For influenza-like-illness (ILI) - 8% to 12%. </li></ul></ul>
  16. 16. Preventive Care <ul><li>People infected with novel H1N1 flu shed virus may be able to infect others from 1 day before getting sick to 5 to 7 days after. </li></ul><ul><ul><li>Cover nose and mouth with a tissue when you cough or sneeze. </li></ul></ul><ul><ul><li>Wash hands often with soap and water, especially after you cough or sneeze. </li></ul></ul><ul><ul><li>Avoid touching eyes, nose or mouth. </li></ul></ul><ul><ul><li>Try to avoid close contact with sick people. </li></ul></ul><ul><ul><li>If sick with flu-like illness, stay home for at least 24 hours after your fever is gone. </li></ul></ul><ul><ul><li>Healthy person with an ill family member at home can go to work as usual with daily health monitoring and precautions. </li></ul></ul>
  17. 17. Novel H1N1 flu infection <ul><li>Case Rate </li></ul><ul><li>Hospitalization Rate </li></ul>
  18. 18. Mortality in 268 Hospitalized Patients
  19. 19. Contamination & Cleaning <ul><li>Virus can survive on surfaces and can infect a person for 2 to 8 hours after being deposited on the surface. </li></ul><ul><li>Virus is destroyed by heat (167-212°F [75-100°C, chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols. </li></ul><ul><li>Virus spread when a person touches something that is contaminated and then touches his or her eyes, nose, or mouth. </li></ul>
  20. 20. Contamination & Cleaning <ul><li>Novel H1N1 viruses are not spread by food. </li></ul><ul><li>Tap water that has been treated by conventional disinfection processes does not spread the virus. </li></ul><ul><li>Chlorine treated water in swimming pool water parks does not spread the virus but recreational water venues can. </li></ul>
  21. 21. Contamination & Cleaning <ul><li>To prevent the spread of influenza virus </li></ul><ul><ul><li>keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean with a household disinfectant. </li></ul></ul><ul><ul><li>Linens, eating utensils, and dishes should not be shared without washing thoroughly with soap and water first. </li></ul></ul><ul><ul><li>Wear face mask when moving in public places </li></ul></ul>
  22. 22. Recommended treatment and Prophylaxis <ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>Same as those recommended for seasonal influenza </li></ul></ul></ul><ul><ul><ul><li>Oseltamivir, zanamivir ( amantadine, rimantadine) for 5 days. </li></ul></ul></ul><ul><ul><ul><li>Start drug treatment within 48 hours of onset of symptoms. </li></ul></ul></ul><ul><li>Chemoprophylaxis </li></ul><ul><ul><li>Oseltamivir, zanamivir for 7 days after the last known exposure to an ill confirmed case. </li></ul></ul><ul><ul><li>Household close contacts who are at high-risk for complications. </li></ul></ul><ul><ul><li>School children who had close contact (face-to-face) with a confirmed or suspected case. </li></ul></ul><ul><ul><li>Travel to infection areas if at high-risk for complications. </li></ul></ul><ul><ul><li>Health care workers or public health workers who had unprotected close contact with an ill confirmed case. </li></ul></ul>
  23. 23. Preventive measures in School <ul><li>Stay home when sick for at least7 days or for 24 hours after no fever, or signs of fever. </li></ul><ul><li>Students who have an ill household member should stay home for five days from the day the first household member got sick. </li></ul><ul><li>Separate ill students and staff and wear face mask. </li></ul><ul><li>Cover nose and mouth when coughing or sneezing. </li></ul><ul><li>Wash hands frequently with soap and water. </li></ul><ul><li>Frequent cleaning of areas that students and staff touch in routine manner. </li></ul><ul><li>Check students and staff for fever and other symptoms of flu daily. </li></ul><ul><li>Early treatment of high-risk students and staff. </li></ul><ul><li>Consideration of selective school closure. </li></ul>