It includes types of FLu and brief about it. It incorporated basics about Ebola infection and Swine flu infection. Level of presentation is for General practitioners and Lehman people..

1. FLU & You
Title page
December 11, 2014
Dr. Pruthvi Puwar
Consultant Physician
Sunshine Global Hospitals
Ph: 8866444474

4. The Forgotten Pandemic
The 1918 Flu Epidemic
http://www.fas.org/programs/ssp/bio/_images/fact_sheet/1918%20flu-1.jpg

5. http://www.whale.to/b/flumania.jpg

6. I had a little bird,
Its name was Enza,
I opened the window,
And in-flew-enza.
American Skipping Rhyme (circa 1918.)

7. It is estimated that anywhere from 20 to 100 million people were
killed worldwide. The pandemic is estimated to have affected up
to one billion people, half the world’s population at the time.
http://wpcontent.answers.com/wikipedia/commons/thumb/4/43/1918_flu_in_Oakland.jpg/180px-1918_flu_in_Oakland.jpg

8. Approximate Deaths
Worldwide Samples *
 India – 17 million
 Japan – 390,000
 U.S. – 675,000
 England – 250,000
 France – 400,000
 Canada – 50,000
* http://en.wikipedia.org/Flu_epidemic_of_1918

9. http://www.wellcome.ac.uk/stellent/groups/corporatesite/@msh_publishing_group/documents/image/wtd028181.jpg

10. This huge death toll was caused by an extremely high infection rate
of up to 50%, and the extreme severity of the symptoms.
.http://lass.calumet.purdue.edu/histpoly/bigott/CALUMETMUSEUMWEB/1918articles/oct25b.JPG

11. Swine Flu 2009
http://graphics8.nytimes.com/images/2009/04/25/world/25mexico2_600.jpg
http://www.huffingtonpost.com/huff-wires/20090428/us-swine-flu-us/images/bb79eda6-71a8-4416-b157-85fb902009af.jpg

12. Swine Flu 2009
http://images.huffingtonpost.com/gadgets/slideshows/1466/slide_1466_20818_large.jpg http://www.cbc.ca/gfx/images/news/photos/2009/04/25/passengers-masks-cp-250-661.jpg

13. Swine Flu 2009
http://media.cnbc.com/i/CNBC/Sections/News_And_Analysis/__Story_Inserts/graphics/__HEALTH/flu_outbreak3.jpg

14. Swine Flu 2009
http://graphics8.nytimes.com/images/2009/04/25/world/25mexicoA_xl.jpg http://www.huffingtonpost.com/huff-wires/20090426/med-swine-flu/images/147c4e39-87ba-49d8-ab1e-51e0e0757865.jpg

15. Notable Epidemic Survivors
Presidents Woodrow Wilson & Franklin D. Roosevelt
http://www.answers.com/topic/http://www.answers.com/topic/woodrow-wilson franklin-d-roosevelt

16. Spanish Flu Survivors
Silent film super-star Mary Pickford
Famed animator Walt Disney
http://www.answers.com/http://www.answers.com/topic/mary-pickford topic/walt-disney

17. Spanish Flu Survivors
U.S. General John J. Pershing, WWI
http://www.answers.com/topic/john-j-pershing-1
Wilhelm II, German Emperor, WWI
http://www.answers.com/topic/wilhelm-ii-of-germany

18. Notable Flu Survivor
Leo Szilard, Inventor
Nuclear Chain Reaction
http://www.answers.com/topic/le-szil-rd-2

20. October 30, 2009 in TOI

21. Overview of Today’s Presentation
 The important flu Basics everyone needs to
know
 The CDC recommends flu vaccination for
everyone age 6 months and older
 The flu can be life-threatening, especially in
older adults
–Our immune system weakens with age

22. What is Influenza/ Flu?
 Influenza, also called the flu
 Common respiratory infection
 Symptoms: high fever, headache, fatigue,
cough, sore throat, runny or stuffy nose, and
body aches
 The flu is a serious disease, especially for
adults age > 65

23. Types of Flu
 Three types of influenza virus: A, B, and C
 Different strains of influenza type A and B
virus can circulate from year to year and cause
illness
– There are many human and animal flu
strains, however only a few predominate and
cause human disease

24. Types of Flu
 Scientists predict which strains will circulate and
should be included in the flu vaccine each year
– The 2012-13 seasonal vaccine contains 3 strains
• Two type A strains
• One type B strain
 The 2009 H1N1 virus was a new type A strain
– It has been included in seasonal flu vaccines since its
appearance

25. Influenza A virus
•The type A viruses are the most virulent human pathogens among the three
influenza types and cause the most severe disease. Type A flu or influenza A
viruses are capable of infecting people as well as animals.
•Wild aquatic birds are the natural hosts for a large variety of influenza A.
•The influenza A virus can be subdivided into different serotypes based on the
antibody response to these viruses. The serotypes that have been confirmed in
humans, ordered by the number of known human pandemic deaths, are:
•H1N1, which caused Spanish flu in 1918, and the 2009 flu pandemic
•H2N2, which caused Asian Flu in 1957
•H3N2, which caused Hong Kong Flu in 1968
•H5N1, a current pandemic threat
•H7N7, which has unusual zoonotic potential
•H1N2, endemic in humans and pigs
•H9N2
•H7N2
•H7N3
•H10N7

29. Treatment
•Treatment with oseltamivir (trade name Tamiflu®) or zanamivir (trade name
Relenza®) is recommended for all people with suspected or confirmed
influenza who require hospitalization.

30. ????

31. Why We Need Annual Flu Vaccination
 Flu strains change genetically over time
 New vaccines are developed each flu season
to account for new strains resulting from
these genetic changes
 Even when there is no strain change in the
vaccine, immunity to the virus gradually
wanes

32. Common Mentality : NEEDS TO CHANGE

34. The Flu Season
 In the United States, the flu season takes place during
the fall and winter
– Flu season usually runs from October through May
– Peaks in January or February
 In India, season usually starts in Winter Season

35. How the Flu Spreads
 The flu is easily passed from person to person
– Transmitted through coughing, sneezing, or contact with an
infected person or surface1
• The flu can survive 24-48 hours on most surfaces
– The flu can spread to others up to 6 feet away
 Symptoms of the flu appear 1-4 days after infection
 Influenza can be spread 1 day before and as many as
7 days after symptoms begin

36. 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 unavailable
– Avoid touching your face; especially your eyes, nose, and mouth
– Limit contact with others when sick

37. High-Risk Groups for Influenza
 Older adults, young children, and pregnant women
 People who live in facilities, like a nursing home
 People with chronic health conditions like asthma,
diabetes, and heart disease
 American Indians and Native Alaskans
 Morbidly obese
 People with a weakened immune system due to disease
or medication, such as HIV or AIDS, or cancer

38. Flu in Older Adults
 People 65 years of age and older are hardest hit
by the flu and its complications1
– 6 out of 10 of the 226,000 flu-related hospitalizations each year1
– 9 out of 10 of the 3,000-49,000 annual flu-related deaths1
 No matter how healthy or young a person looks or feels, older
adults are more vulnerable to the flu because with advancing
age the immune system weakens2
– The body is less able to fight infection from the virus2
– Fewer antibodies are produced in response to vaccination as
compared to younger people2

39. Influenza Complications
 Most common in older adults, people with pre-existing
medical conditions and young children
 Serious complications include:
– Pneumonia
– Inflammation of the heart
 Worsening of chronic conditions:
– Asthma, COPD
– Heart failure, heart attack, and stroke
– Diabetes
– Kidney disease

40. Influenza Vaccination
 Annual flu vaccination is the best way to help prevent the
flu
– Vaccination is safe and effective
– People can get immunized as vaccine becomes available
 The Centers for Disease Control and Prevention
(CDC) recommends annual vaccination for everyone
age 6 months and older
 Vaccination is especially important for adults 65 and older

41. You Can’t Get the Flu
From the Flu Shot
 The flu vaccine is made from a small piece of the killed flu
virus, so it can’t cause the flu
 Some people may experience flu-like or cold-like symptoms
following the flu shot because:
– They were exposed to the flu prior to receiving the shot
– The immune response to the vaccine triggers some symptoms similar
to the disease
 Some may have soreness, mild pain, swelling, fever, headache,
fatigue, and muscle pain following a flu shot
– Side effects vary and usually disappear in a few days

42. Other Things You Can Do To Stay Healthy
 Getting vaccinated is the BEST way to avoid
the flu.
 Avoid close contact.
 Stay home when you are sick.
 Cover your mouth and nose.
 Clean your hands.
 Avoid touching your eyes, nose or mouth.
 Practice other good health habits.

44. CLEAN HANDS SAVE LIVES
Keeping our hands clean is one of the most
important things we can do to save lives!

45. When to Wash Your Hands
 Before, during, and after preparing food
 Before eating food
 Before and after caring for someone who is sick
 Before and after treating a cut or wound
 After using the toilet
 After changing diapers or cleaning up a child who has used
the toilet
 After blowing your nose, coughing, or sneezing
 After touching an animal or animal waste
 After handling pet food or pet treats
 After touching garbage

46. Proper Handwashing Technique
 Wet your hands with clean, running water (warm or cold) and
apply soap.
 Rub your hands together to make a lather and scrub them
well; be sure to scrub the backs of your hands, between your
fingers, and under your nails.
 Continue rubbing your hands for at least 20 seconds. Need a
timer? Hum the "Happy Birthday" song from beginning to end
twice.
 Rinse your hands well under running water.
 Dry your hands using a clean towel or air dry them.

47. What about Hand Sanitizer?
 Washing hands with soap and water is the best way to reduce
the number of germs on them. If soap and water are not
available, use an alcohol-based hand sanitizer that contains at
least 60% alcohol. Alcohol-based hand sanitizers can quickly
reduce the number of germs on hands in some situations, but
sanitizers do not eliminate all types of germs.
 Hand sanitizers are not effective when hands are visibly
dirty.

48. The story of Ebola virus

49. Ebola virus disease (EVD)
 It is one of the world’s most virulent diseases.
 Formerly known as Ebola haemorrhagic fever.
 Severe, often fatal illness, with a case fatality rate of up to 90%.
 EVD outbreaks occur primarily in remote villages in Central and
West Africa, near tropical rainforests.
 All agents that cause viral hemorrhagic fever syndrome are
RNA viruses with a lipid envelope, all are considered zoonoses,
all damage the microvasculature, resulting in increased
vascular permeability, and all are members of one of four
families: Arenaviridae, Bunyaviridae, Flaviviridae, and
Filoviridae.

50. 2014 OUTBREAK
 On 8 August 2014, WHO declared the Ebola virus disease
outbreak in West Africa a Public Health Emergency of
International Concern (PHEIC) in accordance with the IHR
2005.
 The current EVD outbreak is believed to have begun in
Guinea in December 2013.
 Viral sequencing shows strong homology (98%) with Zaïre
Ebolavirus (EBOV)
 As of August 16, 2014,
2,240 suspected or confirmed cases, including
1383 laboratory-confirmed cases and
1,229 deaths

51. 2014 OUTBREAK

52. TRANSMISSION
 Natural Host: Fruit bats of the Pteropodidae family
(Hypsignathus monstrosus, Epomops franqueti, and Myonycteris
torquata)
 Source of human infection: Blood, secretions, organs, or other
bodily fluids of infected animals, Bushmeat
(handling of infected chimpanzees, gorillas, fruit bats,
monkeys, forest antelope, and porcupines found ill or dead or
in the rainforest)

53. ENZOOTIC EPIZOOTIC EPIDEMIC

54. Human-to-Human transmission
 Direct contact (through broken skin or mucous membranes) with the
blood, secretions, organs or other bodily fluids of infected people
 Indirect contact with environments contaminated with fluids.
 Burial ceremonies (mourners direct contact with corpse)
 The patients become contagious once symptoms begin. They are not
contagious during incubation period.
 Virus transmitted through the semen for up to 7 weeks after
recovery from illness.
 Health-care workers have frequently been infected
INCUBATION PERIOD: 2 to 21 days
CASE FATALITY RATE: 53%
 All cases in the current outbreak- H2H

57. EExxppeerriimmeennttaall ttrreeaattmmeenntt
Zmapp
 Combination of monoclonal antibodies which binds with outer
glycoprotein of the virus and prevents its entry to the host cells
 Efficacy yet to be proven, no clinical trials done till date.
 In early trials- all Rhesus monkeys infected with virus survived
when administered 1 hour after infection.
 Produced using specific tobacco plants.
 WHO authorised this treatment for a small group on 11th
August,2014.
 Even if successful, stocks will not be available till 2015
Tekmira, a Canadian biotech company, has begun early human
trials of a new drug

58. PPRREEVVEENNTTIIOONN
 Isolation and Quarantine, Notification
 Contact Tracing
 Standard Precautions–At All Times, For All Patients
 Barrier nursing
 Hand washing
 Personal Protective Equipment (PPE)
 Injection safety, Safe sex practices
 Concomitant & Terminal Disinfection, Sterilisation
 Following SOP for Blood sample collection and Transport
 Appropriate Hospital Waste management
 Enhanced Surveillance
 Health Education: Myths

59. PPPPEE

60. IINNDDIIAA
 No confirmed case of Ebola till date.
 The World Health Organisation (WHO) had informed that one
Indian passenger had travelled on the same flight in which an
Ebola virus patient (a foreign national) was travelling from
Monrovia to Lagos. He was tracked and found healthy.
 24-hour 'Emergency Operation Centre‘:
011-23061469, 3205 and 1302
 TN Helpline- 104
 Rumours from Karnataka-WhatsApp message that student from
the National Institute of Technology Karnataka (NITK) in
Dakshina Kannada districthad ebola and succumbed to it

62. PREVENTION
IS THE ONLY
CURE

63. ADULT VACCINATION RECOMMENDATIONS
 Pneumococcal (Conjugate vaccine)
 Hepatitis – B
 Influenza vaccine

64. SSuunnsshhiinnee GGlloobbaall HHoossppiittaallss
Dr Pruthvi Puwar
Ph: 8866444474