6. Antigenic Drift Small variation Occurs frequently (1-2 yr) Epidemics/Seasonal Flu Antigenic Shift Large variation No immunity in population Pandemics

13. WHO Pandemic Influenza Preparedness and Response Guidance 2009 Phase 1 No animal influenza virus circulating among animals has been reported to cause infection in humans Phase 2 An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is therefore considered specific potential pandemic threat Phase 3 An animal or human-animal reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community–level outbreaks Phase 4 Human-to-human transmission of an animal or human-animal influenza reassortant virus able to sustain community-level outbreaks has been verified Phase 5 The same identified virus has caused sustained community-level outbreaks in two or more countries in one WHO region Phase 6 In addition to criteria defined in phase 5, the same virus has caused sustained community level outbreaks in at least one other country in another WHO region

14. Flu pandemic phase

15. Swine flu, the facts

16. H1N1

19. H1N1 (2009) Influenza

20. Genetics of Swine flu H1N1 Code Protein Source Origin HA Hemagglutinin swine (H1) North America NA Neuraminidase swine (N1) Europe PA Polymerase Acid avian North America PB1 Polymerase Basic Subunit 1 human 1993 H3N2 strain PB2 Polymerase Basic Subunit 2 avian North America NP Nucleoprotein swine North America M Matrix protein M1, M2 swine Eurasia NS Non-structural proteins NS1, NEP swine North America

23. Comparison human avian swine Etiology H2N3 H5N1 H1N1 Epidemiology Seasonal Pandemic threat Pandemic phase 5 Transmission Human to human Animal to human Human to human Morbidity High Low High Clinical Mild to severe, usually mild Similar to human, Many severe fatal Similar to human, usually mild Mortality Low High Low Treatment Oseltamivir Oseltamivir Oseltamivir

40. CDC Swab kit available Method: Horizontal, away from nasal septum

43. Three C’s Clean Cover Contain

44. Cover your mouth and nose Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick

45. How to wear the mask? ×

56. Healthy Habits reduces the Attacks

79. Chemoprophylaxis Doses Duration of prophylaxis depends on epidemiologic setting. Post-exposure use is typically for 7 to 10 days. Patient Age Prophylactic Dose > 13 years 1 capsule (75 mg) once a day 1 to 12 years < 15 kg: 30 mg once a day 15-<23 kg: 45 mg once a day 23-<40 kg: 60 mg once a day > 40 kg: 75 mg once a day

80. NA inhibitors Mechanism of Action

87. Proactive measures VS containment

93. case swab tamiflu hospital home note <5yrs +mild symp. √ √ detoriarated->hospital <5yrs +sever symp. √ √ √ >65yrs +mild symp. √ √ detoriarated->hospital <65yrs +sever symp √ √ √ Pregnant +mild symp √ √ detoriarated->hospital Pregnant +sever symp √ √ √ Chronic disease+mild symp √ √ detoriarated->hospital Chronic disease+ sever symp √ √

94. case swab tamiflu hospital home note 5-65+seve symp √ √ √ mild+ good isolated room √ detoriarated->hospital mild+ bad isolated room √ √ √ pneumonia √ √ √ Acute sever chest infection √ √ √ Suspect avian √ √ √ Separate isolated room

95. ++