This document discusses H1N1 influenza, including its epidemiology, signs and symptoms, risk factors, diagnosis, treatment and prevention. It provides details on the virus itself, including its structure and classification. It specifically focuses on the 2009 H1N1 pandemic virus, noting it was a novel reassortment of genes from swine, avian and human influenza viruses. Pregnant women are identified as a high risk group for H1N1 infection. Clinical features, complications, laboratory diagnosis and treatment recommendations including antiviral medications are summarized.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Hello friends i am BSc Nursing intern.This presentation of mine covers almost each and every aspect related to swine flu.Hope it will help you to increase your knowledge regarding the topic.Looking forward to your feedback.Thank you
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Hello friends i am BSc Nursing intern.This presentation of mine covers almost each and every aspect related to swine flu.Hope it will help you to increase your knowledge regarding the topic.Looking forward to your feedback.Thank you
Clinical management guidelines for swine flu at civic centre on 5 feb2015Vinod Nikhra
A lecture by Dr Vinod Nikhra at Conference on Swine Flu, organised by Health Department, South Delhi Municipal Corporation at Civic Centre, Delhi on 05 February 2015.
Swine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should knowGaurav Gupta
A fun quiz for family practitioners & pediatricians in India to test their knowledge about the ongoing 2015 H1N1 epidemic.
Would be of interest to parents too.
Clinical management guidelines for swine flu at civic centre on 5 feb2015Vinod Nikhra
A lecture by Dr Vinod Nikhra at Conference on Swine Flu, organised by Health Department, South Delhi Municipal Corporation at Civic Centre, Delhi on 05 February 2015.
Swine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should knowGaurav Gupta
A fun quiz for family practitioners & pediatricians in India to test their knowledge about the ongoing 2015 H1N1 epidemic.
Would be of interest to parents too.
Influenza in Pregnancy : Recommendations of Treatment & Prevention ,Dr. Shar...Lifecare Centre
MANAGEMENT OF INFLUENZA IN PREGNANCY
Implementation of infection control measures.
Preferably isolation room should be there, if not available then patients can be kept in well-ventilated isolation ward with beds kept one meter apart.
All those entering the room must use high efficiency masks, gowns, goggles, gloves, cap and shoe cover.
Restrict number of visitors.
Provide antiviral prophylaxis to health care personnel
Dispose waste properly by placing it in sealed impermeable bags labeled as biohazard.
Influenza a emergency prepardness for healthcare facilitiesMoustapha Ramadan
The data presented are per 4th of March 2017 and subject to changes.
The presentation aims to provide the basic infection control requirement for healthcare facilities during large influenza epidemic or pandemic
Seasonal influenza viruses in tropical regions may occur throughout the year, causing outbreaks and epidemics more regularly in humans. There are four types or large groupings of seasonal influenza viruses; Influenza A, B, C, and D, but only influenza A and B viruses cause clinically important human disease and seasonal epidemics. It can cause mild to severe illnesses and even deaths, particularly in high-risk individuals. Vaccination is the most effective means of preventing influenza and its complications. Among healthy adults, influenza vaccine provides protection, even when circulating viruses may not exactly match the vaccine viruses. In elderly, it reduces severity of disease and incidence of complications and deaths. Vaccination is especially important for people at higher risk of serious influenza complications, and for people who live with, care for, high risk individuals.
What is Influenza ?
History of influenza
Influenza Classification
Structure of influenza
Types of influenza viruses
How Influenza Viruses Change
Avian influenza
Swine influenza- Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)
Seasonal flu/ Pandemic
Treatment for H1N1 flu
Influenza, commonly known as "the flu", is an infectious disease of birds and mammals caused
Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death.
Resistance of Virus
Inactivated by heating at 500c for 30 mt
Survive for 1 week at 0 – 40c for 1 week
Ether, formaldehyde, Phenol destroy the virus
•The first recognized pandemic occurred in July and August of 1510 when an outbreak of “gasping oppression” appeared nearly everywhere at once. It was described as a “„gasping oppression‟ with cough, fever, and a sensation of constriction of the heart and lungs”, leaving an impression strong enough for people to write of it decades later (Morens et al, 2010). At least seven contemporary and near-contemporary reports exist of the 1510 pandemic (Morens, North & Taubenberger, 2010).
• 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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Light House Retreats: Plant Medicine Retreat Europe
H1N1 & Pregnancy.Prof Salah Roshdy
1. PREGNANCY & H1N1 (NOVEL
INFLUENZA)
Salah Roshdy Ahmed ,MD
Professor of OB/GYN,
Sohag University . 2014
2. OBJECTIVES:
To discuss Influenza A H1N1
Epidemiology
Signs & symptoms
Risk factors
Diagnosis
Treatment and Prevention
3. INFLUENZA
Acute respiratory illness caused by infection with influenza
viruses.
Affects the upper and/or lower respiratory tract and is often
accompanied by systemic signs and symptoms:
fever
headache
myalgia
weakness
4. Credit: L. Stammard, 1995
• RNA, enveloped
• Viral family: Orthomyxoviridae
• Size:
80-200nm or .08 – 0.12 μm
(micron) in diameter
• Three types
• A, B, C
• Surface antigens
• H (haemaglutinin)
• N (neuraminidase)
INFLUENZA VIRUS
5. o Influenza A viruses categorized by subtype
according to two surface proteins…..
Hemagglutinin (H) – 16 known
- Site of attachment to host cells
- Antibody to HA is protective
Neuraminidase (N) – 9 known
- Helps release virions from cells
- Antibody to NA can help modify disease
severity
N
H
7. INFLUENZA A
The Influenza A virus subtypes that have been
confirmed in humans, ordered by the number of
known human pandemic deaths, are:
H1N1 caused "Spanish Flu" and 2009 H1N1
outbreak
H2N2 caused "Asian Flu"
H3N2 caused "Hong Kong Flu"
H5N1 is "bird flu", endemic in avian
H7N7 has unusual zoonotic potential
H1N2 is currently endemic in humans and pigs
H9N2, H7N2, H7N3, H10N7 (avian)
8. INFLUENZA B
Influenza B viruses are only known to infect
humans and seals giving them influenza.
This limited host range is apparently
responsible for the lack of Influenza virus B
caused influenza pandemics in contrast with
those caused by the morphologically similar
Influenza virus A as both mutate by both
genetic drift and reassortment.
9. INFLUENZA C
Influenza C viruses are known to infect
humans and pigs giving them influenza.
Flu due to the type C species is rare
compared to types A or B, but can be severe
and can cause local epidemics.
10. WHAT IS THE NOVEL
INFLUENZA A (H1N1)?
Quadruple Reassortment
2 swine strains,
1 human strain,
1 avian strain of influenza
Reassortment is the mixing of the genetic material
of a species into new combinations in different
individuals
1. Emergence of a Novel Swine-Origin Influenza A (H1N1)
Virus in Humans. N Engl J Med 2009;361
2. Epidemiology, clinical manifestations, and diagnosis of swine H1N1 influenza
A. Uptodate, May 15, 2009
13. Antigenic drift
Changes in proteins by genetic point mutation &
selection
Ongoing and basis for change in vaccine each year
Antigenic shift
Changes in proteins through genetic reassortment
Produces different viruses not covered by annual
vaccine
Definitions
14. SWINE INFLUENZA A(H1N1)
A confirmed case of H1N1 infection
is defined as a person with an acute febrile respiratory
illness with laboratory confirmed H1N1 virus infection by
one or more of the following tests:
real-time RT-PCR
viral culture
A probable case of H1N1 infection
is defined as a person with an acute febrile
respiratory illness who is:
positive for influenza A, but negative for H1 and H3 by
influenza RT-PCR, or
positive for influenza A by an influenza rapid test or an
influenza immunofluorescence assay (IFA) plus meets
criteria for a suspected case
Source: CDC
15. SWINE INFLUENZA A(H1N1)
A suspected case of H1N1 infection
is defined as a person with acute febrile respiratory
illness with onset
within 7 days of close contact with a person who is a
confirmed case of H1N1 virus infection, or
within 7 days of travel to community where there are
one or more confirmed H1N1 cases, or
resides in a community where there are one or more
confirmed swine influenza cases
Source: CDC
16. HOSTS AND RESERVOIRS
Type A:
Exists in humans and animals
Type B & C:
Exclusively in humans
Reservoir in animals:
Pigs, aquatic birds
Located in the digestive tube: fecal transmission
Reservoirs in humans :
3 sub-types circulate H1N1, H1N2 et H3N2.
H1 has better affinity than H3 for cell receptors.
17. WHAT IS A PANDEMIC?
• There is a new strain of influenza
A virus and humans have little or
no immunity to it.
• The virus spreads from person-
to-person.
• There is a global outbreak with
sustained person- to-person
transmission.
18.
19. 20TH CENTURY FLU PANDEMICS
Pandemic Year
Influenza A
virus
subtype
People
infected
(approx)
Deaths
(est.)
Case
fatality rate
1918 flu
pandemic
1918–19 H1N1
0.5 to 1
billion
(near 50%)
20 to 50
million[
>2.5%
Asian flu 1956–58 H2N2 2 million <0.1% ?
Hong Kong
flu
1968–69 H3N2 1 million <0.1%
19
20. PANDEMIC H1N1/09 VIRUS
Novel strain of influenza A
The strain contained genes from four different
flu viruses:
1. North American swine influenza,
2. North American avian influenza,
3. Human influenza,
4. Two swine influenza viruses typically found
in Asia and Europe.
20
23. EPIDEMIOLOGY
Incubation period- 1-7 days
Transmission
PRIMARY CASE –direct contact with
pigs
SECONDARY CASES
sneezing, coughing , resp droplets,
body fluids(diahrroeal stool) contact
surfaces
24. RISK FROM DRINKING WATER OR
SWIMMING POOLS.
Free chlorine levels typically used in drinking water or
swimming pools treatment are adequate to inactivate
highly pathogenic H5N1 avian influenza.
Free chlorine levels recommended by CDC (1–3 parts
per million [ppm} for pools and 2–5 ppm for spas).
It is likely that other influenza viruses such as novel
H1N1 would also be similarly inactivated by
chlorination.
There has never been a documented case of
influenza virus infection associated with water
exposure.
25. HOW LONG CAN INFLUENZA VIRUS REMAIN
VIABLE ON OBJECTS ?
Studies have shown that
influenza virus can survive on
environmental surfaces and
can infect a person for 2 to 8
hours after being deposited on
the surface.
26. HOW H1N1 VIRUS SPREADS
Spreads through
coughing or sneezing of
infected people
Some people may
become infected by
touching something
with flu viruses on it and
then touching their
mouth, nose or eyes.
27. PREGNANCY -MATERNAL
Physiologic adaptations to
pregnancy may increase
virulence of viral infections
Alterations in maternal
immunity
Increased oxygen
consumption, decreased
functional residual capacity
Increased physiologic dead
space due to upward
displacement by uterus
Hormonally mediated
hyperventilation
28. PREGNANCY- FETUS
Susceptible to external
influences on development
Direct effect of an infectious
agent
Indirect effect due to
hyperthermia, release of
inflammatory cytokines
Teratogenic concerns from
medications used to treat
infection
Prematurity related medical and
developmental complications
29. PREGNANT WOMEN ARE A HIGH-RISK
POPULATION FOR H1N1
6x more likely to get infected with H1N1
4x more likely to be hospitalized
6x more likely to die than other adults
Deaths related to pneumonia with
subsequent ARDS requiring mechanical
ventilation
30. • In seasonal influenza, viremia is believed to occur
infrequently and placental transmission appears to
be rare – may differ with novel influenza strains
• Hyperthermia is a risk factor for some types of birth
defects and other adverse outcomes
• Influenza virus itself is not known to be teratogenic.
Fetal Concerns Regarding Influenza
During Pregnancy
31. • Clinical outcomes data has NOT shown
teratogenic effects of the most commonly
recommended influenza medications
oseltamivir, zanamivir.
• Influenza vaccine has no adverse fetal
effects and has been recommended for
pregnant patients since 2005.
Fetal Concerns Regarding Influenza
During Pregnancy
32. CLINICAL FEATURES
Vomiting or diarrhea (not typical for influenza
but reported by recent cases of swine
influenza infection)
35. DANGER SIGNS IN ALL PATIENTS
Tachypnea
Dyspnea
Cyanosis
Bloody or coloured sputum
Chest pain
Altered mental status
High fever that persists beyond 3 days
Hypotension
Hypoxia
36. CLINICAL FEATURES –COMPLICATED OR
SEVERE INFLUENZA
Presenting secondary complications:
1. renal failure
2. multi‐organ failure
3. septic shock.
Other complications
1. musculoskeletal (rhabdomyolysis)
2. cardiac (myocarditis).
36
37. CLINICAL FEATURES – SUGGESTIVE CNS
COMPLICATION
1. Unconscious
2. Drowsiness
3. Recurring or persistent convulsions
4. Confusion
5. Severe weakness or paralysis.
37
38. COMPLICATIONS
Progressive Pneumonia
Respiratory Failure – cause of most deaths
Acute Respiratory Distress Syndrome
Anna R Thorner, MD. Treatment and prevention of swine H1N1
influenza. Uptodate, May 14, 2009.
39. PNEUMONIA -
Virus can cause pneumonia leading to death
Rapid onset, often within one day after infection
Attributed to "cytokine storm“
Deaths among healthy young people during the first
weeks of the 2009 flu pandemic were attributed to
this cause
39
43. DIAGNOSTIC TEST
Real-Time Reverse Transcription-
Polymerase Chain Reaction (rRT-PCR)
Detection
Qualitative for Influenza A, B, H1, and H3
Positive for influenza A and negative for H1
and H3
If reactivity of real-time RT-PCR for influenza
A is strong , it is more suggestive of a novel
influenza A virus.
Novel H1N1 Influenza (Swine Flu)
http://www.cidrap.umn.edu/cidrap/content/infl
uenza/swineflu/biofacts/swinefluoverview.html
44. TESTS
Culture
Isolation of H1N1 influenza A virus -
diagnostic
too slow
negative viral culture does not
exclude H1N1 influenza A infection
47. TREATMENT
Treatment is recommended for pregnant
women with suspected or confirmed influenza,
regardless of trimester of pregnancy
Do not delay treatment because of a negative
rapid influenza diagnostic test or inability to
test or while awaiting test results
48. OSELTAMIVIR (TAMIFLU)
Adult dose
Rx for acute illness: 75 mg
PO bid for 5 d
Prophylaxis: 75 mg PO qd
available as 30-mg, 45-mg,
and 75-mg oral capsules
and as a powder for
suspension that contains
12 mg/mL after
reconstitution.
49. ZANAMIVIR (RELENZA)
Adult dose
Rx for acute illness: 10 mg
inhaled orally bid for 5 d
Prophylaxis of household
contact: 10 mg inhaled orally
qd for 10 d
(initiate within 36 h)
Prophylaxis for community
outbreak: 10 mg inhaled orally
qd for 28 d (initiate within 5 d of
outbreak)
powder form for inhalation via
the Diskhaler oral inhalation
device
50. SWINE INFLUENZA A(H1N1)
Source: CDC
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
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
51. WHEN IS HOSPITALIZATION NEEDED?
Respiratory symptoms- shortness of breath
Intractable nausea, vomiting
Fever unresponsive to acetaminophen
Contractions, abdominal pain, preterm labor
Decreased fetal movement
52. POST-EXPOSURE CHEMOPROPHYLAXIS
Consider if close contact with suspected or
confirmed case
Zanamivir (Relenza®) Two 5mg inhalations qd
Oseltamivir (Tamiflu®) 75 mg qd
10 day duration
Zanamivir is recommended in pregnancy due to
less systemic absorption
53. CDC RECOMMENDATIONS FOR LABOR WITH
H1N1 (AUGUST 2009)
Place surgical mask on ill mother during labor &
delivery, if tolerable
Mother should consider avoiding close contact with
infant until:
antiviral medication for 48 hours
fever has fully resolved
she can control coughs and secretions
When in contact with the infant, mother should do
following until 7 days after symptom onset and
symptom-free for 24 hours:
wear a facemask
change to clean gown or clothing
adhere to strict hand hygiene and cough etiquette
54. CDC RECOMMENDATIONS FOR
POSTPARTUM WITH H1N1 (AUGUST 2009)
Newborns should be considered potentially
infectious or infected if delivery occurs 2 days
before through 7 days after onset of maternal
illness.
Encourage breast feeding- use pump if in
isolation until mother can breast feed.
55. SAFETY OF INFLUENZA VACCINATION
DURING PREGNANCY
11 studies published between 1964 and
2008 about safety of influenza
vaccination during pregnancy
None identified maternal or fetal
problems with influenza vaccination
One prospective randomized trial
showed significant benefits to mothers
and newborns
56. VACCINE TYPES
Live attenuated vaccine (not licensed for
use in pregnant women)
Multidose inactivated vaccine
Prefilled single dose inactivated vaccine
(preservative-free)
57. H1N1 VACCINE
Strongly recommended for
Pregnant women.
Parents of children under 6 months.
Health care providers with direct patient
contact.
Safety
Use “Flu Shot” (fragments of
killed/inactivated virus) not “nasal spray”
(live-attenuated virus),
2009 H1N1 Influenza Vaccine and Pregnant Women. CDC September
3, 2009 http://www.cdc.gov/h1n1flu/vaccination/pregnant_qa.htm
58. WHEN TO ADMINISTER
Can be given at any time during
pregnancy
Can also be given postpartum, providing
indirect protection for infants <6 months
Recommended even for women who have
had influenza-like illness
59. MEDICATION SUMMARY
Treatment Chemoprophylaxis
Oseltamivir
(Tamiflu®)
75-mg capsule twice
per day for 5 days*
75-mg capsule once
per day for 10 days*
Zanamivir
(Relenza®)
Two 5-mg inhalations
(10 mg total) twice per
day for 5 days
Two 5-mg inhalations
(10 mg total) once per
day for 10 days*
Antiviral medication dosing recommendations for treatment or
chemoprophylaxis of novel influenza A (H1N1) infection
*Currently recommended first choice medications.
CDC: Updated Interim Recommendations for the Use of Antiviral Medications in the
Treatment and Prevention of Influenza for the 2009-2010 Season. 10/16/2009
60. SWINE INFLUENZA A(H1N1)
GUIDELINES FOR GENERAL POPULATION
Covering nose and mouth with a
tissue when coughing or sneezing
Hand washing with soap and water
Cleaning hands with alcohol-based
hand cleaners
Avoiding close contact with sick
people
Avoiding touching eyes, nose or
mouth with unwashed hands
61. AVOID CLOSE CONTACT
Avoid close contact
with people who are
sick. When you are
sick, keep your
distance from others
to protect them from
getting sick too.
Aerosols spread the
virus in any
environment
62. STAY HOME WHEN YOU ARE SICK.
If possible, stay home
from work, school,
and errands when you
are sick. You will help
prevent others from
catching your illness.
63. 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
64. CLEAN YOUR HANDS.
Washing your hands
often will help protect
you from germs.
Hand washing proved
to be best procedure
in prevention of
Majority of
Communicable
diseases.
65. AVOID TOUCHING YOUR EYES, NOSE OR
MOUTH.
Germs are often
spread when a person
touches something
that is contaminated
with germs and then
touches his or her
eyes, nose, or mouth.
66. PRACTICE OTHER GOOD HEALTH HABITS.
Get plenty of sleep, be
physically active,
manage your stress,
drink plenty of fluids.
Unnecessary
Migration of people
from epidemic and
endemic areas to be
reduced.
68. SIMPLE MEASURES CARRY GET GOOD
BENEFITS
Cover your mouth
and nose. Use a
tissue when you
cough or sneeze and
drop it in the trash. If
you don’t have a
tissue, cover your
mouth and nose as
best you can.
69. CLEAN HANDS SAVES YOU
Clean your hands
often. Clean your
hands every time you
cough or sneeze.
Hand washing stops
germs. Alcohol-based
gels and wipes also
work well.
70. WARNING
Aspirin or aspirin-containing products should not be
administered to any confirmed or suspected ill case of
novel influenza A (H1N1) virus infection aged 18
years old and younger due to the risk of Reye’s
syndrome.
Children 5 years of age and older and teenagers with
the flu can take medicines without aspirin, such as
acetaminophen and ibuprofen .
71. ACOG / CDC
Released
Oct 15, 2009
Usable for
office, clinic
or OB Triage
ACOG
websitehttp://www
.acog.org/departments/re
sourceCenter/2009H1N1T
riageTreatment.pdf
72. CONCLUSIONS
Data available thus far suggest
that pregnant women are more
susceptible to H1N1 influenza &
they are at increased risk for
complications and death.
73. CONCLUSIONS
Pregnant women should be
informed about the signs and
symptoms of H1N1 influenza.
Pregnant women who present with
signs and symptoms consistent
with influenza should be treated
empirically with oseltamivir.
74. CONCLUSIONS
Proof of diagnosis is not required for
treatment.
Post-exposure prophylaxis with
zanamivir or oseltamivir can be
considered for pregnant women
75. CONCLUSIONS
Both seasonal and 2009 H1N1 influenza
vaccines recommended for pregnant
women
2009 H1N1 vaccine safety expected to
be similar to seasonal influenza vaccine
Obstetrical care providers should take a
very active part in promoting vaccination
.