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2009 swine flu outbreak
1. 2009 swine flu outbreak2009 swine flu outbreak
DR ROSDINA ABD KAHARDR ROSDINA ABD KAHAR
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3. INTRODUCTIONINTRODUCTION
TheThe 2009 swine flu outbreak2009 swine flu outbreak is the spread of a new strainis the spread of a new strain
ofof H1N1H1N1 influenzainfluenza virus that was first detected by publicvirus that was first detected by public
health agencies in March 2009.health agencies in March 2009.
Localized outbreaks ofLocalized outbreaks of influenza-like illnessinfluenza-like illness (ILI) were(ILI) were
detected in three areas initially indetected in three areas initially in MexicoMexico and soon after inand soon after in
thethe United StatesUnited States andand CanadaCanada..
Following the discovery of the new strain in the UnitedFollowing the discovery of the new strain in the United
States, its presence was quickly suspected in severalStates, its presence was quickly suspected in several
continents, with over 1,600 candidate cases by April 27.continents, with over 1,600 candidate cases by April 27.
Because it is not possible to confirm every one of suchBecause it is not possible to confirm every one of such
cases as being caused by an influenza virus, thecases as being caused by an influenza virus, the
World Health OrganizationWorld Health Organization (WHO) refers to them(WHO) refers to them
collectively as influenza-like illnesses (ILI).collectively as influenza-like illnesses (ILI).
4. The new strain is derived in part from humanThe new strain is derived in part from human influenzavirusinfluenzavirus AA
(subtype H1N1), and in part from two strains of(subtype H1N1), and in part from two strains of swine influenzaswine influenza asas
well as an avian influenzawell as an avian influenza
In April both the WHO and the United StatesIn April both the WHO and the United States
Centers for Disease Control and PreventionCenters for Disease Control and Prevention (CDC) expressed(CDC) expressed
serious concerns about this novel strain, because it apparentlyserious concerns about this novel strain, because it apparently
transmits from human to human, has had a relatively hightransmits from human to human, has had a relatively high
mortality ratemortality rate in Mexico, and because it has the potential to becomein Mexico, and because it has the potential to become
aa flu pandemicflu pandemic..
On April 25, 2009, the WHO determined the situation to be a formalOn April 25, 2009, the WHO determined the situation to be a formal
"public health emergency of international concern", with knowledge"public health emergency of international concern", with knowledge
lacking in regard to "thelacking in regard to "the clinical featuresclinical features,, epidemiologyepidemiology, and, and virologyvirology
of reported cases and the appropriate responses".of reported cases and the appropriate responses".
Government health agencies around the world also expressedGovernment health agencies around the world also expressed
concerns over the outbreak and are monitoring the situation closely.concerns over the outbreak and are monitoring the situation closely.
As of April 26, 2009, Mexico City schools remained closed whileAs of April 26, 2009, Mexico City schools remained closed while
dozens of other schools and school districts in the US closed due todozens of other schools and school districts in the US closed due to
confirmed cases in students.confirmed cases in students.
7. US Human cases of Swine FluUS Human cases of Swine Flu
infection (total 20)infection (total 20)
StateState # of laboratory confirmed# of laboratory confirmed
casecase
CaliforniaCalifornia 77
KansasKansas 22
New York CityNew York City 88
OhioOhio 11
TexasTexas 22
As of Apr 26,2009
8. WASHINGTON (AFP) – The United States declared aWASHINGTON (AFP) – The United States declared a
swine flu outbreak a as officials confirmed 20 cases inswine flu outbreak a as officials confirmed 20 cases in
five US states and warned that they expected more infive US states and warned that they expected more in
the coming days. is monitoring the spreading virus andthe coming days. is monitoring the spreading virus and
has reviewed US capabilities to counter the deadly fluhas reviewed US capabilities to counter the deadly flu
outbreak, which has killed up to 81 people in , homelandoutbreak, which has killed up to 81 people in , homeland
security advisor John Brennan told reporters.security advisor John Brennan told reporters.
Obama has ordered a "very active, aggressive, andObama has ordered a "very active, aggressive, and
coordinated response," Brennan said.coordinated response," Brennan said.
Richard Besser, the acting head of the Centers forRichard Besser, the acting head of the Centers for
Disease Control and Prevention (CDC), told a that thereDisease Control and Prevention (CDC), told a that there
were eight confirmed US cases in , seven in , two inwere eight confirmed US cases in , seven in , two in
Texas, two in Kansas and one inTexas, two in Kansas and one in
9. Published: Monday April 27, 2009 MYT 11:52:00 AMPublished: Monday April 27, 2009 MYT 11:52:00 AM
Updated: Monday April 27, 2009 MYT 3:31:34 PMUpdated: Monday April 27, 2009 MYT 3:31:34 PM
Swine flu: Health Ministry advises against travel to Canada,Swine flu: Health Ministry advises against travel to Canada,
Mexico and US states (Update 3)Mexico and US states (Update 3)
By SIM LEOI LEOI and BEH YUEN HUIBy SIM LEOI LEOI and BEH YUEN HUI
KUALA LUMPUR:KUALA LUMPUR: The Health Ministry has advised Malaysians against travelling toThe Health Ministry has advised Malaysians against travelling to
Canada, Mexico and selected US states where there have been reports of swine fluCanada, Mexico and selected US states where there have been reports of swine flu
infection.infection.
Its minister Datuk Seri Liow Tiong Lai said the United States had recorded 20 casesIts minister Datuk Seri Liow Tiong Lai said the United States had recorded 20 cases
of influenza-like illness in New York (eight cases), California (seven), Texas (two),of influenza-like illness in New York (eight cases), California (seven), Texas (two),
Kansas (two) and Ohio (one).Kansas (two) and Ohio (one).
Mexico has reported 1,149 cases with 71 deaths, out of which 18 cases wereMexico has reported 1,149 cases with 71 deaths, out of which 18 cases were
confirmed to be caused by the swine influenza A/H1N1 virus. Canada has reportedconfirmed to be caused by the swine influenza A/H1N1 virus. Canada has reported
four swine flu cases.four swine flu cases.
““So far, no deaths have been reported in these two countries,” he said, referring toSo far, no deaths have been reported in these two countries,” he said, referring to
Canada and the United States.Canada and the United States.
““Although the World Health Organisation (WHO) has not called for any sanction inAlthough the World Health Organisation (WHO) has not called for any sanction in
travel or trade with those affected countries, I would like to advise all Malaysianstravel or trade with those affected countries, I would like to advise all Malaysians
against travelling to these places,” he told reporters after witnessing the presentationagainst travelling to these places,” he told reporters after witnessing the presentation
of the Joint Commission International award to Prince Court Medical Centre hereof the Joint Commission International award to Prince Court Medical Centre here
Monday.Monday.
Liow said the ministry had also alerted both public and private medical practitioners toLiow said the ministry had also alerted both public and private medical practitioners to
report to the district health office any patient they might have treated for influenza-likereport to the district health office any patient they might have treated for influenza-like
illness or severe pneumonia symptoms and who had a history of travelling to theillness or severe pneumonia symptoms and who had a history of travelling to the
above destinations after April 17.above destinations after April 17.
10. Background of breakBackground of break
Prior influenza seasonPrior influenza season
Nouthern Hemisphere winter 2008-2009Nouthern Hemisphere winter 2008-2009
mild season for flu infection -250,000-mild season for flu infection -250,000-
500,000 death yearly (elderly, very young,500,000 death yearly (elderly, very young,
chronic illness)chronic illness)
Up to Apr 8,2009 – CDC reported death ofUp to Apr 8,2009 – CDC reported death of
43 chlidren from seasonal flu (prev 68)-43 chlidren from seasonal flu (prev 68)-
vaccine H1N1,H3N2vaccine H1N1,H3N2
Dec 2005-Febr 2009, total 12 humanDec 2005-Febr 2009, total 12 human
infection with swine influenzainfection with swine influenza
11. Recent Influenza outbreakRecent Influenza outbreak
The outbreak was first detected in the Federal District of Mexico, whereThe outbreak was first detected in the Federal District of Mexico, where
surveillance began picking up a surge in cases of ILI starting March 18.surveillance began picking up a surge in cases of ILI starting March 18.
The surge was assumed by Mexican authorities to be "late-season flu"The surge was assumed by Mexican authorities to be "late-season flu"
(which usually coincides with a mild(which usually coincides with a mild InfluenzavirusInfluenzavirus BB peak until Aprilpeak until April
21, when a CDC alert concerning two isolated cases of a novel swine21, when a CDC alert concerning two isolated cases of a novel swine
flu was reported in the media.flu was reported in the media.
The first two cases identified (and confirmed) as swine flu were twoThe first two cases identified (and confirmed) as swine flu were two
children living in the United States, inchildren living in the United States, in San Diego CountySan Diego County andand
Imperial County, CaliforniaImperial County, California, who became ill on March 28 and 30., who became ill on March 28 and 30.
This new strain was promptly confirmed in Mexico, connecting the newThis new strain was promptly confirmed in Mexico, connecting the new
strain to the ongoing outbreak of ILI.strain to the ongoing outbreak of ILI.
The first deadly case seems to go back to the 13 April, some samplesThe first deadly case seems to go back to the 13 April, some samples
being sent to the US based CDC the 18being sent to the US based CDC the 18thth
..
News of the connection was broadcast live in Mexico on April 23,News of the connection was broadcast live in Mexico on April 23,
2009.2009.
12. In March and April 2009, over 1000 cases of suspected swine flu inIn March and April 2009, over 1000 cases of suspected swine flu in
humans were detected inhumans were detected in MexicoMexico and theand the southwestern United Statessouthwestern United States..
The strain appears to be unusually lethal in Mexico, causing 103The strain appears to be unusually lethal in Mexico, causing 103
deaths (20 confirmed) so far, mostly in Mexico City.deaths (20 confirmed) so far, mostly in Mexico City.
There have also been cases reported in the states ofThere have also been cases reported in the states of San LuisSan Luis PotosíPotosí,,
HidalgoHidalgo,, QuerétaroQuerétaro andand Mexico StateMexico State, all in central Mexico, all in central Mexico
Some cases in Mexico and the United States have been confirmed bySome cases in Mexico and the United States have been confirmed by
thethe World Health OrganizationWorld Health Organization to be a never-before-seen strain ofto be a never-before-seen strain of
H1N1.H1N1.
The Mexican fatalities are mainly young adults of 25 to 45, a hallmarkThe Mexican fatalities are mainly young adults of 25 to 45, a hallmark
ofof pandemic flupandemic flu..
A new swine flu strain was confirmed in 16 of the deaths and at leastA new swine flu strain was confirmed in 16 of the deaths and at least
100 others were being tested as of April 24, 2009.100 others were being tested as of April 24, 2009.
Mexican Health MinisterMexican Health Minister JoséJosé ÁngelÁngel CórdovaCórdova on April 24, said "We’reon April 24, said "We’re
dealing with a new flu virus that constitutes a respiratory epidemic thatdealing with a new flu virus that constitutes a respiratory epidemic that
so far is controllable."so far is controllable."
MEXICO:
13. Theory…Theory…
The origins of the new virus strain remainThe origins of the new virus strain remain
unknown. One theory is that Asian and Europeanunknown. One theory is that Asian and European
strains traveled to Mexico in migratory birds or instrains traveled to Mexico in migratory birds or in
people, then combined with North Americanpeople, then combined with North American
strains in Mexican pigstrains in Mexican pig factory farmsfactory farms beforebefore
jumping over to farm workers.jumping over to farm workers.
The Mexican health agency acknowledged that theThe Mexican health agency acknowledged that the
original disease vector of the virus may have beenoriginal disease vector of the virus may have been
flies multiplying in manure lagoons of pig farmsflies multiplying in manure lagoons of pig farms
nearnear PerotePerote,, VeracruzVeracruz, owned by Granjas Carroll,, owned by Granjas Carroll,
a subsidiary of Smithfield Foods.a subsidiary of Smithfield Foods.
14. Genetic and effectsGenetic and effects
Dr. Anne Schuchat, interim Deputy Director for CDCDr. Anne Schuchat, interim Deputy Director for CDC
Science and Public Health,Science and Public Health,
the American cases were found to be made up of geneticthe American cases were found to be made up of genetic
elements from four different flu viruses — North Americanelements from four different flu viruses — North American
swine influenza, North American avian influenza, humanswine influenza, North American avian influenza, human
influenza, and swine influenza virus typically found in Asiainfluenza, and swine influenza virus typically found in Asia
and Europe - "an unusually mongrelised mix of geneticand Europe - "an unusually mongrelised mix of genetic
sequences.sequences.
"Pigs have been shown to act as a potential "mixing"Pigs have been shown to act as a potential "mixing
vessel" in which reassortment can occur between fluvessel" in which reassortment can occur between flu
viruses of several species.viruses of several species.
This new strain appears to be a result of reassortment ofThis new strain appears to be a result of reassortment of
human influenza and swine influenza viruses, presumablyhuman influenza and swine influenza viruses, presumably
due to superinfection in an individual human. Influenzadue to superinfection in an individual human. Influenza
viruses readily undergo reassortment because theirviruses readily undergo reassortment because their
genome is packaged in 8 piecesgenome is packaged in 8 pieces
15. Women wear masks as they walk past a closed school in Mexico City April 24, 2009. AWomen wear masks as they walk past a closed school in Mexico City April 24, 2009. A
deadly strain of swine flu never seen before has killed as many as 61 people in Mexicodeadly strain of swine flu never seen before has killed as many as 61 people in Mexico
and has spread into the United States, where several people were reported ill.and has spread into the United States, where several people were reported ill.
(REUTERS/Henry Romero)(REUTERS/Henry Romero)
16. Train commuters in Mexico City
wearing surgical masks
Mexican soldiers distributing
protective masks to citizens
Mexican police officers
17. Pandemic concernPandemic concern
The U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO)The U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO)
are concerned that this outbreak may become aare concerned that this outbreak may become a pandemicpandemic, for the following reasons., for the following reasons.[73][73]
New strainNew strain
– The virus is a new strain of influenza, from which human populations have not beenThe virus is a new strain of influenza, from which human populations have not been vaccinatedvaccinated
oror naturally immunizednaturally immunized..[74][74]
Human transmissionHuman transmission
– The virus appeared to infect by human-to-human transmission. Investigations of infectedThe virus appeared to infect by human-to-human transmission. Investigations of infected
patients indicated no direct contact with swine, such as at a farm or agricultural fair.patients indicated no direct contact with swine, such as at a farm or agricultural fair.[37][37] TheThe
strain was later confirmed to have been transmitted between humans.strain was later confirmed to have been transmitted between humans.[75][75] However, at least oneHowever, at least one
other strain of swine flu has previously been transmitted between humans without widerother strain of swine flu has previously been transmitted between humans without wider
community infection.community infection.[76][76] In contrast, for example, disease transmission in the last severe humanIn contrast, for example, disease transmission in the last severe human
outbreak of influenza, theoutbreak of influenza, the bird flubird flu that peaked in 2006, was determined to be almost entirelythat peaked in 2006, was determined to be almost entirely
from direct contact between humans and birds.from direct contact between humans and birds.[77][77]
VirulenceVirulence
– The virus has produced severe disease in Mexico, and some deaths. Furthermore, in MexicoThe virus has produced severe disease in Mexico, and some deaths. Furthermore, in Mexico
(but not in the United States) the illness has primarily struck young, healthy adults, much like the(but not in the United States) the illness has primarily struck young, healthy adults, much like the
deadly Spanish Flu of 1918. Most other influenza strains produce the worst symptoms in youngdeadly Spanish Flu of 1918. Most other influenza strains produce the worst symptoms in young
children, elderly adults, and others with weaker immune systems.children, elderly adults, and others with weaker immune systems.[78][78][37][37]
GeographyGeography
– The virus has been detected in multiple areas, indicating that containment is unlikely.The virus has been detected in multiple areas, indicating that containment is unlikely.[71][71][38][38]
This is exacerbated by the incubation and infectious periods of influenza.This is exacerbated by the incubation and infectious periods of influenza.
Other pointsOther points
– Some other specificities which are also important to rate, such as theSome other specificities which are also important to rate, such as the contagiousnesscontagiousness settingsetting
the percentage of a population susceptible to this virus, are data which are not yet known.the percentage of a population susceptible to this virus, are data which are not yet known.
18. Prevention and treatmentPrevention and treatment
SStandard personal precautionstandard personal precautions against influenza.against influenza.
This includes frequent washing of hands with soapThis includes frequent washing of hands with soap
and water or with alcohol-based hand sanitizers,and water or with alcohol-based hand sanitizers,
especially after being out in-public.especially after being out in-public.
People should avoid touching their mouth, nose orPeople should avoid touching their mouth, nose or
eyes with their hands unless they've washed theireyes with their hands unless they've washed their
hands.hands.
If people do cough, they should either cough into aIf people do cough, they should either cough into a
tissue and throw it in the garbage immediately or,tissue and throw it in the garbage immediately or,
if they cough in their hand, they should wash theirif they cough in their hand, they should wash their
hands immediately.hands immediately.[79][79]
19. Prevention and treatmentPrevention and treatment
Some physicians in the US are recommending the use ofSome physicians in the US are recommending the use of
masks when in public.masks when in public.
The purpose of a face mask is to effectively cover aThe purpose of a face mask is to effectively cover a
person's mouth and nose so that if a person is aroundperson's mouth and nose so that if a person is around
someone who is infected, there is a decreased likelihood ofsomeone who is infected, there is a decreased likelihood of
transmission.transmission.
Recommendations to protect against the avian flu indicatedRecommendations to protect against the avian flu indicated
that using a face mask with a rating of N99, N100 or P100that using a face mask with a rating of N99, N100 or P100
in the United States or a rating of FFP3 in Europe shouldin the United States or a rating of FFP3 in Europe should
be effective in protecting against transmission.[88] Whilebe effective in protecting against transmission.[88] While
face masks with these ratings provide 99% or greaterface masks with these ratings provide 99% or greater
efficiency in protecting against flu transmission, N95 orefficiency in protecting against flu transmission, N95 or
FFP2 face masks provide about 94% efficiency.[89] N95FFP2 face masks provide about 94% efficiency.[89] N95
and FFP2 rated face masks may therefore also be effectiveand FFP2 rated face masks may therefore also be effective
20. The previously recommended influenza vaccines for the southern andThe previously recommended influenza vaccines for the southern and
northern hemispheres, including that for the 2009/2010 flu season, arenorthern hemispheres, including that for the 2009/2010 flu season, are
ineffective against the new strain.ineffective against the new strain.[80][80] Current development, large-scaleCurrent development, large-scale
manufacturing, distribution and delivery of a new vaccine takes severalmanufacturing, distribution and delivery of a new vaccine takes several
months.months.[71][71]
US based medical product companyUS based medical product company Baxter InternationalBaxter International hashas
requested a virus sample from the WHO in order to begin developmentrequested a virus sample from the WHO in order to begin development
of a new vaccine.of a new vaccine.[81][81] Baxter has patented a cell-based technology thatBaxter has patented a cell-based technology that
may allow the company to develop a vaccine in half the time it usuallymay allow the company to develop a vaccine in half the time it usually
takes, possibly cutting development time from six months to three.takes, possibly cutting development time from six months to three.[82][82]
Of the availableOf the available antiviral treatmentsantiviral treatments for influenza, the WHO stated thatfor influenza, the WHO stated that
the viruses obtained from the human cases with swine influenza in thethe viruses obtained from the human cases with swine influenza in the
United States were sensitive toUnited States were sensitive to oseltamiviroseltamivir (Tamiflu)(Tamiflu)[83][83] andand zanamivirzanamivir
(Relenza) but resistant to(Relenza) but resistant to amantadineamantadine andand remantadineremantadine..[84][84]
Tamiflu and Relenza also have a preventative effect againstTamiflu and Relenza also have a preventative effect against
InfluenzavirusInfluenzavirus AA..[85][85] Roche and the US government have extendedRoche and the US government have extended
the shelf-life of stock-piled Tamiflu from the original five years to seventhe shelf-life of stock-piled Tamiflu from the original five years to seven
years because studies indicated that the medication continues toyears because studies indicated that the medication continues to
maintain its effectiveness.maintain its effectiveness.[[
Vaccine?
21. National responsesNational responses
Many countries confirmed that inbound international passengers will be screened.Many countries confirmed that inbound international passengers will be screened.
Typical airport health screening involves asking passengers which countries they haveTypical airport health screening involves asking passengers which countries they have
visited and checking whether they feel or look particularly unwell.visited and checking whether they feel or look particularly unwell. ThermographicThermographic
equipmentequipment was put into use at a number of airports to screen passengers. In the USA,was put into use at a number of airports to screen passengers. In the USA,
two confirmed cases were detected through their "border infectious diseasetwo confirmed cases were detected through their "border infectious disease
surveillance".surveillance".[71][71] A number of countries advised against travel to known affectedA number of countries advised against travel to known affected
regions.regions.
According to theAccording to the MalaysianMalaysian Health Ministry, health screenings will be carried out onHealth Ministry, health screenings will be carried out on
passengers traveling to and from Mexico beginning on April 17.passengers traveling to and from Mexico beginning on April 17.[107][107] The HealthThe Health
Ministry’s disease control division has activated its operations room to monitor the swineMinistry’s disease control division has activated its operations room to monitor the swine
flu situation and informed medical practitioners who are treating cases with symptoms offlu situation and informed medical practitioners who are treating cases with symptoms of
influenza-like illness or severe pneumonia and persons had visited Mexico, California orinfluenza-like illness or severe pneumonia and persons had visited Mexico, California or
Texas, to inform the district health office immediately for preventive and controlTexas, to inform the district health office immediately for preventive and control
measures.measures.[108][108]
United StatesUnited States
The United States of America has declared a state ofThe United States of America has declared a state of Public Health EmergencyPublic Health Emergency..
According to theAccording to the New York TimesNew York Times, "the emergency declaration frees resources to be, "the emergency declaration frees resources to be
used toward diagnosing or preventing additional cases and releases money for moreused toward diagnosing or preventing additional cases and releases money for more
antiviral drugs," including the transfer of approximately 12 million influenza medicationsantiviral drugs," including the transfer of approximately 12 million influenza medications
from a federal stockpile to states.from a federal stockpile to states.[122][122][129][129] The U.S. plans to follow a guidebookThe U.S. plans to follow a guidebook
developed over the past five years to fight a pandemic flu, such as H5N1.developed over the past five years to fight a pandemic flu, such as H5N1.
22. Residents of States with SwineResidents of States with Swine
Influenza CasesInfluenza Cases
Cover your nose and mouth with a tissue when you coughCover your nose and mouth with a tissue when you cough
or sneeze. Throw the tissue in the trash after you use it.or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especiallyWash your hands often with soap and water, especially
after you cough or sneeze. Alcohol-based hands cleanersafter you cough or sneeze. Alcohol-based hands cleaners
are also effective.are also effective.
Try to avoid close contact with sick people.Try to avoid close contact with sick people.
If you get sick, CDC recommends that you stay home fromIf you get sick, CDC recommends that you stay home from
work or school and limit contact with others to keep fromwork or school and limit contact with others to keep from
infecting them.infecting them.
Avoid touching your eyes, nose or mouth. Germs spreadAvoid touching your eyes, nose or mouth. Germs spread
that way.that way.
23. CliniciansClinicians
Clinicians should consider the possibility of swine influenza virusClinicians should consider the possibility of swine influenza virus
infections in patients presenting withinfections in patients presenting with
1. febrile respiratory illness who live in an area where human cases of1. febrile respiratory illness who live in an area where human cases of
swine influenza A (H1N1) has been identified orswine influenza A (H1N1) has been identified or
2. Have traveled to an area where human cases of swine influenza A2. Have traveled to an area where human cases of swine influenza A
(H1N1) has been identified or(H1N1) has been identified or
3. Have been in contact with ill persons from these areas in the 7 days3. Have been in contact with ill persons from these areas in the 7 days
prior to their illness onset.prior to their illness onset.
If swine flu is suspected, clinicians should obtain a respiratory swab forIf swine flu is suspected, clinicians should obtain a respiratory swab for
swine influenza testing and place it in a refrigerator (not a freezer).swine influenza testing and place it in a refrigerator (not a freezer).
Once collected, the clinician should contact their state or local healthOnce collected, the clinician should contact their state or local health
department to facilitate transport and timely diagnosis at a state publicdepartment to facilitate transport and timely diagnosis at a state public
health laboratory.health laboratory.
24.
25. INFLUENZA LIKE ILLNESS (ILI)INFLUENZA LIKE ILLNESS (ILI)
Definitions of Respiratory IllnessDefinitions of Respiratory Illness
Acute respiratory illnessAcute respiratory illness
Recent onset of at least two of the following:Recent onset of at least two of the following:
– rhinorrhea or nasal congestionrhinorrhea or nasal congestion
– sore throatsore throat
– coughcough
– fever or feverishnessfever or feverishness
Influenza-like illnessInfluenza-like illness: fever >37.8°C (100°F) plus: fever >37.8°C (100°F) plus
cough or sore throatcough or sore throat
26. Case Definitions for Infection with Swine Influenza A (H1N1) VirusCase Definitions for Infection with Swine Influenza A (H1N1) Virus
A Confirmed caseA Confirmed case of swine influenza A (H1N1) virus infection is defined as aof swine influenza A (H1N1) virus infection is defined as a
person with an acute respiratory illness with laboratory confirmed swine influenzaperson with an acute respiratory illness with laboratory confirmed swine influenza
A (H1N1) virus infection at CDC by one or more of the following tests:A (H1N1) virus infection at CDC by one or more of the following tests:
– real-time RT-PCRreal-time RT-PCR
– viral cultureviral culture
– four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodiesfour-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies
A Probable caseA Probable case of swine influenza A (H1N1) virus infection is defined as aof swine influenza A (H1N1) virus infection is defined as a
person with an acute respiratory illness with an influenza test that is positive forperson with an acute respiratory illness with an influenza test that is positive for
influenza A, but H1 and N1 negative.influenza A, but H1 and N1 negative.
A Suspected caseA Suspected case of swine influenza A (H1N1) virus infection is defined as:of swine influenza A (H1N1) virus infection is defined as:
– A person with an acute respiratory illness who was a close contact to a confirmedA person with an acute respiratory illness who was a close contact to a confirmed
case of swine influenza A (H1N1) virus infection while the case was illcase of swine influenza A (H1N1) virus infection while the case was ill OROR
– A person with an acute respiratory illness with a recent history of contact with anA person with an acute respiratory illness with a recent history of contact with an
animal with confirmed or suspected swine influenza A (H1N1) virus infectionanimal with confirmed or suspected swine influenza A (H1N1) virus infection OROR
– A person with an acute respiratory illness who has traveled to an area where there areA person with an acute respiratory illness who has traveled to an area where there are
confirmed cases of swine influenza A (H1N1) within 7 days of suspect case's illnessconfirmed cases of swine influenza A (H1N1) within 7 days of suspect case's illness
onset.onset.
27. Infectious period for confirmed cases =Infectious period for confirmed cases =
1 day before onset to 7 days after onset of1 day before onset to 7 days after onset of
illnessillness
Day before onset = Day -1Day before onset = Day -1
Onset day = Day 0Onset day = Day 0
Days after onset = Days 1-7Days after onset = Days 1-7
28. State Public Health LaboratoriesState Public Health Laboratories
Laboratories should send all unsubtypableLaboratories should send all unsubtypable
influenza A specimens as soon as possible to theinfluenza A specimens as soon as possible to the
Viral Surveillance and Diagnostic Branch of theViral Surveillance and Diagnostic Branch of the
CDC’s Influenza Division for further diagnosticCDC’s Influenza Division for further diagnostic
testing.testing.
Public Health /Animal Health OfficialsPublic Health /Animal Health Officials
Officials should conduct thorough case andOfficials should conduct thorough case and
contact investigations to determine the source ofcontact investigations to determine the source of
the swine influenza virus, extent of communitythe swine influenza virus, extent of community
illness and the need for timely control measures.illness and the need for timely control measures.
29. KESIAPSIAGAAN BAGIKESIAPSIAGAAN BAGI
MENANGANI “SWINE FLU”MENANGANI “SWINE FLU”
Melakukan saringan ke atas mereka yang datang dariMelakukan saringan ke atas mereka yang datang dari
Carlifornia, Texas dan Mexico.Carlifornia, Texas dan Mexico.
Sila ambil sejarah pergerakan mereka untuk 7 hari masaSila ambil sejarah pergerakan mereka untuk 7 hari masa
pengeraman sebelum keluar dari kawasan negarapengeraman sebelum keluar dari kawasan negara
tersebut.tersebut.
Melakukan diagnosa ke atas mereka dengan mengikutMelakukan diagnosa ke atas mereka dengan mengikut
definisi kes ILIdefinisi kes ILI
Bagi mereka yang sakit dengan tanda-tanda ILI hendaklahBagi mereka yang sakit dengan tanda-tanda ILI hendaklah
dirujuk ke Hospital Batu Pahatdirujuk ke Hospital Batu Pahat
Bagi mereka yang tiada tanda-tanda ILI hendaklah di berBagi mereka yang tiada tanda-tanda ILI hendaklah di ber
HEALTH ALERT CARD untuk di bawa bersama-samaHEALTH ALERT CARD untuk di bawa bersama-sama
sebagai panduan pemegang kad dan pengamal perubatansebagai panduan pemegang kad dan pengamal perubatan
masa akan datang.masa akan datang.
30.
31. KESIMPULANKESIMPULAN
WHO : amaran tahap wabak swineWHO : amaran tahap wabak swine
influenzainfluenza
TAHAP 4TAHAP 4
