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Influenza A (H1N1)

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What is Influenza A (H1N1) ?

Swine Flue: infectious acute respiratory disease of pigs; Animal to human; Human to human; Mix of viruses from avian, swine and human seasonal

influenza in pigs influenza virus containing genes from number of sources (reassortant virus)

Direct or indirect contact with infected persons through:– Droplet transmission– Aerosol transmission– Not through well cooked pork meat;

Transmission efficiency of this virus is substantially higher than seasonal influenza.

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Threat of Pandemic Influenza

• Circulating in wild birds, poultry and pigs

Animal Influenza

• Infects humans in rare instances - resulting from close exposure to pigs

• If virus evolves into a human virus it could cause a human influenza pandemic

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Severity of Illness

Attack rates of 22-33%, but it could be higher in densely populated areas, which might cause considerable burden.

Sever illness require hospitalization is 1-2% and increase to 10% in low resource-settings.

Case-fatality ratio (<0.5%) in high-resource settings but higher in low resource settings.

Susceptible population are: Infants and young children, pregnant women, immunosuppressed or have chronic conditions such as cardiovascular disease, asthma, diabetes or tuberculosis

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Detection

Surveillance is important in order to detect initial cases of influenza Possible cases of new influenza A (H1N1) to be investigated

– A case or a cluster of cases of unexplained influenza-like illness (ILI) or severe acute respiratory illness (SARI) and may have any of the following:

• Close contact with a confirmed or probable case of new influenza A (H1N1) virus infection while the patient was ill and up to 24 hours before the onset of symptoms

• Recent travel to an area with sustained community transmission of new influenza A (H1N1) within 7 days of onset of symptoms

– Unexplained SARI occurring in one or more health care worker(s) in the same institution within a 7 day period

– Changes in the epidemiology or mortality associated with the occurrence of ILI or SARI

– Abnormal absenteeism in a school or workplace setting – Persistent changes noted in the treatment response or outcome of SARI

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Treatment

1. Based on the severity of the conditions:– Antiviral drugs: (Oseltamivir (TAMIFLUE), Zanamivir); antibiotics for the related conditions .

Currently no vaccines for H1N12. Health Authorities have to

1. Conduct enhanced surveillance with full epidemiological description of cases:

2. Collect specimens and transport/ship to a pre-identified laboratory within 48 hours for testing;

3. Report probable and confirmed cases in real time to relevant national authorities and to WHO through national focal points

4. Disseminate key education messages to the community on infection risks and prevention to promote respiratory etiquette and hand hygiene.

5. Reinforce health systems and the capacity of health workers to assess, classify and manage respiratory illness (especially pneumonia and respiratory distress)

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Current situation

As of 15 June, 76 countries have officially reported 35,928 cases of influenza A(H1N1) infection, including 163 deaths.

Majority of cases are mild cases but spectrum is broad, evolution unknown;

World better prepared than even;

Increase production of antiviral;

Development of vaccines is ongoing .

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Levels of Pandemic Alert Pandemic level raised from 4 to 5 at April 29

(pandemic is imminent);

Virus has caused sustained community level outbreaks of transmission in at least 2 countries in one WHO region (Mexico, USA);

Pandemic level raised from 5 to 6 on June 11 (Global Pandemic)

Virus has caused sustained community level outbreaks of virus transmission in at least 2 countries of 2 WHO regions

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MoH activities

Up-date pandemic preparedness plan;

Booster lab capacities, enhance diseases surveillance;

Public awareness;

Remain on high alert for unusual outbreaks of Influenza-like-disease

Policies of social distancing;

Take measure to stop spread if disease hits;

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WHO’s support to PA

Disseminating material for surveillance;

Procure supplies for strengthening laboratory capacities; training for lab technicians;

Procure Tamiflue and personal protective equipment;

Technical support to national committees for Influenza and technical working group up-date for national preparedness plan;

Facilitate coordination with neighboring countries;

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Prevention The health impact of an influenza pandemic may be reduced:

1. Be aware, get information!!

2. Respiratory etiquette – covering the nose and mouth when coughing or sneezing.

3. Separation/social distancing* – reduce time spent in crowded settings and gatherings, especially for high risk groups for severe disease such as infants and young children, pregnant women, and those with underlying chronic conditions such as immunosuppression, HIV/AIDS, tuberculosis or lung disease or asthma, heart disease, and diabetes.

4. Household ventilation – keep households well ventilated.

5. Hand hygiene – frequent washing of the hands.

*Explosive outbreaks may be prevented by early school closure, class dismissal or prevention of mass gatherings.

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What Can Individual Do?

The vast majority of patients will have mild to moderate disease and can be managed at home with simple supportive care:

– The key components are bed rest, fluids, good nutrition and use of antipyretics such as paracetamol for fever

All patients with acute respiratory infection should avoid close contact with others for 7 days after onset of symptoms or for 24 hours after resolution of symptoms

practise respiratory etiquette ensure proper hand hygieneStay at home and avoid close contact with uninfected

people, especially high-risk groups, as much as possible.

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What can individual do??

One caregiver, preferably a family member not in a high-risk group. The caregiver should:

– Cover nose and mouth when in close contact (closer than 1 m) of the patient and perform frequent hand hygiene

– Limit close contact with other people as much as possible, especially high-risk groups

– Facilitate air circulation– Wash clothes, bed-linen and scarves that have been in

contact with the patient's respiratory secretions or stools, with soap and water

– Dispose of used masks properly in a sealed bag Patients and caregivers should be supplied with and

trained to wear and dispose of masks.

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What Can Individual Do???

If the patient’s condition deteriorates → health-care facility.

All patients should be encouraged to seek prompt care if signs of severe disease develop. those in high risk groups should seek care at health facilities as soon as symptoms of ILI develop.

In low-resource settings, it is routinely encouraged that care is sought promptly for children less than five years of age in order to reduce mortality from other life-threatening common illnesses whose early symptoms may be indistinguishable from those of influenza, such as, community-acquired pneumonia and diarrhoea.