INFLUENZA A (H1N1) OUTBREAK 2009

INFLUENZA A (H1N1) OUTBREAK 2009

PORTS AND AIRPORTS HEALTH SERVICES DIVISION

A Possible Pandemic..

THE DISEASE

SWINE INFLUENZA (H1N1) OUTBREAK 2009


What is Swine Flu?

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen.


Swine Flu Viruses4 influenza type A virus subtypes that have been isolated in pigs

• H1N1 • H1N2• H3N2• H3N1


Swine Flu Viruses

4 influenza type A virus subtypes that have been isolated in pigs• H1N1 - most recently isolated• H1N2• H3N2• H3N1


Classic Swine Flu Virus: Influenza Virus Type A H1N1


• first isolated from a pig in 1930• is a respiratory disease of pigs • virus circulates among swine throughout the

year • regularly causes outbreaks of influenza in pigs• outbreaks occur fall and winter months

Signs in Pigs


• Fever – sudden onset• Depression• Coughing (barking)• Discharge from the nose or eyes• Sneezing• Breathing difficulties• Eye redness or inflammation• Going off feed

Swine Flu in Humans

• do not normally infect humans• sporadic human infections with swine flu have

occurred• occur in persons with direct exposure to pigs


How common is swine flu infection in humans?

In the past • 1 every 1-2 years in the U.S.

December 2005 - February 2009 • 12 cases of human infection


Signs and Symptoms in Humans

• Fever • Lethargy• Lack of appetite • Coughing• Runny nose• Sore throat• Nausea/Vomiting • Diarrhea


Transmission

1. Directly pigs to humans – close proximity to infected pigs– such as in pig barns and livestock exhibits

housing pigs at fairs. 2. Human to Human– coughing or sneezing – touching something with flu viruses on it and

then touching their mouth or nose3. Directly from humans to pigs


When influenza viruses from different species infect pigs, the viruses can reassort (swap genes) and new influenza viruses can emerge.

How did Influenza A H1N1 came about…?

Influenza A H1N1


Swine H1N1 vs. Human H1N1

• swine H1N1 flu virus NOT the same as human H1N1 virus

• antigenically very different from human H1N1 viruses

• vaccines for human seasonal flu can not protect humans from swine H1N1


Diagnosis and Laboratory Confirmation• Clinically diagnosed• Respiratory Specimen

• first 4 to 5 days of illness • can shed for 10 days or longer

• Specimens sent to US CDC • ONLY laboratory that can isolate and

identify swine influenza type A virus


Treatment

Recommended 1. Oseltamivir 2. Zanamivir

Showed Resistance in the past3. Amantadine4. Rimantadine


Vaccination

• NO vaccines for humans • seasonal influenza vaccine can help provide

partial protection against swine H3N2• pig vaccines are available


THE OUTBREAK


Backgrounder:23 April 2009 National Focal Point person of IHR alerted Bureau of Quarantine of the outbreak “Influenza Like Illness or Swine Influenza” in multiple locations in Mexico and two multiple locations in USA• U.S. Human Cases of Swine Flu Infection

– 7 cases– 0 death

• Mexico Human Cases of Swine Flu Infection– > 854 cases– 59 deaths


Pandemic Alert Phase 3


The current situation constitutes a Public Health emergency of International Concern

(PHEIC).

Serious Public Health ImpactUnusual or UnexpectedInternational disease spreadInterference with international travel or trade

Director-General WHO

Backgrounder:25 May 2009WHO declared,


WHO Recommendation

Intensify Surveillance1. Influenza-like illness (ILI) 2. Severe Pneumonia

Backgrounder:


First Line of Defense

PORTS OF ENTRY


BOQ at PORTS OF ENTRY

• Heightened alert level at all international airports of entry

• Temperature check to screen all passengers and crew of aircraft coming from foreign country

• Assessment of symptomatic crew/passengers at the airport.


• Referral of suspects to dedicated hospital and advise of voluntary home confinement (VHC) for asymptomatic crew/passengers

• Information campaign to inbound/outbound passengers about avian influenza virus through Information, Education and Communication (IEC)


• Distribution of health alert notice upon arrival • Posters or public announcements in airports• Notification to all concerned agencies• Notification to all quarantine stations

As of 1800H , GMT, 29 April 2009 • The Pandemic Alert Level was elevated to : Phase 5– USA 91 cases 1 death– MEXICO 2000 suspected cases, > hundred deaths– 7 more countries affected

• Canada 13 cases • Spain 4 cases• Austria 1 case• Germany 3 cases• Israel 2 cases• New Zealand 3 cases• United Kingdom 5 cases

Backgrounder:


Backgrounder:


Surveillance of Human Infection with Influenza A(H1N1) virus at Ports of Entry

CASE UNDER OBSERVATION


• ILI is defined as fever (Temp. Of 100°F(37.8°C) or greater and a cough and/ or a sore throat in the absence of a known cause other than influenza.

Interim Guidance for the Surveillance of Human Infection with Swine Influenza A(H1N1) virus


• Suspected case of SIV :Person with an acute respiratory illness who was a close contact to a confirmed case of SIV while the case was ill w/ a recent history of contact with an animal w/ confirmed or suspected SIV infection.

• Close contact: having cared for, lived with, or had direct contact with respiratory secretions or body fluids of a probable or confirmed case of swine influenza A(H1N1).



• A Probable case of swine influenza A(H1N1) virus infection is defined as an individual with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection OR

A individual with a clinically compatible illness or who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case.




• A Confirmed case of swine influenza A(H1N1) virus infection is defined as an individual with laboratory confirmed swine influenza A(H1N1) virus infection by one or more of the following tests:• real-time RT-PCR• viral culture• four-fold rise in swine influenza A(H1N1) virus specific neutralizing antibodies.


Republic of the PhilippinesBUREAU OF QUARANTINE

STANDARD MEDICAL SCREENING PROCEDURESFOR INFLUENZA A H1N1

Criteria for Referral of Travelers at Ports of Entry to Designated Hospital

(Case under Investigation- CUI)

FeverSymptoms of

Influenza-Like IllnessHx of travel to affected Country /ies

Contact with a person/s who is a confirmed case or Case

Under Investigation

Refer to Hospital

X X X X Y

X X X Y

X X X Y

X X Y

X X Y

X X X Y

X X Y

X X Y


ALGORITHM FOR FEVER SCREENING VIA FLIR THERMAL SCANNER

THERMAL SCANNER READING OF SURFACE SKIN TEMEPERATURE ABOVE 36.5C OR MORE

RE-CHECK :USING AXILLARY THERMOMETER

NORMAL TEMPERATUE

(37.0C AND BELOW)

NO ILI SYMPTOMSNO HX OF TRAVEL

NORMAL ARRIVAL PROCEDURESHEALTH ALERT NOTICE

ADVISE PRECAUTIONARY MEASURES

FEBRILE(37.1 AND ABOVE)

NO ILI SYMPTOMSNO HX OF TRAVEL

WITH ILI SYMPTOMS AND/ORWITH HX OF TRAVEL AND/ OR CONTACTS

CASE UNDER INVESTIGATION (CUI)REFERRAL TO DESIGNATED HOSPITAL


HEALTH DECLARATION CHECKLIST

HEALTH ALERT NOTICE

INFLUENZA A H1N1

Tanging Idea Pag-iwas Swine influenza


Signs and Symptoms in Humans

• Fever • Lethargy• Lack of appetite • Coughing• Runny nose• Sore throat• Nausea/Vomiting • Diarrhea


How can I prevent INFLUENZA A H1N1 infection?Ten Steps for Keeping Yourself and Others Safe from Swine Influenza or Any Respiratory Illness

1. Wash your hands frequentlyWash your hands with soap and water many times of the day. Dry your hands after washing. There is no substitute for hand washing. However, when water is not available, you may use alcohol-based disposable hand wipes or gel sanitizers.

2. Avoid touching your eyes, nose or mouthInfluenza viruses are often spread when a person touches surfaces that are contaminated with germs and then touches his or her eyes, nose, or mouth.

3. Avoid close contactAvoid close contact with people who are sick. Temporarily, refrain from shaking hands with or kissing other persons while there are reported outbreaks of influenza.

4. Stay home when you are sick.If possible, stay home and avoid crowded places when you are sick. You will help prevent others from catching your illness.

5. Cover your mouth and nose.Cover your mouth and nose with a tissue when coughing or sneezing to prevent spread of the virus.If you do not have a tissue, cough or sneeze into your upper sleeve, not on your hands. Discard your used tissue in the waste basket. You may be asked to put on a surgical mask to protect others.

Ten Steps for Keeping Yourself and Others Safe from Swine Influenza or Any Respiratory Illness

How can I prevent INFLUENZA A H1N1 infection?

6. Keep distance.When you are sick, keep your distance from others to protect them from getting sick too

7. Practice other good health habits.Refrain from smoking. Get enough sleep. Have regular exercise; be physically active. Manage your stress. Drink plenty of fluids. Eat nutritious food.

INLUENZA A H1N1

Ten Steps for Keeping Yourself and Others Safe from Swine Influenza or Any Respiratory Illness

8. Consult a doctor if you are sick.Seek medical care when you have signs of serious illness such as difficulty of breathing, confusion, severe vomiting.

9. Defer travel if you are sick.If you are ill, you should refrain from getting on an airplane or other forms of public transport to travel. If you must travel by plane to a country reported to have swine influenza outbreaks and if you feel ill after returning from it, you must consult a doctor.

10. Listen to your local health authorities. Keep yourself updated of the situation on the influenza outbreak and on health measures advised by your health authorities.

THANK YOU

BUREAU OF QUARANTINEPORTS AND AIRPORTS HEALTH SERVICES DIVISION

INFLUENZA A (H1N1) OUTBREAK 2009

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