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Swine influenza USA/Mexico2009

Information and advice as of 25 th April 2009

WHO/WPRO

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Swine Influenza A H1N1Virology

Swine influenza H1N1 Reassortment - four different genes:

North America swine Asia/Europe swine Human influenza

Avian (Non H5) Unique combination that has never been seen before Level of immunity in general community

Unknown Effectiveness of seasonal influenza vaccine

Unknown Antiviral resistance

Resistant to adamantines Sensitive to tamiflu and relenza

WHO/WPRO

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USA

30 March first case (10y, M) San Diego County- California

28 March second case ( 9y, F) Imperial County- California

As of 25 April 8 cases California (6)

Texas (2) Guadalupe County & San Antonio County No contact with pigs Human to human confirmed by USCDC

WHO/WPRO

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Location of outbreaks: USA

GuadalupeCounty, TX

SanAntonio,TX

San DiegoCA

ImperialCounty, CA

(border withArizona)

WHO/WPRO

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Mexico Higher than expected ILI reports

March and April (usual peak in December) Northern and central Mexico

Steep rise in patients admitted with severe pneumonia inthe following provinces in the past 10 days: Baja, San Luis Potosi, Mexico City, Tlaxala, Hidalgo, Vera Cruz,

Chihuahua Majority pneumonia cases aged 25 to 44 years old Some deaths reported - majority in previously healthy

adults A number of pneumonia cases have tested positive for

swine influenza

WHO/WPRO

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Location of outbreaks: Mexico

Hidalgo

Vera Cruz

San LuisPotosi

TlaxcalaWHO/WPRO

http://www.lonelyplanet.com/destinationRedirector?ethylCobjId=2174

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Clinical Presentation (Mexico)

Incubation period up to 7 days Range of symptoms very mild to severe

acute respiratory symptoms Vomiting and diarrhoea in some cases Fatal cases: ill for 6 days then

deteriorate and many neededventilation

WHO/WPRO

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Advice to clinician unaffectedcountries

Health Travellers who have acute respiratorysymptoms and returned from within 7 days: California, USA

Texas, USA Mexico (all) Report as suspect case, arrange for testing,

isolate

If positive isolation, treatment with antivirals(tamiflu) and inform public health authorities sothat contact tracing can be initiated

WHO/WPRO

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Advice: Infection Control

Infection control for suspect or confirmedcase of swine influenza:

Standard, Droplet and Contact precautions

should be used for all patient care activities:e.g. frequent hands wash, wear disposablenon-sterile gloves, gowns, and eye protection(e.g., goggles) to prevent conjunctivalexposure.

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Laboratory detection of swineinfluenza H1N1

Samples should be collected, handled, storedand shipped using protocols developed for influenza H5N1

Virus isolation should only be carried out infacilities with BSL-3 or higher levels of containment

Most tests designed to detect influenza A virus

SHOULD detect this strain Some tests for subtyping MAY NOT identify thisstrain correctly

WHO/WPRO

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Laboratory detection of swineinfluenza H1N1

To definitively confirm this as swineinfluenza A H1N1, sequencing of viralnucleic acid is recommended. This shouldbe performed promptly.

WHO is currently identifying whichlaboratories in the region are capable of performing this procedure.

WHO/WPRO

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Advice:Border control & International travel

Health information and advice to international travellers

avoid exposure to infected persons

implement precautionary measures to prevent the disease (e.g. handhygiene, cough etiquette etc)

if developing ILI or acute respiratory illness, limit contact with others,report local health authority and seek appropriate medical care

WHO has not recommended border screening (e.g. entry/exitscreening), but countries in the WPR may consider implementing entry screening based on national decision

WHO has not recommended travel restrictions to the countriescurrently experiencing human swine influenza (Mexico andUSA)

WHO does not recommend international border closure

WHO/WPRO

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Advice to general public

Our standard precautions remain in place: Cover your cough or sneeze with a mask or a

tissue or your sleeve

Maintain good personal hygiene. Wash your hands frequently and avoid touching your face.

Avoid obviously sick people

Stay at home if you are unwell See your doctor if you have fever, cough, sore

throat, body aches, headache, chills and fatigue.

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Health information and advice tointernational travellers to affected areas

When travelling Avoid exposure to infected persons Implement precautionary measures to prevent the

disease (e.g. hand hygiene, cough etiquette etc)

If developing ILI or acute respiratory illness, limit contactwith others, report local health authority and seekappropriate medical care

If you are in or have traveled to an affected area:

Monitor your health If you develop symptoms seek medical attention. Advise thehealthcare facility that you have recently been in an area that hasreported swine flu

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Eating pork

Swine influenza viruses are nottransmitted by food. You cannot get swineinfluenza from eating pork products.

Pork meat is safe to eat as long as it ishandled appropriately and cookedthoroughly.