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INFLUENZA A (H1N1)
OUTBREAK
Dr. Rosemawati Ariffin
Infectious Disease Surveillance SectionDisease Control Division
Ministry of Health
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Presentation Road Map
Introduction virus, disease
What is an influenza pandemic?
Influenza A (H1N1) Actions taken by Ministry of Health
Actions should be taken by public
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Introduction
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Influenza Virus
RNA virusSurface glycoproteins:
H / HA- haemagglutinin
N / NA - Neuraminidase
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Influenza sub-groups
Influenza A
highly infective
infects many species
causes frequent widespread epidemics and pandemics
Influenza B only found in humans
capable of producing severe disease
cause of regional epidemics
Influenza C causes mild disease
humans are natural hosts but isolates also found in pigs
does not cause epidemics
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Subtypes ofInfluenza A Virus
(Karl G Nicholson, et al Lancet 2003; 362: 1733-45)
H1
H2
H3
H4
H5
H6
H7
H8
H9
H10
H12
H13
H14
H15
H11
N1
N2
N3
N4
N5
N6
N7
N8
N9
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Influenza Virus - Characteristics
Antigenic drift minor changes in theantigenic composition constantly occurringable to elude host defences
Antigenic shiftability to swap or re-assortgenetic materials and merge resulting in a novel
subtype different from both parent viruses
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Influenza Disease
Seasonal influenza influenza disease inhumans due to influenza virus infection thatcirculating for decades in humans (virus changeslightly from year to year)
Avian influenza- caused by influenza virusesthat occur naturally among wild birds, primarily adisease in birds. Sometimes can transmit tohumans
Swine influenza caused by influenza virusesthat naturally among pigs, primarily a disease inpigs. Occasionally can transmit to humans.
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Disease Transmission
Transmission airborne droplets
Incubation period: 1-3 days
Communicability:- day before & upto 3 5 days after the onset ofsymptoms. Longer in children, 7
days or more
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Influenza - Symptoms
Fever, cough, sore throat, headache, prostration,mylgia, malaise
Clinical presentation
- mild to fatal
- usually fatal in extreme age group
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Influenza A (H1N1) Outbreak
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24 April 2009 (report from WHO)
USA reported 7 confirmed cases of human Swine InfluenzaA/H1N1, no deaths.
Mexico reported a steady increase in cases since 18 Marchthrough April via ILI surveillance
As 23 April 2009, 882 cases of pneumonia were diagnosedwith 62 deaths from Mexico City, San Luis Potosi & Mexicali.
18 laboratory confirmed cases of Swine Influenza A/H1N1 ofwhich 12 of those genetically identical to Swine InfluenzaA/H1N1 from California
Background
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Influenza A (H1N1)
New strain detected in California(24 April 2009)
Laboratory test showed - mixed genes ofhuman, avian & swine (Influenza virusA/California/04/2009)
Everyone is at risk due to absence of immunity
Efficient human to human transmission
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Influenza A (H1N1)
Transmission: same as seasonal influenza
Symptoms: same as seasonal influenza, rangefrom mild respiratory symptoms topneumonia.
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Global Situation of Influenza A (H1N1)till 6 May 2009 18.00 GMT (Malaysia time: 0200 7 May 09)
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Pandemic Phases 5 - Description
Is characterized by human-to-human spread of the virusinto at least two countries in one WHO region.
Phase 5 since 29 April 2009
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Malaysias Current Situation(16 May 2009)
2 cases of Influenza A H1N1 reported
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Pandemic Influenza
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Pandemic influenza: definition
Pandemic can occur when:
New influenza virus
Able to infect humans
Transmissible from person to person
pandemic influenza : wide geographic
spread of novel influenza virus
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Past Influenza Pandemics
1900
1850
1950
2000
1847
1889
1918
1957
1968
42yrs
29yrs
39yrs
11yrs
30
40yearscycle
No Pandemic for > 35 years
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Geographic spread: 1918-19
?01/19
03/1804/18
06/18
05/18
06/18
06/18
?
C.W. Potter, Textbook of Influenza, 1998
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Geographic spread: 1957-58
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C.W. Potter, Textbook of Influenza, 1998
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Potential Impact of Pandemic
Livelihood: food & income loss from decreasedeconomic activity
Human health: high illness & potential higher
death rates
Rule of law & governance: increase demand ofgovernance & security
Humanitarian needs: interruption in in public
services
Economic system: trade & commerce disruption
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Potential impacts on Non Health Sectors
Lack of maintenance
Disrupted supply chain
Etc.
Break down of services
Economic and Social Disruption
Changed Demand
Military (support for logistics,etc.)
Mortuary & burial services
Refuse Collection
Water & Sanitation
Telecommunication (Phone and
Internet) Cleaning Supplies
Cash Withdrawal
Protection against insecurity
Electricity/Power supply
Food Distribution
Emergency Services
Death
Absenteeism
FearCare
Illness
Decreased Supply
Reduced production
Disrupted transportation
International trade of commodities
Trans-company dependencies
Decreased Demand
Retail Trade
Transportation
Leisure Travel
Restaurant
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Pandemic Response
Antiviral drugs
Vaccine, etc
Medical care, PPEMedical
interventional
Non- MedicalInterventions
Personal hygiene
Travel restriction
Quarantine Social distancing
Risk communication
Security
Food & water supply
Power supply
Transportation
Telecommunication
Other essential services
Social Services(keep a society running)
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Pandemic Influenza Preparedness Plan
Following outbreak of avian influenza H5N1outbreak in Hong Kong in 1997, influenzapandemic preparedness plan was produced byWHO
In 2003, WHO asked all countries to preparepandemic preparedness plan following Avianinfluenza H5N1 outbreaks involved manycountries in Asia, Europe & Africa (since end
2003 till now) Since then almost all countries worldwide have
prepare preparedness plan
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Prevention & ControlMeasures Taken by
Ministry of Health
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National Influenza PandemicPreparedness Plan (NIPPP)
Preparation started in 2003
Prepared by National Influenza
Pandemic Planning Committeemultidisciplinary, inter-agencies/departmental and experts.
Launched on 9 Jan. 2006 by Minister
of Health
Documents available in website
http://www.dph.gov.my/survelans
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NIPPP Strategies
Organizational Response
3 main committees
Public Health Response
Medical Response
Laboratory Response
Risk Communication
Social Response
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Actions Taken by Ministry of Health
Activate Operations Room for monitoring of
Influenza A (H1N1) situation & to ensure allproactive prevention & control measures becarried out
Enhance ILI/pneumonia surveillance at all levels ofhealth facilities
Conduct screening on arrival at International Ports
of Entry temperature check, health declarationand health alert card
Health advise to public & travellers via website, TV,radio andtelephone (CPRC)
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Actions Taken by Ministry of Health
Collaborate with WHO for monitoring &surveillance of the outbreaks
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Actions by Public
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Actions by Public
Follow travel advisory
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Actions by Public
Practice cough etiquette Hand hygiene wash hands with clean
water & soap esp. after cough
Do not attend gathering if you are havingsymptoms
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Actions by Industry
Follow preparedness planprepared by your company
Use Recommendations on
Influenza PandemicPreparedness for Industry inMalaysia as a guide.
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Current situation/information & updates,
refer to;Website:
- www.moh.gov.my
www.myhealth.gov.mywww.infosihat.gov.my
Hotlines:- 03-888810200/300
http://www.moh.gov.my/http://www.myhealth.gov.my/http://www.myhealth.gov.my/http://www.myhealth.gov.my/http://www.myhealth.gov.my/http://www.moh.gov.my/8/3/2019 IA (H1N1) - Presentation to Public CDC Div[1]
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THANKYOU
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