VirtuAule English Language System Event!

http://rec1.dimdim.com/view/dimdim/a4a72cba-f744-102c-872d-
003048642bd7

Sunday 20 September 2009

My name is Mark I’m Anthony’s brother. I’m over here in the United States.
I’m a pharmacist and I’m looking forward to giving a talk on a subject here
that has a lot of influence on people and again, it is an English presentation
so if there are any questions or anything about these slides contact Tony or
let him know on his side and I’ll either slow down or we’ll go over

Novel H1N1 Flu - What is this?

It’s commonly called “the swine flu”. It’s a new influenza virus causing illness in
people across the world. This was first detected in people in the United States in April
of this year 2009. it is spreading person-to-person worldwide, similar to the seasonal
influenza or regular flu viruses. On June 11, 2009, the World Health Organization
(WHO) signaled this to be a pandemic which is an epidemic that is geographically
widespread occurring throughout a region or even throughout the world.

Why is novel H1N1 virus sometimes called “the swine flu”?

Originally the swine flu because its genes were similar to those that occur in pigs or
swine. Further studies show that this new virus is different because it has two genes
with flu viruses from pigs as well as birds or avian and human virus. So it’s really not
technically a full swine flu. It does have other genes attached.

The novel H1N1 flu in humans - Are there human infections with infections
with the new H1N1 virus?

You are probably already aware of it that human infections are ongoing. Most people
infected have recovered without medical treatment.

Is novel H1N1 virus contagious?

Yes it is. It is contagious and is spreading from human to human.
How does it spread?
This occurs like the seasonal flu. It spreads from person to person through coughing or
sneezing. Sometimes the infection occurs by touching something infected and then
the nose or mouth.

You went too far – one back – OK

What are the signs and symptoms of this virus in people?

They usually have a fever, cough, sore throat, runny or stuffy nose, body aches,
headache, chills and fatigue. A number of people have reported diarrhea and
vomiting. Severe illnesses and death have occurred with this. It sounds like it’s
basically like a flu, a simple flu that we have now but it does affect other people. We’ll
get into that in a second.

How severe is the illness associated with the virus?

The illness has ranged from mild to severe. As with the regular flu, some people are at
“high risk” . People sixty-five years and older, children younger than five years old,
pregnant women, and people with chronic medical conditions. These are the same as
with the seasonal flu. Adults older than sixty-four do not yet appear to be at increased
risk with this H1N1. No children and few adults younger than sixty have the existing
antibody for this so they seem to be more at risk. About one-third of the adults older
than sixty have these antibodies. It’s unknown if the protection is afforded against the
flu by any existing antibody. Seventy percent of hospitalized people have had previous
high risk medical conditions so these are the ones to be concerned with; the ones
including pregnancy, diabetes, heart disease, asthma and kidney disease. If you have
these, these seem to be at very high risk and your chances of getting really sick are
greater.

How does this compare to seasonal flu in terms of its severity and infection
rates?
The seasonal flu can cause mild to severe illness, sometimes death. This is United
States data, so this might not apply to your area but we do have about 36,000 people
die regularly from flu-related complications, 200,000 people over here are
hospitalized. 20,000 are children younger than 5. Over 90% of the deaths with
seasonal flu or 60 percent of hospitalizations occur in people older than 65. So right
now the information from these mid-April 2009 findings are right now. The greater
burden is in the younger than 25 rather than the older people because of these
antibodies. A few cases and few deaths are reported in people older than 64,
pregnancy high risk medical conditions have increased risk of these complications as
well. So it’s mainly this novel H1N1 – the basic difference is the severity with the
population of the younger people being more at risk than the older people.

How long can an infected person spread this virus to others?

The shed can infect others from 1 day to 5 to 7 days after it has started into people.
This can be longer in some people, especially children and people with weakened
immune systems and in people infected with the new H1N1 virus. So the virus can be
spread in those early days.

Prevention & Treatment

What are we going to do to prevent this from spreading? What can I do to
protect myself from getting sick?
Right now there is no vaccine available. It will be available starting in October here in
the US. There are four companies that got licenses to put this vaccine out. I know one
of them is in France. I can’t remember where the other ones are right off the top of my
head, but this should be available in the US in October. It is in production and may be
ready like you said in the fall. The vaccine will be available to protect against seasonal
influenza so you still have your regular influenza vaccine for your seasonal flu.
Everyday actions can help prevent the spreading of germs that cause respiratory
illnesses like influenza and we’ll get into those in just a second.

These are what you can do to help prevent it.

Follow public health advice, avoid crowds be prepared to stay home for a week or so
if you are sick. So have a good supply of over-the-counter medications in case
something does happen that you have to stay home, use alcohol-based hand rubs.
This is very important because the virus has been shown to be hit upon and
susceptible to alcohol-based hand rubs. Use tissues and other related items. Avoid the
trips out in public while sick and contagious so you don’t spread it to other people as
well as get more sick by being out. Masks can help in crowded situations. The masks
don’t really show any real true effect because the virus is too small to penetrate
through the mask but it will help to keep the people from coughing on you and
spreading the germs that way. And also if you do wear a mask people will stay away
from you. So that’s another idea why the mask may be helpful. You want to cover
your nose and mouth with tissue. Throw the tissue away after each use.

Wash your hands often with soap and water. Avoid touching your eyes, nose or mouth.
If you have flu-like symptoms stay home for at least 24 hours after your fever is gone.
And the fever should be gone without fever-reducing medication. It will go away. Keep
away from others .

If I have a family member at home who is sick with novel H1N1 flu, should I
go to work?
Employees who are well but have ill family members at home can go to work but you
should monitor your health daily. Take everyday precautions. We went over washing
the hands, using Alcohol-based hand cleaners. Employees with underlying medical
conditions or who are pregnant though should call their health advisor or health-care
provider and also receive the influenza antiviral drugs to prevent illness if your doctor
or health-care professional says that’s the way to go.

In children, how can I tell the difference if children n have it or adults have
it. In children, the warning signs that need urgent medical care include:
• Fast breathing or trouble breathing
• Usually Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Irritable, not wanting to be held if they are very small
• The symptoms improve but then return with fever and worse cough
In adults showing these symptoms, the emergency warning signs that need
urgent medical attention include:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• The symptoms do improve but then return with fever and worse cough

Are there medicines to treat novel H1N1 infection?

Yes, there are. Right now there are two available - Oseltamivir and Zanamivir are two
agents now that are out for treatment and prevention of infections. These Antiviral
drugs come in pills, liquid or an inhaled can fight the flu by keeping the viruses from
reproducing . If you get sick, the antiviral drugs can make the illness milder and make
you feel better faster and it also prevents some of the serious flu complications. The
Priority use for these antiviral drugs is to treat severe influenza illness and also High
risk people. There was a study that was just out today that I got off the Internet saying
that worldwide there are 10,000 isolates of the flu that have been tested and found to
be sensitive to the Oseltamivir and right now it’s treating that disease and only 21 of
these isolets that have been tested have shown resistance to the Oseltamivir and 10
of these are in the US. So Oseltamivir is showing that it is a very potent medication in
fighting this right now. We’ll get on to the next thing and tell you about the use of that
later.

Myths or Exposures –these are things about spreading the virus

Can I get infected with this from eating or preparing pork?
The virus is not spread by food. There are no infections from eating pork or pork
products.

Is there a risk from drinking water?

Tap water treated by conventional disinfection processes is not at risk. Drinking water
treatment regulations provide a high degree of protection. Recent studies have
demonstrated that chlorine levels in drinking water are adequate to inactivate even
the highly pathogenic H5N1 avian flu virus. This is another, more serious influenza and
yet the chlorine has shown to inactivate it. So it’s likely that other influenza viruses
can be inactivated by this chlorination. There have been no cases of influenza caused
by exposure to influenza-contaminated drinking water found.

Can novel H1N1 flu virus be spread through water in swimming pools, spas,
water parks, interactive fountains, or other treated recreational water
venues?
Influenza viruses does infect the human upper respiratory tract but no cases of
influenza associated with water exposure have been found. Treated recreational water
does not pose a risk. No research has been completed about virus to chlorine and
other disinfectants. so it depends on how much chlorine you’re putting in your agents
whether this is going to work on all flu but so far they have shown that the pool levels,
the chlorine levels in swimming pools and spas are adequate to disinfect. Other
influenza viruses are also similarly disinfected by chlorine.

What are the plans for developing novel H1N1 vaccine?

We went over this earlier. The vaccines are the best public health tool for control of
influenza. Governments and scientists are working together to make this vaccine. The
manufacturers are using materials to begin vaccine production. The making of the
vaccine is a multi-step process; it takes months to complete. Candidate vaccines are
tested over a few months. All of this was a few months ago but they are going to put
out in the next month, month and a half.

When is it expected that the novel H1N1 vaccine will be available?

Again, this is what we just talked about. The date cannot be provided yet, but they
were talking about Mid-October here in the US. So that’s where we are at.

Will the seasonal flu vaccine also protect against the novel H1N1 flu?
The seasonal flu vaccine is not expected to help against the H1N1 flu. So you
probably or should get not only the regular flu vaccine to protect but also get the
H1N1flu vaccine.

Can this be given at the same time?

The seasonal flu and novel vaccines may be administered on the same day. They can
be given on the same time. the seasonal are available now so a lot of people are
getting the seasonal now and then they’re going to get the H1N1 when it becomes
available.

Key Flu Indicators

What we are talking about here is where the flu is in the world. What types of flues
are out there and how persistent are they. This was back in August 9 through the 15th
so it’s dated a little bit. It’s about a month old. There is more recent data but we can
share that at another time. The key indicators found so far is that the activity has
decreased overall. Still there are higher levels of influenza activity than is normal so it
was peaking and getting a little more prevalent but now it is slowing down a little bit.
Visits per doctor – the highest was in February and rose again in April so just about the
time this was discovered after the new H1N1 virus emerged. Visits are down in April
but are higher than expected. The total hospitalization rates remain low, the
proportionate deaths related to pneumonia and influenza are low and within the
bounds of expectation of the summer. This is where it gets interesting, almost all of
the influenza viruses indentified were the new 2009H1N1 influenza A viruses. This is
what is being found now. The viruses remain similar to the viruses chosen for the 2009
H1H1 vaccines and it’s still remaining susceptible to antiviral drugs.

This map here is showing, again this was back in August 10 through 16 so it’s a little
bit dated but the blue on it is showing the amount of virus that is H1N1 that is
compared to the little tiny purple part that is showing all the other influenzas. So as
you can see across the world, the H1N1 is the major influenza that is out there right
now. The Southern Hemisphere like it is showing over in Australia and New Zealand is
showing that it is getting a little less with the swine flu so it is going down in
proportion but it is mainly to show the co-circulation with the seasonal flu the H1N1 is
the major virus in the world.

Again this just goes over what we have highlighted

The 2009 H1N1 influenza virus is the predominant worldwide. The epidemiology in the
Southern Hemisphere is very similar the US in how it started but there is no real
significant change detected in the Southern as compared the Northern except now
recently in the southern has shown where the H1N1 is slowing down in proportion to
the seasonal virus.
OK. Now this is where the politics start to get involved with the H1N1
Quarantine Measures or how they are going to predict where this flu is heading as
far as the directional accounts and how many people are reported but this is an
example of what we’re going to use here what China did in July of 2009. They
implemented a policy of quarantine to anyone arriving in their country with cases
starting. That they will do a random selection process that makes it impossible to
predict when a traveler is going to be quarantined. The travelers risk being placed into
hospital quarantine is greater. The passengers sitting next to another traveler with
fever or flu-like symptoms, they can take you to a specially-designated hotel for a
quarantine of approximately seven days. So the travelers are advised that Chinese
health authorities have not issued a country-wide policy on keeping family members
together during this quarantine so they may be separated. You may be taken away
from your family if you are taken over there - keeping young children with their
parents or guardians varies by quarantine facility. So again are they going to keep
you together or are they going to separate you? It’s up to them. The parents have
been denied access to their children and there exists the possibility of Chinese
medical personnel administering medications to minors without parental permission to
prevent the H1N1 from spreading. If they have not had the flu shot they are going to
give you that H1N1 flu shot. So this is one country’s approach, and I don’t mean to
pick on China on this one because this can happen to any country and they can make
these decisions later as they feel fit so and we’ll get into this discussion part later.

This just shows a geographic spread again this is just a little bit dated slide we’ll get
another one later if we do this again some other time but you can see the red on this
is the widespread geographic spread of the influenza virus during this week 32. The
others were more regional in where they were at or a lot of the other countries were
also showing no on their report. All the grey which included Italy is showing no report
for activity Now this was again back in week 32. This is updated weekly – the CDC the
Center for Disease Control in the US and the World Health Organization updates this
weekly. But this is the kind of report that we can look at or you can look at on the
Internet to get a little bit more of a basis on how spread this virus is across the world.

This is where we open up for discussion if you have any questions you can
feel free to ask it but this is again talking about the politics involved in this
H1N1. Many countries are moving to what they call a mitigation strategy. Mitigation
strategy means that they may force or may highly recommend that people do not go
to work or are not permitted to be surrounded by “well” people. How are they going to
do this? It is up to the country. What they want to do because you do not want to get
to a pandemic level, I mean severe pandemic level of where everybody gets sick with
this disease. So right now this is kind of where the politics involved in this and where
we are going to go with it may change. Also the case reporting to show whether the
influenza virus is reported correctly or not. England has recently changed their
strategy on how they are going to report the influenza virus. So these numbers that
you see –how much it is spreading, and how big the area is could drop off just due to
the reporting mechanism on how these countries do it. Some of the data for
underlying preconditions may not be extremely accurate. It could be worse in your
area then what you are lead to believe, it can be better. But the main thing is, is why I
recommend going to the websites and checking on some of our sources. I think on our
last slide here that we will flip to. These are the websites that you can go to or you
can visit and they can give you updates as well as what their recommendations are.
Believe you me they are changing them on almost a weekly, or two-monthly level.
With the flu season approaching us right now we are into September. It is usually
October –November – December that the flu actually starts to hit. We just don’t know
how this H1N1 is going to influence us yet. But hopefully this has helped you to
recognize what it is and how to help you in order so you can keep away from it and be
a little more educated about this process.

Questions followed

end 27:16 of recording