Swine flu (Swine influenza,

H1N1 FLU)
BY

Outline

Introduction
Historical Perspective of Swine Flu
Influenza viruses-virology
Mode of transmissions
Other informations

Introduction
1.
2.
3.
4.

There is global evidence of influenza A/H1N1 causing

morbidity and mortality.
WHO has raised the level of influenza pandemic alert
to 6.
Influenza must be taken seriously, precisely because
of their capacity to spread to every country.
Most cases seem to be mild and self limited however
severe illness and death have been reported in a
small proportion of cases.

Objectives
1. To detect and confirm cases of new
Influenza A/H1N1virus infection.
2. To establish and monitor the extend of
spread of new Influenza A/H1N1 contacts.
3. To establish treatment protocols.
4. To assist the hospitals staff in infection
control.
5. To use the personal protective equipment
and removal and disposal with safely.
6. To train medical personnel in collecting
samples and to store them and safely
transport to the national lab.

TIME LINE OF EVENTS

April 12: An outbreak of influenza-like illness in Veracruz, Mexico,
reported to WHO
April 15-17: two cases of a new A(H1N1) virus infection
identified in two southern California counties in U.S.A.
April 23: new influenza A (H1N1) virus infection confirmed in
several patients in Mexico
April 24: WHO declares a public health event of
international concern (PHEIC).
June 11: WHO declares pandemic phase 6 (spread to 2 WHO
regions)
In 9 weeks, all WHO regions reporting cases of pandemic
(H1N1) 2009
Breaking News
Global swine flu deaths pass 10,000 with more than 325000
confirmed cases effecting more than 208 countries.
According to unofficial source, 89 cases in Punjab from
2014 to 2015 till date. 26 deaths so far

Mode of spread
1. The virus is spread from person to person by
exposure to infected droplet expelled by
coughing or sneezing(30 %).
2. Contaminated hands and surfaces(70 %).
3. Viral shedding from just before illness (1 day),
to up to 7 days after onset of symptoms
(shedding may be longer in young).

Mechanisms of Influenza Virus

Adaptation to Human Influenza virus
(shift)
CT
E
R
I
D

Nonhuman
virus

Human
virus

Reassortant
virus

Virology
INFLUENZA VIRUSES
Family orthomyxoviridae
Influenza A H1N1, and H1N2,
H3N2 may be
RNA virus segmented genomes
Each segment encodes a different
protein
Two major surface proteins
(Hemagglutining (HA),
nuraminidase (NA) that determin
the serotypes

Case Definition
Suspected case of pandemic (H1N1) 2016
1. A suspected case is defined as an individual
with acute respiratory illness and fever
(reported or documented fever (more than
38*C) and one of the following; cough, sore
throat, shortness of breath, difficulty in
breathing or chest pains with onset;
- Within seven days of close contact with a
person who is probable or confirmed case.
- Within
seven
days
of
travel
to
a
country/community where there is one or more
confirmed cases of pandemic.

Probable case of pandemic

1. A probable case is defined as an individual with
an influenza like illness who is positive for
influenza A that unsubtypeable by PCR
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.

Confirmed case of pandemic

(H1N1) 2016
1. A confirmed case is defined as an individual
with an influenza like illness with laboratory
confirmed pandemic A/H1N1 2009 virus
infection by one more of the following test:
- PCR
- Elisa
- Viral culture
- Four fold rise in pandemic (H1N1) 2016 virus
specific neutralizing antibodies.

Danger Signs
Shortness of breath, either during physical
activity or while resting.
Difficulty in breathing
Turning blue
Bloody coloured sputum
Chest pain
Altered mental status
High fever that persists beyond 3 days
Low blood pressure.

Danger signs in Children

Fast or difficult breathing

Lack of alertness
Difficulty in waking up
Little or no desire
convulsions

Average age of cases

Occurring in younger people with the median
age reported to be 12-17 years
Average age of cases now increasing from 1045 years
Age group below 5-12 years also susceptible

Risk factors

Cardiovascular disease
Respiratory disease i.e. Asthma etc.
Diabetes
Cancer
Immunosuppressant illnesses
Hepatic and renal diseases
With poor socioeconomics status
pregnancy

Proposed Strategy for Control of

Pandemic H1N1
Containment Phase: Almost over, so airport
surveillance has limited effect
Outbreak
management
Phase:
Through
awareness (like social distancing), improved
diagnosis, updated flu response centres, stock
pilling
drugs,
plan
to
manage
social
disturbances, monitor first case & contacts
Treatment Phase: Based on clinical diagnosis.

Clinical scenario
Variables
Symptoms
Chilly sensation
Cough
Headache
Sore throat
Prostration
Nasal stuffiness
Diarrhea
Dizziness
Eye irritation or pain
Vomiting
Myalgia

Occurrence
++++
+++
+++
+++
++
++
++
+
+
+
+

Signs
Fever
++
++
Pharyngitis
+++
Conjunctivitis (mild)
++
Rhinitis
++
Cervical lymphadenopathy
+
Pulmonary rales, wheezes, or rhonchi
+

Clinical algorithm for consideration

in the assessment of persons with
mild or uncomplicated influenza
illness

Antiviral Drugs for Treatment of

Influenza
The neuraminidase inhibitors are the drugs of
choice
1.Oseltamivir - As capsules or oral suspension
(Tamiflu)
2.Zanamivir - For oral inhalation (Relenza)
3.Peramivir - A third neuraminidase inhibitor
peramivir formulated for intravenous (IV)
administration is an investigational product

Specific Regimens for Treatment and Chemoprophylaxis of

2009 H1N1 Influenza A
Treatment and Chemoprophylaxis Regimens for Adults
and Children by Age and Weight

Table 1. Antiviral medication dosing recommendations

for treatment or chemoprophylaxis of 2009 H1N1
infection
Medication

Treatment Chemoprophylaxis
(5 days)
(10 days)

Oseltamivir1
Adults
75 mg
twice
daily

75 mg once daily

Children > 12 months

Body Weight
(kg)

Body Weight
(lbs)

<15 kg

<33lbs

30 mg twice
daily

30 mg once
daily

> 15 kg to 23
kg

> 33 lbs to 51 45 mg twice

lbs
daily

45 mg once
daily

> 23 kg to 40
kg

> 51 lbs to 88 60 mg twice

lbs
daily

60 mg once
daily

> 40 kg

> 88 lbs

75 mg once
daily

75 mg twice
daily

Children 3 months to > 12 months2

3 mg/kg/dose 3 mg/kg/dose
twice daily
once per day

Children 0 to < 3 months3

3 mg/kg/dose
twice daily

Zanamivir4
Adults

Not recommended
unless situation
judged critical due to
limited data on use
in this age group

10 mg (two 5- 10 mg (two 5-mg

mg
inhalations) once daily
inhalations)
twice daily
Children (> 7 years or older for treatment, > 5 years for
chemoprophylaxis)
10 mg (two 5- 10 mg (two 5-mg
mg
inhalations) once daily
inhalations)
twice daily

Preventive tips

Wash hands frequently with soap and water

Cover mouth & nose when coughing or sneezing
Avoid touching your eyes, nose and mouth
People who are sick with an influenza-like illness (ILI)
(fever plus at least cough or sore throat and possibly other
symptoms like runny nose, body aches, headaches, chills,
fatigue, vomiting and diarrhea) should stay home
Keep away from others; avoid travel, for at least 24 hours
after fever is gone. (Fever should be gone without the use
of fever-reducing medicine).
Avoid close contact (i.e. being within about 6 feet) with
persons with ILI.

Indications for vaccination

Persons at high risk for complication from the flu
All children 6-59 months of age
Person > 65 yr of age
Adults and children >6 mo of age with chronic heart or
lung conditions, including asthma
Adults and children >6 mo of age who needed regular
medical care or were in a hospital during the previous
year because of a metabolic disease (like diabetes),
chronic kidney disease, or immune system, including
immune system problems caused by medicines or by
infection with HIV/AIDS.
Children 6 months to 18 yr of age who are on long term
aspirin therapy because of the increased risk for Reye
syndrome.
Women who will be pregnant during the influenza season
Persons 50-64 yr of age

Persons who can transmit flu to others

This includes all health care workers, household
contacts and out of home caregivers of children
0-23 mo of age, and close contact of persons >
65 yr of age.

Vaccines available
Pandemrix: (Monovalent Influenza A H1N1 2016)
Healthy children aged over six monthsand below
10 years:
- A single dose of 0.25ml.
Immuno compromised children aged over six
months and below 10 years:
- Two doses of 0.25ml given at least three weeks
apart.
Healthy children aged 10 years and over or
healthy adults:
- A single dose of 0.5ml.
Immuno compromised children aged 10 years and
over or immuno compromised adults:
- Two doses of 0.5ml given at least three
weeks apart.

Celvapan: (Monovalent Influenza A H1N1

2016)
All children aged over six months and
below 10 years:
- Two doses of 0.5ml givenat least three
weeks apart.
All children aged 10 years and over or
adults:
- Two doses of 0.5ml given at least three
weeks apart
Vaccine manufacturers are Sonoofi Pasteur,
Novartis, Intranasal by MedImmune, LLC,
CSL Limited.

Levels of Prevention
1. Health Promotion
2. Specific Protection
3. Early diagnosis and prompt
treatment
4. Disability limitation
5. Rehabilitation

METHODS OF CONTROL
1. Preventive measures

Health Education for public and health personnel

Immunoprophylaxis
Chemoprophylaxis

2. Control of patient, contacts and the

immediate environment

Report to local health authority

Isolation
Concurrent disinfection
Quarantine
Protection of contencts

Investigation of contacts
Specific treatment

3.Epidemic Measures
4.Disaster implications
5.International measures

Non Communicable
Diseases
1. Problems with natural history of
disease

Absence of a known agent

Multifactorial causation
Long latent period
Indefinite onset

Burden of DiseaseMeasurement
1.
2.
3.
4.
5.
6.
7.

Proportional mortality ratio

Loss of life expectancy
CHD incidence rate
Age-specific death rates prevalence rate
Case fatality rate
Measurement of risk factor levels
Medical care

Risk Factors-CHD
1. Not modifiable

Age
Sex
Family history
Genetic factors
Personality
(?)

2. Modifiable

Cigarette Smoking
High blood pressure
Elevated serum cholesterol
Diabetes
Obesity
Sedentary habits
Stress

PREVENTIVE STRATEGIES
1. Population Strategy
Prevention in whole populations
Specific Interventions e.g
i) Dietary changes
ii) Smoking
iii) Blood pressure
iv) Physical activity
Primordial prevention in whole populations
2. High Risk Strategy
3. Secondary prevention
Early Diagnosis And Treatment