Novel Influnza A H1N1 Virus

Infection

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Swine Flu Background

• Contagious respiratory disease with mild

to severe symptoms.
• Human to human transmission like
seasonal influenza via sneezing coughing,
etc.
• The first outbreak in 1918 called “Spanish
influenza pandemic affecting 1/3 of world
population (500 million) with 50 million
deaths.
 Swine Flu Background

• Second outbreak in 1976 in New Jersey

• Vaccination halted after 40 million

vaccination due to appearance of Guillain-
Barre Syndrome and 25 deaths.
• Increased flu risk in pregnant women,
particularly during the second and third
trimesters.
• Increased risk of fetal death or spontaneous
abortions in infected pregnant women.
 Novel H1N1 flu infection
• From April 15, 2009 to July 24, 2009, it is
estimated that more than one million people
became ill with novel H1N1 flu in the USA.

• From April 15, 2009 to July 24, 2009, a total of

43,771 confirmed and probable cases of novel
influenza A (H1N1) infection were reported.

• Of these cases reported, 5,011 people were

hospitalized and 302 people died.

• In India 782 cases reported - 511 cured - 4 deaths.

Novel H1N1 flu Global Map

Confirmed death and infections

Confirmed infections
Unconfirmed infections
Swine Flu Features
• Duration 4 – 6 days.

• Infectious period – 1 day prior to onset of

symptoms to 7 days after onset.
• Suspect in pt who present with febrile
respiratory illness
• Onset within 7 days of close contact with
confirmed infection.
• Onset within 7 days of travel to areas where
sustained human transmission exists
• Acute illness in person who resides in
community where atleast 1 confirmed case.
 Symptoms & Complications

• Symptoms of swine flu are similar to

influenza infections.
• Strong immune response may cause
some collateral tissue damage.
• Majority (about 90%-95%) of people
feel terrible but recover with no
problems.
 Symptoms & Complications
• Some patients develop severe
respiratory symptoms and need
respiratory support.
• Patients may get pneumonia
(bacterial secondary infection) if the
viral infection persists, and some
develop seizure.
• Death often occurs from secondary
bacterial infection of the lungs;
appropriate antibiotics need to be
used in these patients.
• Mortality Rate – 1% - 6%
Novel Influenza A H1N1 virus

• Novel H1N1 virus is also called “swine flu”

because many of the genes in this new virus
were very similar to influenza viruses that
normally occur in pigs (swine).
• It has two genes from flu viruses that normally
circulate in pigs, bird (avian) genes and human
genes.
• Scientists call this a "quadruple reassortant"
virus.
Symptoms in hospitalized novel
H1N1 flu patients
Symptom Number (%)
Fever* 249 (93%)
Cough 223 (83%)
Shortness of breath 145 (54%)
Fatigue/Weakness 108 (40%)
Chills 99 (37%)
Myalgias 96 (36%)
Rhinorrhea 96 (36%)
Sore Throat 84 (31%)
Headache 83 (31%)
Vomiting 78 (29%)
Wheezing 64 (24%)
Diarrhea 64 (24%)
 Signs of Emergency

• Novel H1N1 swine flu can progress rapidly.

• Shortness of breath, either during physical
activity or while resting, difficulty in breathing,
turning blue, bloody or colored (not clear)
sputum, chest pain.
• Altered mental status.

• High fever that persists beyond three days.

• Low blood pressure.

• In children, danger signs include fast or difficult

breathing,.
Emergency in Children
• In children, emergency warning signs are:
– Fast breathing or trouble breathing
– Bluish or gray skin color
– Not drinking enough fluids
– Severe or persistent vomiting
– Not waking up or difficulty in waking
up, not interacting , lack of alertness,
little or no desire to play.
– Being so irritable that the child does
not want to be held
– Flu-like symptoms improve but then
return with fever and worse cough
 Emergency in Adults

• In adults, emergency warning signs are:

• Difficulty breathing or shortness of

breath
• Pain or pressure in the chest or
abdomen
• Sudden dizziness

• Confusion

• Severe or persistent vomiting

• Flu-like symptoms improve but then

return with fever and worse cough
Care for Swine Flu
• Sick patient

• Bed rest, increased fluid consumption, cough

supressants, analgesic antipyretics, avoid
close contact, wash hands after contact, avoid
touching eyes, nose and mouth.
• Self isolate in home for 7 days or more if flu
like symptom.
• Wear face mask, if going out.

• Seek medical help if breathing difficulty or

severe illness.
Care for Swine Flu
• Household not sick

• Remain at home at the earliest signs of

sicknes.
• Minimize contact with community

• Designate single family member as care

taker.
• Wash hands with soap and water frequently.

• Do not use utensils and linen used by patient,

without washing.
Novel H1N1 flu infection
• Estimated community rate of influenza-like-
illness approximately 6% - 6.9% of the
population.

• Causes greater disease burden on people

younger than 25 years of age than older
people .
Novel H1N1 flu infection

• Greater risk of serious flu-related

complications in pts of asthma, diabetes,
heart disease, kidney disease, suppressed
immune system, neurocognitive,
neuromuscular disorder, obesity, age group
<5 and >65 yr and pregnancy.
Novel H1N1 flu infection

• The generation time

– acute respiratory illness (ARI) - 2.0-3.1 days

– influenza like illness (ILI) - 2.4-3.1 days

• A secondary attack rate in household contacts

– For acute-respiratory-illness (ARI) -18 % to

19%
– For influenza-like-illness (ILI) - 8% to 12%.
Preventive Care

• People infected with novel H1N1 flu shed virus

may be able to infect others from 1 day before

getting sick to 5 to 7 days after.

– Cover nose and mouth with a tissue when

you cough or sneeze.

– Wash hands often with soap and water,

especially after you cough or sneeze.

Preventive Care

– Avoid touching eyes, nose or mouth.

– Try to avoid close contact with sick people.

– If sick with flu-like illness, stay home for at

least 24 hours after your fever is gone.

– Healthy person with an ill family member at

home can go to work as usual with daily

health monitoring and precautions.

 Novel H1N1 flu infection

Case Rate

Hospitalization Rate
Mortality in 268 Hospitalized Patients
Contamination & Cleaning
• Virus can survive on surfaces and can infect a
person for 2 to 8 hours after being deposited
on the surface.
• Virus is destroyed by heat (167-212°F [75-
100°C, chlorine, hydrogen peroxide,
detergents (soap), iodophors (iodine-based
antiseptics), and alcohols.
• Virus spread when a person touches
something that is contaminated and then
touches his or her eyes, nose, or mouth.
Contamination & Cleaning
• Novel H1N1 viruses are not spread by food.

• Tap water that has been treated by

conventional disinfection processes does not
spread the virus.
• Chlorine treated water in swimming pool water
parks does not spread the virus but
recreational water venues can.
Contamination & Cleaning
• To prevent the spread of influenza virus

• keep surfaces (especially bedside tables,

surfaces in the bathroom, kitchen counters
and toys for children) clean with a
household disinfectant.
• Linens, eating utensils, and dishes should
not be shared without washing thoroughly
with soap and water first.
• Wear face mask when moving in public
places
Recommended
Treatment & Prophylaxis

• Treatment

• Same as those recommended for seasonal

influenza
• Oseltamivir, zanamivir ( amantadine,
rimantadine) for 5 days.
• Start drug treatment within 48 hours of
onset of symptoms.
Recommended
Treatment & Prophylaxis
• Chemoprophylaxis
• Oseltamivir, zanamivir for 7 days after the last
known exposure to an ill confirmed case.
• Household close contacts who are at high-risk for
complications.
• School children who had close contact (face-to-
face) with a confirmed or suspected case.
• Travel to infection areas if at high-risk for
complications.

• Health care workers or public health workers who

had unprotected close contact with an ill confirmed
case.
Preventive Measures In School
• Stay home when sick for at least7 days or for
24 hours after no fever, or signs of fever.
• Students who have an ill household member
should stay home for five days from the day
the first household member got sick.
• Separate ill students and staff and wear face
mask.
• Cover nose and mouth when coughing or
sneezing.
Preventive Measures In School
• Wash hands frequently with soap and water.

• Frequent cleaning of areas that students and

staff touch in routine manner.
• Check students and staff for fever and other
symptoms of flu daily.
• Early treatment of high-risk students and staff.

• Consideration of selective school closure.

All the best……