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ROLL # 05
MSPH 2009-10

It is an acute and highly contagious

respiratory disease of swine caused by
the orthomyxovirus thought to be the
same virus that caused the 1918
influenza pandemic.
Case Definitions

Confirmed case:
A confirmed case of influenza A(H1N1)
virus infection is defined as an individual
with laboratory confirmed new influenza
A(H1N1)virus infection by one or more of
the following tests:
* real time RT-PCR
* viral culture
* four fold rise in new influenza
A(H1N1) virus specific neutralizing
Case Definitions
• Probable case:
Is defined as an individual with a positive
influenza test for influenza A but is
unsubtypable by reagents used to detect
seasonal influenza virus infection
• An individual with clinically compatible
illness who is considered to be
epidemiologically linked to a probable or
confirmed case.

 Unusual tiredness 
 Headache
 Runny nose
 Sore throat
 Shortness of breath or cough
 Loss of appetite
 Aching muscles
 Diarrhea or vomiting
High-Risk Groups

 Chronic (long-term) lung disease

 Chronic heart disease
 Chronic kidney disease
Chronic liver disease
 Chronic neurological disease (neurological
High-Risk Groups

 Immunosuppressant (whether caused by disease or


 Diabetes mellitus
 Patients who have had drug treatment
 For asthma within the past three years
 Pregnant women
 People aged 65 and older, and

The novel H1N1 virus is a type of

swine influenza, derived originally
from a strain that lived in pigs and
this origin gave rise to the common
name of "swine flu", widely used by
mass media. Despite this origin,
however, the strain was transmitted
between people and not from swine .
• The initial outbreak was called the "H1N1 influenza." The
CDC began referring to it as "Novel influenza A (H1N1 )
• In the Netherlands, it was originally called "pig flu", but is
now called "Mexican flu" by the national health institute and
in the media. South Korea and Israel briefly considered
calling it the "Mexican virus". Later, the South Korean press
used "SI", short for "swine influenza". Taiwan suggested
the names "H1N1 flu" or "new flu", which most local media
adopted. The World Organization for Animal Health
proposed the name "North American influenza". The
European Commission adopted the term "novel flu virus .
• The 2009 flu pandemic is a global outbreak of a
new strain of an influenza A virus subtype
H1N1, officially referred to as the novel H1N1,
first identified in April 2009, and commonly
called swine flu


The disease has an incubation period of 1-7

days. The diseased person can spread the virus
to its close contacts from one day prior to the
appearance of symptoms to 7 days after their

J09 Influenza caused by influenza viruses

that normally infect only birds and
less commonly other animals.
Swine Influenza
Influenza A
A (H1N1)
Transmission to
to Humans

 Through contact with infected pigs or

environment contaminated with swine flu viruses

 Through contact with a person with swine flu

 Human to Human spread of swine flu has been
documented also and is thought to occur in the
same way as seasonal flu, through coughing or
sneezing of infected people
The outbreak was first detected in Mexico City on
March 18, 2009, immediately after the outbreak was
officially announced. Mexico requested material support
from the U.S., and within days of the outbreak Mexico
City was effectively shut down

• IN U.S.A
The new strain was first diagnosed in two children,
neither of whom had been in contact with pigs, by the
CDC, first on April 14, 2009 in San Diego County,
The number of new swine flu cases has
almost doubled in the past seven days, with
an estimated 9,000 new cases this week.
Situation in Pakistan
• ISLAMABAD — The first swine flu case in
Pakistan was detected on August 10, 2009 .
• Two new Pakistani patients traveled from
Arab countries on 23rd and 24th of
September this year. Swine flu was detected
through lab investigation of blood samples in
two patients after they were admitted to
the (PIMS) and they had been kept in an
isolation ward.
• ‘The 4th suspected patient arrived at (PIMS)

on 5th Oct 2009 morning from Peshawar,

where he reached recently from Dubai.
• Around two million Pakistanis live in Europe,
North America and other countries where
the swine flu pandemic has appeared.
Key Determinants of
Swine Flu

Control & Human Social &

Prevention Intrinsic Behavioral Factors

Virus Pig

Environmental conditions

Human to human transmission is rapidly occurring and disease has

already affected more than 135 countries, territories and areas.
Although the illness in the affected patients has mostly been mild
with mortality rate (0.45%) comparable to seasonal influenza yet
the threat of its further genetic modification to acquire more
virulence cannot be ruled out. Due to its rapid spread across the
globe, WHO has declared global alert level 6 meaning full-fledged
For most people, the illness appears to be mild. Cases have been
confirmed in all age groups, but children and younger people seem
much more likely to be affected. To date, fewer cases have been
confirmed in older adults. The virus is a novel strain of influenza.
Existing vaccines against seasonal flu provide no protection. A
study at the U.S. Centers for Disease Control and Prevention,
published in May 2009, found that children had no preexisting
immunity to the new strain but that adults, particularly those over
60, had some degree of immunity.
• Children showed no cross-reactive
antibody reaction to the new strain,
adults aged 18 to 64 had 6-9%, and
older adults 33%.
• The CDC noted that the 1918 flu
epidemic which killed hundreds of
thousands in the United States was
preceded by a wave of mild cases in
the spring, followed by more deadly
waves in the autumn
Region Cumulative total
as of 27 September 2009
Cases* Deaths
WHO Regional Office for Africa (AFRO) 8,352 42
WHO Regional Office for the Americas 1,37,147 3,020
WHO Regional Office for the Eastern 12,008 74
Mediterranean (EMRO)
WHO Regional Office for Europe (EURO) Over 56,000 At least 176
WHO Regional Office for South-East Asia 33,594 413
WHO Regional Office for the Western Pacific 96,197 383

Total Over 3,43,298 At least 4,108


Pandem-icYear Lab No. of Mortali-

confirm- Deaths ty Rate
ed cases
H1N1 2009 3,40,000 4,100 >1.04%
za (swine
Aims and
and Objectives


To define strategies regarding control of swine flu in

To reduce opportunities for human to human spread of H1N1.

To strengthen disease early warning system in Pakistan.

Swine Flu - Treatment
and Prevention

• Wash your hands with soap and water. Avoid touching mouth
and nose, close contact with ill people and crowded settings
• Improved ventilation in living places
• Practice good health habits including good sleep, nutritious
food with plenty of fluids and physical activity
• Encourage sufferer to cover their faces with the mask or
handkerchief while coughing and sneezing
• Annual winter vaccination (seasonal anti influenza vaccine) is
recommended for patients suffering from chronic pulmonary,
cardiac or renal disease
• Infected patients should not travel
• Isolation of suspected patients
• Stock pilling of required medicines and logistics
• Activation of district and provincial Influenza Committee /
Task forces
Travel Precautions
• The goal of treatment to alleviate the symptoms.
Antibiotics are not effective against viruses. Bed
rest is advisable till the fever subsides.
• A mild analgesic such as Paracetamol (0.5-1g) every
4-6 hrs usually relieves the headache and
generalized pains and warm fluids help to relieve the
discomfort of the symptoms.
• Pholcodine 5-10mg 3-4 times daily may be used to
suppress nonproductive cough.
• Specific treatment of complications such as
Bronchitis and Pneumonia becomes necessary.
• Virus has been found sensitive to OSELATMIVIR
(TAMIFLU) and ZANAMIVIR but resistant to
Amantidine and Remantadine.
• No vaccine is yet available for H1N1 NOVEL virus
Adverse Reactions to
Tami flu

• Nausea

• Vomiting

• Diarrhea
1. The CDC recommends that students and school
workers with flu symptoms should stay home
for either seven days, or until 24 hours after
symptoms subside—whichever is longer.
2. The new guidelines provided at schools,
colleges, workplaces has a list of strategies to
keep learning facilities open while reducing
exposure of students, faculty, and staff. They
state that the most important actions are to
encourage and facilitate good hand washing and
covering coughs and sneezes, flu vaccinations
for people at risk; and to separate sick people
from healthy people as soon as possible .

Countries have begun quarantining or
have threatened to quarantine foreign
visitors suspected of having or being in
contact with others who may have been
1. Reduction of the oppurtunities for
spread of infection with H1N1 from
human to human by:

– Strengthening the influenza diagnosis and

control at all levels of entry i.e scanners at
– Develop and distribute information materials
for safe behaviours among all communities
– Produce and disseminate guidelines and
health information and promotion material on
swin flu
– Promote the use of personal protective
equipment to prevent the spread
– Separate wards for the diagnosed cases
2. Stregthen DEWS
– To evaluate the capacity for timely detection of
human cases
– Define influenza surveillance objectives
– Expand existing virological surveillance for inflenza
– Establish enhanced surveillance among travellers,
health workers
– Involve community ( schools, millitary personnel)
through educating them with the information
about swine flu and its prevention and spread

3. Improve diagnostic capacity

• Update lab guidelines and data systems for
swine flu
• Provide the required training and the lab
• Increase collaboration between human and
veterinery influenza labs
4. Provide appropriate logistics
• Provide guidelines , PPE and supplies for high
risk groups
5. Provide an enabling environment
– This comprises of regulatory , supervisory,
and institutional support necessary to allow
trained personnel to be productive
– The personnel should be provided with
proper environment and tools so that they
may perform their work effectively. This
includes :
– Train them on infection control and
demonstrate use of protective clothing
• Evaluation can be done by analyzing both
process and outcome indicators.
• # of scanners at airports
• # of exclusive swine flu control centers
• # of health care facilities having
quarantines for swine flu cases.
• # of pts recovering from swine flu.
Critical Factors

• Commitment and political will from all

Member States

• Availability of resources at all levels

• Commitment of partners including

industries, research institutions and