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GLOBAL ALARM:

Swine-Origin Influenza?
An Imminent Pandemic

DOH National Epidemiology Center

Swine Flu Viruses


4 influenza type A virus subtypes that have
been isolated in pigs

H1N1 - most recently isolated


H1N2
H3N2
H3N1

DOH National Epidemiology Center

Classic Swine Flu Virus:


Influenza Virus Type A H1N1
first isolated from a pig in 1930
is a respiratory disease of pigs
virus circulates among swine throughout
the year
regularly causes outbreaks of influenza in
pigs
outbreaks occur fall and winter months
similar to outbreaks in humans
DOH National Epidemiology Center

Swine Flu in Humans


do not normally infect humans
sporadic human infections with swine flu
have occurred
occur in persons with direct exposure to
pigs

DOH National Epidemiology Center

How common is swine flu


infection in humans?
In the past
1 every 1-2 years in the U.S.
December 2005 - February 2009
12 cases of human infection

DOH National Epidemiology Center

Signs and Symptoms in Humans

Fever
Lethargy
Lack of appetite
Coughing
Runny nose
Sore throat
Nausea/Vomiting
Diarrhea
DOH National Epidemiology Center

Transmission
1. Directly pigs to humans
close proximity to infected pigs
such as in pig barns and livestock exhibits
housing pigs at fairs.

2. Human to Human
coughing or sneezing
touching something with flu viruses on it and
then touching their mouth or nose

3. Directly from humans to pigs


DOH National Epidemiology Center

Swine H1N1 vs. Human H1N1


swine H1N1 flu virus NOT the same as
human H1N1 virus
antigenically very different from human
H1N1 viruses
vaccines for human seasonal flu can not
protect humans from swine H1N1

DOH National Epidemiology Center

Transmission: Food-Borne?
NO
Swine influenza viruses are not
transmitted through food
Safe to eat properly handled and cooked
pork and pork products
Cook pork at an internal temperature of
70C (160F)
DOH National Epidemiology Center

Diagnosis and Laboratory


Confirmation
Clinically diagnosed
Respiratory Specimen
first 4 to 5 days of illness
can shed for 10 days or longer
Specimens sent to National Reference
Lab: RT-PCR, Virus Isolation

DOH National Epidemiology Center

Treatment
Recommended
1. Oseltamivir
2. Zanamivir
Showed Resistance in the past
1. Amantadine
2. Rimantadine
DOH National Epidemiology Center

Vaccination
NO vaccines for humans
seasonal influenza vaccine can help
provide partial protection against swine
H3N2
pig vaccines are available

DOH National Epidemiology Center

Swine Influenza Viruses


RNA viruses
Pigs can be infected by avian influenza
and human influenza viruses as well as
swine influenza viruses.
reassort and new viruses that are a mix of
swine, human and/or avian influenza
viruses can EMERGE

DOH National Epidemiology Center

Genetic Reassortment

SIV

DOH National Epidemiology Center

Swine-Origin Influenza H1N1 of 2009


Mexico from April 17-23
854 cases of severe atypical pneumonia
including
59 deaths
Close contacts affected: health care
workers, family members
Age range: 25-45 years old
DOH National Epidemiology Center

Profile of Cases
cases with pneumonia required
mechanical ventilation
the progression of the disease was rapid
fatal

DOH National Epidemiology Center

Laboratory Findings
genetically are reassortant of AmericaEurasian swine influenza viruses
have not been previously detected in pigs
or humans
sensitive to Oseltamivir

DOH National Epidemiology Center

Swine Flu H1N1 as of April 29


Countries

Cases

Deaths

US

91

Mexico

26

Canada

13

United Kingdom

Spain

New Zealand

Germany

Israel

Austria

148

Total

DOH National Epidemiology Center

WHO Recommendations
Public Health Emergency of International
Concern (PHEIC)
Serious Public Health Impact
Unusual or Unexpected
International disease spread
Interference with international travel or trade

DOH National Epidemiology Center

WHO Recommendations

Pandemic Alert: Phase 5


All countries should immediately activate

their pandemic preparedness plans.


Countries should remain on high alert for
unusual outbreaks
1. Influenza-like Illness (ILI)
2. Severe Pneumonia
DOH National Epidemiology Center

DOH National Epidemiology Center


D E PAR T M E N T O F H E AL T H

DOH National Epidemiology Center


D E PAR T M E N T O F H E AL T H

Fighting The Enemy


Planning and Coordination
Situation Monitoring and Assessment
Reducing the Spread of Disease
Continuity of Health Care Provision
Communications

DOH National Epidemiology Center

Fighting The Enemy


Planning and Coordination
Situation Monitoring and Assessment
Reducing the Spread of Disease
Continuity of Health Care Provision
Communications

DOH National Epidemiology Center

Planning and Coordination


Activate Crisis Committee and
National Command and Control
Systems
Update national guidance and
recommendations

DOH National Epidemiology Center

Fighting The Enemy


Planning and Coordination
Situation Monitoring and Assessment
Reducing the Spread of Disease
Continuity of Health Care Provision
Communications

DOH National Epidemiology Center

Situation Monitoring and Assessment


Enhance Pandemic Surveillance
Monitor and Assess Impact of Pandemic
- Monitor essential health-related resources such as:
medical supplies; antivirals and other pharmaceuticals;
health care worker availability; hospital occupancy/
availability; use of alternative health facilities;
laboratory material stocks; and mortuary capacity

DOH National Epidemiology Center

Fighting The Enemy


Planning and Coordination
Situation Monitoring and Assessment
Reducing the Spread of Disease
Continuity of Health Care Provision
Communications

DOH National Epidemiology Center

Reducing the Spread of Disease

DOH National Epidemiology Center

Fighting The Enemy


Planning and Coordination
Situation Monitoring and Assessment
Reducing the Spread of Disease
Continuity of Health Care Provision
Communications

DOH National Epidemiology Center

Continuity of Health Care Provision


Consider implementing pandemic
contingency plans for full mobilization
of health systems, facilities and workers
at all levels
Prepare to switch to pandemic working
arrangements

DOH National Epidemiology Center

Fighting The Enemy


Planning and Coordination
Situation Monitoring and Assessment
Reducing the Spread of Disease
Continuity of Health Care Provision
Communications

DOH National Epidemiology Center

Communications

DOH National Epidemiology Center

Travel Advisory
The World Health Organization advises
no restriction of regular travel or closure
of borders. It is considered prudent for people
to delay international travel and for people
developing symptoms following international
travel to seek medical attention, in line with
Guidance from national authorities.

DOH National Epidemiology Center

God Bless Us All!

DOH National Epidemiology Center

DOH National Epidemiology Center

DOH National Epidemiology Center

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
DOH National Epidemiology Center

(HA) Hemagglutinin
1. An antigenic glycoprotein
found on the surface of
the influenza viruses.
2. Is responsible for binding
the virus to the cell that is
being infected.

DOH National Epidemiology Center

(NA) Neuraminidase
1. An antigenic glycosylated
enzyme found on the surface
of the influenza viruses.
2. It facilitates the release of
progeny viruses from
infected cells.

DOH National Epidemiology Center

Influenza Epidemiology
Incubation period = Time from infection until onset of
symptoms
Period of communicability = Time a case is infectious to
others

Infection
Time

Symptoms
2

Incubation period
Period of communicability
DOH National Epidemiology Center

Days

Exposure

Incubation
Period

Prodromal
Stage

3 days, range 0-1 days


high fever (above
2-4 days
38 C), cough and
shortness of
Breath

Lower
Respiratory
Stage
1-7 days

early dyspnea
crackles
rapid progress to
respiratory
distress respiratory failure

DOH National Epidemiology Center

Antiviral Agents
Tamiflu (oseltamivir phosphate)
An oral anti-viral drug for the treatment of uncomplicated influenza in
patients one year and older whose flu symptoms have not lasted more
than two days
Dosage:
Treatment of Flu (all twice a day for 5 days)
Adults and teens over 13 take 75mg
The dosage for younger children who are 1 year and older depends on their weight:
<33lbs - 30mg - need 1 bottle
>33 to 51lbs - 45mg - need 2 bottles
>51 to 88lbs - 60mg - need 2 bottles
>88lbs - 75mg - need 3 bottles
Prevention of Flu
Adults and teens take 75mg once a day for 10 days
Children over age 1 take the same dose they would for treatment of the flu, but take it
just once a day for 10 days

should be given within the first two days of illness


DOH National Epidemiology Center

DOH National Epidemiology Center

Confirmed Influenza A H1N1 Cases and Death


May 10, 2009 (n=4,329)
Country Affected

Number of Cases

Number of Death

Case Fatality Rate % (CFR)

United States of America

2254

0.09
2.8

Mexico

1626

45

Canada

280

0.4

Costa Rica

12.5

Spain

93

United Kingdom

39

France

12

Germany

11

Italy

Israel

New Zealand

Brazil

Japan

Netherlands

Panama

Korea

El Salvador

China

Columbia

Denmark

Guatemala

Ireland

Poland

Portugal

Sweden

Switzerland

Argentina

Australia

Austria

TOTAL

4329

49

1.13

DOH National Epidemiology Center