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H1N1 INFLUENZA A (SWINE FLU) PANDEMIC

2009( UPDATED )

Dr.K.K.Kuttys Internet Collections - Power Point

Dr.K.Krishnan kutty, M.D.,D.M. Assistant Professor of Medicine & Rheumatologist Kanyakumari Government Medical College

8/23/2009

Nagercoil, Tamil Nadu,India

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SWINE FLU

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Update: Novel Influenza A (H1N1) Virus Infections --- Worldwide, May 6, 2009

Since mid-April 2009, CDC, state and local health authorities in the United States, the World Health Organization (WHO), and health ministries in several countries have been responding to an outbreak of influenza caused by a novel influenza A (H1N1) virus In March and early April 2009, Mexico experienced outbreaks of respiratory illness subsequently confirmed by CDC and Canada to be caused by the novel virus The influenza strain identified in U.S. patients was genetically similar to viruses isolated from patients in Mexico
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This week, one story has been prominent in our output

SWINE FLU
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A global swine-flu pandemic is likely, the World Health Organization (WHO) said Wednesday as it raised its alert level to Phase 5, the next-to-highest level in the worldwide warning system. -The Seattle Times
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The World Health Organization raised the alert level of the fast-spreading swine flu virus, indicating that a "pandemic is imminent." -NY Times

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SWINE FLU

As the swine flu spread throughout the world, countries and citizens moved quickly to protect themselves, 1.donning face masks, 2.cancelling trips, and 3.staying out of crowded areas.
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H1N1 Influenza A

New Delhi: World Health Organisation (WHO) may raise its level of alert to a six depending the situation in Spain, which is the latest country to be hit by the H1N1 virus. WHO decided to stop calling the

disease swine flu

in order to avoid confusion that the flu is caused by pigs. Medical experts have already established that the disease spreads through 8/23/2009 99

Swine flu a pandemic,

declar es WHO in

11

th

June

GENEVA: The World Health Organisation told its member nations on Thursday it was declaring a swine flu pandemic the first global flu epidemic in 41 years as infections climbed in the United States, Europe, Australia, South America and elsewhere. 8/23/2009 In a statement sent to health 1010 officials,

The current WHO phase of pandemic alert is 6

Phase 5, is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.
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U.S. President Gerald Ford being vaccinated for Swine Flu by Dr. William Lukash, 1976

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The current WHO phase of pandemic alert is 6

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Emergency Room Consultations for Pneumonia or Respiratory Infection, Including Influenza-like Illness, at the National Institute of Respiratory Diseases of Mexico.

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Pandemic (H1N1) 2009 update 60

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO As of 31 of July 2009, 168 countries and overseas territories/communities have reported at least one laboratory confirmed case of pandemic (H1N1) 09. All continents are affected by the pandemic.
2020

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Pandemic (H1N1) 2009 update 61

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 6 August 2009

Pandemic influenza H1N1 has now been reported in over 170 countries and territories worldwide. While the case counts no longer reflect actual disease activity, WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states. The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 60) as of 6 August 2009 are: Timore-Leste, Pakistan, Kirabati, Maldives, French Guiana, Falkland Islands (UKOT), Wallis and Futuna (FOC 8/23/2009 2121

Map of affected countries and deaths as of 13 Au 2009

Region WHORegionalOfficefor(AFRO) WHORegionalOfficeforthe(AMRO) WHORegionalOfficeforthe(EMRO) WHORegionalOfficefor(EURO) WHORegionalOfficefor(SEARO) WHORegionalOfficefortheWesternPacific (WPRO) Total8/23/2009

Cumulative total as of 13 Aug 2009 Cases* 1,469 1,05,882 2,532 Over 32,000 13,172 27,111

Deaths 3 1,579 8 53 106 50

Over1,82,166 1,799 2222

SWINE FLU SCARE: Passengers queue up for swine flu examination at an airport

All people entering India via the main airport hubs of Mumbai, New Delhi,Kolkata, Ahmedabad, Goa, Jaipur, Kochi, Chennai, Bangalore and Hyderabad are being 8/23/2009 screened.

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Singapore Changi Airport Thermal Scanning

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First death: 14-yr-old girl dies of swine flu in Pune

New Delhi: The Government on Monday confirmed the country's first death from the H1N1 flu in Pune, a top official said.

"There has been one death in Pune,"

Health Secretary Naresh Dayal said, adding that the victim was a 14-year-old 8/23/2009 2525 girl.

A case of gross negligence, alleges Pune H1N1 Flu victims family

IN DESPAIR: (From left): Shaken and anguished, Rida Shaikhs grandmother Saida Shaikh, aunt Ayesha Shaikh and father Sajid Shaikh presented their case at a press conference in Pune on Tuesday 8/23/2009 2626

Online edition of India's National Newspaper The Hindu,Wednesday, Aug 05, 2009

Pune: The family of 14-year-old Rida Shaikh, who died of swine flu in Pune on Monday, said on Tuesday that it would initiate legal proceedings against Jehangir Hospital, where she was treated. The familys lawyer, Asif Lampwala, alleged that the girls death was a case of gross negligence. The family would claim huge sums in damages and the money would be given to charity. The girls aunt, Ayesha Shaikh, said:
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Online edition , The Hindu,Friday, Jul 17, 2009

Doctor tests positive for swine flu

HYDERABAD: Even the health care providers cant remain immune to A (H1N1) influenza flu virus. On Thursday, authorities confirmed that a doctor, from a corporate hospital in twin cities, tested positive for A (H1N1) strain of virus. In all, authorities said two more persons, including the doctor, tested positive for flu taking the overall tally to 37. The female doctor returned to Hyderabad on an Emirates flight (EK 526) on July 11 from Glasgow after attending a workshop and volunteered to get admitted to the Government Chest Hospital, Erragadda on July 14. A 13-year-old boy, who returned from Melbourne after a sightseeing trip on July 13, also tested positive. Allaying fears that the doctor could have passed on the A (H1N1) virus to other doctors, patients and hospital staff, authorities have already started contacting close associates of the doctor. The Chest Hospital doctors informed that the samples of 13 Google employees sent to NICD, New Delhi for testing have come negative. The samples of close contacts of the 13-year-old boy, including his parents, uncle and twoyear-old sister, have been sent to NICD for testing. The health authorities meanwhile have requested the software companies to postpone any onsite visits of their employees, in view of the flu outbreak in United States and Europe.

The Oseltamivir drug is working well on patients. Within five days, they are recovering and are becoming non-infectious. A few patients have allergic reactions to the drug like rashes and slight giddiness, said State coordinator for A (H1N1) influenza flu virus Dr. K. Subhakar. 8/23/2009 2828
Presently there are 15 flu positive patients admitted to the hospital

PGI doctor tests positive for swine flu

PTI, 21 August 2009, 08:51pm IST

The Times Of India : CHANDIGARH: A doctor attached with a medical institute here has tested positive for the swine flu.

A junior resident doctor with Post Graduate Institute for Medical Education and Research (PGIMER) in the city tested positive for the Swine 8/23/2009 2929

Chennai child dies of swine flu

Chennai, Aug 10 Four-year-old Sanjay Balakrishnan died of influenza A (H1N1) infection at a private hospital here Monday, becoming the sixth swine flu victim in the country. Sources at Neta Hospital, where the boy was admitted, said he had been hospitalised with fever and diarrhoea last week. Later, he was diagnosed with kidney failure and chest 8/23/2009 3030 congestion.

Cennai Victim's timeline: How sanjay died

Suffering from Asthma Hospitalised for diarrhoea Friday: Condition worsened . Kidney, Liver fail Put on dialysis and ventilator Saturday: Tests positive for H1N1 Sanjay was asthmatic and doctors feel 8/23/2009 3131 that may have made him more

Runaway swine flu patient dies in Chennai Chennai, Aug 21

A 47-year-old Chennai resident - who ran away from a government hospital with swine flu symptoms but was readmitted later - died Thursday night, becoming the second victim of the H1N1 virus here, hospital officials said.

"Francis was first admitted to the hospital

with swine flu symptoms Aug 13. He went away without informing us after we took the throat swab and blood sample," Mohana 8/23/2009 3232 Sundaram, dean of the Government General

Third A(H1N1) death in State

THE HINDU- Online edition [23/08/2009]

CHENNAI: G. Sekar of Radha Nagar in Chromepet here, who tested positive for A(H1N1), died at the government General Hospital here late Friday night of complications arising out of the condition. This takes the A(H1N1) death toll in the State to three. Sekar, 45, was admitted to the surgical ward of the GH with breathlessness and bleeding piles. He required surgery for that 3333 problem. 8/23/2009

B.Tech student dies of suspected swine flu

Wed, Aug 19 02:25 PM Dehradun/New Delhi, Aug 19 (PTI) A 24-yearold student, who was pursuing B.Tech in Pune and had recently gone to his hometown, Dehradun, has died of suspected swine flu, raising the nationwide toll to 31. As many as 99 fresh cases of the infection have been reported from various states till yesterday and the total count of those affected has mounted to 2026 across the country. The engineering student, Raunak Singh, a 8/23/2009 3434 resident of Race Course locality in Dehradun,

Swine flu cases climb to 2,242 in the country

Wed, Aug 19 09:24 PM New Delhi, Aug 19 (PTI) Swine flu continued to spread in the country today with 216 people testing positive for the deadly virus, taking the total number of those afflicted with the pandemic to 2,242. Mumbai (48) and Pune (36) topped the list of cases followed by Chennai (30) and Delhi (25). The other cases were from Bangalore (17), Nagpur (13), Coimbatore (9), Dhule (5),
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Swine flu to get worse, say experts

Wed, Aug 19 06:05 AM

The swine flu pandemic is only going to worsen in the coming months as the H1N1 virus, a subtype of influenza virus, is expected to spread the most during the monsoon and the winters but experts sought to allay fears saying though the virus is highly infectious, it has a low mortality rate. 8/23/2009 3636

SWINE FLU
Click to edit Master subtitle style

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What is H1N1 Influenza ("Swine" Flu): ?

H1N1 Influenza ("Swine" Flu): is a respiratory disease of

pigs caused by type A influenza viruses that causes regular outbreaks in pigs

People do not normally get H1N1 Influenza (swine flu), but human infections can and do happen This flu strain has been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people

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Antigenic and Genetic Characteristics of SwineOrigin 2009 A(H1N1) Influenza Viruses Circulating in Humans Science, 10 July 2009:
Vol. 325. no. 5937, pp. 197 - 201

Since its identification in April 2009, an A(H1N1) virus containing a unique combination of gene segments from both North American and Eurasian swine lineages has continued to circulate in humans. The lack of similarity between the 2009 A(H1N1) virus and its nearest relatives indicates that its gene segments have been circulating undetected for an extended period. 8/23/2009 3939

Influenza A virus subtype H1N1

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The 2009 flu outbreak in humans is due to a new strain of influenza A virus subtype H1N1 that derives in part from human influenza, avian influenza, and two separate strains of swine influenza. 4040

Are there human infections with novel H1N1 virus in the U.S.?

Yes. Human infections with the new H1N1 virus are ongoing in the United States

Most people who have become ill with this new virus have recovered without requiring medical treatment

CDC routinely works with states to collect, compile and analyze information about 8/23/2009 influenza, and has done the same 4141 the new for

Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team

NEJM,Volume 360:2605-2615June 18, 2009Number 25

Triple-reassortant swine influenza viruses, which contain genes from human, swine, and avian influenza A viruses, have been identified in swine in the United States since 1998,1,2 and 12 cases of human infection with such viruses were identified in the United States from 2005 through 2009.3

On April 15 and April 17, 2009, the Centers for Disease Control and Prevention (CDC) identified two cases of human4242 infection 8/23/2009

Why swine flu is serious illness ?

In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people Like seasonal flu, this strain of flu may cause a worsening of underlying chronic medical conditions.

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CDC helps in Diagnosis

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Patients in Outbreak - 1

On March 30, 2009, in San Diego County, California, a 10-year-old boy with asthma (Patient 1) had an onset of fever, cough, and vomiting. On April 1, he was evaluated in an urgent care clinic, where he received treatment for his symptoms. He recovered from the illness within approximately 1 week. 8/23/2009 4545 An influenza A virus that could not be

Patients in Outbreak - 2

On March 28, 2009, in Imperial County, California, a 9-year-old girl (Patient 2) without an epidemiologic link to Patient 1 had an onset of cough and fever. Two days later, she was taken to an outpatient clinic that was participating in an influenza surveillance project. A nasopharyngeal swab was collected at the clinic. Patient 2 was treated with amoxicillin clavulanate, and she had an uneventful recovery.
8/23/2009 4646 The nasopharyngeal specimen was sent to the

Epidemiologic investigation

Epidemiologic investigation of Patients 1 and 2 revealed that neither patient had a recent history of exposure to swine.

According to protocol, the

identification of these two epidemiologically unlinked patients with novel S-OIV infection prompted the CDC to notify state and local health departments, which initiated case 8/23/2009 4747 investigations and implemented enhanced

Clinical spectrum

The clinical spectrum of novel S-OIV infection is still being defined, but both self-limited illness and severe outcomes, including respiratory failure and death, have been observed among identified patients a wide clinical spectrum similar to that seen among persons infected with earlier strains of swine-origin influenza viruses3and seasonal influenza viruses

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Severe illness and deaths

The severe illness and deaths associated with seasonal influenza epidemics are in large part the result of secondary complications,including 1.primary viral pneumonia,

2.secondary bacterial pneumonia (particularly with group A streptococcus, Staphylococcus aureus, and Streptococcus pneumoniae) and
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3. exacerbations of underlying chronic 4949

Initial Radiograph of the Lung and Lung-Tissue Sample from Patient

The radiograph (Panel A) shows bilateral alveolar opacities in the base of both lungs that progressed and became confluent. The specimen (Panel B, hematoxylin and eosin) shows necrosis of bronchiolar walls (top arrow), a neutrophilic infiltrate (middle arrow), and diffuse alveolar damage with prominent hyaline membranes (bottom arrow). Bacterial cultures were negative on admission, and no evidence of bacterial infection of the lungs was found. The patient ultimately died
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Risk for severe complications

Patients who are at highest risk for severe complications of S-OIV infection are likely to include but may not be limited to groups at highest risk for severe seasonal influenza : children under the age of 5 years, adults 65 years of age or older, children and adults of any age with underlying chronic medical conditions, and pregnant women
8/23/2009 Of the 22 hospitalized patients with5151 confirmed

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What is novel H1N1 (swine flu)?

Novel H1N1 (referred to as swine flu early on) is a new influenza virus causing illness in people This new virus was first detected in people in the United States in April 2009 This virus is spreading from person-toperson worldwide, probably in much the same way that regular seasonal influenza viruses spread
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Why is novel H1N1 virus sometimes called swine flu?

This virus was originally referred to as swine flu because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America

But further study has shown that this new virus is very different from what normally circulates in North American pig 5454 8/23/2009

H1N1 influenza virus

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Reassortment of different strains

Like all influenza viruses, swine flu viruses change constantly Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge
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Present Swine Flu strains

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Present Swine Flu strains

At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

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3D Influenza virus

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Out breaks among Pigs

Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds Studies have shown 6262 that the swine flu

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How man is exposed

Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others

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Is novel H1N1 virus contagious?

CDC has determined that novel H1N1 virus is contagious and is spreading from human to human Incubation period : 2 to 7 days

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Person to person transmission through coughing or sneezing

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How does novel H1N1 virus spread?

Spread of novel H1N1 virus is thought to occur in the same way that seasonal flu spreads Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza Sometimes people may 6767 become infected by touching

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Avoid close contact

Aerosols spread the virus in any environment

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
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Touching something with swine flu influenza on it

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What surfaces are most likely to be sources of contamination?

The virus can be spread when a person touches something that is contaminated with the virus and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. The virus can then be spread when a person touches respiratory droplets from another person on a surface like a desk, doorknob, childs toy or phone handset and then touches their own eyes, mouth or nose before washing their hands.

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

The symptoms of novel H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue A significant number of people who have been infected with this virus also have reported diarrhea and vomiting Severe illnesses and death has occurred as a result of illness associated with this virus.
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United States

The age distribution of the 35 laboratoryconfirmed hospitalized patients 6 months to 53 years (median: 15

years).

Among patients with confirmed disease for whom data were available, 262 (90%) of 292 reported fever, 249 (84%) of 296 reported cough, 176 (61%) of 290 reported sore 7272 throat,

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How severe is illness associated with novel H1N1 flu virus? [ 1 ]

Illness with the new H1N1 virus has ranged from mild to severe

While most people who have been sick have recovered 8/23/2009 without needing

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How severe is illness associated with novel H1N1 flu virus? [2]

In seasonal flu, certain people are at high risk of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions.

About 70 percent of people who have been hospitalized with this novel H1N1 virus have had one or more medical conditions previously recognized as placing people at high risk of serious seasonal flurelated complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease. 8/23/2009 7575

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

People infected with seasonal and novel H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

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How severe is illness associated with novel H1N1 flu virus? [3]

One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of novel H1N1-related complications thus far.

CDC laboratory studies have shown that children and few adults younger than 60 years old do not have existing antibody to novel H1N1 flu virus; however, about one8/23/2009 7777

How does novel H1N1 flu compare to seasonal flu in terms of its severity and infection rates?

With seasonal flu, we know that seasons vary in terms of timing, duration and severity Seasonal influenza can cause mild to severe illness, and at times can lead to death Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65
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How does novel H1N1 flu compare to seasonal flu in terms of its severity and infection rates? [2 ]

When the novel H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the novel H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people The information analyzed by CDC supports the conclusion that novel H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people

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How does novel H1N1 flu compare to seasonal flu in terms of its severity and infection rates? [3 ]

At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this novel H1N1 These underlying conditions include 8080

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Pandemic (H1N1) 2009 virus

According to FluNet reporting from the Global Influenza Surveillance Network (GISN), 3548 detections of the pandemic (H1N1) 2009 influenza virus were reported from 13 countries in week 30. [20 July 26 July 2009] The majority of detections were reported by China, Hong Kong SAR (25%, 1788 detections), followed by Australia (21%, 834 detections) and Italy (16%, 600 detections).
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Treatment is recommended for

All hospitalized patients with confirmed, probable or suspected novel influenza (H1N1). Patients who are at higher risk for seasonal influenza complications

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If you get sick

Stay home if youre sick

for 7 days after your symptoms begin or until youve been symptom-free for 24 hours, whichever is longer.

8/23/2009 If you are sick, limit your

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SYMPTOMS
fever lethargy lack of appetite Coughing runny nose sore throat nausea vomiting 8/23/2009 diarrhea.

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Emergency warning signs in children

If a child gets sick and experiences any of these warning signs, seek emergency medical care.

In children: Fast breathing or trouble breathing Bluish or gray skin color Not drinking enough fluids Severe or persistent vomiting Not waking up or not interacting Irritable, the child does not want to be held
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To diagnose swine influenza A infection

A respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus) However, some 8/23/2009 persons, especially
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INVESTIGATIONS

Throat swap

Respiratory specimen should be collected within 8/23/2009 8787 4 to 5 days of illness

FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans

The U.S. Food and Drug Administration, in response to requests from the U.S. Centers for Disease Control and Prevention, has issued Emergency Use Authorizations (EUAs) to make available to public health and medical personnel important diagnostic and therapeutic tools to identify and respond to the swine flu virus under certain circumstances. The agency issued these EUAs for the use of certain Relenza and Tamiflu antiviral products, and for the rRTPCR Swine Flu Panel diagnostic test.
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What is the Swine Influenza Test Kit?

The Swine Influenza Test Kit is believed to be a good test to detect the novel H1N1 flu virus. The FDA has not cleared or approved this test. The FDA has agreed that we can use this test under an Emergency Use Authorization.

We dont know for sure if this test can 8/23/2009 8989 identify all people who may get sick with

What are the known risks and benefits of Swine Influenza Test Kit?

The results of this test from nasopharyngeal swabs, nasal swabs, throat swabs, dual nasopharyngeal swabs/throat swabs, and nasal aspirates, along with other information, can help your doctor take better care of you Knowing your test results may help you to prevent the spread of the virus to your family or others.
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Real-Time RT-PCR

The CDC has developed a real-time RT-PCR assay to detect seasonal influenza A, B, H1, H3, and avian H5 serotypes. This assay has been approved by the Food and Drug Administration (FDA) and was distributed in December 2008 through U.S. Public Health laboratories and the WHO's Global Influenza Surveillance Network. Primers and probes specific for swine influenza A (H1 and H3 subtypes) were recently developed and tested for use in a 8/23/2009 9191 modified version of this assay for the detection

PCR ] an Emergency Use The Food and Drug Administration (FDA) issue

Real-time reversetranscription PCR [rRT-

Authorization (EUA) for emergency use of the Focus Diagnostics Influenza A H1N1 (2009) Real-Time RT-PCR for the diagnosis of 2009 H1N1 influenza virus infection, pursuant to section 564 of the Federal Food, Drug, and Cosmetic Act (the Act) (21 U.S.C. 360bbb-3) by CLIA High Complexity Laboratories, which are laboratories certified under the Clinical Laboratory Improvement Amendments of 1988, 42 U.S.C. 263a, to perform high complexity tests (CLIA High Complexity Laboratories).

rRT PCR is used to amplify and simultaneously quantify a targeted DNA molecule. It enables both detection and quantification (as absolute number of copies or relative amount when normalized to DNA input or additional normalizing genes) of a specific sequence in a DNA sample. 8/23/2009 9292

rRT PCR

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If this test is positive, does that mean that I have novel H1N1 flu?

Yes, although there is a very small chance that this test can give a result that is wrong (false positive), it is not likely. If your result from this test is positive, your doctor may decide how to care for you based on the test results along with other factors.

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If this test is negative, does that mean that I do not have novel H1N1 flu?

If this test is negative you may be sick with something that is not novel H1N1 flu There is a small chance that this test can give a result that is wrong (false negative) A false negative result should not affect your care No changes in your medical care should be solely based on a negative result
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As the best treatment of any disease is

PREVENTION
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A nurse carries masks and medicine outside the influenza A (H1N1) ward in Mumbai

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TAKING PRECAUTION:
Students wear masks for the precaution against swine flu in a Mumbai school

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TAKING NO CHANCES: People line up outside a test at New Delhi's RML Hospital

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DOs:

People wearing masks wait to get tested for H1N1 influenza at a special ward in Kasturba Hospital in Mumbai

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Covering sneezes and coughs

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Prevention

Contact with people from the affected areas should be cautionary

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Regular and frequent handwash

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Chinese Flu Inspectors

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Exposures Not Thought to Spread Novel H1N1 Flu

CDC Note:

Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to novel H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available
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Can I get infected with novel H1N1 virus from eating or preparing pork?

No.
Novel H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe
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Can I catch Swine Flu by eating pork?

NO
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Is there a risk from drinking water?

Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of novel H1N1 flu virus to conventional drinking water treatment processes.
115115

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Can novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?

Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses.
8/23/2009 No research has been completed on116116 the

Can novel H1N1 influenza virus be spread at recreational water venues outside of the water?

Yes, recreational water venues are no different than any other group setting. The spread of this novel H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on117117 then it and 8/23/2009

Contamination & Cleaning

8/23/2009

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How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface

8/23/2009

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What kills influenza virus?

Influenza virus is destroyed by heat (167212F [75-100C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels 8/23/2009 120120

*What if soap and water are not available and alcohol-based products are not allowed in my facility?

Though the scientific evidence is not as extensive as that on hand washing and alcohol-based sanitizers, other hand sanitizers that do not contain alcohol may be useful for killing flu germs on hands.

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How should linens, eating utensils and dishes of persons infected with influenza virus be handled?

Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid hugging laundry
122122

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What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air.

Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, 8/23/2009 123123

How should waste disposal be handled to prevent the spread of influenza virus? To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
8/23/2009 124124

What household cleaning should be done to prevent the spread of influenza virus?

To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

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Vaccination

Vaccine are available for different kinds of Swine Flu.

Although the current trivalent influenza vaccine is unlikely to provide protection against the new 2009 H1N1 strain vaccines 8/23/2009

126126

The big vaccine race in Indian pharma Sat, Aug 15 02:13 AM Yahoo News

In early August, Novartis and Sanofi Aventis began the first human tests of their swine flu vaccines. In India, the race is between three Indian biotech companies.

The Pune-based Serum Institute of India seems best placed. It was already working on a vaccine for seasonal flu. Serum Institute's 8/23/2009 127127 products are exported to over 140 countries,

Treatment

CDC recommends the use of TAMIFLU [oseltamivir ]or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.
8/23/2009 128128

FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans [ 2 ]

The EUAs allow for Tamiflu also to be used to treat and prevent influenza in children under 1 year, and to provide alternate dosing recommendations for children older than 1 year.

In addition, under the EUAs, both medications may be distributed to large segments of the population without complying with the label requirements otherwise applicable to dispensed drugs, 8/23/2009 129129 and accompanied by written information

Treatment

If a patient is not in a high-risk group or is not hospitalized, healthcare providers should use clinical judgment to guide treatment decisions, and when evaluating children should be aware that the risk for severe complications from seasonal influenza among children younger than 5 years old is highest among children younger than 2 years old
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Treatment

Once the decision to administer antiviral treatment is made, treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms.

Evidence for benefits from antiviral treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. 8/23/2009 131131

Treatment

Recommended duration of treatment is five days. Antiviral

doses recommended for treatment of novel H1N1 influenza virus infection in adults or children 1 year of age or older are the same as those recommended for seasonal influenza (Table 1).

Oseltamivir use for children <1 year old 8/23/2009 132132 was recently approved by the U.S. Food

Table 1. Antiviral medication dosing recommendations for treatment or chemoprophylaxis of novel influenza A (H1N1) infection.
(Table extracted from IDSA guidelines for seasonal influenza.)

Agent, group

Treatment

Chemoprophylaxis

Oseltamivir [TAMIFLU ]
Adults
15 kg or less 16-23 kg Children 12 months 24-40 kg >40 kg 120 mg per day divided into 2 doses 150 mg per day divided into 2 doses 60 mg once per day 75 mg once per day

75-mg capsule twice per day for 5 days 75-mg capsule once per day
60 mg per day divided into 2 doses 90 mg per day divided into 2 doses 30 mg once per day 45 mg once per day

Zanamivir Adults
Children 8/23/2009 Two 5-mg inhalations (10 mg total) twice per day Two 5-mg inhalations (10 mg total) twice per day (age, 7 years or older) Two 5-mg inhalations (10 mg total) once per day Two 5-mg inhalations (10 mg total) once 133133 per day (age, 5 years or older)

Antiviral Resistance

This novel (H1N1) influenza virus is sensitive (susceptible) to the neuraminidase inhibitor antiviral medications, zanamivir and oseltamivir It is resistant to the adamantane antiviral medications, amantadine and rimantadine

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Antiviral resistance pandemic (H1N1) virus

A total of six oseltamivir resistant pandemic (H1N1) 2009 influenza viruses have now been detected from Denmark, Hong Kong SAR, Japan and Canada. Of these three were from patients in Japan. All six patients had received oseltamivir with the exception of one and have recovered well All resistant viruses had the characteristic mutation at position 274/275 associated

with resistance
8/23/2009 135135

What about Antivirals?

Circulating Strains Oseltamivir Zanamivir Amantidine Rimantidine

Swine H1N1
Human H1N1 Human H3N2

S R S

S S S

R S R

Suspected influenza case (any type): Oseltamivir + amantidine/rimantidine, or zanamivir alone Confirmed Swine H1N1: Oseltamivir or zanamivir Prophylaxis: For close contacts of cases, those with high risk of complications, see guidance for details

http://www.cdc.gov/swineflu/recommendations.htm
8/23/2009 136136

Groups at Higher Risk for Severe Illness from Novel Influenza A (H1N1) Infection Groups of people at higher risk for severe illness from novel influenza A (H1N1) infection are thought to be the same as those people at higher risk for severe illness from seasonal influenza. These groups include:

Children younger than 5 years old Persons aged 65 years or older

Children and adolescents (younger than 18 8/23/2009 137137 years) who are receiving long-term aspirin

Prevention

In areas with confirmed human cases of novel influenza A (H1N1) virus infection, the risk for infection can be reduced through a combination of actions. No single action will provide complete protection, but an
8/23/2009 138138

Transmission

Transmission of novel influenza A (H1N1) is being studied as part of the ongoing outbreak investigation, but limited data available indicate that this virus is likely transmitted in ways similar to other influenza viruses Seasonal human influenza viruses are thought to be transmitted between persons primarily through largeparticle respiratory droplet transmission (e.g., when an infected person coughs or sneezes near a susceptible person) Transmission via these large-particle droplets requires close contact between source and recipient persons because droplets do not remain suspended in the air and generally travel only a short distance (< 6 feet)
8/23/2009 139139

Household Cleaning, Laundry, and Waste Disposal

Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste. Keep surfaces (esp bedside tables, surfaces in the bathroom, childrens toys, phone handles, doorknobs) clean by wiping them down with a household disinfectant according to directions on the product label. Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid hugging laundry prior to washing it to prevent contaminating yourself. Clean your hands with soap after handling dirty 8/23/2009 and water or alcohol-based hand rub right 140140 laundry.

Transmission

Contact with contaminated surfaces is another possible source of transmission and transmission via small-droplet nuclei (also called airborne transmission) might also occur, but the contribution of these modes of transmission to influenza epidemiology is uncertain

Because data on the transmission of 8/23/2009 H1N1 viruses are limited, the 141141 novel

Close contact

Close contact, is defined as having cared for or lived with a person who is a confirmed, probable or suspected case of novel influenza A (H1N1), or having been in a setting where there was a high likelihood of contact with respiratory droplets and/or body fluids of such a person

Examples of close contact include kissing or embracing, sharing eating or drinking utensils, physical examination, or any 8/23/2009 142142 other contact between persons likely to

Facemasks:

Unless otherwise specified, the term facemasks refers to disposable facemasks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks. Such facemasks have several designs. One type is affixed to the head with two ties, conforms to the face with the aid of a flexible adjustment for the nose bridge, and may be flat/pleated or duck-billed in shape. Another type of facemask is pre-molded, adheres to the head with a single elastic band, and has a flexible adjustment for the nose bridge. A third type is flat/pleated and affixes to the head with ear loops.

Facemasks cleared by the FDA for use as medical devices have been determined to have specific levels of protection from penetration of blood and body fluids.
Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing the facemask. They are not designed to protect against breathing in very small particle aerosols that may contain viruses. Facemasks should be used once and then thrown away in the trash

8/23/2009

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Wear masks

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Cover your mouth and nose.

Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick
8/23/2009 145145

3,000 unauthorised swine flu masks seized

Mon, Aug 17 05:11 PM Daman, Aug 17 (PTI)

Over 3,000 unauthorised masks have been seized from different medical stores here during a drive to check their illegal sale in view of swine flu scare. "The mask used for prevention of the viral disease were being sold at high rate in those stores," officials said.
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Respirators

Unless otherwise specified, "respirator" refers to an N95 or higher filtering face piece respirator certified by the CDC/National Institute for Occupational Safety and Health (NIOSH). A respirator is designed to protect the person wearing the respirator against breathing in very small particle aerosols that may contain viruses A respirator that fits snugly on the face can 147147

8/23/2009

Respirators - N95

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148148

There are important differences between facemasks and respirators

Facemasks do not seal tightly to the face and are used to block large droplets from coming into contact with the wearers mouth or nose Most respirators (e.g. N95) are designed to seal tightly to the wearers face and filter out very small particles that can be breathed in by the user
149149

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Antiviral Chemoprophylaxis for Novel (H1N1) Influenza

For antiviral chemoprophylaxis of novel (H1N1) influenza virus infection, either oseltamivir or zanamivir are recommended Duration of antiviral chemoprophylaxis postexposure is 10 days after the last known exposure to novel (H1N1) influenza.

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High-risk groups

A person who is at high-risk for complications of novel influenza (H1N1) virus infection is defined as the same for seasonal influenza at this time As more epidemiologic and clinical data become available, these risk groups might be revised.

Children younger than 5 years old. The risk for severe complications from seasonal influenza is highest among 8/23/2009 151151 children younger than 2 years old.

Pregnant Women

Pregnant women are known to be at higher risk for complications from infection with seasonal influenza viruses, and severe disease among pregnant women was reported during past pandemics. Cases of confirmed novel (H1N1) influenza virus infection in pregnant women resulting in severe disease have been reported, and a pregnant 8/23/2009 152152 woman died in 1988 after being

Special Considerations for Children

Aspirin or aspirincontaining products (e.g. bismuth subsalicylate Pepto Bismol) should not be administered to any confirmed or suspected ill case of novel influenza H1N1 virus infection aged 18 years old and 8/23/2009

153153

NIV conducts study to find out H1N1 pattern

The National Institute of Virology (NIV) has launched a time-bound study to understand how the H1N1 virus affected Pune and Mumbai and figure out its pattern. "It will take at least a year, but we are trying to find out what clinical diseases this virus has presented and the extent of exposure of the community," said Dr Mandeep Chadda, Deputy Director, NIV.
8/23/2009 154154

Pneumonia and Respiratory Failure from Swine-Origin

Influenza A (H1N1) in Mexico

NEJM, Volume 361:680-689August 13, 2009Number 7

ABSTRACT Background In late March 2009, an outbreak of a respiratory illness later proved to be caused by novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Mexico. We describe the clinical and epidemiologic characteristics of persons hospitalized for pneumonia at the national tertiary hospital for respiratory illnesses in Mexico City who had laboratory-confirmed S-OIV infection, also 8/23/2009 155155 known as swine flu.

Initial Radiograph of the Lung and Lung-Tissue Sample from Patient

The radiograph (Panel A) shows bilateral alveolar opacities in the base of both lungs that progressed and became confluent. The specimen (Panel B, hematoxylin and eosin) shows necrosis of bronchiolar walls (top arrow), a neutrophilic infiltrate (middle arrow), and diffuse alveolar damage with prominent hyaline membranes (bottom arrow). Bacterial cultures were negative on admission, and no evidence of bacterial infection of the lungs was found. The patient ultimately died
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The median time of presentation to the hospital was 6 days after the onset of symptoms. Most deaths occurred in patients who required mechanical ventilation on admission. Patient 15 was discharged from the hospital on June 8, 2009.

8/23/2009

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8/23/2009

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N Engl J Med. 2009 Jun 18;360(25):2605-15. Epub 2009 May 7.

BACKGROUND: On April 15 and April 17, 2009, novel swineorigin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We 8/23/2009 159159

Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team

NEJM,Volume 360:2605-2615June 18, 2009Number 25

Triple-reassortant swine influenza viruses, which contain genes from human, swine, and avian influenza A viruses, have been identified in swine in the United States since 1998,1,2 and 12 cases of human infection with such viruses were identified in the United States from 2005 through 2009.3

On April 15 and April 17, 2009, the Centers for Disease Control and Prevention (CDC) 8/23/2009 160160

Patients in Outbreak 1

On March 30, 2009, in San Diego County, California, a 10-year-old boy with asthma (Patient 1) had an onset of fever, cough, and vomiting. On April 1, he was evaluated in an urgent care clinic, where he received treatment for his symptoms. He recovered from the illness within approximately 1 week. 8/23/2009 161161 An influenza A virus that could not be

Patients in Outbreak 2

On March 28, 2009, in Imperial County, California, a 9-year-old girl (Patient 2) without an epidemiologic link to Patient 1 had an onset of cough and fever. Two days later, she was taken to an outpatient clinic that was participating in an influenza surveillance project. A nasopharyngeal swab was collected at the clinic. Patient 2 was treated with amoxicillin clavulanate, and she had an uneventful recovery.
8/23/2009 162162 The nasopharyngeal specimen was sent to the

Epidemiologic investigation

Epidemiologic investigation of Patients 1 and 2 revealed that neither patient had a recent history of exposure to swine. According to protocol, the identification of these two epidemiologically unlinked patients with novel S-OIV infection prompted the CDC to notify state and local health departments, which initiated case investigations and implemented enhanced surveillance for influenza A viruses that 8/23/2009 not be subtyped. 163163 could

Epidemiologic Curve of Confirmed Cases of Human Infection with Swine-Origin Influenza A (H1N1) Virus with Known Date of Illness Onset in the United States (March 28May 5, 2009).

8/23/2009

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Distribution of 642 Confirmed Cases of Human Infection with Swine-Origin Influenza A (H1N1) Virus in the United States (May 5, 2009)

8/23/2009

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Demographic and Clinical Features

The age of patients with confirmed S-OIV infection ranged from 3 months to 81 years A total of 40% of patients were between the ages of 10 and 18 years, and only 5% of patients were 51 years of age or older. Among the patients for whom clinical information was available, the most common symptoms were fever (94%), cough (92%), and sore throat (66%). In addition, 25% of patients had diarrhea, and 25%

had vomiting.
8/23/2009 166166

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167167

8/23/2009

168168

Of the 399 patients with confirmed S-OIV infection for whom hospitalization status was known, 36 (9%) required hospitalization. The age of hospitalized patients ranged from 19 months to 51 years. Of the 22 hospitalized patients for whom data were available, 4 (18%) were children under the age of 5 years, and 1 patient(4%) was pregnant. Nine patients (41%) had chronic medical conditions: a 41-year-old woman with autoimmune disease treated with multiple immunosuppressive agents; a 35-yearold man with Down's syndrome and a history of 8/23/2009 169169 congenital heart disease; a 33-year-old

Severe and fatal illness

Eight patients (36%) required admission to an intensive care unit, and four patients (18%) had respiratory failure requiring mechanical ventilation. Fourteen patients (74%) were treated with oseltamivir after admission to the hospital. As of May 5, 18 of the 22 patients (82%) had recovered from the acute illness;

2 patients a previously healthy 238/23/2009 month-old child and a previously170170 healthy

Severe illness and deaths

The severe illness and deaths associated with seasonal influenza epidemics are in large part the result of secondary complications,including 1.primary viral pneumonia,

2.secondary bacterial pneumonia (particularly with group A streptococcus, Staphylococcus aureus, and Streptococcus pneumoniae) and
8/23/2009

3. exacerbations of underlying chronic 171171

Risk for severe complications

Patients who are at highest risk for severe complications of S-OIV infection are likely to include but may not be limited to groups at highest risk for severe seasonal influenza : children under the age of 5 years, adults 65 years of age or older, children and adults of any age with underlying chronic medical conditions, and pregnant women
8/23/2009 Of the 22 hospitalized patients with172172 confirmed

Real-Time RT-PCR

The CDC has developed a real-time RT-PCR assay to detect seasonal influenza A, B, H1, H3, and avian H5 serotypes. This assay has been approved by the Food and Drug Administration (FDA) and was distributed in December 2008 through U.S. Public Health laboratories and the WHO's Global Influenza Surveillance Network. Primers and probes specific for swine influenza A (H1 and H3 subtypes) were recently developed and tested for173173 in a use 8/23/2009

Comparison of H1N1 Swine Genotypes in Recent Cases in the United States

8/23/2009

174174

Phylogenetic Analysis of Sequences of all Genes Identified in A/California/04/2009

8/23/2009

175175

Susceptibility of 37 Isolates of Swine-Origin Influenza A (H1N1) Virus to Neuraminidase Inhibitors

8/23/2009

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In conclusion[ NEJM ]

We report an outbreak of human infection with a novel influenza A (H1N1) virus of swine origin in the United States, which is spreading through sustained human-tohuman transmission in multiple countries. The identification of human S-OIV infection in geographically dispersed countries and across continents demonstrates the ease with which infection can be spread and facilitated by air and land travel and community networks and gatherings. 8/23/2009 177177

Prevention and control measures

As of May 5, 2009, the CDC has recommended that health care workers who provide direct care for patients with known or suspected S-OIV infection should observe contact and droplet precautions, including the use of gowns, gloves, eye protection, face masks, and fit-tested, disposable N95 respirators. In addition, patients with confirmed or suspected S-OIV infection should be placed in a single-patient room with the door kept closed, and airborne-infection isolation rooms with negativepressure handling should be used whenever an aerosol-generating procedure is being performed. Frequent hand washing with soap and water may reduce the risk of infection and transmission.
8/23/2009 178178

Sense, not scare is the key to stay safe

8/23/2009

179179

A Belarussian veterinarian gives a vaccination to pigs at a hog farm 8/23/2009 180180

Non essential visits to the affected areas should be avoided

8/23/2009

181181

People wait outside a mobile clinic to test for signs of influenza A (H1N1) virus, at a mobile clinic in Mexico City.

8/23/2009

182182

A Red Cross staff carries a patient with symptoms of influenza A (H1N1)

8/23/2009

183183

Greek revolutionist Elefterios Venizelos' monument is seen covered with a protective mask in 8/23/2009 downtown

184184

Overview

As the pandemic progresses, laboratory testing and confirmation may decrease Confirmed figures for the United Kingdom, in particular, are only meaningful up to 2 July 2009, when routine testing stopped and presumed cases were treated without laboratory confirmation of diagnosis Following the recommendations of the World Health Organization (WHO), most countries stopped issuing the numbers of the infected 8/23/2009 185185 population, making this list inaccurate.

The ten countries with most confirmed cases per capita

Includes countries with over 100 confirmed cases only. All population figures are estimates for July 2009 Population Pos. Country Confirmed cases Confirmed cases per 10,000 inhabitants

1 2 3 4 5 6 7 8 9 10

Brunei Australia Chile New Zealand Malta Samoa Iceland Cyprus Canada Israel

388,190 21,262,641 16,601,707 4,213,418 405,165 219,998 306,694 796,740 33,487,208 7,233,701

850 30,111 12,030 3,038 235 100 135 297 11,883 2,148

21.90 14.16 7.25 7.21 5.80 4.55 4.40 3.73 3.55 2.97

World 6,790,062,216 243,875 0.359

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Number of confirmed cases of A(H1N1) virus in Asia (as of 23 June 2009):

50 000+ cases 5 000+ cases 500+ cases 50+ cases 5+ cases 1+ cases

8/23/2009

187187

A map of the infected countries of the H1N1 flu of 2009

Confirmed death and infections Unconfirmed infections Confirmed infections

8/23/2009

188188

WHO issues new guidelines on swine flu

P TI

United Nations: Issuing a new set of guidelines for the use of drugs against swine flu, the WHO has said otherwise patients with uncomplicated illnesses do not need to take antiviral drugs. According to the new guidelines, patients with uncomplicated illnesses do not need to be treated with antiviral medicines. The guidelines emphasised using drugs such as oseltamivir and zanamivir, to which the pandemic virus is susceptible, to prevent severe 8/23/2009 189189

- Published on Sat, Aug 22, 2009 at 13:04 in Health

Civic body launches swine flu quit India campaign in schools, colleges

Indian Express: With educational institutions reopening on August 24, the Pune Municipal Corporation (PMC) on Thursday announced the launch of swine flu quit India campaign which would create awareness about the H1N1 virus in school and colleges Schools must dedicate about 15 minutes of the first period to impart knowledge about swine flu and 8/23/2009 190190

Swine flu claims 20th victim in Pune

PTI : Sat, Aug 22, 2009 at 12:07

Pune:
Pune reported its 20th swine flu death on Saturday with a 60-year-old man succumbing to the virus. Baban Hangule was critical when he was admitted to the Government-run Sassoon Hospital on August 19, hospital officials said. Meanwhile, the authorities are yet to take a decision on reopening of schools and colleges.
8/23/2009

The educational institutions were closed for a

191191

WHO predicts 'explosion' of swine flu cases

The global spread of swine flu will endanger more lives as it speeds up in coming months and governments must step preparations for a swift response, the World Health Organization said. There will soon be a period of further global spread of the virus, and most

countries may see swine

8/23/2009 192192

WHO warns of

second wave of swine flu pandemic

Sun, Aug 23 01:20 PM

Geneva, Aug.23 (ANI): The World Health Organisation (WHO) is urging people around the world to brace themselves for a second wave of the swine flu pandemic as the heavily populated northern hemisphere edges towards the cooler season when flu thrives. "The WHO is still mobilised and worried," spokesman Gregory Hartl said as the global 8/23/2009 193193

Suspected flu deaths take toll to 66; 131 new HINI cases reported

Sun, Aug 23 10:00 PM New Delhi, Aug.23 (ANI): A total of 131 fresh cases of swine flu were reported from different parts of the country on Saturday, Health Ministry sources said in Delhi. The new cases included 44 in Delhi, Karnataka 21, Bangalore 19, Gadag 1, Belgaum 1, Tamil Nadu 20, Chennai 17, Coimbatore 3, Maharashtra 23, Pune 1 and 8/23/2009 194194

SWINE FLU IN INDIA

Cold weather conducive to growth of swine flu virus

New Delhi: Pune and Bangalore have been the worst-hit from H1N1 Influenza (swine flu) cases and experts have been warning that low temperature will lead to a spurt in positive cases. Bangalore has seen more than 85 cases of H1N1 Influenza in the last one week and Pune more than 300 cases since mid July. The reason of so many cases in the two cities is the temperature as virus thrives between 20-35 degrees "Influenza family of viruses like cold condition. H1N1 seems to be more infective in the weather prevalent in Bangalore and Pune," says Dr Purnima 8/23/2009 195195 Parasarthi, Infectious Diseases Institues HOD

Swine flu patient recovers by t

Sunday, August 23, 2009 Bhopal, Aug 23 (IANS) A suspected swine flu patient in Madhya Pradesh's Indore city had recovered on his own by the time his sample report, indicating he had tested positive, was received from New Delhi, officials said Sunday.
8/23/2009

According to Indore District Collector Rakesh 196196

ALARM BELLS: H1N1 virus has spread to almost every country in the world since it was
discovered at the end of March, says WHO.

8/23/2009

197197

H1N1 Swine flu - What should I do? G

Thursday, August 06, 2009 Ministry of Health and Family Welfare, Government of India has issued the revised Guidelines for testing of persons with flu like symptoms reporting at hospitals notified for influenza H1N1. Under the new guidelines, any person with flu like symptoms such as fever, cough, sore throat, cold, running nose etc. should go to a 8/23/2009 designated Government facility for 198198 giving

2009
Government of India,Ministry of Health and Family Welfare

Influenza A [H1N1]

As on 13th August 2009 World Health Organization has reported 1, 82,166 laboratory confirmed cases of influenza A/H1N1 and 1799 deaths. No further update is available. Health screening of passengers coming from affected countries is continuing in 22 International airports. 38058 passengers have been screened on 20.8.2009. 225 doctors and 172 paramedics are manning 83 8/23/2009 199199 counters at these airports. A cumulative total

Swine flu count - India

Aug 22, 2009 [in.com ]

Reported Cases : 2539 Cured Cases : 758 :

Death
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66

[23/9/2009]

200200

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Last, but certainly not the least

8/23/2009 202202

Stay Alert, Stay Safe

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FLU INE SW TOP S

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