1Dr.T.V.Rao MD

SWINE FLUBiosafety and

PreventionDr.T.V.Rao MD

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What is Swine influenza

• Swine influenza (also called H1N1 flu, swine flu, hog flu, and pig flu) is an infection by any one of several types of swine influenza virus. Swine influenza virus (SIV) is any strain of the influenza family of viruses that is endemic in pigs

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Swine flu – Acute

respiratory infection• Swine flu is an infection caused by a

virus. It's named for a virus that pigs can get. People do not normally get swine flu, but human infections can and do happen. The virus is contagious and can spread from human to human. Symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue.

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SWINE FLU • 2009 swine flu outbreak is the

epidemic spread of a new strain of influenza virus that was clinically identified in April 2009 The new virus strain is a type of influenza A (H1N1) virus, commonly called the swine flu. The outbreak has also been called the H1N1 influenza, 2009 H1N1 flu, Mexican flu, or swine-origin influenza.

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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Pigs infect Humans• Pigs can pass

mutated viruses back to humans, and these can be passed from human to human. Transmission among humans is thought to occur in the same way as with seasonal flu.

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What are the flu emergency signs to watch for in

adults?• Difficulty

breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting

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The flu emergency signs to watch for in children?

• Rapid breathing or trouble breathing

• Bluish skin colour• Not drinking enough

fluids• Not waking up or not

interacting• Being so irritable that the

child does not want to be held

• Flu-like symptoms improve but then return with fever and worse cough

• Fever with a rash

Diagnosis• 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 persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus

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Specimen collection for Diagnosis

• Sample Collection and handling is same as for human avian flu or seasonal influenza like illness (Refer CD Alert on AI). Sample Collection: should be labelled clearly and include patient’s complete information and should be sent to designated Laboratory. Laboratory biosafety measures should be followed for collection, storage, packaging and shipping of influenza samples.

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Diagnosis of Swine Flu• For diagnosis of swine influenza

A infection, respiratory specimen (NP (nasopharyngeal swab), throat swab , nasal aspirate, nasal washing) 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 persons, especially children, may shed virus for 10 days or longer.

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Currently Available Tests

• Rapid Antigen Tests: not as sensitive as other available tests. RT–PCR Virus isolation Virus Genome Sequencing Four–fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies. It is important to note that samples from all cases, once the Pandemic starts, are not required to be tested.

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What Protection Laboratory Staff need

1) For those performing rapid immunoassay tests for influenza, splash protection is required; 2) For those performing more complex procedures (e.g., direct or indirect fluorescent antibody tests [DFA, IFA], culture, molecular assays), a Class II biosafety cabinet (BSC) in a biosafety level-2 (BSL-2) laboratory is required.  Biosafety level-3 (BSL-3) practices are no longer required for viral isolation. 

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Precaution during a EISA Test

• Rapid immunoassay test procedures outside a Class II biosafety cabinet (BSC) should be performed to minimize the creation of anticipated splashes and/or aerosols.  The appropriate personal protective equipment (PPE) for minimizing risks associated with splash for these types of rapid tests include: 

• laboratory coat • gloves• eye protection

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Rapid Diagnosis

•RT PCR can make rapid Diagnosis

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Dealing with Bio Hazard Waste in

Swine flu• All bio hazardous waste disposal

procedures should be followed as outlined in your facility standard laboratory operating procedures.  Steam autoclaving is the preferred method for all decontamination processes.  Alternative methods may be considered based on applicable local, state and federal regulations, as well as on a site specific risk assessment.

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What Disinfectants to use during Swine flu

• Several chemical disinfectants, including chlorine, alcohols, peroxygen, detergents, iodophores, quaternary ammonium and phenolic compounds, are effective against human influenza viruses if used at the correct concentration for the appropriate contact time as specified in the manufacturer’s recommendations.

• Work surfaces and equipment should be decontaminated as soon as possible after specimens are processed. Studies have shown that influenza viruses can survive on environmental surfaces and can infect a person for up to 2–8 hours after being deposited on the surface. 

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How we control Health care Associated Spread• Combination of infection control

strategies is recommended to decrease transmission of influenza in health-care settings. These include placing influenza patients in private rooms when possible and having health-care personnel wear masks for close patient contact (i.e., within 3 feet) and gowns and gloves if contact with respiratory secretions is likely .

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Use of Mask by Patients and Health care Workers

• The use of surgical or procedure masks by infectious patients may help contain their respiratory secretions and limit exposure to others. Likewise, when a patient is not wearing a mask, as when in an isolation room, having health-care personnel mask for close contact with the patient may prevent nose and mouth contact with respiratory droplets

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Can the Mask Prevent the Spread of Flu ???

• However, no studies have definitively shown that mask use by either infectious patients or health-care personnel prevents influenza transmission

Prevention is best option

• Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

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Using N95 mask reduces the

Risk

• You can cut your risk of contracting the flu or other respiratory viruses by as much as 80 percent by wearing a mask over your nose and mouth, according to a new study.

Emerging Infectious Diseases, the journal of the Centres for Disease Control and Prevention (CDC) .

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Health Care Personal Should Protect With

• During a surgical or procedure mask should be worn by health-care personnel who are in close contact (i.e., within 3 feet) with a patient who has symptoms of a respiratory infection, particularly if fever is present, as recommended for standard and droplet precautions. These precautions should be maintained until the patient has been determined to be non infectious or for the duration recommended for the specific infectious agent.

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Institutional Measures

• Use of antiviral drugs for treatment and chemoprophylaxis of influenza is a key component of influenza outbreak control in institutions that house patients at higher risk for influenza complications. In addition to antiviral medications, other outbreak-control measures include instituting droplet and contact precautions and establishing cohorts of patients with confirmed or suspected influenza, re-offering influenza vaccination (if available) to unvaccinated staff and patients, restricting staff movement between wards or buildings, and restricting contact between ill staff or visitors and patients.

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Best way to Prevent Influenza

• Vaccination is the primary method for preventing Influenza in persons at high risk for complications secondary to influenza infection. Administration of antiviral medications, either for the early treatment of influenza infection or for prophylaxis against infection, is a useful adjunct in the control of influenza in these persons

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Control with Antiviral Drugs

• Both adamantine and neuraminidase inhibitors have been used successfully to control outbreaks caused by susceptible strains when antiviral medications are combined with other infection-control measures.

• Currently Oseltamivir has gained importance as safe and effective Antiviral agent.

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Swine flu Vaccination• Everyone 6 months of

age and older should get vaccinated against the flu as soon as the 2010-2011 season vaccine is available. People at high risk of serious flu complications include young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older.

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"flu shot”• The "flu shot" — an

inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

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Nasal vaccination• The nasal-spray flu

vaccine —a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "live attenuated influenza vaccine" or FluMist®). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age who are not pregnant.

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HAND WASHING REDUCES

SPREAD OF INFLUENZA

Clean Hands – Safe HandsEven Reduces Inluenza

• Washing your hands often with soap and water, especially after you cough or sneeze. You can also use alcohol-based hand cleaners.

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• Programme Created By Dr.T.V.Rao MD for Medical

and Health Care Professionals

• Email• doctortvrao@gmail.com

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