swine flu h1n1 quiz - india epidemic 2015 - what every pediatrician should know

Dr Gaurav Gupta

Q: How many people in India have already

died in the current H1N1 epidemic, and how

many died in the 2009-10 epidemic?

500 & 1000

1500 & 3000

2500 & 5000

10000 & 20000

Q: Why is it called the Swine Flu?

It comes from eating swine

It is transmitted to humans from staying

close to swine

It is a virus that jumped to humans from

swine

The present strain can infect both humans &

swine

Q: Difference between Swine Flu (H1N1) &Bird Flu

(H5N1)?

More case fatality H1N1 / H5N1

More human to human transmission H1N1 / H5N1

Close contact with animal needed H1N1 / H5N1

Can infect other animals incl. pigs H1N1 / H5N1

Can get it from eating animals H1N1 / H5N1

Q: Difference between Swine Flu (H1N1) &Bird Flu

(H5N1)?

More case fatality H1N1 / H5N1

More human to human transmission H1N1 / H5N1

Close contact with animal needed H1N1 / H5N1

Can infect other animals incl. pigs H1N1 / H5N1

Can get it from eating animals NEITHER

Q: Can I get the swine flu from eating pigs?

Am I protected/ less at risk because I am a

vegetarian? Can I eat pork?

Yes/ No/ Maybe

Q: A mother tells you that her 5 year old

daughter tested +ve for Swine Flu in Mumbai

and was treated with Tamiflu. Should the

child receive the vaccination this year?

Yes/ No

Q: A mother tells you that her 5 year old

daughter tested +ve for Swine Flu in Mumbai

and was treated with Tamiflu. Should the

child receive the vaccination this year?

Yes/ No

Abs appear in 7 days; max level in 2 weeks;

drops to pre-infection level in 8- 12 months.

No cross-immunity.

Q: How long does the flu virus survive on

surfaces?

Hard surfaces like steel / wood/ plastics -

__________

Porous surfaces like cloth / tissues etc -

__________

On hand / skin -

__________

Q: How long does the flu virus survive on

surfaces?

Hard surfaces like steel / wood/ plastics -

Upto 48 hours

Porous surfaces like cloth / tissues etc -

Upto 12 hours

On hand / skin -

Few minutes – Most likely mode of

transmission

Q: Can my pet catch swine flu?

Yes/ No/ Maybe

Q: When to suspect ‘swine flu’?

Fever

Cough

Sore throat

Chills & fatigue

Diarrhea and vomiting

Rhinorrhea

Headache

Body aches & joint pains

Q: When to suspect ‘swine flu’?

Any child with URI can have swine flu, 2 or more of the above symptoms

Fever

Cough

Sore throat

Chills & fatigue

Diarrhea and vomitingRhinorrhea

Headache

Body aches & joint pains

Q: What percentage of Swine Flu disease in

children is life-threatening?

1-2

3-5

10-15

30-50

Sub clinical infection: Almost 30% cases get

no symptoms !

Common cold (Rhino-pharyngitis): Majority of

other patients develop a disease no different

than an ordinary cold & recover with simple

fever and cough medications.

Tracheo-laryngo-bronchitis (Croup): These

patients have fever, hoarseness of voice and

significant cough.

H1N1Pneumonia: Only 3-5 cases out of 100

H1N1 cases develop this level of disease.

So let us be vigilant for symptoms of swine

flu pneumonia and stop bothering about

other level of illnesses.

Q: What is the most specific symptom for

Swine Flu as compared to other types of Flu,

that can help you suspect this in a particular

individual?

__________________

Q: What is the most specific symptom for

Swine Flu as compared to other types of Flu,

that can help you suspect this in a particular

individual?

NONE

Q: How soon will I get sick if I am exposed to

the flu?

1-4 days

5-7 days

10-14 days

14-21 days

Q: How soon will I get sick if I am exposed to

the flu?

1-4 days

5-7 days

10-14 days

14-21 days

The time from when a person is exposed to flu

virus to when symptoms begin is about 1 to 4

days, with an average of about 2 days.

Q: For how long does an individual remains

‘infectious’? What is the time of maximum

viral shedding?

____________________________________

Q: For how long does an individual remains

‘infectious’? What is the time of maximum

viral shedding?

1 day before to 7 days after.

Max viral shedding on day 1 of illness

Do all suspect cases need to be tested?

Should all suspected/confirmed cases be

hospitalized?

Should all suspected/confirmed cases be

treated with antivirals?

Categor

y

Presentation Testing

for

H1N1

Hospital

ization

Oseltamiv

ir

administr

ation

Treatmen

t

modality

A Mild fever plus cough /

sore throat with or

without bodyache,

headache, diarrhoea and

vomiting

No No No Home

treatment

B Signs and symptoms of Cat. A

+ High grade fever, severe sore

throat, Or Cat-A signs &

symptoms with high risk

conditions*

No No Yes Home

confineme

nt

C Signs and symptoms of

Cat. A & B +

breathlessness, chest

pain, drowsiness,

hypotension,

bloody sputum, bluish

discolouration of nails;

convulsions, Or signs and

symptoms of Cat. A & B

+worsening of underlying

Yes yes Yes Immediate

hospitaliza

tion

High risk conditions:

• Children with predisposing risk factors.

• Pregnant women;

• Persons aged > 65 years

• Patients with lung diseases, heart disease,

liver disease, kidney disease, blood

disorders, diabetes, neurological disorders,

cancer and HIV/AIDS;

• Patients on long term cortisone therapy.

Q: 3 year old boy has fever with cough * 5 days. Fever has recurred with higher spikes. Child had received 3 days of Amoxyclav & 2 days of Cefpodoxime.

O/E: Vitals stable. Lethargic, feeding reduced, conscious. B/l fine crepts

Invx: CXR reveals a patchy consolidation.What is the course of action in this situation?

Ct antibiotics for another couple of days & review

Admit & give IV antibiotics

Get evaluated for Swine Flu, start Oseltamivirempirically, explain warning signs

Hospitalize in isolation, get evaluated for Swine flu, start Oseltamivir if +ve.

Q: Where are the diagnostic facilities

available?

_____________

Q: Where are the diagnostic facilities

available?

There are only 21 laboratories for testing A

(H1N1) in the entire country. Samples are

collected at district hospitals of different

states and send to nearby IDSP/ICMR centers

having facility for Influenza virus testing.

Q: Who should be investigated?

Q: Who should be investigated?

A. Priority for testing should be given to:

1. Those who require hospitalization;

2. Those who are at high risk for severe

complications (Table I).

Q: What to do with a 5 year old girl who has

tested +ve from a private lab in Gurgaon, &

is having symptoms of cold cough and mild

fever with normal activity and fair appetite

when afebrile, and only mild throat

congestion & clear chest?

Soup, TLC, cold medicines, Stay Home

Confirm by sending to Govt center,

treatment as per reports

Give Antibiotics, get CBC and CXR done

Q: How soon does Flu vaccine start

protecting against Flu?

3 days

7 days

10 day

14 days

Q: You have 3 doses and these 4 family

member turn up, which is not high risk & can

be deferred?

Pregnant lady,

her 1.5 years daughter,

4 years son,

&70 years old grandfather of the kids

Q: Do all the available flu vaccines provide

protection against current outbreaks of A

(H1N1)?

Yes / No / Maybe

Q: What is the overall efficacy for flu

vaccines when strains are well matched / this

year?

70-80 %/ 20 %

50-60 % / 30 %

40-50 % / 40 %

Q. There is talk of drift in circulating strain

of Flu virus. Will the vaccine be effective?

Yes/ No /Maybe

Q. What are the estimates of effectiveness of

available flu vaccines against ongoing

A(H1N1) outbreaks in India?

_____

Q. What are the estimates of effectiveness of

available flu vaccines against ongoing

A(H1N1) outbreaks in India?

70-80 %

Q. Who should receive influenza vaccine?

Q. Who should receive influenza vaccine?

As per IAP

1-Children with certain high-risk conditions

2-Health care professional including

pediatricians;

3-Laboratory personnel and healthcare

workers;

4-On demand of anxious parents after one-

to-one discussion.

Q. What are the Government of India’s

guidelines on influenza vaccination?

Q. What are the Government of India’s

guidelines on influenza vaccination?

A. Health Care Workers working in close

proximity to influenza patients are at higher

risk of acquiring the disease, like ER, ICU,

Isolation Wards, Screening centers, Rapid

response team, driver & staff of ambulances,

lab workers etc.

Q. Is it okay to advise mass vaccination in

schools in the regions affected with current

outbreaks of swine flu?

Yes / No / maybe

Q. Is it okay to advise mass vaccination in schools in the regions affected with current outbreaks of swine flu?

Yes / No / maybe

It takes about 2-3 weeks for development of immunity

Majority of affected individuals would have only minor, selflimiting disease.

No health authority in India including WHO has recommended mass influenza vaccination.

Q: What are the non-pharmaceutical

interventions to avoid spread of disease?

Q: What are the non-pharmaceutical

interventions to avoid spread of disease?

People need to focus on

good hand hygiene,

staying at home if they are feeling unwell

and

covering their mouth when they cough or

sneeze.

Q: Should I wear a face mask or respirator?

Yes / No / Maybe

Q: Should I wear a face mask or respirator?

Yes / No / Maybe

As per GOI only for the patient in hospital

Maybe recommended in crowded places

during epidemics

Difficult to wear properly.

That’s all folks !

swine flu h1n1 quiz - india epidemic 2015 - what every pediatrician should know

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