SWINE FLUSWINE FLU

V.NEHRUV.NEHRUART CENTERART CENTER

KARURKARUR

INTRODUCTIONINTRODUCTION

Swine flu is a respiratory disease of pigs Swine flu is a respiratory disease of pigs caused by type A Influenza viruscaused by type A Influenza virus

Swine flu in human beings due to direct Swine flu in human beings due to direct exposure to pigs.(Zoonotic)exposure to pigs.(Zoonotic)

CURRENT SITUATIONCURRENT SITUATION Pandemic (H1N1) 2009 - update 58Pandemic (H1N1) 2009 - update 58 Laboratory-confirmed cases of pandemic (H1N1) Laboratory-confirmed cases of pandemic (H1N1)

2009 as officially reported to WHO by States 2009 as officially reported to WHO by States Parties to the International Health Regulations Parties to the International Health Regulations (2005) (2005)

Updated 12/08/2009(DEATH)Updated 12/08/2009(DEATH) US-436,ARGENTINA-337,AUSTRALIA-85,US-436,ARGENTINA-337,AUSTRALIA-85, UK-36UK-36 INDIA CASES 950 DEATH 13,INDIA CASES 950 DEATH 13, Kings Inst sample 376- Positive 50 Kings Inst sample 376- Positive 50 CDH chennai susp.case 138- Positive 38CDH chennai susp.case 138- Positive 38

AFFECTED COUNTRIESAFFECTED COUNTRIES MEXICOMEXICO U.SU.S AUSTRIAAUSTRIA CANADACANADA GERMANYGERMANY ISRAELISRAEL NEW ZEALANDNEW ZEALAND SPAINSPAIN U.KU.K INDIAINDIA AND MORE COUNTRIESAND MORE COUNTRIES

CAUSATIVE AGENTCAUSATIVE AGENT

Swine Influenza A virus (H1N1)Swine Influenza A virus (H1N1)

SWINE FLU VIRUS

SUSPECTED CASESSUSPECTED CASES A Person with acute febrile respiratory illness A Person with acute febrile respiratory illness

(fever >=38(fever >=38 ۬۬ c) c) with onsetwith onset Within 7 days of close contact with a person is a Within 7 days of close contact with a person is a

confirmed case of Swine Influenza A virus (H1N1) confirmed case of Swine Influenza A virus (H1N1) infection orinfection or

Within 7 days of travel to areas where there are one Within 7 days of travel to areas where there are one or more confirmed case of Swine Influenza A virus or more confirmed case of Swine Influenza A virus (H1N1) cases, or(H1N1) cases, or

Resides in a community where there are one or more Resides in a community where there are one or more confirmed case of Swine Influenza A virus (H1N1) confirmed case of Swine Influenza A virus (H1N1) cases. cases.

PROBABLE CASESPROBABLE CASES A Person with acute febrile respiratory illness (fever >=38A Person with acute febrile respiratory illness (fever >=38 ۬۬ c) c)

whowho is is +ve for +ve for Influenza A virus (H1N1) ,but unsubtypable for Influenza A virus (H1N1) ,but unsubtypable for H1&H3 by Influenza RT-PCR or reagent used to detect H1&H3 by Influenza RT-PCR or reagent used to detect

seasonal Influenza virus infection, or seasonal Influenza virus infection, or

is +ve for Influenza A by an Influenza Rapid test or an is +ve for Influenza A by an Influenza Rapid test or an Influenza IFA +CRITERIA for suspected cases ,orInfluenza IFA +CRITERIA for suspected cases ,or

Individual with clinically compatible illness who died of an Individual with clinically compatible illness who died of an unexplained acute respiratory illness who is considered to be unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed caseepidemiologically linked to a probable or confirmed case

CONFIRMED CASECONFIRMED CASE

A Person with acute febrile respiratory A Person with acute febrile respiratory illness (fever illness (fever ≥≥3838 ۬۬ c) with laboratory c) with laboratory confirmed Swine Influenza A virus (H1N1)confirmed Swine Influenza A virus (H1N1)

infection WHO approved labs by one or more infection WHO approved labs by one or more teststests

1.1. Real time PCRReal time PCR2.2. Viral cultureViral culture3.3. Four fold Four fold ↑ ↑ Swine Influenza A virus Swine Influenza A virus

(H1N1) specific neutralizing antibodies.(H1N1) specific neutralizing antibodies.

INCUBATION PERIODINCUBATION PERIOD

1 day prior to the onset of illness to 7 days after 1 day prior to the onset of illness to 7 days after onset onset

MODE OF TRANSMISSONMODE OF TRANSMISSON

Direct pigsDirect pigs→Human→Human Human → Human Human → Human CrowdnessCrowdness Touching/Handling something contaminated Touching/Handling something contaminated

with flu viruseswith flu viruses

NOT TRANSMITTED NOT TRANSMITTED BYBY

FoodFood Properly handled &cooked porkProperly handled &cooked pork

SYMPTOMSSYMPTOMS

Sore throatSore throat CoughCough Runny noseRunny nose FeverFever Lethargy Lethargy Lack of appetiteLack of appetite Nausea ,vomiting, diarrhoeaNausea ,vomiting, diarrhoea

In children emergency warning signs need

urgent medical attention include:

Fast breathing or trouble breathing Bluish skin color Not drinking enough fluids/eating food Not waking up or not interacting Being so irritable that the child does not want to be heldFlu-like symptoms improve but then return with fever and worse coughFever with a rash

In adults, emergency warning signs need urgent medical attention include:

Difficulty in breathing or shortness of breath

Pain or pressure in the chest or abdomen

Sudden dizziness

Confusion

Severe or persistent vomiting

DIAGNOSISDIAGNOSIS Respiratory specimen is neededRespiratory specimen is needed

SAMPLE COLLECTION&LAB.DIAGNOSISSAMPLE COLLECTION&LAB.DIAGNOSIS taken by treating doctor taken by treating doctor swab - Nasopharyngeal swab &throat swabswab - Nasopharyngeal swab &throat swab storage 2-8storage 2-8 ۬۬ cc Transport -Dry ice in triple packing to Transport -Dry ice in triple packing to 1) NIV- Pune or NICD Delhi1) NIV- Pune or NICD Delhi

2) King Institute, Guindy, Chennai. 2) King Institute, Guindy, Chennai. 3) Christian Medical College, Vellore

with in 24 hrs with patient complete informationwith in 24 hrs with patient complete information contd,contd,

contd,contd,

Lab testsLab tests Rapid antigen testsRapid antigen tests Real time PCRReal time PCR Virus isolationVirus isolation Virus Genome SequencingVirus Genome Sequencing Four fold Four fold ↑ ↑ Swine Influenza A virus (H1N1) Swine Influenza A virus (H1N1)

specific neutralizing antibodies.specific neutralizing antibodies.

TREATMENTTREATMENT Oseltamivir Oseltamivir is the DOC is the DOC for both prophylaxis& treatmentfor both prophylaxis& treatment Adult – 5 daysAdult – 5 days Children- 5 daysChildren- 5 days supportive therapysupportive therapy1.1. IV fluidIV fluid2.2. Oxy. Therapy/ventilatory supportOxy. Therapy/ventilatory support3.3. Antibiotics-Prevent secondary infec.Antibiotics-Prevent secondary infec.4.4. Paracetamol/Ibuprofen – myalgiaParacetamol/Ibuprofen – myalgia5.5. Vasopressors for shockVasopressors for shockCONTRAINDICATEDCONTRAINDICATED salicylate/aspirin salicylate/aspirin → Reye’s syndrome→ Reye’s syndrome

CHEMOPROPHYLAXISCHEMOPROPHYLAXIS

Min 10 Days - Max 6 WeeksMin 10 Days - Max 6 Weeks

wtwt DoseDose

<15 kg<15 kg 30 mg od* 10 days30 mg od* 10 days

15-23 kg15-23 kg 45 mg od* 10 days45 mg od* 10 days

24-<40kg 24-<40kg 60 mg od* 10 days60 mg od* 10 days

≥ ≥40 kg40 kg 75 mg od* 10 days75 mg od* 10 days

FOR INFANTSFOR INFANTS

wtwt DoseDose

<3 MONTHS<3 MONTHS Not recommendedNot recommended

3-5 MONTHS3-5 MONTHS 20mg od* 10 days20mg od* 10 days

6-11MONTHS6-11MONTHS 25mg od* 10 days25mg od* 10 days

PREVENTIONPREVENTION

10 Swine Commands (Prevention)10 Swine Commands (Prevention)

Wash your hands frequentlyWash your hands frequently Get enough sleepGet enough sleep Keep HydratedKeep Hydrated Boost your immune systemBoost your immune system Keep informedKeep informed Avoid alcoholAvoid alcohol Be physically activeBe physically active Know when to get helpKnow when to get help Keep away from sick people.Keep away from sick people. Avoid crowded areas.Avoid crowded areas.