Swine influenza USA/Mexico

2009
Information and advice as of 25th
April 2009

WHO/WPRO
 Swine Influenza A H1N1
Virology
• Swine influenza H1N1
• Reassortment - four different genes:
– North America swine
– Asia/Europe swine
– Human influenza
– Avian (Non H5)
• Unique combination that has never been seen before
• Level of immunity in general community
– Unknown
• Effectiveness of seasonal influenza vaccine
– Unknown
• Antiviral resistance
– Resistant to adamantines
– Sensitive to tamiflu and relenza

WHO/WPRO
 USA
• 30 March first case (10y, M) – San Diego County
- California
• 28 March second case ( 9y, F) – Imperial County
- California
• As of 25 April – 8 cases
– California (6)
– Texas (2) – Guadalupe County & San Antonio County
• No contact with pigs
• Human to human confirmed by USCDC
WHO/WPRO
 Location of outbreaks: USA

Imperial
County, CA
(border with
Arizona)

Guadalupe
San Diego County, TX
CA

San
Antonio,
TX

WHO/WPRO
 Mexico
• Higher than expected ILI reports
– March and April (usual peak in December)
– Northern and central Mexico
• Steep rise in patients admitted with severe pneumonia in
the following provinces in the past 10 days:
– Baja, San Luis Potosi, Mexico City, Tlaxala, Hidalgo, Vera Cruz,
Chihuahua
• Majority pneumonia cases aged 25 to 44 years old
• Some deaths reported - majority in previously healthy
adults
• A number of pneumonia cases have tested positive for
swine influenza
WHO/WPRO
 Location of outbreaks: Mexico

Hidalgo
San Luis
Potosi

Tlaxcala Vera Cruz

WHO/WPRO
 Clinical Presentation (Mexico)
• Incubation period – up to 7 days
• Range of symptoms – very mild to severe
acute respiratory symptoms
• Vomiting and diarrhoea in some cases
• Fatal cases: ill for 6 days then
deteriorate and many needed
ventilation

WHO/WPRO
 Advice to clinician – unaffected
countries
• Health Travellers who have acute respiratory
symptoms and returned from within 7 days:
– California, USA
– Texas, USA
– Mexico (all)
• Report as suspect case, arrange for testing,
isolate
• If positive – isolation, treatment with antivirals
(tamiflu) and inform public health authorities so
that contact tracing can be initiated

WHO/WPRO
 Advice: Infection Control
Infection control for suspect or confirmed
case of swine influenza:
• Standard, Droplet and Contact precautions
should be used for all patient care activities:
e.g. frequent hands wash, wear disposable
non-sterile gloves, gowns, and eye protection
(e.g., goggles) to prevent conjunctival
exposure.

WHO/WPRO
 Advice – Surveillance
Clinicians/Public Health Authorities
Ensure immediate reporting of:
• Suspect cases of swine influenza A (H1N1)
– Suspect case: Acute respiratory illness with travel to affect area
within 7 days of onset of illness
• Unusual patterns or clusters of respiratory disease

Laboratory:
• Immediate reporting of untypable influenza A
• Send sample to reference laboratory
• Inform public health so that investigation can be initiated

WHO/WPRO
 Laboratory detection of swine
influenza H1N1
• Samples should be collected, handled, stored
and shipped using protocols developed for
influenza H5N1
• Virus isolation should only be carried out in
facilities with BSL-3 or higher levels of
containment
• Most tests designed to detect influenza A virus
SHOULD detect this strain
• Some tests for subtyping MAY NOT identify this
strain correctly

WHO/WPRO
 Laboratory detection of swine
influenza H1N1
• To definitively confirm this as swine
influenza A H1N1, sequencing of viral
nucleic acid is recommended. This should
be performed promptly.
• WHO is currently identifying which
laboratories in the region are capable of
performing this procedure.

WHO/WPRO
 Advice:
Border control & International travel
• Health information and advice to international travellers
– avoid exposure to infected persons
– implement precautionary measures to prevent the disease (e.g. hand
hygiene, cough etiquette etc)
– if developing ILI or acute respiratory illness, limit contact with others,
report local health authority and seek appropriate medical care
• WHO has not recommended border screening (e.g. entry/exit
screening), but countries in the WPR may consider
implementing entry screening based on national decision
• WHO has not recommended travel restrictions to the countries
currently experiencing human swine influenza (Mexico and
USA)
• WHO does not recommend international border closure

WHO/WPRO
 Advice to general public
Our standard precautions remain in place:
• Cover your cough or sneeze with a mask or a
tissue or your sleeve
• Maintain good personal hygiene. Wash your
hands frequently and avoid touching your face.
• Avoid obviously sick people
• Stay at home if you are unwell
• See your doctor if you have fever, cough, sore
throat, body aches, headache, chills and fatigue.
 Health information and advice to
international travellers to affected areas

When travelling
• Avoid exposure to infected persons
• Implement precautionary measures to prevent the
disease (e.g. hand hygiene, cough etiquette etc)
• If developing ILI or acute respiratory illness, limit contact
with others, report local health authority and seek
appropriate medical care

If you are in or have traveled to an affected area:

• Monitor your health
• If you develop symptoms seek medical attention. Advise the
healthcare facility that you have recently been in an area that has
reported swine flu
 Eating pork

• Swine influenza viruses are not

transmitted by food. You cannot get swine
influenza from eating pork products.
• Pork meat is safe to eat as long as it is
handled appropriately and cooked
thoroughly.