Swine Flu(H1N1)

Dr Sujnanendra Mishra MD (O&G)

 H1N1 Influenza
• last influenza pandemic in 1917 that
accounted for 20 million deaths
worldwide.
• This time first cases of human infection
with novel H1N1 influenza virus were
detected in April 2009 in San Diego.
• The virus is spreading rapidly.
• The virus is widespread in the United
States at this time and has been detected
internationally including INDIA
 • RNA, enveloped
The Virus • Viral family: Orthomyxoviridae
H1N1 Influenza • Size:
80-200nm or .08 – 0.12 μm (micron)
in diameter

• Three types
• A, B, C
• A, associated worldwide
epidemics.
B & C, not severe, no animal
reservoir
• Surface antigens
• H (haemaglutinin)
16 Subtypes (H1,to H16 )
• N (neuraminidase)
9 Subtypes (N1 toN9 )
 Signs and symptoms
Symptoms of H1N1 flu are similar to those with
seasonal flu.
• Running or stuffy nose
• Cough
• Sore throat
• Fever , Chills
• Body aches
• Headache
• Fatigue
• vomiting (25%) and diarrhea (25%) have
also with
Acute Onset beenfebrile
reported.
respiratory illness
How does H1N1 Influenza spread?
• This virus spreads the way
seasonal flu spreads
• Primarily through respiratory
droplets
– Coughing
– Sneezing
– Touching respiratory droplets on
yourself, another person, or an
object, then touching mucus
membranes (e.g., mouth, nose,
eyes) without washing hands
 How is A/H1N1 diagnosed?
 1. Clinical diagnosis. This involves physically examining
the patient and taking a clinical history that may serve to
determine if there are any signs and symptoms and if there
was any close contact with any infected person(s)
including family members.
 2. Pathological diagnosis. This involves laboratory
confirmation first of the A type influenza and then
confirmation of H1N1 strain of virus. A/H1N1 is
diagnosed by taking nasopharyngeal swabs of the
suspected person(s). Swab samples are then subjected to
Polymerase Chain Reaction analysis for RNA
amplification, followed by RNA sequencing and typing.
H1N1 A GLOBAL
ISSUE
 Swine Influenza A(H1N1)
US Case Definitions
 1. Confirmed cases
a. Influenza like illness
b. Confirmation of flu like infection
i. RT-PCR
ii. Viral culture
 2. Probable cases
a. Influenza like illness
b. Positive for influenza A
c. Negative for H1 and H3
d. Confirmation by RT-PCR
 3. Possible cases
a. Previously healthy
b. Less than 65 years
c. Hospitalized for influenza like illness
 Swine Influenza A(H1N1)
US Case Definitions

• Infectious period for a confirmed case of swine influenza A(H1N1)

virus infection is defined as 1 day prior to the case’s illness onset to 7
days after onset
• Close contact is defined as: within about 6 feet of an ill person who is
a confirmed or suspected case of swine influenza A(H1N1) virus
infection during the case’s infectious period
• Acute respiratory illness is defined as recent onset of at least two of
the following: rhinorrhea or nasal congestion, sore throat, cough (with
or without fever or feverishness)
• High-risk groups: A person who is at high-risk for complications of
swine influenza A(H1N1) virus infection is defined as the same for
seasonal influenza (see Reference)
 Swine Influenza A(H1N1)
• Clinicians should consider the possibility of swine
influenza virus infections in patients presenting with
febrile respiratory illness who
– live in areas where human cases of swine influenza A(H1N1)
have been identified or
– have traveled to an area where human cases of swine influenza
A(H1N1) has been identified or
– have been in contact with ill persons from these areas in the 7
days prior to their illness onset

• If swine flu is suspected, clinicians should obtain a

respiratory swab for swine influenza testing and place it
in a refrigerator (not a freezer)
– once collected, the clinician should contact their state or local
health department to facilitate transport and timely diagnosis at
a state public health laboratory
 Swine Influenza A(H1N1)
• Covering nose and mouth with a
tissue when coughing or sneezing
– Dispose the tissue in the trash after use.
– or, Sneeze on to your
sleeve above elbow
• Handwashing with soap and water
– Especially after coughing or sneezing.
• Cleaning hands with alcohol-based
hand cleaners
• Avoiding close contact with sick
people
• Avoiding touching eyes, nose or
mouth with unwashed hands
• If sick with influenza, staying home
from work or school and limit contact
with others to keep from infecting
them
 Swine Influenza
Treatment
A(H1N1)

• No vaccine available
• Antivirals for the treatment and/or prevention of infection:
– Oseltamivir (Tamiflu) or
– Zanamivir (Relenza)
• Use of anti-virals can make illness milder and recovery faster
• They may also prevent serious flu complications
• For treatment, antiviral drugs work best if started soon after getting
sick (within 2 days of symptoms)
• Warning! Do NOT give aspirin (acetylsalicylic acid) or aspirin-
containing products (e.g. bismuth subsalicylate – Pepto
Bismol) to children or teenagers (up to 18 years old) who are
confirmed or suspected ill case of swine influenza A (H1N1)
virus infection; this can cause a rare but serious illness called
Reye’s syndrome. For relief of fever, other anti-pyretic
medications are recommended such as acetaminophen or non
steroidal anti-inflammatory drugs.
 Swine Influenza A(H1N1)
Treatment

Oseltamivir (Tamiflu) Zanamivir (Relenza)

Treatment Prophylaxis Treatment Prophylaxis

Adults 75 mg capsule twice 75 mg capsule once Two 5 mg Two 5 mg

per day for 5 days per day inhalations (10 mg inhalations (10 mg
total) twice per day total) once per day

Children 15 kg or less: 60 mg 30 mg once per day Two 5 mg Two 5 mg

per day divided into inhalations (10 mg inhalations (10 mg
2 doses total) twice per day total) once per day
(age, 7 years or (age, 5 years or
15–23 kg: 90 mg per 45 mg once per day older) older)
day divided into 2
doses

24–40 kg: 120 mg 60 mg once per day

per day divided into
2 doses

>40 kg: 150 mg per 75 mg once per day

day divided into 2
doses
Dosing recommendations for antiviral treatment of children younger than 1 year using
oseltamivir. Recommended treatment dose for 5 days. <3 months: 12 mg twice daily; 3-5
months: 20 mg twice daily; 6-11 months: 25 mg twice daily

Dosing recommendations for antiviral chemoprophylaxis of children younger than 1 year using
oseltamivir. Recommended prophylaxis dose for 10 days. <3 months: Not recommended unless
situation judged critical due to limited data on use in this age group; 3-5 months: 20 mg once
Source: CDC
 Swine Influenza A(H1N1)
Other Protective Measures

Defining Quarantine vs. Isolation vs. Social-Distancing

– Isolation: Refers only to the sequestration of symptomatic
patents either in the home or hospital so that they will not infect
others
– Quarantine: Defined as the separation from circulation in the
community of asymptomatic persons that may have been
exposed to infection
– Social-Distancing: Has been used to refer to a range of non-
quarantine measures that might serve to reduce contact
between persons, such as, closing of schools or prohibiting large
gatherings

Source: CDC
 Swine Influenza A(H1N1)
Other Protective Measures

Infection Control of Ill Persons in a Healthcare Setting

• Standard, Droplet and Contact precautions should be used for all
patient care activities, and maintained for 7 days after illness onset
or until symptoms have resolved. Maintain adherence to hand
hygiene by washing with soap and water or using hand sanitizer
immediately after removing gloves and other equipment and after
any contact with respiratory secretions.
• Personnel providing care to or collecting clinical specimens from
suspected or confirmed cases should wear disposable non-sterile
gloves, gowns, and eye protection (e.g., goggles) to prevent
conjunctival exposure.

Source: CDC
 Swine Influenza A(H1N1)
Other Protective Measures

Infection Control of Ill Persons in a Healthcare Setting

 Patients with suspected or confirmed case-status should be
placed in a single-patient room with the door kept closed.  If
available, an airborne infection isolation room (AIIR) with
negative pressure air handling with 6 to 12 air changes per
hour can be used. Air can be exhausted directly outside or
be recirculated after filtration by a high efficiency
particulate air (HEPA) filter. For suctioning, bronchoscopy, or
intubation, use a procedure room with negative pressure air
handling.

 The ill person should wear a surgical mask when outside of

the patient room, and should be encouraged to wash hands
frequently and follow respiratory hygiene practices. Cups
and other utensils used by the ill person should be washed
with soap and water before use by other persons. Routine
cleaning and disinfection strategies used during influenza
seasons can be applied to the environmental management
of swine influenza.
Source: CDC
 What can you do to stop
spreading….
Stay Safe……
• Wash your hands frequently and thoroughly. Use
soap and warm water when available; use hand
sanitizer between hand washings.
• Avoid close contact with sick people. Close
contact means getting within 6 feet of a sick
person.
• Use the face mask properly and throw it away
after use. Though It's not known whether face
masks protect 100% against infection.
 Avoid spreading the swine flu
virus:
• Stay home if you are sick.
• Don't cough or sneeze into your hands. Instead
Cough/sneeze into a tissue -- or, your sleeve above elbow.
• If you can do so comfortably, wear a face mask if you
come into contact with others.
• Allow Special leave for workers for staying home if sick
or for caring for sick children.
• Encourage Hand washing at home and workplace

Have it everywhere
NO HANDSHAKE
PLEASE !!
SAY
NAMASTE !!
Wash your hands frequently and thoroughly

wear a face mask, if available

and tolerable,
NAMASKAR