Dr.

Ibrahim
khallaf
PHC-NGHA

Definition
Novel H1N1 flu, popularly known
as swine flu, is a respiratory
infection caused by an influenza
virus first recognized in spring
2009.
The new virus, which is officially
called swine influenza A (H1N1),
contains genetic material from
human, swine and avian flu viruses

Why is H1N1 virus

sometimes called "Swine
Flu"?
This virus was originally referred to as swine

flu because laboratory testing showed that many

of the genes in this new virus were very similar to
influenza viruses that normally occur in pigs
(swine) in North America.
But further study has shown that this new virus is
very different from what normally circulates in
North American pigs.
It has two genes from flu viruses that normally
circulate in pigs in Europe and Asia and bird
(avian) genes and human genes.
Scientists call this a "quadruple reassortant"
virus.

Introduction
The H1N1 flu virus is a new strain of
pandemic influenza which is different than
the seasonal flu.
People have no natural immunity to protect
against this virus.
The H1N1 flu virus emerged in April 2009
and surveillance of its spread shows that it
is affecting more young and healthy people
than the regular seasonal flu, which
normally affects seniors and young children.
People with underlying medical conditions
and pregnant women may be at a greater
risk for severe illness.

What is it?
H1N1 Flu Virus has been reported around
the world
World Health Organization (WHO) has
declared it a pandemic influenza virus.
H1N1 is a strain of the influenza virus
that in the past, usually only affected
pigs.
In Spring 2009, it emerged in people in
North & south America.
This is a new strain of influenza and
because humans have little to no natural
immunity to this virus, it can cause
serious and widespread illness.

How is it spread?
The H1N1 flu virus is contagious and is
spread the same way as regular seasonal
influenza.
This happens when an infected person
coughs or sneezes and their germs enter the
nose, eyes, or throat of another person.
The germs can also rest on hard surfaces
like counters and doorknobs, and can be
picked up on hands and transmitted to the
respiratory system when someone touches
their mouth and/or nose.
It is not possible to catch it by eating pork
or pork products or through blood
transfusions.

Risk factors
Because novel H1N1 virus is new,
everyone is at some risk.
Health care workers who provide
direct patient care
College students and children in
school and child care are also at
high risk.
Children typically pick up the virus
in the classroom and pass it to
other members of the household.

Pathogenesis
The H1N1 form of swine flu is one of the
descendants (generations) of the strain that
caused the 1918 flu pandemic
As well as persisting in pigs, the descendants of
the 1918 virus have also circulated in humans
through the 20th century, contributing to the
normal seasonal epidemics of influenza
However, direct transmission from pigs to
humans is rare, with only 12 cases in the U.S.
since 2005
Nevertheless, the retention of influenza strains in
pigs after these strains have disappeared from
the human population might make pigs a
reservoir where influenza viruses could persist,
later emerging to reinfect humans once human
immunity to these strains has waned

Pathogenesis
H1N1 (Swine) Influenzaviruses aren't the
same as human Influenza viruses.
H1N1 (Swine) Influenza doesn't often
infect people, and the rare human cases
that have occurred in the past have
mainly affected people who had direct
contact with pigs.
However, the current H1N1 (Swine)
Influenza outbreak is different.
It's caused by a new Swine Influenza virus
that has spread from person to person -and it's happening among people who
haven't had any contact with pigs

History of reassortment events in the evolution of the 2009 influenza A (H1N1) virus

Symptoms
Almost always:
Cough and fever

Common:
Fatigue
Muscle aches
Sore throat
Headache
Decreased appetite
Runny nose

Sometimes:
Nausea
Vomiting
Diarrhea

More investigation is
needed on how long a
person can be infectious
(be able to spread the
virus to others), but, it is
believed that this period
is for one day before the
onset of symptoms and
continues for
approximately 7 days
after symptoms have
started.

Understanding the difference between H1N1 Flu and Cold symptoms

The following table provides a general guide to symptoms associated
with H1N1 flu and the common cold. However, only health
professionals can reliably diagnose a respiratory illness.
H1N1 Flu

Symptom

Cold

Fever

Almost Always

Rare

Chills

Common

Not common

Onset of Symptoms

Sudden (hours)

Over several days

Aches

Severe

Slight

Nausea, Vomiting,
Diarrhea

Sometimes

Not common

Coughing

Dry Cough

Wet cough

Tiredness

Moderate to Severe

Mild

Headache

Common

Not common

Stuffy Nose/
Sinus Pains

Not Common

Common

Chest Discomfort

Mild to Moderate

Common Severe

Sore Throat

Common

Common

Decreased Appetite

Common

Not common

Runny Nose

Common

Common

Sneezing

Not common

Common

laboratory diagnosis
A number of different laboratory
diagnostic tests can be used for
detecting the presence of influenza
viruses in respiratory specimens,
including
direct antigen detection tests
virus isolation in cell culture
detection of influenza-specific RNA by
real-time reverse transcriptasepolymerase chain reaction (rRT-PCR).

laboratory diagnosis
Serologic tests on paired acute
(within 1 week of illness onset)
and convalescent (collected 2-3
weeks later) sera can help to
establish a retrospective
diagnosis of influenza virus
infection for epidemiological and
research studies.

Treatment
The following groups are not more
likely to get the H1N1
virus;however, they are more at risk
of developing complications if they
do get sick:
Children under five years of age
(especially those less than two years
old)
Women who are pregnant
People with chronic conditions

Antivirals
Antivirals if taken shortly after getting
sick (within the first 24 to 48 hours), they
can reduce flu symptoms, shorten the
length of illness and may reduce serious
complications.
They are available in two forms:
pill (oseltamivir or Tamiflu)
inhaler (zanamivir or Relenza).
Prepared suspension

Antivirals are recommended for the

treatment of moderate to severe illness,
and for people at risk of severe disease.

Prevention
Wash hands often with soap and warm water for
at least 20 seconds, or use hand sanitizer.
Keep your hands away from your face.
Cough and sneeze into your arm, not your hand.
If you use a tissue, dispose of it as soon as
possible and wash your hands.
Get immunized
Keep common surface areas (doorknobs, light
switches, telephones and keyboards) clean and
disinfected.
Eat healthy foods and stay physically active to
keep your immune system strong.
Keep doing what you normally do, but if you get
sick, stay home.

Immunization
The groups recommended to receive the 2009
H1N1 influenza vaccine include:
Pregnant women
Household contacts and caregivers for children
younger than 6 months of age
Healthcare and emergency medical services
personnel
All people from 6 months through 24 years of age
Children from 6 months through 18 years of age because
cases of 2009 H1N1 influenza have been seen in children who
are in close contact with each other in school and day care
settings, which increases the likelihood of disease spread, and
Young adults 19 through 24 years of age because many
cases of 2009 H1N1 influenza have been seen in these healthy
young adults and they often live, work, and study in close
proximity, and they are a frequently mobile population

Persons aged 25 through 64 years who have health

conditions associated with higher risk of medical
complications from influenza, including asthma,

emphysema, heart disease, diabetes, neuromuscular disease, and

kidney, liver or blood disease ,immunosuppressed due to
medications or HIV

How is the vaccine

given?
Some vaccines contain inactivated
(or killed) viruses. These vaccines
are given by injection into the
upper arm for most people. In
infants and younger children the
thigh is the preferred site for the
vaccine shot.
Another type of vaccine is made
with live viruses, and it is
administered by nasal spray.

How many doses of vaccine

are required?
The FDA has approved the use of one
dose of vaccine against 2009 H1N1
influenza virus for persons 10 years of
age and older.
For children who are 6 months through 9
years of age, two doses of the vaccine are
recommended, separated by 4 weeks.
Infants younger than 6 months of age are
too young to get any influenza vaccine.

Is there anyone who should

not have the inactivated
pandemic vaccine?
Inactivated vaccines should not be
administered to:

People with a history of anaphylaxis (or

hypersensitive reactions), or other life-threatening
allergic reactions to any of the constituents or trace
residues of the vaccine
People with history of a severe reaction to previous
influenza vaccination
People who developed Guillain-Barr syndrome
(GBS) within 6 weeks of getting an influenza vaccine;
Children less than 6 months of age (inactivated
influenza vaccine is not approved for this age group)
People who have a moderate-to-severe illness with a
fever (they should wait until they recover to get
vaccinated).

Conclusion
In late March and early April 2009, an
outbreak of H1N1 influenza A virus
infection was detected in Mexico, with
subsequent cases observed in many other
countries including the United States.
On June 11, 2009, the World Health
Organization raised its pandemic alert
level to the highest level, phase 6,
indicating widespread community
transmission on at least two continents

Conclusion
Case definitions of pandemic H1N1 influenza
Influenza-like illness (ILI) is defined as fever
(temperature of 37.8Cor greater) with cough or
sore throat in the absence of a known cause other
than influenza.
A confirmed case of pandemic H1N1 influenza A is
defined as an individual with an ILI with
laboratory-confirmed H1N1 influenza A virus
detected by real-time reverse transcriptase (rRT)PCR or culture.
Pandemic H1N1 influenza A may be suspected in
an individual who does not meet the definition of
confirmed pandemic H1N1 influenza A, but has an
ILI and an epidemiologic link.

Conclusion
The vast majority of strains of
pandemic H1N1 influenza A virus
circulating in 2009 appear sensitive in
vitro to the neuraminidase inhibitors,
oseltamivir and zanamivir, but all
strains tested have been resistant to
amantadine and rimantadine
The duration of therapy is typically
five days

Conclusion
prompt initiation of antiviral therapy (with
zanamivir or oseltamivir) for individuals
with suspected or confirmed influenza
infection and any of the following features
Illness requiring hospitalization
Progressive, severe, or complicated illness,
regardless of previous health status
Risk factors for influenza complications,
including
children <5 years of age (particularly those <2 years
of age),
adults 65 years of age,
pregnant women and women up to two weeks
postpartum (including those who have had pregnancy
loss)
individuals with certain medical conditions

Conclusion
Patients with pandemic H1N1 influenza A
who develop pneumonia should be treated
empirically for community-acquired
pneumonia (CAP), given the risk of secondary
bacterial pneumonia.
In hospitalized patients with severe CAP
requiring intensive care unit admission who
also have either necrotizing/cavitary
infiltrates or empyema, methicillin-resistant
Staphylococcus aureus (MRSA) infections
should be suspected and treated in addition
to other potential causes