Transcript Slide 1
A,B,C of Flu
Human FLU
Deaths worldwide
Seasonal flu: mainly A + B (C rare)
500,000 / yr
Influenza A virus pandemics:
H1N1:
Spanish Flu 1918
H2N2:
Asian Flu 1957
H3N2:
Hong-Kong Flu 1968
50 million
2 million
1 million
H5N1:
Bird Flu
Where does Swine Flu fit in?
Swine Flu
New influenza A(H1N1) virus
Unrelated to seasonal flu
Respiratory disease of pigs,
birds, poultry, horses &
humans
“Quadruple reassortant" virus
Bird-Flu gene
Pig-flu gene
2 genes: Europe & Asia
Human-gene
Pandemic H1N1 2009
Never before circulated in humans
WHO Phase 6 = Pandemic
> 300,000 cases in over 200 countries
Symptoms
Fever (> 38°C / 100.4°F)
Plus 2 or more of:
Tiredness
Headache
Runny nose
Sore throat
SOB /cough
Loss of appetite
Aching muscles
D&V
Who Is At Risk?
Chronic Disease:
Lung
Heart
Kidney
Liver
Neurological
Immunosuppressed
Diabetes
Asthma (Rx past 3 y)
Also:
Pregnant women
Elderly ≥ 65 y
Children <5 y
UK 2009 Timeline
March:
April:
June:
July:
first confirmed cases (US & Mexico)
confirmed in UK
first death in UK, Glasgow
1st death with no underlying medical probs
Containment to Treatment Phase
Diagnose on symptoms NOT testing
All contact tracing stopped
Exposure does not = antiviral drugs
Sept:
Rising new cases
Predictions
Infected = 18.3m
Deaths
18-64,050
Hospital
366,000
Complications
2.74m
Mild
15m
Public Messages
Catch it, bin it, kill it
Cover mouth / tissues / basic hygiene
Hard surfaces e.g. Door handles, keyboards, phones
Stay at Home
If symptoms (5-7d)
Flu friends
Face mask unnecessary
Contact
GP / NHS 24
National Pandemic Flu Service
DOH: General Advice
Children
Attend schools unless flu symptoms
Avoid “flu-parties”
See Doctor if < 1 yr
Pregnant
Routine avoidance measures
Safe to breastfeed if anti-virals
Teachers advised to attend school
Travel:
Unrestricted unless symptomatic
Avoid Mecca Pilgrimages if high-risk group
Headlines
“Swine flu jabs rushed through safety tests”
“GPs demand more money for swine flu jabs” TIMES ONLINE
“NHS staff don’t want swine flu jab”
“Up to half of GPs and one in three nurses ... because of concerns
over safety.” Telegraph
“Vaccine risk outweighs risk of virus” Irish-Times
“Swine flu over-diagnosed”
“Swine-flu under-reported”
HCP Advice
Triage suspected cases
Avoid in surgery if possible
Declutter waiting rooms
Use of PPE
Gloves
Mask
Glasses
Gown
Antivirals
May lessen severity by reducing:
Length of illness (~ 1 day)
Symptoms, and
? Serious complications risk
Maximum benefit
Adults: Within 48 hrs of symptoms onset
Children: Within 36 hrs of symptoms onset
Preparation:
TAMIFLU (Oseltamivir) & RELENZA (Zanamivir)
neuraminidase enzyme inhibitors
Action
Block viral enzyme
Prevent shedding
Safety
Relatively new
report via the MHRA’s
‘Swine Flu ADR Portal’
Tamiflu
Age 1 and over
Caps: 30/45/75mg
Susp: 12mg/ml solution
SEs
676 suspected ADRs since April
nausea, vomiting, diarrhoea, abdo pain,
headache, mild allergic
??seizures/delirium
Caution
Severe renal impairment
AVOID dialysis (CrCl ≤ 10ml/min)
?methotrexate ?probenecid
?? warfarin
Dose:
Age 1-12
BW ≤ 15kg:
BW ≤ 23kg:
BW ≤ 40kg:
Age 13+/>40kg:
30mg
45mg
60mg
75mg
Duration:
Treat = bd for 5 days
Prev = od for 10 days
NB
Best with food
Relenza
Age 5 and over
Inhaled (Diskhaler): 5mg dose
Use: pregnancy, renal disorders
SEs:
22 suspected ADRs since April
V rare: 1 in 10,000
allergy, bronchospasm
Caution:
persistent asthma/severe COPD
AVOID severe asthma
Use bronchodilator before taking
AVOID:
allergy to lactose/milk protein
Dose:
2 inhalations (2 blisters) = 10mg
Duration:
Treat = bd for 5 days
Prev = od for 10 or 28 days*
* Longer duration if community outbreak
Vaccination
Vaccination
First batches expected October
Once licensed by European Medicines Agency (EMEA)
Safety concerns (medical / case reports Guillain-Barre 1970’s)
Prioritised by risk Grp
2 doses, 3 weeks apart
Annual flu vaccination also required
“Previous Swine-flu” does not reduce risk
Even if received anti-virals
Exception is lab (swab) +ve cases
st
1
1.
2.
3.
4.
5.
Stage Contact
High Risk: age > 6m – 65 y
Pregnant
House contacts immunosuppr
High-Risk: age > 65 y
Frontline Health Professionals
TOTAL =
SCOTLAND
ENGLAND
640,700
60,000
53,000
428,250
250,000
_________
5m
0.5 m
0.5 m
3.5 m
2m
________
1.4 million
11 million
Complications
Complications
NEJM 2009
Most common severe complications
Respiratory Distress
Pneumonia
Youth Shift: Age 5-59
87% of total Deaths (exp ~ 17%)
71% of Severe pneumonia (exp~32%)
• Selective Antivirals (WHO Aug 2009)
• High risk groups
• Serious / deteriorating cases =
SOB / Resp distress / cyanosis / haemoptysis /
chest pain / fever >3d / confusion / low BP
Second Wave?
Is it coming back?
Week until 14/9/9: Sentinel GP practice data
New cases in Scotland
Higher now than start of August
Past week
6181
Prev week
3336
Consultation rates
Tayside > Scottish average
Increasing
age < 65
Decreasing
age > 65
Complications
Hospitalised
13 cases (1 ICU)
Deaths
8 cases
2nd wave likely coincide with seasonal flu
Summary
High Risk
“Young people”
Pregnancy
Chronic Disease / immuno-suppressed
esp < 5y & >65y
Course
Most mild self-care
Mortality ~0.3% (= seasonal flu)
Second-wave
Anti-virals
Best evidence severe cases / high-risk
Treat based on risk groups
? Emerging resistance
Vaccination
Late-October
Normal flu-risk group 6m – 65y
Extra:
Frontline health-care workers
The End
www.direct.gov.uk
www.nhs24.com
www.scotland.gov.uk
www.rcgp.org.uk/pandemic
www.hpa.org.uk
www.bma.org.uk/health_promoti
on_ethics/influenza
www.documents.hps.scot.nhs.uk/
respiratory/swineinfluenza/situation-
reports/weekly-h1n1v