Transcript What do I need to know about this ‘bird flu’ everyone is

H1N1 2009 pandemic
What you need to Know
ALI HASSOUN, MD
ALABAMA INFECTIOUS DISEASES CENTER
HUNTSVILLE, AL
What is ‘the flu’?
An illness caused by influenza virus
 A sudden onset respiratory illness with fever
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Affects nose, throat, air passages, and lung
Yearly epidemics
Occurs worldwide causing significant illness
How are viruses different from other germs?
 Much smaller than animal cells or bacteria
 Viruses need to get a life!
 Need to be inside our cells to live
 Our cells become virus factories
 Influenza virus kills cells in breathing passages
What does an influenza virus look like?
Fig.1 Electron
micrograph
 Hemagglutinin protein
 Allows virus to stick to cells
of some animals and not
others
 Neuraminidase protein
 Helps release new virus from
cells
 Genes (RNP) divided into
8 parts
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Fig.2 Schematic of influenza virus
Allows 2 or more viruses to
mix and match genes
Why are the numbered “H” and “N” important?
 Used to subtype influenza A strains
 16 different H’s
 9 different N’s
 Current human subtypes
 A(H1N1) and A(H3N2) primarily
 Antibodies against H’s and N’s
made by our immune system
protect us
 H and N subtypes are basis for flu vaccines
How is influenza spread?
 Patients with pandemic H1N1 influenza A virus infection are likely to
be contagious from one day prior to the development of signs and
symptoms until resolution of fever.
 Incubation– Typically 2 days
 Range 1 to 4 days
 Viral shedding
 Can begin 1 day before the onset of symptoms
 Peak shedding first 3 days of illness
 Correlates with fever
 Subsides usually by 7 days
 Can be 10+ days in children
Is flu only spread through the air?
 Large droplet mostly
Generated by coughing,
sneezing, talking
 “spitting distance”
 Contact with contaminated
hands or surfaces,
sometimes
 Microscopic droplets less
common
 Certain other bodily fluids
(eg, diarrheal stool) should
also be considered
potentially infectious
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the consequences of yearly epidemics in U.S.A?
 > 36,000 die and 200,000 are hospitalized
 5 to 20% of general population infected
 Nursing home attack rates of up to 60%
 85% of flu-related deaths in ages > 65
 Over $10 billion lost
What about past flu pandemics?
Credit: US National Museum of Health and
Medicine
1918: “Spanish Flu”
A(H1N1)
1957: “Asian Flu”
A(H2N2)
1968: “Hong Kong Flu”
A(H3N2)
20-40 m deaths
1-4 m deaths
1-4 m deaths
675,000 US deaths
70,000 US deaths
34,000 US deaths
H1N1 2009 pandemic
 In March and April 2009, an outbreak of respiratory
illnesses was first noted in Mexico, which was eventually
identified as being related to H1N1 influenza A. The
outbreak spread rapidly to the United States, Canada,
and throughout the world as a result of airline travel
 As of July 31, 2009, over 162,000 laboratory-confirmed
cases had been reported in over 160 countries
 In the United States, as of July 24, 2009, over 43,000
confirmed cases had been reported from 55 states and
territories.
 In Alabama as of August 19, 1587 confirmed cases and
madison county had 115 cases
Novel H1N1 Confirmed and Probable Case Rate in the
United States, By Age Group
What are symptoms of H1N1 flu?
 Fever, usually > 101oF, and chills
 Sore throat
 Nasal congestion and runny nose
 Headache
 Body and muscle aches
 Dry cough
 Tiredness and weakness
 Nausea, vomiting, diarrhea. gastrointestinal manifestations
appear to be more common
Who is at risk for severe infection with H1N1 virus?
 the most common risk factors for influenza complications
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Chronic lung disease (asthma or chronic obstructive
pulmonary disease)
Immunosuppressive conditions
Cardiac disease
Pregnancy
Diabetes mellitus
Obesity
How is H1N1 influenza treated?
 Treatment is mostly supportive with rest, fluids,
cough medicine, and antipyretics such as Tylenol.
Aspirin should be avoided.
 It can be treated with antivirals. Mainly for at risk
population and hospitalized patients with more than
mild symptoms.
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Oseltamivir (Tamiflu)–
 capsules and oral liquid
Zanamivir (Relenza)–
 Inhaled powder
Will a regular flu vaccine protect me?
 No protection from current flu vaccine
 H1N1 vaccine will be available mid October, initially will be
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indicated:
Pregnant women,
People who live with and care for children younger than 6
months of age,
Healthcare and emergency medical services personnel,
People between the ages of 6 months and 24 years
People ages 25–64 years of age who have chronic health
conditions (such as asthma, heart disease, or diabetes) or
compromised immune systems.
When should I call my healthcare provider?
 Call if you get concerned about your symptoms especially
if you or a family member are high risk.
 If you have a fever and two or more other flu symptoms
especially if symptoms are severe
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Your provider may recommend tests or treatment with antivirals
 If unable to drink fluids, have dark urine, or feel dizzy when
standing (signs of dehydration)
 If you have a fever for more than 3 to 5 days even if you
have already been treated
 If you start to recover from the flu symptoms and you get
fever again.
When to Seek Emergency Medical Care
 has difficulty breathing or chest pain
 has purple or blue discoloration of the lips
 is vomiting and unable to keep liquids down
 has signs of dehydration such as dizziness when
standing, absence of urination, or in infants, a lack of
tears when they cry
 has seizures (for example, uncontrolled convulsions)
 is less responsive than normal or becomes confused
What should I do if I’m exposed to someone with
H1N1 influenza?
 Anti-viral prophylaxis is recommended for certain
groups of people.
 Household close contacts who are at high-risk of
complications of a confirmed or probable case
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Your healthcare provider can tell you if you need preventative
medication
 If you are not in a high-risk group you should:
 Limit your contact with others in the community
 Stay home at the earliest sign of flu symptoms
For updates see: http://www.cdc.gov/h1n1flu/recommendations.htm
What should People with novel H1N1 flu do ?
 Check with their health care provider about whether they should take antiviral
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medications
Keep away from others as much as possible. Do not go to work or school while
ill
Stay home for at least 24 hours after fever is gone, except to seek medical care
or for other necessities. (Fever should be gone without the use of a feverreducing medicine.)
Drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for
infants) to keep from being dehydrated
Cover coughs and sneezes. Clean hands with soap and water or an alcoholbased hand rub often and especially after using tissues and after coughing or
sneezing into hands
Wear a facemask – if available and tolerable – when sharing common spaces
with other household members to help prevent spreading the virus to others.
be watchful for emergency warning signs that might indicate you need to seek
medical attention.
Placement of the sick person
 Keep the sick person in a room separate from the
common areas of the house. Keep the sickroom
door closed.
 Unless necessary for medical care or other
necessities, people who are sick with an influenzalike-illness should stay home and keep away from
others as much as possible
 If possible, sick persons should use a separate
bathroom. This bathroom should be cleaned daily
with household disinfectant.
Protect other persons in the home
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The sick person should not have visitors other than caregivers.
If possible, have only one adult in the home take care of the sick person.
If you are in a high risk group for complications from influenza, you should attempt to
avoid close contact (within 6 feet) with household members who are sick with influenza.
Avoid having sick family members care for infants and other groups at high risk for
complications of influenza.
All persons in the household should clean their hands frequently, including after every
contact with the sick person or the person’s room or bathroom.
Use paper towels for drying hands after hand washing or dedicate cloth towels to each
person in the household. For example, have different colored towels for each person.
If possible, consideration should be given to maintaining good ventilation in shared
household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
Antiviral medications can be used to prevent the flu, so check with your health care
provider to see if some persons in the home should use antiviral medications.
What about masks in a pandemic?
Masks outside a healthcare setting can be considered in
some circumstances.
 Facemasks considered for crowded settings (avoid if
possible and minimize time)
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Protect wearer from others’ cough and protect others from wearer’s
cough
Single use
 Respirators (N95) considered when close contact with
infected person is unavoidable
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Care of sick person at home
Requires fit-testing to be effective
Single use
What about household cleaning, laundry, and waste disposal?
 Throw away tissues and other disposable items used by sick
person in the trash (wash hands)
 Keep surfaces clean by wiping down with a household
disinfectant according to label
 Eating utensils and dishes of sick person
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Do not need to be cleaned separately; wash thoroughly in dishwasher
or with soap and water
 Linens and towels
 Household laundry soap and tumble dry on hot
 Avoid “hugging” laundry prior to washing to prevent contaminating
yourself
 Clean hands with soap and water or alcohol-based hand rub right
after handling dirty laundry
THANK YOU