Transcript H1N1 2009

H1N1 2009
dr.faiza shaukat
Statistics of H1N12009 (sep
2009)
 In US, 183,572 cases and 663 deaths
 In mexico, 32,025 cases and 358
deaths
 In china, 14,663 cases and with no
deaths
 In japan, 13, 339 cases and 08
deaths
influenza
 Influenza is an acute highly infectious
disease characterized by abrupt
onset, with fever, headache, chills,
aches or pains, coryza, sore throat &
non productive cough.
 It occurs in pandemics, epidemics &
as sporadic cases.
Infectious agent…
 It is a virus of myxovirus group.
 3 types are identified; type A
responsible for pandemics, type B
which causes epidemics and type C
which causes sporadic infection.
 Virus surface have alternating
projections of two antigenic proteins
called heamagglutinin (H) and
neuaminidase (N)
Infectious agent…
 H and N antigens over a period of
years undergo minor changes called
“antigenic drift”
 These antigens go major changes
once about every 10 years called
“antigenic shift”
What is the H1N1 Influenza Virus?
 New Strain of Influenza Virus
 First Detected in April 2009 in the U.S.
 Originally Called “Swine Flu”
 Initial Tests Showed Many Genes Similar
to Influenza Virus that Occurs in Pigs
 Further Studies - New Virus is Very
Different from Viruses in North American
Pigs
Influenza virus…
 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, avian genes, and human genes.
Scientists call this a "quadruple
reassortment virus.“
Current H1N1 Flu Outbreak
 In the U.S., as of May 18 2009:
 5123 Confirmed/Probable Cases
 5 Fatalities
 Texas–3, Washington-1, Arizona-1
 553 Confirmed/Probable Cases in
California
1918 Pandemic Flu (Spanish Flu)
 1918 Influenza Flu Outbreak
 Estimated 70 to 100 Million Deaths Worldwide
 First Wave – Beginning March 1918
 Mild Seasonal Flu Virus
 Second Deadly Wave – Summer/Fall of
1918
 Virus Mutated to a More Deadly Strain
 Majority of the Fatalities – In the Second Wave
 Primarily in the 20 to 40 Year Old Age Range
 Current H1N1 Outbreak May Return in the
Fall
 Need to Prepare
Spread of Infection
 Infected Person Can Infect Others:
 Beginning 1 Day Before Symptoms
Develop
 Up to 7 Days or More After Becoming
Sick
 Younger Children – May Be
Contagious for Longer Periods
Routes of Exposure to Spread the
Infection
 Primary Exposure Route – Person to
Person
 Inhalation of Airborne Droplets from
Infected Person Coughing or Sneezing
Routes of Exposure to Spread the
Infection
 Secondary Route of Exposure Viruses on Surfaces
 Can Live on Surfaces for 2 Hours or More
 Person Touching Contaminated Tables,
Doorknobs, Desks, Then Touching Face,
Eyes, Nose, or Mouth
H1N1 Flu Symptoms
 Symptoms
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Fever
Body Aches
Runny Nose
Sore Throat
Nausea
Vomiting or Diarrhea
 If Concerned About Symptoms – Contact Your
Health Care Provider
Emergency Warning Symptoms
 Adults
 Difficulty breathing or shortness of
breath
 Pain or pressure in chest or
abdomen
 Sudden dizziness
 Confusion
 Severe or persistent vomiting
Emergency Warning Symptoms
 Children
Fast breathing or trouble breathing
Bluish skin color
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that child does not want
to be held
 Flu-like symptoms improve but then return
with fever and worse cough
 Fever with a rash
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Prevention Measures
 Cough/Sneeze - Cover Nose/Mouth
with Tissue or Sneeze into the Sleeve
 Dispose Used Tissues in the Trash
Other Prevention Measures
 Wash Hands with Soap & Water (At Least 20
Seconds) or Use Alcohol-Based Hand Sanitizers
 Avoid Touching Eyes, Nose, or Mouth
 Avoid Contact with Sick People
 If Sick, Stay at Home Away from Work or
School and Limit Contact with Others
Travel
 Conditions Constantly Change
 Link to the CDC Travel Advisory
Website
In Summary
 Best Precautions
 Stay Healthy & Get Plenty of Rest
 Wash Your Hands Frequently
 Avoid Contact with Persons Who Are Sick
 If Sick, Stay at Home, Away from
Work/School
 Must Prepare for Its Possible Return as a
Mutated Virus
2009 H1N1 Vaccines
 This season, vaccines to protect
against the 2009 H1N1 virus
(sometimes called “swine flu”) have
been produced. Like seasonal flu
vaccines
 there are two kinds of 2009 H1N1
vaccines: a "flu shot " that is given
with a needle, usually in the arm; and
a nasal spray flu vaccine
Vaccine H1N12009…
 The same manufacturers who
produce seasonal flu vaccines are
producing the vaccines against the
pandemic 2009 H1N1 virus in the
same way that the seasonal vaccines
are made.
 This vaccine is the best way to
protect against the 2009 H1N1
pandemic virus
Vaccine contd…
 They are expected to be as safe and
effective as seasonal flu vaccines.
 They will not prevent “influenza-like”
illnesses caused by other viruses.
 Inactivated vaccine (vaccine that
has killed virus in it) is injected into
the muscle, like the annual flu
shot.
Vaccine contd…
 Some people have suggested that
thimerosal might be related to
autism.
 In 2004 a group of experts at the
institute of Medicine reviewed
many studies looking into this
theory,and found no association
between thimerosal and autism.
Vaccine contd…
 A live, intranasal vaccine ( the
nasal spray vaccine) is also
available.
 Some inactivated 2009H1N1
vaccine contains a preservative
called thimerosol to keep it free
from germs.
Who should get 2009H1N1
influenza vaccine and when?
 Group recommended to receive 2009
H1N1 vaccine first:
♦ Pregnant women
♦ people who live with or care for
infants younger than 6 months of
age.
♦ health care and emergency medical
personnel.
Who should…
♦ Any one from 6 months through 24 years
of age.
♦ Any one from 25 through 64 years of age
with certain chronic medical condition or
weakened immune system.
 As more vaccine becomes available,
these group should also be vaccinated:
♦ Healthy 25 through 64 years olds
♦ Adults, 65 years and older
When ?...
 Get vaccinated as soon as the vaccine
is available.
 Children under 9 years of age should
get two doses of vaccine, about a
month apart.
 Older children and adults need only
one dose.
Some people should not get
the vaccine or should wait
 You should not get 2009 H1N1 LAIV if
you have a severe (life threatening)
allergy to eggs, or to any other
substance in the vaccine.
 2009 H1N1 LAIV should not be given
to the following groups:
♦Children younger than 2 year and
adults 50 years and older.
Who should wait?..
♦ Pregnant women
♦ Anyone with a weakened immune
system
♦ Any one with a long term health
problem such as
Heart disease, kidney or liver disease,
Lung disease, metabolic
disease(diabetes)
Who should ?...
Asthma, anemia and other blood disorders
♦ Children younger than 5 years with
asthma or wheezing.
♦ Any one with certain muscle or nerve
palsy.
♦ Any one in close contact with a person
with a severely weakened immune
system.
♦ Children or adolescents on long term
aspirin treatment.
Vaccine protocol…
 If you are moderately or severely ill,
you might be advised to wait until
you recover before getting the
vaccine, if you have a mild cold then
there is no need to wait.
 Tell your doctor if you ever had:
♦ A life threating allergic reaction after
a dose of seasonal flu vaccine,
♦ Guillain-Barre syndrome
Vaccine protocol…
 These may not be the reason to avoid
vaccine but medical staff can help you
decide.
 2009H1N1 LAIV may be given at the
same time as most other vaccines. Tell
your doctor if you got any other vaccine
within the past month or plan to get any
within the next month. H1N1 LAIV and
seasonal LAIV should not be given
together.
What are the risks from
2009H1N1?
 a vaccine like any medicine Could
cause a serious problem, such as a
severe allergic reaction. But the risk
of any vaccine causing serious harm
or death is extremely rare.
 The risk from H1N1 LAIV are
expected to be similar to those from
seasonal LAIV:
Avccine side effects…
 Mild problems:
Some children and adolescents 2-17
years of age have repeated reactions
including:
Runny nose, nasal congestion, cough,
fever, head ach, muscle aches,
wheezing, abdominal pain, occasional
vomiting or diarrhea
Vaccine side effects…
Some adults 18-49 years of age have
reported:
Runny nose or nasal congestion, sore
throat, cough, chills, tiredness,
headache
 Severe problems:
Life threatening allergic reactions to
vaccines are very rare. If they do occur,
it is usually within a few minutes to a
few hours after vaccination,
Vaccine side effects…
 In 1976, an earlier type of inactivated
swine flu vaccine was associated with
cases of Guillain-Barre syndrome
LAIV has not been linked to GBS.
What if there is a severe
reaction?
 What should I look for?
♦ Any unusual condition, such as a high
fever or behavior changes.
♦ Signs of a severe allergic reaction can
include difficulty breathing,
hoarseness or wheezing, hives,
paleness, weakness, a fast heart beat
or dizziness.
Vaccine side effects…
 What should I do?
♦ Contact the doctor immediately
♦ Ask the provider to report the
reaction at vaccine adverse event
reporting system (VAERS)
Vaccine safety
 Vaccine Adverse Event Reporting
System (VAERS)
 VAERS will be the front-line
monitoring system for collecting and
analyzing voluntary reports of
adverse events following 2009 H1NI
monovalent vaccination.
Vaccine safety
 VAERS is a US vaccine safety
surveillance system, co-managed by
CDC and FDA.
 VAERS is a key mechanism to identify
potential vaccine safety concerns.
Generally VAERS cannot determine if
an adverse event was caused by
vaccine but can help determine if
further investigations are needed.
Vaccine safety…
 Healthcare providers are encouraged
to report clinically significant adverse
events after 2009 H1N1 mono valent
vaccine or any vaccine to VAERS.
 A report should be submitted even if
the reporter is not certain that the
vaccine caused the event.
Vaccine safety…
 Anyone can submit a VAERS report,
including healthcare providers, vaccine
providers, public health officials, vaccine
manufacturers, and persons vaccinated or
their caregivers.
 Reports may be filed securely online, by
mail, or by fax. Report forms are available
online or can be obtained by
calling
1-800-822-7967
1800-822-7967 to request reporting forms
or other assistance.
Other Vaccine Safety Monitoring
Activities
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Vaccine Safety Datalink (VSD).
Vaccine analytic unit (VAC)
Emerging Infections Programs (EIP).
The Clinical Immunization Safety
Assessment (CISA)
Vaccine safety…
 In this case call 1-888-275-4772 or
visit
www.hrsa.gov/countermeasuresureco
mp/default.htm
How can I learn more
 Ask your provider
 Call your local or state health dept
 Call the center for disease control
Call 1-800-232-4636(1-800-CDC-INFO)
Web site of CDC www.cdc.gov/h1n1flu
In Summary
 Best Precautions
 Stay Healthy & Get Plenty of Rest
 Wash Your Hands Frequently
 Avoid Contact with Persons Who Are Sick
 If Sick, Stay at Home, Away from
Work/School
 Must Prepare for Its Possible Return as a
Mutated Virus