Transcript Swine Flu - RBS Medical

H1 N1 (SWINE) INFLUENZA
RBS Leumit
Medical Group
Dr Micha Halperin
MBBS, MPH, FRACGP
INTRODUCTION
• Influenza pandemics are caused
by influenza viruses that have
adapted to human beings.
• Influenza virus can affect human,
pigs, poultry, and horses.
LATEST INFLUENZA PANDEMICS
Name of
pandemic
Date
Asiatic
(Russian) Flu
Spanish Flu
1889–90 1 million
possibly H2N2
1918–20 50
million
1957–58 1.5 to 2
million
1968–69 1 million
H1N1
As of
6,250
Nov 8/09
novel H1N1
Asian Flu
Hong Kong
Flu
Swine Flu
Deaths
Subtype
involved
H2N2
H3N2
SWINE INFLUENZA
• Swine influenza is a respiratory disease of pigs
caused by type A influenza virus that regularly
causes influenza outbreaks.
• Illness was first recognised in 1930.
• Current pandemic of influenza related to the
spread of human cases of swine flu.
AGENT
• Recent Swine influenza is being caused by
Influenza type A H1N1 virus.
• Like all influenza viruses, swine flu virus also
changes constantly due to reassortment of genes
and new novel strain can emerge for which
human being have no immunity.
HOST
• Swine influenza do not normally infect
human. Sporadic human infection can
occur.
• Most commonly these cases occur in
persons having direct exposure to pigs.
Transmission
• The transmission is by droplet infection
and fomites (infected surfaces)
• Infected flu droplets can travel 1 meter
with sneezing and coughing
• Disease spread quickly in crowded places
• Cold and dry weather enables the virus to
survive longer outside the body
• Virus is not transmitted by food
INCUBATION PERIOD
1-7 days.
1-4 days (most likely)
COMMUNICABILITY
• From 1 day before to 7 days after the onset of
symptoms. If illness persist for more than 7 days,
chances of communicability may persist till
resolution of illness.
• Children may spread the virus for a longer period
(14 days).
CLINICAL FEATURES
• Fever
– Not everyone with flu will
have a fever
• Upper respiratory symptoms such as cough and
sore throat, running nose.
• Headache, body aches and pain, lethargy,
reduced appetite, diarrhea and vomiting
CLINICAL FEATURES
• Fever
– Not everyone with flu will
have a fever
• Upper respiratory symptoms such as cough and
sore throat, running nose.
• Headache, body aches and pain, lethargy,
reduced appetite, diarrhea and vomiting
CLINICAL FEATURES
• Fever
– Not everyone with flu will
have a fever
• Upper respiratory symptoms such as cough and
sore throat, running nose.
• Headache, body aches and pain, lethargy,
reduced appetite, diarrhea and vomiting
What to do if you get the flu?
• Most people with seasonal flu or 2009 H1N1
flu have mild illness (hope this continues to be
the case)
• Most people can be managed at home without
seeing a doctor or receiving antiviral
medications.
What to do if you get the flu?
• Rest
• Drink plenty of fluids
• Analgesia (acamol) or cold/flu meds (dexamol
cold)
• Stay away from others to avoid spread
• Consider antiviral medication (tamiflu) if in
high risk group (best to commence within
first 48 hours)
High Risk Group
• Elderly (65+) and very young patients (<5yrs)
• Residents of institutions for elderly/disabled
• Pregnancy
• Chronic heart, lung, kidney, metabolic or
immunodeficiency diseases
• Diseases requiring long term aspirin treatment
• Neuromuscular disorders, seizure disorders or
cognitive dysfunction that may compromise the
handling of respiratory secretions
Emergency signs
• In adults:
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Difficult breathing or shortness of breath
Pain of pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
• Healthy people can develop severe illness
• See a doctor at the clinic or emergency room quickly
Emergency signs
• In adults:
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Difficult breathing or shortness of breath
Pain of pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
• Healthy people can develop severe illness
• See a doctor at the clinic or emergency room quickly
Emergency signs
• In children:
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Fast or difficult breathing
Bluish skin color
Not drinking enough fluids
Not waking up or playing/interacting normally
Irritability
Ongoing fever or cough beyond 5 days
Fever with rash
• See a doctor at the clinic or emergency room quickly.
INVESTIGATIONS
Confirmation of influenza A(H1N1) infection is
through:
• Real time RT PCR or
• Isolation of the virus in culture or
• Four-fold rise in virus specific neutralizing
antibodies.
Vaccination
• Seasonal flu vaccination is very important!
– Don’t ignore risks of seasons flu
– Available October
• H1N1 flu vaccination
– Vaccine available mid November
– Immunization for people with high-risk
conditions is highly recommended
TREATMENT: Guiding principles
• Early implementation of infection control
precautions to minimize spread of disease.
• Prompt treatment (within 48 hours) to prevent
severe illness and death.
• Early identification and follow up of persons at
risk.
Preventing spread
Preventing spread
• Frequent hand washing
• Covering mouth /nose for coughs and sneezes
• Avoidance of crowded settings when possible
• Sick persons to stay home (except to seek medical
care) and minimize contact with others in household
• Voluntary home quarantine of members of
households with probable swine influenza cases
Face Masks
• Not clear how effective face masks are at
protecting against influenza
• Not recommended in most situations
• EXCEPTIONS:
– High risk person caring for someone who has flulike illness
– High risk people in crowded setting where H1N1 is
present
– People with flu-like illness to use a mask to prevent
spreading their illness to others
HAND HYGIENE
• Hands should be washed frequently with soap
and water / alcohol based hand rubs/ antiseptic
hand wash and thoroughly dried preferably using
disposable tissue or towel.
After contact with respiratory secretions or such
contaminated surfaces.
Any activity that involves hand to face contact
such as eating, normal grooming or smoking.
STEPS OF HAND WASHING
1. Wash palms and
fingers.
2. Wash back of
hands.
STEPS OF HAND WASHING
3. Wash fingers and
knuckles.
4. Wash thumbs.
STEPS OF HAND WASHING
5. Wash fingertips.
• 6. Wash wrists.
TREATMENT
• Oseltamivir (Tamiflu) is the recommended drug both for
prophylaxis and treatment.
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Dosing:
For weight <15kg
30 mg x2/day for 5 days
15-23kg
45 mg x2/day for 5 days
24-<40kg
60 mg x2/day for 5 days
>40kg
75 mg x2/day for 5 days
For infants:
< 3 months
12 mg x2/day for 5 days
3-5 months
20 mg x2/day for 5 days
6-11 months
25 mg x2/day for 5 days
Available as syrup (12mg per ml )
ADVERSE REACTION
• Oseltamivir is generally well tolerated,
gastrointestinal side effects (transient nausea,
vomiting) may increase with increasing doses,
particularly above 300 mg/day.
• Occasionally it may cause bronchitis, insomnia and
vertigo. Less commonly angina, pseudo
membranous colitis and peritonsillar abscess have
also been reported.
• There have been rare reports of anaphylaxis and
skin rashes.
INFECTION CONTROL MEASURES AT HOME
• Get plenty of sleep, manage your stress, drink plenty of fluids and eat nutritious
food.
• People who are sick and their household members should wash their hands with
soap and water frequently; consider alcohol based hand gel.
• When the patient is within 6 feet of other family member, he can wear a face
mask or handkerchief.
• Sweeping and dusting to be done with wet cloth. Small amount of disinfectant
may be mixed in water.
• If any family member develop any symptoms: stay at home, rest, drink fluids,
try analgesia and report to clinic if difficultly breathing, vomiting or in high risk
category (very young, pregnant or other health problems)
• Precautions to continue during the period of infectivity
CHEMO PROPHYLAXIS
• Not currently recommended, but consider for:
• Close contacts of confirmed cases.
– Close contacts include household /social contacts,
family members, workplace or school contacts,
fellow travelers
• All health care personnel coming in contact
with probable or confirmed cases
PROPHYLAXIS
• Tamiflu is the drug of choice.
• Prophylaxis should be provided till 10 days after last exposure
(maximum period of 6 weeks)
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For weight <15kg
15-23kg
24-<40kg
>40kg
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For infants:
< 3 months
3-5 months
6-11 months
30 mg x1/day
45 mg x1/day
60 mg x1/day
75 mg x1/day
not recommended unless judged by MD to be critical
20 mg x1/day
25 mg x1/day
For more information:
• Call the clinic: (02) 992 2727
• On-call night physician: 1700 507 507
• Dr Efraim Rosenbaum: 054 280 2823
Websites
• www.flu.gov (English – CDC, US)
• www.flublog.co.il (Hebrew – Leumit, Israel)
• www.RBSMedical.com (English / Hebrew)