IMA PATHANKOT

“Academic Committee IMA Pathankot” WELCOME YOU ALL

“Swine Flu” Dr. Deepak Manhas

Virus consists of a Nucleic acid surrounded by one or more proteins.

Influenza is an acute respiratory illness Orthomyxoviruses (RNA viruses)  1. Influenza virus A  2. Influenza virus B  Influenza virus C  Isavirus, Thogotovirus  6. Quaranjavirus. Influenza is an acute respiratory illness caused by Influenza viruses. The Influenza Type A the most virulent human pathogens

The Influenza Type A ( H1 N1 ) There are 18 H and 9 N subtypes known, but only H 1, 2 and 3, and N 1 and 2 are commonly found in humans

Viruses are obligate intracellular parasites. They can only multiply within the cell.

Haemagglutinin 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 H1N1 H3N2 Neuraminidases 1 2 3 4 5 6 7 8 9 So there are total 18 x 9 = 162 type of H and N combinations

Circulating Influenza Strains and Pandemics in The 20th Century 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” 1-4 million deaths 20-40 million deaths 1-4 million deaths H3N2 H2N2 H1N1 1920 1940 1960 1980 2000

Prerequisites for pandemic and interpandemic influenza A A new influenza virus emerges to which the general population has little/no immunity The new virus must be able to replicate in humans and cause disease 2 of the 3 prerequisites for a human pandemic have been met A novel influenza virus has emerged and the general population has demonstrated little or no immunity And the new virus has been able to replicate in humans The main questions that remains are: Will the virus will develop into a form that is efficiently transmitted from one human to another? (thus meeting the criteria for a pandemic) If so, where, when, how quickly, and how severely? The first two of three prerequisites have been met: A novel virus Virus must be able to replicate in humans and cause disease New virus must be efficiently transmitted from one human to another Virus can improve its transmissibility via two mechanisms: adaptive mutation genetic reassortment (can take place in humans without prior adaptation in another mammalian species, such as the pig) The new virus must be efficiently transmitted from one human to another

A new influenza virus has emerged in June 2009  WHO named this virus as “Pandemic H1N1/09 virus” CDC named it as "Novel influenza A (H1N1)” ( This Novel H1N1 virus is a hybrid of swine, avian and human strains )

The most common symptoms are abrupt onset and include: Incubation Period----18 to 72 Hours Respiratory Symptoms: Runny nose Sore throat Coughing Constitutional Symptoms: High fever with chills Muscle and joint pains Tiredness Headache Nausea & Vomiting Virus shedding stops within 2 to 5 days after symptoms 1st appear

High risk groups Extremes of ages Immunosuppression because of HIV, DM, Malignancy, CS Treatment, Anticancer Drugs,CKD,Malnutrition, etc. Third Trimester Pregnancy CHF MS COPD Bronchial Asthma Unhealthy lung because of any disease.

Complications Respiratory Failure…..leads to Death Pneumonia ( Viral, Bacterial, Mixed Viral and Bacterial) Myositis Myocarditis GB Syndrome TM Respiratory Failure…..leads to Death

A 5 day course of Oseltamivir or Zanamivir reduces duration of s/s of uncomplicated influenza by 1 to 2 days if treatment is started within 2 days of onset of illness.

Swine Influenza A(H1N1) Treatment Oseltamivir (Tamiflu) Zanamivir (Relenza) Treatment Prophylaxis Adults 75 mg capsule twice per day for 5 days 75 mg capsule once per day Two 5 mg inhalations (10 mg total) twice per day Two 5 mg inhalations (10 mg total) once per day Children 15 kg or less: 60 mg per day divided into 2 doses 30 mg once per day Two 5 mg inhalations (10 mg total) twice per day (age, 7 years or older) Two 5 mg inhalations (10 mg total) once per day (age, 5 years or older) 15–23 kg: 90 mg per day divided into 2 doses 45 mg once per day 24–40 kg: 120 mg per day divided into 2 doses 60 mg once per day >40 kg: 150 mg per day divided into 2 doses 75 mg once per day Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatment dose for 5 days. <3 months: 12 mg twice daily; 3-5 months: 20 mg twice daily; 6-11 months: 25 mg twice daily Dosing recommendations for antiviral chemoprophylaxis of children younger than 1 year using oseltamivir. Recommended prophylaxis dose for 10 days. <3 months: Not recommended unless situation judged critical due to limited data on use in this age group; 3-5 months: 20 mg once daily; 6-11 months: 25 mg once daily Source: CDC

Other Modalities for Treatments or Prophylaxis Vaccine :- Inactivated Vaccine Live attenuated Vaccine Chemoprophylaxis Other Modalities for Treatments or Prophylaxis Any role of steroids, Ayurvadic Treatment, Homeopathy ???????????

Spread Survival of Influenza Virus in Enviourment Air borne, Close personal contacts, Hand shakes, Fomites Survival of Influenza Virus in Enviourment Hard non-porous surfaces like Plastic, stainless steel etc. Recoverable for ---- 24-48 hours Transferable to hands up to --- 24 hours Cloth, paper & tissue * Recoverable for ------ 8-12 hours Humidity 35-40%, Temperature 28C (82F) Source: Bean B, et al. JID 1982;146:47-51

Diagnosis Throat Swab, Tissue Culture — 48 to 72 hours Detection of Ag-Antibodies----2 weeks Gold Standard is– RT-PCR by using CBNAAT WHO Supra-National labs National Labs

How to collect Nasal Swab

Prevention Role of Mask

Therapeutic audit of Diagnostic , Preventive, and Treatment Modalities Other side of Story Is it a Real Situation or A Media Created Situation Storm in a cup of tea Are Corporate Forces behind the curtain ? (Diagnosis, Treatment, Vaccine) Therapeutic audit of Diagnostic , Preventive, and Treatment Modalities

Conclusion Effectiveness of these antiviral drugs in treatment or prevention of complications of influenza is UNCLEAR We have less than 48 hours for diagnosis and starting treatment

Swine Flu ……Do Not “Panic” “Prevention is better than cure” TB kills 1 person per minute in India that means 1000 to 1500 Peoples die in a day while Number of Deaths because of Swine Flu is not more than 1000 in 4 months that too in previously unhealthy people. Swine Flu ……Do Not “Panic” “Prevention is better than cure” Open up to Sun and Air Thanks