FOR MORE LECTURES SWINE FLU OUTBREAK 2009 Dr.T.V.Rao MD Professor of Microbiology Sri Deva Raj Urs University Medical College, Kolar India Kolar India DISTRIBUTED BY

FOR MORE LECTURES SWINE FLU swine flu outbreak is the epidemic spread of a new strain of influenza virus that was clinically identified in April 2009 The new virus strain is a type of influenza A (H1N1) virus, commonly called the swine flu. The outbreak has also been called the H1N1 influenza, 2009 H1N1 flu, Mexican flu, or swine-origin influenza swine flu outbreak is the epidemic spread of a new strain of influenza virus that was clinically identified in April 2009 The new virus strain is a type of influenza A (H1N1) virus, commonly called the swine flu. The outbreak has also been called the H1N1 influenza, 2009 H1N1 flu, Mexican flu, or swine-origin influenza. Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES WHO alerts it as Phase 5 WHO to change its pandemic alert phase to "Phase 5", which is defined as "...human-to- human spread of the virus into at least two countries in one WHO region WHO to change its pandemic alert phase to "Phase 5", which is defined as "...human-to- human spread of the virus into at least two countries in one WHO region

FOR MORE LECTURES Qualifies as Phase 5 By April 28, the new strain was confirmed to have spread to Spain, the United Kingdom, New Zealand, and Israel, and the virus was suspected in many other nations, with a total of over 4,400 candidate cases, prompting the WHO to change its pandemic alert phase to "Phase 5" By April 28, the new strain was confirmed to have spread to Spain, the United Kingdom, New Zealand, and Israel, and the virus was suspected in many other nations, with a total of over 4,400 candidate cases, prompting the WHO to change its pandemic alert phase to "Phase 5" Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Early cases - Mexico Although the exact time and location of the outbreak is unknown, it is believed to have been first detected when an influenza-like illness was reported by both health agencies and local news media in Mexico Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES A New Strain of Influenzae Virus The virus responsible was clinically identified as a new strain on April 24, 2009 The virus responsible was clinically identified as a new strain on April 24, 2009 Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES A serious Concern to Health Authorities In late April officials from both World Health Organization (WHO) and the CDC expressed serious concern about the situation, stating that the virus had the potential to become a flu pandemic. Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Virologists Optimistic By late April, however, some virologists believed that this strain was unlikely to cause as many fatalities as earlier pandemics, and may not even be as damaging as a typical flu season.

FOR MORE LECTURES New virus is a Reassortment The new strain is an apparent reassortment of four strains of influenza A virus subtype H1N1 Analysis at the United States Centers for Disease Control and Prevention (CDC) identified the four component strains as one endemic in humans, one endemic in birds, and two endemic in pigs (swine). One swine strain was widespread in the United States, the other in Euras The new strain is an apparent reassortment of four strains of influenza A virus subtype H1N1 Analysis at the United States Centers for Disease Control and Prevention (CDC) identified the four component strains as one endemic in humans, one endemic in birds, and two endemic in pigs (swine). One swine strain was widespread in the United States, the other in Euras Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Why Called as Swine Flu Although called swine flu due to it predominantly containing swine strains, the World Organisation for Animal Health have proposed the name North American influenza. Although called swine flu due to it predominantly containing swine strains, the World Organisation for Animal Health have proposed the name North American influenza. Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Flu in Pigs Identified By May 2, some pigs in Canada were diagnosed with H1N1. The Canadian Food Inspection Agency (CFIA) indicates that it has found H1N1 flu virus in a swine herd in Alberta. Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Proper Handling of Pig meat a Priority Influenza viruses do not affect the safety of pork, according to the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO). As with any raw meat, pork should always be properly handled and cooked to eliminate a range of food safety concerns. Influenza viruses do not affect the safety of pork, according to the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO). As with any raw meat, pork should always be properly handled and cooked to eliminate a range of food safety concerns.

FOR MORE LECTURES New Virus a New combination The CDC determined that the strain contained genes from four different flu viruses – North American swine influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe – "an unusually mongrelised mix of genetic sequences.

FOR MORE LECTURES The pig strains carry several other genes But the North American pig strain was itself the product of previous reassortments, and has carried an avian PB2 gene for at least ten years and a human PB1 gene since These genes were passed on to the new virus. But the North American pig strain was itself the product of previous reassortments, and has carried an avian PB2 gene for at least ten years and a human PB1 gene since These genes were passed on to the new virus.

FOR MORE LECTURES Pigs a Mixing vessel Pigs can catch human and avian or bird flu. When flu viruses from different species infect pigs, they can mix inside the pig and new, mixed viruses can emerge. Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Pigs infect Humans Pigs can pass mutated viruses back to humans, and these can be passed from human to human. Transmission among humans is thought to occur in the same way as with seasonal flu. Pigs can pass mutated viruses back to humans, and these can be passed from human to human. Transmission among humans is thought to occur in the same way as with seasonal flu. Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Case Definitions for Infection with Swine-origin Influenza A (H1N1) Virus (S-OIV) A confirmed case of S- OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests. A confirmed case of S- OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests. Real-time RT-PCR Real-time RT-PCR Viral culture Viral culture

FOR MORE LECTURES A probable case of S-OIV A probable case of S- OIV infection is defined as a person with an acute febrile respiratory illness who is positive for influenza A, but negative for H1 and H3 by influenza RT-PC PCR A probable case of S- OIV infection is defined as a person with an acute febrile respiratory illness who is positive for influenza A, but negative for H1 and H3 by influenza RT-PC PCR Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES A suspected case of S-OIV suspected case of S-OIV infection is defined as a person with acute febrile respiratory illness with onset suspected case of S-OIV infection is defined as a person with acute febrile respiratory illness with onset Within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or Within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or Within 7 days of travel to community either within the United States or internationally where there are one or more confirmed cases of S-OIV infection, or Within 7 days of travel to community either within the United States or internationally where there are one or more confirmed cases of S-OIV infection, or Resides in a community where there are one or more confirmed cases of S-OIV infection. Resides in a community where there are one or more confirmed cases of S-OIV infection. Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Simple Measures Help By touching something contaminated with flu viruses and then touching one's mouth or nose, and through coughing or sneezing. One of the most effective prevention measures is regular hand washing.

FOR MORE LECTURES Eating Pork Safe? People cannot catch swine flu from eating pork or pork products. Cooking pork to an internal temperature of 160 degrees Fahrenheit (71 degrees Celsius) kills the swine flu virus along with other bacteria and viruses People cannot catch swine flu from eating pork or pork products. Cooking pork to an internal temperature of 160 degrees Fahrenheit (71 degrees Celsius) kills the swine flu virus along with other bacteria and viruses Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Yet no fully protective Vaccine Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu, although the CDC is formulating one. The seasonal influenza vaccine may help to provide partial protection against swine H3N2, but not against swine H1N1 viruses like the one circulating now.

FOR MORE LECTURES Past Vaccines proved not safe In 1976 a new strain of swine flu started infecting people and worried U.S. health officials started widespread vaccination. More than 40 million people were vaccinated. But several cases of Guillain-Barré syndrome, a severe and sometime fatal condition that can be linked to come vaccines, caused the U.S. government to stop the program. The incident led to widespread distrust of vaccines in general In 1976 a new strain of swine flu started infecting people and worried U.S. health officials started widespread vaccination. More than 40 million people were vaccinated. But several cases of Guillain-Barré syndrome, a severe and sometime fatal condition that can be linked to come vaccines, caused the U.S. government to stop the program. The incident led to widespread distrust of vaccines in general Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Prevention is best option Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Clean Hands – Safe Hands Washing your hands often with soap and water, especially after you cough or sneeze. You can also use alcohol-based hand cleaners. Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Avoid Unnecessary Actions Avoiding touching your eyes, nose or mouth. Germs spread this way Avoiding touching your eyes, nose or mouth. Germs spread this way Trying to avoid close contact with sick people. Trying to avoid close contact with sick people. Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Staying at home if sick Staying home from work or school if you are sick Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Several countreis effected WHO The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (34), China, Hong Kong Special Administrative Region (1), Denmark (1), France (1), Germany (4), Israel (2), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (13), Switzerland (1) and the United Kingdom (13). The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (34), China, Hong Kong Special Administrative Region (1), Denmark (1), France (1), Germany (4), Israel (2), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (13), Switzerland (1) and the United Kingdom (13). Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Prompt to seek Medical Attention There is also no risk of infection from this virus from consumption of well- cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Drug options in Swine Flu There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir, Amantidine and rimantadine). The swine influenza A (H1N1) viruses that have been detected in humans in the United States and Mexico are resistant to Amantidine and rimantadine so these drugs will not work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1) viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir, Amantidine and rimantadine). The swine influenza A (H1N1) viruses that have been detected in humans in the United States and Mexico are resistant to Amantidine and rimantadine so these drugs will not work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1) viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Drugs are Highly Beneficial If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. Influenza antiviral drugs work best when started soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. Influenza antiviral drugs work best when started soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications. Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES CDC Recommends CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses. Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Oseltamivir Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent influenza A and B virus infection in people one year of age and older Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Zanamivir Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older. Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older. Doctortvrao’s ‘e’ learning series Doctortvrao’s ‘e’ learning series

FOR MORE LECTURES Spread the Message of Flu to Everyone

FOR MORE LECTURES A good health preparedness Possible Option in Prevention

FOR MORE LECTURES Updates on Swine Flu 2009 Doctortvrao's ‘e’ learning series Dr.T.V.Rao MD

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