1 |1 | Current Situation Influenza A (H1N1) 19 May 09

2 |2 | Types of influenza – A,B,C Influenza A and B cause diseases in humans, Influenza A virus subtypes – There are 16 different HA (H1 to H16) – Nine different NA (N1-N9_ Influenza A virus causes seasonal influenza in many countries in the world: – Estimated to affect 5-15% of the global population, – results in severe illness in 3-5 million people and causing 250, 000 – 500,000 deaths worldwide. Introduction – Influenza A (H1N1)

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4 |4 | Past experiences indicate that – No regularity to pandemics – No reliable basis for predicting when/where it might arise. – 3 pandemics occurred in the 20 th century : interval of years PandemicYear Influenza A Virus sub type Deaths (Estimated) Case Fatality rate Spanish Flu H1N140million>2.5% Asian Flu H2N22 million<0.1% Hong Kong Flu H3N21 million<0.1% HISTORY

5 |5 | The Pandemic Influenza in USA The flu caused more deaths than suffered World Wars I and II combined

6 |6 | HISTORY -2 In Ethiopia – Influenza named as The Hedar Beshita (An Introduction to the medical history of Ethiopia Richard Pankhrust, 1990) – Alaqa Kinfe: Many people were dying in AA. Just as a brother would walk over the corpse of his brother on a battlefield so no body troubled to bury the dead by the road side. They simply walked by……. – Ras Tafari Makonnen ( later Emperor Haile Sellasei) in his autobiography stated that he had been seriously ill but by Gods goodness he survived.

7 |7 | Current Status

8 |8 | Threat of Pandemic Influenza Criteria for A Pandemic: –A new subtype of the influenza A virus must emerge –Most people in the world would then have little or no immunity causing more morbidity and mortality. –The virus must be sufficiently transmissible from one human to another to cause sustained chains of transmission.

9 |9 | Threat of Pandemic Influenza - Circulating in wild birds, poultry and pigs Animal Influenza Infects humans in rare instances - resulting from close exposure to pigs/Birds If virus evolves into a human virus it could cause a human influenza pandemic

10 | The 2009 outbreak of influenza A (H1N1) virus is an epidemic due to a new strain of influenza A virus The current outbreak was first detected in Mexico City, where surveillance began picking up a surge in cases of influenza like illness (ILI) starting March 18. –The surge was assumed by Mexican authorities to be "late-season flu" April 21, CDC sent alert concerning two isolated cases (one from a patient admitted on March 29 and a second from a patient admitted on March 30, 2009 for ILI) of a novel flu virus Some samples were sent to CDC on April 18 from Mexico and cases were confirmed to be a new strain of H1N Influenza A (H1N1) epidemic

11 | 2009 Influenza A (H1N1) epidemic- Chronology 1: April 15, 2009 = CDC identified the Virus from a specimen taken from a patient admitted on March 30 for ILI 2: April 17, 2009 = CDC identified the Virus from the 2nd pt admitted on March 29 for ILI and notified WHO/IHR 3: April 23, 2009 = Press Briefing 4: April 25, 2009= WHO declared Public Health Emergency of International Concern 5: April 26, 2009 = WHO reactivated Pandemic Phase 3 6: April 27, 2009 = WHO raised Pandemic alert Phase to 4 7: April 29, 2009 = WHO raised Pandemic alert phase to 5

12 | Pandemic Phases

13 | Phase 5 is characterized by the same identified virus causing sustained community level outbreaks in at least 2 countries in 1 WHO region. Most countries won't be affected at this stage Declaration of Phase 5 signals a pandemic could be imminent Time to finalize organization, communication, implementation of planned mitigation measures is short.

14 | Phase 6 is characterized by widespread community level outbreaks of the same virus in at least 1 other country in a different WHO region. Designation of this phase would indicate that a global pandemic is under way. PHASE 6 IS NOT YET DECLEARED!!

15 | Current situation- Global Status as of May 18, 2009 Total : Cases=8829 Deaths: 74

16 | Influenza A (H1N1) Epidemic -Trend

17 | Current situation- Africa /National No confirmed case to date in Africa – Six countries reported suspected cases – most ruled out after lab investigation Ethiopia – No report of suspected cases –The FMoH – reactivated the national taskforce and established various sub groups –Disseminated SCD and alert to all HFs –Daily monitoring of surveillance reports –Press briefing provided – 3 occasions –Trained health personnel from all regions

18 | –Strengthened surveillance and screening activities at Ports of entry (esp Bole International Airport) isolation and quarantine in place at Bole Int. Airport Air lines staff provided orientation and PPE All incoming travelers fill in forms and message being relayed at the Airport –National reference lab at EHNRI- capacity strengthened. Capacity to do PCR in place –More than 100,800 treatment courses of tamiflu –WHO –32 Hospitals identified nationwide –Identified national requirements and presented to partners Current situation- National

19 | WHO - Guidance The Epidemic is due to a new strain of the influenza A (H1N1) that has not been isolated in pigs –It is a recombinant of the endemic strain of influenza A that is present in Pigs, Birds and humans –Thus - New influenza A (H1N1 – not Swine flu (April 30, 2009) –No risk of infection from this virus from consumption of well- cooked pork and pork products. No travel restrictions related to the outbreak of the influenza A(H1N1) virus. Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care

20 | Prevention: –Cover your mouth while sneezing or coughing –Wash hands regularly –Avoid shaking hands; touching eyes, nose or mouth –Avoid contact with individuals with ILI symptoms –Stay at home when you develop ILI –Seek medical advise immediately WHO - Guidance

21 | More Information Phase 5 available at

22 | Thank You !!!