For More Lectures Influenza A (H1N1) National Center for Disease Prevention and Control, DOH ROMEO ALMAZAN BITUIN, MD, MHA Medical Specialist III HEMS Coordinator Dr. Jose Fabella Memorial Hospital Department of Health DISTRIBUTED BY

For More Lectures Influenza A (H1N1) Is PANDEMIC Imminent? National Center for Disease Prevention and Control, DOH

For More Lectures Influenza is usually a respiratory infection Transmission – Regular person-to-person transmission – Primarily through contact with respiratory droplets – Transmission from objects (fomites) possible National Center for Disease Prevention and Control, DOH

For More Lectures Transmission of Influenza Limited studies, varying interpretations Contact, droplet, and droplet nuclei (airborne) transmission all likely occur – Relative contribution of each unclear Droplet thought most important – Coughing, sneezing, talking – Most studies either Animals or human experiments under artificial conditions Outbreak investigations – Unclear of infection source National Center for Disease Prevention and Control, DOH

For More Lectures Key Characteristics Communicability – Viral shedding can begin 1 day before symptom onset – Peak shedding first 3 days of illness – Correlates with temperature – Subsides usually by 5-7th day in adults – can be 10+ days in children – Infants, children and the immuno- compromised may shed the virus longer National Center for Disease Prevention and Control, DOH

For More Lectures Incubation period – Time from exposure to onset of symptoms – 1 to 4 days (average = 2 days) Seasonality – In temperate zones, sharp peaks in winter months – In tropical zones, circulates year-round with seasonal increases. National Center for Disease Prevention and Control, DOH

For More Lectures Clinical Illness, Seasonal Influenza Abrupt onset Fever and constitutional symptoms: body aches, headaches, fatigue Cough, rhinitis, sore throat GI symptoms and myositis more common in young children Sepsis-like syndrome in infants Complications: viral and bacterial pneumonia, febrile seizures, cardiomyopathy, encephalopathy/encephalitis, worsening underlying chronic conditions National Center for Disease Prevention and Control, DOH

For More Lectures Individuals at Increased Risk for Hospitalizations and Death Elderly > 65 years Children less than two years Certain chronic diseases – Heart or lung disease, including asthma – Metabolic disease, including diabetes – HIV/AIDs, other immuno-suppression – Conditions that can compromise respiratory function or the handling of respiratory secretions Pregnant women National Center for Disease Prevention and Control, DOH

For More Lectures Vaccination Influenza vaccine is the best prevention for seasonal influenza. Inactivated viruses in the vaccine developed from three circulating strains (generally 2 Type A and 1 Type B strain) – Therefore, seasonal “flu shot” only works for 3 influenza subtypes and will not work on pandemic strains. Live, intranasal spray vaccine for healthy non-pregnant persons 5-49 years Inactivated, injectable vaccine for persons 6 months and older National Center for Disease Prevention and Control, DOH

For More Lectures Influenza Viruses Classified into types A, B, and C Only Types A and B cause significant disease Types B and C limited to humans Type A viruses More virulent Affect many species C Goldsmith, CDC National Center for Disease Prevention and Control, DOH

For More Lectures Influenza A Viruses Influenza A viruses categorized by subtype Classified according to two surface proteins Hemagglutinin (H) – 16 known – Site of attachment to host cells – Antibody to HA is protective Neuraminidase (N) – 9 known – Helps release virions from cells – Antibody to NA can help modify disease severity N H National Center for Disease Prevention and Control, DOH

For More Lectures A / Sydney / 05 / 97 (H3N2) Nomenclature Virus type Strain number Virus subtype Place virus isolated Year isolated National Center for Disease Prevention and Control, DOH

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Influenza A (H1N1) is a novel virus Unusual combination of genetic material from pigs, birds & humans which have re-assorted human-to-human transmission occurs through respiratory droplets generated from sneeze or cough Affects all age groups Vaccines for human seasonal flu can not protect humans against the novel virus National Center for Disease Prevention and Control, DOH

For More Lectures Swine Influenza Viruses RNA viruses Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. Re-assort and new viruses that are a mix of swine, human and avian influenza viruses can EMERGE National Center for Disease Prevention and Control, DOH

For More Lectures SIV Genetic Re-assortment National Center for Disease Prevention and Control, DOH

For More Lectures Signs & Symptoms of Influenza A (H1N1) Fever Lethargy Lack of appetite Coughing Runny Nose Sore throat Nausea / Vomiting Diarrhea National Center for Disease Prevention and Control, DOH

For More Lectures Swine H1N1 vs. Human H1N1 swine H1N1 flu virus NOT the same as human H1N1 virus antigenically very different from human H1N1 viruses vaccines for human seasonal flu can not protect humans from swine H1N1 National Center for Disease Prevention and Control, DOH

For More Lectures Transmission: Food-Borne? NO Influenza A (H1N1) viruses are not transmitted through food Safe to eat properly handled and cooked pork and pork products Cook pork at an internal temperature of 70°C (160°F) National Center for Disease Prevention and Control, DOH

For More Lectures Diagnosis and Laboratory Confirmation Clinically diagnosed Respiratory Specimen first 4 to 5 days of illness can shed for 10 days or longer Specimens sent to US CDC ONLY laboratory that can isolate and identify swine influenza type A virus National Center for Disease Prevention and Control, DOH

For More Lectures Treatment Influenza A (H1N1) is sensitive to: – Oseltamivir (tamiflu) – Zanamivir Self medication is discouraged, may induce drug resistance Chemoprophylaxis – Oseltamivir National Center for Disease Prevention and Control, DOH

For More Lectures Vaccine No Influenza A (H1N1) vaccine yet Process of production is underway, but may take 5 – 6 months Seasonal influenza vaccine provides protection against the seasonal human influenza strains only National Center for Disease Prevention and Control, DOH

For More Lectures Influenza A (H1N1) is a Public Health Emergency of International Concern (PHEIC) Serious Public Health Impact Unusual or Unexpected International disease spread Interference with international travel or trade **WHO Recommends intensifying and enhancing national surveillance systems for Influenza-like Illnesses and atypical pneumonia National Center for Disease Prevention and Control, DOH

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Pandemic Alert Phase 5

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Influenza A (H1N1) Preparedness Plan Goal: – To minimize the public health & socio-economic impact of influenza pandemic in the Philippines Objectives: – To maintain a functional command & control structure during an influenza pandemic – To adopt early warning system for pandemic influenza – To identify & monitor cases of pandemic influenza – To manage large numbers of ill & dying people – To maintain essential services during a pandemic – To prevent spread through public health interventions – To manage public anxiety & panic & ensure effective & appropriate information, education & campaign National Center for Disease Prevention and Control, DOH

For More Lectures What has been done? Activation of the DOH Management Committee on Prevention and Control of Re-Emerging Infectious Diseases (DOHMC-PCREID) with the Secretary of Health as the Chairperson of the DOH Central Command Enhanced health surveillance in hospitals, seaports, and airports which include thermal scanning of arriving passengers from affected countries – emergency procurement of 4 additional thermal scanners National Center for Disease Prevention and Control, DOH

For More Lectures What has been done? Health Declaration Checklist to screen for potential signs & symptoms & possible exposure to the virus Health Alert Notice (HAN) distributed to all arriving travelers who are strongly advised to monitor body temperature daily up to 10 days from date of arrival & to contact health authorities A.S.A.P. if they become ill during this period National Center for Disease Prevention and Control, DOH

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For More Lectures What has been done? Issuance of travel advisory to the public – No travel ban but travelers are asked to reconsider their plans to travel to affected countries unless extremely necessary – The World Health Organization does not recommend any travel restrictions or closure of borders at this time Activation of DOH HOTLINE ( / ) for immediate reporting of suspected Influenza A (H1N1), flu-like illness and atypical pneumonia by DOH regional Offices, LGUs, hospitals, and the public National Center for Disease Prevention and Control, DOH

For More Lectures Influenza A (H1N1) Surveillance Reporting Flow Bureau of Quarantine Referral Hospitals Influenza-like Illness Surveillance Event-based Surveillance NEC/HOTLINE Surveillance Team Response needed? Yes Daily zero reporting No WHO Inform other offices, agencies, etc. involved in the response EXECOM Central Command Media End Cases under investigation Probable/ Confirmed Probable/ Confirmed National Center for Disease Prevention and Control, DOH

For More Lectures What has been done? Firmed up national stockpile of Personal Protective Equipment (PPE) & the antiviral drug (Oseltamivir) and other logistics – Priority will be high-risk exposure groups consisting of frontline health workers and surveillance teams – Interim Guidelines on Clinical Management of Influenza A (H1N1) Virus Infection and the Use of Antivirals – Interim Guidelines on the Use of Personal Protective Equipments and Infection Control During Influenza A (H1N1) Outbreaks National Center for Disease Prevention and Control, DOH

For More Lectures Interim Guidelines on Clinical Management of Influenza A (H1N1) Virus Infection and the Use of Antivirals Case definitions for infections with Influenza A (H1N1) Clinical Management of Influenza A (H1N1) Virus Infection Use of Antiviral Agents – Priority groups to receive antiviral agents for prophylaxis Health workers First responders Workers providing essential services – For treatment, priority will be the patients considered at high risk of severe disease Discharge guidelines National Center for Disease Prevention and Control, DOH

For More Lectures Interim Guidelines on the Use of Personal Protective Equipments & Infection Control During Influenza A (H1N1) Outbreaks Rational use of personal protective equipments Guidelines on the use of masks Public health measures Personal hygiene Guidelines on infection control in health care setting National Center for Disease Prevention and Control, DOH

For More Lectures What has been done? National Referral Centers for EID readied in the event of suspected or confirmed swine flu cases – Research Institute of Tropical Medicine (RITM) – Lung Center of the Philippines – San Lazaro Hospital – Vicente Sotto Memorial Medical Center – Davao Medical Center Organized the DOH Central Command for A (H1N1) that will oversee the operations of the different components of the A(H1N1) Task Force – Planning, Operations, Financing, Logistics National Center for Disease Prevention and Control, DOH

For More Lectures Health Emergency Management Structure National Center for Disease Prevention and Control, DOH

For More Lectures What has been done? Convened a meeting of all Metro Manila DOH Hospitals to orient them on the situation & come up with a response plan for hospitals Secretary Francisco T. Duque IIII called for a DOH Command Conference to check the readiness plans & command & control systems of all regions nationwide Secretary Francisco T. Duque III is made de facto Crisis Manager of the national Disaster Coordinating Council (NDCC) to coordinate government efforts in responding to the threat of Influenza A/H1N1 National Center for Disease Prevention and Control, DOH

For More Lectures What has been done? Request of Php 93.5 M calamity fund for the preparedness phase of a possible pandemic Meeting with Metro Manila private hospitals and DOH retained hospitals on referral procedures to DOH-Designated Hospitals for the Isolation & Treatment of suspected Influenza A (H1N1) cases; as well as contingency plans for a worse case scenario National Center for Disease Prevention and Control, DOH

For More Lectures DOH – Medical City Joint Forum (May 4, 2009) Guidance on – Surveillance Case definitions, case reporting forms – Infection control Will the private hospitals be allowed to admit cases? As of now, only the referral hospitals will be allowed to admit cases – Use of oseltamivir Prophylaxis, treatment Societal approach rather than health sectors only Updates to be provided on a regular basis National Center for Disease Prevention and Control, DOH

For More Lectures Public Health Advisory Cover nose and mouth with a tissue when coughing or sneezing. Wash hands regularly with soap and water, especially after you cough or sneeze. Alcohol- based hand cleaners are also effective Avoid close contact with sick people. If sick, self-monitor and stay home from work or school and limit contact with others. Consult your doctor immediately should signs and symptoms of flu persist. National Center for Disease Prevention and Control, DOH

For More Lectures Risk Communications Challenges How to communicate with stakeholders minimizing fear and panic Informing or instructing widely divergent audiences Minimizing / overcoming misinformation, rumors and myths Encouraging the adoption of appropriate protective actions Building trust National Center for Disease Prevention and Control, DOH

For More Lectures What’s next? Coordination with other concerned agencies regarding national response in the event of a pandemic – OP, DA, DILG, DFA, NDCC National Center for Disease Prevention and Control, DOH

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Thank you for listening National Center for Disease Prevention and Control, DOH and God Bless Us All ! DISTRIBUTED BY