INFLUENZA A (H1N1) OUTBREAK 2009 PORTS AND AIRPORTS HEALTH SERVICES DIVISION A Possible Pandemic..

THE DISEASE SWINE INFLUENZA (H1N1) OUTBREAK 2009 PORTS AND AIRPORTS HEALTH SERVICES DIVISION

What is Swine Flu? Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Swine Flu Viruses 4 influenza type A virus subtypes that have been isolated in pigs H1N1 H1N2 H3N2 H3N1 4 influenza type A virus subtypes that have been isolated in pigs H1N1 H1N2 H3N2 H3N1 PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Swine Flu Viruses 4 influenza type A virus subtypes that have been isolated in pigs H1N1 - most recently isolated H1N2 H3N2 H3N1 4 influenza type A virus subtypes that have been isolated in pigs H1N1 - most recently isolated H1N2 H3N2 H3N1 PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Classic Swine Flu Virus: Influenza Virus Type A H1N1 first isolated from a pig in 1930 is a respiratory disease of pigs virus circulates among swine throughout the year regularly causes outbreaks of influenza in pigs outbreaks occur fall and winter months first isolated from a pig in 1930 is a respiratory disease of pigs virus circulates among swine throughout the year regularly causes outbreaks of influenza in pigs outbreaks occur fall and winter months PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Signs in Pigs Fever – sudden onset Depression Coughing (barking) Discharge from the nose or eyes Sneezing Breathing difficulties Eye redness or inflammation Going off feed Fever – sudden onset Depression Coughing (barking) Discharge from the nose or eyes Sneezing Breathing difficulties Eye redness or inflammation Going off feed PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Swine Flu in Humans do not normally infect humans sporadic human infections with swine flu have occurred occur in persons with direct exposure to pigs do not normally infect humans sporadic human infections with swine flu have occurred occur in persons with direct exposure to pigs PORTS AND AIRPORTS HEALTH SERVICES DIVISION

How common is swine flu infection in humans? In the past 1 every 1-2 years in the U.S. December February cases of human infection In the past 1 every 1-2 years in the U.S. December February cases of human infection PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Signs and Symptoms in Humans Fever Lethargy Lack of appetite Coughing Runny nose Sore throat Nausea/Vomiting Diarrhea Fever Lethargy Lack of appetite Coughing Runny nose Sore throat Nausea/Vomiting Diarrhea PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Transmission 1.Directly pigs to humans –close proximity to infected pigs –such as in pig barns and livestock exhibits housing pigs at fairs. 2.Human to Human –coughing or sneezing –touching something with flu viruses on it and then touching their mouth or nose 3.Directly from humans to pigs 1.Directly pigs to humans –close proximity to infected pigs –such as in pig barns and livestock exhibits housing pigs at fairs. 2.Human to Human –coughing or sneezing –touching something with flu viruses on it and then touching their mouth or nose 3.Directly from humans to pigs PORTS AND AIRPORTS HEALTH SERVICES DIVISION

When influenza viruses from different species infect pigs, the viruses can reassort (swap genes) and new influenza viruses can emerge. How did Influenza A H1N1 came about…? Influenza A H1N1 PORTS AND AIRPORTS HEALTH SERVICES DIVISION

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 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 PORTS AND AIRPORTS HEALTH SERVICES DIVISION

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 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 PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Treatment Recommended 1.Oseltamivir 2.Zanamivir Showed Resistance in the past 1.Amantadine 2.Rimantadine Recommended 1.Oseltamivir 2.Zanamivir Showed Resistance in the past 1.Amantadine 2.Rimantadine PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Vaccination NO vaccines for humans seasonal influenza vaccine can help provide partial protection against swine H3N2 pig vaccines are available NO vaccines for humans seasonal influenza vaccine can help provide partial protection against swine H3N2 pig vaccines are available PORTS AND AIRPORTS HEALTH SERVICES DIVISION

THE OUTBREAK

Backgrounder: 23 April 2009 National Focal Point person of IHR alerted Bureau of Quarantine of the outbreak “Influenza Like Illness or Swine Influenza” in multiple locations in Mexico and two multiple locations in USA U.S. Human Cases of Swine Flu Infection – 7 cases – 0 death Mexico Human Cases of Swine Flu Infection –> 854 cases –59 deaths 23 April 2009 National Focal Point person of IHR alerted Bureau of Quarantine of the outbreak “Influenza Like Illness or Swine Influenza” in multiple locations in Mexico and two multiple locations in USA U.S. Human Cases of Swine Flu Infection – 7 cases – 0 death Mexico Human Cases of Swine Flu Infection –> 854 cases –59 deaths PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Pandemic Alert Phase 3 PORTS AND AIRPORTS HEALTH SERVICES DIVISION

The current situation constitutes a Public Health emergency of International Concern (PHEIC). Serious Public Health Impact Unusual or Unexpected International disease spread Interference with international travel or trade Director-General WHO The current situation constitutes a Public Health emergency of International Concern (PHEIC). Serious Public Health Impact Unusual or Unexpected International disease spread Interference with international travel or trade Director-General WHO Backgrounder: 25 May 2009 WHO declared, PORTS AND AIRPORTS HEALTH SERVICES DIVISION

WHO Recommendation Intensify Surveillance 1.Influenza-like illness (ILI) 2.Severe Pneumonia Intensify Surveillance 1.Influenza-like illness (ILI) 2.Severe Pneumonia Backgrounder: PORTS AND AIRPORTS HEALTH SERVICES DIVISION

PORTS OF ENTRY First Line of Defense

BOQ at PORTS OF ENTRY Heightened alert level at all international airports of entry Temperature check to screen all passengers and crew of aircraft coming from foreign country Assessment of symptomatic crew/passengers at the airport. Heightened alert level at all international airports of entry Temperature check to screen all passengers and crew of aircraft coming from foreign country Assessment of symptomatic crew/passengers at the airport. PORTS AND AIRPORTS HEALTH SERVICES DIVISION

BOQ at PORTS OF ENTRY Referral of suspects to dedicated hospital and advise of voluntary home confinement (VHC) for asymptomatic crew/passengers Information campaign to inbound/outbound passengers about avian influenza virus through Information, Education and Communication (IEC) Referral of suspects to dedicated hospital and advise of voluntary home confinement (VHC) for asymptomatic crew/passengers Information campaign to inbound/outbound passengers about avian influenza virus through Information, Education and Communication (IEC) PORTS AND AIRPORTS HEALTH SERVICES DIVISION

BOQ at PORTS OF ENTRY Distribution of health alert notice upon arrival Posters or public announcements in airports Notification to all concerned agencies Notification to all quarantine stations Distribution of health alert notice upon arrival Posters or public announcements in airports Notification to all concerned agencies Notification to all quarantine stations PORTS AND AIRPORTS HEALTH SERVICES DIVISION

As of 1800H, GMT, 29 April 2009 The Pandemic Alert Level was elevated to : Phase 5 –USA 91 cases 1 death –MEXICO 2000 suspected cases, > hundred deaths –7 more countries affected Canada13 cases Spain 4 cases Austria 1 case Germany 3 cases Israel 2 cases New Zealand 3 cases United Kingdom 5 cases As of 1800H, GMT, 29 April 2009 The Pandemic Alert Level was elevated to : Phase 5 –USA 91 cases 1 death –MEXICO 2000 suspected cases, > hundred deaths –7 more countries affected Canada13 cases Spain 4 cases Austria 1 case Germany 3 cases Israel 2 cases New Zealand 3 cases United Kingdom 5 cases Backgrounder: PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Backgrounder: PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Surveillance of Human Infection with Influenza A(H1N1) virus at Ports of Entry CASE UNDER OBSERVATION

ILI is defined as fever (Temp. Of 100°F(37.8°C) or greater and a cough and/ or a sore throat in the absence of a known cause other than influenza. Interim Guidance for the Surveillance of Human Infection with Swine Influenza A(H1N1) virus PORTS AND AIRPORTS HEALTH SERVICES DIVISION

Suspected case of SIV :Person with an acute respiratory illness who was a close contact to a confirmed case of SIV while the case was ill w/ a recent history of contact with an animal w/ confirmed or suspected SIV infection. Close contact: having cared for, lived with, or had direct contact with respiratory secretions or body fluids of a probable or confirmed case of swine influenza A(H1N1). Suspected case of SIV :Person with an acute respiratory illness who was a close contact to a confirmed case of SIV while the case was ill w/ a recent history of contact with an animal w/ confirmed or suspected SIV infection. Close contact: having cared for, lived with, or had direct contact with respiratory secretions or body fluids of a probable or confirmed case of swine influenza A(H1N1). PORTS AND AIRPORTS HEALTH SERVICES DIVISION Interim Guidance for the Surveillance of Human Infection with Swine Influenza A(H1N1) virus

A Probable case of swine influenza A(H1N1) virus infection is defined as an individual with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection OR A individual with a clinically compatible illness or who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case. PORTS AND AIRPORTS HEALTH SERVICES DIVISION Interim Guidance for the Surveillance of Human Infection with Swine Influenza A(H1N1) virus

A Confirmed case of swine influenza A(H1N1) virus infection is defined as an individual with laboratory confirmed swine influenza A(H1N1) virus infection by one or more of the following tests: real-time RT-PCR viral culture four-fold rise in swine influenza A(H1N1) virus specific neutralizing antibodies. A Confirmed case of swine influenza A(H1N1) virus infection is defined as an individual with laboratory confirmed swine influenza A(H1N1) virus infection by one or more of the following tests: real-time RT-PCR viral culture four-fold rise in swine influenza A(H1N1) virus specific neutralizing antibodies. PORTS AND AIRPORTS HEALTH SERVICES DIVISION Interim Guidance for the Surveillance of Human Infection with Swine Influenza A(H1N1) virus

Republic of the Philippines BUREAU OF QUARANTINE STANDARD MEDICAL SCREENING PROCEDURES FOR INFLUENZA A H1N1 Criteria for Referral of Travelers at Ports of Entry to Designated Hospital (Case under Investigation- CUI) Fever Symptoms of Influenza-Like Illness Hx of travel to affected Country /ies Contact with a person/s who is a confirmed case or Case Under Investigation Refer to Hospital XXXXY XXXY XXXY XXY XXY XXXY XXY XXY PORTS AND AIRPORTS HEALTH SERVICES DIVISION

ALGORITHM FOR FEVER SCREENING VIA FLIR THERMAL SCANNER THERMAL SCANNER READING OF SURFACE SKIN TEMEPERATURE ABOVE 36.5C OR MORE RE-CHECK :USING AXILLARY THERMOMETER NORMAL TEMPERATUE (37.0C AND BELOW ) NORMAL TEMPERATUE (37.0C AND BELOW ) NO ILI SYMPTOMS NO HX OF TRAVEL NO ILI SYMPTOMS NO HX OF TRAVEL NORMAL ARRIVAL PROCEDURES HEALTH ALERT NOTICE ADVISE PRECAUTIONARY MEASURES NORMAL ARRIVAL PROCEDURES HEALTH ALERT NOTICE ADVISE PRECAUTIONARY MEASURES FEBRILE (37.1 AND ABOVE) FEBRILE (37.1 AND ABOVE) NO ILI SYMPTOMS NO HX OF TRAVEL NO ILI SYMPTOMS NO HX OF TRAVEL WITH ILI SYMPTOMS AND/OR WITH HX OF TRAVEL AND/ OR CONTACTS WITH ILI SYMPTOMS AND/OR WITH HX OF TRAVEL AND/ OR CONTACTS CASE UNDER INVESTIGATION (CUI) REFERRAL TO DESIGNATED HOSPITAL CASE UNDER INVESTIGATION (CUI) REFERRAL TO DESIGNATED HOSPITAL PORTS AND AIRPORTS HEALTH SERVICES DIVISION

HEALTH DECLARATION CHECKLIST

HEALTH ALERT NOTICE

INFLUENZA A H1N1 Tanging Idea Pag-iwas Swine influenza

Signs and Symptoms in Humans Fever Lethargy Lack of appetite Coughing Runny nose Sore throat Nausea/Vomiting Diarrhea Fever Lethargy Lack of appetite Coughing Runny nose Sore throat Nausea/Vomiting Diarrhea PORTS AND AIRPORTS HEALTH SERVICES DIVISION

How can I preve nt INFLUENZA A H1N1 infection? Ten Steps for Keeping Yourself and Others Safe from Swine Influenza or Any Respiratory Illness 1. Wash your hands frequently Wash your hands with soap and water many times of the day. Dry your hands after washing. There is no substitute for hand washing. However, when water is not available, you may use alcohol-based disposable hand wipes or gel sanitizers. 2. Avoid touching your eyes, nose or mouth Influenza viruses are often spread when a person touches surfaces that are contaminated with germs and then touches his or her eyes, nose, or mouth. 3. Avoid close contact Avoid close contact with people who are sick. Temporarily, refrain from shaking hands with or kissing other persons while there are reported outbreaks of influenza. 4. Stay home when you are sick. If possible, stay home and avoid crowded places when you are sick. You will help prevent others from catching your illness.

5. Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing to prevent spread of the virus. If you do not have a tissue, cough or sneeze into your upper sleeve, not on your hands. Discard your used tissue in the waste basket. You may be asked to put on a surgical mask to protect others. 6. Keep distance. When you are sick, keep your distance from others to protect them from getting sick too 7. Practice other good health habits. Refrain from smoking. Get enough sleep. Have regular exercise; be physically active. Manage your stress. Drink plenty of fluids. Eat nutritious food. Ten Steps for Keeping Yourself and Others Safe from Swine Influenza or Any Respiratory Illness How can I prevent INFLUENZA A H1N1 infection?

INLUENZA A H1N1 Ten Steps for Keeping Yourself and Others Safe from Swine Influenza or Any Respiratory Illness 8. Consult a doctor if you are sick. Seek medical care when you have signs of serious illness such as difficulty of breathing, confusion, severe vomiting. 9. Defer travel if you are sick. If you are ill, you should refrain from getting on an airplane or other forms of public transport to travel. If you must travel by plane to a country reported to have swine influenza outbreaks and if you feel ill after returning from it, you must consult a doctor. 10. Listen to your local health authorities. Keep yourself updated of the situation on the influenza outbreak and on health measures advised by your health authorities.

THANK YOU BUREAU OF QUARANTINE PORTS AND AIRPORTS HEALTH SERVICES DIVISION