1. IMA
PATHANKOT

2. “Academic Committee IMA Pathankot”
WELCOME
YOU
ALL

3. “Swine Flu” Dr. Deepak Manhas

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

5. Influenza is an acute respiratory illness
Orthomyxoviruses (RNA viruses)
  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

6. 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

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

8. Haemagglutinin
H1N1
H3N2
Neuraminidases
So there are total 18 x 9 = 162 type of H and N combinations

11. 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

12. 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

13. 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 )

16. The most common symptoms are abrupt onset and include:
Incubation Period 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

17. 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.

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

20. 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.

22. 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

23. 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
???????????

24. 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 hours
Transferable to hands up to hours
Cloth, paper & tissue
* Recoverable for hours
Humidity 35-40%, Temperature 28C (82F)
Source: Bean B, et al. JID 1982;146:47-51

25. 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

26. How to collect Nasal Swab

27. Prevention
Role of Mask

30. 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

31. 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

32. 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