1. Emerging and Re-emerging Infectious Diseases Epidemiology & Control
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Infectious Diseases
CHP400
COMMUNITY
HEALTH PROGRAM-II
Emerging and Re-emerging Infectious Diseases
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Novel H1N1 (Swine)
Epidemiology & Control
Mohamed M. B. Alnoor

2. Content Swine Influenza A (H1N1) Previous influenza pandemics
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Novel H1N1
Swine Influenza A (H1N1)
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Content
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Previous influenza pandemics
Definitions
Transmission Through Species
Transmission to humans
Pandemic-Alert Levels and WHO Regions
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The Global H1N1 Pandemic
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Lessons Learned form Past Pandemics
Prevention of H1N1 infection
Who Should Be Vaccinated?
Antiviral Protection
Summary

3. Previous influenza pandemics
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Novel H1N1
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Previous influenza pandemics
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Pandemic
Deaths in the US
Deaths Worldwide
Population Affected
Spanish Flu (H1N1)
500,000
40 million
Persons years
Asian Flu (H2N2)
70,000
1-2 million
Infants, elderly
Hong Kong Flu (H3N2)
36,000
700,000
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4. They do not normally infect humans
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Novel H1N1
Swine Influenza A (H1N1)
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Definition:
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What is swine flu?
Swine Influenza (swine flu)
is a respiratory disease of pigs caused by
Type A influenza viruses
causing regular outbreaks
in pigs.
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They do not normally infect humans

5. three people. Definition: What is swine flu?
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Novel H1N1
Swine Influenza A (H1N1)
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Definition:
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What is swine flu?
Swine flu viruses have been reported to
spread from person-to-person
but in the past
this transmission was limited
and not sustained beyond
three people.
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6. This swine influenza A (H1N1) virus
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Novel H1N1
Swine Influenza A (H1N1)
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Definition:
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What is swine flu?
This swine influenza A (H1N1) virus
is contagious
and is spreading
from
human to human.
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7. Swine Influenza A (H1N1) Transmission Through Species
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Novel H1N1
Swine Influenza A (H1N1) Transmission Through Species
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North American swine
North American avian
North American human
Eurasian swine
Avian Virus
Human Virus
Swine Virus
Avian/Human
Reassorted Virus
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Swine/
Reassortment in Pigs

8. Transmission to humans:
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Novel H1N1
Swine Influenza A (H1N1)
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Transmission to humans:
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How does swine flu spread?
Contact with:
- infected pigs
- contaminated environments
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- a person with swine flu
Infected people may be able to infect others beginning 1 day before fever begins until 24 hours after fever ends. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick (same as seasonal flu)
Sometimes people may become infected by touching something with live flu viruses on it and then touching their mouth or nose.
Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions
Airborne(from infected people)
- coughing
- sneezing

9. Swine Influenza A (H1N1) Pandemic-Alert Levels
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Novel H1N1
Swine Influenza A (H1N1) Pandemic-Alert Levels
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Phase 1: Animals viruses, no humans infections.
Phase 2: Virus in domesticated/wild animals, caused infection in humans: a potential pandemic threat.”
Phase 3: Reassortant v: sporadic cases or small clusters in humans.
Phase 4: Reassortant v:community-level outbreaks.
Phase 5: There is human-to-human spread of the virus into at least two countries in one WHO region.
Phase 6: Phase 5 + community-level outbreaks in at least one other country in a different WHO region.
A global pandemic is occurring.
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10. WHO Regions African Region South East Asia Region
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Novel H1N1
WHO Regions
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African Region
South East Asia Region
East Mediterranean Region
Region of the Americas
European Region
Western Pacific Region

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Novel H1N1
Swine Influenza A (H1N1)
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12. Lessons Learned form Past Pandemics
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Novel H1N1
Lessons Learned form Past Pandemics
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Pandemics are unpredictable:
- Mortality
- severity of illness
- pattern of spread
Capacity to cause severe disease in nontraditional groups is a major determinant of pandemic impact
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Epidemiology reveals waves of infection: Ages/areas not initially infected likely vulnerable in future waves
Subsequent waves may be more severe

13. Lessons Learned form Past Pandemics
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Novel H1N1
Lessons Learned form Past Pandemics
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Public health interventions delay, but do not stop pandemic spread
Quarantine, travel restriction show little effect
Temporary banning of public gatherings,
potentially effective
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Delaying spread is desirable:
Quarantine, travel restriction show little effect: Does not change population susceptibility
Temporary banning of public gatherings, closing schools potentially effective in case of severe disease and high mortality
Delaying spread is desirable: Fewer people ill at one time improve capacity to cope with sharp increase in need for medical care

14. Prevention of H1N1 INFECTION
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Novel H1N1
Swine Influenza A (H1N1)
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Prevention of H1N1 INFECTION
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General prevention and control measures
Tips to Reduce the Infection
Respiratory hygiene and cough etiquette
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Social-Distancing

15. Prevention of H1N1 INFECTION
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Novel H1N1
Swine Influenza A (H1N1)
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Prevention of H1N1 INFECTION
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Tips to Reduce the H1N1 Influenza Infection
Use a tissue when coughing or sneezing.
Frequently wash hands with warm water and soap .
Try not to touch your eyes, nose or mouth .
Wipe down kitchen and bathroom countertops, home and office phones, keyboards , etc
If exhibiting symptoms, stay home.
If coworkers or family members become ill, consider taking anti-viral medication .
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Pandemics may not be avoidable but spread of the disease and the ensuing mortality rates can be reduced. To help check the spread of the disease, the Centers for Disease Control and Prevention suggests the following guidelines: 1.Use a tissue when coughing or sneezing; dispose of the tissue immediately. 2. Frequently wash hands with warm water and soap or an alcohol-based hand cleanser. Soap and water is best. Keep nails short and pay good attention to cleaning cuticles. 3. Try not to touch your eyes, nose or mouth unless your hands are freshly washed. 4. Wipe down hard surfaces with disinfecting cleaner or use a spray. Common areas of transmission are kitchen and bathroom countertops, home and office phones, keyboards, doorknobs, shopping cart handles, and steering wheels of company or rental vehicles. 5. If exhibiting symptoms, stay home. The influenza virus is capable of being passed from the day prior to symptoms being noticed to seven days after becoming ill. Committing to voluntary isolation when ill is an effective way to help reduce the spread of the disease. 6. If coworkers or family members become ill, consult your doctor about the possibility of taking a prescription anti-viral medication such as Tamiflu or Relenza. This is especially important if you take care of children or the elderly.

16. vaccine Prevention of H1N1 INFECTION Swine Influenza A (H1N1)
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Novel H1N1
Swine Influenza A (H1N1)
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Prevention of H1N1 INFECTION
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Specific preventive measures
vaccine
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The H1N1 Inactivated Vaccine (the shot)
The H1N1 Live Attenuated Vaccine (the nasal spray)

17. Who Should Be Vaccinated?
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Novel H1N1
Swine Influenza A (H1N1)
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Who Should Be Vaccinated?
The groups recommended to receive the 2009 H1N1 influenza vaccine include:
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Pregnant women
Contacts and caregivers <6 months
Healthcare and emergency personnel
All people from 6 mo - 24 years
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Children from 6 mo - 18 years
Young adults years
Pregnant women (higher risk of complications and take care of infants who cannot be vaccinated)Household contacts and caregivers for children younger than 6 months of age(younger infants are at higher risk of influenza-related complications and cannot be vaccinated) Healthcare and emergency medical services personnel (source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity)
All people from 6 months through 24 years of age: Children from 6 months through 18 years of age because cases of 2009 H1N1 influenza have been seen in children who are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, andYoung adults 19 through 24 years of age(many cases of 2009 H1N1 influenza were seen in these healthy young adults who often live, work, and study in close proximity, and they are a frequently mobile population)Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.(1- Asthma, Neurological and neuro-developmental conditions. 3- Chronic lung disease [COPD] , 4- Heart disease, 5- Blood, Endocrine, Kidney, Liver and Metabolic disorders , 6- Weakened immune system due to disease or medication, 7- < 19 years, receiving long-term aspirin therapy.
Persons years
(higher risk of complications from influenza)

18. Who Should NOT Be Vaccinated?
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Novel H1N1
Swine Influenza A (H1N1)
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Who Should NOT Be Vaccinated?
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People with allergy to chicken eggs or had a severe reaction to an influenza vaccination.
Children younger than 6 months of age
People who have a moderate-to-severe illness with a fever (delay vaccination.)
History of Guillain–Barré Syndrome.
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19. Swine Influenza A(H1N1) Antiviral Protection
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Novel H1N1
Swine Influenza A(H1N1) Antiviral Protection
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Treatment (Antiviral drugs )
Make illness milder and recovery faster
May prevent serious flu complications
Work best if started within 2 days of symptoms.
Warning! Do NOT give aspirin: Reye’s syndrome.
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Reye's syndrome is a potentially fatal disease affecting the brain and liver. The classic features are a rash, vomiting, and liver damage. It has been associated with aspirin consumption by children with viral illness.

20. Importance of the Early Treatment
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Novel H1N1
Importance of the Early Treatment
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Prognosis and days before treatment
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Recovered m
Total number
Dead
1 day
2 days
3 days
>4 days
Days from onset till initiation of treatment

21. Swine Influenza A(H1N1) Antiviral Protection
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Novel H1N1
Swine Influenza A(H1N1) Antiviral Protection
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Treatment (Antiviral drugs )
Who to treat
Suspected or confirmed influenza with:
Illness requiring hospitalization
Progressive, severe, or complicated illness, regardless of previous status
Patients at risk for severe disease
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Children <2, 2-4
Adults > 65
Pregnancy & 2wks postpartum
Persons with certain conditions:
Persons with increased risk of complications because of certain medical conditions: 1- Asthma, 2- Neurological and neuro-developmental conditions
3- Chronic lung disease [COPD] , 4- Heart disease, 5- Blood, Endocrine, Kidney, Liver and Metabolic disorders , 6- Weakened immune system due to disease or medication, < 19 years, receiving long-term aspirin therapy.

22. Swine Influenza A(H1N1) Antiviral Protection
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Novel H1N1
Swine Influenza A(H1N1) Antiviral Protection
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Prophylaxis (Antiviral drugs )
Who may be considered:
Vaccine takes 10 – 14 days to act
Close contact of a person with H1N1 :
Persons at high risk for complications of influenza;
Health care workers and emergency medical personnel;
Pregnant women.
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When the vaccine is not available

23. The hajj Season Swine Influenza A (H1N1)
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Novel H1N1
Swine Influenza A (H1N1)
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The hajj Season
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The health authorities of Saudi Arabia has advised certain populations against attending Hajj
Children younger than 10
Adults older than 65
Pregnant women
Those with chronic health conditions
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That was the position of many countries
Vaccination against H1N1 required

24. The hajj Season Swine Influenza A (H1N1)
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Novel H1N1
Swine Influenza A (H1N1)
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The hajj Season
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To ensure pilgrim and resident safety, Saudi Arabia has set up:
Health screenings at all ports of entry
H1N1 vaccine secured
Antiviral medication is available
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Meeting of Arab health ministers(In July)
working very closely with
World Health Organization
Other international experts
Schools started by mid-October

25. Summary Swine Influenza A (H1N1) This is a NEW virus
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Novel H1N1
Swine Influenza A (H1N1)
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Summary
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This is a NEW virus
This virus is contagious and is spreading from human to human.
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The disease has low fatality
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This will not be the last pandemic