1. Managing Novel Influenza A H1N1 (earlier called Swine flu)

2. What is influenza – A(H1N1) Influenza – A (H1N1) (earlier know as swine flu) is a new influenza virus causing illness in people. Influenza A (H1N1) virus is contagious and spread from human to human

3. Global Scenario (as per WHO update) Number of countries reporting cases ~160 Over 810 deaths as on 27 July 09 Number of cases worldwide: >134,500 Situation in India India has 574 positive cases of H1N1 infection, expects the number to rocket over the next few months. First The H1N1 virus or swine flu claimed its first life in India on 4 th Aug 2009 in Pune

4. How Influenza - AH1N1 or Swine Flu Spreads Spread primarily through respiratory droplets - Coughing - Sneezing - Contact with respiratory droplets It can also spread through surface contacts The majority of these cases have occurred in otherwise healthy young adults. Incubation Period 1-7 days Influenzas can spread quickly: – May be contagious BEFORE developing symptoms – Virus can survive on hard surfaces for many hours

5. Potential Infection Time Line 123 45 678 10 11 12 13 14 Severity Days exposed Protential for death Asymptoatic incubation period Earliest return to work Infectious after 1 day 9 symptoms COMPLICATIONS

6. Symptoms Symptoms similar to seasonal flu Important clinical features of swine influenza include fever, and upper respiratory symptoms such as cough and sore throat. Head ache, body ache,running nose or stuffy nose fatigue diarrhea and vomiting have also been observed.

7. Emergency Warning Signs If you become ill and experience any of the warning signs, seek emergency medical care In Children -Fast breathing or trouble breathing - Bluish or gray skin colour - Not drinking enough fluids - Severe or persistent vomiting - Not waking up or interacting - Flu like symptoms improve but return with fever and worse cough In Adults - Difficulty breathing or shortness of breath - Pain or pressure in the chest or abdomen - Sudden dizziness - Severe or persistent vomiting - Flu like symptoms improve but return with fever and worse cough

8. Precautions Follow simple steps as cough etiquettes (covering mouth & nose with handkerchief or tissue paper while coughing) Stay at least an arm’s length from persons coughing or sneezing, avoid gathering and wash your hands frequently Try to stay in good general health Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids and eat nutritious food. Wash your hands often with soap and water, especially after you cough or sneeze. Avoid touching your eyes, nose or mouth. Germs spread this way. If infected with influenza, one must stay at home, away from work or school and limit contact with others to keep from infecting them and should seek medical assisstance at designated centres immediately

9. What Else Can be Done? Social Isolation – Work From Home, no public gatherings Personal Hygiene – Hand wash, Cough etiquette Personal Protective Equipment (PPE) – Masks,Gloves,Hair covers,Protective clothing (gown or apron),Boot or shoe covers. School Closures – Children major “spreaders” Home Quarantine – Stay home if family member ill Travel Restrictions – To follow travel advisory issued by Govt.

10. Medicines for Swine Flu Necessary medicines in sufficient quantity are available. The Government has, in the designated hospitals, stored medicines if required. It is strongly advisable not to take medicines of your own, as it will lower your immunity

11. Guidelines by Health Ministry of India Any person with flu like symptoms such as fever, cough, sore throat, cold, running nose etc. should go to a designated Government facility for giving his/her sample for testing for the H1N1 virus After clinical assessment, the designated medical officer would decide on the need for testing If tested as positive for H1N1 and the patient opts for home isolation and treatment, he/she would be provided with detailed guidelines / safety measures to be strictly adhered to by the entire household of the patient He/ she would have to provide full contact details of his entire household. The house hold and social contacts would be provided with the preventive treatment.

12. The Union Government has identified hospitals in all cities for testing suspected swine flu patients. Also screening facility available at all International airport for all the inbound passengers to prevent the spread of H1N1. Doctors from the Hospital are round the clock screening the passengers at the Airport. Bangalore Dr. Rajiv Gandhi Institute of Chest Diseases and SDS TB Hospital Hosur Road, Near NIMHANS, Bangalore-29, Karnataka Dr. S. Buggi - 09448042579 Dr. Nagraj- 09448057093 MUMBAI Kasturba Hospital Arthur Road, Sane Guruji Marg, Mumbai 400011 Ph: 022- 23083901 / 23092458 / 23000889 Dr. Umesh Aigal – 09820935680 Chennai Communicable Disease Hospital, 87, T.H. Road, Tondiarpet, Chennai, Tamil Nadu Dr. Lakshmi- 044-25912688. M- 09841250567

13. Hyderabad Govt. General and Chest Diseases Hospital, Erragadda, Hyderabad Hospital Helpline Number - 040-23814939 Dr. Prasad – 9849902995 New Delhi Yellow Fever Quarantine Centre, Near AAI Residential Colony, New Delhi 91-11-25652129 Dr S.K Singh:09868252314 Influenza Ward, Ward no 5, Second Floor, New Building, RML Hospital, Delhi-1 RML- 91-11-24525211,23404328,23365525- Ext 4328

14. Ahmedabad Civil Hospital attached to Medical College, Asarwa, Ahmedabad, Gujarat-380016 Dr. Ancheliah – 09426347531 Pune Dr. Naidu Infectious Disease Hospital, Pune, Maharastra Dr. Barathe – 09923130909