SWINE

SWINE FLU
FLU
SYMPTOMS SIGNS AND
MANAGEMENT
IS IT SWINE FLU OR H1N1 influenza

Swine Influenza Virus (SIV) is a strain of the influenza family of

viruses that is hosted by pigs.

As of 2009, the known SIV strains are the influenza C virus and the
subtypes of the influenza A virus known as H1N1, H1N2, H3N1,
H3N2, and H2N3.

The 2009 swine flu outbreak in humans is due to a new strain of

influenza A virus subtype H1N1 that contains genes closely
related to swine influenza.

The origin of this new strain is unknown.

The World Organization for Animal Health (OIE) reports that this
strain has not been isolated in pigs.

This strain can be transmitted from human to human, and causes the
normal symptoms of influenza
June 11
World now at the start of 2009 influenza pandemic

Dr Margaret Chan
Director-General of the World Health Organization

“On the basis of available evidence, and these expert assessments of the evidence,
the scientific criteria for an influenza pandemic have been met.
I have therefore decided to raise the level of influenza pandemic alert from phase 5
to phase 6.
The world is now at the start of the 2009 influenza pandemic.”
June 11 th :
Clinical features

Fever,
Cough,
Sore Throat,
Malaise, And
Headache;
Vomiting And Diarrhea, Both Of Which Are Unusual Features Of Seasonal Influenza.
Chills, Myalgias, And Arthralgias.

• In New York City, 95 percent of patients with H1N1 influenza A have met the case
definition for influenza-like illness (subjective fever plus cough and/or sore throat).
• One third of patients seen at two hospitals in Mexico had no fever at presentation.
• Certain groups, such as infants, elderly individuals, and immunocompromised hosts, may have
atypical presentations.
• The full range of complications of infection with the current strain of H1N1 influenza A is
not yet known, although fatal and non-fatal cases of pneumonia have occurred.
Complications
Exacerbation of underlying chronic medical conditions
• Upper respiratory tract disease (sinusitis, otitis media, croup)
• Lower respiratory tract disease (pneumonia, bronchiolitis, status
asthmaticus)
• Myocarditis, Pericarditis
• Acute and post-infectious encephalopathy,
• Encephalitis,
• Febrile seizures,
• Status epilepticus)

• Toxic shock syndrome

• ARDS
• Secondary bacterial pneumonia with or without sepsis
When to investigate ??

Whom to investigate ??

How to investigate ??
Incubation period 10 days :
Clinical criteria -
Fever > 37.5 C and signs of respiratory infection
Pneumonia
Death from unexplained respiratory illness
With atleast one epidemiological criteria
Travel to area where there are new confirmed cases
Close contact with new confirmed case of influenza
Laboratory criteria atleast one of the following positive test
RT PCR
Four fold increase in neutralising antibodies
Viral culture
Case classification

A Case under investigation

Any person meeting clinical and epidemiological criteria
B Probable case
Any person meeting clinical and epidemiological criteria and
confirmed influenza A virus infection but un subtypable

C Confirmed case
Any person with laboratory confirmation.
Investigation

Real-time RT-PCR is the recommended test for confirmation of influenza A (H1N)1 cases.
Rapid influenza antigen test
Differentiates between A and B influenza virus
Unknown specificity and sensitivity

Immunofluorescence (DFA or IFA)

Differentiate type A and B
Sensitivity and specificity unknown
Cannot subtype with accuracy

Viral culture
elaborate
Preferred respiratory specimens
To be collected at the onset of illness:
nasopharyngeal swab,
nasal aspirate or a
combined nasopharyngeal swab with oropharyngeal swab.
For patients who are intubated, an endotracheal aspirate should also be
collected.
Bronchoalveolar lavage (BAL) and sputum specimens are also acceptable.

Specimens should be placed into sterile viral transport media (VTM) and
immediately placed on ice or cold packs or at 4°C (refrigerator) for
transport to the laboratory.

 
Thermal scanners used  
Infra red technology
The skin temperature of
passengers is screened
Anyone with higher than normal
temperature are subjected to
further evaluation and if
needed quarantined
 
Treatment
(H1N1) influenza virus is sensitive (susceptible) to the neuraminidase inhibitor
antiviral medications, zanamivir and oseltamivir.
It is resistant to the adamantane antiviral medications, amantadine and
rimantadine.

Antiviral Treatment for Novel (H1N1) Influenza

Oseltamavir, Zanamavir

Treatment is recommended for:

• All hospitalized patients with confirmed, probable or suspected novel
influenza (H1N1).
• Patients who are at higher risk for seasonal influenza complications.
Age > 65, smokers, chronic ailments
Treatment with zanamivir or oseltamivir to be initiated as soon as possible
after the onset of symptoms.

Maximum benefits if treatment is initiated within 48 hrs

 48 hrs reduces hspital stay and gives mrtality benefit

 Duration of treatment 5 days

Antiviral medication dosing recommendations for treatment or chemoprophylaxis of novel influenza A
(H1N1) infection.
Agent, group Treatment Chemoprophylaxis
Oseltamivir
Adults 75-mg capsule twice per day for 5 days 75-mg capsule once day
Children ≥ 12 months
15 kg or less 60 mg per day divided into 2 doses 30 mg once per day
16-23 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

Zanamivir

Adults Two 5-mg inhalations twice per day Two 5-mg inhalations once per day

Children Two 5-mg inhalations twice per day

(age, 7 years or older) Two 5-mg inhalations (10 mg
total) once per day (age, 5 years
or older)
Is chemoprophylaxis indicated ????
Indications

A.Post exposure prophylaxis

1.Close contact with a person who is a confirmed, probable or suspected case of influenza A (H1N1)
virus infection during the infectious period of the case.

infectious period is defined as one day before until 7 days after the case’s onset of illness

B.Pre exposure prophylaxis

1. Antiviral medications should be given during the potential exposure period and continued for 10
days after the last known exposure to a person with (H1N1) influenza
Oseltamivir and zanamivir are “Pregnancy Category " medications,

- No clinical studies have been conducted to assess the safety of these

medications for pregnant women.
- Few adverse effects have been reported
- Pregnancy should not be considered a contraindication to oseltamivir or
zanamivir use.
- Because of its systemic activity, oseltamivir is preferred for
treatment of
pregnant women
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