Influenza A (H1N1)

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Dr FERMIZET RUDY SpPD
National Center for Disease Prevention and Control, DOH

Pandemics of
Recorded human
pandemic influenza
influenza
(early sub-types inferred)
H2N2

H2N2

H1N1

H1N1

H3N8
1895 1905

1889
Russian
influenza
H2N2

1915

1925

1900
Old Hong
Kong influenza
H3N8

1955

1918
Spanish
influenza
H1N1

1965

1957
Asian
influenza
H2N2

1975

1985

Reproduced and adapted (2009) with permission of Dr Masato Tashiro, Director, Center for Influenza Virus Research,
National Institute of Infectious Diseases (NIID), Japan.

1965

1975

1985

2005

2010

2009
Novel
influenza
H1N1v

H9*
H5
H7 1980

1955

1995

1968
Hong Kong
influenza
H3N2

Recorded new avian influenzas

H1N1v

H3N2

1999
1997 2003

1996

1995

2002

2005

Animated slide: Press space bar

2015

Influenza A reservoir

Wild aquatic birds are the main reservoir of influenza A viruses. Virus transmission has been reported from weild waterfowl to poultry, sea
mammals, pigs, horses, and humans. Viruses are also transmitted between pigs and humans, and from poultry to humans. Equine
influenza viruses have recently been transmitted to dogs. (From Fields Vriology (2007) 5th edition, Knipe, DM & Howley, PM, eds, Wolters
Kluwer/Lippincott Williams & Wilkins, Philadelphia, Fig 48.1)

Influenza A (H1N1)
Is PANDEMIC Imminent?

National Center for Disease Prevention and Control, DOH

Influenza is usually a respiratory

infection
Transmission
Regular person-to-person transmission
Primarily through contact with
respiratory droplets
Transmission from objects (fomites)
possible

National Center for Disease Prevention and Control, DOH

Transmission of Influenza
Limited studies, varying
interpretations
Contact, droplet, and droplet
nuclei (airborne) transmission all
likely occur
Relative contribution of each
unclear
Droplet thought most important
Coughing, sneezing, talking

Most studies either

Animals or human experiments
under artificial conditions
Outbreak investigations
Unclear of infection source

National Center for Disease Prevention and Control, DOH

Key Characteristics
Communicability
Viral shedding can begin 1
day before symptom onset
Peak shedding first 3 days
of illness
Correlates with
temperature
Subsides usually by 5-7th
day in adults
can be 10+ days in
children
Infants, children and the
immuno-compromised may
shed the virus longer
National Center for Disease Prevention and Control, DOH

Incubation period
Time from exposure to onset of
symptoms
1 to 4 days (average = 2 days)

Seasonality
In temperate zones, sharp peaks in winter
months
In tropical zones, circulates year-round
with seasonal increases.

National Center for Disease Prevention and Control, DOH

Clinical Illness, Seasonal

Influenza

Abrupt onset
Fever and constitutional symptoms: body aches,
headaches, fatigue
Cough, rhinitis, sore throat
GI symptoms and myositis more common in young
children
Sepsis-like syndrome in infants
Complications: viral and bacterial pneumonia,
febrile seizures, cardiomyopathy,
encephalopathy/encephalitis, worsening underlying
chronic conditions

National Center for Disease Prevention and Control, DOH

Individuals at Increased Risk for

Hospitalizations and Death
Elderly > 65 years
Children less than two years
Certain chronic diseases

Heart or lung disease, including asthma

Metabolic disease, including diabetes
HIV/AIDs, other immuno-suppression
Conditions that can compromise respiratory function or
the handling of respiratory secretions

Pregnant women

National Center for Disease Prevention and Control, DOH

Vaccination
Influenza vaccine is the best prevention for
seasonal influenza.
Inactivated viruses in the vaccine developed
from three circulating strains (generally 2
Type A and 1 Type B strain)
Therefore, seasonal flu shot only works for 3
influenza subtypes and will not work on pandemic
strains.

Live, intranasal spray vaccine for healthy

non-pregnant persons 5-49 years
Inactivated, injectable vaccine for persons 6
months and older
National Center for Disease Prevention and Control, DOH

Influenza Viruses
Classified into types A, B,
and C
Only Types A and B cause
significant disease
Types B and C limited to
humans
Type A viruses
More virulent
Affect many species

C Goldsmith, CDC

National Center for Disease Prevention and Control, DOH

Influenza A Viruses
Influenza A viruses categorized by subtype
Classified according to two surface proteins
Hemagglutinin (H) 16 known
Site of attachment to host cells
Antibody to HA is protective

Neuraminidase (N) 9 known

Helps release virions from cells

Antibody to NA can help modify disease severity

N
H

National Center for Disease Prevention and Control, DOH

Influenza replication

Replication of influenza A virus. After binding (1) to sialic acid-containing receptors, influenza is endocytosed and fuses (2) with the vesicle
membrane. Unlike for most other RNA viruses, transcription (3) and replication (5) of the genome occur in the nucleus. Viral proteins are
synthesized (4), helical nucleocapsid segments form and associate (6) with the M1 protein-lined membranes containing M2 and the HA and NA
glycoproteins. The virus buds (7) from the plasma membrane with 11 nucleocapsid segments. (-), Negative sense; (+), positive sense; ER,
endoplasmic reticulum. (From Medical Microbiology, 5th ed., Murray, Rosenthal & Pfaller, Mosby Inc., 2005, Figure 60-2.)

Nomenclatur
e
Virus type

Strain number

Virus subtype

A / Sydney / 05 / 97 (H3N2)
Place virus
isolated

Year isolated

National Center for Disease Prevention and Control, DOH

Influenza A (H1N1) is a
novel virus
Unusual combination of genetic
material from pigs, birds & humans
which have re-assorted
human-to-human transmission occurs
through respiratory droplets generated
from sneeze or cough
Affects all age groups
Vaccines for human seasonal flu can not
protect humans against the novel virus
National Center for Disease Prevention and Control, DOH

Swine Influenza Viruses

RNA viruses
Pigs can be infected by avian
influenza and human influenza
viruses as well as swine influenza
viruses.
Re-assort and new viruses that are a
mix of swine, human and avian
influenza viruses can EMERGE
National Center for Disease Prevention and Control, DOH

Genetic Re-assortment

SIV

National Center for Disease Prevention and Control, DOH

Signs & Symptoms of Influenza A

(H1N1)

Fever
Lethargy
Lack of appetite
Coughing
Runny Nose
Sore throat
Nausea / Vomiting
Diarrhea
National Center for Disease Prevention and Control, DOH

Seasonal Influenza vs. Common Cold

Influenza

Cold

Onset

sudden

sub acute

Fever

Very high

rare

HA

severe

rare

Fatigue

extreme

mild

Myalgia

common

mild

Cough

Common

rare

Sore throat

Sometimes

common

Nasal sx

Sometimes

common

Complications

Lung, heart

Ear, sinus

Influenza pathogenesis

Pathogenesis of influenza A virus. The symptoms of influenza are caused by viral pathologic and immunopathologic effects, but the
infection may promote secondary bacterial infection. CNS, Central nervous system. (From Medical Microbiology, 5th ed., Murray,
Rosenthal & Pfaller, Mosby Inc., 2005, Figure 60-3.)

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

National Center for Disease Prevention and Control, DOH

Transmission: Food-Borne?
NO
Influenza A (H1N1) viruses are not
transmitted through food
Safe to eat properly handled and
cooked pork and pork products
Cook pork at an internal temperature
of 70C (160F)

National Center for Disease Prevention and Control, DOH

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
National Center for Disease Prevention and Control, DOH

Treatment
Influenza A (H1N1) is sensitive to:
Oseltamivir (tamiflu)
Zanamivir

Self medication is discouraged, may

induce drug resistance
Chemoprophylaxis
Oseltamivir
National Center for Disease Prevention and Control, DOH

Vaccine
No Influenza A (H1N1) vaccine yet
Process of production is underway,
but may take 5 6 months
Seasonal influenza vaccine provides
protection against the seasonal
human influenza strains only

National Center for Disease Prevention and Control, DOH

National Center for Disease Prevention and Control, DOH

What can you do to protect yourself?

Cover mouth/nose when cough/sneeze
Wash your hands after cough/sneeze
Dont touch eyes, mouth or nose
Avoid contact with sick people
Stay home if you are sick
Stay informed: check CDC, public health website!

What should you do if you think you

have the flu?
Contact your doctor and follow the advise given
Limit contact with others
Cover your mouth/nose
Wash hands
Stay home
Keep away from school, work or crowds

Thank you for listening

and God Bless Us All !

National Center for Disease Prevention and Control, DOH