Dr M N Rama Krishna

B.Sc.,M.B.B.S, M.D, A.F.I.H.PGDHSc.(Diab)

Dy. Chief Medical Officer (splt) Main Hospital

KOTHAGUDEM

SWINE FLU

Flu in swine

- Influenza ( FLU ) is an acute respiratory tract Infection caused by Influenza Virus . Of which there are 3 types, A, B, & C. There is no cross immunity between A,B &C.

S W I N E F L U

- All known pandemics were caused by

Influenza A strains.

- The present pandemic of SWINE FLU

also belongs to Influenza Virus A (H1N1).

- WHO put pandemic level of Swine Flu at

Phase 5 implying wide spread human infection.

- Influenza Virus A Strains occurring

between 1946 & 1957 are called H1 N1 strains.

THE AGENT:
Genetic sequencing shows a new sub type of Influenza A ( H1 N1 ) virus with segments from 4 Influenza viruses: a). b). c). d). North American Swine North American Avian Human Influenza Eurasian Swine

S W I N E F L U

SWINE FLU

Influenza Virus A&B have two distinct surface antigens - the Haemagglutinin (H)and Neuraminidase (N) antigens.
The H antigen initiates infection following attachment of the virus to susceptible cells. The N Antigen is responsible for the release of virus from the infected cells.

- Influenza Virus A is unique

because it is frequently subject to antigenic variation both major and minor. - When there is sudden complete major change, it is called SHIFT.
- When the antigenic change is gradual over a period of time it is called as DRIFT.

SWINE FLU

- Shift appears to result from

genetic recombination of Human with Animal or Avian Virus, providing major antigenic change. This can cause major epidemic or pandemic.
- Drift involves point mutation in the gene.

SWINE FLU

Host Factors :
- Majority of the cases have occurred in healthy individuals. - Age and Sex: All ages and both sexes are involved. - High Risk:Children below 5 years, adults above 65 years, persons with chronic ailments ( DM, CAD,CKD & TB etc. ) - Human mobility - Immunity

SWINE FLU

Transmission
Through droplet infection and fomites

INCUBATION PERIOD
1to 7 days People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following onset of illness. Children, especially younger children, might potentially be contagious for longer periods

Communicability
From one day before to 7 days after the on set of symptoms. If illness persists for more than 7 days, chances of communicability may persist till resolution of illness. Children may spread the virus for longer period.

SWINE FLU

What are the signs and symptoms of swine flu in people?

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue.

Some people have reported diarrhea and vomiting associated with swine flu. Severe illness (pneumonia and respiratory failure) can cause death in swine flu infection in people.
Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

COMPLICATIONS
Clinicians should expect complications similar to seasonal influenza i.e. Sinusitis Otitis media Croup Pneumonia Bronchiolitis Status asthamaticus Myocarditis Myositis Rhabdomyolysis Encephalitis Seizures Toxic shock syndrome Secondary bacterial pneumonia

In children emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing Bluish skin color Not drinking enough fluids Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms improve but then return with fever and worse cough Fever with a rash

SWINE FLU

In adults, emergency warning signs that need urgent medical attention include:
Difficulty in breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting

Investigations
-Real time RT PCR or -Isolation of the Virus in culture or -Four fold rise in virus specific neutralizing anti bodies. Specimens to be sent are: - Nasopharyngeal Swab. - Throat Swab - Nasal Swab or - Tracheal aspirate. Specimen should be kept at 4 degrees centigrade in viral transport media until transported for testing.

SWINE FLU PREVENTION

 A Sardar sees a lot of guys running on the Highway. He asks a bystander as to what these guys are doing and whatfor are they running. The bystander said , a marathon race is going on. SARDAR : What do they get from that ? BYSTANDER : The winner will get a Prize SARDAR : Then why are the others running ?

Is there a vaccine for Pandemic Flu?

Because the virus is new, it took almost 6-9 months for production of a vaccine. Presently two types of vaccine are available. Injectable vaccine & Nasal spray vaccine. Seasonal flu vaccine or post flu immunization will not provide protection.

What surfaces are most likely to be sources of contamination?

The virus can spread when a person touches something that is contaminated with the virus and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. The virus can then be spread when a person touches respiratory droplets from another person on a surface like a desk, doorknob, childs toy or phone handset and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?

The viruses can live unto 2 hours or longer on surfaces like cafeteria tables, doorknobs, desks etc.,
Frequent hand washing will help you reduce the chance of getting contamination from these common surfaces.

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill.
Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. When you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

Household Cleaning, Laundry, and Waste Disposal

Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste. Keep surfaces (esp bedside tables, surfaces in the bathroom, childrens toys, phone handles, doorknobs) clean by wiping them down with a household disinfectant according to directions on the product label. Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid hugging laundry prior to washing it to prevent contaminating yourself. Clean your hands with soap and water or alcohol-based hand rub right after handling dirty laundry. Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Government guidelines for treatment of A(HINI) Influenza patients

NEW GUIDELINES FOR SWINE FLU PATIENTS

Category A:
Mild fever and cough/sore throat, body aches, headache, diarrhea and vomiting.

Treatment:
Symptomatic Monitoring No Tamiflu (Oseltamivir) No testing Rest at home

Category B: 1
Signs and symptoms of Category A and High grade fever, severe sore throat.

Treatment:
Home Isolation Tamiflu (Oseltamivir) Symptomatic treatment

 CATEGORY : B - 2
Signs and symptoms of Cat A and children under 5yrs / pregnant women/ persons above 65 years age / lung disease / heart disease / liver disease / kidney disease / blood disorders / DM / Neurological disorders / HIV/AIDS / patients on cortisone therapy.

Treatment:
No testing Home Isolation Symptomatic Treatment Tamiflu (Oseltamivir) Monitoring

Category C:
In addition to signs and symptoms of Cat A and B with Breathlessness, Chest pain, drowsiness, low B.P. blood in sputum , cyanosis, irritability in children, refusal of food, worsening of chronic diseases.

Treatment:
Testing required Hospitalization Necessary Treatment

CHEMO PROPHYLAXIS
- All close contacts of suspected, probable and confirmed cases, close contacts include household / social contacts, family members, workplaces or school contacts, fellow travels etc.

- All health care personnel coming in contact with suspected, probable or confirmed cases
- Oseltamivir is the drug of choice.

- Prophylaxis should be provided till 10 days after last exposure (maximum period of 6 weeks )
contdnext

CHEMO PROPHYLAXIS
- by Weight :
for weight <15kg for weight 15 - 23 kg for weight 24 - <40 kg for weight >40 kg 30 mg OD 45 mg OD 60 mg OD 75 mg OD

- For Infants : <3 months not recommended unless situation judged critical due to limited data on use in this age group 3 - 5 months 6 - 11 months 20 mg OD 25 mg OD

GUIDELINES FOR EDUCATIONAL INSTITUTIONS

Any student/staff member shows Flu like symptoms such as fever, cold, cough, difficulty in breathing should be allowed to stay at home. Institution should not insist on medical certificate. Institution should monitor health status of student/staff with such symptoms. In case of hostel students, Institution should not only monitor but also provide all necessary care. The care providers should wear mask and regularly wash hands. Institutions should report such incidences to local Govt. hospitals for further monitoring. Institutions should discourage Excursions etc. As the magnitude of the present Swine Flu epidemic is mild, it is not recommended to close Educational Institutions.

Two Sardars were fighting after the Exams.

SIR : Why are you both fighting ?

SARDAR : This fool left the answer sheet Blank.

SIR : So what ?
SARDAR : Even I did the same thing. Now our teacher would think that we copied each other and reduce my marks !