1 Lecture Influenza A (H1N1)

Influenza A
(H1N1)
b, Santos,
Influenza A (H1N1)
Is PANDEMIC Imminent?
Abello,Ongsip, Santos,
Influenza is usually a respiratory
infection
Transmission
– Regular person-to-person transmission
– Primarily through contact with respiratory
droplets
– Transmission from objects (fomites)
possible
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
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
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.
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
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
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
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 C Goldsmith, CDC
• Affect many species
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
Nomenclatur
e
Virus Strain Virus
type number subtype
A / Sydney / 05 / 97 (H3N2)
Place virus Year isolated
isolated
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
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
Genetic Re-assortment
SIV
Signs & Symptoms of Influenza A
(H1N1)
• Fever
• Lethargy
• Lack of appetite
• Coughing
• Runny Nose
• Sore throat
• Nausea / Vomiting
• Diarrhea
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
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 70°C (160°F)
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
Treatment
• Influenza A (H1N1) is sensitive to:
– Oseltamivir (tamiflu)
– Zanamivir
• Self medication is discouraged, may

induce drug resistance
• Chemoprophylaxis
– Oseltamivir
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
Influenza A (H1N1) is a Public Health
Emergency of International Concern
(PHEIC)
Serious Public Health Impact
Unusual or Unexpected
International disease spread
Interference with international
travel or trade
**WHO Recommends intensifying and enhancing
national surveillance systems for Influenza-like
Illnesses and atypical pneumonia
Pandemic Alert Phase 5
Influenza A (H1N1)
Preparedness Plan
• Goal:
– To minimize the public health & socio-economic
impact of influenza pandemic in the Philippines
• Objectives:
– To maintain a functional command & control structure
during an influenza pandemic
– To adopt early warning system for pandemic influenza
– To identify & monitor cases of pandemic influenza
– To manage large numbers of ill & dying people
– To maintain essential services during a pandemic
– To prevent spread through public health interventions
– To manage public anxiety & panic & ensure effective
& appropriate information, education & campaign
What has been done?
• Activation of the DOH Management
Committee on Prevention and Control of
Re-Emerging Infectious Diseases
(DOHMC-PCREID) with the Secretary of
Health as the Chairperson of the
DOH Central Command
• Enhanced health surveillance in
hospitals, seaports, and airports which
include thermal scanning of arriving
passengers from affected countries
– emergency procurement of 4 additional
thermal scanners
What has been done?
• Health Declaration Checklist to screen for
potential signs & symptoms & possible
exposure to the virus
• Health Alert Notice (HAN) distributed to
all arriving travelers who are strongly
advised to monitor body temperature
daily up to 10 days from date of arrival &
to contact health authorities A.S.A.P. if
they become ill during this period
What has been done?
• Issuance of travel advisory to the public
– No travel ban but travelers are asked to
reconsider their plans to travel to affected
countries unless extremely necessary
– The World Health Organization does not
recommend any travel restrictions or closure
of borders at this time
• Activation of DOH HOTLINE (+632-
7111001 / +632-7111002) for
immediate reporting of suspected
Influenza A (H1N1), flu-like illness and
atypical pneumonia by DOH regional
Offices, LGUs, hospitals, and the public
Influenza A (H1N1) Surveillance Reporting Flow
Influenza-like
Bureau of Referral Illness Event-based
Quarantine Hospitals Surveillance Surveillance
Daily
zero
Inform other reportin Probable/
Yes Respons NEC/HOTLINEg
offices, Confirme
agencies, etc. e Surveillance WHO
d
involved in the needed? Team
response
No Probable/ Cases under
Confirme investigatio
d n
End EXECOM
Central Command
Media
What has been done?
• Firmed up national stockpile of Personal
Protective Equipment (PPE) & the antiviral drug
(Oseltamivir) and other logistics
– Priority will be high-risk exposure groups consisting of
frontline health workers and surveillance teams
– Interim Guidelines on Clinical Management of Influenza
A (H1N1) Virus Infection and the Use of Antivirals
– Interim Guidelines on the Use of Personal Protective
Equipments and Infection Control During Influenza A
(H1N1) Outbreaks
Interim Guidelines on Clinical Management of
Influenza A (H1N1) Virus Infection and the Use of
Antivirals
• Case definitions for infections with Influenza A
(H1N1)
• Clinical Management of Influenza A (H1N1) Virus
Infection
• Use of Antiviral Agents
– Priority groups to receive antiviral agents for
prophylaxis
• Health workers
• First responders
• Workers providing essential services
– For treatment, priority will be the patients considered
at high risk of severe disease
• Discharge guidelines
Interim Guidelines on the Use of Personal Protective
Equipments & Infection Control During Influenza A (H1N1)
Outbreaks
• Rational use of personal protective

equipments
• Guidelines on the use of masks
• Public health measures
• Personal hygiene
• Guidelines on infection control in
health care setting
What has been done?
• National Referral Centers for EID readied in the
event of suspected or confirmed swine flu cases
– Research Institute of Tropical Medicine (RITM)
– Lung Center of the Philippines
– San Lazaro Hospital
– Vicente Sotto Memorial Medical Center
– Davao Medical Center
• Organized the DOH Central Command for A
(H1N1) that will oversee the operations of the
different components of the A(H1N1) Task Force
– Planning, Operations, Financing, Logistics
Health Emergency Management
Structure
What has been done?
• Convened a meeting of all Metro Manila DOH
Hospitals to orient them on the situation &
come up with a response plan for hospitals
• Secretary Francisco T. Duque IIII called for a
DOH Command Conference to check the
readiness plans & command & control
systems of all regions nationwide
• Secretary Francisco T. Duque III is made de
facto Crisis Manager of the national Disaster
Coordinating Council (NDCC) to coordinate
government efforts in responding to the
threat of Influenza A/H1N1
What has been done?
• Request of Php 93.5 M calamity fund for the
preparedness phase of a possible pandemic
• Meeting with Metro Manila private hospitals
and DOH retained hospitals on referral
procedures to DOH-Designated Hospitals for
the Isolation & Treatment of suspected
Influenza A (H1N1) cases; as well as
contingency plans for a worse case scenario
DOH – Medical City Joint Forum
(May 4, 2009)
• Guidance on
– Surveillance
• Case definitions, case reporting forms
– Infection control
• Will the private hospitals be allowed to admit cases?
As of now, only the referral hospitals will be allowed
to admit cases
– Use of oseltamivir
• Prophylaxis, treatment
• Societal approach rather than health
sectors only
• Updates to be provided on a regular basis
Public Health Advisory
• Cover nose and mouth with a tissue when
coughing or sneezing.
• Wash hands regularly with soap and water,
especially after you cough or sneeze.
Alcohol-based hand cleaners are also
effective
• Avoid close contact with sick people.
• If sick, self-monitor and stay home from
work or school and limit contact with
others.
• Consult your doctor immediately should
signs and symptoms of flu persist.
Risk Communications
Challenges
• How to communicate with stakeholders minimizing fear and panic
• Informing or instructing widely
divergent audiences
• Minimizing / overcoming
misinformation, rumors and myths
• Encouraging the adoption of
appropriate protective actions
• Building trust
What’s next?
• Coordination with other concerned
agencies regarding national response
in the event of a pandemic
– OP, DA, DILG, DFA, NDCC
Thank you for listening
and God Bless Us All !

1 Lecture Influenza A (H1N1)

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1 Lecture Influenza A (H1N1)

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Influenza A

– Viral shedding can begin 1

• Affect many species

• Self medication is discouraged, may

• Rational use of personal protective

and God Bless Us All !

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