1. SWINE FLU V.NEHRU ART CENTER KARUR

2. INTRODUCTION Swine flu is a respiratory disease of pigs caused by type A Influenza virus Swine flu is a respiratory disease of pigs caused by type A Influenza virus Swine flu in human beings due to direct exposure to pigs.(Zoonotic) Swine flu in human beings due to direct exposure to pigs.(Zoonotic)

3. CURRENT SITUATION Pandemic (H1N1) 2009 - update 58 Pandemic (H1N1) 2009 - update 58 Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the International Health Regulations (2005) Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the International Health Regulations (2005) Updated 12/08/2009(DEATH) Updated 12/08/2009(DEATH) US-436,ARGENTINA-337,AUSTRALIA-85, US-436,ARGENTINA-337,AUSTRALIA-85, UK-36 UK-36 INDIA CASES 950 DEATH 13, INDIA CASES 950 DEATH 13, Kings Inst sample 376- Positive 50 Kings Inst sample 376- Positive 50 CDH chennai susp.case 138- Positive 38 CDH chennai susp.case 138- Positive 38

5. AFFECTED COUNTRIES MEXICO MEXICO U.S U.S AUSTRIA AUSTRIA CANADA CANADA GERMANY GERMANY ISRAEL ISRAEL NEW ZEALAND NEW ZEALAND SPAIN SPAIN U.K U.K INDIA INDIA AND MORE COUNTRIES AND MORE COUNTRIES

6. CAUSATIVE AGENT Swine Influenza A virus (H1N1) Swine Influenza A virus (H1N1) SWINE FLU VIRUS

7. SUSPECTED CASES A Person with acute febrile respiratory illness (fever >=38 ۬ c) with onset A Person with acute febrile respiratory illness (fever >=38 ۬ c) with onset Within 7 days of close contact with a person is a confirmed case of Swine Influenza A virus (H1N1) infection or Within 7 days of close contact with a person is a confirmed case of Swine Influenza A virus (H1N1) infection or Within 7 days of travel to areas where there are one or more confirmed case of Swine Influenza A virus (H1N1) cases, or Within 7 days of travel to areas where there are one or more confirmed case of Swine Influenza A virus (H1N1) cases, or Resides in a community where there are one or more confirmed case of Swine Influenza A virus (H1N1) cases. Resides in a community where there are one or more confirmed case of Swine Influenza A virus (H1N1) cases.

8. PROBABLE CASES A Person with acute febrile respiratory illness (fever >=38 ۬ c) A Person with acute febrile respiratory illness (fever >=38 ۬ c) who who is +ve for Influenza A virus (H1N1),but unsubtypable for is +ve for Influenza A virus (H1N1),but unsubtypable for H1&H3 by Influenza RT-PCR or reagent used to detect seasonal Influenza virus infection, or H1&H3 by Influenza RT-PCR or reagent used to detect seasonal Influenza virus infection, or is +ve for Influenza A by an Influenza Rapid test or an Influenza IFA +CRITERIA for suspected cases,or is +ve for Influenza A by an Influenza Rapid test or an Influenza IFA +CRITERIA for suspected cases,or Individual with clinically compatible illness who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case Individual with clinically compatible illness who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case

9. CONFIRMED CASE A Person with acute febrile respiratory illness (fever ≥38 ۬ c) with laboratory confirmed Swine Influenza A virus (H1N1) A Person with acute febrile respiratory illness (fever ≥38 ۬ c) with laboratory confirmed Swine Influenza A virus (H1N1) infection WHO approved labs by one or more tests infection WHO approved labs by one or more tests 1. Real time PCR 2. Viral culture 3. Four fold ↑ Swine Influenza A virus (H1N1) specific neutralizing antibodies.

10. INCUBATION PERIOD 1 day prior to the onset of illness to 7 days after onset

11. MODE OF TRANSMISSON Direct pigs→Human Direct pigs→Human Human → Human Human → Human Crowdness Crowdness Touching/Handling something contaminated with flu viruses Touching/Handling something contaminated with flu viruses

12. NOT TRANSMITTED BY Food Food Properly handled &cooked pork Properly handled &cooked pork

13. SYMPTOMS Sore throat Sore throat Cough Cough Runny nose Runny nose Fever Fever Lethargy Lethargy Lack of appetite Lack of appetite Nausea,vomiting, diarrhoea Nausea,vomiting, diarrhoea

14. In children emergency warning signs need urgent medical attention include:  Fast breathing or trouble breathing  Bluish skin color  Not drinking enough fluids/eating food  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

15. In adults, emergency warning signs 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

16. DIAGNOSIS Respiratory specimen is needed Respiratory specimen is needed SAMPLE COLLECTION&LAB.DIAGNOSIS SAMPLE COLLECTION&LAB.DIAGNOSIS taken by treating doctor taken by treating doctor swab - Nasopharyngeal swab &throat swab swab - Nasopharyngeal swab &throat swab storage 2-8 ۬ c storage 2-8 ۬ c Transport -Dry ice in triple packing to Transport -Dry ice in triple packing to 1) NIV- Pune or NICD Delhi 1) NIV- Pune or NICD Delhi 2) King Institute, Guindy, Chennai. 3) Christian Medical College, Vellore with in 24 hrs with patient complete information with in 24 hrs with patient complete information contd, contd,

17. contd, Lab tests Lab tests Rapid antigen tests Rapid antigen tests Real time PCR Real time PCR Virus isolation Virus isolation Virus Genome Sequencing Virus Genome Sequencing Four fold ↑ Swine Influenza A virus (H1N1) specific neutralizing antibodies. Four fold ↑ Swine Influenza A virus (H1N1) specific neutralizing antibodies.

18. TREATMENT Oseltamivir is the DOC Oseltamivir is the DOC for both prophylaxis& treatment for both prophylaxis& treatment Adult – 5 days Adult – 5 days Children- 5 days Children- 5 days supportive therapy supportive therapy 1. IV fluid 2. Oxy. Therapy/ventilatory support 3. Antibiotics-Prevent secondary infec. 4. Paracetamol/Ibuprofen – myalgia 5. Vasopressors for shock CONTRAINDICATED salicylate/aspirin → Reye’s syndrome salicylate/aspirin → Reye’s syndrome

19. CHEMOPROPHYLAXIS Min 10 Days - Max 6 Weeks wt wtDose <15 kg <15 kg 30 mg od* 10 days 15-23 kg 45 mg od* 10 days 24-<40kg 60 mg od* 10 days ≥40 kg ≥40 kg 75 mg od* 10 days

20. FOR INFANTS wt wtDose <3 MONTHS Not recommended 3-5 MONTHS 20mg od* 10 days 6-11MONTHS 25mg od* 10 days

21. PREVENTION PREVENTION

22. 10 Swine Commands (Prevention) Wash your hands frequently Wash your hands frequently Get enough sleep Get enough sleep Keep Hydrated Keep Hydrated Boost your immune system Boost your immune system Keep informed Keep informed Avoid alcohol Avoid alcohol Be physically active Be physically active Know when to get help Know when to get help Keep away from sick people. Keep away from sick people. Avoid crowded areas. Avoid crowded areas.