DR. ELSIE A. HERRERA EMS PHYSICIAN EMS, ABQAIQ H1N1 (SWINE FLU) DR. ELSIE A. HERRERA EMS PHYSICIAN EMS, ABQAIQ

dr. eaherrera/ems abqaiq/10/10/09 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 EPIDEMEOLOGY Over the past several days, cases of swine flu have been reported in Mexico, USA, Canada, New Zealand and a few European countries 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 TRANSMISSION the same way as seasonal flu is - from person to person. mainly through coughing and sneezing by people who are ill with the virus. It may also be spread by touching infected objects and then touching your nose or mouth. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 Signs and Symptoms are like those of the seasonal flu, fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people infected virus -also reported diarrhea and vomiting. Severe illnesses and death has occurred as a result of illness associated with this virus. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

Typical Signs and Symptoms The incubation period for H1N1 influenza is 1-4 days, possibly as long as 7 days. The clinical features of influenza are well known and include: Sudden onset of fever (usually high); Headache; Extreme tiredness; Dry cough; Sore throat; Runny nose; and Muscle aches and stomach symptoms -- more common in children 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 Cough (98%); Subjective fever (96%); Fatigue (89%); Headache (82%); Sore throat (82%); Abdominal pain (50%); Diarrhea (48%); Dyspnea (48%); and Joint pain (46%). 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 DANGER SIGNS SHORTNESS OF BREATH, EITHER DURING PHYSICAL ACTIVITY OR WHILE RESTING DIFFICULTY OF BREATHING TURNING BLUE BLOODY OR COLORED SPUTUM CHESTPAIN ALTERED MENTAL STATUS HIGH FEVER THAT PERSIST BEYOND 3 DAYS LOW BLOOD PRESSURE IN CHILDREN DANGER SIGNS INCLUDE: FAST OR DIFFICULTY OF BREATHING, LACK OF ALERTNESS, DIFFICULTY IN WAKING UP, AND LITTLE OR NO DESIRE TO PLAY 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 DURATION/INCUBATION People infected with Influenza A (H1NI) may be able to infect others from 1 day before getting sick and up to 5 - 7 days after. The infectious period may be even longer in some people, especially children and those with weakened immune systems, I.E. DIABETES, POSTCHEMOTHERAPY, CANCER PATIENTS, OLD AGE, IMMUNOCOMPROMISE PATIENTS 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 SEVERITY ranges from very mild symptoms -severe illnesses that can result in death. The majority -experience the milder disease and recover without antiviral treatment or medical care. serious cases- more than half of hospitalized people had underlying health conditions or weak immune systems. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 Age Cases/100,000 Hospitalization/100,000 Death % 0-4 yrs 23 4.5 7 (2%)a 5-24 yrs 27 2.1 48 (16%) 25-49 yrs 7 1.1 124 (41%) 50-64 yrs 4 1.2 71 (24%) > 65 yrs 1.3 1.7 26 (2%) 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 H1N1 VS SEASONAL FLU SEASONAL FLU H1N1 HIGH RISK- 65 years and older > 25 YEARS OLD THAN OLDER children younger than five years old few deaths reported in people older than 65 pregnant women people of any age with certain chronic medical conditions unusual when compared with seasonal flu. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 PREVENTIVE MEASURES The following measures are recommended by WHO in order to protect oneself from Influenza A (H1NI). (trying to maintain a distance of about 1 meter if possible) and taking the following measures: avoid touching your mouth and nose clean hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated) avoid close contact with people who might be ill reduce the time spent in crowded settings if possible improve airflow in your living space by opening windows practice good health habits including adequate sleep, eating nutritious food, and keeping physically active 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 What about using a mask? WHO recommends not wearing a mask if you are not sick. If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact. Cleanse your hands thoroughly afterwards. If you are sick and must travel or be around others, cover your mouth and nose. Using a mask correctly in all situations is essential, because incorrect use actually increases the chance of spreading infection. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 Either procedure masks) (respirators such as N-95 or above are not necessary for this purpose). When space and chair availability permit, encourage coughing persons to sit at least three feet away from others in common waiting areas. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

What should I do if I think I have the illness? Avoid close contact with people who are sick. Stay home when you are sick. Cover your mouth and nose when coughing or sneezing. Wash your hands frequently. Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

What should I do if I think I have the illness? Stay at home and keep away from work, school or crowds as much as possible Rest and take plenty of fluids Cover your mouth and nose with disposable tissues when coughing and sneezing and dispose of the used tissues properly Wash hands with soap and water frequently and thoroughly, especially after coughing or sneezing Inform family and friends about your illness and seek help for household chores that require contact with other people (such as shopping) 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

When should someone seek medical care? if they experience shortness of breath or difficulty breathing if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures). 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

Is there a vaccine for Influenza A (H1NI)? a vaccine is currently in production and may be ready for the public in the upcoming months. Vaccine- intranasal  4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

If you need medical attention: Contact your doctor or healthcare provider and strictly follow the advice given to you for care. If it is not possible to contact your healthcare provider in advance, communicate your suspicion of having influenza A (H1NI) immediately upon arrival at the healthcare facility. Take care to cover your nose and mouth during travel. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 SAMSO's Response SAMSO is liaising closely with the Ministry of Health (MOH) on the status of Influenza A (H1NI) in Saudi Arabia and will communicate information related to Influenza A (H1NI) released by the MOH. SAMSO has resources such as Tamiflu, isolation facilities, infection control supplies and well-prepared staff to cope with cases. A Pandemic Flu Task Force is addressing issues related to this outbreak. This is a rapidly evolving situation and SAMSO will provide updated guidance and new information as it becomes available. Saudi Aramco is prepared for managing and treating Influenza A (H1NI) and has a pandemic preparedness plan in place. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 SUMMARY 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 SUMMARY: REMEMBER Flu symptoms can include fever* cough sore throat runny or stuffy nose body aches headache chills fatigue sometimes diarrhea and vomiting * *It’s important to note that not everyone with flu will have a fever. 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 Emergency Warning Signs In Children: 1. Fast breathing or trouble breathing 2. Bluish skin color 3. Not drinking enough fluids 4. Not waking up or not interacting 5. 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 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 Emergency Warning Signs In Adults: 1. Difficulty breathing or shortness of breath 2. Pain or pressure in the chest or abdomen 3. Sudden dizziness 4. Confusion 5. Severe or persistent vomiting 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09

dr. eaherrera/ems abqaiq/10/10/09 SOURCES Sources: 1. WHO : 1. http://www.who.int 2. CDC: http://www.cdc.gov/h1n1flu/qa.html 4/24/2017 dr. eaherrera/ems abqaiq/10/10/09