1. H1N1 2009 dr.faiza shaukat

2. Statistics of H1N12009 (sep 2009)  In US, 183,572 cases and 663 deaths  In mexico, 32,025 cases and 358 deaths  In china, 14,663 cases and with no deaths  In japan, 13, 339 cases and 08 deaths

3. influenza  Influenza is an acute highly infectious disease characterized by abrupt onset, with fever, headache, chills, aches or pains, coryza, sore throat & non productive cough.  It occurs in pandemics, epidemics & as sporadic cases.

4. Infectious agent…  It is a virus of myxovirus group.  3 types are identified; type A responsible for pandemics, type B which causes epidemics and type C which causes sporadic infection.  Virus surface have alternating projections of two antigenic proteins called heamagglutinin (H) and neuaminidase (N)

5. Infectious agent…  H and N antigens over a period of years undergo minor changes called “antigenic drift”  These antigens go major changes once about every 10 years called “antigenic shift”

6. What is the H1N1 Influenza Virus?  New Strain of Influenza Virus First Detected in April 2009 in the U.S. First Detected in April 2009 in the U.S.  Originally Called “Swine Flu” Initial Tests Showed Many Genes Similar to Influenza Virus that Occurs in Pigs Initial Tests Showed Many Genes Similar to Influenza Virus that Occurs in Pigs Further Studies - New Virus is Very Different from Viruses in North American Pigs Further Studies - New Virus is Very Different from Viruses in North American Pigs

7. Influenza virus…  this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia, avian genes, and human genes. Scientists call this a "quadruple reassortment virus.“

8. Current H1N1 Flu Outbreak  In the U.S., as of May 18 2009: 5123 Confirmed/Probable Cases 5123 Confirmed/Probable Cases 5 Fatalities 5 Fatalities  Texas–3, Washington-1, Arizona-1 553 Confirmed/Probable Cases in California 553 Confirmed/Probable Cases in California

9. 1918 Pandemic Flu (Spanish Flu)  1918 Influenza Flu Outbreak Estimated 70 to 100 Million Deaths Worldwide Estimated 70 to 100 Million Deaths Worldwide  First Wave – Beginning March 1918 Mild Seasonal Flu Virus Mild Seasonal Flu Virus  Second Deadly Wave – Summer/Fall of 1918 Virus Mutated to a More Deadly Strain Virus Mutated to a More Deadly Strain Majority of the Fatalities – In the Second Wave Majority of the Fatalities – In the Second Wave  Primarily in the 20 to 40 Year Old Age Range  Current H1N1 Outbreak May Return in the Fall Need to Prepare Need to Prepare

10. Spread of Infection  Infected Person Can Infect Others: Beginning 1 Day Before Symptoms Develop Beginning 1 Day Before Symptoms Develop Up to 7 Days or More After Becoming Sick Up to 7 Days or More After Becoming Sick Younger Children – May Be Contagious for Longer Periods Younger Children – May Be Contagious for Longer Periods

11. Routes of Exposure to Spread the Infection  Primary Exposure Route – Person to Person Inhalation of Airborne Droplets from Infected Person Coughing or Sneezing Inhalation of Airborne Droplets from Infected Person Coughing or Sneezing

12. Routes of Exposure to Spread the Infection  Secondary Route of Exposure - Viruses on Surfaces Can Live on Surfaces for 2 Hours or More Can Live on Surfaces for 2 Hours or More Person Touching Contaminated Tables, Doorknobs, Desks, Then Touching Face, Eyes, Nose, or Mouth Person Touching Contaminated Tables, Doorknobs, Desks, Then Touching Face, Eyes, Nose, or Mouth

13. H1N1 Flu Symptoms  Symptoms Fever Fever Body Aches Body Aches Runny Nose Runny Nose Sore Throat Sore Throat Nausea Nausea Vomiting or Diarrhea Vomiting or Diarrhea  If Concerned About Symptoms – Contact Your Health Care Provider

14. Emergency Warning Symptoms  Adults Difficulty breathing or shortness of breath Difficulty breathing or shortness of breath Pain or pressure in chest or abdomen Pain or pressure in chest or abdomen Sudden dizziness Sudden dizziness Confusion Confusion Severe or persistent vomiting Severe or persistent vomiting

15. Emergency Warning Symptoms  Children Fast breathing or trouble breathing Fast breathing or trouble breathing Bluish skin color Bluish skin color Not drinking enough fluids Not drinking enough fluids Not waking up or not interacting Not waking up or not interacting Being so irritable that child does not want to be held Being so irritable that child does not want to be held Flu-like symptoms improve but then return with fever and worse cough Flu-like symptoms improve but then return with fever and worse cough Fever with a rash Fever with a rash

16. Prevention Measures Prevention Measures  Cough/Sneeze - Cover Nose/Mouth with Tissue or Sneeze into the Sleeve Dispose Used Tissues in the Trash Dispose Used Tissues in the Trash

17. Other Prevention Measures  Wash Hands with Soap & Water (At Least 20 Seconds) or Use Alcohol-Based Hand Sanitizers  Avoid Touching Eyes, Nose, or Mouth  Avoid Contact with Sick People If Sick, Stay at Home Away from Work or School and Limit Contact with Others If Sick, Stay at Home Away from Work or School and Limit Contact with Others

18. Travel  Conditions Constantly Change Link to the CDC Travel Advisory Website Link to the CDC Travel Advisory Website

19. In Summary  Best Precautions Stay Healthy & Get Plenty of Rest Stay Healthy & Get Plenty of Rest Wash Your Hands Frequently Wash Your Hands Frequently Avoid Contact with Persons Who Are Sick Avoid Contact with Persons Who Are Sick  If Sick, Stay at Home, Away from Work/School Must Prepare for Its Possible Return as a Mutated Virus Must Prepare for Its Possible Return as a Mutated Virus

20. 2009 H1N1 Vaccines  This season, vaccines to protect against the 2009 H1N1 virus (sometimes called “swine flu”) have been produced. Like seasonal flu vaccines  there are two kinds of 2009 H1N1 vaccines: a "flu shot " that is given with a needle, usually in the arm; and a nasal spray flu vaccine flu shot nasal spray flu vaccine

21. Vaccine H1N12009…  The same manufacturers who produce seasonal flu vaccines are producing the vaccines against the pandemic 2009 H1N1 virus in the same way that the seasonal vaccines are made.  This vaccine is the best way to protect against the 2009 H1N1 pandemic virus

22. Vaccine contd…  They are expected to be as safe and effective as seasonal flu vaccines.  They will not prevent “influenza-like” illnesses caused by other viruses.  Inactivated vaccine (vaccine that has killed virus in it) is injected into the muscle, like the annual flu shot.

23. Vaccine contd…  Some people have suggested that thimerosal might be related to autism.  In 2004 a group of experts at the institute of Medicine reviewed many studies looking into this theory,and found no association between thimerosal and autism.

24. Vaccine contd…  A live, intranasal vaccine ( the nasal spray vaccine) is also available.  Some inactivated 2009H1N1 vaccine contains a preservative called thimerosol to keep it free from germs.

25. Who should get 2009H1N1 influenza vaccine and when?  Group recommended to receive 2009 H1N1 vaccine first: ♦ Pregnant women ♦ people who live with or care for infants younger than 6 months of age. ♦ health care and emergency medical personnel.

26. Who should… ♦ Any one from 6 months through 24 years of age. ♦ Any one from 25 through 64 years of age with certain chronic medical condition or weakened immune system.  As more vaccine becomes available, these group should also be vaccinated: ♦ Healthy 25 through 64 years olds ♦ Adults, 65 years and older

27. When ?...  Get vaccinated as soon as the vaccine is available.  Children under 9 years of age should get two doses of vaccine, about a month apart.  Older children and adults need only one dose.

28. Some people should not get the vaccine or should wait  You should not get 2009 H1N1 LAIV if you have a severe (life threatening) allergy to eggs, or to any other substance in the vaccine.  2009 H1N1 LAIV should not be given to the following groups: ♦ Children younger than 2 year and adults 50 years and older.

29. Who should wait?.. ♦ Pregnant women ♦ Anyone with a weakened immune system ♦ Any one with a long term health problem such as Heart disease, kidney or liver disease, Lung disease, metabolic disease(diabetes)

30. Who should ?... Asthma, anemia and other blood disorders ♦ Children younger than 5 years with asthma or wheezing. ♦ Any one with certain muscle or nerve palsy. ♦ Any one in close contact with a person with a severely weakened immune system. ♦ Children or adolescents on long term aspirin treatment.

31. Vaccine protocol…  If you are moderately or severely ill, you might be advised to wait until you recover before getting the vaccine, if you have a mild cold then there is no need to wait.  Tell your doctor if you ever had: ♦ A life threating allergic reaction after a dose of seasonal flu vaccine, ♦ Guillain-Barre syndrome

32. Vaccine protocol…  These may not be the reason to avoid vaccine but medical staff can help you decide.  2009H1N1 LAIV may be given at the same time as most other vaccines. Tell your doctor if you got any other vaccine within the past month or plan to get any within the next month. H1N1 LAIV and seasonal LAIV should not be given together.

33. What are the risks from 2009H1N1?  a vaccine like any medicine Could cause a serious problem, such as a severe allergic reaction. But the risk of any vaccine causing serious harm or death is extremely rare.  The risk from H1N1 LAIV are expected to be similar to those from seasonal LAIV:

34. Avccine side effects…  Mild problems: Some children and adolescents 2-17 years of age have repeated reactions including: Runny nose, nasal congestion, cough, fever, head ach, muscle aches, wheezing, abdominal pain, occasional vomiting or diarrhea

35. Vaccine side effects… Some adults 18-49 years of age have reported: Runny nose or nasal congestion, sore throat, cough, chills, tiredness, headache  Severe problems: Life threatening allergic reactions to vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after vaccination,

36. Vaccine side effects…  In 1976, an earlier type of inactivated swine flu vaccine was associated with cases of Guillain-Barre syndrome LAIV has not been linked to GBS.

37. What if there is a severe reaction?  What should I look for? ♦ Any unusual condition, such as a high fever or behavior changes. ♦ Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.

38. Vaccine side effects…  What should I do? ♦ Contact the doctor immediately ♦ Ask the provider to report the reaction at vaccine adverse event reporting system (VAERS)

39. Vaccine safety  Vaccine Adverse Event Reporting System (VAERS)  VAERS will be the front-line monitoring system for collecting and analyzing voluntary reports of adverse events following 2009 H1NI monovalent vaccination.

40. Vaccine safety  VAERS is a US vaccine safety surveillance system, co-managed by CDC and FDA.  VAERS is a key mechanism to identify potential vaccine safety concerns. Generally VAERS cannot determine if an adverse event was caused by vaccine but can help determine if further investigations are needed.

41. Vaccine safety…  Healthcare providers are encouraged to report clinically significant adverse events after 2009 H1N1 mono valent vaccine or any vaccine to VAERS.  A report should be submitted even if the reporter is not certain that the vaccine caused the event.

42. Vaccine safety…  Anyone can submit a VAERS report, including healthcare providers, vaccine providers, public health officials, vaccine manufacturers, and persons vaccinated or their caregivers.  Reports may be filed securely online, by mail, or by fax. Report forms are available online or can be obtained by calling 1-800-822-7967 1- 800-822-7967 to request reporting forms or other assistance. online

43. Other Vaccine Safety Monitoring Activities  Vaccine Safety Datalink (VSD). Vaccine Safety Datalink (VSD)  Vaccine analytic unit (VAC)  Emerging Infections Programs (EIP). Emerging Infections Programs (EIP)  The Clinical Immunization Safety Assessment (CISA) The Clinical Immunization Safety Assessment (CISA)

44. Vaccine safety…  In this case call 1-888-275-4772 or visit www.hrsa.gov/countermeasuresureco mp/default.htm

45. How can I learn more  Ask your provider  Call your local or state health dept  Call the center for disease control Call 1-800-232-4636(1-800-CDC-INFO) Web site of CDC www.cdc.gov/h1n1flu

46. In Summary  Best Precautions Stay Healthy & Get Plenty of Rest Stay Healthy & Get Plenty of Rest Wash Your Hands Frequently Wash Your Hands Frequently Avoid Contact with Persons Who Are Sick Avoid Contact with Persons Who Are Sick  If Sick, Stay at Home, Away from Work/School Must Prepare for Its Possible Return as a Mutated Virus Must Prepare for Its Possible Return as a Mutated Virus