Swine Flu

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Presentation Outline

• Introduction• Magnitude of problem• Epidemiological Triad• Route of Transmission• Sign and Symptoms• Prevention• Treatment• Situation in Nepal

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Introduction

• Respiratory disease of pigs caused by type A influenza that regularly causes outbreaks of influenza among pigs

• Normally do not infect humans, however human infection with swine flu occurs and cases of human to human transmission have been documented

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History

• 1918 pandemic in humans• 1976 U.S. outbreak• 1998 US outbreak in swine• 2007 Philippine outbreak in swine• 2009 outbreak in humans

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2009 Outbreak

• The 2009 flu pandemic is a global outbreak of a new strain of influenza A virus subtype H1N1, termed Pandemic H1N1/09 virus by WHO, novel influenza A (H1N1) and 2009 H1N1 flu by CDC

• First identified in April 2009

• The main strain of virus has been termed A/California/07/2009 (H1N1) by scientists

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•On June 11, WHO declared swine flu pandemic

•The overall Global case fatality rate is 0.5%

• Deaths: 168 in Mexico, eight confirmed as swine flu and rest suspected. One confirmed in US

Magnitude of Problem

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Global Distribution of Reported Cumulative Laboratory Confirmed Cases of Swine Influenza

A(H1N1) by Countries, June 11, 2009

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• RNA, enveloped virus of family Orthomyxoviridae

• Size: 80-200nm or .08 – 0.12 μm in diameter

• Three typesA, B, C

• Surface antigens• H (haemaglutinin)• N (neuraminidase)

Epidemiological TriadAgent

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Host

• Swine population

• Immuno- compromised people

• Children and young adults

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Environment

• The virus is readily inactivated by disinfectants

• Outbreaks in pigs occur year round, usually in the autumn and winter in temperate zones

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Transmission to Humans

• Through contact with infected pigs or environment contaminated with swine flu viruses

• Through contact with the person with swine flu, human to human contact thought to occur through coughing , sneezing of infected person

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Transmission between pigs

• Direct contact between infected and uninfected animals

• Airborne transmission through the aerosols produced by pigs, coughing or sneezing

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Sign and Symptoms in Swine

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Sign and symptom in human

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Prevention in SwineFacility management-use of disinfectants and ambient

temperature to control virus in the environment.

Herd management-• not adding exposed pigs carrying influenza to the

healthy herds • New animals should be quarantined.

Vaccination- on swine

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Prevention in human

Prevention of pig to human transmission Although strains of swine influenza are usually not

able to infect humans this may occasionally happen, so

• farmers and veterinarians are encouraged to use a face mask when dealing with infected animals

• use of vaccines on swine to prevent their infection

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Swine flu vaccineVaccination programe began on 21 October 2009, because of

limited supply it is given to those at the greatest risk first in the order:

• Pregnant women • Healthcare and emergency medical services personnel • Children 6 months to 4 years of age, and • Children 5 to 18 years of age who have chronic medical

conditions It was expected that virtually all general population would

have received their first delivery of swine flu vaccination by the 13th November.

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Prevention in human

Prevention of Human to human transmission• Early Diagnosis- The swine flu in humans is most

contagious during the first five days of the illness. Diagnosis can be made by sending a specimen, collected during the first five days for analysis

• Use of standard infection control against influenza : Frequent washing of hands with

soap and water or with alcohol-based hand sanitizers especially after being out in public.

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Disinfection of household surfaces, with a diluted chlorine bleach solution.

Use of mask

• Avoiding touching eyes, nose and mouth with hands

• Social distancing can be another tactic

contd…

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TreatmentIn swine• Supportive care is required• Veterinary efforts should focus on preventing the

spread of the virus throughout the farm, or to other farms

• Vaccination and animal management techniques are most important

• Use of Antibiotics are proved important in preventing bacterial pneumonia and other secondary infections in influenza-weakened herds

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Treatment

In humans

• Use of Antiviral drugs (work best when used within 2 days of symptoms)

• Supportive care , focuses on controlling fevers, relieving pain and maintaining fluid balance, as well as identifying and treating any secondary infections or other medical problems.

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Contd…

• CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses

• Majority of people infected with the virus make a full recovery without requiring medical attention or antiviral drugs.

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Swine Flu in Nepal

• The first swine flu case reported in Nepal in June,2009

• With the diagnosis, the number of swine flu patients in Nepal has gone up to 48.

• Unlike India, where the death toll has reached 478, there have been no deaths in Nepal with all the quarantined patients recovering

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Threat in Nepal

• In November 2009, Nepal sounded an alarm after the discovery that the epidemic could be spreading in two districts in the west where school children and security personnel tested positive for the disease.

• The rise of the disease in India has created fear in Nepal’s border districts from where thousands of migrant workers flock to India seeking jobs.

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National Actions

• According to Dr Senendra raj Upreti (Director EDCD), on 29 April, the government issued an alert to over 40 Rapid Response Teams and stationed a team of health professionals at Tribhuwan International Airport.

• It has also stepped up vigilance for symptoms of the flu at border points.

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National Actions

• Deployment of surveillance teams across the country

• Strengthening of hospitals, mainly TUTH and Sukraraj Tropical and Infectious Disease Hospital to enable them to provide special treatment.

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Contd…

• Stockpiling of drugs, namely Tamiflu and masks capable of attending to 40,000 patients. Nonetheless, he advised precautionary measures

• Active involvement of communication media radio, television in giving information on precautionary measures to general public

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References

• http://www.nhs.uk/conditions/pandemic-flu/Pages/Introduction.aspx

• http://www.who.int/csr/disease/swineflu/en/index.html (WHO)

• http://www.asianewsnet.net/news.php?id=6605&sec=14• www.cdc.com• N Engl J Med 2009;361:279-85.• http://www.who.int/wer• http://www.pitt.edu/~super1/• Infectious disease epidemiology ,theory and

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Thank You

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