HUMAN SWINE INFLUENZA: A Clinician's Perspective

8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective

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HUMAN SWINE INFLUENZA:HUMAN SWINE INFLUENZA:

A CLINICIANS PERSPECTIVEA CLINICIANS PERSPECTIVE

Noahdel Hallel C. FranciscoNoahdel Hallel C. Francisco

BS BiologyBS Biology

Major in ZoologyMajor in Zoology


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I.I. What is influenza virus?What is influenza virus?

II.II. Clinical presentation of the influenzaClinical presentation of the influenzapandemicpandemic

III.III. Treatment of influenzaTreatment of influenza

IV.IV. Current updates on A(H1N1) CasesCurrent updates on A(H1N1) Cases

OUTLINEOUTLINE


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OBJECTIVESOBJECTIVES

1.1. ToTo discussdiscuss aboutabout humanhuman swineswine influenzainfluenzavirusvirus oror A(HA(H11NN11)) andand itsits history,history,evolutionevolution andand diagnosticdiagnostic trailtrail;;

2.2. ToTo elaborateelaborate onon thethe clinicalclinical presentationpresentationofof thethe pandemicpandemic influenzainfluenza;;


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OBJECTIVESOBJECTIVES

3.3. ToTo discussdiscuss howhow influenzainfluenza isis beingbeing managedmanaged

throughthrough selfself--carecare treatmenttreatment proceduresproceduresandand recommendedrecommended medicationsmedications;; andand

4.4. ToTo givegive thethe currentcurrent updatesupdates regardingregardinginfluenzainfluenza casescases..


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ORTHOMYXOVIRIDAEORTHOMYXOVIRIDAE

Genus Species Serotypes Hosts

Influenzavirus A Influenza A virus H1N1, H1N2, H2N2,H3N1, H3N2, H3N8,

H5N1, H5N2, H5N3,H5N8, H5N9, H7N1,H7N2, H7N3, H7N4,H7N7, H9N2, H10N7

Human, pig,bird, horse

Influenzavirus B Influenza B virus Human, seal

Influenzavirus C Influenza C virus Human, pig

Isavirus Infectious salmonanemia virus

Atlantic salmon

Thogotovirus Thogoto virus Batken virus,Dhori virus

Tick, mosquito,mammal (inc.

human)Dhori virus

Table 1. Genera-associated species and serotypes ofOrthomyxoviridae


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Genus Species Serotypes HostsInfluenzavirus A Influenza

A virusH1N1, H1N2,H2N2, H3N1,H3N2, H3N8,H5N1, H5N2,H5N3, H5N8,H5N9, H7N1,H7N2, H7N3,H7N4, H7N7,

H9N2, H10N7

Human, pig,bird, horse


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INFLUENZA A VIRUSINFLUENZA A VIRUS

www.wikipedia.org


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SWINE INFLUENZA VIRUSSWINE INFLUENZA VIRUS

anyany strainstrain ofof thethe influenzainfluenza familyfamily ofofvirusesviruses thatthat isis endemicendemic inin pigspigs

duedue toto reassortment,reassortment, therethere havehave beenbeentransferstransfers ofof genesgenes amongamong strainsstrains

crossingcrossing swine,swine, avian,avian, andand humanhumanspeciesspecies boundariesboundaries


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HISTORY OF PANDEMICHISTORY OF PANDEMICINFLUENZAINFLUENZA

Spanish FluSpanish Flu

-- earliest known pandemicearliest known pandemic-- 1918 to 19201918 to 1920

-- killed 40 million peoplekilled 40 million people

-- major cause: troop movementsmajor cause: troop movementsduring World War 1during World War 1


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Asian FluAsian Flu

-- 1.5 M fatalities1.5 M fatalities

-- 1957 to 19581957 to 1958

HongkongHongkong FluFlu-- 1 M fatalities1 M fatalities

-- 1968 to 19691968 to 1969


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1976 US outbreak1976 US outbreak

19881988 zoonosiszoonosis

1998 US outbreak in swine1998 US outbreak in swine

2007 Philippine outbreak in swine2007 Philippine outbreak in swine

2009 outbreak in human2009 outbreak in human


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Photo courtesy of: National Institute

of Allergy and Infectious Diseases(NIAID)


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DIAGNOSTIC TRAILDIAGNOSTIC TRAIL

Novel strain of humanH1N1 influenza A virus

mysterious influenza-like illness in the townof La Gloria

WHO alert due to

further cases in Mexico

First reports in Englishlanguage media April21st

Confirmed A(H1N1) intwo children in SanDiego, California

642 confirmed cases in USA

Virus also reached

Canada and Europe

Remote countries werealso afflicted, includingAustralia


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CASE DEFINITIONSCASE DEFINITIONS

vary between countries with few cases ofvary between countries with few cases ofswine flu compared to those with manyswine flu compared to those with many

casescases

e.g. Australia (only 400 cases)e.g. Australia (only 400 cases)

1. acute febrile respiratory illness1. acute febrile respiratory illness2. acute respiratory illness2. acute respiratory illness


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CDCs case definition:CDCs case definition:

InfluenzaInfluenza--like illness (ILI)like illness (ILI)

-- fever and cough and/or a sore throat infever and cough and/or a sore throat inthe absence of a known cause other thanthe absence of a known cause other than

the influenzathe influenza


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CDCs case definition:CDCs case definition:

1.1. Confirmed caseConfirmed case

2.2. Probable caseProbable case

3.3. Suspected caseSuspected case


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SYMPTOMSSYMPTOMS

Sudden fever of 38Sudden fever of 38 C or higherC or higher

HeadacheHeadache

Dry coughDry cough Extreme weakness and exhaustionExtreme weakness and exhaustion

Other symptoms may include:Other symptoms may include:

Chills, loss of appetite, sore throat andChills, loss of appetite, sore throat andrunny or stuffy noserunny or stuffy nose


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CONFIRMING DIAGNOSISCONFIRMING DIAGNOSIS

rapid diagnosis of human swinerapid diagnosis of human swineinfluenza infection is essential to:influenza infection is essential to:

-- minimise spread of conditionminimise spread of condition

-- protect patients from developingprotect patients from developing

complicationscomplications-- inform public health responseinform public health response


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CONFIRMING DIAGNOSISCONFIRMING DIAGNOSIS

Does illness in the patient meet the current casedefinition for possible swine influenza?

Patient is isolated

Throat and nasal swab for viral PCRtesting and viral culture is collected

Testing involves health care worker

Patient sent home for isolation,wait for pending result of the test

Use of antiviral will be recommended

when diagnosis is confirmed positive


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MODE OF TRANSMISSIONMODE OF TRANSMISSION

Droplets of moistureDroplets of moisture

from an infectedfrom an infectedperson throughperson throughsneezing, coughingsneezing, coughing

or talkingor talking


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Touching infectedTouching infected

hard surfaces andhard surfaces andtouching the mouthtouching the mouthor nose afterwards,or nose afterwards,without washing thewithout washing thehands first.hands first.

MODE OF TRANSMISSIONMODE OF TRANSMISSION


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STANDARD PROCEDURES TOSTANDARD PROCEDURES TOPREVENT SPREADING THE VIRUSPREVENT SPREADING THE VIRUS

1. Get a flu shot.

2. Clean your hands.

3. Cover your cough.

4. Stay at home.

5. Call your doctor.


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PERSONAL CARE OF ANPERSONAL CARE OF ANINFLUENZAINFLUENZA--INFECTED PATIENTINFECTED PATIENT

1.1. Rest and get lots of sleep.Rest and get lots of sleep.

2.2. Try to stay away fromTry to stay away frompeople for 7 days afterpeople for 7 days afterfirst symptom occurs.first symptom occurs.

3.3. Drink lots of fluids.Drink lots of fluids.

4.4. Gargle with warm saltGargle with warm saltwater.water.


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5.5. Use saline nose drops orUse saline nose drops or

spray.spray.6.6. Do not smoke. AvoidDo not smoke. Avoid

second hand smoke.second hand smoke.

7.7. Take recommended overTake recommended over--thethe--counter medications.counter medications.

PERSONAL CARE OF ANPERSONAL CARE OF ANINFLUENZAINFLUENZA--INFECTED PATIENTINFECTED PATIENT


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POTENTIALLY RECOMMENDEDPOTENTIALLY RECOMMENDEDANTIANTI--VIRALSVIRALS

1.1. OseltamivirOseltamivir [[TamifluTamiflu]]

2.2. ZanamivirZanamivir [[RelenzaRelenza ]]3.3. AmantidineAmantidine

4.4. RimantidineRimantidine


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Dose by Age Treatment dose for 5 days

< 3 months 12 mg twice daily

3-5 months 20 mg twice daily

6-11 months 25 mg twice daily

Table 2. Treatment doses of oseltamivir [Tamiflu] for infants authorized by

the FDA on April 27th 2009


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Table 3. Treatment doses of oseltamivir [Tamiflu] for 1 year of age authorized

by the FDA on April 27th 2009

Dose by age[years]

Dose byweight

[kg]

Dose for 5 days Number ofbottles needed

of oralsuspension for5-day course

Number ofcapsules

needed for5-daycourse

1-2 < 15 30 mg twice daily 1 10 capsules[30 mg]

3-5 15-23 45 mg twice daily 2 10 capsules[45 mg]

6-9 23-40 60 mg twice daily 2 20 capsules[30 mg]

> 10 > 40 75 mg twice daily 3 10 capsules

[75

mg]


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VACCINESVACCINES

Identification of a new virus

Preparation of vaccine strain

Verification of vaccine

strain

Optimization of virus growth

conditions

Vaccine filling and release

Clinical studies

Quality control

Vaccine bulk manufacture

Preparation of reagents totest the vaccine

Activities at WHO

collaborating centers

Activities at vaccine

manufacturers


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FoodFood andand DrugDrug AdministrationAdministration (FDA)(FDA)issuedissued EmergencyEmergency UseUse AuthorizationsAuthorizations

toto makemake availableavailable RelenzaRelenza andand TamifluTamifluantiviralantiviral drugsdrugs

LegalLegal immunityimmunity setset forfor swineswine fluflu vaccinevaccinemakersmakers

ACROSS THE GLOBEACROSS THE GLOBE


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WHOWHO issuedissued guidelinesguidelines forfor thethe useuse of ofantiviralsantivirals inin thethe managementmanagement ofof patientspatients

infectedinfected withwith thethe HH11NN11 pandemicpandemic virusvirus

MonitoringMonitoring ofof outbreaksoutbreaks

PreparationPreparation forfor aa secondsecond wavewave of ofpandemicpandemic spreadspread (northern(northern hemisphere)hemisphere)

ACROSS THE GLOBEACROSS THE GLOBE


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PHILIPPINE SETTINGPHILIPPINE SETTING

July 17, 2009: 1 new death confirmed inJuly 17, 2009: 1 new death confirmed inthe Philippinesthe Philippines

Policy of mitigationPolicy of mitigation

Government is preparing for possibleGovernment is preparing for possiblesecond pandemic spread by continuouslysecond pandemic spread by continuouslymonitoring the situation (DOH)monitoring the situation (DOH)


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PHILIPPINE SETTINGPHILIPPINE SETTING

Current Philippine response alert level is:Current Philippine response alert level is:

LEVEL 4LEVEL 4

ConfirmedConfirmed case(s)case(s) and/orand/or deathdeath relatedrelated totoInfluenzaInfluenza A(HA(H11NN11)) virusvirus inin thethe PhilippinesPhilippines..

ConfirmedConfirmed case(s)case(s) inin school(s)school(s)..

ConfirmedConfirmed humanhuman--toto--humanhuman transmission(s)transmission(s)..

DeclaredDeclared communitycommunity outbreak(s)outbreak(s)..


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Fig. 1 Outbreak in the

Philippines as confirmed orsuspected by different

agencies (09:47 pm,

Saturday, August 29, 2009)

Confirmed cases followed by death

Confirmed community outbreak of

H1N1

Confirmed cases by the DOH

Unconfirmed or suspected cases


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INTERNATIONAL RESPONSEINTERNATIONAL RESPONSETO INFLUENZAS THREATTO INFLUENZAS THREAT

InternetInternet

Authoritative websitesAuthoritative websites

Medical journalsMedical journals


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SUMMARY ANDSUMMARY ANDCONCLUSIONCONCLUSION

InfluenzaInfluenza AA isis currentlycurrently thethe greatestgreatestpandemicpandemic threatthreat toto humankindhumankind..

AA newnew strainstrain ofof swineswine influenzainfluenza virusvirus beganbeganitsits outbreakoutbreak inin MexicoMexico andand hashas takentaken itsits tolltoll

untiluntil now,now, declaringdeclaring aa hugehuge threatthreat amongamongthethe humankindhumankind..


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PreventivePreventive measuresmeasures havehave beenbeen promotedpromotedsuchsuch asas selfself--carecare treatmenttreatment proceduresprocedures andand

takingtaking inin of of recommendedrecommended medications,medications, ee..gg..oseltamiviroseltamivir andand zanamivirzanamivir..

ClinicalClinical casescases havehave beenbeen rapidlyrapidly increasing,increasing,thusthus internetinternet hashas beenbeen aa majormajor sourcesource ofofspreadingspreading andand accessingaccessing informationinformation onlineonline..


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BeingBeing awareaware andand informedinformed ofof thethe humanhumanswineswine influenzainfluenza virusvirus andand itsits pandemicpandemic

effecteffect cancan leadlead toto concernedconcerned peoplepeople withwithestablishedestablished hygienichygienic practicespractices toto minimizeminimizespreadingspreading ofof thethe virusvirus..

Prevention is better than cure.Prevention is better than cure.


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HUMAN SWINE INFLUENZA: A Clinician's Perspective

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