Swine Flu Disease

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    What is

    Swine Flu?

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    a highly contagious acute

    respiratory disease caused byany strain of the influenza virus

    endemic in pigs (swine) that

    regularly cause outbreaks of influenza among pigs. In some

    instances, people have developed

    the swine flu infection when theyare closely associated with pigs

    (for example, farmers, pork

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    What is SIV?

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    influenza cases that arecaused by Orthomyxovirus

    endemic to pig populations.

    SIV strains isolated to date

    have been classified either as

    Influenza(virus C or one of thevarious subtypes of the genus

    Influenza virus A)

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    Modes of

    Transmission

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    Most infections occur among people with

    direct pig contact.

    Sometimes a flu virus can mutate to be

    more transmissible to humans.

    People who work with swine, especially

    people with intense exposures, are at risk ofcatching swine influenza if the swine carry a

    strain able to infect humans.

    Swine flu cannot be spread by porkproducts, since the virus is not transmitted

    through food

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    Period of

    Communicability

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    The swine flu in humans is mostcontagious during the first five

    days of the illness although some

    people, most commonly children,can remain contagious for up to

    ten days.

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    Risk Factors

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    Direct Contact with Pigs

    Smoking

    Not Wearing Gloves when Working

    with Sick Pigs

    Children aged 6 months up to their

    19yrs

    Pregnant women People 50 years of age and older

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    People of any age with certainmedical conditions, such as heart

    or lung disease (Asthma, COPD,

    Emphysema ), Diabetes or thosewith weakened immune systems

    e.g. HIV

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    Pathology

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    Direct

    contact with

    Pigs

    Weak

    Immune

    System

    Pregnant

    Women

    Age:

    6 mos. up

    50 yrs old

    upVirus enters the

    Respiratory Tract

    Bind throughHemogglutinin to the

    Epithelial cellsRespiratory tract

    becomes swollen andinflammed

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    Enters the blood stream

    Virus particles attaches to a livingcell and injects the genetic

    materialsGenetic materials hijacks the cells

    normal RNA/DNA machinery

    Cell burst

    Virus particles are released

    Target cells are infected and

    burst

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    Diagnostic Tests

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    Real-time RT-PCR

    - This method allows a specific diagnosis of

    novel influenza (H1N1) as opposed to seasonalinfluenza.

    Nasopharyngeal Swab Sample

    - Done to see if the patient is infected withinfluenza A or B virus.

    Viral Culture

    - It provides results in 3-10 days. A negative viralculture does not exclude infection with swine-

    origin influenza A (H1N1) virus.

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    Rapid Influenza Diagnostic Tests &

    Immunofluroscence

    - These tests can distinguish between

    influenza A and B viruses. A patient with a

    positive for influenza A may meet criteria for

    a suspected case. But they cannotdistinguish between seasonal influenza A

    and swine influenza, which is a subtype of A.

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    Nursing Diagnoses

    with Nursing

    Management

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    Risk for ineffective breathing r/t response

    to infectious process: inflammation 2o

    swine flu- Assist patient to assume position, eg.

    Elevate the position of the patients head,

    facilitates respiratory function by use ofgravity.

    - Encourage or assist patient with

    abdominal breathing exercises, Providesthe patient with some means to cope with

    and control dyspnea and reduced air-

    trapping.

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    - Observe characteristic of cough, eg.

    Persistent, hacking, moist. Assist with

    measures to improve effectiveness of

    cough effort, coughing is most

    effective in an upright or in a head-

    down position after chest percussion.

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    Fluid Volume Deficit r/t excessive

    gastric losses: vomiting 2o swine flu- Monitor V/S, capillary refill, status of mucous

    membranes, skin turgor. Indications of

    adequacy of circulating volume. Orthostatic

    hypotension may occur with risk of falls/injuryfollowing sudden change in position.

    - Discuss strategies to stop vomiting and

    laxative/diuretics use, patient may obtain from

    all intakes with resulting dehydration; or

    substitute fluids for caloric intake, disturbing

    electrolyte balance.

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    -Monitor intake and output balance to

    ensure accurate picture of fluid status.-Encourage oral intake, offer fluids

    between meals.

    -Instruct to have small frequent feedingsafter vomiting stops and provide crackers

    only if he always feels nauseated.

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    Altered Body Temperature: Hyperthermia r/t

    effects of circulating toxins 2o Swine Flu

    - Monitor v/s q 4 hours to evaluate pts condition.

    - Provide TSB to maintain a normal body

    temperature.

    - Encourage increase fluid intake to replace fluid

    loss.

    - Encourage food rich in Vitamin C to boost body

    resistance to infection.

    - Maintain bed rest to preserve energy.

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    s or act v ty nto erance r t

    decreased oxygen-carrying

    capacity- Evaluate clients actual and perceivedlimitations/ degree of deficit in light of usual

    status, provides comparative baseline and

    information about needed education regardingquality of life

    - Instruct patient in energy conserving techniques,

    e.g. carrying out activities at a slower pace,energy saving techniques reduce the energy

    expenditure thereby assisting in equalization of

    oxygen supply and demand.

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    - Facilitate development of appropriate

    activity/ rest schedule, alternating rest

    and activity conserves energy while

    allowing most productivity.

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    Medical Management

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    Tamiflu (oseltamivir) Relenza (zanamivir)

    Vaccination (Prevention)

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    Recent Journals

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    Cell-Culture HINI swine flu vaccine

    launchedHyderabad, Oct 18 : Vaccine maker, Bharat

    Biotech, today announced the launch of ''India's

    first indigenously developed cell culture H1N1

    swine flu vaccine'' under the brand name'HNVAC'.

    ''HNVAC is the only developing world flu vaccine

    to be manufactured in cell culture, a highlysterile and controlled manufacturing process,

    instead of eggs''. "HNVAC was tested

    extensively in one of the largest Phase I, II and

    III clinical trials for flu

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    vaccines in India and has proved that it is safe

    and well tolerated''.

    ''Bharat Biotech received the approval from theDrugs Controller General of India earlier this

    month to launch HNVAC vaccine.

    ''HNVAC was developed with approved strainsfrom WHO and CDC Atlanta.

    ''This single dose vaccine has been developed by

    Bharat Biotech's scientists at the Genome

    Valley Facility in Hyderabad,'' the company said

    in a release here. --UNI

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    Swine flu jab 'may trigger rare

    nerve disease'London, Oct 18 : Experts have indicated a

    possible link between the swine flu jab and an

    increased risk of developing a rare nerve

    disease.The authorities are carrying out studies to

    examine a possible association between the

    vaccine and Guillain-Barre Syndrome, acondition that attacks the nervous system and

    can cause paralysis and even death, reports

    the Telegraph.

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    The Medicines and Health care products

    Regulatory Agency (MHRA) has published a

    report that suggests that further tests are tobe carried out.

    It reads, "Given the uncer-tainties in the

    available information and as with seasonal fluvaccines, a slightly elevated risk of GBS

    following H1N1 vaccines cannot be ruled out.

    "Epidemiological studies are ongoing to

    further assess this possible association."

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    A vaccine used to combat a different form of

    swine flu in the US in 1976 led to 25 deathsfrom the condition, compared with just one

    death from swine flu itself.

    Amid fears there could be a repeat,

    neurologists were asked to record cases ofGBS in the UK swine flu outbreak. Government

    experts say there is no evidence of an increase

    in risk similar to 1976, but the MHRA reportreveals they are calculating if there might be a

    smaller raised risk.

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    A spokesman for the MHRA said the risk with

    the vaccine had not changed and that thereport "simply expands" on ongoing GBS

    analysis.

    "The position was and remains that there is noconfirmed evidence that the vaccines are a

    cause of GBS," he said. --ANI

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    Study finds hope for new drugs

    that fight flu10/21/2010 : Discovery of new trait in influenzaA may lead to finding drug that can fight all

    virus strains

    New images of the influenza A virus, whose

    strains cause the seasonal flu and the H1N1

    "swine" flu, have revealed its Achilles' heel,

    researchers say, and the finding could lead toa targeted drug that can fight all strains of the

    virus.

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    The weakness stems from a basic structure

    in all flu viruses, called the M2 channel,

    which is key in helping the virus

    reproduce.

    About four years ago, a tiny change

    occurred in this channel, the researcherssaid, making flu drugs such as

    amantadine and rimantadine ineffective.

    The Centers forDisease Control andPrevention stopped recommending using

    the drugs to fight the flu.

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    "We think we can pin down the types of

    changes that could occur, and find drugs for

    all" strains of flu, said study researcherDavidBusath, a biophysicist at Brigham Young

    University in Utah.

    The finding helps researchers understand whythe virus isn't susceptible to the old influenza

    drugs anymore, Busath said.

    With a drug developed to target this particularchannel, "you could be safe tomorrow,"

    Busath said.

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    The flu virus is mutating and changing all the

    time, which is why there must be a new flu

    vaccine every year to accommodate the newmutations, he said. But every flu virus has an

    M2 channel, and it must work properly for the

    virus to infect a host."It turns out there's only a small handful of

    changes, in the heart of the channel, that still

    allow the virus to work well," Busath said. "And

    if it can't work, the virus can't reproduce. And

    we know all of the possible changes that allow

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    it to work.

    Previous images of influenza A didn't

    reveal the changes in the M2 channel,

    making it hard for scientists to develop

    a drug that could effectively target the

    structure.

    Because the structures of the virus are so

    tiny, Busath and researchers from

    Florida State University used atechnique called solid-state nuclear

    magnetic resonance

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    which is similar to an MRI, but used on atoms and

    molecules to get a refined view of the flu's

    structure."We have some new theories to test for possible

    compounds that would work on the M2

    [channel], and we're excited to try them out,"Busath told MyHealthNewsDaily.

    The imaging technique the researchers used

    could also be used to provide images of the

    proteins in plasma membranes in the nervous

    system, he said.

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    Swine Flu Variant Linked To Fatal Cases

    Might Have Disabled The Clearing

    Mechanism Of Lungs,S

    tudyS

    uggestsDate: 23 Oct 2010

    A variant of last year's pandemic influenza

    linked to fatal cases carried a mutation thatenabled it to infect a different subset of cells

    lining the airway, according to new

    research. The study, due to be published

    next week in the Journal of Virology,suggests that the mutant virus could have

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    impaired the lungs' ability to clear out

    germs. The researchers behind the study,

    from Imperial College London, the

    Medical Research Council National

    Institute forMedical Research and the

    University ofMarburg said the findingshighlight the potential for deadlier strains

    of flu to emerge and spread.

    The 2009 pandemic of H1N1 influenzacaused thousands of deaths worldwide,

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    but the majority of cases were relatively mild.

    A variant of the virus carried a mutation

    termed D222G in a protein on the surface of

    the virus, and people infected with this

    variant were more likely to have severe and

    fatal illness. According to a World HealthOrganisation report, the D222G mutation

    was found in less than two in every hundred

    cases of 2009 pandemic flu, but was

    responsible for around seven in every

    hundred deaths.

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    Viruses infect cells by attaching to receptor

    molecules on the cell surface. Different

    receptors are present on different celltypes, and a virus can only infect cells that

    have the right receptors for the protein on

    its own surface.The new research shows that flu virus with

    the D222G mutation can bind to a broader

    range of receptors in the airway, including

    receptors that are present on cells calledciliated cells. These cells, found in the

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    lining of the airway, have hair-like projections

    called cilia. The cilia sway back and forth to

    move mucus with trapped particles upwardtoward the mouth, and this is normally

    swallowed or coughed up. When ciliated

    cells become infected, the cilia stop movingand this vital clearance function is impaired.

    Inhaled viruses and bacteria can then

    reach the lung more easily, where they can

    potentially cause pneumonia.

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    The mutant virus has an increased capacity

    to infect ciliated cells, as shown by the

    collaborating group at the University ofMarburg. Infection of the ciliated cells

    would sabotage the lungs' clearing

    mechanism and could be one factor thatmade the D222G mutation more virulent,

    the researchers suggest.

    "This simple mutation, which swapped one

    building block of a virus protein for another,

    apparently resulted in a more

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    virulent version of the H1N1 virus," said

    Professor Ten Feizi from the Department of

    Medicine at Imperial College London, who

    led the study. "We think this is at least partly

    due to the virus being able to bind to

    different receptors, which allowed it to infectciliated cells and stop them from clearing

    out germs.

    "If the mutant virus were to acquire the abilityto spread more widely, the

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    consequences could be very serious. The

    study goes to show how important it is that

    the WHO Global Influenza SurveillanceNetwork continues to monitor closely the

    emergence of new variants of the flu virus.

    Even though the 2009 pandemic wasrelatively mild, it's vital that we handle

    outbreaks cautiously and stay vigilant. The

    virus is constantly evolving, and it's possible

    that a new form as dangerous as the 1918pandemic could emerge."

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    Professor Feizi and her team study the

    receptor specificity of different flu viruses

    by attaching onto a glass surface a rangeof different carbohydrates, resembling the

    receptors present on the surface of airway

    lining cells. The virus is then incubated ontop of the glass surface, and using a

    fluorescent dye, the researchers can see

    the receptors on the plate to which the virus

    binds.The study builds on earlier work by

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    Professor Feizi and her colleagues which

    showed that compared with seasonal

    influenza, the 2009 pandemic virus couldbind to a broader range of receptor types.

    The previous study showed that pandemic

    flu had some affinity for so-called alpha2-3 receptors, as well as the alpha2-6

    receptors favoured by seasonal flu. Now

    they have shown that this affinity for

    alpha2-3 receptors is substantially

    enhanced in cases of pandemic flu with

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    the D222G mutation. Whereas alpha2-6

    receptors are found in the nose, throat and

    upper airway, alpha2-3 receptors areprevalent in the lung but also on ciliated

    cells throughout the respiratory system.

    The study was funded by the WellcomeTrust, the Medical Research Council,

    Biotechnology and Biological Sciences

    Research Council, the UK Research

    Councils' Basic Technology Initiative,

    EPSRC's Follow-on Translational grant,

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    and German grants from the Von

    Behring-Roentgen Foundation andLOEWE Program UGMLC of the

    State of Hesse.

    Sources: Imperial College London,

    AlphaGalileo Foundation.

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    Prevention Of

    Human To HumanTransmission

    Stay Home When You Are Sick :

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    Stay Home When You Are Sick :

    Stay Home When You Are Sick If possible, stay

    home from work, school & errands when youare sick. You will help prevent others from

    catching your illness.

    Cover Your Mouth & Nose :

    Cover YourMouth & Nose Cover your mouth

    and nose with a tissue when coughing or

    sneezing. If you dont have a tissue, cover

    your mouth and nose as best you can. It mayprevent those around you from getting sick

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    Clean Your Hands :

    Clean Your Hands Clean your handsoften. Clean your hands every time

    you cough or sneeze. Hand washing

    stops germs .It is the best procedurein prevention of majority of

    communicable diseases. Use alcohol

    based gels & wipes also worked well .

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    Avoid Touching Your Eyes, Nose

    or Mouth :

    Avoid Touching Your Eyes, Nose or

    Mouth Germs are often spread when

    a person touches something that is

    contaminated with germs and then

    touches his or her eyes, nose, or

    mouth.

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    Healthy Habits Reduces The

    Attacks :Healthy Habits Reduces The Attacks

    Get plenty of sleep,be physically

    active, manage your stress, drinkplenty of fluids, and eat nutritious.

    Unnecessary Migration of people

    from epidemic and endemic areas tobe reduced.

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    _The End_