8ab3h1n1 influenza a (swine flu ) pandemic 2009 power point

8/3/2019 8ab3h1n1 Influenza a (Swine Flu ) Pandemic 2009 Power Point

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SWINE FLU

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Update: Novel Influenza A (H1N1)Virus Infections --- Worldwide, May 6,

2009 Since mid-April 2009, CDC, state and local health

authorities in the United States, the World HealthOrganization (WHO), and health ministries in severalcountries have been responding to an outbreak of

influenza caused by a novel influenza A (H1N1) virus

In March and early April 2009, Mexico experiencedoutbreaks of respiratory illness subsequently confirmed by

CDC and Canada to be caused by the novel virus

The influenza strain identified in U.S. patients was

genetically similarto viruses isolated from patients in Mexico448/23/2009


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This week, one story has been prominent in our output

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A global swine-flu pandemic is likely, the WorldHealth Organization (WHO) said Wednesday as itraised its alert level to Phase 5, the next-to-highest

level in the worldwide warning system.-The Seattle Times

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The World Health Organization raised thealert level of the fast-spreading swine flu virus,

indicating that a "pandemic isimminent."

-NY Times

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SWINE FLU

As the swine fluspread throughout theworld, countries and

citizens moved quicklytoprotect themselves,

1.donning face masks,

2.cancelling trips, and

3.staying out ofcrowded areas.

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H1N1 Influenza A New Delhi:

World Health Organisation (WHO) mayraise its level of alert to a six dependingthe situation in Spain, which is the latestcountry to be hit by the H1N1 virus.

WHO decided to stop calling the

disease swine fluin order to avoidconfusionthat the flu is caused by pigs. Medical experts have already established

that the disease spreads through8/23/2009 99


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Swine flu a pandemic,declaresWHOin 11 th June

GENEVA: The World HealthOrganisation told its member nations

on Thursday it was declaring a swineflu pandemic the first global fluepidemic in 41 years as

infections climbed in the United States,Europe, Australia, South America andelsewhere.

In a statement sent to health officials,10108/23/2009


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The current WHO phase ofpandemic alert is 6

1111

Phase 5, is characterized by human-to-human spreadof the virus into at least two countries in one WHOregion. While most countries will not be affected at thisstage, the declaration of Phase 5 is a strong signal that a

pandemic is imminent and that the time to finalize theorganization, communication, and implementation ofthe planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized bycommunity level outbreaks in at least one other countryin a different WHO region in addition to the criteriadefined in Phase 5. Designation of this phase willindicate that a global pandemic is under way.

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U.S. President Gerald Ford being vaccinatedfor Swine Flu by Dr. William Lukash, 1976

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h h f


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The current WHO phase ofpandemic alert is 6

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Emergency Room Consultations for Pneumonia or RespiratoryInfection, Including Influenza-like Illness, at the

National Institute of Respiratory Diseases of Mexico.

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Pandemic (H1N1) 2009 -update 60

Laboratory-confirmed cases of pandemic(H1N1) 2009 as officially reported to WHO

As of 31 of July 2009, 168 countries andoverseas territories/communities havereported at least one laboratory confirmed

case of pandemic (H1N1) 09.

All continents are affected by the pandemic.20208/23/2009

P H N


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Pan em c H1N1 2009 -update 61

Laboratory-confirmed cases of pandemic (H1N1) 2009 asofficially reported to WHO by States Parties to the IHR (2005) asof 6 August 2009

Pandemic influenza H1N1 has now been reported in over 170 countriesand territories worldwide. While the case counts no longer reflectactual disease activity, WHO is actively monitoring the progress of thepandemic through frequent consultations with the WHO Regional Offices andmember states.

The countries and overseas territories/communities that have newly reportedtheir first pandemic (H1N1) 2009 confirmed case(s) since the last web update(No. 60) as of 6 August 2009 are:

Timore-Leste, Pakistan, Kirabati, Maldives, French Guiana, Falkland Islands(UKOT), Wallis and Futuna (FOC

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Map of affected countries and deaths as of 13 A2009Region

Cumulative totalas of 13 Aug 2009

Cases* DeathsWHO Regional Office for (AFRO) 1,469 3

WHO Regional Office for the (AMRO) 1,05,882 1,579WHO Regional Office for the (EMRO) 2,532 8

WHO Regional Office for (EURO) Over 32,000 53

WHO Regional Office for (SEARO) 13,172 106WHO Regional Office for the Western Pacific(WPRO) 27,111 50

Total Over 1,82,166 1,7998/23/2009
http://www.who.int/entity/csr/don/GlobalSubnationalMasterGradcolour_20090813_20090819.pnghttp://www.who.int/entity/csr/don/GlobalSubnationalMasterGradcolour_20090813_20090819.pnghttp://www.who.int/entity/csr/don/GlobalSubnationalMasterGradcolour_20090813_20090819.pnghttp://www.who.int/entity/csr/don/GlobalSubnationalMasterGradcolour_20090813_20090819.png


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SWINE FLU SCARE: Passengers queue upfor swine flu examination at an airport

All people enteringIndia via the mainairport hubs of

Mumbai, NewDelhi,Kolkata,

Ahmedabad, Goa,Jaipur, Kochi,Chennai,Bangalore andHyderabad are

being screened.8/23/2009 2323
http://en.wikipedia.org/wiki/Indiahttp://en.wikipedia.org/wiki/Mumbaihttp://en.wikipedia.org/wiki/New_Delhihttp://en.wikipedia.org/wiki/New_Delhihttp://en.wikipedia.org/wiki/Kolkatahttp://en.wikipedia.org/wiki/Ahmedabadhttp://en.wikipedia.org/wiki/Goahttp://en.wikipedia.org/wiki/Jaipurhttp://en.wikipedia.org/wiki/Kochihttp://en.wikipedia.org/wiki/Chennaihttp://en.wikipedia.org/wiki/Bangalorehttp://en.wikipedia.org/wiki/Hyderabad,_Andhra_Pradeshhttp://en.wikipedia.org/wiki/Hyderabad,_Andhra_Pradeshhttp://en.wikipedia.org/wiki/Bangalorehttp://en.wikipedia.org/wiki/Chennaihttp://en.wikipedia.org/wiki/Kochihttp://en.wikipedia.org/wiki/Jaipurhttp://en.wikipedia.org/wiki/Goahttp://en.wikipedia.org/wiki/Ahmedabadhttp://en.wikipedia.org/wiki/Kolkatahttp://en.wikipedia.org/wiki/New_Delhihttp://en.wikipedia.org/wiki/New_Delhihttp://en.wikipedia.org/wiki/Mumbaihttp://en.wikipedia.org/wiki/India


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Singapore Changi AirportThermal Scanning

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First death: 14-yr-old girldies of swine flu in Pune

New Delhi:

The Government on Monday confirmedthe country's first death from the H1N1

flu in Pune, a top official said.

"There has been one death

in Pune,"Health Secretary Naresh Dayal said,

adding that the victim was a 14-year-oldirl.8/23/2009 2525


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A case of gross negligence, allegesPune H1N1 Flu victims family

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IN DESPAIR: (From left): Shaken and anguished, Rida Shaikhsgrandmother Saida Shaikh, aunt Ayesha Shaikh and father Sajid Shaikhpresented their case at a press conference in Pune on Tuesday

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Online edition of India's National NewspaperThe Hindu,Wednesday, Aug 05, 2009

Pune: The family of14-year-old RidaShaikh, who died of swine flu in Pune onMonday, said on Tuesday that it would initiatelegal proceedings against Jehangir Hospital,where she was treated.

The familys lawyer, Asif Lampwala, alleged thatthe girls death was a case of gross negligence.

The family would claim huge sums in damagesand the money would be given to charity.

The girls aunt, Ayesha Shaikh, said:

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O li diti Th Hi d F id J l


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Online edition , The Hindu,Friday, Jul 17, 2009

Doctor tests positive for swine flu

HYDERABAD: Even the health care providers cant remain immune to A (H1N1) influenza fluvirus. On Thursday, authorities confirmed that a doctor, from a corporate hospital in twin

cities, tested positive for A (H1N1) strain of virus. In all, authorities said two more persons,including the doctor, tested positive for flu taking the overall tally to 37.

The female doctor returned to Hyderabad on an Emirates flight (EK 526) on July 11 fromGlasgow after attending a workshop and volunteered to get admitted to the Government ChestHospital, Erragadda on July 14. A 13-year-old boy, who returned from Melbourne after asightseeing trip on July 13, also tested positive.

Allaying fears that the doctor could have passed on the A (H1N1) virus to other doctors,patients and hospital staff, authorities have already started contacting close associates of thedoctor. The Chest Hospital doctors informed that the samples of 13 Google employees sent toNICD, New Delhi for testing have come negative.

The samples of close contacts of the 13-year-old boy, including his parents, uncle and two-year-old sister, have been sent to NICD for testing. The health authorities meanwhile have

requested the software companies to postpone any onsite visits of their employees, in view ofthe flu outbreak in United States and Europe.

The Oseltamivir drug is working well on patients. Within fivedays, they are recovering and are becoming non-infectious. A fewpatients have allergic reactions to the drug like rashes and slight

giddiness, said State coordinator for A (H1N1) influenza flu virus Dr. K. Subhakar.Presently there are 15 flu positive patients admitted to the hospital

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PGI d t t t iti f i


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PGI doctor tests positive for swineflu

PTI, 21 August 2009, 08:51pm IST

The Times Of India : CHANDIGARH:

Adoctor attached with a medical institute

here has tested positive for the swine flu.

A junior resident doctor withPost Graduate Institute forMedical Education andResearch (PGIMER) in the city

tested positive for the Swine8/23/2009 2929
http://timesofindia.indiatimes.com/news/city/chandigarh/PGI-doctor-tests-positive-for-swine-flu/articleshow/4920251.cmshttp://timesofindia.indiatimes.com/news/city/chandigarh/PGI-doctor-tests-positive-for-swine-flu/articleshow/4920251.cms


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Chennai child dies of swineflu

Chennai, Aug 10

Four-year-old Sanjay Balakrishnan diedofinfluenza A (H1N1) infection at a private

hospital here Monday, becoming the sixthswine flu victim in the country.

Sources at Neta Hospital,where the boy wasadmitted, said he had been hospitalised withfever and diarrhoea last week. Later, he wasdiagnosed with kidney failure and chestcongestion.8/23/2009 3030


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Cennai Victim's timeline:How sanjay died

Suffering from Asthma

Hospitalised for diarrhoea

Friday: Condition worsened .Kidney, Liver fail

Put on dialysis and ventilator

Saturday: Tests positive for H1N1

Sanjay was asthmatic and doctors feel

that may have made him more8/23/2009 3131


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Runaway swine flu patient dies in ChennaiChennai, Aug 21

A 47-year-old Chennai resident - whoran away from a government hospital withswine flu symptoms but was readmitted later- died Thursday night, becoming the secondvictim of the H1N1 virus here, hospitalofficials said.

"Francis was first admitted to the hospitalwith swine flu symptoms Aug 13. He wentaway without informing us after we took thethroat swab and blood sample," MohanaSundaram, dean of the Government General8/23/2009 3232

Thi d A(H N ) d h i S


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Third A(H1N1) death in StateTHE HINDU- Online edition [23/08/2009]

CHENNAI: G. Sekar of Radha Nagar inChromepet here, who tested positive forA(H1N1), died at the government GeneralHospital here late Friday night of

complications arising out of the condition.This takes the A(H1N1) death toll in theState to three.

Sekar, 45, was admitted to the surgical wardof the GH with breathlessness and bleeding

piles. He required surgery for that problem.8/23/2009 3333

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B.Tech student dies of suspected swine flu

Wed, Aug 19 02:25 PM

Dehradun/New Delhi, Aug 19 (PTI) A 24-year-old student, who was pursuing B.Tech inPune and had recently gone to his hometown,

Dehradun, has died of suspected swine flu,raising the nationwide toll to 31. As many as99 fresh cases of the infection have beenreported from various states till yesterday and

the total count of those affected has mountedto 2026 across the country.

The engineering student, Raunak Singh, a

resident of Race Course locality in Dehradun,34348/23/2009


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Swine flu cases climb to 2,242in the country

Wed, Aug 19 09:24 PM

New Delhi, Aug 19 (PTI) Swine flu continuedto spread in the country today with 216

people testing positive for the deadly virus,taking the total number of those afflicted withthe pandemic to 2,242. Mumbai (48) and

Pune (36) topped the list of cases followed byChennai (30) and Delhi (25).

The other cases were from Bangalore (17),

Nagpur (13), Coimbatore (9), Dhule (5),35358/23/2009


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Swine flu to get worse, sayexperts

Wed, Aug 19 06:05 AM

The swine flu pandemic is only going toworsen in the coming months as the H1N1virus, a subtype of influenza virus, isexpected to spread the most during the

monsoon and the winters but expertssought to allay fears saying though thevirus is highly infectious, it has a low

mortality rate. 36368/23/2009


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Click to edit Master subtitle style

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SWINE FLU


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What is H1N1 Influenza ("Swine" Flu): ?

H1N1 Influenza ("Swine" Flu): is a respiratory disease ofpigs caused by type A influenza viruses that causesregular outbreaks in pigs

People do not normally get H1N1 Influenza(swine flu), but human infections can and dohappen

This flu strain has been reported to spread from

person-to-person, but in the past, this transmissionwas limited and not sustained beyond three people

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A ti i d G ti Ch t i ti f S i


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Antigenic and Genetic Characteristics of Swine-Origin 2009 A(H1N1) Influenza Viruses Circulating

in Humans Science,10 July 2009:Vol. 325. no. 5937, pp. 197 - 201

Since its identification in April 2009, anA(H1N1) virus containing a uniquecombination of gene segments from bothNorth American and Eurasian swine lineageshas continued to circulate in humans.

The lack of similarity between the 2009A(H1N1) virus and its nearest relativesindicates that its gene segments have beencirculating undetected for an extended

period. 39398/23/2009

f


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Influenza A virus subtypeH1N1

The 2009 fluoutbreak inhumans is due to a

new strain ofinfluenza A virussubtype H1N1 thatderives in part fromhuman influenza,avian influenza, andtwo separate strains of

swine influenza.40408/23/2009


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Are there human infections withnovel H1N1 virus in the U.S.?

Yes. Human infections with the new H1N1virus are ongoing in the United States

Most people who have become ill withthis new virus have recoveredwithout requiring medical treatment

CDC routinely works with states to collect,compile and analyze information about

influenza, and has done the same for the new41418/23/2009


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Emergence of a Novel Swine-OriginInfluenza A (H1N1) Virus in Humans

Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team

NEJM,Volume 360:2605-2615June 18,2009Number 25 Triple-reassortant swine influenza viruses,

which contain genes from human, swine,and avian influenza A viruses, havebeen identified in swine in the United Statessince 1998,1,2 and 12 cases of humaninfection with such viruses were identified in

the United States from 2005 through 2009.3 On April 15 and April 17, 2009, the Centers

for Disease Control and Prevention (CDC)

identified two cases of human infection42428/23/2009
http://content.nejm.org/content/vol360/issue25/index.dtlhttp://content.nejm.org/content/vol360/issue25/index.dtlhttp://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R1http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R2http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R3http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R3http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R2http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R1http://content.nejm.org/content/vol360/issue25/index.dtlhttp://content.nejm.org/content/vol360/issue25/index.dtl


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In the past, severe illness (pneumonia andrespiratory failure) and deaths have beenreported with swine flu infection in people

Like seasonal flu, this strain of flu maycause a worsening of underlying chronic

medical conditions.

Why swine flu is serious illness ?

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CDC helps in Diagnosis

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Patients in Outbreak - 1 On March 30, 2009, in San Diego

County, California, a 10-year-old boywith asthma (Patient 1) had an onset offever, cough, and vomiting.

On April 1, he was evaluated in anurgent care clinic, where he received

treatment for his symptoms. Herecovered from the illness withinapproximately 1 week.

An influenza A virus that could not be45458/23/2009

P ti t i O tb k


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Patients in Outbreak - 2 On March 28, 2009, in Imperial County,

California, a 9-year-old girl (Patient 2) withoutan epidemiologic link to Patient 1 had anonset of cough and fever. Two days later, she

was taken to an outpatient clinic that wasparticipating in an influenza surveillanceproject. A nasopharyngeal swab was collectedat the clinic.

Patient 2 was treated with amoxicillinclavulanate, and she had an uneventfulrecovery.

The nasopharyngeal specimen was sent to the46468/23/2009

id i l i i i i


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Epidemiologic investigation

Epidemiologic investigation of Patients 1and 2 revealed that neither patient hada recent history of exposure toswine.

According to protocol, theidentification of these two

epidemiologically unlinked patients withnovel S-OIV infection prompted theCDC to notify state and local healthdepartments, which initiated case

investi ations and im lemented enhanced47478/23/2009


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Clinical spectrum

The clinical spectrum of novel S-OIV infection is stillbeing defined, but both self-limited illness and

severe outcomes, including respiratory failure anddeath, have been observed among identifiedpatients a wide clinical spectrum similar to thatseen among persons infected with earlier strains

of swine-origin influenza viruses3and seasonalinfluenza viruses

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Severe illness and deaths

The severe illness and deaths associatedwith seasonal influenza epidemics are inlarge part the result of secondary

complications,including1.primary viral pneumonia,

2.secondary bacterial

pneumonia (particularly with group Astreptococcus, Staphylococcusaureus, and Streptococcus pneumoniae) and

3. exacerbations of underlying chronic49498/23/2009

Initial Radiograph of the Lung and


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Initial Radiograph of the Lung andLung-Tissue Sample from Patient

The radiograph (Panel A) shows bilateralalveolar opacities in the base of bothlungs that progressed and becameconfluent.

The specimen (Panel B, hematoxylinand eosin) shows necrosis of bronchiolarwalls (top arrow), a neutrophilic infiltrate(middle arrow), and diffuse alveolardamage with prominent hyaline

membranes (bottom arrow). Bacterialcultures were negative on admission,and no evidence of bacterial infection ofthe lungs was found. The patientultimately died

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Risk for severe


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Risk for severecomplications

Patients who are at highest risk for severecomplications of S-OIV infection are likely toinclude but may not be limited to groups athighest risk for severe seasonal influenza

: children under the age of 5 years, adults 65years of age or older,

children and adults of any age with underlyingchronic medical conditions, and

pregnant women

Of the 22 hospitalized patients with confirmed51518/23/2009


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Wh t i l H1N1 ( i


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What is novel H1N1 (swineflu)?

Novel H1N1 (referred to as swine fluearly on) is a new influenza virus causingillness in people

This new virus was first detected in peoplein the United States in April 2009

This virus is spreading from person-to-

person worldwide, probably in much thesame way that regular seasonal influenzaviruses spread

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Wh i l H N i


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Why is novel H1N1 virussometimes called swine flu?

This virus was originally referred to asswine flu because laboratory testingshowed that many of the genes in this new

virus were very similar to influenza virusesthat normally occur in pigs (swine) in North

America

But further study has shown that this newvirus is very different from what normally

circulates in North American pig 54548/23/2009


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H1N1 influenza virus

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Reassortment of different strains


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Reassortment of different strains

Like all influenza viruses, swine flu viruses

change constantly Pigs can be infected by avian influenza and

human influenza viruses as well as swine

influenza viruses. When influenza viruses from different species

infect pigs, the viruses can reassort (i.e.

swap genes) and new viruses that are a mixof swine, human and/or avian influenza virusescan emerge

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P t S i Fl t i


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Present Swine Flu strains

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3D Influenza virus

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Out breaks among Pigs

Outbreaks among pigsnormally occur incolder weather

months (late fall andwinter) andsometimes with theintroduction of newpigs into susceptibleherds

Studies have shownthat the swine flu62628/23/2009


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How man is exposed


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How man is exposed

Most commonly, these cases occur in persons withdirect exposure to pigs (e.g. children near pigs at a fairor workers in the swine industry). In addition, therehave been documented cases of one person spreading

swine flu to others

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Is novel H1N1 virus


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Is novel H1N1 virus

contagious?

CDC has determined that novel H1N1virus is contagious and is spreading fromhuman to human

Incubation period : 2 to 7 days

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Person to person transmission


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Person to person transmissionthrough coughing or sneezing

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How does novel H1N1 virus


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How does novel H1N1 virusspread?

Spread of novel H1N1 virusis thought to occur in thesame way that seasonal flu

spreads Flu viruses are spread

mainly from person to person

through coughing orsneezing by people withinfluenza

Sometimes people may

become infected by touching67678/23/2009

Avoid close contact


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Avoid close contactAerosols spread the virus in any

environment

Avoid close contactwith people who

are sick. When you are sick,

keep your distance

from others toprotect them fromgetting sick too.

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Touching something with swine flu


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Touching something with swine fluinfluenza on it

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What surfaces are most likely


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yto be sources ofcontamination?

The virus can be spread when a persontouches something that is contaminatedwith the virus and then touches his or hereyes, nose, or mouth.

Droplets from a cough or sneeze of aninfected person move through the air. Thevirus can then be spread when a persontouches respiratory droplets from anotherperson on a surface like a desk,

doorknob, childs toy or phonehandset and then touches their owneyes, mouth or nose before washing theirhands.

What are the signs and symptoms


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What are the signs and symptomsof this virus in people?

The symptoms of novel H1N1 flu virus in peopleinclude fever, cough, sore throat, runny or stuffynose, body aches, headache, chills and fatigue

A significant number of people who have beeninfected with this virus also have reporteddiarrhea and vomiting

Severe illnesses and death has occurred as a

result of illness associated with this virus.71718/23/2009


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United States

The age distribution of the 35 laboratory-confirmed hospitalized patients

6 months to 53 years (median: 15

years). Among patients with confirmed disease

for whom data were available,

262 (90%) of 292 reported fever,

249 (84%) of 296 reported cough,

176 (61%) of 290 reported sore throat,72728/23/2009


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How severe is illness associated with


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How severe is illness associated withnovel H1N1 flu virus? [ 1 ]

Illness with the newH1N1 virus hasranged from mild to

severe

While most peoplewho have been sickhave recovered

without needing8/23/2009 7474

How severe is illness associated


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How severe is illness associatedwith novel H1N1 flu virus? [2]

In seasonal flu, certain people are at high risk ofserious complications.

This includes people 65 years and older, children

younger than five years old, pregnant women, andpeople of any age with certain chronic medicalconditions.

About 70 percent of people who have been

hospitalized with this novel H1N1 virus have had oneor more medical conditions previously recognized asplacing people at high risk of serious seasonal flu-related complications. This includes pregnancy,

diabetes, heart disease, asthma and kidney disease.75758/23/2009

How long can an infected person


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How long can an infected personspread this virus to others?

People infected with seasonal and novel H1N1flu shed virus and may be able to infect othersfrom 1 day before getting sick to 5 to 7 days

after This can be longerin some people, especially

children and people with weakened immunesystems and in people infected with the new

H1N1 virus.

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How severe is illness associated


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How severe is illness associatedwith novel H1N1 flu virus? [3]

One thing that appears to be different fromseasonal influenza is that adults older than64 years do not yet appear to be at

increased risk of novel H1N1-relatedcomplications thus far.

CDC laboratory studies have shown thatchildren and few adults younger than 60years old do not have existing antibody tonovel H1N1 flu virus; however, about one-

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How does novel H1N1 flu compare to seasonal flu in


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How does novel H1N1 flu compare to seasonal flu interms of its severity and infection rates? [2 ]

When the novel H1N1 outbreak was first detected in mid-April2009, CDC began working with states to collect, compile andanalyze information regarding the novel H1N1 flu outbreak,including the numbers of confirmed and probable cases and the

ages of these people

The information analyzed by CDC supports the conclusion thatnovel H1N1 flu has caused greaterdisease burden in people

younger than 25 years of age than older people

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How does novel H1N1 flu compare to seasonal flu


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How does novel H1N1 flu compare to seasonal fluin terms of its severity and infection rates? [3 ]

At this time, there are few cases and fewdeaths reported in people older than 64years old, which is unusual when

compared with seasonal flu However, pregnancy and other previously

recognized high risk medical conditions

from seasonal influenza appear to beassociated with increased risk ofcomplications from this novel H1N1

These underlying conditions include80808/23/2009

Pandemic (H1N1) 2009 virus


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Pandemic (H1N1) 2009 virus

According to FluNet reporting from the

Global Influenza Surveillance Network(GISN), 3548 detections of the pandemic(H1N1) 2009 influenza virus were reported

from 13 countries in week 30. [20 July -26 July 2009]

The majority of detections were reported

by China, Hong Kong SAR (25%, 1788detections), followed by Australia (21%,834 detections) and Italy (16%, 600detections).

81818/23/2009

T i d d f


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Treatment is recommended for

All hospitalized patients with confirmed,probable or suspected novel influenza

(H1N1).

Patients who are at higher risk for seasonal

influenza complications

82828/23/2009

If t i k


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If you get sick

Stay home if youre sick

for 7 days after your

symptomsbegin or until youve

been

symptom-free for 24hours,

whichever is longer.

If ou are sick, limit our 83838/23/2009

SYMPTOMS


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SYMPTOMS

fever lethargy

lack of appetite

Coughing

runny nose

sore throat nausea

vomiting

diarrhea. 84848/23/2009

Emergency warning signs in


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Emergency warning signs inchildren

If a child gets sick and experiencesany of these warning signs, seekemergency medical care.

In children: Fast breathing or trouble breathing

Bluish or gray skin color

Not drinking enough fluids

Severe or persistent vomiting

Not waking up or not interacting

Irritable, the child does not want to beheld

- 85858/23/2009

To diagnose swine


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To diagnose swineinfluenza A infection

A respiratoryspecimen wouldgenerally need to be

collected within thefirst 4 to 5 days ofillness (when aninfected person is

most likely to beshedding virus)

However, some

ersons es eciall 86868/23/2009

INVESTIGATIONS - Throat swap


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INVESTIGATIONS Throat swap

Respiratory specimen should be collected within

4 to 5 days of illness 87878/23/2009

FDA Authorizes Emergency Use of Influenza


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Medicines, Diagnostic Test in Response toSwine Flu Outbreak in Humans

The U.S. Food and Drug Administration, in response torequests from the U.S. Centers for Disease Control andPrevention, has issued Emergency Use Authorizations(EUAs) to make available to public health and medical

personnel important diagnostic and therapeutic tools toidentify and respond to the swine flu virus under certaincircumstances.

The agency issued these EUAs for the use of certainRelenza and Tamiflu antiviral products, and for the rRT-PCR Swine Flu Panel diagnostic test.

88888/23/2009


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What are the known risks and benefits


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What are the known risks and benefitsof Swine Influenza Test Kit?

The results of this test from nasopharyngealswabs, nasal swabs, throat swabs, dualnasopharyngeal swabs/throat swabs, andnasal aspirates, along with other information,can help your doctor take better care of you

Knowing your test results may help you toprevent the spread of the virus to your familyor others.

90908/23/2009

Real-Time RT-PCR


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Real-Time RT-PCR

The CDC has developed a real-time RT-PCRassay to detect seasonal influenza A, B, H1,H3, and avian H5 serotypes.

This assay has been approved by the Food

and Drug Administration (FDA) and wasdistributed in December 2008 through U.S.Public Health laboratories and the WHO'sGlobal Influenza Surveillance Network.

Primers and probes specific for swineinfluenza A (H1 and H3 subtypes) wererecently developed and tested for use in a

modified version of this assa for the detection91918/23/2009

Real-time reverse-t i ti PCR [ RT


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transcription PCR[rRT-PCR ]

The Food and Drug Administration (FDA) issue an Emergency UseAuthorization (EUA) for emergency use of the Focus Diagnostics InfluenzaA H1N1 (2009) Real-Time RT-PCR for the diagnosis of 2009 H1N1 influenzavirus infection, pursuant to section 564 of the Federal Food, Drug, andCosmetic Act (the Act) (21 U.S.C. 360bbb-3) by CLIA High ComplexityLaboratories, which are laboratories certified under the Clinical LaboratoryImprovement Amendments of 1988, 42 U.S.C. 263a, to perform highcomplexity tests (CLIA High Complexity Laboratories).

rRT PCR is used to amplify and simultaneouslyquantify a targeted DNA molecule. It enables both

detection and quantification (as absolute number ofcopies or relative amount when normalized to DNAinput or additional normalizing genes) of a specificsequence in a DNA sample.

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rRT PCR


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rRT PCR

93938/23/2009


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If this test is negative, does that mean


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g ,that I do not have novel H1N1 flu?

If this test is negative you may be sick withsomething that is not novel H1N1 flu

There is a small chance that this test cangive a result that is wrong (false negative)

A false negative result should not affectyour care

No changes in your medical care shouldbe solely based on a negative result

95958/23/2009


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As the best treatment of any disease is

PREVENTION96968/23/2009


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A nurse carries masks and medicineoutside the influenza A (H1N1) ward in


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outside the influenza A (H1N1) ward inMumbai

98988/23/2009

TAKING PRECAUTION:S d k f h i


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Students wear masks for the precautionagainst swine flu in a Mumbai school

8/23/2009 9999


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TAKING NO CHANCES: People line up


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outside a test at New Delhi's RML Hospital

1031038/23/2009

People wearing masks wait to get tested for H1N1 influenzaat a special ward in Kasturba Hospital in Mumbai

DOs:


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at a special ward in Kasturba Hospital in Mumbai

8/23/2009 104104

Covering sneezes and coughs


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Covering sneezes and coughs

1051058/23/2009


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Prevention


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Prevention

Contact with people from the affectedareas should be cautionary

1071078/23/2009


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Regular and frequent handwash1081088/23/2009


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Chinese Flu Inspectors


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Chinese Flu Inspectors

1111118/23/2009

Exposures Not Thought to


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p gSpread Novel H1N1 Flu

Much of the information in this document is based onstudies and past experience with seasonal (human)influenza.

CDC believes the information applies to novel H1N1(swine) viruses as well, but studies on this virus areongoing to learn more about its characteristics.

This document will be updated as new informationbecomes available

112112

CDC Note:

8/23/2009

Can I get infected with novel H1N1i f i i k


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virus from eating or preparing pork?

No. Novel H1N1 viruses are not spread by food. You cannot get infected with novel HIN1

virus from eating pork or pork products.

Eating properly handled and cooked porkproducts is safe

1131138/23/2009

Can I catch Swine Flu by eatingk?


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pork?

114114

NO8/23/2009

Is there a risk fromd i ki ?


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drinking water? Tap water that has been treated by

conventional disinfection processes does notlikely pose a risk for transmission of

influenza viruses. Current drinking water treatment

regulations provide a high degree of

protection from viruses. No research hasbeen completed on the susceptibility of novelH1N1 flu virus to conventional drinkingwater treatment processes.

1151158/23/2009

Can novel H1N1 flu virus be spread throughwater in swimming pools spas water parks


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water in swimming pools, spas, water parks,interactive fountains, and other treated

recreational water venues?

Influenza viruses infect the human upperrespiratory tract. There has never been a

documented case of influenza virus infectionassociated with water exposure. Recreationalwater that has been treated at CDC

recommended disinfectant levels does notlikely pose a risk for transmission of influenzaviruses.

No research has been completed on the1161168/23/2009

Can novel H1N1 influenza virus bespread at recreational water venues


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spread at recreational water venuesoutside of the water?

Yes, recreational water venues are no differentthan any other group setting.

The spread of this novel H1N1 flu is thought to behappening in the same way that seasonal fluspreads.

Flu viruses are spread mainly from person to

person through coughing or sneezing of peoplewith influenza.

Sometimes people may become infected bytouching something with flu viruses on it and then

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118118

Contamination & Cleaning

8/23/2009

How long can influenzavirus remain viable on


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virus remain viable on

objects (such as books anddoorknobs)?

Studies have shown that influenza virus cansurvive on environmental surfaces and can

infect a person for 2 to 8 hoursafter being deposited on the surface

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*What if soap and water are not availableand alcohol-based products are not


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pallowed in my facility?

Though the scientific evidence is not as

extensive as that on hand washing andalcohol-based sanitizers, other handsanitizers that do not contain alcohol maybe useful for killing flu germs on hands.

1211218/23/2009

How should linens, eating utensilsand dishes of persons infected with


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pinfluenza virus be handled?

Linens, eating utensils, and dishesbelonging to those who are sickdo not needto be cleaned separately, but importantly

these items should not be shared withoutwashing thoroughly first.

Linens (such as bed sheets and towels)

should be washed by using householdlaundry soap and tumbled dry on a hotsetting.

Individuals should avoid hu in laundr1221228/23/2009


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How should waste disposal be handled toprevent the spread of influenza virus?


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prevent the spread of influenza virus?

To prevent the spread of influenza virus, it isrecommended that tissues and other

disposable items used by an infectedperson be thrown in the trash.

Additionally, persons should wash their

hands with soap and water after touchingused tissues and similar waste.

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What household cleaning should bedone to prevent the spread of


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done to prevent the spread ofinfluenza virus?

To prevent the spread of influenza virus it isimportant to keep surfaces (especiallybedside tables, surfaces in the bathroom,

kitchen counters and toys for children) cleanby wiping them down with a householddisinfectant according to directions on the

product label.

1251258/23/2009

Vaccination


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Vaccine are available fordifferent kinds of SwineFlu.

Although the currenttrivalent influenza

vaccine is unlikely toprovide protectionagainst the new 2009H1N1 strain vaccines

1261268/23/2009

The big vaccine race in Indian pharmaSat, Aug 15 02:13 AM Yahoo News


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In early August, Novartis and SanofiAventisbegan the first human tests of theirswine flu vaccines.

In India, the race is between three Indianbiotech companies.

The Pune-based Serum Institute of Indiaseems best placed. It was already working ona vaccine for seasonal flu. Serum Institute's

products are exported to over 140 countries1271278/23/2009

Treatment


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CDC recommendsthe use ofTAMIFLU

[oseltamivir ]orzanamivir for thetreatment and/orprevention of

infection withswine influenzaviruses.

1281288/23/2009

FDA Authorizes Emergency Use of InfluenzaMedicines, Diagnostic Test in Response to Swine


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Flu Outbreak in Humans [ 2 ]

The EUAs allow forTamiflu also to beused to treat and prevent influenza inchildren under 1 year, and to providealternate dosing recommendations forchildren older than 1 year.

In addition, under the EUAs, bothmedications may be distributed to largesegments of the population withoutcomplying with the label requirementsotherwise applicable to dispensed drugs,

and accompanied by written information1291298/23/2009

Treatment


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If a patient is not in a high-risk group oris not hospitalized, healthcare providersshould use clinical judgment to guide

treatment decisions, and whenevaluating children should be aware thatthe risk for severe complications fromseasonal influenza among childrenyounger than 5 years old is highestamong children younger than 2 years old

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Treatment


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Once the decision to administer antiviraltreatment is made, treatment withzanamivir or oseltamivir should be initiatedas soon as possible after the onset ofsymptoms.

Evidence forbenefits from antiviraltreatment in studies of seasonal influenzais strongest when treatment is startedwithin 48 hours of illness onset.

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Treatment


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Recommended duration oftreatment is five days. Antiviraldoses recommended for treatment of novel

H1N1 influenza virus infection in adults orchildren 1 year of age or older are the sameas those recommended for seasonal

influenza (Table 1).

Oseltamivir use for children


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Antiviral Resistance


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This novel (H1N1) influenza virus is sensitive(susceptible) to the neuraminidase inhibitorantiviral medications, zanamivir and oseltamivir

It is resistant to the adamantane antiviral

medications, amantadine and rimantadine

1341348/23/2009

Antiviral resistance pandemic(H1N1) virus


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(H1N1) virus

A total ofsix oseltamivir resistant pandemic(H1N1) 2009 influenza viruses have nowbeen detected from Denmark, Hong KongSAR, Japan and Canada.

Of these three were from patients in Japan.All six patients had received oseltamivir withthe exception of one and have recovered well

All resistant viruses had the characteristicmutation at position 274/275 associatedwith resistance

1351358/23/2009

What about Antivirals?


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Circulating Strains Oseltamivir Zanamivir Amantidine

Rimantidine

Swine H1N1 S S R

Human H1N1 R S S

Human H3N2 S S R

Suspected influenza case (any type): Oseltamivir +amantidine/rimantidine, or zanamivir aloneConfirmed Swine H1N1: Oseltamivir or zanamivir

Prophylaxis: For close contacts of cases, those with high risk ofcomplications, see guidance for details

http://www.cdc.gov/swineflu/recommendations.htm1361368/23/2009


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Transmission


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Transmission of novel influenza A (H1N1) is being studied as

part of the ongoing outbreak investigation, but limited dataavailable indicate that this virus is likely transmitted in wayssimilar to other influenza viruses

Seasonal human influenza viruses are thought to be

transmitted between persons primarily through large-particle respiratory droplet transmission (e.g.,when an infected person coughs or sneezes near asusceptible person)

Transmission via these large-particle droplets requires closecontact between source and recipient persons becausedroplets do not remain suspended in the air and generallytravel only a short distance (< 6 feet)

1391398/23/2009

Household Cleaning, Laundry, and Waste Disposal


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Throw away tissues and other disposable items used by the sick personin the trash. Wash your hands after touching used tissues and similarwaste.

Keep surfaces (esp bedside tables, surfaces in the bathroom, childrens

toys, phone handles, doorknobs) clean by wiping them down with ahousehold disinfectant according to directions on the product label.

Linens, eating utensils, and dishes belonging to those who are sick donot need to be cleaned separately, but importantly these items should

not be shared without washing thoroughly first.

Wash linens (such as bed sheets and towels) by using householdlaundry soap and tumble dry on a hot setting. Avoid hugging laundryprior to washing it to prevent contaminating yourself. Clean your handswith soap and water or alcohol-based hand rub right after handling dirty

laundry.8/23/2009 140140

Transmission


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Contact with contaminated surfaces isanother possible source of transmissionand transmission via small-droplet

nuclei (also called airbornetransmission) might also occur, butthe contribution of these modes oftransmission to influenza epidemiologyis uncertain

Because data on the transmission of

novel H1N1 viruses are limited the1411418/23/2009

Close contact


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Close contact, is defined as having cared

for or lived with a person who is aconfirmed, probable or suspected case ofnovel influenza A (H1N1), or having been

in a setting where there was a highlikelihood of contact with respiratorydroplets and/or body fluids of such aperson

Examples of close contact include kissingor embracing, sharing eating or drinkingutensils, physical examination, or any

other contact between ersons likel to1421428/23/2009

Facemasks: Unless otherwise specified the term facemasks refers to disposable facemasks cleared


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Unless otherwise specified, the term facemasks refers to disposable facemasks clearedby the U.S. Food and Drug Administration (FDA) for use as medical devices

This includes facemasks labeled as surgical, dental, medical procedure, isolation, or lasermasks. Such facemasks have several designs.

One type is affixed to the head with two ties, conforms to the face with the aid of a flexibleadjustment for the nose bridge, and may be flat/pleated or duck-billed in shape.

Another type of facemask is pre-molded, adheres to the head with a single elastic band,and has a flexible adjustment for the nose bridge.

A third type is flat/pleated and affixes to the head with ear loops.

Facemasks cleared by the FDA for use as medical devices have beendetermined to have specific levels of protection from penetration of bloodand body fluids.

Facemasks help stop droplets from being spread by the person wearing them.

They also keep splashes or sprays from reaching the mouth and nose of the personwearing the facemask.

They are not designed to protect against breathing in very small particle aerosolsthat may contain viruses.

Facemasks should be used once and then thrown awa in the trash

1431438/23/2009


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Wear masks

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Cover your mouth and nose.


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Cover your mouthand nose with atissue whencoughing orsneezing. It mayprevent those

around you fromgetting sick

1451458/23/2009

3,000 unauthorised swine flu masks seized


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Mon, Aug 17 05:11 PM Daman, Aug 17(PTI)

Over 3,000 unauthorised masks have

been seized from different medicalstores here during a drive to check theirillegal sale in view of swine flu scare.

"The mask used for prevention of theviral disease were being sold at high ratein those stores," officials said.

1461468/23/2009

Respirators


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Unless otherwise specified, "respirator"refers to an N95 or higher filtering facepiece respirator certified by theCDC/National Institute for OccupationalSafety and Health (NIOSH).

A respirator is designed to protect theperson wearing the respirator againstbreathing in very small particle aerosolsthat may contain viruses

A respirator that fits snugly on the face can1471478/23/2009

Respirators - N95


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AntiviralChemoprophylaxis for


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Chemoprophylaxis for

Novel (H1N1) Influenza For antiviral chemoprophylaxis of novel (H1N1)

influenza virus infection, either oseltamivir orzanamivir are recommended

Duration of antiviral chemoprophylaxispost-exposure is 10 days after the last known

exposure to novel (H1N1) influenza.

1501508/23/2009

High-risk groups


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A person who is at high-risk for

complications of novel influenza (H1N1)virus infection is defined as the same forseasonal influenza at this time

As more epidemiologic and clinicaldata become available, these riskgroups might be revised.

Children younger than 5 years old. Therisk for severe complications fromseasonal influenza is highest amongchildren younger than 2 years old.1511518/23/2009

Pregnant Women Pregnant women are known to be at


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Pregnant women are known to be at

higher risk for complications frominfection with seasonal influenzaviruses, and severe disease among

pregnant women was reportedduring past pandemics. Cases ofconfirmed novel (H1N1) influenza

virus infection in pregnant womenresulting in severe disease havebeen reported, and a pregnant

woman died in 1988 after bein1521528/23/2009

Special Considerations forChildren


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Children

Aspirin or aspirin-containing products(e.g. bismuthsubsalicylate PeptoBismol) should not beadministered to anyconfirmed or

suspected ill case ofnovel influenza H1N1virus infection aged18 years old and8/23/2009 153153

NIV conducts study to findout H1N1 pattern


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out H1N1 pattern

The National Institute of Virology (NIV) haslaunched a time-bound study to understandhow the H1N1 virus affected Pune andMumbai and figure out its pattern.

"It will take at least a year, but we are tryingto find out what clinical diseases this virushas presented and the extent of exposure of

the community," said Dr Mandeep Chadda,Deputy Director, NIV.

1541548/23/2009

Pneumonia and Respiratory Failure from Swine-OriginInfluenza A (H1N1) in Mexico

NEJM Volume 361:680-689August 13 2009Number 7
http://content.nejm.org/content/vol361/issue7/index.dtlhttp://content.nejm.org/content/vol361/issue7/index.dtl


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NEJM,Volume 361:680 689August 13, 2009Number 7

ABSTRACT BackgroundIn late March 2009, an outbreak

of a respiratory illness later proved to be caused

bynovel swine-origin influenza A (H1N1)virus (S-OIV)was identified in Mexico. Wedescribe the clinical and epidemiologiccharacteristics of persons hospitalized forpneumonia at the national tertiary hospital forrespiratory illnesses in Mexico City who hadlaboratory-confirmed S-OIV infection, also

known as swine flu1551558/23/2009

Initial Radiograph of the Lung andLung-Tissue Sample from Patient
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The radiograph (Panel A) shows bilateral

alveolar opacities in the base of bothlungs that progressed and becameconfluent.

The specimen (Panel B, hematoxylin

and eosin) shows necrosis of bronchiolarwalls (top arrow), a neutrophilic infiltrate(middle arrow), and diffuse alveolardamage with prominent hyalinemembranes (bottom arrow). Bacterial

cultures were negative on admission,and no evidence of bacterial infection ofthe lungs was found. The patientultimately died

1561568/23/2009

The median time of presentation to the hospital was 6 days after theonset of symptoms. Most deaths occurred in patients who required

mechanical ventilation on admission. Patient 15 was dischargedfrom the hospital on June 8 2009


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from the hospital on June 8, 2009.

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N Engl J Med. 2009 Jun 18;360(25):2605-15. Epub 2009 May 7.

BACKGROUND: On April 15 and


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BACKGROUND: On April 15 and

April 17, 2009, novel swine-origin influenza A (H1N1)virus(S-OIV) was identified in specimensobtained from twoepidemiologically unlinked patients

in the United States. The samestrain of the virus was identified inMexico, Canada, and elsewhere. We

1591598/23/2009

Emergence of a Novel Swine-OriginInfluenza A (H1N1) Virus in Humans

Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team


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g f ( ) g

NEJM,Volume 360:2605-2615June 18, 2009Number 25

Triple-reassortant swine influenza viruses,which contain genes from human, swine,and avian influenza A viruses, have

been identified in swine in the UnitedStates since 1998,1,2 and 12 cases of humaninfection with such viruses wereidentified in the United States from 2005through 2009.3

On April 15 and April 17, 2009, the Centersfor Disease Control and Prevention (CDC)1601608/23/2009

Patients in Outbreak 1 On March 30 2009 in San Diego
http://content.nejm.org/content/vol360/issue25/index.dtlhttp://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R1http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R2http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R3http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R3http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R2http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R1http://content.nejm.org/content/vol360/issue25/index.dtl


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On March 30, 2009, in San Diego

County, California, a 10-year-old boywith asthma (Patient 1) had an onset offever, cough, and vomiting.

On April 1, he was evaluated in anurgent care clinic, where he receivedtreatment for his symptoms. Herecovered from the illness withinapproximately 1 week.

An influenza A virus that could not be1611618/23/2009

Patients in Outbreak 2 On March 28, 2009, in Imperial County,


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On March 28, 2009, in Imperial County,

California, a 9-year-old girl (Patient 2) withoutan epidemiologic link to Patient 1 had an onsetof cough and fever. Two days later, she wastaken to an outpatient clinic that was

participating in an influenza surveillanceproject. A nasopharyngeal swab was collectedat the clinic.

Patient 2 was treated with amoxicillinclavulanate, and she had an uneventfulrecovery.

The nasopharyngeal specimen was sent to the1621628/23/2009


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Epidemiologic Curve of Confirmed Cases of Human Infection withSwine-Origin Influenza A (H1N1) Virus with Known Date of Illness

Onset in the United States (March 28May 5, 2009).


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Demographic and Clinical Features


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The age of patients with confirmed S-OIV infection

ranged from 3 months to 81 years

A total of 40% of patients were between the ages of 10and 18 years, and only 5% of patients were 51 years of

age or older. Among the patients for whom clinical information was

available, the most common symptoms werefever (94%), cough (92%), and sore throat (66%).

In addition, 25% of patients had diarrhea, and 25%had vomiting.

1661668/23/2009


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Of the 399 patients with confirmed S-OIVinfection for whom hospitalization status wasknown, 36 (9%) required hospitalization.


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The age of hospitalized patients ranged from 19months to 51 years. Of the 22 hospitalizedpatients for whom data were available, 4 (18%)were children under the age of 5 years, and 1

patient(4%) was pregnant.

Nine patients (41%) had chronic medicalconditions: a 41-year-old woman with

autoimmune disease treated withmultiple immunosuppressive agents; a 35-year-old man with Down's syndrome and a history of

congenital heart disease; a 33 year old1691698/23/2009

Severe and fatal illness


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Eight patients (36%) required admission toan intensive care unit, and four patients(18%) had respiratory failure requiringmechanical ventilation.

Fourteen patients (74%) were treated withoseltamivir after admission to the hospital.

As of May 5, 18 of the 22 patients (82%)had recovered from the acute illness;

2 patients a previously healthy 23-month-old child and a previously healthy1701708/23/2009

Severe illness and deaths


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The severe illness and deaths associatedwith seasonal influenza epidemics are inlarge part the result of secondarycomplications,including

1.primary viral pneumonia,

2.secondary bacterialpneumonia (particularly with group A

streptococcus, Staphylococcusaureus, and Streptococcus pneumoniae) and

3. exacerbations of underlying chronic1711718/23/2009

Risk for severecomplications
http://var/www/apps/conversion/current/tmp/scratch23575/78927196.pptx#R16


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Patients who are at highest risk for severecomplications of S-OIV infection are likely toinclude but may not be limited to groups athighest risk for severe seasonal influenza

: children under the age of 5 years, adults 65years of age or older,

children and adults of any age with underlying

chronic medical conditions, and pregnant women

Of th 22 h s itali d ati ts ith fi d1721728/23/2009

Real-Time RT-PCR

The CDC has developed a real time RT PCR


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The CDC has developed a real-time RT-PCR

assay to detect seasonal influenza A, B, H1,H3, and avian H5 serotypes.

This assay has been approved by the Food

and Drug Administration (FDA) and wasdistributed in December 2008 through U.S.Public Health laboratories and the WHO'sGlobal Influenza Surveillance Network.

Primers and probes specific for swineinfluenza A (H1 and H3 subtypes) wererecently developed and tested for use in a1731738/23/2009

Comparison of H1N1 Swine Genotypes inRecent Cases in the United States


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Phylogenetic Analysis of Sequences of allGenes Identified in A/California/04/2009


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Susceptibility of 37 Isolates of Swine-Origin Influenza A(H1N1) Virus to Neuraminidase Inhibitors


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In conclusion[ NEJM ]

We report an outbreak of human infection


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We report an outbreak of human infection

with a novel influenza A (H1N1) virus ofswine originin the United States, which isspreading through sustained human-to-

human transmission in multiple countries. The identification of human S-OIV infection in

geographically dispersed countries and

across continents demonstrates the ease withwhich infection can be spread and facilitated byair and land travel and community networksand gatherings. 1771778/23/2009

reven on an con romeasures As of May 5, 2009, the CDC has recommended that health care


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s o ay 5, 009, t e C C as eco e ded t at ea t ca eworkers who provide direct care for patients with known or

suspected S-OIV infection should observe contact and dropletprecautions, including the use ofgowns, gloves, eye protection,face masks, and fit-tested, disposable N95 respirators.

In addition, patients with confirmed or suspected S-OIVinfection should be placed in a single-patient room with the doorkept closed, and airborne-infection isolation rooms with negative-pressure handling should be used whenever an aerosol-generatingprocedure is being performed.

Frequent hand washing with soap and watermay reduce the risk of

infection and transmission.1781788/23/2009

Sense, not scare is the key to stay safe


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8/23/2009 A Belarussian veterinarian gives a vaccination to pigs at a hogfarm

1801808/23/2009

Non essential visits to the affectedareas should be avoided


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People wait outside a mobileclinic to test for signs ofinfluenza A (H1N1) virus at a


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influenza A (H1N1) virus, at a

mobile clinic in Mexico City.

1821828/23/2009

A Red Cross staff carries apatient with symptoms of

influenza A (H1N1)


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( )

1831838/23/2009


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GreekrevolutionistElefterios

Venizelos'monument isseen covered

with aprotectivemask in

t1841848/23/2009

Overview


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As the pandemic progresses, laboratory testingand confirmation may decrease

Confirmed figures for the United Kingdom, inparticular, are only meaningful up to 2 July2009, when routine testing stopped andpresumed cases were treated withoutlaboratory confirmation of diagnosis

Following the recommendations of the WorldHealth Organization (WHO), most countriesstopped issuing the numbers of the infectedpopulation, making this list inaccurate.1851858/23/2009

The ten countries with most confirmed cases per capita

Pos. Country PopulationConfirmedcases

Confirmed casesper 10,000inhabitants

Includes countries with over 100 confirmed cases only.All population figures are estimates for July 2009
http://en.wikipedia.org/wiki/2009_flu_pandemic_in_the_United_Kingdomhttp://en.wikipedia.org/wiki/2009_flu_pandemic_in_the_United_Kingdom


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8/23/2009 186186

1 Brunei 388,190 850 21.902 Australia 21,262,641 30,111 14.16

3 Chile 16,601,707 12,030 7.25

4 New Zealand 4,213,418 3,038 7.21

5 Malta 405,165 235 5.80

6 Samoa 219,998 100 4.55

7 Iceland 306,694 135 4.40

8 Cyprus 796,740 297 3.73

9 Canada 33,487,208 11,883 3.5510 Israel 7,233,701 2,148 2.97

World 6,790,062,216 243,875 0.359

8/23/2009

Number of confirmed cases of A(H1N1) virus in Asia(as of 23 June 2009):
http://en.wikipedia.org/wiki/Bruneihttp://en.wikipedia.org/wiki/Australiahttp://en.wikipedia.org/wiki/Chilehttp://en.wikipedia.org/wiki/New_Zealandhttp://en.wikipedia.org/wiki/Maltahttp://en.wikipedia.org/wiki/Samoahttp://en.wikipedia.org/wiki/Icelandhttp://en.wikipedia.org/wiki/Cyprushttp://en.wikipedia.org/wiki/Canadahttp://en.wikipedia.org/wiki/Israelhttp://en.wikipedia.org/wiki/Israelhttp://en.wikipedia.org/wiki/Canadahttp://en.wikipedia.org/wiki/Cyprushttp://en.wikipedia.org/wiki/Icelandhttp://en.wikipedia.org/wiki/Samoahttp://en.wikipedia.org/wiki/Maltahttp://en.wikipedia.org/wiki/New_Zealandhttp://en.wikipedia.org/wiki/Chilehttp://en.wikipedia.org/wiki/Australiahttp://en.wikipedia.org/wiki/Brunei


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50 000+ cases 5 000+ cases

500+ cases

50+ cases

5+ cases

1+ cases

1871878/23/2009

A map of the infected countriesof the H1N1 flu of 2009

Confirmed death and infections


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Confirmed infections

Confirmed death and infections

Unconfirmed infections

8/23/2009


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Civic body launches swine flu quitIndia campaign in schools, colleges


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Indian Express: With educational institutions reopening on

August 24, the Pune Municipal Corporation

(PMC) on Thursday announced the launchof swine flu quit India campaign whichwould create awareness about the H1N1virus in school and colleges

Schools must dedicate about 15 minutes ofthe first period to impart knowledge aboutswine flu and

1901908/23/2009

Swine flu claims 20th victim in PunePTI : Sat, Aug 22, 2009 at 12:07
http://www.indianexpress.com/news/civic-body-launches-swine-flu-quit-india-campaign-in-schools-colleges/504912/http://www.indianexpress.com/news/civic-body-launches-swine-flu-quit-india-campaign-in-schools-colleges/504912/


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Pune: Pune reported its 20th swine flu death on

Saturday with a 60-year-old man succumbingto the virus.

Baban Hangule was critical when he wasadmitted to the Government-run SassoonHospital on August 19, hospital officials said.

Meanwhile, the authorities are yet to take adecision on reopening of schools and colleges.

Th d ti l i tit ti l d f

8/23/2009 191191

WHO predicts 'explosion'of swine flu cases


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The global spread of swine flu willendanger more lives as it speeds up incoming months and governments must

step preparations for a swift response,the World Health Organization said.

There will soon be a period of furtherglobal spread of the virus, and mostcountries may see swine8/23/2009 192192

WHO warns ofsecond wave of swine flu pandemic

Sun, Aug 23 01:20 PM


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Geneva, Aug.23 (ANI):

The World Health Organisation (WHO) isurging people around the world to bracethemselves for a second wave of the swine flupandemic as the heavily populated northernhemisphere edges towards the cooler season

when flu thrives. "The WHO is still mobilised and worried,"

spokesman Gregory Hartl said as the global8/23/2009 193193

Suspected flu deaths take toll to 66;131 new HINI cases reported


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Sun, Aug 23 10:00 PM

New Delhi, Aug.23 (ANI):A total of 131

fresh cases of swine flu were reported fromdifferent parts of the country on Saturday,Health Ministry sources said in Delhi.

The new cases included 44 in Delhi,Karnataka 21, Bangalore 19, Gadag 1,Belgaum 1, Tamil Nadu 20, Chennai 17,Coimbatore 3, Maharashtra 23, Pune 1 and8/23/2009 194194

SWINE FLU IN INDIACold weather conducive to growth of swine flu virus

New Delhi: Pune and Bangalore have been the worst hit


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New Delhi: Pune and Bangalore have been the worst-hit

from H1N1 Influenza (swine flu) cases and experts havebeen warning that low temperaturewill lead to a spurtin positive cases.

Bangalore has seen more than 85 cases of H1N1 Influenzain the last one week and Pune more than 300 cases sincemid July.

The reason of so many cases in the two cities is the

temperature asvirus thrives between 20-35 degrees "Influenza family of viruses like cold condition. H1N1

seems to be more infective in the weatherprevalent in Bangalore and Pune," says Dr Purnima

t t t t

1951958/23/2009

Swine flu patient recovers by
http://weeksupdate.com/2009/08/swine-flu-patient-recovers-by-time-test.htmlhttp://weeksupdate.com/2009/08/swine-flu-patient-recovers-by-time-test.html


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Sunday, August 23, 2009 Bhopal, Aug 23 (IANS)

A suspected swine flu patient in

Madhya Pradesh's Indore cityhadrecovered on his ownby the time hissample report, indicating he had tested

positive, was received from New Delhi,officials said Sunday.

According to Indore District Collector Rakesh8/23/2009 196196

ALARM BELLS: H1N1 virus has spread toalmost every countryin the world since it was

discovered at the end of March, says WHO.


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H1N1 Swine flu - What should I do?
http://weeksupdate.com/2009/08/h1n1-swine-flu-what-should-i-do.htmlhttp://weeksupdate.com/2009/08/h1n1-swine-flu-what-should-i-do.html


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Thursday, August 06, 2009 Ministry of Health and Family Welfare,

Government of India has issued the revisedGuidelines for testing of persons with flu likesymptoms reporting at hospitals notified forinfluenza H1N1.

Under the new guidelines, any person withflu like symptoms such as fever, cough, sorethroat, cold, running nose etc. should go to a

d i t d G t f ilit f i i

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2009Government of India,Ministry of Health and Family WelfareInfluenza A [H1N1]


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As on 13th August 2009World HealthOrganization has reported 1, 82,166laboratory confirmed cases of influenzaA/H1N1 and 1799 deaths. No further update

is available. Health screening of passengers coming from

affected countri

8ab3h1n1 influenza a (swine flu ) pandemic 2009 power point

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