human swine influenza: a clinician's perspective
TRANSCRIPT
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
1/46
HUMAN SWINE INFLUENZA:HUMAN SWINE INFLUENZA:
A CLINICIANS PERSPECTIVEA CLINICIANS PERSPECTIVE
Noahdel Hallel C. FranciscoNoahdel Hallel C. Francisco
BS BiologyBS Biology
Major in ZoologyMajor in Zoology
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
2/46
I.I. What is influenza virus?What is influenza virus?
II.II. Clinical presentation of the influenzaClinical presentation of the influenzapandemicpandemic
III.III. Treatment of influenzaTreatment of influenza
IV.IV. Current updates on A(H1N1) CasesCurrent updates on A(H1N1) Cases
OUTLINEOUTLINE
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
3/46
OBJECTIVESOBJECTIVES
1.1. ToTo discussdiscuss aboutabout humanhuman swineswine influenzainfluenzavirusvirus oror A(HA(H11NN11)) andand itsits history,history,evolutionevolution andand diagnosticdiagnostic trailtrail;;
2.2. ToTo elaborateelaborate onon thethe clinicalclinical presentationpresentationofof thethe pandemicpandemic influenzainfluenza;;
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
4/46
OBJECTIVESOBJECTIVES
3.3. ToTo discussdiscuss howhow influenzainfluenza isis beingbeing managedmanaged
throughthrough selfself--carecare treatmenttreatment proceduresproceduresandand recommendedrecommended medicationsmedications;; andand
4.4. ToTo givegive thethe currentcurrent updatesupdates regardingregardinginfluenzainfluenza casescases..
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
5/46
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
6/46
ORTHOMYXOVIRIDAEORTHOMYXOVIRIDAE
Genus Species Serotypes Hosts
Influenzavirus A Influenza A virus H1N1, H1N2, H2N2,H3N1, H3N2, H3N8,
H5N1, H5N2, H5N3,H5N8, H5N9, H7N1,H7N2, H7N3, H7N4,H7N7, H9N2, H10N7
Human, pig,bird, horse
Influenzavirus B Influenza B virus Human, seal
Influenzavirus C Influenza C virus Human, pig
Isavirus Infectious salmonanemia virus
Atlantic salmon
Thogotovirus Thogoto virus Batken virus,Dhori virus
Tick, mosquito,mammal (inc.
human)Dhori virus
Table 1. Genera-associated species and serotypes ofOrthomyxoviridae
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
7/46
Genus Species Serotypes HostsInfluenzavirus A Influenza
A virusH1N1, H1N2,H2N2, H3N1,H3N2, H3N8,H5N1, H5N2,H5N3, H5N8,H5N9, H7N1,H7N2, H7N3,H7N4, H7N7,
H9N2, H10N7
Human, pig,bird, horse
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
8/46
INFLUENZA A VIRUSINFLUENZA A VIRUS
www.wikipedia.org
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
9/46
SWINE INFLUENZA VIRUSSWINE INFLUENZA VIRUS
anyany strainstrain ofof thethe influenzainfluenza familyfamily ofofvirusesviruses thatthat isis endemicendemic inin pigspigs
duedue toto reassortment,reassortment, therethere havehave beenbeentransferstransfers ofof genesgenes amongamong strainsstrains
crossingcrossing swine,swine, avian,avian, andand humanhumanspeciesspecies boundariesboundaries
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
10/46
HISTORY OF PANDEMICHISTORY OF PANDEMICINFLUENZAINFLUENZA
Spanish FluSpanish Flu
-- earliest known pandemicearliest known pandemic-- 1918 to 19201918 to 1920
-- killed 40 million peoplekilled 40 million people
-- major cause: troop movementsmajor cause: troop movementsduring World War 1during World War 1
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
11/46
HISTORY OF PANDEMICHISTORY OF PANDEMICINFLUENZAINFLUENZA
Asian FluAsian Flu
-- 1.5 M fatalities1.5 M fatalities
-- 1957 to 19581957 to 1958
HongkongHongkong FluFlu-- 1 M fatalities1 M fatalities
-- 1968 to 19691968 to 1969
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
12/46
HISTORY OF PANDEMICHISTORY OF PANDEMICINFLUENZAINFLUENZA
1976 US outbreak1976 US outbreak
19881988 zoonosiszoonosis
1998 US outbreak in swine1998 US outbreak in swine
2007 Philippine outbreak in swine2007 Philippine outbreak in swine
2009 outbreak in human2009 outbreak in human
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
13/46
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
14/46
Photo courtesy of: National Institute
of Allergy and Infectious Diseases(NIAID)
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
15/46
DIAGNOSTIC TRAILDIAGNOSTIC TRAIL
Novel strain of humanH1N1 influenza A virus
mysterious influenza-like illness in the townof La Gloria
WHO alert due to
further cases in Mexico
First reports in Englishlanguage media April21st
Confirmed A(H1N1) intwo children in SanDiego, California
642 confirmed cases in USA
Virus also reached
Canada and Europe
Remote countries werealso afflicted, includingAustralia
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
16/46
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
17/46
CASE DEFINITIONSCASE DEFINITIONS
vary between countries with few cases ofvary between countries with few cases ofswine flu compared to those with manyswine flu compared to those with many
casescases
e.g. Australia (only 400 cases)e.g. Australia (only 400 cases)
1. acute febrile respiratory illness1. acute febrile respiratory illness2. acute respiratory illness2. acute respiratory illness
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
18/46
CASE DEFINITIONSCASE DEFINITIONS
CDCs case definition:CDCs case definition:
InfluenzaInfluenza--like illness (ILI)like illness (ILI)
-- fever and cough and/or a sore throat infever and cough and/or a sore throat inthe absence of a known cause other thanthe absence of a known cause other than
the influenzathe influenza
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
19/46
CASE DEFINITIONSCASE DEFINITIONS
CDCs case definition:CDCs case definition:
1.1. Confirmed caseConfirmed case
2.2. Probable caseProbable case
3.3. Suspected caseSuspected case
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
20/46
SYMPTOMSSYMPTOMS
Sudden fever of 38Sudden fever of 38 C or higherC or higher
HeadacheHeadache
Dry coughDry cough Extreme weakness and exhaustionExtreme weakness and exhaustion
Other symptoms may include:Other symptoms may include:
Chills, loss of appetite, sore throat andChills, loss of appetite, sore throat andrunny or stuffy noserunny or stuffy nose
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
21/46
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
22/46
CONFIRMING DIAGNOSISCONFIRMING DIAGNOSIS
rapid diagnosis of human swinerapid diagnosis of human swineinfluenza infection is essential to:influenza infection is essential to:
-- minimise spread of conditionminimise spread of condition
-- protect patients from developingprotect patients from developing
complicationscomplications-- inform public health responseinform public health response
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
23/46
CONFIRMING DIAGNOSISCONFIRMING DIAGNOSIS
Does illness in the patient meet the current casedefinition for possible swine influenza?
Patient is isolated
Throat and nasal swab for viral PCRtesting and viral culture is collected
Testing involves health care worker
Patient sent home for isolation,wait for pending result of the test
Use of antiviral will be recommended
when diagnosis is confirmed positive
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
24/46
MODE OF TRANSMISSIONMODE OF TRANSMISSION
Droplets of moistureDroplets of moisture
from an infectedfrom an infectedperson throughperson throughsneezing, coughingsneezing, coughing
or talkingor talking
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
25/46
Touching infectedTouching infected
hard surfaces andhard surfaces andtouching the mouthtouching the mouthor nose afterwards,or nose afterwards,without washing thewithout washing thehands first.hands first.
MODE OF TRANSMISSIONMODE OF TRANSMISSION
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
26/46
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
27/46
STANDARD PROCEDURES TOSTANDARD PROCEDURES TOPREVENT SPREADING THE VIRUSPREVENT SPREADING THE VIRUS
1. Get a flu shot.
2. Clean your hands.
3. Cover your cough.
4. Stay at home.
5. Call your doctor.
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
28/46
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
29/46
PERSONAL CARE OF ANPERSONAL CARE OF ANINFLUENZAINFLUENZA--INFECTED PATIENTINFECTED PATIENT
1.1. Rest and get lots of sleep.Rest and get lots of sleep.
2.2. Try to stay away fromTry to stay away frompeople for 7 days afterpeople for 7 days afterfirst symptom occurs.first symptom occurs.
3.3. Drink lots of fluids.Drink lots of fluids.
4.4. Gargle with warm saltGargle with warm saltwater.water.
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
30/46
5.5. Use saline nose drops orUse saline nose drops or
spray.spray.6.6. Do not smoke. AvoidDo not smoke. Avoid
second hand smoke.second hand smoke.
7.7. Take recommended overTake recommended over--thethe--counter medications.counter medications.
PERSONAL CARE OF ANPERSONAL CARE OF ANINFLUENZAINFLUENZA--INFECTED PATIENTINFECTED PATIENT
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
31/46
POTENTIALLY RECOMMENDEDPOTENTIALLY RECOMMENDEDANTIANTI--VIRALSVIRALS
1.1. OseltamivirOseltamivir [[TamifluTamiflu]]
2.2. ZanamivirZanamivir [[RelenzaRelenza ]]3.3. AmantidineAmantidine
4.4. RimantidineRimantidine
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
32/46
POTENTIALLY RECOMMENDEDPOTENTIALLY RECOMMENDEDANTIANTI--VIRALSVIRALS
Dose by Age Treatment dose for 5 days
< 3 months 12 mg twice daily
3-5 months 20 mg twice daily
6-11 months 25 mg twice daily
Table 2. Treatment doses of oseltamivir [Tamiflu] for infants authorized by
the FDA on April 27th 2009
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
33/46
POTENTIALLY RECOMMENDEDPOTENTIALLY RECOMMENDEDANTIANTI--VIRALSVIRALS
Table 3. Treatment doses of oseltamivir [Tamiflu] for 1 year of age authorized
by the FDA on April 27th 2009
Dose by age[years]
Dose byweight
[kg]
Dose for 5 days Number ofbottles needed
of oralsuspension for5-day course
Number ofcapsules
needed for5-daycourse
1-2 < 15 30 mg twice daily 1 10 capsules[30 mg]
3-5 15-23 45 mg twice daily 2 10 capsules[45 mg]
6-9 23-40 60 mg twice daily 2 20 capsules[30 mg]
> 10 > 40 75 mg twice daily 3 10 capsules
[75
mg]
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
34/46
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
35/46
VACCINESVACCINES
Identification of a new virus
Preparation of vaccine strain
Verification of vaccine
strain
Optimization of virus growth
conditions
Vaccine filling and release
Clinical studies
Quality control
Vaccine bulk manufacture
Preparation of reagents totest the vaccine
Activities at WHO
collaborating centers
Activities at vaccine
manufacturers
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
36/46
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
37/46
FoodFood andand DrugDrug AdministrationAdministration (FDA)(FDA)issuedissued EmergencyEmergency UseUse AuthorizationsAuthorizations
toto makemake availableavailable RelenzaRelenza andand TamifluTamifluantiviralantiviral drugsdrugs
LegalLegal immunityimmunity setset forfor swineswine fluflu vaccinevaccinemakersmakers
ACROSS THE GLOBEACROSS THE GLOBE
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
38/46
WHOWHO issuedissued guidelinesguidelines forfor thethe useuse of ofantiviralsantivirals inin thethe managementmanagement ofof patientspatients
infectedinfected withwith thethe HH11NN11 pandemicpandemic virusvirus
MonitoringMonitoring ofof outbreaksoutbreaks
PreparationPreparation forfor aa secondsecond wavewave of ofpandemicpandemic spreadspread (northern(northern hemisphere)hemisphere)
ACROSS THE GLOBEACROSS THE GLOBE
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
39/46
PHILIPPINE SETTINGPHILIPPINE SETTING
July 17, 2009: 1 new death confirmed inJuly 17, 2009: 1 new death confirmed inthe Philippinesthe Philippines
Policy of mitigationPolicy of mitigation
Government is preparing for possibleGovernment is preparing for possiblesecond pandemic spread by continuouslysecond pandemic spread by continuouslymonitoring the situation (DOH)monitoring the situation (DOH)
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
40/46
PHILIPPINE SETTINGPHILIPPINE SETTING
Current Philippine response alert level is:Current Philippine response alert level is:
LEVEL 4LEVEL 4
ConfirmedConfirmed case(s)case(s) and/orand/or deathdeath relatedrelated totoInfluenzaInfluenza A(HA(H11NN11)) virusvirus inin thethe PhilippinesPhilippines..
ConfirmedConfirmed case(s)case(s) inin school(s)school(s)..
ConfirmedConfirmed humanhuman--toto--humanhuman transmission(s)transmission(s)..
DeclaredDeclared communitycommunity outbreak(s)outbreak(s)..
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
41/46
Fig. 1 Outbreak in the
Philippines as confirmed orsuspected by different
agencies (09:47 pm,
Saturday, August 29, 2009)
Confirmed cases followed by death
Confirmed community outbreak of
H1N1
Confirmed cases by the DOH
Unconfirmed or suspected cases
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
42/46
INTERNATIONAL RESPONSEINTERNATIONAL RESPONSETO INFLUENZAS THREATTO INFLUENZAS THREAT
InternetInternet
Authoritative websitesAuthoritative websites
Medical journalsMedical journals
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
43/46
SUMMARY ANDSUMMARY ANDCONCLUSIONCONCLUSION
InfluenzaInfluenza AA isis currentlycurrently thethe greatestgreatestpandemicpandemic threatthreat toto humankindhumankind..
AA newnew strainstrain ofof swineswine influenzainfluenza virusvirus beganbeganitsits outbreakoutbreak inin MexicoMexico andand hashas takentaken itsits tolltoll
untiluntil now,now, declaringdeclaring aa hugehuge threatthreat amongamongthethe humankindhumankind..
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
44/46
SUMMARY ANDSUMMARY ANDCONCLUSIONCONCLUSION
PreventivePreventive measuresmeasures havehave beenbeen promotedpromotedsuchsuch asas selfself--carecare treatmenttreatment proceduresprocedures andand
takingtaking inin of of recommendedrecommended medications,medications, ee..gg..oseltamiviroseltamivir andand zanamivirzanamivir..
ClinicalClinical casescases havehave beenbeen rapidlyrapidly increasing,increasing,thusthus internetinternet hashas beenbeen aa majormajor sourcesource ofofspreadingspreading andand accessingaccessing informationinformation onlineonline..
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
45/46
SUMMARY ANDSUMMARY ANDCONCLUSIONCONCLUSION
BeingBeing awareaware andand informedinformed ofof thethe humanhumanswineswine influenzainfluenza virusvirus andand itsits pandemicpandemic
effecteffect cancan leadlead toto concernedconcerned peoplepeople withwithestablishedestablished hygienichygienic practicespractices toto minimizeminimizespreadingspreading ofof thethe virusvirus..
Prevention is better than cure.Prevention is better than cure.
-
8/8/2019 HUMAN SWINE INFLUENZA: A Clinician's Perspective
46/46