Influenza A H1N1 Virus Infection

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Influenza A (H1N1) Virus Infection

• Dr. Amar Fettle, DSO, IDSP- Tvm
• State Nodal Officer-H1N1
• 94474 51846 E-mail amarfettle_at_gmail.com

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Public Health Concern

• affected countries with Influenza A H1N1 is
  increasing.
• human cases also is increasing.
• human population has no immunity.
• further mutation to a lethal novel Influenza
  virus.

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Transmission

• virus is transmitted through
• large-particle respiratory droplet
• close contact
• contaminated surfaces

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Survival of the influenza virus H5N1

• Survives well in environment
• Non porous (stainless steel) surface- 24 hrs.
• Porous (handkerchief, tissue paper) surface- 12
  hrs
• Hand 5 minutes.

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Incubation period

• The estimated incubation period is unknown and
  could range from 1-7 days, and more likely 1-4
  days.

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Case Definitions

• A confirmed case of H1N1 infection is defined as
  a person fever and respiratory illness
  with
  laboratory confirmed H1N1 infection at a
  Reference Lab

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Symptoms

• Fever
• chills
• headache
• upper respiratory tract symptoms
• (cough, sore throat, cold shortness of
  breath),
• myalgias, arthralgias,
• fatigue,
• vomiting, or diarrhea.

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Complications

• similar to those of seasonal influenza
• Worsening of underlying medical conditions

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Groups at high risk for complications

• Children lt 5 years old
• Persons aged 65 years or older
• Children and adolescents receiving long-term
  aspirin therapy Pregnant women
• Adults and children with chronic disorders
• Adults and children who have immunosuppression
  Residents of nursing homes / chronic-care
  facilities

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Infectivity

• from -1 to up to 7 days.
• Children, especially younger children- longer
  periods.  

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Testing for swine-origin influenza A (H1N1) virus
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Lab facilities in India

• NICD Delhi
• NIV - Pune
• 16 more centres soon
• CMC Vellore,
• JIPMER,
• NIMHANS, Bangalore
• Hyderabad

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Sample collection

• Nasal swab and
• Throat swab

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Who should be tested?

• Priority for testing includes persons who
• 1) require hospitalization or
• 2) are at high-risk for severe disease (as
  listed above).

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Drugs- Tamiflu

• To treat suspected/confirmed cases.
• To give prevention to
• 1. Case contacts.
• 2. Other exposed individuals.
• 3. For mass prophylaxis during pandemic
  phase.
• 4. For mass prophylaxis during intervening
  period till vaccination becomes effective.

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Social interventions

• Simple public health Measures
• Respiratory etiquettes.
• Frequent hand wash.
• Keeping distance.
• Self monitoring of fever.
• Reporting
• Isolation Home quarantine

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Community measures

• Social distancing measures.
• Avoiding crowded places.
• Border / Port /Airport control.
• Infection Control practices.
• Risk communications.

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Dos Donts

• Avoid close contact with people having
  respiratory illness.
• Sick persons to keep distance from others.
• Cover Mouth Nose with towel while
  coughing/sneezing.
• Hand washing.
• Get plenty of sleep, be physically active, manage
  stress, drink plenty of fluids nutritious diet.

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OCCUPATIONAL HEALTH

• Prompt recognition of staff with influenza like
  illness and those who are symptomatic should be
  evaluated and excluded from duty
• Develop a system to monitor work absenteeism for
  health reason
• Availability of antiviral agents for treatment of
  exposure

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Maintenance of Work/Business Continuity

• Expect high absenteeism, upto 70
• Essential services plan of action to
• key persons to keep things running, at all
  levels, standby

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Essential services

• Medical
• Law and order
• Transport
• Water
• Electricity
• Sanitation
• Telecom
• Public distribution
• Airlines

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Passengers on Aircraft from affected countries
(Interim recommendations)

• Look for
• Passengers with respiratory symptoms or fever.
• Any passenger who appears ill, or who reports not
  feeling well, should be observed or queried for
  the following signs or symptoms
• Feeling feverish or temperature greater than
  100F (37.8C) if measured.
• For children, feeling warm by parents report.
• Sore throat
• Cough
• Stuffy or runny nose
• Any passengers observed to have or who report
  having two or more of these symptoms should be
  reported immediately to the Quarantine Station of
  jurisdiction where the planeis expected to land.

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• Guidelines available in websites
• ( www.arogyakeralam.gov.in
• www.mohfw.nic.in)