Influenza A H1N1

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Influenza A (H1N1)

• Dr A Almusleh
• Chairman ED HMC Emergency Preparedness Committee

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• Influenza Viruses
• Influenza Viruses discovered 1933
• There are four main influenza A virus subtypes
  been isolated in pigs H1N1, H1N2, H3N2, and
  H3N1.
• The classical Swine flu virus Regularly causes
  outbreaks of influenza among pigs
• The H1N1 swine flu viruses are antigenicly very
  different from human H1N1 viruses

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Causes of Global pandemics

• Pandemics Death Toll Since 1900
• 1918-1919 (Spanish Flu Subtype H1N1)
• U.S.... 675,000
• Worldwide... 50,000,000
• 1957-1958( Asian Flu Subtype H2N2)
• U.S.... 70,000
• Worldwide... 1-2,000,000
• 1968-1969 ( Hong Kong Flu H3N2)
• U.S.... 34,000
• Worldwide... 700,000

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What is (H1N1 Flu) (Swine flu)?

• H1N1 Flu (Previously Swine flu) is a novel
  influenza virus causing illness in Human.
• In Mexico, surveillance began picking up cases of
  ILI starting March 18, 2009
• First reported in people in late March 2009 in
  the United States in Southern California and near
  San Antonio, Texas.

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• Transmission
• Spread, in much the same way as seasonal
  influenza viruses
• Respiratory droplets
• Airborne
• Touching infected Surfaces

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Preventing Transmission

• Cover your nose or mouth with a tissue when you
  sneeze or cough
• Wash your hands frequently with soap and water
• Wearing a mask helps to prevent spread of
  airborne droplets

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• Role of pigs
• Pig cells possess receptors for both avian and
  human influenza strains
• This strain represents a genetic re assortment
  (i.e. swapping genes) of swine, human, and avian
  strains of influenza .

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• Symptoms
• Similar to the symptoms of regular human flu and
  include
• Fever
• Cough
• Sore throat
• Body aches, Chills
• Fatigue
• Headaches
• Some people have reported diarrhea and vomiting
• Rapidly progressive pneumonia, respiratory
  failure, and acute respiratory distress syndrome
  have been reported

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• Case Definitions for Infection with Novel
  Influenza A (H1N1) Virus
• A confirmed case
• is defined as a person with an acute febrile
  respiratory illness with laboratory confirmed A
  (H1N1) infection by
• RT-PCR ( Polymerase Chain reaction)
• Viral culture

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• A probable case
• is defined as a person with an acute febrile
  respiratory illness who is positive for influenza
  A, but negative for H1 and H3 by influenza RT-PCR
  

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A suspected case

• is defined as a person with acute febrile
  respiratory illness with onset
• within 7 days of close contact with a person who
  is a confirmed case of H1N1 infection, or
• within 7 days of travel to community where there
  are one or more confirmed cases of H1N1
  infection, or
• resides in a community where there are one or
  more confirmed cases of H1N1 infection

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• Close contact
• Close contact is defined as within about 6
  feet(2 M) of an ill person who is a confirmed or
  suspected case influenza A (H1N1) virus infection
  during the cases infectious period.

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• Infectious period
• Infectious period for a confirmed case of
  influenza A (H1N1) virus infection is defined as
  1 day prior to the cases illness onset to 7 days
  after onset.
• In children may last up to 10 days.
• .

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• Potential Impact of Pandemic
• A substantial percentage of the world's
  population will require some form of medical
  care.
• Health care facilities can be overwhelmed,
  creating a shortage of hospital staff, beds,
  ventilators and other supplies.

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• How many people die from a pandemic depends upon
• The number of people who become infected
• The severity of disease caused by the virus (its
  virulence)
• The vulnerability of affected populations
• The effectiveness of preventive steps

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Table Range of possible deaths in Qatar based on
various presumptions of case-fatality and
clinical attack rates.
mortality
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Estimates of anticipated impact In Qatar
(assuming an attach rate between 10-50 and
mortality rates of 0.37-2.5)

•  People with symptoms 170,000-850,000
• GP Visits 17000-85,000
• AE visits 17,000-85,000
• Excess Hospitalization 850-34,000
• Excess Deaths 544-18190

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Severity Assessment
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• Patients who are ill and experience any of the
  following should come to the Emergency
  Department.
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Confusion
• Severe or persistent vomiting

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• Vaccine Antiviral Agents
• The need for vaccine is likely to outstrip supply
  (5 0f population)
• The supply of antiviral drugs is also likely to
  be inadequate early in a pandemic.
• Difficult decisions will need to be made
  regarding who gets antiviral drugs and vaccines.

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Antiviral Treatment

• Antiviral treatment with zanamivir or oseltamivir
• For Suspected, Confirmed Probable cases of
  influenza A(H1N1)

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• Antiviral Chemoprophylaxis
• recommended for
• Contacts of a confirmed or probable case,
  high-risk for complications of influenza
• persons 65 or older,
• children younger than 5 years old, and
• pregnant women

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Antiviral Chemoprophylaxis

• Health care workers who were not using PPE during
  close contact with an ill confirmed, probable, or
  suspect case of swine-origin influenza A (H1N1)
  virus infection during the cases infectious
  period.

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• The use of masks in the community setting
  inInfluenza A (H1N1) outbreaks
• In health-care settings use of masks could reduce
  the transmission of influenza.
• In the community, however, the benefits of
  wearing masks has not been established,
• Using a mask incorrectly however, may actually
  increase the risk of transmission.

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HMC Influenza Pandemic Preparedness and Response
Plan
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Tiered Response

• 3 Levels
• Stand by (Interpandemic Phase)
• MCI
• Disaster

(Pandemic Phase)
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Stand by

• The situation when cases of pandemic influenza A
  confirmed in other countries, but pandemic
  Influenza not declared yet in Qatar
• Screening Clinics at ports of entry
• Screening Clinics _at_ HGH ED, Al Khor ED, Alsaad
  ED, Algharafa Alwakra UCC and 3 PHC

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• Rapid Testing will be carried out for suspected
  cases _at_ these centers
• Differentiate between A B
• Treat if required accordingly
• Contact precaution Instructions
• Disposition
• Home
• Admission
• Quarantine

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Rapid Flu Test

• Results in 10 minutes
• Influenza AB test allows for the rapid,
  qualitative detection of influenza type A and
  type B antigens directly from nasal swab, or
  nasopharyngeal swab.
• Patients who are Rapid test A are considered
  suspected cases for H1N1

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Resources

• Website for Healthcare workers Public
• www.hmc.org.qa/h1n1
• Public Hotlines 439-4012-16
• CDC Website www.cdc.gov/h1n1flu/
• www.pandemicflu.gov/

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• MCI Disaster State
• MCI Limited transmission not many patients (up
  to 200 non-critical patients or up to 30 critical
  patients)
• Disaster Highly transmissible (many patients
  More than 200 non critical patients or more than
  30 critical patients)
• Create a triage area in front of HGH ED
• Redirect all triaged patient who are suspected
  of having the specific influenza Flu to A
  secondary ED in Outpatient Department to asses
  treat suspected cases.

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• Public should report to the Outpatient Department
  if they have flu like symptoms
• Outpatient Department appointments would be
  cancelled as needed.

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MCI Disaster State

• Dispose patients as follows

ICU Rumailah
Home with Instructions or Quarantined
To General Units in Rumailah
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• Patients In Rumailah will be transferred to other
  HMC facilities
• If Rumailah is overwhelmed by Flu patients, then
  the HGH and other facilities will also be
  providing care for excess patients.
• Accident / Emergency will keep providing
  emergency care for non-flu patients at ED

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Thank you