Influenza and swine flu - Dr Monisha Mary P.pdf

The presentation serves as an educational resource, offering insights into the nature of influenza, its transmission, symptoms, and the importance of vaccination in preventing its spread. It also provides practical tips for individuals and communities to protect themselves during flu season.

1. INFLUENZA(AVIAN & SWINE FLU)
BY DR MONISHA MARY P

2. SPECIFIC LEARNING OBJECTIVES
At the end of today’s seminar, one should be able to
❖Describe the important timelines of
Influenza Pandemic.
❖Describe the frequency, distribution.
❖List the determinants of Influenza.
❖Describe the preventive and control
measures of Influenza
2
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3. SPANISH FLU 1918 – THE
GREATEST MEDICAL
HOLOCAUST IN HISTORY
H1N1 STRAIN OF
INFLUENZA A
EMERGED IN 1918 TO
CAUSE A DISASTER
HIGH MORTALITY
RATE
2002 ESTIMATION-
50 – 100 MILLION
LIVES LOST
1918 TO 1920
THE NEED OF
PUBLIC HEALTH
MEASURES
https://www.bbc.com/future/article/20200302-coronavirus-what-can-we-learn-from-the-spanish-flu
3

4. THE CORONAVIRUS,
THOUGH CAPTURING
PUBLIC ATTENTION, IS
SIGNIFICANTLY LESS LETHAL
THAN SPANISH FLU
https://www.bbc.com/future/article/20200302-coronavirus-what-can-we-learn-from-the-spanish-flu
4

5. MASKS WERE IN HIGH DEMAND DURING
THE SPANISH FLU OUTBREAK AS WELL
https://www.bbc.com/future/article/20200302-coronavirus-what-can-we-learn-from-the-spanish-flu
5

6. INTRODUCTION
Caused by – RNA
influenza virus of
Orthomyxoviridae family
Avian influenza and
Pandemic influenza are
epidemic and pandemic
diseases
Avian influenza virus –
Zoonotic virus
Pandemic influenza- through
genetic reassortment of animal,
avian, and human
strains.
6

7. CHARACTERISTICS OF INFLUENZA STRAINS
A
INFLUENZA
INFECTS HUMAN
BEINGS AND
ANIMALS
Responsible
for Pandemics
B
CIRCULATES
AMONG
HUMANS
Responsible for
seasonal epidemics
C
INFECT HUMANS
AND ANIMALS
Infections are
mild
D
INFECTS
ANIMALS
Inflammation
and necrosis
INFLUENZA INFLUENZA INFLUENZA
7

8. GLOBAL BURDEN OF AVIAN AND PANDEMIC INFLUENZA
1997
JAN 2003 TO
21 NOV 2019
861 HUMAN
CASES OF
AVIAN
INFLUENZA
EGYPT, INDONESIA,
VIETNAM
HPAI A(H5N1
STRAIN)
2003
16 YEARS
17 COUNTRIES
WITH 455
DEATHS
SPANISH,ASIAN,
HONG KONG
,SWINE FLU
Endemic in
poultry
populations
1 2 3 4
8

9. GLOBAL BURDEN OF PANDEMIC INFLUENZA
SPANISH FLU
H1N1
1918 TO 1920
40-50
MILLION
HONG KONG
FLU
H3N2
1968 TO 1970
500,000- 2
MILLION GLOBAL BURDEN
ASIAN FLU
H2N2
1957 TO 1958
1-2 MILLION
SWINE FLU
H1N1
2009 TO 2010
UP TO
575,000
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10. 25
TH

APRIL
2009
WHO – PUBLIC
HEALTH
EMERGENCY OF
INTERNATIONAL
CONCERN(PHEIC)
11
TH

JUNE
2009
WHO-INFLUENZA
PANDEMIC
1 AUG
2010
18,449 DEATHS
FROM 214
COUNTRIES
(CDC,DISEASE
BURDEN OF
INFLUENZA)
SEP
2011
WHO-ADOPTED
A NEW
NOMENCLATURE
INFLUENZA
A(H1N1)
IMPORTANT HISTORICAL EVENTS
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11. TITLE
LOREM
IPSUM
DOLOR
2009
28,798 CONFIRMED INFLUENZA CASES
2019
INFLUENZA PANDEMIC (H1N1)
2020
1,218 DEATHS IN INDIA
BURDEN OF AVIAN AND PANDEMIC INFLUENZA IN INDIA
NCDC, SEASONAL
INFLUENZA H1N1 2020
2020
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National Centre For Disease Control (NVDC) 2020

12. DIFFERENCES BETWEEN SEASONAL INFLUENZA AND
PANDEMIC/AVIAN INFLUENZA
CHARACTERISTIC SEASONAL PANDEMIC/AVIAN
ANTIGENIC
REASSORTMENT
Antigenic drift Antigenic shift
PUBLIC HEALTH PROBLEMEndemic disease Pandemic/Epidemic
IMMUNITY Active immunity No Immunity
PEOPLE AT RISK People without
immunity
All are at risk
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13. EPIDEMIOLOGICAL
DETERMINANTS OF
INFLUENZA
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14. AGENT
RNA Influenza virus
A,B,C,D
Genome- 8 segments
HOST
Age ,Sex,
Immunity,
Occupation
ENVIRONMENT
Seasons
Overcrowding
14

15. HOST FACTORS
OCCUPATION
IMMUNITY
SEX
AGE
15

16. HIGH RISK
GROUPS
❖Children/infected poultry
❖Poultry handlers
❖Cullers/no proper PPE
❖Consumers – undercooked poultry
products
❖Consumers of chicken or duck blood
❖Hospital functionaries
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17. ENVIRONMENTAL FACTORS
SEASONS OVERCROWDING
❖SEASONS- Winter in
temperate zones and in
rainy seasons in tropical
zones
❖OVERCROWDING- helps
to spread the virus
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18. WHY IS THIS A POTENTIAL AGENT FOR
EPIDEMIC/PANDEMIC?
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❖Constant changing nature of the
antigens
❖Variable immunity
states(Diabetes , Elderly)
❖Constant pool of susceptible
population
❖Lack of awareness regarding the
preventive measures
❖Multiple reservoirs of infection
❖Difficult to control once human
to human transmission ensue

19. GENETIC REASSORTMENT OF
PANDEMIC INFLUENZA VIRUS
Pig – plays an
important
role in genetic
reassortment
Pandemic
influenza-
different
human,avian
and swine
strains
The virus with
novel genome-
new
characteristics
Infection
with novel
recombinant
causes
epidemics
The virus is new
to the human
population with
no pre-existing
immunity
PONIT
1
POINT
2
POINT
3
POINT
4
POINT
5
19

20. Source- https://clinmedjournals.org/articles/jide/jide-6-159-002.jpg
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21. CASE DEFINITIONS
INFLUENZA
LIKE ILLNESS
Measured fever of > 38° C
Cough, Onset within the last 10 days
SEVERE ACUTE RESPIRATORY ILLNESS
History of fever or measured fever of > 38C
Cough
With onset within last 10 days
Requires Hospitalization
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22. RESERVOIR
Migratory
waterfowl –
natural reservoir
of avian
influenza
Migratory
waterfowl can
get infection with
all H and N
subtypes of
Avian influenza
virus
Different
strains isolated
from
❖Wild birds
❖Migratory
waterfowl
❖Pigs
❖Swines
❖Horses.
22

23. MIGRATORY WATERFOWL
Migratory
waterfowl
23

24. A Subclinical or clinical case of influenza
Viral load of respiratory infections is high – initial
days of infections
Epidemics- Asymptomatic and mild symptomatic
cases
Avian influenza-Virus spreads through feco-oral
among birds and farmers handling infected birds
SOURCE OF INFECTION
1
2
3
24

25. PORTAL OF EXIT ,TRANSMISSION AND ENTRY
Infected birds shed virus in
feces
Farmers handling them can get
infection
AVIAN INFLUENZA
HUMAN TO HUMAN
TRANSMISSION
Direct and indirect
methods
TRANSMISSION
Transmits through
droplets and droplet
nuclei.
PANDEMIC INFLUENZA
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26. PERIOD OF COMMUNICABILITY
INCUBATION PERIOD
1 – 2 days before and 1 – 2 days after
the onset of symptoms
The incubation period is 2 – 5 days
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27. CLINICAL FEATURES OF AVIAN INFLUENZA
1.Lower respiratory tract
infection
2.Later stages of the
disease
3.Chest X ray of the
patient
•High grade fever
•Cough
•Shortness of breath
•Bilateral pneumonia
•Respiratory failure
•Widespread collapse
•Consolidation
•Interstitial shadowing
27

28. CLINICAL FEATURES OF PANDEMIC (H1N1 INFLUENZA)
1.Initial symptoms of the
disease
2.Rapidly progressive
pneumonia
3.Complications of the
patient
•Fever ,sore throat
•Runny nose,cough
•Headache ,myalgia
•By lower respiratory tract
of lungs in children
•Young middle aged adults
•Otitis media,Pneumonia
•Sinusitis,Bronchiolitis
myositis
•Myocarditis
28

29. APPROACHES FOR PREVENTION
AND CONTROL
RESERVOIR OR SOURCE OF
INFECTION
EARLY DIAGNOSIS AND
PROMPT TREATMENT
NOTIFICATION
ISOLATION
QUARANTINE
ROUTES OF INFECTION
DISINFECTION AS A
METHOD TO INTERRUPT
THE TRANSMISSION OF
DISEASE
SUSCEPTIBLE HOSTS
IMMUNIZATION
CHEMOPROPHYLAXIS
29
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30. HOW WE
CONTROL AND
PREVENT THE
VIRUS
EARLY DIAGNOSIS AND
PROMPT TREATMENT

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31. EARLY DIAGNOSIS AND PROMPT
TREATMENT
CRUCIAL
STEP
SPECIALISTS ALGORITHM PROMPT
TREATMENT
HALTS
COMMUNICABILITY
OF DISEASE
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32. EARLY DIAGNOSIS- LABORATORY
CONFIRMATION
SPECIMEN
SAMPLE
COLLECTION
TRANSPORTATION
OF SAMPLES
LABORATORY
TEST
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33. SPECIMEN
❖Oropharyngeal or nasopharyngeal
swab
❖Avian influenza- endotracheal
aspirate if available
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34. SAMPLE COLLECTION
❖Health care providers with
universal precautions
❖People handling samples
should wash their hands
before and after handling the
specimens
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35. TRANSPORTATION OF SAMPLES
.
Triple packaging
system, WHO in viral
transport media
Reference laboratory
maintaining cold chain
Samples need to be
packed properly
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36. TRIPLE PACKAGING SYSTEM, WHO
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https://www.cdc.gov/smallpox/images/lab-personnel/cat-a-schematic-800.jpg

37. Sample Footer Text
LABORATORY TEST
RAPID DIAGNOSTIC KITS RT- PCR CULTURE GOLD STANDARD TEST
37
28-04-2024

38. CASE DEFINITIONS AND CASE DISCHARGE POLICY
REPORTING AND
CLASSIFICATION
STANDARDIZATION
OF LANGUAGE
COMPARABILITY OF
DATA
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39. MEDICAL TREATMENT
39
CONCURRENT DISINFECTION
•Immediate disinfection
•To prevent transmission
SUPPORTIVE TREATMENT
•Oxygen therapy
/associated hypoxia
•Severely ill patients-
mechanical ventilation/
Steroid
ANTIVIRAL DRUGS
•M2 inhibitors-
Amantadin,Rimantadin
•Neuraminidase
inhibitors-
Oseltamivir,Zanamivir
and Ribavirin
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40. NOTIFICATION
International Health Regulations
(IHR)
Always Notifiable
1.Smallpox
2.Poliomyelitis
3.Human Influenza
4.SARS
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Integrated Health Information Platform

41. 41
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TheMinistry of Health & Family
Welfarehas launched theIntegrated
Health Information Platform (IHIP)
INTEGRATED HEALTH INFORMATION PLATFORM
https://www.drishtiias.com/daily-updates/daily-news-analysis/integrated-health-information-platform/print_manual

42. Sample Footer Text
OVERVIEW OF HOW THE INTEGRATED HEALTH
INFORMATION PLATFORM WORKS IN HOSPITALS
Digitization of
Health Records
Electronic
Health Records
(EHRs)
Health
Management
Information System
(HMIS)
Mobile Application
28-04-2024
42

43. ISOLATION OF
INFLUENZA CASE
43

44. QUARANTINE
44

45. INTERRUPTION OF TRANSMISSION OF INFLUENZA IN
PANDEMICS
HEALTH AND SAFETY TIPS
Wash your
handsoften
Use hand
sanitizer
Wear a mask Don’t
touch your
face
Cover your
sneezes
and coughs
Avoid close
contact
Use your own
supplies
​Clean your
electronics
45

46. PROPER HAND
WASHING PRACTICES
46

47. USE OF PERSONAL
PROTECTIVE
EQUIPMENT (PPE)
47

48. COHORTING OF
INFLUENZA CASES
IN HOSPITAL
6 feet | 2 m
48

49. CONCURRENT
DISINFECTION OF
PATIENTS BELONGING
49

50. PROTECTING SUSCEPTIBLE HOST
CHEMOPROPHYLAXIS AND VACCINE
28-04-2024 SEMINAR-INFLUENZA 50

51. CHEMOPROPHYLAXIS
M2
INHIBITORS
Children
Elderly
Debilitated
people
DRUG
Till the epidemic
is over
OSELTAMIVIR
Avian Influenza
DRUG
Within 2 days of
exposure to
cases of avian flu
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52. DIFFERENCES BETWEEN INTRANASAL AND
INJECTABLE VACCINES (H1N1)
CHARACTERISTIC
INTRANASAL
VACCINE
INJECTABLE VACCINE
TYPE AND DOSE Live attenuated/singleInactivated/killed/2 doses
AGE >2 years >6 months
LOCAL IMMUNITY
Yes No
SYSTEMIC IMMUNITY No Yes
SPREADING THE DISEASE No Yes
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53. SURVEILLANCE
DOLOR SIT AMET
28-04-2024
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54. SURVEILLANCE OF INFLUENZA
INFLUENZA
SURVEILLANCE LAB
NETWORK
FLU NET GLOBAL INFLUENZA SURVEILLANCE AND
RESPONSE SYSTEM
Influenza
caused by
H1N1 –
Declared under
PHEIC by WHO
The H1N1 and
H5N1 –
Integrated
Health
Information
Platform
The community
spread of the
disease (H1N1 )
25 or more
epidemiologically
linked suspect ,
atleast 1 or more
laboratory
confirmed
In 2 or more
cities, for 2
weeks
1
2
3
4
5
54

55. INFLUENZA SURVEILLANCE LAB NETWORK
PREVENTION
The Human health component of avian influenza surveillance under Indias IDSP
CONTROL RESPONSE NETWORKING
STRENGTHENING OF
REFERENCE
LABORATORIES
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56. IDSP INFLUENZA NETWORK
SOURCE- IDSP,NCDC , Government of Inda
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57. FLUNET
WEB BASED PLATFORM FOR
INFLUENZA VIROLOGICAL
SURVEILLANCE
57
❖Helps to track the movement
of virus in the world
❖Data is updated every week
in the web
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58. 1
Formerly known
as Global
Influenza
Surveillance
Network (GISN)
2
They monitor the
influenza virus
strains
3
It serves a global
alert system
4
Case definitions
for Influenza like
illness and
Severe Acute
Respiratory
Illness
GLOBAL INFLUENZA SURVEILLANCE AND RESPONSE
SYSTEM
58

59. WHO’S 6 PHASES OF PANDEMIC ALERT FOR
INFLUENZA PANDEMIC
SOURCE – Emergencies preparedness , response, WHO.
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60. IS IT POSSIBLE TO ERADICATE OR
ELIMINATE INFLUENZA?
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61. IT CANNOT BE POSSIBLE
61
INFLUENZA A VIRUS
ANIMAL HOSTS
FORMATION OF NOVEL STRAIN
VIRUSES
ANTIGENIC SHIFT AND
ANTIGENIC DRIFT
RESTRICTS THE USE OF
VACCINES
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62. THANK YOU
If you address
influenza, you
actually are
addressing the
whole of
thehealthsystem
-Dr Janneth