H1N1 2009 virus

1. 2009 H1N1 Info gathered by Dr. Mona Youssef

2. "quadruple reassortant" RNA virus Study has shown virus to be different from the normally circulating North American pig virus.It has two genes from flu viruses that normally circulate in pigs in Europe and Asia , avian genes and human genes. How is it then that it made its first appearance in Mexico and the US?

3. Genomic mapping of the virus revealed that it has been present and circulating in pigs for the past 7.5 to ten years (obviously undetected due to laxity in surveillance of pigs).

4. Charecteristics • Influenza virus can survive on environmental surfaces and remain infectious for up to 2-8 hours after being deposited on the surface. • Virus is destroyed by: • heat 75-100 degrees Celcius. • chemical germicides: chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols. *wipes or gels with alcohol in them should be rubbed into hands until they are dry. A person can sneeze on someone’s luggage in an airport, and start an outbreak in a country without even entering it!

5. Swine flu virus(Not novel H1N1) • 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 mix of swine, human and/or avian influenza viruses can emerge. • Over the years, different variations of swine flu viruses have emerged. There are currently four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. • Most of the recently isolated influenza viruses from pigs have been H1N1 viruses. H3 subtypes infect older population and tend to be more severe.

6. Drinking waterSwimming Pools and Spas No completed research for novel H1N1 virus. Research on H5N1 has shown: • Free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. • Free chlorine levels recommended by CDC to disinfect avian influenza A (H5N1) virus: for swimming pools :1–3 parts per million (ppm or mg/L) spas: 2–5 ppm It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination.

7. Dealing with the Deceased • Transport of deceased persons does not require any additional precautions when bodies have been secured in a transport bag. Hand hygiene should be performed after completing transport. • For deceased persons with confirmed, probable, or suspect novel influenza A (H1N1): • limit contact with the body in health care settings to close family members • Direct contact with the body is discouraged • Necessary contact may occur as long as hands are washed immediately with soap and water. NO need for mass burials yet….

8. Autopsy: • Standard Precautions. • Additional respiratory protection is needed procedures that generate aerosols (e.g., use of oscillating saws). • minimize the number of personnel participating in post mortem examinations. • Follow standard safety procedures for preventing percutaneous injuries during autopsy.

9. He says ice-cream made him feel better, and Thank God has now recovered full health. But the rest of the planet has a quick –paced pandemic marching on…. 'Patient Zero' in Swine Flu Outbreak Identified as 5-Year-Old Mexican Boy: Edgar Hernandez

10. Timeline

11. Mexico MidMarch: La Gloria,Veracruz, 60% of the town's population is sickened by a respiratory illness of unknown provenance. April 23 :S-OIV (swine origin influenza virus) confirmed, same strain detected in two California children as in Mexico. PAHO informed of Mexico cluster of S-OIV April 16 : Mexico Authorities notify the PAHO (Pan American Health Organization) of the atypical pneumonia. Canadian labs

12. WHO • April 24: 2009 H1N1 first disease outbreak notice. • April 25: WHO Director General declares a formal “Public health emergency of international concern” • April 27: “containment of the outbreak is not feasible” pandemic alert raised from phase 3 to phase 4. • April 29: phase 4 to phase 5. • June 11: phase 5 to phase 6. During this time interim, the WHO was vastly criticized for not announcing phase 6

13. WHO Report 95 AFFECTED COUNTRIES Nothing’s holding this virus back…….!!!

14. A pandemic means an epidemic of an infectious disease, that spreads throughout a large number of people and can spread worldwide. A pandemic begins when: there is person-to-person sustained transmission on multiple continents. keyword

15. TheWorld Health Organization uses a six stage phase for alerting the general public to an outbreak

16. Phase 1 – animal to animal transmission. Phase 2 – an animal influenza virus is capable of human infection. Phase 3 - small outbreaks among close populations but not through human to human contact. Phase 4 -Human to human transmission Phase 5 - spread across two countries or more in one of the WHO regions (continents). Phase 6 – spread across two countries or more in one of the WHO regions plus spread to another WHO region.

17. W.H.O. identifies the following six epidemiological sub-regions. - African Region - Eastern Mediterranean Region - European Region - Region of the Americas - South-East Asian Region - Western Pacific Region

21. Even an island in the middle of the ocean isn’t out of its reach….

23. June 15/2009

26. Who asked him to deny?

27. Any closer we’ll probably find him in the living room watching TV

28. Graveness of the situation In one week, the United Nations agency raised the alert level twice, from phase 3 to phase 5, in response to the sustained transmission of H1N1 in Mexico and the United States.( 1976 swine flu Hsw1N1 outbreak never passed phase 3. The vaccine developed caused 10 per million Guillain Barre syndrome as compared to the 1-2 per million with the seasonal flu vaccine and was banned.) Clippings from the past

29. 19/6/2009 WHO report 19/6/2009 WHO report

30. Any half-brain would know that these three subgroups were the most imortant to keep an eye on... Countries of origin. Mixing of NH1N1 with seasonal flu virus could result in a strain resistant to tamiflu (NH1N1 is already resistant to other antivirals Mixing with H5N1 could produce strains capable of human to human transmission (Death toll of H5N1 is app. 66%)

31. Surprise? Just when you think you know... You don’t! And then Fate has it that the first detected viral strains resistant to tamiflu would show up in China! NOT Australia, and Not Chilli

32. Consequences of a declaration of a full pandemic • Institution of pandemic response plans, which may include measures affecting hospitals, schools or public events. • Provision of support for developing countries including: drugs, diagnostic tests, and medical staff • WHO is still expected to make an announcement to specify whether • manufacturers should switch from making seasonal to pandemic flu vaccines.

33. June 5 CDC Report: • Testing • CDC has developed a PCR diagnostic test kit for distribution throughout U.S. as • well as internationally. • Vaccine • CDC has isolated the new H1N1 virus, for use as a candidate vaccine virus • (Novartis manufactures first vaccine June 11 2009) • Strategic National Stockpile • CDC has deployed 25 percent of the supplies in the Strategic National Stockpile • (SNS) to all states in the continental United States and U.S. territories. • This included antiviral drugs, personal protective equipment, and respiratory • protection devices.

34. Previous Global Pandemics

35. 1918 - Spanish Flu (originated in birds). First hit soldiers in Europe during World War I, as their immune systems were weakened by war. The mortality rate was highest between 20 to 50 year olds. There was never any vaccine developed, after about 18 months, the virus seemed to just disappear. The final death toll was written as 40 million people worldwide. Many of the victims who have died in Mexico have been young and otherwise healthy.

36. 1957 - Asian Flu This flu started in birds in Asia. In September schools and public places started closing in an effort to contain the virus. In December the virus started to subside, but reappeared in January. over two million people died Reappeared

37. 1968 - The Hong Kong Flu This is the mildest pandemic It was first found in the early months of 1968 in Hong Kong, and was declared a global pandemic by December. Children were out of school and were therefore not able to spread it as much. It made a mild reappearance in 1970 and 1972. it claimed about a million lives Reappeared…!!! Seasonal influenza normally claims app. ¼ to ½ a million lives yearly.

38. What we do know

39. Novel H1N1 spreads just as easily as regular winter flu; ranging from very mild self-limited disease to Death. Novel H1N1 virus tends to affect younger people just like the seasonal H1N1. (Older adults were shown to possess serum neutralizing antibodies to the new virus, most likely due to cross‐immunity with human H1N1 viruses. ) Pandemic (H1N1) influenza virus continues to be the predominant circulating virus of influenza, both in the northern and southern hemisphere. All pandemic H1N1 2009 influenza viruses analysed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus.

41. Seasonal H1N1 virus that we've had this past year is resistant to Tamiflu. Seasonal flu vaccine production is to continue as is, in an attempt to reduce the chances of the viruses mingling together in the same environment. Influenza is unpredictable.

42. Characteristics of reported cases of influenza A(H1N1) by country Of note , the prevailing clinical picture in other countries has been GIT related.

43. Past Data limitations : • countries were using different surveillance methods and case definitions. • Caution must be exercised in interpreting information such as age as it may reflect • patterns of travel or the occurrence of outbreaks in special settings such as schools. • Due to early stage of disease spread and the limited number of settings : • Incomplete picture of the epidemiological and clinical characteristics of the • virus. • Estimates of important epidemiological parameters such as incubation • period, attack rate and case fatality ratio may not be broadly applicable.

44. The  objectives  of  on‐going  monitoring  of  influenza  activity  throughout  the  pandemic    • are  to  track: • global  geographical  spread   • disease  trend   • intensity   • impact  of  the  pandemic  on  health‐care  services   • the  number  of  deaths  due  to  acute  respiratory  disease   • (by  age  group  if  available)   • changes  in  viral  antigenicity  and  antiviral  sensitivity.  

45. Reporting  requirements • National  health  authorities  from  all  countries  should  inform  WHO  on  a  weekly  basis  of  their  qualitative  assessment  of  the  geogrphical  spread, trend  of  cases,  intensity  of  disease,  impact  on  the  health‐care  system,  and  deaths. • National  health  authorities  from  countries  with  established  influenza  surveillance  systems  should  report  on  a  weekly  basis  data on  ILI  and/or  SARI   • National  influenza  centres  or  reporting  laboratories  are  asked  to  report  weekly  via  FluNeton  the  number  of  specimens  collected  and  processed for  influenza  and  the  number  of  specimens  tested  that  are  positive  for  influenza  by  subtype.  

47. Case  definition  for  the  reporting  of  pandemic  (H1N1) •  2009  virus  infections  in  humans • The  following  case  definition  should  be  used  to  report  confirmed  cases  of •  pandemic  (H1N1)  2009  virus  infection  to  WHO:    • An  individual  with  laboratory‐confirmed  pandemic  (H1N1)  2009  virus  infection   • by  one  or  more  of  the  following  tests:   • polymerase  chain  reaction  (PCR);   • viral  culture;    • 4‐fold  rise  in  pandemic  (H1N1)  2009  virus  virus‐specific  neutralizing  antibodies.