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INFLUENZA A H1N1

INFLUENZA A H1N1. PREVENTIVE & CONTROL GUIDELINES 25 Jan 2015. National Scenario - 2015. Situational Update- Maharashtra. District Wise Cases & Deaths. Influenza Surveillance. INFLUENZA H1N1. Incubation Period- 1 to 7 days.

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INFLUENZA A H1N1

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  1. INFLUENZA A H1N1 PREVENTIVE & CONTROL GUIDELINES 25 Jan 2015

  2. National Scenario - 2015

  3. Situational Update- Maharashtra

  4. District Wise Cases & Deaths

  5. Influenza Surveillance

  6. INFLUENZA H1N1 • Incubation Period- 1 to 7 days. • Infectious Period- 1 day prior to the onset of illness to 7 days after onset. • Close Contact -Close Contact is defined within 6 feet of an ill person who is a confirmed, probable or suspected case of influenza A H1N1 virus infection during the infectious period.

  7. Case Definition • Suspected Case of Influenza - A person with an acute febrile respiratory illness commonly in the form of- -High grade fever ( >38 degree C) -Severe Pharyngitis -Running nose & cough -Body ache -Head ache

  8. INFLUENZA SURVEILLANCE INLUENZA LIKE ILLNESS (ILI) SEVERE ACUTE RESP INF (SARI) is defined as: • Sudden onset of a fever over 38°C, AND • Cough or sore throat, AND • An absence of other diagnoses. > 5 YEARS Sudden onset of fever over 38°C, & Cough or sore throat, & Shortness of breath or difficulty in breathing, & Requiring hospital admission < 5 YEARS Pnumonia Requires hospitalization

  9. Surveillance Guidelines • Active surveillance for ILI at all levels. • Focus on – Schools, Hostels,Anganwadis Ashramshalas, Orphanages, madarasas. • Report clusters of ILI to district/divisional & state authority immediately. • ANMs should screen pregnant mothers for ILI during routine check up in ANC clinic. • Tackle clusters effectively to avoid further spread.

  10. CATEGORIES OF PATIENTS

  11. High Risk Patients • Children below 5 years of age. • Persons above 65 years of age. • Pregnant Women. • Persons having lung,heart,liver,kidney diseases. Persons with blood & neurological disorders. • HIV/AIDS patients. • Patients on long term steroid treatment.

  12. Action Plan Civil Surgeon District Health Officer District Nodal Officer of H1N1 Establish SDH 50 & 100 bed hospitals and DH as Lab sample collection & Treatment centers. Isolation ward of 4 beds at each hospital - Ventilator Ensure logistics. Training of MO,LT & Nursing staff. Workshop for private doctors & coordination with pvt hospitals Coordination with FDA Surveillance of ILI & SARI by PHC staff. Contact tracing & treatment of symptomatic treatment. Treatment of mild ILI cases ( Category C) Referral of Cat B & A cases to identified hospital. ( Referral Centers for each Taluka should be identified by CS & DHO) Training of MO & Paramedicals IEC

  13. ISOLATION WARD GUIDELINES

  14. Guidelines For IIWs-1 • Separate ward for positive & suspected patients. • Distance of 6 feet between two beds. • Isolation ward should have following facilities- 1. Oxygen cylinders with accessories. 2.Pulse Oxymeter. 3.Electric & foot suction machine. 4.Emergency tray 5.Ventilators with trained staff.

  15. Guidelines For IIWs-2 • Well ventilated ward with exhaust fan. • Disinfection measures & Biomedical waste management according to standard guideline. • One separate on road ambulance. • Sufficient stock of Tamiflu,PPE,VTM. • Trained staff & doctors to operate all instruments. • At least one on call physician available for 24 hours.

  16. LAB SAMPLE COLLECTION

  17. IDENTIFIED LABS

  18. Guidelines About Sample Collection • Swab should be accompanied with detailed clinical history of patient. • Preferably prior to giving Oseltamivir. • No swab collection on OPD basis. • Swabs of admitted patients only. • In clusters of ILI, send only 5% samples. • Do not take samples of asymptomatic contacts. • Do not collect swabs after more than 8 days of onset of illness. • If required do other tests also – eg Dengue, Malaria, Lepto etc.

  19. Sample Collection & Laboratory Diagnosis-1 What sample to be collected? • Nasopharyngeal/oropharyngeal swabs. • Brochoalveolar lavage. • Tracheal aspirates. • Nasopharyngeal/oropharyngeal aspirates as washes. • Samples should be collected in VTM.

  20. Sample Collection & Laboratory Diagnosis-2 When to collect Specimens -As soon as possible after symptoms begin -Before administration of antiviral medications. • Full complement of PPE should be worn before initiating sample collection.

  21. Transportation of Samples • All samples should be kept at 2-8 degree Celsius until they can be placed at -70 C. • Samples transported on dry ice in triple packaging. • Clear labels with patient’s complete information. • Samples should be sent to NIV,Pune, IGMC Nagpur, Kasturba Hospital Mumbai or Haffkine Mumbai within 24 hrs.

  22. TREATMENT PROTOCOL

  23. PEDIATRIC DOSES- TAMIFLU AGE DOSE • < 3 months • 3-5 months • 6-11 months • 12 mg bid for 5 days • 20 mg bid for 5 days • 25 mg bid for 5 days

  24. No Need of chemoprophylaxis.. Guidelines for Close Contacts • Search meticulously for all close contacts of every positive case of Influenza A H1N1 case. • Start Oseltamivir in therapeutic dose to all close contacts with Influenza like symptoms. • Keep asymptomatic contacts under surveillance for 10 days, if any one of them develop Influenza like symptoms within that period start Oseltamivir in therapeutic dose. • Don’t give Oseltamivir to close contacts who are asymptomatic during the entire period of observation.

  25. Treatment of Serious Patients

  26. Antiviral drugs in Pregnancy • Category C medication. • No clinical studies to assess safety. • It should be used when potential benefit justifies the potential risk to the embryo/fetus. • So far no adverse effects have been reported. • Some prefer Zanamivir over Oseltamivir as systemic absorption is minimal.

  27. Warning Signs- Children • Fast breathing/trouble breathing. • Bluish skin colour. • Not drinking enough fluids/eating food. • Increased irritability. • Flu like symptoms improve but later return with fever and worse cough. • Fever with rash. EMERGENCY WARNING SIGNS NEED URGENT MEDICAL ATTENTION.

  28. Warning Signs- Adults • Difficulty breathing/shortness of breath. • Pain /pressure in the chest or abdomen. • Sudden dizziness. • Confusion. • Severe or persistent vomiting. EMERGENCY WARNING SIGNS NEED URGENT MEDICAL ATTENTION.

  29. Pregnant Women • Active Screening of pregnant women during routine ANC check up by MOs & paramedical staff for ILI. • Timely initiation of Oseltamivir in symptomatic pregnant women.

  30. Influenza- Educating the Public • Covering nose & mouth with a tissue/handkerchief when coughing / sneezing Dispose the tissue in the trash after use. • Hand washing with soap & water-especially after coughing/sneezing. • Cleaning hands with alcohol based hand cleaners. • Avoiding close contact with sick people. • Avoiding touching eyes ,nose or mouth with unwashed hands. • Avoid hand shaking & spitting. • If sick with Influenza staying home away from work/school & limit contact with others to keep from infecting them. • No need to use mask by common public. • If you found more people suffering from Flu like symptoms from your area, inform concerned health authority.

  31. Use of Masks • No need of mask for common people. • Tissue or handkerchief is sufficient to cover nose/mouth while sneezing or coughing. • Improper use of disposable mask spreads infection.

  32. Guidelines for Educational Institutions • Avoid large gatherings. • Active screening of flu like symptoms by teacher. • Students, teaching/non teaching staff with ILI- ask for medical consultation & home isolation. • No need of medical certificate for such preventive absentees. • Identify students with high risk condition. • Regular cleaning of area with ordinary cleaner. • Hostel- regular check up of students & staff. Closure of school not advised. • Local district administration can take decision after reviewing the situation. • Display Do’s and Don’ts prominently.

  33. Ensure …. • Surveillance of ILI & SARI • Special focus on pregnant women & children • Contact tracing & treatment of symptomatic contacts. • Functional screening centers & IIWs • Stock position • Coordination with FDA for availability of Oseltamivir in private medical stores. • Coordination with private hospitals & labs. • Death investigation • Coordination with educational institutions • Sharing of H1N1 prevention & control guidelines with all stake holders • Health Education

  34. Thanks…! Thanks…!

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