Swine Flu Update: Symptoms, Treatment and Prevention of H1N1 Virus
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Swine influenza, also known as swine flu, is caused by type A influenza viruses that typically infect pigs. The 2009 H1N1 virus was a new strain that was able to infect humans and spread from person to person. Swine flu in humans causes similar symptoms as seasonal flu, including fever, cough and sore throat. While the virus is now considered a seasonal flu virus, there is no vaccine specifically for it. Good hand hygiene and practicing droplet precautions are recommended to limit its spread.
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Swine Flu Update: Symptoms, Treatment and Prevention of H1N1 Virus
- 1. Swine Influenza Update (Swine flu) PAPER-203
- 2. What is Swine Influenza (Swine flu)? • H1N1 - originally referred to as Swine Flu • Swine Influenza is typically a respiratory disease of pigs • Swine flu has expanded to human-to-human transmission • Swine flu is a type of: – Influenza-Like Illness (ILI)
- 3. Influenza Virus Types A and B Type A (Seasonal, avian, swine influenza,….) Type B (Seasonal influenza) Can cause significant disease Generally causes milder disease but may also cause severe disease Infects humans and other species (e.g., birds; H5N1) Limited to humans Can cause epidemics and pandemics (worldwide epidemics) Generally causes milder epidemics 3
- 4. Seasonal Influenza – A public health problem each year – Usually some immunity built up from previous exposures to the same subtype – Infants and elderly most at risk Influenza Pandemics – Appear in the human population rarely and unpredictably – Human population lacks any immunity – All age groups, including healthy young adults Seasonal Epidemics vs. Pandemics
- 5. The new virus must beThe new virus must be efficientlyefficiently transmitted from one human to anothertransmitted from one human to another The new virus must beThe new virus must be efficientlyefficiently transmitted from one human to anothertransmitted from one human to another Prerequisites for pandemic influenza A new influenza virus emerges to which the general population has little/no immunity The new virus must be able to replicate in humans and cause disease
- 6. WHO Pandemic PhasesWHO Pandemic Phases
- 7. A H1N1 :new virus • The 2009 H1N1 virus is a hybrid of swine, avian and human strains Influenza A (H1N1) • The H1N1 flu virus caused a world-wide pandemic in 2009. It is now a human seasonal flu virus that also circulates in pigs. • While the H1N1 viruses have continued to circulate since the pandemic, 2014 is the first season since 2009 that H1N1 has been so predominant in the United States. • Getting the flu vaccine is your best protection against H1N1. • You cannot get H1N1 from properly handled and cooked pork or pork products. • Symptoms of H1N1 are similar to seasonal flu symptoms.
- 8. What is H1N1 flu? • H1N1 is a flu virus. When it was first detected in 2009, it was called “swine flu” because the virus was similar to those found in pigs. • The H1N1 virus is currently a seasonal flu virus found in humans. • Although it also circulates in pigs, you cannot get it by eating properly handled and cooked pork or pork products.
- 9. What is the current Status? • Centers for Disease Control (CDC) has confirmed seven (7) cases of Swine Influenza caused by swine influenza (H1N1) viruses • Viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in United States
- 10. Signs and Symptoms Human Influenza Type of infection Upper and lower respiratory Fever Yes Headache Yes Cough Yes Respiratory symptoms Varies; sore throat to difficulty breathing Gastrointestinal symptoms Uncommon, except children, elderly Recovery 2-7 days
- 11. Big droplets fall on people surfaces bed clothes Courtesy of CDC
- 12. Pathogenesis of influenza in humans •When influenza virus is introduced into the respiratory tract, by aerosol or by contact with saliva or other respiratory secretions from an infected individual, it attaches to and replicates in epithelial cells. •The virus replicates in cells of both the upper and lower respiratory tract. • •Viral replication combined with the immune response to infection lead to destruction and loss of cells lining the respiratory tract. •As infection subsides, the epithelium is regenerated, a process that can take up to a month. •Cough and weakness may persist for up to 2 weeks after infection.
- 13. Where is the Incidence Swine Flu? • According to the CDC as of April 27, 2009 documented human-to- human transmission of swine flu have now occurred in: – California – Texas – Ohio – New York – Mexico – Eastern Canada – New Zealand
- 14. Viral Re-assortment Reassortment in pigs Reassortment in humans Pandemic Influenza Virus
- 15. What are the symptoms of swine flu in humans? • The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza & include: – fever (greater than 100.0º F or 37.8 º C), AND – cough & sore throat – lack of appetite • Internationally, some people with swine flu also have reported runny nose, nausea, vomiting, & diarrhea
- 16. How can human infections with swine influenza be diagnosed? • To diagnose swine influenza A infection – A respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus) – Some persons, especially children, may shed virus for 10 days or longer – Identification as a swine flu influenza A virus requires sending the specimen to a laboratory for testing.
- 17. Is the H1N1 swine flu virus the same as human H1N1 viruses? • No, H1N1 swine flu viruses are antigenically very different from human H1N1 viruses • Vaccines for human seasonal flu do not provide protection from this H1N1 set of swine flu viruses
- 18. How does swine flu spread? • Human-to-human transmission of swine flu predominantly occurs through direct droplet transmission • This is thought to occur in the same way as seasonal flu, which is mainly person-to-person transmission through coughing or sneezing of infected people • People may become infected by touching something with flu viruses on it & then touching their mouth or nose (moist mucous membranes).
- 19. What should I do if I think I may be sick? • Stay home & reduce the spread of infectious diseases • Utilize barrier protection • Utilize personal protective equipment (PPE)
- 20. How can I limit the spread of contact transmission? • Good hand hygiene or hand washing • Create a barrier between yourself and the virus • Remove the virus whenever possible through good cleansing of surfaces
- 21. What is a barrier? • The first barrier is distance – If you are sick, stay home – If you suspect someone of having the virus then protect yourself with person protective equipment (PPE) prior to entering their 6 foot radius.
- 22. What is person protective equipment (PPE)? • Personal protective equipment, commonly referred to as "PPE", is equipment worn to minimize exposure to a variety of hazards
- 23. What is PPE for medical providers regarding droplet precautions? • Wear a fit-tested N95 respirator, disposable gloves, gown, & eye protection (face shield or goggles) • Place a surgical mask on the patient & utilize devices to reduce secretion distribution • Before & after contact with respiratory infected people: – clean hands thoroughly with soap & water or an alcohol- based hand gel.
- 24. What is good hand hygiene? • Washing hand for more than 15 seconds with soap & water or apply an alcohol-based cleanser rubbing hands until dry
- 25. When should you wash your hands with soap & water? Wash your hands with plain soap & water or with antimicrobial soap & water if: • your hands are visibly soiled (dirty) • hands are visibly contaminated with blood or body fluids • hands come in contact with respiratory secretions • before eating • after using the restroom
- 26. Are alcohol-based handrubs effective? • More than 20 published studies have shown that alcohol-based handrubs are more effective than either plain soap or antibacterial soaps in reducing the number of live bacteria on the hands
- 27. Won’t frequent use of alcohol dry out my skin? • No! In fact, studies have proven that nurses who routinely cleaned their hands between patients by using a modern alcohol-based handrub had less skin irritation and dryness than nurses who washed their hands with soap and water • Modern alcohol-based handrubs contain skin conditioners (emollients) that help prevent the drying effects of alcohol
- 28. Do I need a prescription for hand cleansers? • Most over-the- counter skin cleansers will remove bacteria and viruses if used as directed
- 31. Droplet precautions: SurgicalDroplet precautions: Surgical MasksMasksN-95Filtering Masks Personal Protective Equipment (PPE)
- 34. What medications are available to treat swine flu infections in humans? • At this time, CDC recommends the use of : – Tamiflu (oseltamivir phosphate) or – Relenza (zanamivir) – As part of the treatment &/or reduction of severity of infection with swine influenza viruses • More information on treatment recommendations can be found at: www.cdc.gov/flu/swine/recommendations.htm
- 36. Is there a vaccine for swine flu? • There is no vaccine to protect humans from swine flu at this time
- 37. How can I reduce the spread of infectious diseases? • Good hand washing • Universal precautions at all times • Respiratory droplet precautions – When an airborne illness is suspected
- 38. Thank you
Editor's Notes
- Eighteen black nurses met at the home of Dr. Mary Harper and resolved to start a professional black organization that addressed both the needs of the African-American nurse but also the needs of the African American community. This took place on 12/18/1971. This historical event has blossomed into 79 chapters and over 150,000 members.
- While there are three types of influenza viruses—A, B, and C—only two cause significant disease in humans (A and B). Type B influenza viruses are limited to humans, whereas Type A viruses can cause severe disease in humans and affect more species. Influenza Type A Type A influenza is considered to cause the most serious disease among the influenza viruses, although not all strains cause clinical disease. Influenza A can cause severe epidemics (as well as severe worldwide epidemics; or pandemics) among all ages. Influenza type A infects multiple species including people, birds, pigs, horses, and other animals. Wild birds are the natural hosts for these viruses. Influenza Type B Influenza B viruses are usually found only in humans. Influenza B viruses can cause some morbidity and mortality among humans, but in general are associated with less severe epidemics (chiefly among children) than influenza A viruses. Although influenza type B viruses can cause human epidemics, they have not caused pandemics. Because avian influenza and all pandemic viruses are of the Type A variety, we will focus this session on Type A influenza viruses.
- While seasonal influenza occurs every year, pandemic influenza rarely occurs. Here we compare some features of seasonal influenza with features of pandemic influenza. While the population usually has some immunity built up from previous exposures to seasonal influenza, the human population lacks any immunity to pandemic influenza strains. In seasonal influenza epidemics, infants and the elderly are most at risk of illness and complications. But during an influenza pandemic, even healthy, young people are at increased risk for serious complications. Seasonal influenza strains are the result of Antigenic Drift, while pandemic influenza strains are the result of Antigenic Shift.
- 2 of the 3 prerequisites for a human pandemic have been met A novel influenza virus has emerged and the general population has demonstrated little or no immunity And the new virus has been able to replicate in humans The main questions that remains are: Will the virus will develop into a form that is efficiently transmitted from one human to another? (thus meeting the criteria for a pandemic) If so, where, when, how quickly, and how severely? The first two of three prerequisites have been met: A novel virus Virus must be able to replicate in humans and cause disease New virus must be efficiently transmitted from one human to another Virus can improve its transmissibility via two mechanisms: adaptive mutation genetic reassortment (can take place in humans without prior adaptation in another mammalian species, such as the pig)
- Eighteen black nurses met at the home of Dr. Mary Harper and resolved to start a professional black organization that addressed both the needs of the African-American nurse but also the needs of the African American community. This took place on 12/18/1971. This historical event has blossomed into 79 chapters and over 150,000 members.
- It can be difficult to tell if a patient has influenza because the signs and symptoms for influenza are similar to those for other diseases that may cause respiratory illnesses. If you do suspect influenza, there are a few differences between human influenza and avian influenza that you can assess, especially in the early days of illness. Human influenza usually causes both upper respiratory (sore throat runny nose) and lower respiratory (cough, bronchitis) symptoms. Common signs and symptoms include fever, headache, cough, sore throat, muscle ache, and exhaustion. Other respiratory symptoms may appear, varying from sore throat to difficulty breathing. Children and the elderly may also have gastrointestinal symptoms like diarrhea, vomiting and nausea, but adults uncommonly have gastrointestinal symptoms, except loss of apetitie. People generally recover anywhere from 2 to 7 days after symptoms appear. However, cough and muscle ache may last more than 14 days. Although influenza generally causes an upper respiratory infection with tracheobronchitis, it can progress to pneumonia and respiratory failure in some cases. Although similar initially, avian influenza differs from human influenza in its course. Avian influenza leads to a lower respiratory illness with variable upper respiratory involvement. Initial symptoms are similar to human influenza. These include fever, headache, cough, sore throat, muscle ache, and exhaustion. Gastrointestinal symptoms of watery diarrhea, vomiting, and abdominal pain have been more commonly reported from H5N1 patients (20-70% diarrhea rate depending on case series). Symptoms of a lower respiratory infection appear early in course of the illness. About five days after symptoms appear, patients often begin to have difficulty breathing leading to respiratory distress, and an increased respiratory rate may also be observed. By this time, cough is prominent, sputum production may occur sometimes containing blood. Most patients develop pneumonia with bilateral pulmonary infiltrates. Ref: Writing Committee on WHO Consultation. NEJM 353:1374-85, 2005
- Eighteen black nurses met at the home of Dr. Mary Harper and resolved to start a professional black organization that addressed both the needs of the African-American nurse but also the needs of the African American community. This took place on 12/18/1971. This historical event has blossomed into 79 chapters and over 150,000 members.