Mohit Bhutani Dr D Himanshu MD Influenza pandemics amp emerging new pandemic threats exist since 1900 The emergence of H1N1 has demonstrated the difficulty in predicting pandemics ID: 914855
Download Presentation The PPT/PDF document "SWINE FLU AWARENESS BY Dr." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
SWINE FLU AWARENESS
BYDr. Mohit Bhutani Dr. D. Himanshu M.D
Slide2Influenza pandemics & emerging new pandemic threats exist since 1900!
The emergence of H1N1 has demonstrated the difficulty in predicting pandemicsNicholson KG, Wood JM, Zambon M. Lancet 2003; 362:1733-1745; WHO, Cumulative number of confirmed human cases of avian influenza A/(H5N1), available at: http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_09_10/en/index.html (accessed 5 November 2008); CDC, Avian Influenza, available at: http://www.cdc.gov/flu/avian/outbreak.htm (accessed 5 November 2008).
Pandemic outbreaks
Recent outbreaks of influenza
1918
1957
1977
2000
2008
>50 million deaths
H1N1
1918
Spanish
1957
Asian
~2 million deaths
H2N2
1968
Hong Kong
~1 million deaths
H3N2
<1 million deaths
H1N1
1977
Russian
H9N2
1999
Hong Kong
2
cases
H5N1
1997
Hong Kong
18 cases
Six deaths
H7N7
82 cases
One
death
H5N1
2003-2008
Global
387 cases
245 deaths
2003
Dutch
1968
H1N1
2009
Global
~30,000 cases
145 deaths
2009
Pandemic
Slide3The guiding principles are:*
Early implementation of infection control precautions to minimize nosocomical / household spread of disease Prompt treatment to prevent severe illness & death. Early identification and follow up of persons at risk. *Pandemic Influenza A H1N1 Clinical management Protocol and Infection Control Guidelines Directorate
Slide4Infrastructure / manpower / material support *
Isolation facilities: if dedicated isolation room is not available then patients can be cohorted in a well ventilated isolation ward with beds kept one meter apart.Manpower: Dedicated doctors, nurses, paramedical workers.Equipment: Portable X Ray machine, ventilators, large oxygen cylinders, pulse oxymeters Supplies: Adequate quantities of Personal Protection Equipments (PPE), disinfectants and medications (Oseltamivir, antibiotics and other medicines) *Pandemic Influenza A H1N1 Clinical management Protocol and Infection Control Guidelines Directorate
Slide5Standard Operating Procedures *
Reinforce standard infection control precautions all those entering the room must use high efficiency N95 masks, gowns, goggles, gloves, cap and shoe cover.Restrict number of visitors and provide them with PPE.Provide antiviral prophylaxis to health care personnel managing the case and ask them to monitor their own health twice a day. Dispose waste properly by placing it in sealed impermeable bags labeled as Bio- Hazard*Pandemic Influenza A H1N1 Clinical management Protocol and Infection Control Guidelines Directorate
Slide6MANAGEMENT
Slide7The first thing is to differentiate between a flu and a cold
Slide8CATEGORISATION OF CASES*
MILD OR UNCOMPLICATED ILLNESSPROGRESSIVE ILLNESSSEVERE OR COMPLICATED ILLNESS*Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
Slide9Mild or
Uncomplicated illnessFever CoughSore throatRhinorrheaMuscle painHeadacheChillsMalaiseDiarrhea and vomitingThese patients do not require treatment with anti-viral drugs as they do not need hospitalization.
Slide10TREATMENT ALGORITHM FOR MILD DISEASE
Slide11HIGH RISK GROUP*
Children younger than 2 years old Adults 65 years of age or olderPregnant women and women up to 2 weeks postpartum (regardless of how the pregnancy ended)Persons with certain medical conditions: asthma, chronic lung disease, heart disease, blood disorders, kidney and liver disease, diabetes mellitus, immunocompromised and obese*Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
Slide12Progressive illness
Typical symptoms plus Chest pain Tachypnea i.e. respiratory rate > 30 Hypoxia i.e. SpO2 < 94% at room air Labored breathing in children Low blood pressure i.e. SBP < 90mmHgConfusion Severe dehydration Exacerbations of chronic conditions These patients require urgent hospitalization and treatment.
Slide13Severe or Complicated Illness
Abnormal CXRRequiring mechanical ventilationEncephalitisEncephalopathyOrgan failureMyocarditis RhabdomyolysisInvasive secondary bacterial infection based on laboratory testing or clinical signs (e.g. persistent high fever and other symptoms beyond three days)These patients require prompt admission and treatment with anti-viral drugs.
Slide14Whom to test
The following people should receive influenza diagnostic testingpeople who are hospitalized with suspected flu i.e. patients with progressive or severe/complicated diseaseSymptomatic patients in high risk groupAdditional people may be recommended for testing based on the clinical judgment of their health care providerDuring 2009 H1N1 CDC considered that most people with flu symptoms would not require testing because the test results usually do not change the way one is treated. *Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
Slide15How to treat !!!
Antiviral drugs: oseltamivir (oral), zanamivir (inhaled)Initiate treatment as early as possible after onset of symptomsTreat empirically before diagnostic test results are reported*Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
Slide16OSELTAMIVIR : oral (cap/suspension)
Oseltamivir is the recommended drug both for prophylaxis and treatment. Neuraminidase inhibitorPregnancy category ‘c’
Slide17SCHEDULE
Slide18ADVERSE EFFECTS(oseltamivir)
>10%- gastrointestinal- vomiting, nausea , pain abdomen1%- conjuctivitis 1%- epistaxis<1%- anaphylactic reaction, pseudomembranous colitis, SJS/TEN, abnormal LFT, neuropsychiatric events
Slide19Zanamivir
– inhalational .(Relenza®) FDA-approved for the treatment of influenza in patients 7 years of age and olderCaution Bronchospasm in asthma patients
Slide20SINGLE DOSE
Peramivir A third neuraminidase inhibitor formulated for intravenous (IV) administration for 18yrs and older pt.Treatment approved only if: (1) the patient has not responded to either oral or inhaled antiviral therapy; (2) drug delivery by a route other than IV is not expected to be dependable or is not feasible
Slide21AMANTADINERIMANATADINE Not recommended due to widespread resistance in 2009 H1N1 strain
Slide22Duration of antiviral therapy*
Recommended duration: 5 days Hospitalized patients with severe infections might require longer treatment coursesTreatment is most effective when started in the first 48 hours of illness Limited data from observational studies suggests, treatment started 48 hours after onset of illness also reduced mortality/ duration of hospitalization*Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
Slide23Supportive therapy
IV Fluids. Oxygen therapy/ ventilatory supportAntibiotics for secondary infection Vasopressors for shockParacetamol or ibuprofen for fever, myalgia and headache. Avoid smoking. For sore throat, short course of topical decongestants, saline nasal drops, throat lozenges and steam inhalation. Salicylate / aspirin is strictly contra-indicated in any influenza patient due to its potential to cause Reye’s syndrome.
Slide24Discharge Policy
Patients responded within 2-3 days can be discharged after 5 days of treatment. No need for a repeat test. Patients who continue to have symptoms of fever, sore throat etc. even on the 5th day should continue treatment for 5 more days. If symptomatic even after 10th day of treatment in the absence of secondary infection, retestIf positive, do check for resistanceWhile discharging, educate family on personal hygiene and infection control measures at home
Slide25ACTIVE PREVENTION
Slide26Antiviral Chemoprophylaxis of exposed individuals
INFECTIOUS PERIOD One day before fever begins until 24 hours after fever ends or 7 days after onset of symptoms. Children may spread the virus for a longer period Mode of exposureDroplet exposure of mucosal surfaces (e.g. nose, mouth, and eyes) by respiratory secretions from coughing or sneezing Contact, usually of hands, with an infectious patient or fomites followed by self-inoculation of virus onto mucosal surfaces such as those of the nose, mouth, and eyesSmall particle aerosols in the vicinity of the infectious individual.
Slide27Who may be considered for antiviral chemoprophylaxis
The following persons who are a close contact of a person with suspected or confirmed H1N1 influenza during the infectious period:Persons at high risk for complications of influenza;Health care workers and emergency medical personnel;Pregnant women.Whom not to treat chemoprophylacticallyGroups of healthy children or adults based on potential exposures in the community, workplace, school, camp or other settings; If >48 hours have elapsed since the last close contactThe close contact did not occur during the infectious period
Slide28Oseltamivir AND
Zanamivir drug of choice Prophylaxis should be provided till 10 days after last exposure
Slide29Use of the Pandemic (H1N1) 2009 vaccines
1. Inactivated – killedProduced by growing virus in chicken eggsGiven by injection into the upper arm. In infants and younger children the thigh is the preferred site for the vaccine shot.TYPES: Trivalent VAXIGRIP (flu shot: A/H1N1, A/H3N2, and B) 50-80% protectionCan be given in pregnancySingle dose in adultsImmunosuppressed and in children < 10 yr two doses 4 wks apartS/E: fever ; GBS 1 in 1 lac . C/I – ALLERGIC pts.
Slide302.LIVE ATTENUATED
administered by nasal spray.healthy individuals 2-49 yr of ageContraindicated in pregnancy immunosuppresed90% protection rateNot advised for health care professionals Influenza vaccines only become effective about 14 days after vaccination
Slide31Who will receive priority for vaccination?
WHO recommend that health workers be given first priority for early vaccination to protect themselves and their patients Those caring for high risk individuals who cannot receive vaccinationOther groups at higher risk for severe illnesspregnant womenaged above 6 months with one of several chronic medical conditions, healthy adults of 65 years of age and above
Slide32PASSIVE
PREVENTION
Slide33Guidelines on Infection control Measures
FOR HEALTH CARE INDIVIDUALS Personal Protection Equipments reduces the risk of infection if used correctly• Gloves (nonsterile), • Mask (high-efficiency mask) / Three layered surgical mask, • Long-sleeved cuffed gown, • Protective eyewear (goggles/visors/face shields), • Cap (may be used in high risk situations where there may be increased aerosols), • Plastic apron if splashing of blood, body fluids, excretions and secretions is anticipated
Slide34N95 Respirator
Filters 95% of airborne particulates *NIOSH- National Institute for Occupational Safety and Health. Agency under CDC.
Slide35During Hospital Care
o The patient should be admitted directly to the isolation facility and continue to wear a three layer surgical maskO The identified medical, nursing and paramedical personnel attending the suspect/ probable / confirmed case should wear full complement of PPE . If splashing with blood or other body fluids is anticipated, a water proof apron should be worn over the PPE
Slide36Perform hand hygiene before and after patient contact and following contact with contaminated items, whether or not gloves are worn. Hand washing and Hand rub
Slide37The virus is inactivated by
70% ethanol, 5% benzalkonium chloride (Lysol) and 10% sodium hypochlorite. Patient rooms/areas should be cleaned at least daily and finally after discharge of patient. To avoid possible aerosolization of the virus, damp sweeping should be performed. Recommended bed to bed distance should be at least 1m All waste generated from influenza patients is infectious clinical waste and should be treated and disposed in accordance with national regulations.
Slide38FOR GENERAL POPULATION IN COMMUNITY
Wash hands frequently with soap and water. If soap and water are not available, use an alcohol-based hand rubCover your mouth and nose with a tissue when coughing or sneezingAvoid touching your eyes, nose and mouth People who are sick with an influenza-like illness should stay home for at least 24 hours after fever is gone except to get medical care or for other necessities Avoid close contact (i.e. being within about 6 feet) with persons with Influenza like illnessGuidelines on Infection control Measures
Slide39Slide40THANK YOU