Novel Influenza A Novel Influenza A H1N1 H1N1

or “or “Swine Flu”Swine Flu”Dr. Simon ChongDr. Simon Chong

K.N. Chin & AssociatesK.N. Chin & Associates

Often misunderstood and Often misunderstood and underestimated, underestimated,

Influenza is not just “a bad cold”!Influenza is not just “a bad cold”!

Annual, winter influenza epidemics

Influenza pandemics every few decades

(11–36 years)

Differences between Differences between Allergy, Cold Allergy, Cold andand Flu Flu

SymptomsSymptoms Airborne allergyAirborne allergy Common ColdCommon Cold Flu or Influenza InfectionFlu or Influenza Infection

FeverFever NeverNever RareRareUsual. Usual. High (100-102F)(37.8-38.9C)High (100-102F)(37.8-38.9C) sometimes higher (especially in young sometimes higher (especially in young children); last 3-5 dayschildren); last 3-5 days

HeadacheHeadache RareRare RareRare CommonCommon

General aches & painsGeneral aches & pains NeverNever SlightSlight Usual; often Usual; often severesevere

Fatigue, weaknessFatigue, weakness SometimesSometimes SometimesSometimes Usual, can Usual, can last up to 3 weekslast up to 3 weeks

Extreme exhaustionExtreme exhaustion NeverNever NeverNever UsualUsual, at the beginning of the illness, at the beginning of the illness

Stuffy or Stuffy or ‘‘runnyrunny’’ nose nose CommonCommon CommonCommon SometimesSometimes

SneezingSneezing UsualUsual UsualUsual SometimesSometimes

Sore throatSore throat SometimesSometimes CommonCommon SometimesSometimes

CoughCough Sometimes. Dry Sometimes. Dry (non-productive)(non-productive)

Common, hacking, Common, hacking, often productiveoften productive

CommonCommon, can become severe. Usually , can become severe. Usually non-productivenon-productive

Chest discomfortChest discomfort RareRare Mild to moderateMild to moderate CommonCommon

Differences between Differences between Allergy, Cold Allergy, Cold andand Flu Flu

SymptomSymptom Airborne allergyAirborne allergy Common ColdCommon Cold Flu/Influenza InfectionFlu/Influenza Infection

OnsetOnset May be suddenMay be sudden GradualGradual Acute & suddenAcute & sudden

DurationDuration Over a weekOver a week 3-5 days3-5 days Over 5 daysOver 5 days

RRed ed eyeeye�/Conjunctivitis�/Conjunctivitis

PossiblePossible UncommonUncommon May be prominentMay be prominent

Influenza Virus StructureInfluenza Virus Structure

Haemaglutinin

Neuraminidase

Nucleoprotein

H1N1 Virus

Human Influenza – Some FactsHuman Influenza – Some Facts

Caused by Influenza VirusCaused by Influenza Virus 3 main types: A, B & C3 main types: A, B & C

A & B: Cause A & B: Cause EpidemicsEpidemics nearly every year nearly every year A: Cause of A: Cause of PandemicsPandemics ““A”: A”: SubtypesSubtypes based on different surface based on different surface

proteins – Haemaglutinin(H) & Neuraminidase (N)proteins – Haemaglutinin(H) & Neuraminidase (N)

Human Influenza – Some FactsHuman Influenza – Some Facts

Antigenic DRIFT Antigenic DRIFT yearly epidemics yearly epidemics Antigenic SHIFT Antigenic SHIFT influenza pandemic influenza pandemic

(every 10-40 years)(every 10-40 years)

Antigenic ShiftAntigenic Shift

Bird Flu

Swine Flu

Human Flu

Human Host

H1N1 Virus(new)

Past PandemicsPast Pandemics

1918 – Spanish flu (20 – 40 million cases)1918 – Spanish flu (20 – 40 million cases) 1957 – Asian flu (1 million cases)1957 – Asian flu (1 million cases) 1968 – Hong Kong flu (0.7 million cases)1968 – Hong Kong flu (0.7 million cases)

The "Spanish flu" pandemic of 1918 killed over 20 million people worldwide. Above: Two Red Cross

nurses tend to a patient at a Red Cross emergency ambulance station in Washington, D.C., during the

outbreak.

Recent H1N1 Influenza “A” Recent H1N1 Influenza “A” OutbreakOutbreak

April 4: 1April 4: 1stst case in Mexico case in Mexico April 12: First deathApril 12: First death April 21-23: US confirms first 4 casesApril 21-23: US confirms first 4 cases April 26: Canada confirms first casesApril 26: Canada confirms first cases April 27: Europe, Spain & Britain. WHO raises April 27: Europe, Spain & Britain. WHO raises

pandemic alert status to phase 4pandemic alert status to phase 4 April 28: New Zealand & IsraelApril 28: New Zealand & Israel April 29-30: Germany, Austria, Switzerland, April 29-30: Germany, Austria, Switzerland,

NetherlandsNetherlands May 1: Hong Kong, Denmark, FranceMay 1: Hong Kong, Denmark, France May 2: South Korea, ItalyMay 2: South Korea, Italy

Latest Count of Confirmed Cases & Deaths

How Does H1N1 Spread?How Does H1N1 Spread?

Droplet (e.g. coughing, sneezing, speaking)

Contact (touching a contaminated surface)

To To PreventPrevent H1N1 Spreading or H1N1 Spreading or Contracting?Contracting?

Droplet (e.g. coughing, sneezing, speaking)

Good Personal Hygiene-habits viaa) covering of mouth with a tissue

when coughing or sneezing and disposing it properly into the waste-basket

b) Wearing Surgical Masks when unwell

Personal Protective Equipments/PPEa) N95 Masks - for those who are wellb) Gowns - for those who are well

To To PreventPrevent H1N1 Spreading or H1N1 Spreading or Contracting?Contracting?

Contact (touching a contaminated surface)

Good Personal Hygiene-habits viaa) Hand-Washing/Cleansing with

soap or with Alcohol-based sanitizers

PPEa) Gloves

Environmental HygieneEnsuring regular cleaning and sterilizing of work areas or equipments

To To PreventPrevent H1N1 Spreading or H1N1 Spreading or Contracting?Contracting?

Exercise Social ResponsibilityWhen sick and not feeling well, to see adoctor and stay at home. Put on a maskif you really need to go out.

Maintaining a Healthy Lifestylea) Exercisingb) Consuming a Balanced Diet and adequate

amount of Water dailyc) Essential Supplements such as Vitamins A,

C, E, and Zincd) Adequate rest

To To PreventPrevent H1N1 Spreading or H1N1 Spreading or Contracting?Contracting?

Monitoring of TemperatureTemperature should be measured

twice a day (morning and afternoon).

Fever is Oral Temp >37.4 degrees Celsius(immediately don a mask and visit the Doc)

36.0-38.0 deg C can be normal for aural temp.

Oral Temperature

Aural/Ear Temperature

Forehead Temperature(Inaccurate)

How Does How Does Seasonal Influenza VaccinationSeasonal Influenza Vaccination help to Prevent H1N1 Infection?help to Prevent H1N1 Infection?

Does Does NOTNOT protect against H1N1 protect against H1N1

But recommended because of : - Personal protection against human influenza- Precaution against possible re-assortment- Enable Early Diagnosis & Isolation of true H1N1 Influenza patients

Recommendation For Seasonal Recommendation For Seasonal Influenza VaccinationInfluenza Vaccination

Who should be vaccinated?Who should be vaccinated? TravelersTravelers Children 6 months – 5 yearsChildren 6 months – 5 years Elderly > 65Elderly > 65 Residents of nursing homesResidents of nursing homes People with long term-illnesses (e.g. heart/lung)People with long term-illnesses (e.g. heart/lung) People with depressed immunityPeople with depressed immunity Pregnant women in 2Pregnant women in 2ndnd-3-3rdrd trimester trimester Healthcare workersHealthcare workers EVERYONEEVERYONE in the face of a in the face of a Pandemic-threatPandemic-threat

Treatment of Novel H1N1 Treatment of Novel H1N1 Influenza AInfluenza A

Tamiflu Relenza(Can also be taken as a prophylaxis

against Influenza infections)

Advice to Travelers Advice to Travelers priorprior to travel to travel

a) a) AvoidAvoid unnecessary travel especially to unnecessary travel especially to epicenters of outbreakepicenters of outbreak

b) Get the b) Get the Flu VaccinationFlu Vaccination at least 2 weeks at least 2 weeks before travelingbefore traveling

c) Carry along a box of c) Carry along a box of Tamiflu Tamiflu & some& some N95 N95 MasksMasks

d) Bring a d) Bring a Travel Medicine KitTravel Medicine Kit

Advice to Travelers Advice to Travelers afterafter travel travela)a) QuarantineQuarantine self and work from home, if self and work from home, if

traveling from epicenters, for 7 days while traveling from epicenters, for 7 days while monitoring temperature regularly and for monitoring temperature regularly and for symptomssymptoms

b)b) Keep self updated on the news in regards to Keep self updated on the news in regards to possible contacts with confirmed cases while possible contacts with confirmed cases while travelingtraveling

c)c) To see doctor immediately if symptoms To see doctor immediately if symptoms developed after traveling to Non-Epicentersdeveloped after traveling to Non-Epicenters

General AdviceGeneral Advice

Avoid crowded placesAvoid crowded places Avoid unnecessary travelAvoid unnecessary travel Spend more time in the outdoors or open Spend more time in the outdoors or open

spaces than in an enclosed air-con spaces than in an enclosed air-con environmentenvironment

Be prepared by stocking up on masks, Be prepared by stocking up on masks, thermometers and Tamiflu.thermometers and Tamiflu.

Important AdviceImportant Advice

If you have…If you have… Recently traveledRecently traveled to Mexico, USA, Canada, to Mexico, USA, Canada,

Chile, Australia & Japan (Kobe & Osaka)Chile, Australia & Japan (Kobe & Osaka)

OROR

ContactContact with anyone who traveled to the above with anyone who traveled to the above placesplaces

Fever > 38 degreesFever > 38 degrees +/- flu symptoms +/- flu symptoms Call 993Call 993 immediately immediately

Thank You!

VenkateshQatar