If You Look Like This……

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Swine flu is also known as…a. H5N1b. Influenza A (H1N1)c. Piggy pox

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Answer B Known as H1N1 based on serologic

testing. H5N1 is the avian flu

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Can you have swine flu without fever? Yes No

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Yes A New England Journal of medicine article

on the 1st 642 US cases found 94% had fever, 92% had cough, 66% had sore throat, 25% had diarrhea and 254 had vomiting.

Most people will have fever, but never say never. Your temperature may, however, be only slightly elevated

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Can someone carry swine flu without feeling sick? Yes No

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Yes It is possible. A carrier may have a runny

nose and/or a headache, but assume that it’s just a cold or allergies.

However, it is also possible for someone to become infected with a flu virus and have no symptoms.

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Surgical masks help keep flu or virions out. True False

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False Surgical masks are actually designed to

keep your germs in, though if someone coughs on you, it can help keep droplets out.

The N95 respirator masks keeps “germs” out, but must be sealed airtight against a person’s skin.

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Surgical masks Easily available and commonly used for routine surgical and examination

procedures High-filtration respiratory mask

Special microstructure filter disc to flush out particles bigger than 0.3 micron. These masks are further classified:• oil proof• oil resistant• not resistant to oil

The more a mask is resistant to oil, the better it is The masks have numbers beside them that indicate their filtration efficiency.

For example, a N95 mask has 95% efficiency in filtering out particles greater than 0.3 micron under normal rate of respiration.

The next generation of masks use Nano-technologywhich are capable of blocking particles as small as 0.027 micron.

The best way for people to protect themselves… Handwashing and using disinfectants Taking antivirals Tamiflu or Relenza Getting a vaccine

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Washing your hands frequently is still the best means of protection. Also avoid touching the mouth and eyes after touching a hard surface (fomite).

A vaccine is in the making and should be available in early to mid October.

Tamiflu or Relenza are effective, but should not be taken “just in case.” They are a precious commodity and can be toxic/harmful to the individual. Overuse could actually make one more vulnerable by encouraging the resistant strains.

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You can catch swine flu by… Feeding a person Feeding a pig Feeding a bird Feeding yourself with pork The 1st two answers are correct, but not the

last two

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The 1st two answers are correct H1N1 can be transmitted from swine to

human if in close contact, but most people are at greater risk of

catching it from another human who coughs or sneezes on or near you or on a surface you touch.

Birds aren’t transmitting the disease and eating pork is safe.

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Health experts advise against domestic travel on planes, trains and buses. True False

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False The VP was wrong to tell people not to

fly. Although this flu is passed between humans and the CDC recommends you not fly if you are feeling ill or diagnosed with the flu,

they recommend most take normal precautions such as regular hand washing.

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Which threat has killed the most Americans in the past?a. The Viet Nam warb. World War IIc. The 1918 influenza pandemicd. Hurricane

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The correct answer is C.

The 1918 flu killed more than 600,000 Americans.

Worldwide, the toll was over 50 million. By comparison, no single war has taken

as many Americans in battle. The Galveston Hurricane of 1900,

considered the deadliest in U.S. history, killed an estimated 8,000 people.

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What is the best known cure for the new H1N1 virus?a. Antiviral drugs like Tamiflu or Relenzab. The H1N1 vaccinec. Antibioticsd. None of the above

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The correct answer is D.

There is no cure for H1N1. Antiviral medications can shorten the duration of the

sickness in some cases Antibiotics can save you from deadly secondary

bacterial infections, but are not effective against viral infections.

Vaccine is the best way to prevent it to begin with. But there is no way to cure it once you get it, aside from

getting rest, drinking plenty of fluids and checking (early on) with a doctor if you have flu symptoms –

that's especially important for pregnant women, school-aged children and patients with co-morbid conditions (asthma, diabetes, heart disease or other ongoing health conditions…)

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If I get the regular, seasonal flu vaccine, will that protect me from H1N1, too?a. Yesb. Noc. Maybe

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The correct answer is B.

The seasonal vaccine is designed for a different strain of flu.

Health officials recommend that Americans get both vaccines

The seasonal flu vaccine is available now, so experts advise getting it first.

If you choose to get both vaccines at the same time, avoid the weakened live-virus form of the seasonal flu vaccine, which is administered by nasal spray.

According to the government, vaccinations given simultaneously should be the killed-virus form that is injected, each in a different part of the body.

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The new H1N1 vaccine, which will be available later this fall, (somewhere around the first to second week of October) has been tested on:a. Healthy young adultsb. Pregnant womenc. Children aged 6 mos to 17 years oldd. Elderly peoplee. All of the above

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The correct answer is E.

This summer, research institutions around the country tested the H1N1 vaccine on thousands of volunteers of all ages, including pregnant women. The National Institutes of Health oversaw the trials. (Similar studies are being conducted in several other countries.)

So far, no safety problems have been found -- which is what scientists expected, since the H1N1 vaccine is made in the same way that regular seasonal flu vaccines are made every year.

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One sneeze can contain how many viruses?a. Dozensb. Hundredsc. Billions

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The correct answer is C.

Influenza viruses are diabolically resilient. Their sole purpose is to reproduce. And one way they do that is to make you cough and sneeze.

Each time you sneeze, it's like blowing a dandelion seed-puff of virus across the room -- which is why President Obama keeps nagging you to wash your hands and sneeze into your sleeve.

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It is possible that fewer Americans will die from influenza (of all kinds) this year than in past years?a. Trueb. False

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The correct answer is A.

New pandemic influenza viruses tend to crowd out the normal seasonal flu viruses.

It's sort of a survival-of-the-fittest situation, and the pandemic virus -- to which the population has little natural immunity -- is the fittest. (This crowding-out has already happened in the southern hemisphere with H1N1, in fact.)

As a result, Americans may see many more people getting sick this fall, but many fewer dying overall, because H1N1 is more infectious but (so far) less deadly.

Good news? Well, yes. And no. The people who will die will likely be much younger than in a normal flu season, because H1N1 targets children and young adults.

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If I get the vaccine as soon as it is available -- probably in mid-October -- when will I have immunity against H1N1?a. Immediatelyb. In two daysc. In three weeksd. Never

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The correct answer is C.

The early results of a vaccine trial in Australia found that a single dose of H1N1 vaccine was enough to confer immunity in adults.

Three weeks after the 120 volunteers in the study received their vaccine shot, 97% had enough antibodies to be considered protected.

That was welcome news for public health experts, who had previously thought that people would need two doses of the vaccine -- a process that would have taken about five weeks, from the delivery of the first shot to the point at which the body becomes immune.

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If I am over 55, I am at higher risk and should get the vaccine as soon as it's available.

a. Trueb. False

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The correct answer is B.

Finally, it pays to be old! Older people seem to have some built-in immunity to this new flu. They may have been exposed to a related strain when they were younger.

So while they should still get the seasonal flu shot, older adults needn't consider the H1N1 vaccine a high priority in most cases.

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According to guidelines drafted by the Centers for Disease Control and Prevention (CDC), there are five key populations that should be vaccinated against the H1N1 virus:

Pregnant women People who live with or care for children

younger than 6 months of age Children and young people between the

ages of 6 months and 24 years Health care workers and emergency

medical service providers People between 25 and 64 years of age

who have chronic medical disorders or compromised immune systems.

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The above groups account for approximately 159 million Americans.

The CDC urges these at-risk populations to get both the swine flu shot and the seasonal flu shot. (The regular flu shot doesn't protect against the H1N1 virus.)

So what should the remaining half of the U.S. population do this flu season? The answer isn't clear, especially in light of the 1976 swine flu debacle.

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In 1976, a 19-year-old Army private stationed in Fort Dix, N.J., died from the swine flu, while another 115 soldiers stationed there tested positive for swine flu antibodies.

The CDC was called in to investigate, and its scientists concluded that the soldiers had a strain similar to the Spanish Influenza of 1918, which was responsible for the deadliest human pandemic of the 20th century.

Although the virus hadn't spread beyond the fort, the CDC convinced then-president Gerald Ford's advisors that a mass inoculation was required. Pharmaceutical companies rushed to develop a vaccine.

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By mid-October of 1976, approximately 40 million people had been vaccinated against swine flu and not long after, reports of serious side effects began to pour in.

Within a couple of months, 25 people died from Guillain-Barré, a neuromuscular disorder that can result in paralysis or death,

An additional 500 were diagnosed with the condition. (Doctor's don't know what causes Guillain-Barré, but it can develop after a post-surgery infection or vaccination.)

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Experts are not expecting any major health risks associated with the current H1N1 vaccine.

"We aren't expecting any side effects beyond what we normally see.“

Typical side effects include soreness at the injection site and mild body aches.

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But it's too early to tell if the vaccine is safe and effective, cautions some experts.

"According to clinical trial results it is safe and effective, but we won't know the side effects until large groups of people have been vaccinated.”

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Today, while CDC spokesman Tom Skinner acknowledges the problems that plagued 1976 inoculation program, he says that this time around his agency and the FDA have taken extra steps to protect the public.

"We have good surveillance monitors in place," he says, referring to the Vaccine Adverse Effect Reporting System (VAERS), a mechanism that allows the public to report and monitor adverse reactions to inoculations.

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He also contends that the current swine flu virus, while contagious, is relatively mild.

"The virulence is basically the same as seasonal influenza," he says.

And even if that's too much for some to risk catching, one expert says that getting an H1N1 shot might not provide full protection if the virus mutates.

"We've been told that the second viral wave might be more lethal, and that would make the vaccine less effective.”

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Pain and redness at the injection site

Drowsiness or tiredness Muscle aches Low grade fever Malaise Headache

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Severe allergic reaction (anaphylaxis) Guillian-Barre Syndrome (nervous

system disorder featuring paralysis) From the evidence collected by

experts: GBS is 4 to 7 times more likely after an

attack of the actual flu than after the influenza vaccine

There have been reports overseas of a possible association between influenza vaccinations and GBS

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Influenza (flu) is a contagious respiratory illness caused by viruses.

Infection results in mild to severe illness and can lead to death.

Every year, an average of 5 to 20 percent of the U.S. population gets the flu.

Some influenza viruses can also infect birds, pigs, horses, seals, whales and other animals.

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Influenza Influenza The Normal Burden of DiseaseThe Normal Burden of Disease

Seasonal Influenza Globally: 250,000 to 500,000 deaths per year In the US (per year)

~35,000 deaths >200,000 Hospitalizations $37.5 billion in economic cost (influenza &

pneumonia) >$10 billion in lost productivity

Pandemic Influenza An ever present threat

Credit: L. Stammard, 1995

• RNA, enveloped

• Viral family: Orthomyxoviridae

• Size: 80-200nm or .08 – 0.12 μm (micron) in diameter

• Three types• A, B, C

• Surface antigens• H (haemaglutinin)• N (neuraminidase)

ssRNA consists of 10 genes encoded on 8 separate RNA segments.

3 distinct influenza virus types: A, B, C; Type A causes most infections

Virus attaches to, and multiplies in, the cells of the respiratory tract; finished viruses are assembled and budded off.

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Key to influenza are glycoprotein spikes – hemagglutinin (H) – 15 different subtypes;

most important virulence factor; binds to host cells

neuraminidase (N) – 9 subtypes – hydrolyzes mucus and assists viral budding and release

Both glycoproteins frequently undergo genetic changes decreasing the effectiveness of the host immune response.

Constant mutation is called, antigenic drift – influenza gradually change their amino acid composition

Antigenic shift – one of the genes or RNA strands is substituted with a gene or strand from another influenza virus from a different animal host

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Source: Bean B, et al. JID 1982;146:47-51

Hard non-porous surfaces 24-48 hours Plastic, stainless steel

Recoverable for > 24 hours Transferable to hands up to 24 hours

Cloth, paper & tissue Recoverable for 8-12 hours Transferable to hands 15 minutes

Viable on hands <5 minutes only at high viral titers Potential for indirect contact transmission

*Humidity 35-40%, Temperature 28C (82F)

H1N1 is a new (novel) influenza virus.   This new virus was first detected in people in the

U.S. in April 2009 and was initially call “swine flu.” In some respects the H1N1 virus is just like any

other influenza virus. It causes a predominantly respiratory illness.  This new virus has caused some anxiety around

the world, though most of those who get it say it feels like regular flu.  

What is unique about this virus is that it is a mutated type of virus so that nobody in the U.S. or probably worldwide has any immunity to it.  

That is why it has the ability to cause widespread infections

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Unlike with the seasonal flu, young people are at higher risk of H1N1 infection than people 65 and older.

However, infected people 65 or older are still at increased risk of H1N1 influenza-related complications.

The worldwide spread of the H1N1 virus this spring was both rapid and unusual as it affected some countries outside of the time frame of a normal flu season.

While most people who have become ill with the H1N1 virus have recovered without needing medical treatment, hospitalizations and deaths have occurred.

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Through contact with infected pigs or environments contaminated with swine flu viruses

Through contact with a person with swine flu

Human-to-human spread of swine flu has been documented also and is thought to occur in the same way as seasonal flu, through coughing or sneezing of infected people

This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America.

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Avian Virus

Human Virus

Swine Virus

Avian/HumanReassorted

Virus

Reassortment in Pigs

H1 N1H2 N2H3 N3H4 N4H5 N5H6 N6H7 N7H8 N8H9 N9

H10H11H12H13H14H15H16

Haemagglutinin subtype Neuraminidase subtype

The CDC believes that this H1N1 virus is spread in the same way that seasonal flu spreads.

You could catch the flu directly from droplets from the cough or sneeze of an infected person, or by touching an object they recently touched, and then touching your eyes, mouth, or nose.

That's why you should make washing your hands a habit, even when you're not ill.

Infected people can start spreading flu germs up to a day before symptoms start, and for up to seven days after getting sick, according to the CDC.

Children, especially younger children, might potentially be contagious for longer periods.

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No. H1N1 (swine) influenza viruses are not

transmitted by food. You can not get H1N1 (swine) influenza from eating pork or pork products.

Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the H1N1 (swine) flu virus as it does other bacteria and viruses

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You will not be able to tell the difference between seasonal flu and H1N1 influenza without medical help.

Only your medical practitioner and local health authority can confirm a case of influenza of H1N1 flu.

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If possible, try to avoid close contact with people who maybe ill.

Additionally: avoid touching your mouth and nose; clean hands thoroughly with soap and water, or

cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated);

reduce the amount of time you spend in crowded settings;

practice good health habits including adequate sleep, eating nutritious food, and keeping physically active.

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While most of the current H1N1 influenza cases have been mild so far, infected individuals should still be aware of some of the more severe illness with H1N1 flu.

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In children, emergency warning signs that need urgent medical attention include:

Fast breathing or trouble breathing Bluish skin color Dehydration, or not drinking enough fluids Sluggish, not waking up or not interacting Irritability to the point that the child does not

want to be held Flulike symptoms improve but then return

with fever and worse cough Fever with a rash

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In adults, symptoms that need emergency medical attention include:

Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting If a person has any of the above symptoms

they should seek medical care immediately. For any questions consult your regular medical provider or the local health department.

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Follow the same precautions you would to avoid ordinary seasonal flu.

Limit your contact with the affected person. Avoid close contact such as kissing, and do

not share towels, glasses or toothbrushes with the affected person.

Avoid having visitors. If visitors must enter the home, they should

avoid close contact with the affected person. Wash your hands with soap and water or

with an alcohol-based hand rub.

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TreatmentTreatment

H1N1 flu is sensitive to the antiviral drugs Tamiflu and Relenza.

Antivirals aren’t usually necessary for mild illness (except perhaps for those who are at high risk for complications)

Rest and fluids work best Should be started early for

maximum effectiveness State/federal stockpiles have

been sent to designated providers

It's probably important for people to first understand what a pandemic is. So if one goes to the World Health Organization a pandemic is defined by meeting three criteria:

the emergence of a disease that is new to a population;

the agent infects humans and results in serious illness and

that agent is then easily spread amongst populations.

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The First Flu Pandemic of the 21The First Flu Pandemic of the 21stst CenturyCentury

On June 11, 2009 WHO raised pandemic alert

level to Phase 6 A global pandemic was

underway Community-level outbreaks

in multiple parts of the world

Declaration was reflection of the spread of the virus – not of the severity of the disease it causes

World Health Organization, Retrieved July 7, 2009, form

http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

1918 H1N1 Pandemic 50 Million deaths

worldwide 500,000 deaths in US

alone Reduced U.S. life

expectancy by 13 years

“Herald Wave”

Herald Wave

Herald wave

2009

Is GA Here?

There is reason to believe the worst may be over for Georgia

Still significant risk to our student population Virus mutation Pregnant Disparity of Latinos and African Americans

These groups of people are at risk of complications of influenza and are high priority for vaccination:

1. Pregnant women or women up to 4 weeks post-partum.

2. People with the following conditions: Chronic pulmonary conditions (asthma, COPD, cystic

fibrosis) Chronic cardiac (heart) conditions. Except

hypertension. Renal, hepatic disease. (kidney/liver) Sickle cell disease. Neurologic or neuromuscular disorders (compromise

ability to clear airway secretions)80

Diabetes mellitus and other metabolic disorders Obesity Immunosuppression (caused by medications or HIV).

3. Persons younger than 19 yrs who are receiving long-term aspirin therapy.

4. Children younger than 5 yrs old. The risk for severe complications from seasonal influenza is highest among children younger than 2 years old.

5. Persons aged 65 yrs. and over with comorbid conditions.

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Rapid enzyme immunoassay• Type A: seasonal or new H1N1• Sensitivity for new H1N1

~75%? PCR diagnostic kit available

• High-risk for complications• Severe or hospitalized cases• Prior approval: 800-392-0272.

Use personal protective equipment when swabbing.

Wash your hands often with soap and warm water,

especially after you cough or sneeze. Wash for 15 – 20seconds.

Alcohol-based hand wipes or gel sanitizers are also effective.

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

Avoid touching your eyes, nose or mouth.Germs spread this way.

Avoid contact with sick people.

Stay home if you’re sick for 7 days after your symptoms begin or until you’ve been symptom-free for 24 hours, whichever is longer.

If you are sick, limit your contact with other people as much as possible.

Do not treat children with ASPIRIN Aspirin treatment in children with the flu

or other viral infections has a known association with Reyes Syndrome – a potentially fatal complication

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Are you saying this pandemic will be as bad as 1918? NO – vaccine will be available sooner – potential

for large numbers of deaths are possible Advances in medical care – antibiotics

How do we know if someone has H1N1 or seasonal influenza Difficult to determine – subtle clues / symptoms Fever, chills, cough, sore throat Treated the same – NO TESTING

What should we do for people who have ILI? Rest, fluids, control fever with

acetaminophen / naproxen / ibuprofen Seek care at campus / student health Isolate to room / home Single caregiver (already exposed and not

high risk preferred) Close contacts should take antivirals

1. Past experience with pandemics have taught us that the second wave is worse than the first causing more deaths due to: Primary viral pneumonia, Acute Respiratory Distress

Syndrome (ARDS), & Secondary bacterial infections, particularly pneumonia

Fortunately compared to the past now we have anti-virals and antibiotics (to treat secondary bacterial infections)

Based upon past experience and the way the current H1N1 pandemic is acting (current wave is contagious, spreading rapidly and in Mexico/Canada based upon preliminary data affecting the healthy), there is a likelihood that come fall there might be a second wave which could be more virulent

2. At present most of the deaths due to H1N1 strain has been reported from Mexico. • The disease, though spreading rapidly across

the globe, is of a mild form (exception Mexico) • Most people do not have immunity to this virus

and, as it continues to spread. More cases, more hospitalizations and some more deaths are expected in the coming days and weeks

• Disease seems to be affecting the healthy strata of the population based upon epidemiological data from Mexico and EU

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3. Each locality/jurisdiction needs to Have enhanced disease and virological

surveillance capabilities Develop a plan to house large number of

severely sick and provide care if needed to deal with mildly sick at home (voluntary quarantine)

Healthcare facilities/hospitals need to focus on increasing surge capacity and stringent infection prevention/control

General population needs to follow basic precautions

4. In the Northern Hemisphere influenza viral transmission traditionally stops by the beginning of May but in pandemic years (1957) sporadic outbreaks occurred during summer among young adults Likelihood that

This wave will fade in North America by the end of June or will cause disease in a few cases (influenza virus cannot survive high humidity or temperature)

Will reappear in autumn in North America with the likelihood of being a highly pathogenic second wave

Will continue to circulate and cause disease in the Southern Hemisphere

5. Border Closure and Travel Restrictions: The disease has already crossed all borders and

continents, thus, border closure or travel restrictions will not change the course of the spread of disease• Most recently, the 2003 experience with SARS

demonstrated the ineffectiveness of such measures • In China, 14 million people were screened for fever at

the airport, train stations, and roadside checkpoints, but only 12 were found to have probable SARS

• Singapore reported that after screening nearly 500,000 air passengers, none were found to have SARS

• Passive surveillance methods (in which symptomatic individuals report illness) can be important tools

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6. School Closures: Preemptive school closures will merely delay

the spread of disease Once schools reopen (as they cannot be

closed indefinitely), the disease will be transmitted and spread

Furthermore, this would put unbearable pressure on single-working parents and would be devastating to the economy (as children cannot be left alone)

Closure after identification of a large cluster would be appropriate as absenteeism rate among students and teachers would be high enough to justify this action

7. High priority should be given to develop and include the present “North American” (swine) influenza A(H1N1) virus in next years vaccine. A critical look at manufacturing capacity is called for

8. It is imperative to appreciate that “times-have-changed” • Though this strain has spread very quickly across

the globe and seems to be highly infectious, today we are much better prepared than 1918. There is better surveillance, communication, understanding of infection control, anti-virals, antibiotics and advancement in science and resources to produce an affective vaccine

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