H1N1
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This document provides an outline on influenza virus including definitions, types, transmission, treatment guidelines, and the 2009 H1N1 pandemic. It discusses the virus structure and types A, B, and C. It outlines seasonal flu, pandemics, and the 2009 H1N1 outbreak in Mexico and the US. Treatment guidelines recommend antiviral medications like oseltamivir and zanamivir. It also discusses case definitions, personal protective equipment, and infection control measures.
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H1N1
- 13. Pandemic Phases Phase 1-3 Preparedness Phase 5-6 Pandemic
- 15. Swine Influenza A(H1N1) Mexico Confirmed Case Distribution, by Age Total Number of Confirmed Cases = 6,241* As of June 09, 2009 Source: Secretaria de Salud, Mexico *NOTE: 54 confirmed cases not included
- 16. Swine Influenza A(H1N1) Mexico Confirmed Cases & Death, by Age Groups Total Number of Confirmed Cases = 6,241* Deaths = 108 As of June 09, 2009 Source: Secretaria de Salud, Mexico *NOTE: 43 confirmed cases not included 71.3% Deaths
- 36. Swine Influenza A(H1N1) Treatment Source: CDC Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatment dose for 5 days. <3 months: 12 mg twice daily; 3-5 months: 20 mg twice daily; 6-11 months: 25 mg twice daily Dosing recommendations for antiviral chemoprophylaxis of children younger than 1 year using oseltamivir. Recommended prophylaxis dose for 10 days. <3 months: Not recommended unless situation judged critical due to limited data on use in this age group; 3-5 months: 20 mg once daily; 6-11 months: 25 mg once daily Oseltamivir (Tamiflu) Zanamivir (Relenza) Treatment Prophylaxis Treatment Prophylaxis Adults 75 mg capsule twice per day for 5 days 75 mg capsule once per day Two 5 mg inhalations (10 mg total) twice per day Two 5 mg inhalations (10 mg total) once per day Children 15 kg or less: 60 mg per day divided into 2 doses 30 mg once per day Two 5 mg inhalations (10 mg total) twice per day (age, 7 years or older) Two 5 mg inhalations (10 mg total) once per day (age, 5 years or older) 15–23 kg: 90 mg per day divided into 2 doses 45 mg once per day 24–40 kg: 120 mg per day divided into 2 doses 60 mg once per day >40 kg: 150 mg per day divided into 2 doses 75 mg once per day
- 48. Timeline of Emergence Influenza A Viruses in Humans 1918 1957 1968 1977 1997 1998/9 2003 H1 H1 H3 H2 H7 H5 H5 H9 Spanish Influenza H1N1 Asian Influenza H2N2 Russian Influenza Avian Influenza Hong Kong Influenza H3N2 2009 H1 Reassorted Influenza virus (Swine Flu) 1976 Swine Flu Outbreak, Ft. Dix
Notas del editor
- The internal antigens (M1 and NP proteins) are the type-specific proteins (type-specific antigens) used to determine if a particular virus is A, B or C. The M1 proteins of all members of each type show cross reactivity. The NP proteins of all members of each type also show cross reactivity. The external antigens (HA and NA) show more variation and are the subtype and strain-specific antigens. These are used to determine the particular strain of influenza A responsible for an outbreak Flu strains are named after their types of hemagglutinin and neuraminidase surface proteins, so they will be called, for example, H3N2 for type-3 hemagglutinin and type-2 neuraminidase. If two different strains of influenza infect the same cell simultaneously, their protein capsids and lipid envelopes are removed, exposing their RNA, which is then transcribed to mRNA. The host cell then forms new viruses that combine antigens; for example, H3N2 and H5N1 can form H5N2 this way. Because the human immune system has difficulty recognizing the new influenza strain, it may be highly dangerous.
- Influenza A viruses are found in many different animals, including ducks, chickens, pigs, whales, horses, and seals. There are 16 different haemaglutinin subtypes and 9 different neuraminidase subtypes, all of which have been found among influenza A viruses in wild birds. Wild birds are the primary natural reservoir for all subtypes of influenza A viruses and are thought to be the source of influenza A viruses in all other animals. Most influenza viruses cause asymptomatic or mild infection in birds; however, the range of symptoms in birds varies greatly depending on the strain of virus. Infection with certain avian influenza A viruses (for example, some strains of H5 and H7 viruses) can cause widespread disease and death among some species of wild and especially domestic birds such as chickens and turkeys. Pigs can be infected with both human and avian influenza viruses in addition to swine influenza viruses. Infected pigs get symptoms similar to humans, such as cough, fever, and runny nose. Because pigs are susceptible to avian, human and swine influenza viruses, they potentially may be infected with influenza viruses from different species (e.g., ducks and humans) at the same time. If this happens, it is possible for the genes of these viruses to mix and create a new virus.
- Reassortment, or Viral Subunit Reassortment, is the exchange of DNA between viruses inside a host cell. Two or more viruses of different strains (but usually the same species) infect a single cell and pool their genetic material creating numerous genetically diverse progeny viruses. It is a type of genetic recombination. Reassortment can lead to a viral shifts under some conditions.
- WHO Definition of Phases Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion. Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way. During the post-peak period , pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave. Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature. In the post-pandemic period , influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.
- There seems to be a protective affect with increase in age, suggesting past exposure and immunity in people above the age of 60 years.
- Highest % Case-Fatality (77.5%) was observed in the 20-54 year age group.
- For more information about Reye’s syndrome, visit the National Institute of Health website at http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm For information on homecare visit: http://www.cdc.gov/swineflu/guidance_homecare.htm
- Pregnant Women Oseltamivir and zanamivir are &quot;Pregnancy Category C&quot; medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers' package inserts should be consulted. However, no adverse effects have been reported among women who received oseltamivir or zanamivir during pregnancy or among infants born to women who have received oseltamivir or zanamivir. Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Because of its systemic activity, oseltamivir is preferred for treatment of pregnant women. The drug of choice for prophylaxis is less clear. Zanamivir may be preferable because of its limited systemic absorption; however, respiratory complications that may be associated with zanamivir because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems. Adverse Events: http://www.cdc.gov/flu/professionals/antivirals/side-effects.htm
- Two candidate vaccine the CDC is analyzing contain a mix of genes from the new swine flu virus with components of other viruses that allow them to grow better in the eggs that manufacturers use to produce vaccine. If one or both prove usable, manufacturers could begin producing pilot lots for testing this summer to see if the shots are safe, trigger immune protection and require one dose or two.