AH1N1 Basic Facts

Influenza A (H1N1)Influenza A (H1N1)

Understanding Understanding

National Center for Health Promotion, DOH

Transmission:Transmission:– Regular person-to-person

transmission – Primarily through contact

with respiratory droplets – Transmission from objects

(fomites) possible

Influenza is usually a respiratory infection


Key CharacteristicsKey Characteristics

CommunicabilityCommunicability

– Viral shedding can begin 1 day before symptom onset

– Peak shedding first 3 days of illness

– Correlates with temperature– Subsides usually by 5-7th day in

adults– can be 10+ days in children– Infants, children and the

immunocompromised may shed the virus longer


Incubation periodIncubation period– Time from exposure to onset of symptoms– 1 to 4 days (average = 2 days)

SeasonalitySeasonality– In temperate zones, sharp peaks in winter months

– In tropical zones, circulates year-round with

seasonal increases.


Individuals at Increased Risk for Individuals at Increased Risk for Hospitalizations and DeathHospitalizations and Death

• Elderly Elderly >> 65 years 65 years• Children less than two yearsChildren less than two years• Certain chronic diseasesCertain chronic diseases

– Heart or lung disease, including asthmaHeart or lung disease, including asthma– Metabolic disease, including diabetesMetabolic disease, including diabetes– HIV/AIDs, other immunosuppression HIV/AIDs, other immunosuppression – Conditions that can compromise respiratory function or the handling Conditions that can compromise respiratory function or the handling

of respiratory secretionsof respiratory secretions• Pregnant womenPregnant women


VaccinationVaccination

• Influenza vaccine is the best prevention for Influenza vaccine is the best prevention for seasonal influenza.seasonal influenza.

• Live, intranasal spray vaccine for healthy non-Live, intranasal spray vaccine for healthy non-pregnant persons 5-49 yearspregnant persons 5-49 years

• Inactivated, injectable vaccine for persons 6 Inactivated, injectable vaccine for persons 6 months and oldermonths and older


Influenza VirusesInfluenza Viruses

• Classified into types A, B, and CClassified into types A, B, and C

• Only Types A and B cause significant Only Types A and B cause significant diseasedisease

• Types B and C limited to humansTypes B and C limited to humans

• Type A viruses Type A viruses

• More virulentMore virulent• Affect many speciesAffect many species

C Goldsmith, CDC


Influenza A (H1N1) is a novel virus

• Unusual combination of genetic material from pigs, Unusual combination of genetic material from pigs, birds & humans which have re-assortedbirds & humans which have re-assorted

• human-to-human transmission occurs through human-to-human transmission occurs through respiratory droplets generated from sneeze or respiratory droplets generated from sneeze or coughcough

• Affects all age groupsAffects all age groups

• Vaccines for human seasonal flu can not protect Vaccines for human seasonal flu can not protect humans against the novel virushumans against the novel virus


Swine Influenza VirusesSwine Influenza Viruses

• RNA virusesRNA viruses• Pigs can be infected by avian influenza and Pigs can be infected by avian influenza and

human influenza viruses as well as swine human influenza viruses as well as swine influenza viruses. influenza viruses.

• reassort and new viruses that are a mix of reassort and new viruses that are a mix of swine, human and/or avian influenza swine, human and/or avian influenza viruses can EMERGEviruses can EMERGE


SIV

Genetic Reassortment


Signs & Symptoms of Influenza A (H1N1)Signs & Symptoms of Influenza A (H1N1)Like Seasonal Influenza;Like Seasonal Influenza;

• Fever• Fatigue• Lack of appetite• Coughing• Runny Nose• Sore throat• Nausea / Vomiting• Diarrhea


Swine H1N1 vs. Human H1N1Swine H1N1 vs. Human H1N1

• swineswine H1N1 flu virus NOT the same as H1N1 flu virus NOT the same as human H1N1 virushuman H1N1 virus

• antigenically very different from human antigenically very different from human H1N1 viruses H1N1 viruses

• vaccines for human seasonal flu can not vaccines for human seasonal flu can not protect humans from protect humans from swineswine H1N1 H1N1


Transmission: Food-Borne?Transmission: Food-Borne?

• NO• Influenza A (H1N1) viruses are not

transmitted through food • Safe to eat properly handled and cooked

pork and pork products• Cook pork at an internal temperature of 70°C

(160°F)


Diagnosis and Laboratory ConfirmationDiagnosis and Laboratory Confirmation

• Clinically diagnosed• Respiratory Specimen

• first 4 to 5 days of illness • can shed for 10 days or longer

• Specimens sent to US CDC • ONLY laboratory that can isolate and

identify swine influenza type A virus


TreatmentTreatment

• Influenza A (H1N1) is sensitive to:Influenza A (H1N1) is sensitive to:– OseltamivirOseltamivir– ZanamivirZanamivir

• Self medication is discouraged, may induce Self medication is discouraged, may induce drug resistancedrug resistance

• ChemoprophylaxisChemoprophylaxis– OseltamivirOseltamivir


VaccineVaccine

• No Influenza A (H1N1) vaccine yetNo Influenza A (H1N1) vaccine yet• Process of production is underway, but Process of production is underway, but

may take 5 – 6 monthsmay take 5 – 6 months• Seasonal influenza vaccine provides Seasonal influenza vaccine provides

protection against the seasonal human protection against the seasonal human influenza strains onlyinfluenza strains only


Influenza A (H1N1) is a Public Health Influenza A (H1N1) is a Public Health Emergency of International Concern (PHEIC)Emergency of International Concern (PHEIC)

Serious Public Health ImpactSerious Public Health ImpactUnusual or UnexpectedUnusual or UnexpectedInternational disease spreadInternational disease spreadInterference with international travel or Interference with international travel or

tradetrade**WHO Recommends intensifying and enhancing national surveillance systems for Influenza-like Illnesses and atypical pneumonia


WHO PANDEMIC PHASES

Pandemic Alert Phase 6

WHO PANDEMIC PHASES AND DESCRIPTION

WHO PANDEMIC PHASES AND DESCRIPTION

Public Health AdvisoryPublic Health Advisory

• Cover nose and mouth with a tissue when coughing or sneezing.

• Wash hands regularly with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

• Avoid close contact with sick people.

• If sick, self-monitor and stay home from work or school and limit contact with others.

• Consult your doctor immediately should signs and symptoms of flu persist.


Transmission GenerationsTransmission Generations

First First generationgeneration

(Index (Index Case)Case)

Second Second generation generation


Third Third generation generation


Fourth Fourth generation generation


Case 1Case 1Case 2Case 2

Case 3Case 3

Case 4Case 4

Case 5Case 5

Case 6Case 6

Case 7Case 7

Case 8Case 8

Case 9Case 9

What are the What are the implications of the implications of the

third generation third generation transmission?transmission?

• Transmission in Transmission in ongoingongoing

• Transmission could Transmission could be fast be fast (superspreading)(superspreading)

•* Need to identify the * Need to identify the factors that cause factors that cause “superspreading”“superspreading”

•* Need to implement * Need to implement aggressive infection-aggressive infection-control measurescontrol measures

Ex. Usually the health care Ex. Usually the health care workers, patients, visitors & workers, patients, visitors &

patient’s family memberspatient’s family members

Ex. Family Ex. Family members of members of

health health workersworkers

Other Other contracts in contracts in

the the communitycommunity

What has been done?What has been done?• Activation of the DOH Management Committee Activation of the DOH Management Committee

on Prevention and Control of Re-Emerging on Prevention and Control of Re-Emerging Infectious Diseases Infectious Diseases

• Enhanced health surveillance in hospitals, Enhanced health surveillance in hospitals, seaports, and airports which include thermal seaports, and airports which include thermal scanning of arriving passengers from affected scanning of arriving passengers from affected countriescountries


What has been done?What has been done?

• Health Declaration Checklist to screen for potential signs & symptoms & possible exposure to the virus

• Health Alert Notice (HAN) distributed to all arriving travelers who are strongly advised to monitor body temperature daily up to 10 days from date of arrival & to contact health authorities A.S.A.P. if they become ill during this period


What has been done?What has been done?• Issuance of travel advisory to the publicIssuance of travel advisory to the public

– No travel ban but travelers are asked to reconsider their No travel ban but travelers are asked to reconsider their plans to travel to affected countries unless extremely plans to travel to affected countries unless extremely necessarynecessary

– The World Health Organization does not recommend any The World Health Organization does not recommend any travel restrictions or closure of borders at this timetravel restrictions or closure of borders at this time

• Activation of Activation of DOH HOTLINE (+632-7111001 / +632-7111002) DOH HOTLINE (+632-7111001 / +632-7111002) for immediate reporting of suspected Influenza A (H1N1), for immediate reporting of suspected Influenza A (H1N1), flu-like illness and atypical pneumonia by DOH regional flu-like illness and atypical pneumonia by DOH regional Offices, LGUs, hospitals, and the publicOffices, LGUs, hospitals, and the public



• Firmed up national stockpile of Personal Firmed up national stockpile of Personal Protective Equipment (PPE) & the antiviral drug Protective Equipment (PPE) & the antiviral drug (Oseltamivir) and other logistics(Oseltamivir) and other logistics– Priority will be high-risk exposure groups consisting Priority will be high-risk exposure groups consisting

of frontline health workers and surveillance teamsof frontline health workers and surveillance teams



• National Referral Centers for EID readied in the event of suspected or confirmed swine flu cases

– Research Institute of Tropical Medicine (RITM)– Lung Center of the Philippines– San Lazaro Hospital– Vicente Sotto Memorial Medical Center– Davao Medical Center

• Organized the DOH Central Command for A (H1N1) that will oversee the operations of the different components of the A(H1N1) Task Force


What has been done?What has been done?• Convened a meeting of all Metro Manila DOH Hospitals to Convened a meeting of all Metro Manila DOH Hospitals to

orient them on the situation & come up with a response orient them on the situation & come up with a response plan for hospitalsplan for hospitals

• Command Conference to check the readiness plans & Command Conference to check the readiness plans & command & control systems of all regions nationwidecommand & control systems of all regions nationwide

• Secretary Francisco T. Duque III is made Secretary Francisco T. Duque III is made de factode facto Crisis Crisis Manager of the national Disaster Coordinating Council Manager of the national Disaster Coordinating Council (NDCC) to coordinate government efforts in responding to (NDCC) to coordinate government efforts in responding to the threat of Influenza A/H1N1the threat of Influenza A/H1N1



• Meeting with Metro Manila private hospitals and DOH retained hospitals on referral procedures to DOH-Designated Hospitals for the Isolation & Treatment of suspected Influenza A (H1N1) cases; as well as contingency plans for a worse case scenario


What’s next?What’s next?• IEC Materials DevelopedIEC Materials Developed


What’s next?What’s next?• IEC Materials DevelopedIEC Materials Developed


What’s next?What’s next?

• IEC Materials DevelopedIEC Materials Developed


What’s next?What’s next?

• Coordination with other concerned Coordination with other concerned agencies regarding national response in agencies regarding national response in the event of a pandemicthe event of a pandemic– OP, DA, DILG, DFA, NDCCOP, DA, DILG, DFA, NDCC


Thank you for listening!


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AH1N1 Basic Facts