IA (H1N1) - Presentation to Public_CDC Div

7/28/2019 IA (H1N1) - Presentation to Public_CDC Div

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Ministry of Health Malaysia

INFLUENZA A (H1N1)OUTBREAK

Dr. Rosemawati Ariffin

Infectious Disease Surveillance Section

Disease Control DivisionMinistry of Health


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Presentation Road Map

Introduction virus, disease

What is an influenza pandemic?

Influenza A (H1N1)

Actions taken by Ministry of Health

Actions should be taken by public


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Introduction


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Influenza Virus

RNA virusSurface glycoproteins:

H / HA- haemagglutinin

N / NA - Neuraminidase


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Influenza sub-groups

Influenza A

highly infective

infects many species

causes frequent widespread epidemics and pandemics

Influenza B

only found in humans

capable of producing severe disease

cause of regional epidemics

Influenza C causes mild disease

humans are natural hosts but isolates also found in pigs

does not cause epidemics


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Subtypes ofInfluenza A Virus

(Karl G Nicholson, et al Lancet 2003; 362: 1733-45)

H1

H2

H3

H4

H5

H6

H7

H8

H9

H10

H12

H13

H14

H15

H11

N1

N2

N3

N4

N5

N6

N7

N8

N9



Influenza Virus - Characteristics

Antigenic drift minor changes in theantigenic composition constantly occurring able to elude host defences

Antigenic shift ability to swap or re-assortgenetic materials and merge resulting in a novel

subtype different from both parent viruses



Influenza Disease

Seasonal influenza influenza disease inhumans due to influenza virus infection that

circulating for decades in humans (virus changeslightly from year to year)

Avian influenza - caused by influenza viruses

that occur naturally among wild birds, primarily adisease in birds. Sometimes can transmit tohumans

Swine influenza caused by influenza virusesthat naturally among pigs, primarily a disease inpigs. Occasionally can transmit to humans.



Disease Transmission

Transmission airborne droplets

Incubation period: 1-3 days

Communicability:- day before & up

to 3 5 days after the onset of

symptoms. Longer in children, 7

days or more



Influenza - Symptoms

Fever, cough, sore throat, headache, prostration,

mylgia, malaise

Clinical presentation

- mild to fatal

- usually fatal in extreme age group



Influenza A (H1N1) Outbreak



24 April 2009 (report from WHO)

USA reported 7 confirmed cases of human Swine Influenza

A/H1N1, no deaths.

Mexico reported a steady increase in cases since 18 Marchthrough April via ILI surveillance

As 23 April 2009, 882 cases of pneumonia were diagnosedwith 62 deaths from Mexico City, San Luis Potosi & Mexicali.

18 laboratory confirmed cases of Swine Influenza A/H1N1 ofwhich 12 of those genetically identical to Swine InfluenzaA/H1N1 from California

Background



Influenza A (H1N1)

New strain detected in California(24 April 2009)

Laboratory test showed - mixed genes ofhuman, avian & swine (Influenza virus

A/California/04/2009)

Everyone is at risk due to absence of immunity

Efficient human to human transmission



Influenza A (H1N1)

Transmission: same as seasonal influenza

Symptoms: same as seasonal influenza, rangefrom mild respiratory symptoms topneumonia.



Global Situation of Influenza A (H1N1) till 6 May 2009 18.00 GMT (Malaysia time: 0200 7 May 09)



Pandemic Phases 5 - Description

Is characterized by human-to-human spread of the virus

into at least two countries in one WHO region.

Phase 5 since 29 April 2009



Malaysias Current Situation(16 May 2009)

2 cases of Influenza A H1N1 reported



Pandemic Influenza



Pandemic influenza: definition

Pandemic can occur when:

New influenza virus

Able to infect humans

Transmissible from person to person

pandemic influenza : wide geographic

spread of novel influenza virus


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Past Influenza Pandemics

1900

1850

1950

2000

1847

1889

1918

1957

1968

42 yrs

29 yrs

39 yrs

11 yrs

30 40 years cycle

No Pandemic for > 35 years


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Geographic spread: 1918-19

?01/19

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04/18

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?

C.W. Potter, Textbook of Influenza, 1998


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Geographic spread: 1957-58

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C.W. Potter, Textbook of Influenza, 1998


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Potential Impact of Pandemic

Livelihood: food & income loss from decreased

economic activity Human health: high illness & potential higher

death rates

Rule of law & governance: increase demand ofgovernance & security

Humanitarian needs: interruption in in publicservices

Economic system: trade & commerce disruption


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Potential impacts on Non Health Sectors

Lack of maintenance

Disrupted supply chain

Etc.

Break down of services

Economic and Social Disruption

Changed Demand

Military (support for logistics,etc.)

Mortuary & burial services

Refuse Collection

Water & Sanitation

Telecommunication (Phone andInternet)

Cleaning Supplies

Cash Withdrawal

Protection against insecurity

Electricity/Power supply

Food Distribution

Emergency Services

Death

Absenteeism

FearCare

Illness

Decreased Supply

Reduced production

Disrupted transportation

International trade of commodit ies

Trans-company dependencies

Decreased Demand

Retail Trade

Transportation

Leisure Travel

Restaurant


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Pandemic Response

9 Antiviral drugs

9 Vaccine, etc

9 Medical care, PPEMedical

interventional

Non- Medical

Interventions

9 Personal hygiene

9 Travel restriction

9 Quarantine

9Social distancing

9 Risk communication

9 Security

9 Food & water supply

9 Power supply

9 Transportation

9 Telecommunication

9 Other essential services

Social Services(keep a society running)


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Pandemic Influenza Preparedness Plan

Following outbreak of avian influenza H5N1

outbreak in Hong Kong in 1997, influenza

pandemic preparedness plan was produced byWHO

In 2003, WHO asked all countries to prepare

pandemic preparedness plan following Avianinfluenza H5N1 outbreaks involved many

countries in Asia, Europe & Africa (since end

2003 till now)

Since then almost all countries worldwide have

prepare preparedness plan


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Prevention & ControlMeasures Taken byMinistry of Health


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National Influenza Pandemic

Preparedness Plan (NIPPP)

Preparation started in 2003

Prepared by National Influenza

Pandemic Planning Committee

multidisciplinary, inter-

agencies/departmental and experts.

Launched on 9 Jan. 2006 by Minister

of Health

Documents available in website

http://www.dph.gov.my/survelans
http://www.dph.gov.my/survelanshttp://www.dph.gov.my/survelans


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NIPPP Strategies

Organizational Response

3 main committees

Public Health Response

Medical Response

Laboratory Response

Risk Communication

Social Response


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Actions Taken by Ministry of Health

Activate Operations Room for monitoring of

Influenza A (H1N1) situation & to ensure all

proactive prevention & control measures be

carried out

Enhance ILI/pneumonia surveillance at all levels of

health facil ities

Conduct screening on arrival at International Ports

of Entry temperature check, health declarationand health alert card

Health advise to public & travellers via website, TV,

radio and telephone (CPRC)


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Designated hospitals on alert & ready to receive

suspected cases Antiviral stockpile storage sites alerted for rapid

distribution of antivirals when needed

Viral laboratory at IMR on alert and ready to

receive clinical specimens from suspected cases

Development guidelines


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Risk Communication

- Health education materials;

hand & good personal hygiene

cough etiquette

current facts regarding the disease & pandemic

travel advisories other FAQs

advice to persons with symptoms of disease

advice to healthcare personnel involved in prevention &control activities

- Daily press statement


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Collaborate with WHO for monitoring &

surveillance of the outbreaks


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Actions by Public


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Actions by Public

Follow travel advisory


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Actions by Public

Practice cough etiquette

Hand hygiene wash hands with clean

water & soap esp. after cough

Do not attend gathering if you are having

symptoms


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Actions by Industry

Follow preparedness plan

prepared by your company Use Recommendations on

Influenza Pandemic

Preparedness for Industry inMalaysia as a guide.


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Current situation/information & updates,refer to;

Website:

- www.moh.gov.my

www.myhealth.gov.my

www.infosihat.gov.my

Hotlines:- 03-888810200/300
http://www.moh.gov.my/http://www.myhealth.gov.my/http://www.myhealth.gov.my/http://www.myhealth.gov.my/http://www.myhealth.gov.my/http://www.moh.gov.my/


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THANK

YOU