Swine Flu - Kamal

8/8/2019 Swine Flu - Kamal

1/118

SWINE FLU


2/118

DEFINITIONy It can be defined as a respiratory disease of pigs

caused by type A influenza viruses that causes

regular outbreaks in pigs.

y Human infections can and do happen.

y Swine flu, Hog flu, and Pig flu


3/118

HISTORYy The influenza virus, known to be circulating as

a pathogen in the human population since at

least the 16th centuryis notable for its uniqueability to cause recurrent epidemics and global

pandemics.

y Each century has seen some pandemics rapidlyprogressing to all parts of the world due to emergenceof a novel virus to which the overall population holdsno immunity.


4/118

Antigenic Shifts and Pandemicsy

Year Designation ResultingPandemic

Death Toll

1892 H3N2 Moderate NotAvailable

1918 H1N1(Spanish)

Devastating 50-100million

1957 H2N2(Asian)

Moderate 1-4 million

1968 H3N2(Hong Kong)

Mild 1-4 million


5/118

ETIOLOGYy The name infuenza was given by Italians in the 1743

malevolent infuence of heavenly bodies or of

inclement weather

y 1933 - Influenza virus was isolated by Smith ,Andrews & Laidlaw

y Influenza Virus Orthomyxovirus


6/118

y Divided into three serotypes; type A, type B or type C.

on the basis of antigenic nature of the internal orribonucleoprotein and the matrix (M) proteins

y Nonhuman isolates - type A

y Type B , C exclusively human

y Type C subclinical disease


7/118

RES

IS

TANCE PATTERN

y Killed by heat (56C for 3 hrs or 60 C for 30 mins) andwith common disinfectants such as formalin, iodine

compounds, ether, phenol, heavy metal salts

y Indefinite survival in frozen material at -70C

y viable in fomites such as blankets for about 2 weeks


8/118

SURVIVAL OF THE VIRUSTEMPERATURE SURVIVAL TIME

Contaminatedmanure Cool 3 months

Water 22C 4 days

0c 30 days


9/118

MORPHOLOGYy Spherical Virus 80 to 120 nm diameter

y pleomorphism, filamentous form

y Core - Ribonucleoprotein in helical symmetry

y Negative Sense single stranded RNA genome

ySegmented 8 pieces

y Viral RNA-dependentRNA polymerase which is essentialfor transcription of the viral RNA in infected host cells


10/118

y The nucleocapsid is surrounded by an envelope

which has an inner membrane protein layer and anouter lipid layer

y The membrane protein is also known as matrix or M

Protein composed of 2 components , M1 & M2

y The protein part Virus Coded

y The lipid layer is derived from the modified host cellmembrane during the process of replication bybudding


11/118

y Projecting from the envelope are two types ofspikes

(peplomers) :

y HaemagglutininSpikes Triangular in cross section

y Neuraminidase Peplomers mushroom shaped ,less numerous

y subtypes based on their hemagglutinin (H) &

neuraminidases (N)

y 16 hemaglutinins (H) and 9 neuramindases (N)identified in humans, animals and birds


12/118


13/118

y HAEMAGGLUTININ

Glycoprotein 2 polypeptides HA 1 and HA 2

enables virus to attach to respiratory epithelial cells

y NEURAMINIDASEGlycoprotein destroys receptor cells by hydrolyticcleavage

Internal RNP antigen and M protein antigen are stable


14/118


15/118

ANTIGENIC DRIFT

y gradual sequential change in antigenic structureoccuring regularly at frequent intervals

y The new antigens though different from the previousantigens , are yet related to them, so that they react

with the antisera to the predecessor virus strains, tovarying degrees

y mutation and selection

y Periodical epidemics


16/118

ANTIGENIC SHIFT

y Abrupt Drastic discontinuous variation in antigenicstructure, resulting in a novel virus strain unrelatedantigenically to the predecessor strain

y involves haemagglutinin, neuraminidase or both

y antibodies to the previous viruses do not neutralise

the new variants ( not accounted by mutations)y major epidemics and pandemics


17/118


18/118

y genetic reassortment ( coinfection with influenza

virus from diverse animal species)

y pigs Mixing Vessels avian & human viruses


19/118

SWINE FLU IN PIGS

y Swine flu viruses cause high levels of illness and low

death rates in pigs.

y Swine influenza viruses usually circulate among swinethroughout the year, but most outbreaks occur duringthe late fall and winter months similar to outbreaks inhumans.

y classical swine flu virus (an influenza type A H1N1virus) was first isolated from a pig in 1930.


20/118


21/118


22/118

ANTIGENIC CHARACTERIZATION

y March 2009 pandemic -H1N1 influenza A virus .

y Quadruple reassortment of two swine strains, onehuman strain, and one avian strain of influenza .

y 30.6 percent from North American swine influenza strains,17.5 percent from Eurasian swine influenza strains,

y Followed by North American avian influenza strains (34.4percent) and

y Human influenza strains (17.5 percent)


23/118


24/118


25/118

y


26/118

CURRENT SCENARIOy A novel influenza A (H1N1) virus of swine origin emergedamong people in Mexico during the spring of2009(march18) and spread with travellers worldwide, resultingin the first influenza pandemic since 1968.

y On 11thJune, 2009, World Health Organizationdeclared this a pandemic

y As of October 2009, over 200 countries have reportedconfirmed human cases of pandemic (H1N1) 2009.

y While the majority of illnesses caused by pandemic (H1N1)2009 virus infection have been self-limited mild-to-moderate uncomplicated disease, severe complicationsincluding fatal outcomes have been reported.


27/118

y After Mexico, subsequent confirmed cases in USA,

Canada , U.K., Australia, Brazil, France , Israel, NewZealand

y On April 26, 2009 Declared a National PublicHealth Emergency by the US Deptt of Health &Human Services

y

On April 27, 2009 Health services in Indiaw

ereput on high alert


28/118

y The pandemic (H1N1) 2009 influenza virus differs in

its pathogenicity from seasonal influenza in two keyaspects.

y First, as the majority of human population has little or

no pre-existing immunity to the virus, the impactof the infection has been in a wider age range, inparticular among children and young adults.

y Secondly, the virus can infect the lower respiratorytract and cause rapidly progressive pneumoniaespecially in childrenand young to middle-aged adults.

y High morbidity, low mortality (1-4%)


29/118

CDC (DEC 09)

SUMMARYOF STATISTICS - CDCOfficial US Total:

(According to CD

C)

44640 cases, 10837 deaths

Unofficial US Total:(Other Reliable Sources)

115431 cases, 10837 deaths

Worldwide Total:

(Various Reliable Sources)1483520 cases, 25174 deaths

Most Infected States:(According to CDC)

Wisconsin: 6222 casesTexas: 5151 casesIllinois: 3404 cases

Most Infected Countries:(Various Reliable Sources)

Germany: 222006 casesPortugal: 166922 casesChina (Mainland): 120940 cases


30/118

WHO UPDATE - INFLUENZA

(13TH AUG 10)y Influenza H1N1 virus transmission remains locally

intense in parts of India and NewZealand

y India- The number of new H1N1 cases per week,including fatal cases, continued to increase since mid

June 2010 in several states

y Particularly in the western state of Maharashtra and toa lesser extent in Gujarat, Andhra Pradesh, and WestBengal.


31/118

Death Rate per Infection- DEC 09

Country Cases Deaths % Dead Frequency

India 29303 1302 4.44% 1 in 23


32/118

yCURRENT STATUS IN INDIAy Total cases 6050

y deaths - 173


33/118

PUNJABy 30 per cent rise in the number of H1N1 flu (swine flu)

patients due to change of season

y 24 confirmed cases of the pandemic

y More than 700 contacts of these 24 patients too havebeen administered prophylactic treatment


34/118

LUDHIANA

y 45 year old Mura Kawa

y Nodal officerDr. Deepak Bhatia


35/118

TRANSMISSION

y Influenza viruses can be directly transmitted from pigs topeople and from people to pigs.

y

Human infection with flu viruses from pigs are most likelyto occur when people are in close proximity to infectedpigs, such as in pig barns and livestock exhibits housingpigs at fairs.

Human-to-human transmission of swine flu can alsooccur. This is thought to occur in the same way as seasonalflu which is mainly person-to person transmission throughcoughing or sneezing by people infected with theinfluenza virus.


36/118

y Cold and dry weather

y not transmitted by food.

y

Eating properly handled and cooked pork (at aninternal temperature of 160F) and pork products issafe.


37/118

RISK FACTORS

y Persons of any age with chronic pulmonarydisease(e.g. asthma, COPD), chronic cardiac disease (e.g.congestive cardiac failure), metabolic disorders (e.g.diabetes), chronic renal disease, chronic hepatic

disease, certain neurological conditions (includingneuromuscular, neurocognitive, and seizuredisorders), hemoglobinopathies

y immunosuppression,whether due toprimaryimmunosuppressive conditions, such as HIVinfection, or secondary conditions,such asimmunosuppressive medication or malignancy


38/118

y Infants and young children, in particular


39/118

SUSPECTED CASE

A person with acute febrile respiratory illness (fever =38C) with onset

y within 7 days of close contact with a person who is a

confirmed case of swine influenza(H1N1 virusinfection)

y within 7 days of travel to areas where there are one ormore confirmed cases of swine influenza(H1N1 virusinfection)

y resides in a community where there are one or moreconfirmed cases of swine influenza.


40/118

PROBABLE CASEy positive for influenza A, but unsubtypable for H1 and H3

by influenza RT-PCRor reagents used to detect seasonalinfluenza virus infection

y positive for influenza A by an influenza rapid test or aninfuenza immunofluorescence assay (IFA) plus meetscrieteria for a suspected case

y individual with a clinically compatible illness who died ofan unexplained acute respiratory illness who is consideredto be epidemiologically linked to a probable or confirmedcase


41/118

CONFIRMED CASEA person with an acute febrile respiratory illness withlaboratory confirmed swine influenza A(H1N1) virusinfection at WHO appproved laboratories by one or moreof the following tests:

y Real Time PCR

y Viral culture

y Four-fold rise in swine influenza A(H1N1) virus specific

neutralising antibodies.


42/118


43/118

y Symptoms and signs suggesting oxygen

impairment or cardiopulmonary insufficiency:

y - Shortness of breath (with activity or at rest),difficulty in breathing, turning blue, bloody or

coloured sputum, chest pain, and low blood pressure

y In children, fast or laboured breathing; and

y Hypoxia, as indicated by pulse oximetry.


44/118

y Symptoms and signs suggesting CNS

complications:

yAltered mental status, unconsciousness, drowsiness,or difficult to awaken and

y recurring or persistent convulsions (seizures),confusion, severe weakness, or

y paralysis.


45/118

y Evidence of sustained virus replication or invasivesecondary bacterial infection based on laboratorytesting or clinical signs (e.g. persistent high feverand other symptoms beyond 3 days).

y Severe dehydration, manifested as decreasedactivity, dizziness, decreased urine output, andlethargy


46/118

LABORATORY

DIAGNOSIS


47/118


48/118

y Hyderabad ( Andhra Pradesh)

1. Institute of Preventive Medicine Narayanaguda,2.Centre for DNA Fingerprinting & Diagnostics, Hyderabady Port Blair (Arunachal Pradesh )

Regional Medical Research Centre, Port Blairy Dibrugarh( Assam)Regional Medical Research Centre

y

Patna (Bihar)Rajendra Memorial Research Institute of Medical Sciences, Patnay Chattisgarh( NewDelhi)

National Centre for Disease Controly Goa

1.National Centre for Disease Control, New Delhi2.Kasturba Medical College, Manipal

y Ahmedabad (Gujarat)B. J. Medical College,Asarwa

y Madhya PradeshDefence Research Development Establishment,Gwalior


49/118

y Haryana

y National Centre for Disease Control,NewDelhi

y PostGraduate Institute of Medical Education and Research,Chandigarhy Himachal Pradesh

y Central Research Institute,Kasauli Dist. Solan,Himachal Pradesh

y Indira Gandhi Medical College,Shimla

y

Jammu and KashmirNational Centre for Disease Control, NewDelhi

y Jharkhand

y National Institute of Cholera & Enteric Diseases,Kolkata

y Karnataka

y

National Institute of Mental Health and Neuro Sciences(NIMHANS) Bangalorey Kasturba Medical College,Manipal

y Kerala

y RajivGandhi Centre for Biotechnology, Thiruvananthapuram

y Kasturba Medical College,Manipal


50/118

y Maharashtray Haffkine Institute,Mumbaiy

National Institute of Virology, Puney National Institute of Virology, Microbial Containment Puney Manipur

National Institute of Cholera & EntericDiseases, Kolkatay Meghalayay Regional Medical Research Centre,Dibrugarhy Mizoramy

National Institute of Cholera & EntericDiseases, Kolkatay Nagalandy Regional Medical Research Centre,Dibrugarhy Orissay Regional Medical Research Centre, Bhubaneswary Sikkim

y National Institute of Cholera & EntericDiseases, Kolkatay Rajasthany Vallabhbhai Patel Chest Institute University ofDelhi,

Delhi


51/118

y Tamil Naduy King Institute of Preventive Medicine,Chennai

y Christian Medical College, Vellorey Hi-TechDiagnostic Centre Lab,Chennaiy Bharath Scan Lab, Chennaiy Diagnostic Services,Chennaiy Microbiology Lab Coimbatorey Dr. Rath Lab,Tiruchyy Tripuray National Institute of Cholera & EntericDiseases,Kolkatay Uttar Pradeshy SanjayGandhi PostGraduate Institute of Medical Sciences

Lucknowy

Uttarakhandy All India Institute of Medical Sciences,NewDelhiy West Bengaly National Institute of Cholera & EntericDiseases,Kolkata


52/118

y Andaman and Nicobar

y

Regional Medical Research Centre,Port Blairy Dadra and Nagar Haveli

y B. J. Medical College,Ahmedabad

y Daman and Diu

y Haffkine Institute, Mumbai

y Lakshadweep

y RajivGandhi Centre for Biotechnology,Thiruvananthapuram

y Puducherry

y JIPMER


53/118

y DELHIy National Centre forDisease Control

y Vallabhbhai Patel Chest Institute,

y University ofDelhiAll India Institute of Medical Sciences,

y Super Religare Laboratories (SRL)

y Dr. Lal's Path Lab

y Dr. Naveen Dang's Medical Diagnostic Centre,

y Auroprobe Laboratories,


54/118

PUNJAB & CHANDIGARH

y PostGraduate Institute of Medical Education andResearchSector-12, Chandigarh-160012,

Phone: 0172-2746018, 2756565, 2747585,Fax: 0172-2744401, 2745078


55/118

SPECIMENSy nasopharyngeal swab

y nasal aspirate

y

combined nasopharyngeal swabwithoropharyngeal swab.

y nasal swab

y oropharyngeal swab

y Intubated patients - an endotracheal aspirate .Bronchoalveolar lavage (BAL) and sputumspecimens also acceptable.


56/118

TIME OF SPECIMEN COLLECTIONy Soon after symptoms begin

y Before administration of antiviral medications

y

Even if symptoms began more than oneweek agoy Multiple specimens on multiple days can be

collected


57/118

y Swabswith a synthetic tip (eg, polyester orDacron) and an aluminium or plastic shaftpreferred

y Swabswith cotton tips and wooden shafts not

recommended.y Swabs made of calcium alginate not acceptable.

y Collection vial for swab should contain 1 to 3 ml ofviral transport media.


58/118

BIOSAFETY MEASURES FOR

SPECIMEN COLLECTIONy Collection by trained hospital / lab staff

y N95 masks should be used while taking samples & ifthey are not available, triple layer well fitted surgicalfacemasks can be used

y disposable latex gloves

y lab coat / disposable apron

y Head cover

y Use of protective eyewear (goggles)/faceshields ifprocedure likely to generate aerosols, or splashes ofsecretions


59/118


60/118

y Intensive Care Unit & Laboratory personnel :

N 95 Respirators.y Mortuary:

Triple layer surgical mask.


61/118

Methods OfSample Collection


62/118

Nasopharyngeal Swab

y Insert a dry swab into the nostril and take it backto the nasopharynx

y Leave in place for a fewseconds

y Slowly remove itwhile slightly rotating it

y Newswab for other nostril

Nasal SwabCollected from the anterior turbinate


63/118


64/118

Nasopharyngeal aspirates

y 3 to 7 ml saline introduced through the nose andaspirated by a small tubing inserted into the othernostril


65/118


66/118

Throat Swab

y Patients mouth should be wide open

y Touch the swab at the back of the throat near thetonsils


67/118


68/118


69/118


70/118

Viral transportmediay protein stabilises the virus (serum ,albumin,gelatin)

y foetal calf serum less inhibitory factors, antibodies

y buffers- ph maintenance

y Antifungals, antibacterials y Penicillin(500units/ml)

y streptomycin(500 to 1000 units/ml)

y Vancomycin(20mcg/ml)

y gentamicin(50mcg/ml)

y amphotericin(10mcg/ml)


71/118


72/118

y stuarts medium, amies medium

y Leibovitz-Emory mediumy Hanks balanced salt solution

y Eagles tisue culture medium


73/118

Labelling OfSpecimensy Pre-printed barcode labels to be used

y On the specimen container

y

On the field data collection formy On the log book


74/118

Specimen Storagey Within 48 hours store at 4 C before and after

transport

y

Beyond 48

hours- -70 Cy Do not store in standard freezer- keep on ice or in

refrigerator


75/118

TransportyAll specimens should be

transported after packagingusing the WHO triplepackaging system.

y While transportation coldchain should be maintained.


76/118

Triple Packaging System1) Primary receptacle: a labelled primarywatertight,

leak-proof receptacle containing the specimen.

2) Secondary receptacle: a second durable,watertight, leak-proof receptacle to enclose andprotect the primary receptacle(s).

3) Outer package: the package around the secondaryreceptaclewhich protects the receptacle and itscontents from outside influences such as physicaldamagewhile in transit.


77/118

DiagnosticTests


78/118

Test Method Infuenza VirusTypes Detected

Time For Results

Virus Culture A and B 5 10 days

FluorescentImmunoasssay

A and B 2 4 hrs

RT - PCR A and B 1 -2 days

Serological Tests A and B > 2weeks

EnzymeImmunoassay(EIA)

A and B 2 hours

Rapid AntigenDetection

A ; A and B < 30 mins


79/118

y Diagnostic Tests

y Demonstration of virus antigen (IF , PCR)

y Isolation of virus

y Serology

y Other tests


80/118

Immunofluorescence (DFAor IFA)y done using fluorescent tagged influenza antiserum

y distinguishes between influenza A and B .

y positive for influenza A by immunofluorescence maymeet criteria for a suspected case.

y not possible to differentiate from seasonal influenzaA viruses

y A negative DFA or IFA does not exclude H1N1 influenza

A infection .y should not be assumed a final diagnostic test for

novel influenza A(H1N1) virus infection.


81/118


82/118

PCRseveral PCR assays for detection of:

y highly conserved parts of the influenza genome

(matrix M gene) to confirm the presence of influenzaA;

y detect current human influenza virus H1 and H3genes;

y When the result of PCR assay on M gene is negative,the diagnosis of Influenza could be ruled out. Whenthe PCR M gene is positive together with either PCRH1/H3 is positive, human influenza is diagnosed


83/118

y

Real-time RT-PCR is the recommended test forconfirmation of novel influenza A(H1N)1 cases.

y Currently, novel influenza A(H1N1) virus will testpositive for influenza A and negative for H1 and

H3 by real-time RT-PCR.y If reactivity of real-time RT-PCR for influenza A is

strong it is more suggestive of a novel influenza A(H1N1) virus


84/118

Cell Culturey Done in monkey kidney cells or human embryo

kidney cells

y Isolation of H1N1 influenza A virus using cultureis diagnostic

y culture is usually too slowto help guide clinicalmanagement.

y

A negative viral culture does not exclude H1N1influenza A infection.


85/118

y

more chance of isolation in 1st

2 or 3 days of illnessy Egg inoculation

y amniotic cavity 11 to 13 day old eggs( six eggs perspecimen)

y Incubation at 35C for 3 daysy Chilling, Harvesting of Amniotic and alllantoic fluid

separately

y Tested for haemaggglutination with guinea pig and

fowl RBCs in parallel, at room temperature & at 4C


86/118

y Influenza A agglutinate only guinea pigs

y Influenza B both guinea pig & fowly Influenza C - only fowl cells

y Inhibition of haemagg specific viral antiserum

y Haemadsoption addition of fresh guinea pig RBC tocell culture

y Adv no damage to the culture


87/118

y MonkeyKidney or Baboon Kidney Cell cultures:

y incubated without serum in presence of trypsin whichincreases isolation

y Incubation at roller drums

y No cytopathic effects or focal enlarged granular cells

followed by sloughing,rapid progression


88/118

y Shell vial culture

y Detection within 1 to 2 daysy 15*45mm vial having coverslip in the bottom covered

with growth medium and appropriate cell monolayer

y specimen inoculated by low speed inoculation

y Coverslips are stained using virus specificimmunofluorescent conjugates


89/118


90/118

Rapid Influenza Antigen Testy can distinguish between influenza A and B

viruses.

y Can detect the HSI Influenza A(H1N1) virus

y not possible to differentiate from seasonalinfluenza A viruses.

y suboptimal sensitivity to detect seasonalinfluenza viruses

y negative rapid test could be a false negativey should not be assumed a final diagnostic test for

novel influenza A(H1N1) virus infection.


91/118

Interpretation OfRapid Testy There are several possibilitieswhen a patient tests

positive for influenza A by rapid antigen test:

y The patient might have novel H1N1 virus infection

y The patient might have seasonal influenza A virusinfection or

y The patient might have a false positive test result


92/118

y many new confirmed cases of novel H1N1 flu infection andwhere community spread of H1N1 is occurring- patients

who test positive on a rapid influenza diagnostic test can betreated empirically with antiviral medications if clinicallyindicated without further testing


93/118

y Haemagglutination Inhibition tests

y Serial dilution of sera + Influenza virus suspensioncontaining 4 HA units + Fowl RBC

y Highest dilution of serum that inhibitsHaemagglutination - HI titre

y Disadv- Antihaemagglutinin antibodies are subtypespecific and hence it is necessary to use as antigen thestrain currently causing the infection


94/118

y Paired Sample for SerologyStudy at an interval of14 days

y To demonstrate a four-fold or more rise in HSIinfluenza A(H1N1) virus specific antibodies


95/118


96/118

y Complement Fixation Test

yWith RNP antigeny Useful as antibodies formed only after infection not

immunisation with inactivated virus

y Enzyme Neutralisation tests estimation ofneuraminidase antibody

y Radioimmunodiffusion in agarose gel antibodies toRNP, haemagglutinin & neuraminidase


97/118

TREATMENT

ANDPROPHYLAXIS


98/118

y salicylate/aspirin is strictly c/i due to its potentialto cause reye s syndrome.


99/118

y Oseltamivir (brand name Tamiflu )- to both treatand prevent influenza A and B virus infection inpeople one year of age and older.

y Zanamivir (brand name Relenza )- to treatinfluenza A and B virus infection in people 5 yearsand older and to prevent influenza A and B virusinfection in people 5 years and older.


100/118


101/118

y For adolescents (13 to17 years of age) and adults the

recommended oral dose is 75 mg oseltamivir twicedailyfor 5 days

y children 6 to 12 months of age is 3 mg per kg body

weight twice dailyfor 5 days for treatment


102/118

y>3 months to 12 months - 3 mg/kg twice daily

y >1 month to 3 months - 2.5 mg/kg twice daily

y 0 to 1 month - 2 mg/kg twice daily

y 15 kg or less - 30 mg orally twice a day for 5 days

y 15-23 kg - 45 mg orally twice a day for 5 days

y 24-40 kg- 60 mg orally twice a day for 5 days

y>40 kg - 75 mg orally twice a day for 5 days


103/118

y Zanamivir

y recommended dose for treatment of adults andchildren from the age of 5 years (based is twoinhalations (2 x 5mg) twice daily for 5 days.


104/118

y SUPPORTIVETHERAPYINCLUDES-

y IV Fluids

y

Parenteral nutritiony Oxygen therapy/ventilatory support

yAntibiotics for secondary infection

yVasopressors for shock

y Paracetamol or ibuprofen is prescribed forfever,myalgia and headache.


105/118

y Adult patients should be discharged 7 days after symptomshave subsided.

y Children should be discharged 14 days after symptoms havesubsided.

y The family of patients discharged earlier should beeducated on personal hygiene and infection control

measures at home.

y Children should not attend school during this period.


106/118

ANTIVIRAL CHEMOPROPHYLAXISy given to

yAll close contacts of suspected,probable andconfirmed cases.

yAll health care personnel coming in contact withsuspected,probable or confirmed cases.

y Oseltamivir is the drug of choice.

y

Prophylaxis should be provided till 10 days after lastexposure(maximum period of 6 weeks).


107/118

y Less than 15 kgs - 30mg OD

y 15-23 kg 45 mg OD

y 24- less than 40kg -60 mg OD

y More than or equal to 40kg -75 mg OD


108/118

y DOSE FOR INFANTS-

y Less than 3 mnths-not recommended unless situationjudged critical due to limited data on use in this agegroup.

y3 5 mnths- 20mg OD

y 6 11 mnths-25mg OD


109/118

y Close contacts of suspected , probable and confirmedcases should be advised to remain at home for at least7 days after the last contact with the case.

y Monitoring of fever should be done for at least 7 days.

y Prompt testing and hospitalization must be donewhen symptoms are reported.


110/118

VACCINES


111/118

y Egg based vaccines formalin inactivated

y

Subunit vaccines disrupted by detergents so thatthey have only immunogenic haemagglutinin andneuraminidase subunits

y no bulk preparation

y Recombinant vaccinesy ts mutants


112/118

y 1.5 million doses of vaccine to vaccinate selected populationamong the high risk group.

y PANENZA, the pandemic vaccine procured from M/s SanofiPasteur, France, is a split virus inactivated, non-adjuvantedmonovalentvaccine against pandemic Influenza

y The active ingredient containing antigen equivalent to:

y A/California/7/2009(H1N1)v-like strain (NYMC X-179A) - 15

micrograms** per 0.5 ml dosey propagated in eggs

y ** expressed in microgram haemagglutinin


113/118

y The other ingredients are: thiomersal (45 microgramsper 0.5 ml dose), sodium chloride, potassium chloride,disodium phosphate dihydrate, potassium dihydrogenphosphate, and water.

y

suspension for injection in a multidose vial (10doses of 0.5ml) - Pack of10 vials. The suspension isa colourless liquid, clear to opalescent

y

One dose (0.5 ml) intra muscular


114/118

yVaxiFlu-S

y

Zydus Cadilay Drug ControllerGeneral of India (DCGI) has gave

approval to Zydus Cadila to market the H1N1 (swineflu) vaccine.

y The egg-based, inactivated vaccine based onconventional technology has been developed by thegroups researchers at its Vaccine Technology Centre(VTC) in Ahmedabad.

y Rs 350y unveiled with health minister Ghulam Nabi Azad.


115/118

y It can only be used by people aged between 18-60 andcant be used on small children or pregnant women

who are believed to be at high risk of getting infected.

y The Swine Flu Vaccine, with a shelf life of a year from

date of manufacture, will provide protection only forone year

fi i di i l i l h d i


116/118

y first indigenous intra-nasal vaccine was launched inMumbai (Nasovac)- Serum institute of India Pune

y Launched on 15 July 201o mumbaiy children over three years of age as well as for the

elderly

y donor virus' from WHO clinical trials on 380 people,

including children, the young and the elderlyRs 160/shot

y dose of 0.5ml directly to the nasal cavity

y Contraindicated -pregnant women, infants and

people with compromised immunity


117/118

Hospital wastegeneratedy disposed off as per BIOMEDICAL WASTEGUIDELINES


118/118

y Disposal of used masks

y In the hospital setting it should be disposed off in theidentified infectious waste disposal bag/container.

y In community settingswhere medical wastemanagement protocol cannot be practiced, it may be

disposed off either byburning or deep burial.

y During home care patients and contacts using Triplelayer mask should first disinfect used mask with

ordinary bleach solution or sodium hypochloritesolution or Quaternary Ammonium house holdDisinfectant and then dispose off either byburning ordeep burial

Documents

Swine Flu - Kamal