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Swine origin influenza virus H1N1Case Report Ibrahim DAndrea

OVERVIEWWhat we already knowGenetic history of SOI-VOur role as Emergency physicians

PHASE 1- no animal influenza virus infecting humansPHASE 2- virus in animals has caused infection in humansPHASE 3-animal virus has caused clusters of human infection. No human to humanPHASE 4- human to human transmission capable of sustained community outbreakPHASE 5- same virus causing 2 or more sustained community outbreaks in 2 countries in one WHO regionPHASE 6-phase 5 plus one sustained outbreak in another who region

NICD Stats as of 24 August 2009

CLINICAL PICTUREInfluenza likeSevere acute respiratory infectionSevere illness

Influenza - likeTemp > 38 and any of the followingSore throatRhinorrhoea/blocked nose/coughMyalgiaDiarrhoea

Severe Acute Respiratory Infection2 days to 3 monthsAny child with sepsis or LRTI3 months to 5 yearsAny child with LRTI( bronchiolitis , pneumonia, bronchitis , pleural effusion)>5 Sudden onset fever>38 PLUSCough and sore throatShortness of breath with or without xray changes

Severe IllnessChild -cough and difficulty breathing PLUS -danger signs:-cant drink -vomiting -lethargy -unconscious -indrawing/stridor in calm childAdult -respiratory distress -dyspnoea -hypotension -hypoxia

TESTINGSARI if: -testing will assist diagnosis - no other cause is found - influenza is part of the differentialComorbid disease and at risk and symptomaticClusters of outbreakAny death from H1N1

Who is high risk?Underlying medical conditionImmunosuppressedAny disease which would compromise respiratory function>65 yearsPatients on long-term aspirin therapy-ReyesNursing home residentsPregnant women

What to doMild cases - avoid aspirin - high risk for treatment at discretion of physician when therapy can be started in 48 hours of infectionSARI or severe infection - treat with oseltamivir or zanamivir

DRUGS OSELTAMIVIRAdults 75mg bdChildren 40 kg 75 bdFor 5 daysZANAMIVIRAdults 10mg bdChildren 10 mg bdOnly for >12 years oldFor 5 days

ProphylaxisFor high risk close contacts of suspected or confirmed cases.Daily dose instead of bd

1918H1N11968H3N21998 H1N1 triple reassortment1979 H1NI EurasiaSwine Origin Influenza Virus genetic composition

1918 Spanish flu H1N1 Pandemic40 50 000 000 dead within 1 yearGenetic material appears to originate from birdsStarted in EuropeCame South for the winterReturned to Europe with a vengeance

H1N1 Swine fluFrom the humans pigs got the flu.Before 1918 flu was unknown in swineSep 30 to Oct 5 1918 at Cedar Rapids Swine show influenza entered swine historyThis became known as the North American Classic Swine flu and is endemic in swine today.

1957 H2N2 PANDEMIC3 Avian segments5 Human segmentsHuman H1N1 became extinct at the onset of H2N2BUT in 1977 it was reintroduced into society from what is believed to be a lab leakageH2N2 subsequently became extinct as well

1967 H3N2 PandemicTwo new genes from avian pool

H3N2H1N1 SwineAvian origin1998-2009 triple reassortment H1N2

1979 Eurasian H1N1 Swine fluIntroduced from birds into European pigs

Eurasian H1N1Triple reassortmentSOI-V H1N1

Genetic transmission of SOI-V H1N1

EMERGENCY MEDICINE

Who are we?Why do we exist?What is our role in a pandemic??

A revolution (from the Latin revolutio, "a turn around") is a fundamental change in power or organizational structures that takes place in a relatively short period of time. Aristotle described two types of political revolution:Complete change from one constitution to another Modification of an existing constitution.[1] REVOLUTION

Swinging along

v.t. 1. to be the first to open or prepare (a way, settlement, etc.). 2. to take part in the beginnings of; initiate: to pioneer an aid program. 3. to lead the way for (a group); guide.

PIONEER

References

Historical perspective emergence of H1N1 virussesN Engl J Med 2009;361:279-85.The origins of pandemic influenza- lessons from 1918 pandemic n engl j med 353;21 www.nejm.org november 24, 20053. Revised health workers handbook on pandemic influenza A(H1N1) 2009 swine flu4. www.nicd.ac.za5.www.doh.gov.za/swineflu/swineflu-f.html6.www.cdc.gov/h1n1flu/7. www.who.int/csr/disease/swineflu/en/