A fun quiz for family practitioners & pediatricians in India to test their knowledge about the ongoing 2015 H1N1 epidemic. Would be of interest to parents too.

1. Dr Gaurav Gupta

2. Q: How many people in India have already
died in the current H1N1 epidemic, and how
many died in the 2009-10 epidemic?
 500 & 1000
 1500 & 3000
 2500 & 5000
 10000 & 20000

3. Q: How many people in India have already
died in the current H1N1 epidemic, and how
many died in the 2009-10 epidemic?
 500 & 1000
 1500 & 3000
 2500 & 5000
 10000 & 20000

4. Q: Why is it called the Swine Flu?
 It comes from eating swine
 It is transmitted to humans from staying
close to swine
 It is a virus that jumped to humans from
swine
 The present strain can infect both humans &
swine

5. Q: Why is it called the Swine Flu?
 It comes from eating swine
 It is transmitted to humans from staying
close to swine
 It is a virus that jumped to humans from
swine
 The present strain can infect both humans &
swine

6. Q: Difference between Swine Flu (H1N1) &Bird Flu
(H5N1)?
 More case fatality H1N1 / H5N1
 More human to human transmission H1N1 / H5N1
 Close contact with animal needed H1N1 / H5N1
 Can infect other animals incl. pigs H1N1 / H5N1
 Can get it from eating animals H1N1 / H5N1

7. Q: Difference between Swine Flu (H1N1) &Bird Flu
(H5N1)?
 More case fatality H1N1 / H5N1
 More human to human transmission H1N1 / H5N1
 Close contact with animal needed H1N1 / H5N1
 Can infect other animals incl. pigs H1N1 / H5N1
 Can get it from eating animals H1N1 / H5N1

8. Q: Difference between Swine Flu (H1N1) &Bird Flu
(H5N1)?
 More case fatality H1N1 / H5N1
 More human to human transmission H1N1 / H5N1
 Close contact with animal needed H1N1 / H5N1
 Can infect other animals incl. pigs H1N1 / H5N1
 Can get it from eating animals H1N1 / H5N1

9. Q: Difference between Swine Flu (H1N1) &Bird Flu
(H5N1)?
 More case fatality H1N1 / H5N1
 More human to human transmission H1N1 / H5N1
 Close contact with animal needed H1N1 / H5N1
 Can infect other animals incl. pigs H1N1 / H5N1
 Can get it from eating animals H1N1 / H5N1

10. Q: Difference between Swine Flu (H1N1) &Bird Flu
(H5N1)?
 More case fatality H1N1 / H5N1
 More human to human transmission H1N1 / H5N1
 Close contact with animal needed H1N1 / H5N1
 Can infect other animals incl. pigs H1N1 / H5N1
 Can get it from eating animals H1N1 / H5N1

11. Q: Difference between Swine Flu (H1N1) &Bird Flu
(H5N1)?
 More case fatality H1N1 / H5N1
 More human to human transmission H1N1 / H5N1
 Close contact with animal needed H1N1 / H5N1
 Can infect other animals incl. pigs H1N1 / H5N1
 Can get it from eating animals NEITHER

12. Q: Can I get the swine flu from eating pigs?
Am I protected/ less at risk because I am a
vegetarian? Can I eat pork?
 Yes/ No/ Maybe

13. Q: Can I get the swine flu from eating pigs?
Am I protected/ less at risk because I am a
vegetarian? Can I eat pork?
 Yes/ No/ Maybe

14. Q: A mother tells you that her 5 year old
daughter tested +ve for Swine Flu in Mumbai
and was treated with Tamiflu. Should the
child receive the vaccination this year?
 Yes/ No

15. Q: A mother tells you that her 5 year old
daughter tested +ve for Swine Flu in Mumbai
and was treated with Tamiflu. Should the
child receive the vaccination this year?
 Yes/ No
 Abs appear in 7 days; max level in 2 weeks;
drops to pre-infection level in 8- 12 months.
No cross-immunity.

16. Q: How long does the flu virus survive on
surfaces?
 Hard surfaces like steel / wood/ plastics -
__________
 Porous surfaces like cloth / tissues etc -
__________
 On hand / skin -
__________

17. Q: How long does the flu virus survive on
surfaces?
 Hard surfaces like steel / wood/ plastics -
Upto 48 hours
 Porous surfaces like cloth / tissues etc -
Upto 12 hours
 On hand / skin -
Few minutes – Most likely mode of
transmission

18. Q: Can my pet catch swine flu?
 Yes/ No/ Maybe

19. Q: Can my pet catch swine flu?
 Yes/ No/ Maybe

20. Q: When to suspect ‘swine flu’?
 Fever
 Cough
 Sore throat
 Chills & fatigue
 Diarrhea and vomiting
Rhinorrhea
 Headache
 Body aches & joint pains

21. Q: When to suspect ‘swine flu’?
Any child with URI can have swine flu, 2 or
more of the above symptoms
 Fever
 Cough
 Sore throat
 Chills & fatigue
 Diarrhea and vomiting
Rhinorrhea
 Headache
 Body aches & joint pains

22. Q: What percentage of Swine Flu disease in
children is life-threatening?
 1-2
 3-5
 10-15
 30-50

23. Q: What percentage of Swine Flu disease in
children is life-threatening?
 1-2
 3-5
 10-15
 30-50

24.  Sub clinical infection: Almost 30% cases get
no symptoms !
 Common cold (Rhino-pharyngitis): Majority of
other patients develop a disease no different
than an ordinary cold & recover with simple
fever and cough medications.
 Tracheo-laryngo-bronchitis (Croup): These
patients have fever, hoarseness of voice and
significant cough.
 H1N1Pneumonia: Only 3-5 cases out of 100
H1N1 cases develop this level of disease.

25.  So let us be vigilant for symptoms of swine
flu pneumonia and stop bothering about
other level of illnesses.

26. Q: What is the most specific symptom for
Swine Flu as compared to other types of Flu,
that can help you suspect this in a particular
individual?
 __________________

27. Q: What is the most specific symptom for
Swine Flu as compared to other types of Flu,
that can help you suspect this in a particular
individual?
 NONE

28. Q: How soon will I get sick if I am exposed to
the flu?
 1-4 days
 5-7 days
 10-14 days
 14-21 days

29. Q: How soon will I get sick if I am exposed to
the flu?
 1-4 days
 5-7 days
 10-14 days
 14-21 days
The time from when a person is exposed to flu
virus to when symptoms begin is about 1 to 4
days, with an average of about 2 days.

30. Q: For how long does an individual remains
‘infectious’? What is the time of maximum
viral shedding?
 ____________________________________

31. Q: For how long does an individual remains
‘infectious’? What is the time of maximum
viral shedding?
 1 day before to 7 days after.
 Max viral shedding on day 1 of illness

32.  Do all suspect cases need to be tested?
 Should all suspected/confirmed cases be
hospitalized?
 Should all suspected/confirmed cases be
treated with antivirals?

33. Categor
y
Presentation Testing
for
H1N1
Hospital
ization
Oseltamiv
ir
administr
ation
Treatmen
t
modality
A Mild fever plus cough /
sore throat with or
without bodyache,
headache, diarrhoea and
vomiting
No No No Home
treatment
B Signs and symptoms of Cat. A
+ High grade fever, severe sore
throat, Or Cat-A signs &
symptoms with high risk
conditions*
No No Yes Home
confineme
nt
C Signs and symptoms of
Cat. A & B +
breathlessness, chest
pain, drowsiness,
hypotension,
bloody sputum, bluish
discolouration of nails;
convulsions, Or signs and
symptoms of Cat. A & B
Yes yes Yes Immediate
hospitaliza
tion

34. High risk conditions:
• Children with predisposing risk factors.
• Pregnant women;
• Persons aged > 65 years
• Patients with lung diseases, heart disease,
liver disease, kidney disease, blood
disorders, diabetes, neurological disorders,
cancer and HIV/AIDS;
• Patients on long term cortisone therapy.

35. Q: 3 year old boy has fever with cough * 5 days.
Fever has recurred with higher spikes. Child had
received 3 days of Amoxyclav & 2 days of
Cefpodoxime.
O/E: Vitals stable. Lethargic, feeding reduced,
conscious. B/l fine crepts
Invx: CXR reveals a patchy consolidation.
What is the course of action in this situation?
 Ct antibiotics for another couple of days & review
 Admit & give IV antibiotics
 Get evaluated for Swine Flu, start Oseltamivir
empirically, explain warning signs
 Hospitalize in isolation, get evaluated for Swine flu,
start Oseltamivir if +ve.

36. Q: 3 year old boy has fever with cough * 5 days.
Fever has recurred with higher spikes. Child had
received 3 days of Amoxyclav & 2 days of
Cefpodoxime.
O/E: Vitals stable. Lethargic, feeding reduced,
conscious. B/l fine crepts
Invx: CXR reveals a patchy consolidation.
What is the course of action in this situation?
 Ct antibiotics for another couple of days & review
 Admit & give IV antibiotics
 Get evaluated for Swine Flu, start Oseltamivir
empirically, explain warning signs
 Hospitalize in isolation, get evaluated for Swine flu,
start Oseltamivir if +ve.

37. Q: Where are the diagnostic facilities
available?
 _____________

38. Q: Where are the diagnostic facilities
available?
 There are only 21 laboratories for testing A
(H1N1) in the entire country. Samples are
collected at district hospitals of different
states and send to nearby IDSP/ICMR centers
having facility for Influenza virus testing.

39. Q: Who should be investigated?

40. Q: Who should be investigated?
A. Priority for testing should be given to:
1. Those who require hospitalization;
2. Those who are at high risk for severe
complications (Table I).

41. Q: What to do with a 5 year old girl who has
tested +ve from a private lab in Gurgaon, &
is having symptoms of cold cough and mild
fever with normal activity and fair appetite
when afebrile, and only mild throat
congestion & clear chest?
 Soup, TLC, cold medicines, Stay Home
 Confirm by sending to Govt center,
treatment as per reports
 Give Antibiotics, get CBC and CXR done

42. Q: What to do with a 5 year old girl who has
tested +ve from a private lab in Gurgaon, &
is having symptoms of cold cough and mild
fever with normal activity and fair appetite
when afebrile, and only mild throat
congestion & clear chest?
 Soup, TLC, cold medicines, Stay Home
 Confirm by sending to Govt center,
treatment as per reports
 Give Antibiotics, get CBC and CXR done

43. Q: How soon does Flu vaccine start
protecting against Flu?
 3 days
 7 days
 10 day
 14 days

44. Q: How soon does Flu vaccine start
protecting against Flu?
 3 days
 7 days
 10 day
 14 days

45. Q: You have 3 doses and these 4 family
member turn up, which is not high risk & can
be deferred?
 Pregnant lady,
 her 1.5 years daughter,
 4 years son,
 &70 years old grandfather of the kids

46. Q: You have 3 doses and these 4 family
member turn up, which is not high risk & can
be deferred?
 Pregnant lady,
 her 1.5 years daughter,
 4 years son,
 &70 years old grandfather of the kids

47. Q: Do all the available flu vaccines provide
protection against current outbreaks of A
(H1N1)?
 Yes / No / Maybe

48. Q: Do all the available flu vaccines provide
protection against current outbreaks of A
(H1N1)?
 Yes / No / Maybe

49. Q: What is the overall efficacy for flu
vaccines when strains are well matched / this
year?
 70-80 %/ 20 %
 50-60 % / 30 %
 40-50 % / 40 %

50. Q: What is the overall efficacy for flu
vaccines when strains are well matched / this
year?
 70-80 %/ 20 %
 50-60 % / 30 %
 40-50 % / 40 %

51. Q. There is talk of drift in circulating strain
of Flu virus. Will the vaccine be effective?
 Yes/ No /Maybe

52. Q. There is talk of drift in circulating strain
of Flu virus. Will the vaccine be effective?
 Yes/ No /Maybe

53. Q. What are the estimates of effectiveness of
available flu vaccines against ongoing
A(H1N1) outbreaks in India?
 _____

54. Q. What are the estimates of effectiveness of
available flu vaccines against ongoing
A(H1N1) outbreaks in India?
 70-80 %

55. Q. Who should receive influenza vaccine?

56. Q. Who should receive influenza vaccine?
As per IAP
 1-Children with certain high-risk conditions
 2-Health care professional including
pediatricians;
 3-Laboratory personnel and healthcare
workers;
 4-On demand of anxious parents after one-
to-one discussion.

57. Q. What are the Government of India’s
guidelines on influenza vaccination?

58. Q. What are the Government of India’s
guidelines on influenza vaccination?
A. Health Care Workers working in close
proximity to influenza patients are at higher
risk of acquiring the disease, like ER, ICU,
Isolation Wards, Screening centers, Rapid
response team, driver & staff of ambulances,
lab workers etc.

59. Q. Is it okay to advise mass vaccination in
schools in the regions affected with current
outbreaks of swine flu?
 Yes / No / maybe

60. Q. Is it okay to advise mass vaccination in
schools in the regions affected with current
outbreaks of swine flu?
 Yes / No / maybe
 It takes about 2-3 weeks for development of
immunity
 Majority of affected individuals would have
only minor, selflimiting disease.
 No health authority in India including WHO
has recommended mass influenza
vaccination.

61. Q: What are the non-pharmaceutical
interventions to avoid spread of disease?

62. Q: What are the non-pharmaceutical
interventions to avoid spread of disease?
People need to focus on
 good hand hygiene,
 staying at home if they are feeling unwell
and
 covering their mouth when they cough or
sneeze.

63. Q: Should I wear a face mask or respirator?
 Yes / No / Maybe

64. Q: Should I wear a face mask or respirator?
 Yes / No / Maybe
 As per GOI only for the patient in hospital
 Maybe recommended in crowded places
during epidemics
 Difficult to wear properly.

65. That’s all folks !