The document discusses the 2009 H1N1 virus, including its origins and characteristics. It emerged from pigs in North America but contains genes from flu viruses found in pigs in Europe and Asia. The virus has been circulating undetected in pigs for 7.5-10 years. It can survive on surfaces for 2-8 hours and is destroyed by heat, chemicals, and alcohol-based disinfectants. The pandemic was declared in phases by the WHO as the virus spread globally.

1. 2009 H1N1 Info gathered by Mona Youssef

2. Study has shown virus to be different from the normally circulating North American pig virus. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia , avian genes and human genes. "quadruple reassortant" virus How is it then that it made its first appearance in Mexico and the US?

9. He says ice-cream made him feel better, and Thank God has now recovered full health. But the rest of the planet has a quick –paced pandemic marching on…. 'Patient Zero' in Swine Flu Outbreak Identified as 5-Year-Old Mexican Boy: Edgar Hernandez

10. Timeline

13. WHO Report 95 AFFECTED COUNTRIES Nothing’s holding this virus back…….!!!

14. keyword A pandemic means an epidemic of an infectious disease, that spreads throughout a large number of people and can spread worldwide. A pandemic begins when : there is person-to-person sustained transmission on multiple continents.

15. The World Health Organization uses a six stage phase for alerting the general public to an outbreak

16. Phase 1 – animal to animal transmission. Phase 2 – an animal influenza virus is capable of human infection. Phase 3 - small outbreaks among close populations but not through human to human contact. Phase 4 - Human to human transmission Phase 5 - spread across two countries or more in one of the WHO regions (continents). Phase 6 – spread across two countries or more in one of the WHO regions plus spread to another WHO region.

17. W.H.O. identifies the following six epidemiological sub-regions. - African Region - Eastern Mediterranean Region - European Region - Region of the Americas - South-East Asian Region - Western Pacific Region

21. Even an island in the middle of the ocean isn’t out of its reach….

23. June 15/2009

26. Who asked him to deny?

27. Any closer we’ll probably find him in the living room watching TV

28. In one week , the United Nations agency raised the alert level twice, from phase 3 to phase 5, in response to the sustained transmission of H1N1 in Mexico and the United States. ( 1976 swine flu Hsw1N1 outbreak never passed phase 3. The vaccine developed caused 10 per million Guillain Barre syndrome as compared to the 1-2 per million with the seasonal flu vaccine and was banned.) Graveness of the situation Clippings from the past

29. 19/6/2009 WHO report 19/6/2009 WHO report Country Cumulative total Newly confirmed since the last reporting period Cases Deaths Cases Deaths Country Cumulative total Newly confirmed since the last reporting period Cases Deaths Cases Deaths Country Cumulative total Newly confirmed since the last reporting period Cases Deaths Cases Deaths Argentina 918 4 185 3 Australia 2199 0 87 0 Austria 8 0 1 0 Bahamas 2 0 0 0 Bahrain 12 0 0 0 Barbados 4 0 1 0 Belgium 19 0 0 0 Bermuda, UKOT 1 0 0 0 Bolivia 11 0 0 0 Brazil 96 0 17 0 British Virgin Islands, UKOT 1 0 0 0 Bulgaria 2 0 0 0 Canada 4905 12 856 5 Cayman Islands, UKOT 4 0 0 0 Chile 3125 2 790 0 China 519 0 137 0 Colombia 60 1 7 0 Costa Rica 149 1 0 0 Cuba 15 0 8 0 Cyprus 1 0 0 0 Czech Republic 5 0 1 0 Denmark 22 0 7 0 Dominica 1 0 0 0 Dominican Republic 93 1 0 0 Ecuador 86 0 0 0 Egypt 29 0 3 0 El Salvador 160 0 35 0 Estonia 5 0 1 0 Finland 13 0 1 0 France 131 0 13 0 French Polynesia, FOC 1 0 0 0 Martinique, FOC 1 0 0 0 Germany 238 0 43 0 Greece 31 0 8 0 Guatemala 153 1 25 0 Honduras 108 0 8 0 Hungary 7 0 3 0 Iceland 4 0 0 0 India 30 0 0 0 Ireland 16 0 4 0 Israel 219 0 67 0 Italy 88 0 16 0 Jamaica 14 0 2 0 Japan 690 0 24 0 Jordan 2 0 0 0 Korea, Republic of 84 0 19 0 Kuwait 18 0 0 0 Laos 1 0 1 0 Lebanon 12 0 1 0 Luxembourg 2 0 0 0 Malaysia 23 0 6 0 Mexico 7624 113 1383 5 Morocco 8 0 5 0 Netherlands 87 0 19 0 Netherlands Antilles, Curaçao * 3 0 2 0 Netherlands Antilles, Sint Maarten 1 0 1 0 New Zealand 216 0 89 0 Nicaragua 144 0 26 0 Norway 17 0 4 0 Oman 3 0 3 0 Panama 272 0 0 0 Papua New Guinea 1 0 1 0 Paraguay 27 0 2 0 Peru 141 0 29 0 Philippines 311 0 118 0 Poland 7 0 0 0 Portugal 5 0 2 0 Qatar 3 0 0 0 Romania 18 0 2 0 Russia 3 0 0 0 Samoa 1 0 0 0 Saudi Arabia 22 0 5 0 Singapore 77 0 28 0 Slovakia 3 0 0 0 South Africa 1 0 1 0 Spain 512 0 13 0 Sri Lanka 1 0 0 0 Suriname 11 0 11 0 Sweden 43 0 6 0 Switzerland 27 0 0 0 Thailand 518 0 208 0 Trinidad and Tobago 18 0 13 0 Turkey 20 0 4 0 Ukraine 1 0 0 0 United Arab Emirates 2 0 1 0 United Kingdom 1752 1 291 0 Isle of Man, Crown Dependency 1 0 0 0 Jersey, Crown Dependency 1 0 0 0 United States of America 17855 44 0 0 Uruguay 36 0 0 0 Venezuela 60 0 15 0 Viet Nam 27 0 0 0 West Bank and Gaza Strip 5 0 3 0 Yemen 4 0 3 0 Grand Total 44287 180 4667 13

30. Countries of origin. Mixing of NH1N1 with seasonal flu virus could result in a strain resistant to tamiflu (NH1N1 is already resistant to other antivirals Mixing with H5N1 could produce strains capable of human to human transmission (Death toll of H5N1 is app. 66%) Any half-brain would know that these three subgroups were the most imortant to keep an eye on... Australia 2199 0 87 0 Chile 3125 2 790 0 Egypt 29 0 3 0 Mexico 7624 113 1383 5 United States of America 17855 44 0 0 Grand Total 44287 180 4667 13 Country 19/6/2009 Cumulative total Newly confirmed since the last reporting period (17/6) Cases Deaths Cases Deaths

34. Previous Global Pandemics

35. 1918 - Spanish Flu (originated in birds). First hit soldiers in Europe during World War I, as their immune systems were weakened by war. The mortality rate was highest between 20 to 50 year olds. There was never any vaccine developed, after about 18 months, the virus seemed to just disappear . The final death toll was written as 40 million people worldwide . Many of the victims who have died in Mexico have been young and otherwise healthy.

36. 1957 - Asian Flu This flu started in birds in Asia. In September schools and public places started closing in an effort to contain the virus. In December the virus started to subside , but reappeared in January. over two million people died Reappeared

37. 1968 - The Hong Kong Flu This is the mildest pandemic It was first found in the early months of 1968 in Hong Kong, and was declared a global pandemic by December. Children were out of school and were therefore not able to spread it as much. It made a mild reappearance in 1970 and 1972 . it claimed about a million lives Seasonal influenza normally claims app. ¼ to ½ a million lives yearly. Reappeared…!!!

39. Novel H1N1 virus tends to affect younger people just like the seasonal H1N1. (Older adults were shown to possess serum neutralizing antibodies to the new virus, most likely due to cross‐immunity with human H1N1 viruses. ) Novel H1N1 spreads just as easily as regular winter flu; ranging from very mild self-limited disease to Death. Pandemic (H1N1) influenza virus continues to be the predominant circulating virus of influenza, both in the northern and southern hemisphere. All pandemic H1N1 2009 influenza viruses analysed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus.

42. Characteristics of reported cases of influenza A(H1N1) by country Of note , the prevailing clinical picture in other countries has been GIT related.

45. Reporting requirements • N ational health authorities from all countries should inform WHO on a weekly basis of their qualitative assessment of the geogrphical spread , trend of cases , intensity of disease , impact on the health‐care system, and deaths. • National health authorities from countries with established influenza surveillance systems should report on a weekly basis data on ILI and/or SARI • National influenza centres or reporting laboratories are asked to report weekly via FluNet on the number of specimens collected and processed for influenza and the number of specimens tested that are positive for influenza by subtype.

57. (iv) Manufacturers are urged to develop clinical trial batches and accelerate initiation of clinical trials of influenza A (H1N1) vaccines and to start preparing for a potential future recommendation to move to commercial‐scale production. (v) The above activities should not interfere with the present production of the Northern hemisphere seasonal vaccines (vi) The number of needed doses of A (H1N1) vaccine will depend on the spread of influenza A (H1N1) virus in the next few weeks and on a better definition of the groups to be targeted (vii) An evidence‐based recommendation for the groups to be targeted for vaccination still requires more data

58. Medpage 7/24/2009 from an article written by Dr. Zalman S. Agus: The FDA is likely to approve 2009 H1N1 (swine flu) vaccines before trial data can prove their safety and effectiveness against the virus. Having a licensed vaccine doesn't mean that an immunization program will kick-off immediately -- that call has to come from the Secretary of Health and Human Services (HHS).

60. If the vaccine is ineffective at stimulating an immune response, the FDA might have to issue an "emergency use authorization" for an oil-in-water adjuvant that sparks a stronger reaction in the immune system, but causes more side effects. Two companies, GlaxoSmithKline and Novartis, are applying for approval for vaccines that contain oil-in-water adjuvants. The NIH is also conducting a trial of an adjuvant-enhanced vaccine. Adjuvanted flu vaccines have been used for a decade in Europe and have not been shown to harm vulnerable populations, such as children.(Theodore Eickhoff). The government has already purchased a supply of 120 million adjuvant doses that it will add to its antigen supply if it there is a shortage of the vaccine, or if the standard versions are shown to be ineffective.

61. Human infection with 2009 H1N1virus: clinical observations from Mexico and other affected countries, May 2009

67. WHO Guidance

71. Antiviral medication dosing recommendations for treatment or chemoprophylaxis of 2009 H1N1 infection Chemoprophylaxis (10 days) Treatment (5 days) 75-mg capsule once per day Oseltamivir 75-mg capsule once per day 75-mg capsule twice per day Adults 30 mg once per day 60 mg per day divided into 2 doses 15 kg or less Children ≥ 12 months 45 mg once per day 90 mg per day divided into 2 doses 16-23 kg 60 mg once per day 120 mg per day divided into 2 doses 24-40 kg 75 mg once per day 150 mg per day divided into 2 doses >40 kg Zanamivir Two 5-mg inhalations (10 mg total) once per day Two 5-mg inhalations (10 mg total) twice per day Adults Two 5-mg inhalations (10 mg total) once per day (age, 5 years or older) Two 5-mg inhalations (10 mg total) twice per day (age, 7 years or older) Children

72. Dosing recommendations for antiviral treatment or chemoprophylaxis of children younger than 1 year using oseltamivir Recommended prophylaxis dose for 10 days Recommended treatment dose for 5 days Age Not recommended unless situation judged critical due to limited data on use in this age group 12 mg twice daily Younger than 3 months daily 20 mg once 20 mg twice daily 3-5 months 25 mg once daily 25 mg twice daily 6-11 months

76. Roooooar! …… . Nobody’s scared of me nomore! Round and round she goes, where it stops , nobody knows…

77. Hey, who said that?

78. swine flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death

80. People with 2009 NH1N1 who are cared for at home should: I wish everyone could have a home like this

83. When to Seek Emergency Medical Care Emergency Warning Signs

85. Medications to Help Lessen Symptoms of the Flu (fever and aches)

88. Steps to Lessen the Spread of Flu in the Home

91. Placement of the sick person

93. Protect other persons in the home

95. If you are the caregiver

99. Using Facemasks or Respirators

101. Household Cleaning, Laundry, and Waste Disposal

104. Pandemic Flu Planning Checklist for Individuals and Families

107. Looks to me like he’s conquered his matador , and has every right to fly……….