This document summarizes information about swine flu (H1N1 influenza) in humans and its relationship to HIV/AIDS. It describes what swine flu is, its epidemiology, symptoms, diagnosis, treatment, and prevention. Key points are that swine flu is more severe for those with HIV/AIDS, especially those with low CD4 counts, and that antiviral medications like oseltamivir are recommended for treatment and prevention of swine flu in this population.

4. EPIDEMIOLOGY The disease is considered endemic in the United States. Outbreaks are also known to have occurred in North and South America, Europe, Africa (Kenya), Mexico and in parts of Asia. Notable outbreaks:- 1918 - pandemic in humans 1976 - U.S. outbreak 1988 zoonosis – there was no community outbreak 1998 - US outbreak in swine 2007 - Philippine outbreak in swine 2009 - outbreak in humans

7. 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

8. In India till today, 10233 cases have been reported of which 359 have died. Maximum cases have been reported from Pune(Maharashtra), Delhi, Karnataka & Tamilnadu. The first fatality was a 14 year old girl from Pune. She had come in contact with 40 students who travelled from NASA in the US to Pune and though she had not travelled hereself, she got the infection from them. Pune girl Rida Sekh

9. In U.P. till now 328 cases of Swine flu has been confirmed in Lucknow out of which 2 had died. Two confirmed cases of swine flu reported from jhansi till date. 2

11. THE VIRUS The 2009 swine flu outbreak in humans is due to an apparently virulent new strain of influenza A virus subtype H1N1, produced by reassortment from one strain of human influenza virus, one strain of avian influenza virus and two separate strains of swine influenza. This virus was originally referred to as swine flu but the WHO decided to rename it as Influenza A H1N1 virus on 30 th April 2009 in order to avoid confusion over the danger posed by pigs, especially pork consumption, by which the disease is not known to occur. This was also to avoid unnecessary slaughter of pigs.

14. Electron microscope image of the reassorted H1N1 virus. The viruses are 80-120 nanometers in diameter.

18. Pigs can harbour influenza viruses can be adapted to Humans www.medicalppt.blogspot.com FOR MORE LECTURES

20. Human to Human Tranmission – Limited to close contacts and closed groups of people. If a swine virus established efficient human to human transmission, it can cause an influenza pandemic. The impact of a pandemic caused by such a virus is difficult to predict: It depends on- virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection host factor Swine influenza viruses can give rise to a hybrid virus by mixing with a human influenza virus and can cause pandemic.

23. H1N1 INFLUNZA AND AIDS

31. DIAGNOSIS During the 2009 swine flu outbreak in the United States, CDC advised physicians to consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flue cases or in Mexico during the 7 days preceding their illness onset. A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab)

32. LABORATORY STUDIES CBC Leukopenia and relative lymphopenia Thrombocytopenia may be present Real time PCR (RTPCR) Viral culture Four-fold rise in swine influenza A(H1N1) virus-specific neutralizing antibodies

33. There are 19 labs all over our country to test for Swine flu. We have only 5000 kits for testing but attempts are being done to procure more kits.

34. PREVENTION Prevention in swine- Facility Management Using disinfectants Ambient temperature to control virus in the environment. The virus is unlikely to survive outside living cells for > 2 wks except in cold (above freezing) conditions.

43. Healthy Habits reduces the Attacks www.medicalppt.blogspot.com FOR MORE LECTURES

44. * Household close contacts (of confirmed, probable, or suspected case) at high-risk for complications of influenza + chronic medical conditions + aged ≥ 65 years + aged ≤ 5 years + pregnant women * School children or children in daycare at high-risk for complications of influenza (certain chronic medical conditions) who had close contact (face-to-face) with confirmed, probable, or suspected case Indications for antiviral chemoprophylaxis

45. * Any healthcare worker at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) working in area with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness Indications for antiviral chemoprophylaxis

48. TREATMENT GUIDANCE NOTE The majority of influenza cases may be cared for at home with the simple supportive care. However, if they develop dangers signs then patients may need to access a health-care facility. These danger signs may include: weakness/not able to stand inability to drink lethargy dehydration and unconsciousness high fever convulsions very difficult/obstructed breathing or shortness of breath

49. In the case of mild illness, patients should be provided with supportive care at home by a designated caregiver. Supportive care entails- Bed rest Fluids Medication for fever Antibiotics if prescribed Good nutrition

50. Inpatient treatment should include: Treatment of dehydration with IV or oral rehydration fluids; Supplemental oxygen therapy by face mask rather than nasal prongs; Antibiotics (oral or parenteral) for secondary bacterial infections; Non-aspirin antipyretics for pain and fever Nutritional supplementation as needed. In HIV infected individuals, a distinction between opportunistic pneumonia and secondary pneumonia from pandemic influenza may be difficult.

54. In health-care settings, a system of triage Patient separation Prioritization of use of antiviral medicines and Personal protective equipment (PPE) which include high efficiency masks ideally (N95 mask or else triple layer surgical mask) gowns, goggle, gloves, caps and shoe covers. According to risk of exposure, and patient management should be in place to focus efforts on the most effective interventions to reduce mortality and any further morbidity. DISCHARGE POLICY Adult patients should be discharged 7 days after symptoms have subsided, where as children should be discharged 14 days after symptoms have subsided.

55. Protection of staff: Standard Precautions – Basic measures to minimize direct unprotected exposure to blood and body fluids. Droplet Precautions – Medical masks when close to patients with respiratory symptoms. Patients and caregivers should be trained to wear and dispose off masks during the infectious period of the patient. The mask need not be worn all day and only when close contact (within approximately 1m) with the caregiver or others is anticipated. Mask should be disposed off safely if wet with secretions.

56. Self-monitoring – Health staff should monitor their temperatures twice daily. Fevers should be reported. If a staff member becomes unwell, treatment with antiviral as well as supportive care as for other patients should be provided at home by a caregiver.

58. Single-dose swine flu vaccine in the works

59. GOVERNMENT RESPONSIBILTIES

60. The general public must be educated about the signs symptoms and spread of Swine flu. This can be done by television, radio, newspaper etc. PUBLIC AWARENESS

61. Government of India is taking steps to control this pandemic. There are plans to stockpile 15 billion oseltamivir pills. Steps are also being taken to prevent the spread of the disease.

62. Government should ensure proper screening of passengers at all international airports, isolating the positive cases and wearing personal protective equipments are the mainstay of prevention.

63. Let’s work together with no panic !!