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Вирусология / Orthomyxo-2011-20

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Swine Influenza A(H1N1) May 25, 2009

Status Update

•MEXICO: March 01-June 09, a total of

–6,241 Laboratory confirmed cases

–108 deaths reported

–All 32 States

•UNITED STATES: March 28-June 09, a total of

–13,217 Laboratory confirmed cases,

–27 deaths

–All Sates plus District of Columbia and Puerto Rico

–Vast majority of cases mild

•CANADA: As of June 10, a total of

–2,978 Laboratory confirmed cases,

–4 deaths

–12 of 13 States

–533 new Laboratory confirmed cases June

–Vast majority of cases mild

Source: Secretaria de Salud, Mexico, CDC, Public Health Agency of Canada, European CDC, WHO

Swine Influenza A(H1N1)

Mexico Epidemic Curve Confirmed, by Day

As of June 09, 2009

Total Number of Confirmed Cases = 6,241*

No. of Confirmed Cases

400

350

300

250

200

150

100

Suspension of Non-essential Activities

School Closure

400			School Open
			School Open
385

																						309
																							290
																							290
																								270
																								270
																						262							224
																													224
																									221				217
																									221
																													214
																													214
																										199		201
																						186
																						186
																											176			168
																											176

																															158
																																148
																																128	126
																																128
												Epidemiological Alert																				127
												Epidemiological Alert										122												112				92
																																		112
																																			90


																						77													85						75
																					76															76			69		75
																					76															76			69
																																					71			65		6159 59
																																										6159 59
																					31																						5052	41	3637	3129 33		25
																					31																							41	3637	3129 33
																	14	15		14	22																										20			16
1	0	0 0 1	1 2 1	1 1	1 2 2	4	3 2	0 2	3	5 3	6 7 7		3 2	8 4 8	3 1	3 4			10 10																														8		4
1	0	0 0 1	1 2 1	1 1	1 2 2	4	3 2	0 2	3	5 3	6 7 7		3 2	8 4 8	3 1	3 4			10 10																														8		4

Day

*NOTE: 54 confirmed cases not included

Source: Secretaria de Salud, Mexico

Swine Influenza A(H1N1)

EU & EFTA Countries Confirmed Case Distribution, by Age

Confirmed Cases

27 April to 8 May 2009 N=46

0-9

10-19

20-29

30-39

40-49

50-59

Age Group (Years)

Source: ECDC

Global Distribution of Reported Cumulative Laboratory Confirmed Cases

of Swine Influenza A(H1N1) by Countries, June 11, 2009 (14:00 GMT)

Source: WHO

Swine Influenza A(H1N1)

Guidelines for General Population

•Covering nose and mouth with a tissue when coughing or sneezing

–Dispose the tissue in the trash after use.

•Handwashing with soap and water

–Especially after coughing or sneezing.

•Cleaning hands with alcohol-based hand cleaners

•Avoiding close contact with sick people

•Avoiding touching eyes, nose or mouth with unwashed hands

•If sick with influenza, staying home from work or school and limit contact with others to keep from infecting them

Swine Influenza A(H1N1)

Treatment

•No vaccine available (till September, 2009)

•Antivirals for the treatment and/or prevention of infection:

–Oseltamivir (Tamiflu) or

–Zanamivir (Relenza)

•Use of anti-virals can make illness milder and recovery faster

•They may also prevent serious flu complications

•For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms)

•Warning! Do NOT give aspirin (acetylsalicylic acid) or aspirincontaining products (e.g. bismuth subsalicylate – Pepto Bismol) to children or teenagers (up to 18 years old) who are confirmed or suspected ill case of swine influenza A (H1N1) virus infection; this can cause a rare but serious illness called Reye’s syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.

Source: CDC

Swine Influenza A(H1N1)

Treatment

	Oseltamivir (Tamiflu)		Zanamivir (Relenza)

	Treatment	Prophylaxis	Treatment	Prophylaxis

Adults	75 mg capsule	75 mg capsule	Two 5 mg	Two 5 mg
	twice per day for 5	once per day	inhalations (10 mg	inhalations (10 mg
	days		total) twice per day	total) once per day

Children	15 kg or less: 60	30 mg once per	Two 5 mg	Two 5 mg
	mg per day divided	day	inhalations (10 mg	inhalations (10 mg
	into 2 doses		total) twice per day	total) once per day
			(age, 7 years or	(age, 5 years or
	15–23 kg: 90 mg	45 mg once per	(age, 7 years or	(age, 5 years or
	15–23 kg: 90 mg	45 mg once per	older)	older)
	per day divided	day	older)	older)
	per day divided	day
	into 2 doses

	24–40 kg: 120 mg	60 mg once per
	per day divided	day
	into 2 doses

	>40 kg: 150 mg	75 mg once per
	per day divided	day

into 2 doses

Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatment dose for 5 days. <3 months: 12 mg twice daily; 3-5 months: 20 mg twice daily; 6-11 months: 25 mg twice daily

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

Source: CDC

1918

Spanish

Influenza

H1N1

Timeline of Emergence

Influenza A Viruses in Humans

Reassorted Influenza

virus (Swine Flu)

1976 Swine

Flu Outbreak,

Ft. Dix Avian

Influenza

H9	H7
H5	H5

1957	1968	1977	1997	2003	2009
Asian	Hong	Russian	1998/9
Influenza	Kong	Influenza	1998/9
H2N2	Influenza
	H3N2

Lessons Learned form

Past Pandemics

•First outbreaks March 1918 in Europe, USA

–Highly contagious, but not deadly

–Virus traveled between Europe/USA on troop ships

–Land, sea travel to Africa, Asia

–Warning signal was missed

•August, 1918 simultaneous explosive outbreaks in in France, Sierra Leone, USA

–10-fold increase in death rate

–Highest death rate ages 15-35 years

•Cytokine Storm?

–Deaths from primary viral pneumonia, secondary bacterial pneumonia

–Deaths within 48 hours of illness

–Coincident severe disease in pigs

•20-40 million killed in less than 1 year

–World War I –8.3 million military deaths over 4 years

•25-35% of the world infected

Lessons Learned form

Past Pandemics

•Pandemics are unpredictable

–Mortality, severity of illness, pattern of spread

•A sudden, sharp increase in the need for medical care will always occur

•Capacity to cause severe disease in nontraditional groups is a major determinant of pandemic impact

•Epidemiology reveals waves of infection

–Ages/areas not initially infected likely vulnerable in future waves

–Subsequent waves may be more severe

•1918virus mutated into more virulent form

•1957 schoolchildren spread initial wave, elderly died in second wave

•Public health interventions delay, but do not stop pandemic spread

–Quarantine, travel restriction show little effect

•Does not change population susceptibility

•Delay spread in Australia— later milder strain causes infection there

–Temporary banning of public gatherings, closing schools potentially effective in case of severe disease and high mortality

–Delaying spread is desirable

•Fewer people ill at one time improve capacity to cope with sharp increase in need for medical care

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