Influenza Seasonal, Avian, Pandemic

1
InfluenzaSeasonal, Avian, Pandemic
Dr Roger Gajraj Consultant in Communicable
Disease Control
Birmingham Solihull Health Protection Unit
June 2006
2
Influenza
3
Influenza
N Protein

• Virus
• Type A
• humans, birds, mammals
• epidemics, pandemics
• Type B, C
• humans only
• milder

H Protein
4
Seasonal influenza(ordinary flu)
5
Signs and symptoms

• Abrupt onset, Fever, Cough 
• Also
• Malaise, Chills, Headache, Loss of appetite,
  Runny nose, Sneezing, Muscle aches, Sore throat
• No symptoms in many people
• Severe complications in some

6
Spread
Large droplets fall on people, surfaces, bed,
clothes

• Spreads easily
• How does it spread?
• Direct droplet spread
• Indirect contact with contaminated surfaces
• Airborne

Courtesy of CDC
7
Annual influenza vaccine

• Winter 12,000 deaths annually
• Vaccine two A strains and one B strain
• Risk groups
• Elderly (over 65s)
• Chronic illness asthma, bronchitis, diabetes,
  heart, kidney, liver, weak immunity
• Nursing and residential homes
• Carers
• Health and social care workers

8
Avian influenza(bird flu)
9
Bird flu

• A disease of birds wild and domestic  
• Spreads rapidly between birds sickness death
• Poultry farms or live bird markets
• Bird saliva, nasal fluids, droppings, feathers
• H5N1
• Severe
• Chickens, ducks, wild birds
• Many countries
• Very small number of humans affected
• local people with close contact with infected
  birds
• does NOT spread easily to and among humans

10
What to do if you find a dead bird

• Dead swan, goose, duck, at least 3 wild/garden
  birds together in the same place
• Defra Helpline on 08459 33 55 77
• Dead single, small, garden/wild bird
• Avoid touching the bird with your bare hands
• Leave it alone or safe disposal guidelines

11
Bird flu travel advice for affected countries

• No travel restrictions to affected countries
• Do not visit bird or poultry farms or markets
•  
• Avoid close contact with live or dead poultry
• Do not eat raw or poorly-cooked poultry
• Do not eat raw or poorly-cooked poultry products,
  including blood
• Wash your hands frequently with soap and water

12
Bird flu symptoms for travellers in contact with
live or dead birds

• Similar to ordinary flu sudden onset
• Fever (temperature of 38C or more)
• Cough
• Shortness of breath
• Headache
• Sore throat
• Sore eyes
• Muscle aches

13
Pandemic influenza
14
What is a pandemic?

• Epidemic serious outbreak in a single area
• Pandemic epidemic spreading around the world
  affecting hundreds of thousands of people, across
  many countries

15
What conditions are necessary for a pandemic?

• New strain of influenza Type A
• Causes significant illness
• Spreads easily

16
New pandemic strain

• bird flu ordinary flu
• exchange genes
• ordinary flu
• abrupt major mutation
• bird flu
• slowly adapt

17
New influenza strain
Migratory water birds
Domestic bird
18
What an influenza pandemic will mean for the UK

• High levels of illness
• Pressure on health services
• Disruption to many aspects of daily life

19
Pandemic flu impact

• Estimates of impact are available
• Cannot predict when it will begin
• Difficult to accurately predict impact
• Which age groups predominantly affected?
• How many cases?
• How serious the illness?

20
What have we learnt from past pandemics?

• Start in SE Asia
• Global spread will be rapid
• Pandemic waves
• lasting 3-5 mth
• weeks to months apart
• 2nd wave may be worst than 1st

Number of cases
May
June
July
August
21
Antiviral drugs Tamiflu

• The only medical treatment available in early
  stages
• Only effective if taken within 48 hrs of onset
• Not a magic bullet
• Shortens illness by ONE day!!
• Reduce severity of symptoms
• Likely to reduce need for hospital admission?
• Possibly reduce number of cases and deaths
• But
• Unknown if it will be effective vs pandemic strain

22
Pandemic vaccine?

• Ordinary flu vaccine or past flu jab will not
  provide protection
• Takes 4-6 months to develop likely unavailable
  in 1st wave
• Once developed, likely to be very effective

23
If you do catch the flu

• Stay at home and rest
• Take medicines such as aspirin, ibuprofen or
  paracetamol to relieve the symptoms
• Follow the instructions with the medicines
• Children under 16 must not be given aspirin or
  ready made flu remedies containing aspirin
• Drink plenty of fluids

24
You can reduce, but not eliminate the risk of
catching or spreading influenza during a pandemic
by

• Cover your nose and mouth when coughing or
  sneezing use a tissue when possible
• Dispose of dirty tissues promptly and carefully
  bag and bin them
• Avoid non-essential travel and large crowds
  wherever possible
• Maintain good basic hygiene, eg wash your hands
  frequently with soap and water to reduce
  spreading the virus from your hands to your face,
  or to other people
• Clean hard surfaces (eg, kitchen worktops, door
  handles) frequently using a normal cleaning
  product
• Make sure your children follow this advice

25
END