Swine Flu update

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Swine Flu update

• Jacob Kool
• Communicable Disease Surveillance and Response
• WHO South Pacific
• 29 April 2009

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Influenza

• Symptoms
• Sudden onset of high fever ( 38 C)
• Cough and/or sore throat
• Runny nose, other respiratory symptoms
• Body aches, headache, fatigue.
• More severe influenza
• Difficulty breathing, death
• Transmission
• touching, shaking hands, or kissing
• coughing, sneezing, or talking, at close distance
  (lt 2 meters)

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Swine Influenza A H1N1A new virus

• Reassortment - four different genes
• North America swine
• Asia/Europe swine
• Human influenza
• Avian (Non H5)
• Unique combination that has never been seen
  before
• Human to human transmission confirmed
• Level of immunity in general community Unknown
• Effectiveness of seasonal influenza vaccine
  Unknown
• Antiviral drugs
• Sensitive to Tamiflu and Relenza
• Resistant to amantadines

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Latest update (29/4/09 AM)

• The outbreak started in Mexico in February or
  March
• 26 confirmed cases, 5 died
• gt2000 suspected cases, 152 deaths thought linked
  to swine flu
• Many severe cases among young adults
• Outbreak may be levelling off
• Confirmed cases in other countries
• USA 67
• Canada 6
• Spain 1
• New Zealand 3
• UK 2
• Israel (2)
• Not yet in the Pacific?
• All cases outside of Mexico are mild no deaths
• WHOs Dr Fukuda this pandemic may be mild

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Google map updated 29/4
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Clinical Presentation (Mexico)

• Range of symptoms very mild to severe acute
  respiratory symptoms
• Vomiting and diarrhoea in some cases
• Incubation period up to 7 days
• Fatal cases ill for 6 days, then deteriorate

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Why is the illness more severe in Mexico?

• No explanation yet
• Some theories
• Inaccurate information? Biased by panic?
• Are many mild cases missed?
• Did the virus change after it spread to other
  countries?
• Multiple different viruses?

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Control measures in Mexico

• Closed schools, churches, bars, restaurants, etc.
• People advised to stay home
• Ill people advised to quickly get medical
  attention
• Handing out of face masks in public places
• Intensive surveillance and case investigation

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WHO health emergency

• Public Health Emergency of International
  Concern under the International Health
  Regulations
• Pandemic alert -gt phase 4
• All countries must intensify their surveillance
  and report to WHO any suspicious cases or
  clusters
• Surveillance guidelines have been disseminated

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Overview of WHO Pandemic Alert Phases
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WHO pandemic alert phases

• Phase 4 is characterized by verified
  human-to-human transmission of a new virus,
  causing community-level outbreaks.
• Emphasis on surveillance and rapid containment
• Phase 5 is characterized by human-to-human spread
  of the virus into at least two countries in one
  WHO region.
• Focus on (preparing) mitigation efforts
• Phase 6, pandemic phase outbreaks in at least
  one other country in a different WHO region in
  addition to the criteria in Phase 5.
• Focus on mitigation and continuation of essential
  services

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Pandemic Response

• Antiviral drugs
• Vaccines, etc
• Medical care, PPE

Medical interventions
Non-Medical interventions

• Personal hygiene
• Travel restriction
• Quarantine
• Social distancing
• Risk Communication

Public Health Measures

• Security
• Food water supply
• Power supply
• Transportation
• Telecommunication
• other essential services

Social Services (keep a society running)
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What needs to be done - NOW

• Intensify surveillance
• Report to WHO any cases or unusual outbreaks
• Share samples
• Inform clinicians
• Inform travellers
• screening was not effective in the past
• Inform the public

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When cases are confirmed

• Inform the public, medical staff
• How to protect themselves, seek medical care
• Social distancing
• School, church closures
• No public gatherings
• Stay home

15
Advice to general public

• Wash hands frequently with soap and avoid
  touching your face.
• Cover your mouth or nose when coughing or
  sneezing
• Avoid close contact with obviously sick people
• Stay at home if you are unwell
• See your doctor if you have flu symptoms

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Border control International travel

• Health information and advice to international
  travellers
• Protect yourself
• Seek health care if you get ill
• Countries may consider entry screening
• Travel restrictions, border closures not
  recommended
• But islands may benefit from temporary travel ban