New Influenza AH1N1 Virus Infection

1
New Influenza A/H1N1 Virus Infection
- Clinical Management
???
?.?.(?????)??????????? ?????????????? ???????????
??????? 11, ????????????????????????????????? ????
??????? ???????????????? ?????? 19 ??????? 2552

2
?????????????????? ????????? (Pandemic Influenza)
????? -

• ??????????????? (??????????????????)
• ??????????
• ????????????? ??-???-?? ???????
• ( ???????????????? 3/6 )

3
????????
"Pandemic Influenza"
New influenza A (H1N1)
4
2008 Proposed Phases
5
New A(H1N1) influenza were reported in 40
country,8829 cases/ 74 deaths (18 May 09)
6
Case Definition of New A/H1N1 Virus Infection

• Confirmed case - positive for real-time RT-PCR
  viral culture
• Probable case - Acute febrile respiratory
  illness
• who positive for Influenza A, but
• negative for H1 and H3 by PCR
• Suspected case - Acute febrile respiratory
  illness
• with onset
• - Within 7 d. of close contact with
• confirmed case
• - Within 7 d. of travel to community
• where there are confirmed case (s)
• - Living in a community where there
  are confirmed case (s)

7
????????????????????????????????
A/H1N1????????????, 5 ?????? 5 ??????? 2552 (1)

• 642 ??? ??? 41 ?????
• ???? 3 ?. 81 ??
• 40 ???? 10-18 ??
• 5 ???? gt 50 ??
• ????????? - ??? 94
• - ?? 92
• - ?????? 66
• - ???????? ??????? 25

( JW Pediatr and Adolescent Med, May 8, 2009. )
8
????????????????????????????????
A/H1N1????????????, 5 ?????? 5 ??????? 2552 (2)

• ????????????????
• - 36 ??? (91 ???? 19 ?. 49 ??) ??? ?.?.
• - 9 ??? ?????????????????????????
• - 11 ??? ????????????????
• - 8 ??? ??????? ICU
• - 18 ??????????? ?.?. ?????????
• - 2 ??? ??? (1 ??? myasthenia gravis, 1
  ????????????)

( JW Pediatr and Adolescent Med, May 8, 2009. )
9
The Different of Clinical Features of New A/H1N1
from Seasonal Influenza (8 May 2009)

• Percentage of hospitalization is higher than
  typical flu season
• Age of hospitalized patient is different
• - seasonal influenza, age lt 2 yr. and gt 65 yr.
• - new A/H1N1, high among aged 30-40 yr.
• Death has been reported in previously healthy
  young adult and children (CFR 0.2)

( MMWR. 2009 58 (17) 453-8. )
10
Number and percentage of confirmed cases of novel
influenza A (H1N1) virus infection, by patient
age group and hospitalization status---United
States and Mexico, March 1 May 5, 2009
No of case
Hospitalized
Age
( MMWR 2009 58 (17) 453-8. )
11
???????????????????????????????????????? A/H1N1

• ??????? -
• 1. ????????????? ???????????????????????
• 2. ??????????? ???????????????????????????? ?
• 3. ????????????????????????????????????-?????????

12
????????????????????????

• ????????????
• ??????????????????????????????????
• ??????????????????????????????????????????????????
  ?
• ????????????????????????
• ???????
• ?????????????????????????????????????
• ????????????????????
• ?????????????????????????????

13
?????????? 3 ????????????????????????????????????
??????????????????????(pandemic influenza)
?????????????? ?????????????????????????????? (1)
????????????????????

• ???????????????? ????????????????????????????????
  ????????? ?????? ?????? ???????? ?????????
  ??????? ??? ?????
• ??????? ????????????? ??????
• 1. ?????????????????????????????????????????
  ??????????????????????????? A/H1N1
  ??????????????????????????????
• ?????? ?????? 7 ???????????????????
• 2. ??????????????????????????????????????????
  ??????????????????????????????????
  ???????????????????? ?????????????????
• ??????????????????????????????? A/H1N1
  ???????????????????????????????????? ?????? 7
  ???????????????????
• 3. ?????????????????????????????/
  ???????????????????????????????????? ? ????? 7
  ????????????????
• 4. ?????????????????????????????????????????
  ????????????????? 14 ???????????????????
• ?????????????????????????????
  ?????????????????????????? ????
  ???????????????????????????????????? ???????????
• ??????

• ???????????? Throat swab/ Nasopharyngeal swab
  ????????????? Viral Study ?????????????????? ?
• ??????????????????
• ???????????????????????????? ???????????????????

14
?????????? 3 ????????????????????????????????????
??????????????????????(pandemic influenza)
?????????????? ?????????????????????????????? (2)

• ?????????????????????????????????????????????????
  ???
• ???????? PCR ????????????????????
• ????????????????????????????? ???? AIIR (?????)
• ????????????????????????????????????????????????
  (Droplet precaution) ??????????????
• ????????? H5 ???? ???????????????????? ????????
  ??????????????????????????

PCR Negative
PCR for H5 Positive
PCR positive H1, H3 or B (seasonal flu)
PCR positive for New A (H1N1)

• ?????????????????
• ??????????????
• ??????????

• ?????????????? AIIR (?????) ????????????
• ???
• ??????????????
• ???????????????????????

• ????????????? ??????????? ????
• ??????????????
• ???????????????????????

???????????????? 3, ?????????????? 13 ???????
?.?. 2552 ?????????????????????????????
??????????? ???????????????? ???????????????????
??????????????????????????????????????????????????
??????????? www.moph.go.th ???????????
?????? ??????????????????????? 5 ??
?????????????????? 65 ?? ?????????????
?????????????????????? ???????????????????????????
????
15
?????????? 5 ?????????????????????????????????
??????????????????????????????? ??????
??????????? ???? ???????????????????? (1)
?????????????????????????? ????????????????????

• ???????????????? ????????????????????????????????
  ????????? ?????? ?????? ????????
• ????????? ??????? ??? ??? ?????????
  ????????????? ??????
• 1. ?????????????????????????????????????????
  ??????????????????????????? A/H1N1
• ????????????????????????????????????
  ?????? 7 ???????????????????
• 2. ??????????????????????????????????????????
  ?????????????????????????????????? ??????
• ?????????????? ??????????????????????????
  ?????????????????????? A/H1N1 ????????
• ???????????????????????????? ?????? 7
  ???????????????????
• 3. ?????????????????????????????/
  ???????????????????????????????????? ? ????? 7
  ???
• ?????????????
• 4. ?????????????????????????????????????????
  ????????????????? 14 ???????????????????
• ?????????????????????????????
  ?????????????????????????? ???? ??????????????
• ?????????????????????? ?????????????????

• ??????????????
• ?????????????????????

16
?????????? 5 ?????????????????????????????????
??????????????????????????????? ??????
??????????? ???? ???????????????????? (2)
??????????????????

• ??????????????? ???????????

??????????????
???????????
????????????????? 48 ???????
??????????????
???????????????????? ??????????????????? ????
???????????????? ??????????
???????????????? 3, ?????????????? 13 ???????
?.?. 2552 ?????????????????????????????
??????????? ???????????????? ???????????????????
??????????????????????????????????????????????????
??????????? www.moph.go.th
17
?????????? 6 ?????????????????????????????????
???????????????????????????????
????????????????? ???? PCU
?????????????????????? ???? PCU

• ???????????????? ????????????????????????????????
  ????????? ?????? ?????? ????????
• ????????? ??????? ??? ??? ?????????
  ????????????? ??????
• 1. ??????????????????????????????????????????
  ?????????????????????????? A/H1N1 ????????
• ???????????????????????????? ?????? 7
  ???????????????????
• 2. ??????????????????????????????????????????
  ?????????????????????????????????? ??????
• ?????????????? ??????????????????????????
  ?????????????????????? A/H1N1 ????????
• ???????????????????????????? ?????? 7
  ???????????????????
• 3. ?????????????????????????????/
  ???????????????????????????????????? ? ????? 7
  ???????
• ?????????
• 4. ?????????????????????????????????????????
  ????????????????? 14 ???????????????????
• ?????????????????????????????
  ?????????????????????????? ????
  ?????????????????
• ??????????????????? ?????????????????

• ??????????????
• ?????????????????????

????????????????????
???????????????????? 3 ???????? 13 ???????
?.?.2552 ?????????????????????????????
??????????? ????????????????
18
??????????????????????????????????????-????
A/H1N1
19
Treatment and Care
20
?????????????????? Pandemic Influenza
1. ??????? - ????? ?????? ????????
???????? - lab. ??????????? 2. ????? -
??????????? - ????? ?????? ????????
???????? - ???????????????????? -
?????????????????????-??????? 3. ?????????????
- Pandemic vaccine ??????????????
21
Screening at OPD (wear surgical mask)
22
Isolation room negative-pressure
23
. Goggle or Face shield . Mask (surgical or
N95) . Gown (surgical or water- proof ) .
Glove
24
?????????????????? Pandemic Influenza
1. ??????? - ????? ?????? ????????
???????? - lab. ??????????? 2. ????? -
??????????? - ????? ?????? ????????
???????? - ???????????????????? -
?????????????????????-??????? 3. ?????????????
- Pandemic vaccine ??????????????
25
Antiviral drug
1. For treatment
2. For chemoprophylaxis
26
Licensed (in 2004) and available in Thailand
27
Licensed (in 2006) but not available in Thailand
28
Recommendation for Antiviral Rx in New A/H1N1
Virus

• All data on antiviral effectiveness, clinical
  spectrum, side effect etc. are unknown
• Considered for CONFIRMED, PROBABLE
• or SUSPECTED A/H1N1 virus infection
• Should be initiated as soon as possible
• after the onset of symptoms

( WHO Report 25 April 2009 )
29
Antiviral drug
1. For treatment
2. For chemoprophylaxis
30
Recommendation for Antiviral Chemoprophylaxis in
New A/H1N1 Virus

• Household close contacts who are at high-risk for
  complication of influenza of a CONFIRMED or
  PROBABLE case
• HCWs who were not using appropriate PPE during
  close contacts with an ill CONFIRMED, PROBABLE or
  SUSPECTED case of new A/H1N1 virus infection

( WHO Report 25 April 2009 )
31
???????? Oseltamivir ???????????? ? - ??.2552

• ??????????? stockpile ???????????????????
• ????????????? ??? oseltamivir ????????
• ????????????? ??? oseltamivir ????????
• ?????????????????? ??? oseltamivir ?????????
• ????????? ??? oseltamivir ????? ??
• (????????????????????????)

32
???????????????????????????????????????????
????????????? A/H1N1

• ??????????? - ?????? confirmed, Probable and
  Suspected
• (seasonal flu ?????????????????????????????
  ?)
• ???????????????? - ?????????????????????????????
  ????
• Confirmed, Probable ??????????? PPE
• - ???????????????????????? confirmed,
• Probable ??????????????????????????????
• ????????

33
?????????????????? Pandemic Influenza
1. ??????? - ????? ?????? ????????
???????? - lab. ??????????? 2. ????? -
??????????? - ????? ?????? ????????
???????? - ???????????????????? -
?????????????????????-??????? 3. ?????????????
- Pandemic vaccine ??????????????
34
Pandemic Vaccine
35
???? - ???????? Pandemic Vaccines

• 1. ???????????????????????????????????????????????
  
• 2. ???????????????????????????????
• 3. ????????????? 2 ???????????????????????????????
  ???
• 4. ?????? antigen ??????????? ????????????????????
  ????????
• 5. ????????????????????? gt 6000
  ?????????????????????

( WHO/IVB/06.13 WHO/CDS/EPR/GIP/2006.1 )
36
Pandemic Influenza Medical Intervention

• 1. Pharmaceutical Intervention
• Antiviral agents - treatment, prevention
• Pandemic Vaccine - most important
• (time consuming)
• 2. Non-Pharmaceutical Intervention
• General advices hand washing
• Masking surgical mask, N95 respirator
• Social distancing

37
?????????????????? ????????????????????
??????????

• ??????? ??????? ???????
• ????????????? ???

38
????????????? ???.... ????????????????????
??????????????????????? ?
???????????? ? ????????????????? 5 ????
????????????????? ???????????? ? ??????????? 1 -
2 ???? ??????????????
Source Tang T et al, submitted, 2005 (courtesy
of Dr Li Yuguo, Hong Kong University)
22 Aug 07
39
?????????????????????? ????????????????????????
H1N1 - ????????????

• 1. Early detection - ??????????????
• 2. Early containment - ???????????? (Treatment)
• - ???????????????? (Prophylaxis)
• - ???????????????? (Vaccination)

40
Pandemic Influenza Waves
2nd
1st
3rd
4th
1-3 1-2 1-3
1-2 1-2 1-2
start
Month
41
THANK YOU