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Current Situation Influenza A (H1N1)

19 May 09

Current Situation Influenza A (H1N1)

19 May 09

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Types of influenza– A,B,C

Influenza A and B cause diseases in humans,

Influenza A virus subtypes– There are 16 different HA (H1 to H16)– Nine different NA (N1-N9_

Influenza A virus causes seasonal influenza in many countries in the world:

– Estimated to affect 5-15% of the global population, – results in severe illness in 3-5 million people and

causing 250, 000 – 500,000 deaths worldwide.

Introduction – Influenza A (H1N1)

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H1 N1H2 N2H3 N3H4 N4H5 N5H6 N6H7 N7H8 N8H9 N9

H10H11H12H13H14H15H16

Haemagglutinin subtype Neuraminidase subtype

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Past experiences indicate that– No regularity to pandemics– No reliable basis for predicting when/where it might

arise.– 3 pandemics occurred in the 20th century : interval

of 10-39 years PandemicYearInfluenza A Virus sub type

Deaths(Estimated)

Case Fatality rate

Spanish Flu1918-20H1N140million>2.5%

Asian Flu1957-58H2N22 million<0.1%

Hong Kong Flu1968-69H3N21 million<0.1%

HISTORY

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The 1918- Pandemic Influenza in USAThe 1918- Pandemic Influenza in USA

The flu caused more deaths than suffered World Wars I and II combined

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HISTORY -2HISTORY -2

In Ethiopia – Influenza named as “The Hedar Beshita” (An Introduction to the medical history of Ethiopia Richard Pankhrust, 1990)

– Alaqa Kinfe: “ Many people were dying in AA . Just as a brother would walk over the corpse of his brother on a battlefield so no body troubled to bury the dead by the road side. They simply walked by…….”

– Ras Tafari Makonnen ( later Emperor Haile Sellasei) in his autobiography stated that he had been “ seriously ill” but by “God’s goodness he survived.”

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Current Status Current Status

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Threat of Pandemic InfluenzaThreat of Pandemic Influenza

Criteria for A Pandemic:

– A new subtype of the influenza A virus must emerge– Most people in the world would then have little or no

immunity causing more morbidity and mortality. – The virus must be sufficiently transmissible from one

human to another to cause sustained chains of transmission.

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Threat of Pandemic Influenza -Threat of Pandemic Influenza -

•Circulating in wild birds, poultry and pigs

Animal Influenza •Infects humans in rare instances - resulting from close exposure to pigs/Birds

•If virus evolves into a human virus it could cause a human influenza pandemic

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The 2009 outbreak of influenza A (H1N1) virus is an epidemic due to a new strain of influenza A virus

The current outbreak was first detected in Mexico City, where surveillance began picking up a surge in cases of influenza like illness (ILI) starting March 18.

– The surge was assumed by Mexican authorities to be "late-season flu"

April 21, CDC sent alert concerning two isolated cases (one from a patient admitted on March 29 and a second from a patient admitted on March 30, 2009 for ILI) of a novel flu virus

Some samples were sent to CDC on April 18 from Mexico and cases were confirmed to be a new strain of H1N1.

2009 Influenza A (H1N1) epidemic2009 Influenza A (H1N1) epidemic

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2009 Influenza A (H1N1) epidemic- Chronology2009 Influenza A (H1N1) epidemic- Chronology

1 :April 15, 2009 = CDC identified the Virus from a specimen taken from a patient admitted on March 30 for ILI

2 :April 17, 2009 = CDC identified the Virus from the 2nd pt admitted on March 29 for ILI and notified WHO/IHR

3 :April 23, 2009 = Press Briefing

4 :April 25, 2009= WHO declared Public Health Emergency of International Concern

5 :April 26, 2009 = WHO reactivated Pandemic Phase 3

6 :April 27, 2009 = WHO raised Pandemic alert Phase to 4

7 :April 29, 2009 = WHO raised Pandemic alert phase to 5

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Pandemic PhasesPandemic Phases

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Phase 5Phase 5

is characterized by the same identified virus causing sustained community level outbreaks in at least 2 countries in 1 WHO region.

Most countries won't be affected at this stage

Declaration of Phase 5 signals a pandemic could be imminent

Time to finalize organization, communication, implementation of planned mitigation measures is short.

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Phase 6Phase 6

is characterized by widespread community level outbreaks of the same virus in at least 1 other country in a different WHO region.

Designation of this phase would indicate that a global pandemic is under way.

PHASE 6 IS NOT YET DECLEARED!!

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Current situation- GlobalCurrent situation- GlobalStatus as of May

18, 2009

Total :

Cases=8829

Deaths: 74

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Influenza A (H1N1) Epidemic -Trend Influenza A (H1N1) Epidemic -Trend

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Current situation- Africa /NationalCurrent situation- Africa /National

No confirmed case to date in Africa– Six countries reported suspected cases – most

ruled out after lab investigation

Ethiopia – No report of suspected cases– The FMoH – reactivated the national taskforce and

established various sub groups– Disseminated SCD and alert to all HFs– Daily monitoring of surveillance reports – Press briefing provided – 3 occasions– Trained health personnel from all regions

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– Strengthened surveillance and screening activities at Ports of entry (esp Bole International Airport)

• isolation and quarantine in place at Bole Int. Airport• Air lines staff provided orientation and PPE• All incoming travelers fill in forms and message being relayed

at the Airport– National reference lab at EHNRI- capacity

strengthened. Capacity to do PCR in place– More than 100,800 treatment courses of tamiflu –WHO– 32 Hospitals identified nationwide– Identified national requirements and presented to partners

Current situation- NationalCurrent situation- National

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WHO - GuidanceWHO - Guidance

The Epidemic is due to a new strain of the influenza A (H1N1) that has not been isolated in pigs

– It is a recombinant of the endemic strain of influenza A that is present in Pigs, Birds and humans

– Thus - New influenza A (H1N1 – not Swine flu (April 30, 2009) – No risk of infection from this virus from consumption of well-

cooked pork and pork products.

No travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care

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Prevention: – Cover your mouth while sneezing or coughing – Wash hands regularly– Avoid shaking hands; touching eyes, nose or mouth– Avoid contact with individuals with ILI symptoms– Stay at home when you develop ILI– Seek medical advise immediately

WHO - GuidanceWHO - Guidance

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More InformationMore Information

Phase 5

available at

http://www.who.int/en/

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Thank You !!!Thank You !!!