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    DETERMINENTS OF SWINE FLU

    TOPICS COVERED:

    Cause and Etiology

    Risk Factors

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    It seems likely that the

    new version of H1N1

    resulted from a mixing

    of different versions ofthe virus, which may

    usually affect different

    species, in the same

    animal host.Pigs provide an

    excellent 'melting pot'

    for these viruses to mix

    and match with each

    other.

    What is new

    about this type

    of swine flu?

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    CAUSE AND ETIOLOGY

    Orthomyxoviridae (RNA virus) of five genera:

    Influenza virus A

    Influenza virus B

    Influenza virus C

    Thogotovirus

    Isavirus

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    CAUSE AND ETIOLOGY

    Orthomyxoviridae (RNA virus) of five genera:

    Influenza virus A (flu endemics found in humans, birds and majority of

    mammals.

    Influenza virus B (only afflict the seals and humans )

    Influenza virus C (afflicts swines and us, humans)

    Thogotovirus

    Isavirus

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    CAUSE AND ETIOLOGY

    Orthomyxoviridae (RNA virus) of five genera:

    Influenza virus A (flu endemics found in humans, birds and majority of

    mammals.

    Influenza virus B (only afflict the seals and humans )

    Influenza virus C (afflicts swines and us, humans)

    Thogotovirus

    IsavirusIt is believed that the famous swine flu is a mixture of

    Influenza virus A, particularly the subtype Influenza

    A virus subtype H1N1 H1N1 and Influenza virus C.

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    Risk Factors for Swine Flu

    Children less than 5 years oldChildren less than 5 years old

    Persons aged 50 years or olderPersons aged 50 years or older

    Children and adolescents (

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    Risk Factors for Swine Flu

    upper respiratory tract disease (sinusitis, otitis media, croup)upper respiratory tract disease (sinusitis, otitis media, croup)

    lower respiratory tract disease (pneumonia, bronchiolitis, asthma)lower respiratory tract disease (pneumonia, bronchiolitis, asthma)

    cardiac (myocarditis, pericarditis), musculoskeletal (myositis,cardiac (myocarditis, pericarditis), musculoskeletal (myositis,

    rhabdomyolysis),rhabdomyolysis),

    neurologic (acute and postneurologic (acute and post--infectious encephalopathy, encephalitis, febrileinfectious encephalopathy, encephalitis, febrileseizures, status epilepticus)seizures, status epilepticus)

    secondary bacterial pneumonia with or without sepsissecondary bacterial pneumonia with or without sepsis

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    Transmission of Swine Flu

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    Transmission of Swine Flu

    this virus isthis virus is transmittedtransmitted in ways similarto other influenzato other influenzavirusesviruses

    human influenza viruses are spread from person to personhuman influenza viruses are spread from person to personprimarily throughprimarily through largelarge--particle dropletparticle droplet transmission (e.g.,transmission (e.g.,

    coughs or sneezes)coughs or sneezes) dropletsdroplets requires close contactrequires close contact (

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    Timeline of events

    April 12: an outbreak of influenza-like illness in Veracruz, Mexico, reported

    to WHO

    April 15-17: two cases of a new A(H1N1) virus infection identified in twosouthern California counties in U.S.A.

    April 23: new influenza A (H1N1) virus infection confirmed in severalpatients in Mexico

    April 24: WHO declares a public health event of international concern(PHEIC).

    April 27: WHO declares pandemic phase 4 - sustained communitytransmission in Mexico

    April 29: WHO declares pandemic phase 5 (2 countries affected)

    June 11: WHO declares pandemic phase 6 (spread to 2 WHO regions)

    In 9 weeks, all WHO regions reporting cases ofpandemic (H1N1) 2009

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    PANDEMIC INFLUENZA PHASES

    Phase 1 No animal influenza virus circulating among animals has beenreported to cause infections in humans.

    Phase 2An animal influenza virus circulating among domesticated or wild

    animals is known to have caused infection in humans, and is therefore

    considered a specific potential pandemic threat.

    Phase 3An animal or human-animal influenza reassortant virus has caused

    sporadic cases or small clusters of disease in people, but has not resulted inhuman to- human transmission sufficient to sustain community-level outbreaks.

    Phase 4 Human-to-human transmission(H2H) of an animal or human-animal

    influenza reassortant virus able to sustain community-level outbreaks has

    been verified.

    Phase 5 The same identified virus has caused sustained community level

    outbreaks in two or more countries in one WHO regionPhase 6 The pandemic phase, is characterized by community level

    outbreaks in at least one other country in a different WHO region in addition to

    the criteria defined in Phase 5.

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    Phases cont

    Post Peak Period Levels of pandemic influenza in most countries with

    adequate surveillance have dropped below peak levels

    Possible new wave Level of pandemic influenza activity in mostcountries with adequate surveillance rising again

    Post Pandemic Period Levels of Influenza activity have

    returned to levels seen for seasonal influenza in most countries withadequate surveillance.

    The current WHO phase of pandemic alert is 5.

    WHO has declared the outbreak as PUBLIC HEALTH EMERGENCYOF INTERNATIONAL CONCERN (PHEIC)

    (Source: WHO: Pandemic influenza)

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    COMPARISON

    human avian swineEtiology H1N1 H5N1 H1N1

    Epidemiology Seasonal Pandemic threat Pandemic phase 5

    Transmission Human to human Animal to human Human to human

    Morbidity High Low High

    Clinical Mild to severe, Similar to human, Similar to human,

    usually mild Many severe fatal usually mild

    Mortality Low High Low

    Treatment Oseltamivir Oseltamivir Oseltamivir