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Francisco George

DIRECTORATE-GENERAL OF HEALTH. Influenza A(H1N1)2009. Francisco George. Notes on Influenza. The most frequent zoonosis Reservoir Multiple hosts Species barrier Epizootics and epidemics Impossible to erradicate Individually avoidable. About the 2009 Pandemic. Expected phenomenon

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Francisco George

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  1. DIRECTORATE-GENERAL OF HEALTH Influenza A(H1N1)2009 Francisco George

  2. Notes on Influenza • The most frequent zoonosis • Reservoir • Multiple hosts • Species barrier • Epizootics and epidemics • Impossible to erradicate • Individually avoidable

  3. About the 2009 Pandemic • Expected phenomenon • Fast global ignition process Phase 4  Phase 5  Phase 6  Portugal • No pandemics are alike: 1889, 1900, 1918, 1957, 1968, 2009 • Different issue from seasonal influenza • Emergence of the A(H1N1)2009 virus H1 generations

  4. Global situation Worldwide impact Ongoing spread of infection over both hemispheres Common trends in each hemisphere National impact Variable patterns according to location Flu activity with up & down pattern over the weeks Source: WHO

  5. Global situation Southern hemisphere General widespread infection, though decreasing as Winter ends Northern hemisphere General flu activity during all Summer Japan reporting a significant increase of ILI cases Source: WHO

  6. Global situation Some aspects differ from seasonal flu: High activity during Summer, in the northern hemisphere Severe and fatal cases mainly in younger age groups Death mainly associated with a rapid respiratory failure Very fast worldwide spreading All world regions in just 9 weeks Source: WHO

  7. Global situation Lab. confirmed cases in Chile, EU and EFTA countries, Japan, Panama and Mexico Source: WHO

  8. Global situation Wide spectrum of severity (no symptoms  death) Proportion of cases with no symptoms not yet established Majority of patients develops self-limited clinical cases Risk groups: Pregnancy, chronic respiratory disease, cardiovascular diseases, diabetes, obesity, immunodepression. Source: WHO

  9. Most patients recover without hospitalization Care-providers must pay attention to signs of aggravation: Risk groups Severe respiratory failure can develop very quickly Guidelines issued on care provision and use of antivirals Global situation Source: WHO

  10. Global situation Viruses remain unchanged Will evolve and diverge over time Sensitive to oseltamivir and zanamivir Resistant to amantadine and rimantadine 12 cases of oseltamivir resistance reported Increased incidence of the pandemic virus Source: WHO

  11. Situation in Portugal • Containment phase - April 24 – August 21 • First reported case - April 29 • First secondary case - July 4 • First cluster - July 5 • 100 cumulative cases - July 14 • 1000 cumulative cases – August 14 • 2000 cumulative cases – August 21 • Mitigation phase - August 21

  12. Coordination • Minister of Health • DGS, INSA,INFARMED, INEM • Emergency Coordination Committee • Articulation with all sectors involved • Involvement of citizens, families and enterprises

  13. Cumulative cases Containment

  14. Progression

  15. Age groups 77% 25% 35% 17%

  16. Attack rate

  17. Cases by region (N=3467)

  18. Clinical severity (N=1816)

  19. Use of antivirals(oseltamivir) (N=1106)

  20. Week 39 • Cumulative cases: 3472 (lab confirmed) • Weekly incidence of lab confirmed cases: 259 • ILI weekly incidence (estimated): 1271 • Hospitalized cases: 21 • ICU: 6

  21. Containment Without intervention Number of daily cases With intervention No of weeks from first reported case Based on data from CDC Atlanta.

  22. Thank you franciscogeorge@dgs.pt

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