If You Look Like This……

1. If You Look Like This……

3. Swine Flu – Test Your Knowledge

4. Swine flu is also known as… • H5N1 • Influenza A (H1N1) • Piggy pox

5. Answer B • Known as H1N1 based on serologic testing. • H5N1 is the avian flu

6. Can you have swine flu without fever? • Yes • No

7. Yes • A New England Journal of medicine article on the 1st 642 US cases found 94% had fever, 92% had cough, 66% had sore throat, 25% had diarrhea and 254 had vomiting. • Most people will have fever, but never say never. Your temperature may, however, be only slightly elevated

8. Can someone carry swine flu without feeling sick? • Yes • No

9. Yes • It is possible. A carrier may have a runny nose and/or a headache, but assume that it’s just a cold or allergies. • However, it is also possible for someone to become infected with a flu virus and have no symptoms.

10. Surgical masks help keep flu or virions out. • True • False

11. False • Surgical masks are actually designed to keep your germs in, though if someone coughs on you, it can help keep droplets out. • The N95 respirator masks keeps “germs” out, but must be sealed airtight against a person’s skin.

12. Types of Protective Masks • Surgical masks • Easily available and commonly used for routine surgical and examination procedures • High-filtration respiratory mask • Special microstructure filter disc to flush out particles bigger than 0.3 micron. These masks are further classified:• oil proof• oil resistant• not resistant to oil • The more a mask is resistant to oil, the better it is • The masks have numbers beside them that indicate their filtration efficiency. For example, a N95 mask has 95% efficiency in filtering out particles greater than 0.3 micron under normal rate of respiration. • The next generation of masks use Nano-technologywhich are capable of blocking particles as small as 0.027 micron.

13. The best way for people to protect themselves… • Handwashing and using disinfectants • Taking antivirals Tamiflu or Relenza • Getting a vaccine

14. Washing your hands frequently is still the best means of protection. Also avoid touching the mouth and eyes after touching a hard surface (fomite). • A vaccine is in the making and should be available in early to mid October. • Tamiflu or Relenza are effective, but should not be taken “just in case.” They are a precious commodity and can be toxic/harmful to the individual. Overuse could actually make one more vulnerable by encouraging the resistant strains.

15. You can catch swine flu by… • Feeding a person • Feeding a pig • Feeding a bird • Feeding yourself with pork • The 1st two answers are correct, but not the last two

16. The 1st two answers are correct • H1N1 can be transmitted from swine to human if in close contact, • but most people are at greater risk of catching it from another human who coughs or sneezes on or near you or on a surface you touch. • Birds aren’t transmitting the disease and eating pork is safe.

17. Health experts advise against domestic travel on planes, trains and buses. • True • False

18. False • The VP was wrong to tell people not to fly. Although this flu is passed between humans and the CDC recommends you not fly if you are feeling ill or diagnosed with the flu, • they recommend most take normal precautions such as regular hand washing.

19. Which threat has killed the most Americans in the past? • The Viet Nam war • World War II • The 1918 influenza pandemic • Hurricane

20. The correct answer is C. • The 1918 flu killed more than 600,000 Americans. • Worldwide, the toll was over 50 million. • By comparison, no single war has taken as many Americans in battle. • The Galveston Hurricane of 1900, considered the deadliest in U.S. history, killed an estimated 8,000 people.

21. What is the best known cure for the new H1N1 virus? • Antiviral drugs like Tamiflu or Relenza • The H1N1 vaccine • Antibiotics • None of the above

22. The correct answer is D. • There is no cure for H1N1. • Antiviral medications can shorten the duration of the sickness in some cases • Antibiotics can save you from deadly secondary bacterial infections, but are not effective against viral infections. • Vaccine is the best way to prevent it to begin with. • But there is no way to cure it once you get it, aside from getting rest, drinking plenty of fluids and checking (early on) with a doctor if you have flu symptoms – • that's especially important for pregnantwomen, school-agedchildren and patients with co-morbidconditions (asthma, diabetes, heart disease or other ongoing health conditions…)

23. If I get the regular, seasonal flu vaccine, will that protect me from H1N1, too? • Yes • No • Maybe

24. The correct answer is B. • The seasonal vaccine is designed for a different strain of flu. • Health officials recommend that Americans get both vaccines • The seasonal flu vaccine is available now, so experts advise getting it first. • If you choose to get both vaccines at the same time, avoid the weakened live-virus form of the seasonal flu vaccine, which is administered by nasal spray. • According to the government, vaccinations given simultaneously should be the killed-virus form that is injected, each in a different part of the body.

25. The new H1N1 vaccine, which will be available later this fall, (somewhere around the first to second week of October) has been tested on: • Healthy young adults • Pregnant women • Children aged 6 mos to 17 years old • Elderly people • All of the above

26. The correct answer is E. • This summer, research institutions around the country tested the H1N1 vaccine on thousands of volunteers of all ages, including pregnant women. The National Institutes of Health oversaw the trials. (Similar studies are being conducted in several other countries.) • So far, no safety problems have been found -- which is what scientists expected, since the H1N1 vaccine is made in the same way that regular seasonal flu vaccines are made every year.

27. One sneeze can contain how many viruses? • Dozens • Hundreds • Billions

28. The correct answer is C. • Influenza viruses are diabolically resilient. Their sole purpose is to reproduce. And one way they do that is to make you cough and sneeze. • Each time you sneeze, it's like blowing a dandelion seed-puff of virus across the room -- which is why President Obama keeps nagging you to wash your hands and sneeze into your sleeve.

29. It is possible that fewer Americans will die from influenza (of all kinds) this year than in past years? • True • False

30. The correct answer is A. • New pandemic influenza viruses tend to crowd out the normal seasonal flu viruses. • It's sort of a survival-of-the-fittest situation, and the pandemic virus -- to which the population has little natural immunity -- is the fittest. (This crowding-out has already happened in the southern hemisphere with H1N1, in fact.) • As a result, Americans may see many more people getting sick this fall, but many fewer dying overall, because H1N1 is more infectious but (so far) less deadly. • Good news? Well, yes. And no. The people who will die will likely be much younger than in a normal flu season, because H1N1 targets children and young adults.

31. If I get the vaccine as soon as it is available -- probably in mid-October -- when will I have immunity against H1N1? • Immediately • In two days • In three weeks • Never

32. The correct answer is C. • The early results of a vaccine trial in Australia found that a single dose of H1N1 vaccine was enough to confer immunity in adults. • Three weeks after the 120 volunteers in the study received their vaccine shot, 97% had enough antibodies to be considered protected. • That was welcome news for public health experts, who had previously thought that people would need two doses of the vaccine -- a process that would have taken about five weeks, from the delivery of the first shot to the point at which the body becomes immune.

33. If I am over 55, I am at higher risk and should get the vaccine as soon as it's available. • True • False

34. The correct answer is B. • Finally, it pays to be old! Older people seem to have some built-in immunity to this new flu. They may have been exposed to a related strain when they were younger. • So while they should still get the seasonal flu shot, older adults needn't consider the H1N1 vaccine a high priority in most cases.

35. Who should get the swine flu shot? • According to guidelines drafted by the Centers for Disease Control and Prevention (CDC), there are five key populations that should be vaccinated against the H1N1 virus: • Pregnant women • People who live with or care for children younger than 6 months of age • Children and young people between the ages of 6 months and 24 years • Health care workers and emergency medical service providers • People between 25 and 64 years of age who have chronic medical disorders or compromised immune systems.

36. The above groups account for approximately 159 million Americans. • The CDC urges these at-risk populations to get both the swine flu shot and the seasonal flu shot. (The regular flu shot doesn't protect against the H1N1 virus.) • So what should the remaining half of the U.S. population do this flu season? The answer isn't clear, especially in light of the 1976 swine flu debacle.

37. In 1976, a 19-year-old Army private stationed in Fort Dix, N.J., died from the swine flu, while another 115 soldiers stationed there tested positive for swine flu antibodies. • The CDC was called in to investigate, and its scientists concluded that the soldiers had a strain similar to the Spanish Influenza of 1918, which was responsible for the deadliest human pandemic of the 20th century. • Although the virus hadn't spread beyond the fort, the CDC convinced then-president Gerald Ford's advisors that a mass inoculation was required. Pharmaceutical companies rushed to develop a vaccine.

38. By mid-October of 1976, approximately 40 million people had been vaccinated against swine flu and not long after, reports of serious side effects began to pour in. • Within a couple of months, 25 people died from Guillain-Barré, a neuromuscular disorder that can result in paralysis or death, • An additional 500 were diagnosed with the condition. (Doctor's don't know what causes Guillain-Barré, but it can develop after a post-surgery infection or vaccination.)

39. Experts are not expecting any major health risks associated with the current H1N1 vaccine. • "We aren't expecting any side effects beyond what we normally see.“ • Typical side effects include soreness at the injection site and mild body aches.

40. But it's too early to tell if the vaccine is safe and effective, cautions some experts. • "According to clinical trial results it is safe and effective, but we won't know the side effects until large groups of people have been vaccinated.”

41. Today, while CDC spokesman Tom Skinner acknowledges the problems that plagued 1976 inoculation program, he says that this time around his agency and the FDA have taken extra steps to protect the public. • "We have good surveillance monitors in place," he says, referring to the Vaccine Adverse Effect Reporting System (VAERS), a mechanism that allows the public to report and monitor adverse reactions to inoculations.

42. He also contends that the current swine flu virus, while contagious, is relatively mild. • "The virulence is basically the same as seasonal influenza," he says. • And even if that's too much for some to risk catching, one expert says that getting an H1N1 shot might not provide full protection if the virus mutates. • "We've been told that the second viral wave might be more lethal, and that would make the vaccine less effective.”

43. Common side effects include • Pain and redness at the injection site • Drowsiness or tiredness • Muscle aches • Low grade fever • Malaise • Headache

44. Very rare side effects • Severe allergic reaction (anaphylaxis) • Guillian-Barre Syndrome (nervous system disorder featuring paralysis) • From the evidence collected by experts: • GBS is 4 to 7 times more likely after an attack of the actual flu than after the influenza vaccine • There have been reports overseas of a possible association between influenza vaccinations and GBS

45. Questions?

46. What about viruses in general?

47. What is influenza? • Influenza (flu) is a contagious respiratoryillness caused by viruses. • Infection results in mild to severe illness and can lead to death. • Every year, an average of 5 to 20 percent of the U.S. population gets the flu. • Some influenza viruses can also infect birds, pigs, horses, seals, whales and other animals.

48. Influenza The Normal Burden of Disease • Seasonal Influenza • Globally: 250,000 to 500,000 deaths per year • In the US (per year) • ~35,000 deaths • >200,000 Hospitalizations • $37.5 billion in economic cost (influenza & pneumonia) • >$10 billion in lost productivity • Pandemic Influenza • An ever present threat

49. RNA, enveloped • Viral family: Orthomyxoviridae • Size: • 80-200nm or .08 – 0.12 μm (micron) in diameter • Three types • A, B, C • Surface antigens • H (haemaglutinin) • N (neuraminidase) Influenza Virus Credit: L. Stammard, 1995

50. The Biology of Orthomyxoviruses: Influenza • ssRNA consists of 10 genes encoded on 8 separate RNA segments. • 3 distinct influenza virus types: A, B, C; Type A causes most infections • Virus attaches to, and multiplies in, the cells of the respiratory tract; finished viruses are assembled and budded off.