1 / 26

HOT TOPIC: Swine Flu

HOT TOPIC: Swine Flu. H1N1. A,B,C of Flu. Human FLU Deaths worldwide Seasonal flu : mainly A + B (C rare) 500,000 / yr. Influenza A virus pandemics: H1N1 : Spanish Flu 1918 50 million H2N2 : Asian Flu 1957 2 million H3N2 : Hong-Kong Flu 1968 1 million H5N1 : Bird Flu.

cora-collier
Download Presentation

HOT TOPIC: Swine Flu

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HOT TOPIC: Swine Flu H1N1

  2. A,B,C of Flu Human FLUDeaths worldwide • Seasonal flu: mainly A + B (C rare) 500,000 / yr Influenza A virus pandemics: • H1N1: Spanish Flu 1918 50 million • H2N2: Asian Flu 1957 2 million • H3N2: Hong-Kong Flu 1968 1 million • H5N1: Bird Flu

  3. Where does Swine Flu fit in?

  4. Swine Flu • New influenza A(H1N1) virus • Unrelated to seasonal flu • Respiratory disease of pigs, birds, poultry, horses & humans “Quadruple reassortant" virus • Bird-Flu gene • Pig-flu gene • 2 genes: Europe & Asia • Human-gene

  5. Pandemic H1N1 2009 • Never before circulated in humans • WHO Phase 6 = Pandemic • > 300,000 cases in over 200 countries

  6. Symptoms • Fever (> 38°C / 100.4°F) Plus 2 or more of: • Tiredness • Headache • Runny nose • Sore throat • SOB /cough • Loss of appetite • Aching muscles • D&V

  7. Who Is At Risk? Chronic Disease: • Lung • Heart • Kidney • Liver • Neurological • Immunosuppressed • Diabetes • Asthma (Rx past 3 y) Also: • Pregnant women • Elderly ≥ 65 y • Children <5 y

  8. UK 2009 Timeline • March: first confirmed cases (US & Mexico) • April: confirmed in UK • June: first death in UK, Glasgow • July: 1st death with no underlying medical probs • Containment to Treatment Phase • Diagnose on symptoms NOT testing • All contact tracing stopped • Exposure does not = antiviral drugs • Sept: Rising new cases

  9. Predictions Infected = 18.3m Deaths • 18-64,050 Hospital • 366,000 Complications • 2.74m Mild • 15m

  10. Public Messages • Catch it, bin it, kill it • Cover mouth / tissues / basic hygiene • Hard surfaces e.g. Door handles, keyboards, phones • Stay at Home • If symptoms (5-7d) • Flu friends • Face mask unnecessary • Contact • GP / NHS 24 • National Pandemic Flu Service

  11. DOH: General Advice • Children • Attend schools unless flu symptoms • Avoid “flu-parties” • See Doctor if < 1 yr • Pregnant • Routine avoidance measures • Safe to breastfeed if anti-virals • Teachers advised to attend school • Travel: • Unrestricted unless symptomatic • Avoid Mecca Pilgrimages if high-risk group

  12. Headlines • “Swine flu jabs rushed through safety tests” • “GPs demand more money for swine flu jabs” TIMES ONLINE • “NHS staff don’t want swine flu jab” • “Up to half of GPs and one in three nurses ... because of concerns over safety.” Telegraph • “Vaccine risk outweighs risk of virus” Irish-Times • “Swine flu over-diagnosed” • “Swine-flu under-reported”

  13. HCP Advice • Triage suspected cases • Avoid in surgery if possible • Declutter waiting rooms • Use of PPE • Gloves • Mask • Glasses • Gown

  14. Antivirals • May lessen severity by reducing: • Length of illness (~ 1 day) • Symptoms, and  • ? Serious complications risk • Maximum benefit • Adults: Within 48 hrs of symptoms onset • Children: Within 36 hrs of symptoms onset • Preparation: • TAMIFLU (Oseltamivir) & RELENZA (Zanamivir) • neuraminidase enzyme inhibitors

  15. Action • Block viral enzyme • Prevent shedding Safety • Relatively new • report via the MHRA’s ‘Swine Flu ADR Portal’

  16. Tamiflu • Age 1 and over • Caps: 30/45/75mg • Susp: 12mg/ml solution SEs • 676 suspected ADRs since April • nausea, vomiting, diarrhoea, abdo pain, headache, mild allergic • ??seizures/delirium Caution • Severe renal impairment • AVOID dialysis (CrCl ≤ 10ml/min) • ?methotrexate ?probenecid • ?? warfarin Dose: • Age 1-12 • BW ≤ 15kg: 30mg • BW ≤ 23kg: 45mg • BW ≤ 40kg: 60mg • Age 13+/>40kg: 75mg Duration: • Treat = bd for 5 days • Prev = od for 10 days NB • Best with food

  17. Relenza • Age 5 and over • Inhaled (Diskhaler): 5mg dose • Use: pregnancy, renal disorders SEs: • 22 suspected ADRs since April • V rare: 1 in 10,000 • allergy, bronchospasm Caution: • persistent asthma/severe COPD • AVOID severe asthma • Use bronchodilator before taking AVOID: • allergy to lactose/milk protein Dose: • 2 inhalations (2 blisters) = 10mg Duration: • Treat = bd for 5 days • Prev = od for 10 or 28 days* * Longer duration if community outbreak

  18. Vaccination

  19. Vaccination • First batches expected October • Once licensed by European Medicines Agency (EMEA) • Safety concerns (medical / case reports Guillain-Barre 1970’s) • Prioritised by risk Grp • 2 doses, 3 weeks apart • Annual flu vaccination also required • “Previous Swine-flu” does not reduce risk • Even if received anti-virals • Exception is lab (swab) +ve cases

  20. 1st Stage Contact SCOTLAND ENGLAND • High Risk: age > 6m – 65 y 640,700 5 m • Pregnant 60,000 0.5 m • House contacts immunosuppr53,000 0.5 m • High-Risk: age > 65 y 428,250 3.5 m • Frontline Health Professionals 250,000 2 m _______ __ ________ TOTAL = 1.4 million 11 million

  21. Complications

  22. Complications NEJM 2009 • Most common severe complications • Respiratory Distress • Pneumonia • Youth Shift: Age 5-59 • 87% of total Deaths (exp ~ 17%) • 71% of Severe pneumonia (exp~32%) • Selective Antivirals (WHO Aug 2009) • High risk groups • Serious / deteriorating cases = • SOB / Resp distress / cyanosis / haemoptysis / chest pain / fever >3d / confusion / low BP

  23. Second Wave?

  24. Is it coming back? Week until 14/9/9: Sentinel GP practice data • New cases in Scotland • Higher now than start of August • Past week 6181 • Prev week 3336 • Consultation rates • Tayside > Scottish average • Increasing age < 65 • Decreasing age > 65 • Complications • Hospitalised 13 cases (1 ICU) • Deaths 8 cases • 2nd wave likely coincide with seasonal flu

  25. Summary • High Risk • “Young people” • Pregnancy • Chronic Disease / immuno-suppressed • esp < 5y & >65y • Course • Most mild  self-care • Mortality ~0.3% (= seasonal flu) • Second-wave • Anti-virals • Best evidence severe cases / high-risk • Treat based on risk groups • ? Emerging resistance • Vaccination • Late-October • Normal flu-risk group 6m – 65y Extra: • Frontline health-care workers

  26. The End • www.direct.gov.uk • www.nhs24.com • www.scotland.gov.uk • www.rcgp.org.uk/pandemic • www.hpa.org.uk • www.bma.org.uk/health_promotion_ethics/influenza • www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/situation-reports/weekly-h1n1v

More Related