Health Care Workers Safety Influenza Dr.T.V.Rao MD

1. Health Care Workers Safety InfluenzaDr.T.V.Rao MD Dr.T.V.Rao MD

2. Circulating Influenza Strains and Pandemics in The 20th Century 1968: “Hong Kong Flu” 1918: “Spanish Flu” 1957: “Asian Flu” 20-40 million deaths 1-4 million deaths 1-4 milliondeaths H3N2 H2N2 H1N1 1920 1940 1960 1980 2000 Dr.T.V.Rao MD

3. What is Swine Flu? • Swine flu (also called swine influenza) is outbreaks in pigs. • People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people. • The 2009 swine fluoutbreak (began in April) in humans is due to a new strain of influenza A virus subtype H1N1 that derives in part from human influenza, avian influenza, and two separate strains of swine influenza. Dr.T.V.Rao MD

4. CHALLENGES WE FACE • Recognition of disease • Not to forget chikungunya & dengue, other viral infections • Difficulty in Confirmation of disease • Self protection • Protection of people around us • Notification • To know more ; Are we facing the pandemic? Dr.T.V.Rao MD

5. How does swine flu spread? Dr.T.V.Rao MD

6. Viral Re-assortment Reassortment in humans Reassortment in pigs Pandemic Influenza Virus Dr.T.V.Rao MD

7. PIG THE CREATOR Dr.T.V.Rao MD

8. EPIDEMIOLOGY • Incubation period- 1-7 days • Transmission PRIMARY CASE –direct contact with pigs SECONDARY CASES sneezing, coughing respiratory droplets body fluids(diarroeal stool) contact surfaces Dr.T.V.Rao MD

9. Transmission Dr.T.V.Rao MD

10. Spread of Influenza Virus • This virus is not transmitted from eating pork or pork products • Contagiousness: 1 day onset of symptoms 7 days Children are contagious for longer periods. . Majority of patients were previously healthy. Clinical course mild in PCR negative influenza. Dr.T.V.Rao MD

11. EARTH LIVING SPACE FOR ALL Including Influenza Virus • Epidemic: An increase in disease above what is normally expected • Pandemic: A worldwide epidemic • A pandemic begins when: there is person-to-person sustained transmission on multiple continents Dr.T.V.Rao MD

12. Proper Handling of Pig meat a Priority • Influenza viruses do not affect the safety of pork, according to the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO). As with any raw meat, pork should always be properly handled and cooked to eliminate a range of food safety concerns. Dr.T.V.Rao MD

13. Signs and Symptoms Dr.T.V.Rao MD

14. Swine flu – A Acute respiratory infection • Swine flu is an infection caused by a virus. It's named for a virus that pigs can get. People do not normally get swine flu, but human infections can and do happen. The virus is contagious and can spread from human to human. Symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Dr.T.V.Rao MD

15. Swine flu spreads through Respiratory route • The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. Dr.T.V.Rao MD

16. Swine flu can begin with • Fever with Sudden symptoms of • Aches • Chills • Tiredness Dr.T.V.Rao MD

17. May Preset with more severe Symptoms • Fever (usually high) • Headache • Muscle aches • Chills • Extreme tiredness • Dry cough • Runny nose may also occur but is more common in children than adults • Stomach symptoms, such as nausea, vomiting, and diarrhea, may also occur but are more common in children than adults • Donot self Diagnose Visit a Health Centre Dr.T.V.Rao MD

18. Collection of Specimens  • Nasopharyngeal swab, nasal swab, throat swab, combined oropharyngeal/ nasopharyngeal swab, or nasal aspirate • Swabs with a synthetic tip (eg, polyester or Dacron) and an aluminum or plastic shaft should be used. Swabs with cotton tips and wooden shafts are not recommended. • The collection vial in which the swab is placed should contain 1 to 3 mL of viral transport media. Dr.T.V.Rao MD

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20. Collection and Transportation • Respiratory specimen should be collected within 4 to 5 days of illness or at the earliest • Specimens should be placed in viral transport media and placed on ice (4ºC) or refrigerated immediately for transportation to the laboratory Dr.T.V.Rao MD

21. Whom to test • Testing for pandemic H1N1 influenza A should be considered in individuals with an acute febrile respiratory illness ( temperature of 100ºF or higher and recent onset of at least one of the following: rhinorrhea, nasal congestion, sore throat, or cough) or sepsis-like syndrome Dr.T.V.Rao MD

22. Priority and Recommendations in Testing Priority for testing should be given to : Those who require hospitalization and Those who are at high risk for severe complications No testing if illness is mild or the person resides in an area with confirmed cases Recommended test for suspected cases is real-time reverse transcriptase (RT)-PCR for influenza A, B, H1, and H3 Dr.T.V.Rao MD

23. Diagnosis • To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus Dr.T.V.Rao MD

24. Rapid Diagnosis • RT PCR can make rapid Diagnosis Dr.T.V.Rao MD

25. General precautions: • Frequent hand washing • Covering coughs and sneezes • Avoidance of crowded settings when possible • advising ill persons to stay home (except to seek medical care) and minimize contact with others in household • voluntary home quarantine of members of households with confirmed or probable swine influenza cases Dr.T.V.Rao MD

26. Hand Washing Method • Wet hands with clean (not hot) water • Apply soap • Rub hands together for at least 20 seconds • Rinse with clean water • Dry with disposable towel or air dry • Use towel to turn off faucet Dr.T.V.Rao MD

27. Alcohol-based Hand Rubs • Effective if hands not visibly soiled • More costly than soap & water Method • Apply appropriate (3ml) amount to palms • Rub hands together, covering all surfaces until dry Dr.T.V.Rao MD

28. Isolation Precautions Dr.T.V.Rao MD

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30. Care for common materials used by Swine flu patients • Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Dr.T.V.Rao MD

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32. Antivirals- Oseltamivir Treatment is 75 mg twice a day for 5 days. Prophylaxis is 75 mg once a day for 7 days after last exposure. Prophylaxis: High risk exposure (household contacts) Moderate risk (unprotected very close exposure to sick animals; HCW with unprotected exposure to patients) Low risk exposure: no need for prophylaxis unless activation of exceptional measures. Dr.T.V.Rao MD

33. Indications for antiviral chemoprophylaxis * household close contacts (of confirmed, probable, or suspected case) at high-risk for complications of influenza + chronic medical conditions + aged ≥ 65 years + aged ≤ 5 years + pregnant women * school children or children in daycare at high-risk for complications of influenza (certain chronic medical conditions) who had close contact (face-to-face) with confirmed, probable, or suspected case Dr.T.V.Rao MD

34. Indications for antiviral chemoprophylaxis *Any healthcare worker at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) working in area with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness * Non-high risk travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection Dr.T.V.Rao MD

35. Chemoprophylaxis treatment • Pre-exposure – • Treat during exposure period and for 10 days after last known exposure to ill confirmed case of swine influenza A (H1N1) virus infection • Post-exposure – • Treat for 10 days after last known exposure to ill confirmed case of swine influenza A (H1N1) virus infection Dr.T.V.Rao MD

36. Use of Mask by Patients and Health care Workers • The use of surgical or procedure masks by infectious patients may help contain their respiratory secretions and limit exposure to others. Likewise, when a patient is not wearing a mask, as when in an isolation room, having health-care personnel mask for close contact with the patient may prevent nose and mouth contact with respiratory droplets Dr.T.V.Rao MD

37. Can the Mask Prevent the Spread of Flu ??? However, no studies have definitively shown that mask use by either infectious patients or health-care personnel prevents influenza transmission Dr.T.V.Rao MD

38. Prevention is best option • Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. D Dr.T.V.Rao MD

39. Using N95 mask reduces the Risk • You can cut your risk of contracting the flu or other respiratory viruses by as much as 80 percent by wearing a mask over your nose and mouth, according to a new study. Emerging Infectious Diseases, the journal of the Centres for Disease Control and Prevention (CDC) . Dr.T.V.Rao MD

40. Mask can increase Personal Protection Dr.T.V.Rao MD

41. RAPID GLOBAL SPREAD SEASONAL VACCINE PROTECTION? VACCINE COST EFFECTIVE TARGET AT RISK PEOPLE WINTER SEASON TO COME(LOW HUMIDITY,TEMP) Why do we need vaccine Dr.T.V.Rao MD

42. "flu shot” • The "flu shot" — an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions. Dr.T.V.Rao MD

43. Nasal Vaccination • The nasal-spray flu vaccine —a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "live attenuated influenza vaccine" or FluMist®). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age who are not pregnant. Dr.T.V.Rao MD

44. How to Keep Away from Swine Flu?A,B,C,D of Prevention • Wash your hands with soap or hand cleaners. • Avoid touching your eyes, nose or mouth. • Drink plenty of fluids and eat nutritious food. • Cover your nose and mouth with a tissue. • Try to stay in good general health. • Get plenty of sleep to be physically active. • Manage your stress. • Try not touch surfaces that may be contaminated with the flu virus. • Avoid close contact with people who are sick. • Get treatment and/or prevention of the infection with antiviral drugs. Dr.T.V.Rao MD

45. Dealing with the Deceased • Transport of deceased persons in a transport bag. • Hand hygiene should be performed after completing transport. • For deceased persons with confirmed, probable, or suspect novel influenza A (H1N1): • limit contact with the body in health care settings to close family members • Direct contact with the body is discouraged • Necessary contact may occur as long as hands are washed immediately with soap and water. Dr.T.V.Rao MD

46. Stop Spreading Virus Promote Prevention Dr.T.V.Rao MD

47. Your Hand Washing Practices are best contribution to Hospital Safety Dr.T.V.Rao MD

48. The Programme Created by Dr.T.V.Rao MD as Public Health Message on Prevention and Control of Swine Flu among the Health Care Workers • Email • doctortvrao@gmail.com Dr.T.V.Rao MD