viral droplet infections dr. abd el hamied mohamed abd el hamied lecturer of occupational health...
DESCRIPTION
Seasonal influenza Avian Influenza Swine flu Acute highly infectious viral disease characterized by fever, general & catarrhal manifestations. Infectious viral disease of birds. Some (AI) viruses can cause infections (clinical or subclinical) in humans. Acute infection caused by Type A influenza viruses (H1N1 subtype).TRANSCRIPT
Viral Droplet InfectionsDr. Abd El hamied
Mohamed Abd El hamied
Lecturer of Occupational Health & Industrial Medicine
Viral Droplet Infections Seasonal
Influenza Avian Influenza Swine Influenza
Seasonal influenza
Avian Influenza
Swine flu
Acute highly infectious viral disease characterized by fever, general & catarrhal manifestations.
Infectious viral disease of birds. Some (AI) viruses can cause infections (clinical or subclinical) in humans.
Acute infection caused by Type A influenza viruses (H1N1 subtype).
Public health significance:
Seasonal influenzaOccurs as sporadic cases, outbreaks, epidemics &
pandemics.
In the last century, there are 3 pandemics. During epidemics, clinical attack rates range from 10-20% in general population to >50% in closed population.
Influenza epidemics evolve rapidly, spread widely with serious complications & death especially in elderly & patients with chronic debilitated diseases.
Avian Influenza1st direct bird to human spread of H5NI occurred
in Hong Kong in 1997.
Re-emergence in December 2003 & spread from Asia to Europe & Africa (pandemic), resulting in millions of poultry infections, hundreds of human cases & many human deaths.
In Egypt, 1st direct bird to human spread of H5N1 occurred in 2006 & total cases in 2009 were 85 with a total deaths of 27 (CFR is 31.7%)
Globally general CFR reached ► 50%.
Swine flu In April 2009 WHO declared a "public health ►
emergency of international concern" when 1st 2 cases of H1N1 virus were reported in US, followed by hundreds of cases in Mexico.
In April 2010,CFR was at least 17.700 deaths worldwide.
Risk factors : extremities of agepregnant females individuals with syst emic diseases.
In Egypt in 2009 → 808 cases were confirmed with 2 deaths (CFR around 0.2%).
In Aug-2010, WHO declared that swine flu pandemic officially over.
Causative agent
Seasonal influenzaType A: epidemics & pandemics. Type B: regional epidemicsType C: sporadic cases & localized outbreaks.
☻Has 2 antigens projecting from its surface:
Haemagglutinin (HA) Neuraminidase (NA)16 known subtypes 9 known subtypesSite of attachment to host cells
Helps releasing newly formed viruses from host cells
WHO nomenclature for influenza
Strain type (A, B or C) / Geographical origin / Laboratory reference number/ year of occurrence / (description of H&N antigens).
For example; A/ Mississippi/1/85/ (H3N2)
Antigenic drift Antigenic shiftModification of HA & NA
viral proteins → a new variant of A subtype with antibodies against previous strains are not able to neutralize this new variant → regional outbreaks & annual epidemics
Replacement of viral proteins, mostly due to genetic recombination of human & animal influenza viruses → a completely new A subtype → pandemic.
Since 1918, the only 3 influenza A sub-types
known to cause human disease are: H1N1, H2N2
& H3N2. Other subtypes such as H5N1 are rare.
Since isolation of influenza virus in 1933,
antigenic shifts occurred 3 times: in 1957, 1968 &
1977 (causing pandemic every time).• •
No cross immunity between different antigenic strains.
Avian Influenza Current pandemic is caused by subtype H5N1.
Swine flu Type A influenza viruses (H1N1 subtype).
Resistance: Killed by heat& oxidizing
agents.
Killed at 70C,by
alcohol, vinegar &
disinfectants.
Reservoir of infection: Human cases (typical or
atypical)+ swine + avian
Birds (wild &
domestic) + pigs
Human cases + pigs
Exit: Nasopharyngeal secretions
Nasopharyngeal
discharges,
lacrimal
discharges,
faeces & blood.
Period of communicability: 3-5 days from clinical
onset in adult. 7 days in young
children.
1 day before symptoms
up to 7 or more days
after becoming sick.
Resistance: Killed by heat& oxidizing
agents.
Survives in low
temperature & water.
Killed at 70C,by
alcohol, vinegar &
disinfectants.
Reservoir of infection: Human cases (typical or
atypical)+ swine + avian
Birds (wild &
domestic) + pigs
Human cases + pigs
Exit: Nasopharyngeal secretions
Nasopharyngeal
discharges,
lacrimal
discharges,
faeces & blood.
Period of infectivity: 3-5 days from clinical
onset in adult. 7 days in young
children.
1 day before up to 7
days after becoming
sick.
Modes of transmission
1. Direct droplet.2. Nasal inoculation after hand contamination with
virus. 3.Freshly contaminated articles with
nasopharyngeal discharges.
4. Air borne: (droplet nuclei & infected dust).
Seasonal influenza
Avian Influenza1. ANIMAL TO ANIMAL INFECTION: direct
contact of susceptible animal to secretions (saliva, nasopharyngeal, feces or blood) of infected animals. Many different animals are infected including ducks, chicken, pigs, whales, horses & seals.
2. Animal to human infection: direct contact of humans with infected poultry, its discharges & feces.
Antigenic shift & the danger of person to person transmission:
If a pig is infected with both human influenza A
virus & AI virus in the same time, mixing genes
(Re-assortment) occur →a new virus → able to
infect humans & spread from person to person
resulting in an influenza pandemic.
IP: 1-3 days International 7 days.
Susceptibility:
1. Age: all ages are susceptible. 2.Immunity: Type specific & Transient immunity. Recurrent attacks due to multiple
strains, genetic mutation & no cross immunity between different strains.
3.Environment:Cold, over-crowdness & ill ventilation.
Clinical Picture: Sub-clinical, mild, moderate or severe form. Acute fever, headache, myalgia, prostration, back pain, sore throat, rhinorrhea & cough. Self limited disease (recovery within 2-4 days).
High fever + influenza-like symptoms.
Diarrhea, vomiting, abdominal pain & bleeding from nose and gums.
As seasonal human flu.
Some people have reported diarrhea + vomiting.
Complications:1. 2ry bacterial infection e.g.
bronchitis, 2. Children with salicylate therapy ►Reye disease (CNS & liver).
Diagnosis ofSeasonal Influenza
Laboratory Diagnosis
1.Direct identification of viral antigen in nasopharyngeal cells by FA test or ELISA.
2. A rising titre of specific serum antibodies.
Diagnosis ofSwine Flu
Case classification:
•Possible case: clinical +epidemiological criteria.
•Probable case: clinical + epidemiological criteria + positive influenza rapid testing.
•Confirmed case: laboratory confirmation
Clinical criteria: one of the following:
1. Fever >38°C OR history of fever AND flu-like illness (≥2 of the following symptoms: cough, headache, rhinorrhea or vomiting/diarrhea).
2. Severe/life-threatening illness .
• Epidemiological criteria:
• At least one of the following in a person during the 7 days before onset of illness:
1. Close contact with a confirmed or probable case of swine flu A (H1 N1) virus infection.
2. Traveled to a geographical area known to have confirmed cases of swine influenza A/H1 N1
Prevention & Control
Prevention: General: Specific:
A.Active immunization:
1. Inactivated trivalent vaccine:
Nature:Killed containing 2 subtypes of A virus (H1N1 & H3N2), B strain (currently circulating strains present in the locality).
☻Efficacy: 80%
reduce complications by
60% & death by 80 %.
☻Dose: 2 doses 0.5 ml I.M. for
children not immunized
before. Single dose if immunized
before. Vaccine should be given
each year before season
of expected influenza.
☻Indications:1. Old aged persons above
65 years
2. Cases with chronic
debilitating diseases.
3. HCWs.
4. Immunosuppressed
children.
2. Live attenuated intranasal vaccine:
Formed of 2 subtypes
A&B Heat sensitive
vaccine. Given 0.5 ml by
intranasal spraying. Produces local &
systemic immunity.B.
Chemoprophylaxis: for
influenza A not B Admantadine HCL: 200
mg orally for 10 days for
adults & 100 mg for
children. Side effects: fever & CNS
(5-10 % of cases). Indications: high risk
groups as elderly,
children & chronic
disease. Contraindicated in patient
with psychological or
neurological disorders.
Prevention + Control:
1. General measures of prevention for droplet & contact infections.
2. Measures for patients with AI:
a. Isolation: in fever hospital with standard precautions.
Respiratory
precautions, hand
hygiene, gloves,
gowns, eye
protection,
disposable blood
pressure cuffs,
thermometers….etc
.
3.Measures for HCWs: Standard
precautions,
surveillance,
vaccination to
reduce risk of co-
infection with
human & avian
strain.
4. Precautions for food preparation especially poultry:
Raw poultry
should be handled
hygienically. Cook all poultry&
poultry products to
reach a high
temperature
above 70. Eggs should not
be consumed raw
or partially
cooked. Washing of hands
with soap + water
after handling
frozen or raw
chicken or eggs.
5. LAV given to
poultry.
6. Tamiflu: anti viral
drug of choice.
Prevention: A. General A. General
1. HE of public: Wash your hands.
Avoid touching your
eyes, nose or mouth
Avoid touching
surfaces
contaminated with
virus.
Healthy habits during
cough & sneezing.
Sanitary environment.Measures for swine: Culling: killing large
numbers of infected &
potentially infected
animals. Quarantine: putting
infected farms in
quarantine. Cook pork
thoroughly. Avoid live animal
markets, poultry and
pig farms in infected
countries.
B. Specific prevention
A recently developed
vaccine given for at
risk groups e.g.
pilgrims.
Prevention: General: Specific:
A.Active immunization:
1. Inactivated trivalent vaccine:
☻Nature:Killed
2 subtypes of A & B strains.
☻Efficacy: 80%
reduce complications by
60% & death by 80 %.
☻Dose: 2 doses 0.5 ml I.M. for
children not immunized
before. Single dose if immunized
before.
☻Indications:1. Old aged persons > 65
years
2. Chronic debilitating
diseases.
3. HCWs.
4. Immunosuppressed.
2. Live attenuated intranasal vaccine:
Formed of 2 subtypes
A&B Heat sensitive
vaccine. Given 0.5 ml by
intranasal spraying. Produces local &
systemic immunity.B.
Chemoprophylaxis: for
influenza A not B Admantadine HCL: 200
mg orally for 10 days for
adults & 100 mg for
children. Side effects: fever & CNS
(5-10 % of cases). Indications: high risk
groups as elderly,
children & chronic
disease. Contraindicated in patient
with psychological or
neurological disorders.
Prevention + Control:
1. General measures of prevention for droplet & contact infections.
2. Isolation precautions for patients with avian flu:
b. Nursing precautions: hand hygiene, gloves, gowns, eye protection, disposable blood pressure cuffs, thermometers, etc.c. Tamiflu: anti viral drug of choice.
3. Measures for HCWs: Standard
precautions,
surveillance,
vaccination to ↓ risk of
co-infection with
human & avian strain.
4. Precautions for food preparation especially poultry:
Raw poultry
should be handled
hygienically. Cook all poultry&
poultry products to
reach a high
temperature
above 70. Eggs should not
be consumed raw
or partially
cooked. Washing of hands
with soap + water
after handling
frozen or raw
chicken or eggs.
5. LAV given to
poultry.
6. Tamiflu: anti viral
drug of choice.
Prevention: A. General Prevention
1. HE of public: Wash your hands. Avoid touching your
eyes, nose or mouth.Avoid touching
surfaces
contaminated with
virus.Avoid contact with
sick people.Healthy habits during
cough & sneezing.
2. Measures for swine: Culling: killing large
numbers of infected &
potentially infected
animals.
Quarantine: putting
infected farms in
quarantine.
Cook pork
thoroughly.
Avoid live animal
markets.
B. Specific prevention
A recently developed
vaccine given for at
risk groups e.g.
pilgrims.
Prevention: General: Specific:
A.Active immunization:
1. Inactivated trivalent vaccine:
☻Nature:Killed
2 subtypes of A & B strains.
☻Efficacy: 80%
reduce complications by
60% & death by 80 %.
☻Dose: 2 doses 0.5 ml I.M. for
children not immunized
before. Single dose if immunized
before.
☻Indications:1. Old aged persons above
65 years
2. Chronic debilitating
diseases.
3. HCWs.
4. Immunosuppressed.
2. LA intranasal vaccine: 2 subtypes A&B Heat sensitive vaccine. 0.5 ml intranasal. Produces local & systemic
immunity.
Indication: only for healthy
people aged 5–49 ys.
B. Chemoprophylaxis: 1. Admantadine HCL: adults 200 mg (children100 mg) orally for 10 days.
2. Remantadine HCL: for influenza A but not B.
Side effects: fever & CNS
(5-10 % of cases). Indications: high risk
groups as elderly,
children & chronic
disease. Contraindicated in patient
with psychological or
neurological disorders.
Prevention + Control:
1. General measures of prevention for droplet & contact infections.
2. Isolation precautions for patients with avian flu:
Respiratory,hand,
gloves, gowns, eye
protection,
disposable cuffs,
thermometers….etc
3.Measures for HCWs: Standard
precautions,
surveillance,
vaccination to
reduce risk of co-
infection with
human & avian
strain.
4. Measures during food preparation especially poultry: a. Hygienic Handling of raw poultry. b. Hand washing with soap & water after handling frozen or raw chicken or eggs. c. Cook all poultry & products to a high temperature > 70.
Washing of hands
with soap + water
after handling
frozen or raw
chicken or eggs.
5. LAV given to
poultry.
6. Tamiflu: anti viral
drug of choice.
Prevention: A. General
1. HE of public: Wash your hands. Avoid touching your
eyes, nose or mouth.Avoid touching
surfaces
contaminated with
virus.Avoid contact with
sick people.Healthy habits during
cough & sneezing.
2. Sanitary environment.
3. Measures for swine: Culling: killing large
numbers of infected &
potentially infected
animals. Quarantine: putting
infected farms in
quarantine. Cook pork
thoroughly. Avoid live animal
markets.
B. Specific prevention
Vaccination of at risk groups e.g. pilgrims.
Prevention: General: Specific:
A.Active immunization:
1. Inactivated trivalent vaccine:
☻Nature:Killed
2 subtypes of A & B strains.
☻Efficacy: 80%
reduce complications by
60% & death by 80 %.
☻Dose: 2 doses 0.5 ml I.M. for
children not immunized
before. Single dose if immunized
before.
☻Indications:1. Old aged persons above
65 years
2. Chronic debilitating
diseases.
3. HCWs.
4. Immunosuppressed.
2. LA intranasal vaccine: 2 subtypes A&B Heat sensitive
vaccine. 0.5 ml intranasal. Produces local &
systemic immunity.B.
Chemoprophylaxis:
For influenza A not B Admantadine HCL: 200
mg orally for 10 days for
adults & 100 mg for
children.
Side effects: fever & CNS (5-10 % of cases).
Contraindicated in patient with psychological or
neurological disorders.
Prevention + Control:
1. General measures of prevention for droplet & contact infections.
2. Isolation precautions for patients with avian flu:
Respiratory,hand,
gloves, gowns, eye
protection,
disposable cuffs,
thermometers….etc
3.Measures for HCWs: Standard
precautions,
surveillance,
vaccination to
reduce risk of co-
infection with
human & avian
strain.
4. Precautions for food preparation especially poultry:
Raw poultry
should be handled
hygienically. Cook all poultry&
poultry products to
reach a high
temperature
above 70. Eggs should not
be consumed raw
or partially
cooked.
d. Eggs should not be consumed raw or partially cooked.
5. LAV given to poultry.
Prevention: A. General
1. HE of public: Wash your hands. Avoid touching your
eyes, nose or mouth.Avoid touching
surfaces
contaminated with
virus.Avoid contact with
sick people.Healthy habits during
cough & sneezing.
2. Sanitary environment.
3. Measures for swine: Culling: killing large
numbers of infected &
potentially infected
animals. Quarantine: putting
infected farms in
quarantine. Cook pork
thoroughly. Avoid live animal
markets.
B. Specific prevention
A recently developed
vaccine given for at
risk groups e.g.
pilgrims.
Control ofSeasonal Flu
I. Case: Treatment: Antibiotics + Antiviral
(Amantadine or Remantadine within 48 h of onset for 3-5 days).
II. Contacts:Surveillance for IP.
Chemoprophylaxis.
III. Epidemic measures:1. HE of the public, particularly high risk groups.
2. Immunization for high risk groups.
3. Surveillance of the community.
4. Adequate supplies of antiviral drugs & vaccination.
Control ofSwine Flu
I. Case: Notification to WHO. Treatment: Tamiflu II. Contacts: Surveillance for maximum IP. Chemoprophylaxis.
III. Epidemic measures:1. Locally organized immunization programs for high risk groups.2. Surveillance.3. HE through media: about mode of transmission + prevention.
MOH plan for flu pandemic, 20071. Database of all available health care settings.
2. ↑ number & quality of Labs for diagnosis of H1 N1virus.
3. HE of individuals, HCWs about signs , symptoms & prevention.
4. Vaccination of HCWs with seasonal flu vaccine.
5. Provision of a strategic store of Antiviral drugs.
6. Provision of a strategic store of PPE e.g. masks.
7. Quarantine measures & sentinel surveillance e.g. at airports & fever hospitals.
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