DETERMINENTS OF SWINE FLU

TOPICS COVERED:
• Cause and Etiology
• Risk Factors
 What is new
about this type
?of swine flu
It seems likely that the
new version of H1N1
resulted from a mixing
of different versions of
the virus, which may
usually affect different
species, in the same
animal host.
Pigs provide an
excellent 'melting pot'
for these viruses to mix
and match with each
other.
 CAUSE AND ETIOLOGY
Orthomyxoviridae (RNA virus) of five genera:
• Influenza virus A

• Influenza virus B

• Influenza virus C

• Thogotovirus

• Isavirus
 CAUSE AND ETIOLOGY
Orthomyxoviridae (RNA virus) of five genera:
• Influenza virus A (flu endemics found in humans, birds and majority of
mammals.
• Influenza virus B (only afflict the seals and humans )

• Influenza virus C (afflicts swines and us, humans)

• Thogotovirus

• Isavirus
 CAUSE AND ETIOLOGY
Orthomyxoviridae (RNA virus) of five genera:
• Influenza virus A (flu endemics found in humans, birds and majority of
mammals.
• Influenza virus B (only afflict the seals and humans )

• Influenza virus C (afflicts swines and us, humans)

• Thogotovirus

• Isavirus
It is believed that the famous swine flu is a mixture of
Influenza virus A, particularly the subtype “Influenza
A virus subtype H1N1″ H1N1 and Influenza virus C.
 Risk Factors for Swine Flu
• Children less than 5 years old

• Persons aged 50 years or older

• Children and adolescents (<18 yrs) who are receiving long-term aspirin therapy

• Obesity

• Pregnant women

• Patients who have chronic medical conditions

• Patients in immunosuppressed condition

• Residents of nursing homes and other chronic-care facilities

• Smoking
 Risk Factors for Swine Flu

• upper respiratory tract disease (sinusitis, otitis media, croup)

• lower respiratory tract disease (pneumonia, bronchiolitis, asthma)

• cardiac (myocarditis, pericarditis), musculoskeletal (myositis,

rhabdomyolysis),

• neurologic (acute and post-infectious encephalopathy, encephalitis, febrile

seizures, status epilepticus)

• secondary bacterial pneumonia with or without sepsis

Transmission of Swine Flu
 Transmission of Swine Flu
• this virus is  transmitted in ways similar to other influenza
viruses
• human influenza viruses are spread from person to person
primarily through large-particle droplet transmission (e.g.,
coughs or sneezes)
• droplets requires close contact (<1 meter) between source
and recipient persons
• contaminated surfaces is another possible source of
transmission
• all respiratory secretions and bodily fluids (diarrheal stool) of
swine flu cases should be considered potentially infectious
 Timeline of events
 April 12: an outbreak of influenza-like illness in Veracruz, Mexico, reported
to WHO

 April 15-17: two cases of a new A(H1N1) virus infection identified in two
southern California counties in U.S.A.

 April 23: new influenza A (H1N1) virus infection confirmed in several

patients in Mexico

 April 24: WHO declares a public health event of international concern

(PHEIC).

 April 27: WHO declares pandemic phase 4 - sustained community

transmission in Mexico

 April 29: WHO declares pandemic phase 5 (2 countries affected)

 June 11: WHO declares pandemic phase 6 (spread to 2 WHO regions)

 In 9 weeks, all WHO regions reporting cases of pandemic (H1N1) 2009

 PANDEMIC INFLUENZA PHASES
•Phase 1 No animal influenza virus circulating among animals has been
reported to cause infections in humans.
•Phase 2 An animal influenza virus circulating among domesticated or wild
animals is known to have caused infection in humans, and is therefore
considered a specific potential pandemic threat.
•Phase 3 An animal or human-animal influenza reassortant virus has caused
sporadic cases or small clusters of disease in people, but has not resulted in
human to- human transmission sufficient to sustain community-level outbreaks.
•Phase 4 Human-to-human transmission(H2H) of an animal or human-animal
•influenza reassortant virus able to sustain “community-level outbreaks has
been verified.
•Phase 5 The same identified virus has caused sustained community level
outbreaks in two or more countries in one WHO region
•Phase 6 The pandemic phase, is characterized by community level outbreaks
in at least one other country in a different WHO region in addition to the criteria
defined in Phase 5.
 Phases cont……

Post Peak Period Levels of pandemic influenza in most countries with

adequate surveillance have dropped below peak levels

Possible new wave Level of pandemic influenza activity in most

countries with adequate surveillance rising again

Post Pandemic Period Levels of Influenza activity have

returned to levels seen for seasonal influenza in most countries with
adequate surveillance.
The current WHO phase of pandemic alert is 5.

WHO has declared the outbreak as PUBLIC HEALTH EMERGENCY

OF INTERNATIONAL CONCERN (PHEIC)
(Source: WHO: Pandemic influenza)
 COMPARISON
human avian swine
Etiology H1N1 H5N1 H1N1

Epidemiology Seasonal Pandemic threat Pandemic phase 5

Transmission Human to human Animal to human Human to human

Morbidity High Low High

Clinical Mild to severe, Similar to human, Similar to human,

usually mild Many severe fatal usually mild

Mortality Low High Low

Treatment Oseltamivir Oseltamivir Oseltamivir