Hospital Preparedness and H1N1 2009 influenza Khachornsakdi Silpapojakul MD

1. Hospital Preparedness and H1N1 2009 influenza Khachornsakdi Silpapojakul MD Prince of Songkla University Hat yai, Songkla, Thailand

2. What ???

3. Swine influenza Influenza as a disease of pigs was first recognized during the Spanish influenza pandemic of 1918–1919. Veterinarian J. S. Koen was the first to describe the illness,observing frequent outbreaks of influenza in families followed immediately by illness in their swine herds,and vice versa.

4. Why important ?????

6. Country Cases Deaths MEXICO 4174 80 U.S.A 6552 9 CANADA 805 1 JAPAN 345 0 SPAIN 133 0 UK 122 0 PANAMA 76 0 Total 12515 91 (0.7%)

7. Pandemics? the three important criteria for a new pandemic influenza virus—ie, the ability to replicate in human beings and the absence of antibodies to the virus in the human population at large. The third criterium is the potential to rapidly spread from man to man.

8. Neuraminidase Hemagglutinin M2 ion channel Drugs 2001;61:263-83

9. H5N1 Avian influenza

10. Human influenza A receptor = SAα2,6-linked Avian influenza A receptor = SAα2,3-linked

12. Nasal mucosa Sinus Bronchus bronchiole Alveoli Avian SAα2,3-linked receptors = red Human SAα2,6-linked receptors = green

13. Why are pigs important regarding pandemics ???

15. Avian SAα2,3-linked receptors = red Swine SAα2,6-linked receptors = green

16. Pigs are thought to have an important role in interspecies transmission of influenza, because they have receptors to both avian and human influenza virus strains.

17. Why important ?????

18. Pandemics the three important criteria for a new pandemic influenza virus—ie, the ability to replicate in human beings and the absence of antibodies to the virus in the human population at large. The third criterium is the potential to rapidly spread from man to man.

19. Swine flu: Mortality??

20. Country Cases Deaths MEXICO 4174 80 U.S.A 6552 9 CANADA 805 1 JAPAN 345 0 SPAIN 133 0 UK 122 0 PANAMA 76 0 Total 12515 91 (0.7%)

21. EID 2006;12: 15-22 Case fatality rates were >2.5%, compared to <0.1% in other influenza pandemics.

25. High school A with 2,686 students and 228 staff members. April 23–24, a total of 222 students got ill. During April 26–28, 44 (86%) of 51 specimens collected were tested positive at CDC for S-OIV,

26. Median age = 15 years (range: 14–21 years). All were students, The only adult was a teacher aged 21 years. None of the 44 patients reported recent travel to California, Texas, or Mexico.

29. Further enhanced surveillance among all students, staff members, and family members of persons at high school A indicated widespread influenza-like symptoms, with hundreds of students and many staff members reporting symptoms that met the case definition for ILI.

32. Several students participating in the on-line survey (none of whom had confirmed S-OIV) reported travel to Mexico during the week before April 20; an undetermined number were symptomatic at the time of survey participation.

33. Swine flu: Morbidity??

37. N Engl J Med 2009;361:1-10

39. Severe Swine Flu: Who ???

40. Of the 22 hospitalized patients for whom data were available, 4 (18%) were children under the age of 5 years, and 1 patient (4%) was pregnant. Nine patients (41%) had chronic medical conditions.

41. Severe Swine Flu: Old age???

43. March 1–April 30,2009 1,918 suspected cases 286 probable cases 97 confirmed cases 7 died

48. EID 2006;12: 15-22 Case fatality rates were >2.5%, compared to <0.1% in other influenza pandemics.

50. Probable Scenario of Pandemic Influenza Outbreak. What? When?, How long? Where? Who? Why? How?