1.Influenza A H1N1: Risk factors and Response Actions Mnica C. Del Moral Department of Biology University of Puerto Rico at Cayey Review Paper

2. Outline Background information Influenza A H1N1 Strain Relation of different strains 2009 H1N1 According to studies- Risk factors observed Vaccine and Control measures 3. Introduction 4. Background information: Influenza Influenza- contagious airbornedisease that expresses febrile illness. (Derlet and Nguyen, 2013) Symptoms range from fatigue torespiratory failure or death Seasonal strains arecommon, but deadly ones have emerged (Derlet and Nguyen, 2013) Pandemics- influenza virus +hemagglutinin (Garten et al, 2009) http://commons.wikimedia.org/wiki/File:Dia grama_de_s%C3%ADntomas_de_la_gripe _AH1N1.svg 5. Background information: Strains Lethal strains lead to pandemics- 1918 Spanish flu (Kilbourne, 2006) 1/3 of the world infected 50 million deaths (Taubenberger and Morens, 2006) Strains affect animals- species specific (Derlet and Nguyen, 2013) Avian influenza Swine influenzahttp://thedrumsinthedeep.blogspot.com/2013/ 02/island-earth-audio-logo.html 6. Background information: Avian, Swine and Humans (Taubenberger and Morens, 2006) 1918- relationbetween avian and swine was unknown 1930s- viruses wereisolated Transmission- pigs tohumans (Stuart et al.http://www.thepattersonfoundation.org/ 2013) blog/long-distance-caregivinghttp://doblelol.com/20/funny-farm-pictures.htm snowbirds-seagulls-and-piegons/birds- 7. 2009 H1N1 Mix of swine, avian and humangene segments (Derlet and Nguyen, 2013) Start- cases identified inMexico (Stuart et al., 2013) (Michaelis et al. 2009) The WHO stated that these viruses were not previously detected Majority of cases- healthyyoung adults WHO- pandemic alert level 6 http://www2c.cdc.gov/podcasts/player.asp?f= June 11 2009 11226 8. Vulnerability and Risk Factors 1918 Spanish flu and the First World War(Erkoreka, 2009) Many soldiers living in poor conditions, harshclimate, wild animals, etc. Similarity with 2009 9. Vulnerability and Risk Factors New Mexico study- relation between racial/ethnicgroups and the outcome of the infection (Thompson et.al 2011) NMDOH- developed hospital surveillance system Results: American Indians- highest rate of related hospitalizations Age- young (hospitalization), older (mechanical ventilation) High risk medical conditions- most common were diabetes,asthma, and chronic lung diseases Obesity (mechanical ventilation, not death) 10. Vulnerability and Risk Factors Outbreak in a Germany hospital (Grund et al.2010) In immunocompromised ward- 5 infected people To identify infection- tested to see the viral RNA andvirus antigen: Nasopharyngeal swabs Bronchoalveolar or pharyngeal lavages Healthcare workers were also tested- if results werepositive control measures would be implementedhttp://entertainmentguide.local.com/make-nursecostume-using-materials-home-8585.html 11. Vulnerability and Risk Factors Control measures such as: Isolation of influenza positive patients Hand washing and others Results were negative for influenza, but positive forantibodies against influenza A and B It is suggested that infection occurred within andspread through staff 12. Response 13. Vaccine implementation Canadian study in 2011 (Conway et al. 2011)designed a model to visualize the transmission of Pandemic H1N1 in urban sites Model included: demographic and behavioralfactors Strategies: Actual coverage Uniform Coverage Parents and Children Parents-and-children/Actual sequence 14. Vaccine implementation Stratified population: Susceptible Vaccinated Exposed Pre-symptomatically infectious Infectious Immune Activity level and social contacthttp://www.druglessdrs.com/vaccines-childrentoday-are-receiving-vaccines-today-12-times- 15. Vaccine implementation Assumed and confirmed: with vaccine therewould be a reduction of 90% risk of infection Diversifying campaign start dates were tested Results confirmed vaccine efficacy and strategyused- relative to moment of campaign implementation (prior or on peak) 16. Control Measures CDC (Stuart et al. 20013) makesrecommendations to manage the H1N1 virus: Isolation for approximately 7 days Inform and report case to a health care provider If in social contact, wear masks Strict hand washinghttp://www.picstopin.com/1750/pin-washing-hands-2-clip-art-onpinterest/http:%7C%7Chanamitiii*files*wordpress*com%7C2011%7 C09%7Cwash-hands-12171*jpg/ 17. Summary Out of patterns studied, risk factors can be identified Social interaction- 1918 and 2009 Age, weight, income, race/ethnicity, and high riskmedical conditions Vaccine campaign timing varies efficacy Key control measures- isolation and hand washand/or disinfection 18. Conclusion We can now: identify some high risk groups to provide them helpwith prevention plans and treatments identify risk factors to either avoid them or be alertof cases around and reduce chance of infection be prepared to face the infection with commonhygiene practices and proper vaccine campaigns. 19. References Anonymous. Influenza-like illness in the United States andMexico. World Health Organization. [Cited 2013 Nov/8]. Available source at: http://www.who.int/csr/don/2009_04_24/en/index.html Brook I. Last update: April/4/2013. Pediatric Influenza. [Internet]. [Cited 2013 Nov/8]. Available source at: http://emedicine.medscape.com/article/972269overview#aw2aab6b2b2 CDC. Interim Guidance for Clinicians on the Prevention and Treatment of Swine-Origin Influenza Virus Infection in Young Children. Centers for Disease Control and Prevention. Available source at: http://www.cdc.gov/swineflu/childrentreatment.htm Conway J, Tuite A, Fisman D, Hupert N, Meza R, Davoudi B, English K, Driessche P, Brauer F, Ma J et al. 2011.Vaccination against 2009 pandemic H1N1 in a population dynamical model of Vancouver, Canada: timing is everything. BMC Public Health 11: 1-14 Derlet R, Nguyen N. Last update: Nov/4/2013. Influenza. [Internet]. [Cited 2013 Nov/8]. Available source at: http://emedicine.medscape.com/article/219557-overview#a0101 20. References Erkoreka A. 2009. Origins of the Spanish Influenza pandemic(19181920) and its relation to the First World War. Journal of Molecular and Genetic Medicine 3(2): 190-194. Available source at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805838/ Garten R, Davis CT, Russell C, Shu Bo, Lindstrom S, Balish A, Sessions W, Xu X, Skepner E, Deyde V, et al. 2009. Antigenic and Genetic Characteristics of the Early Isolates of Swine-Origin 2009 A (H1N1) Influenza Viruses Circulating in Humans. Science 325(5937): 197-201. Available source at: http://dx.doi.org/10.1126%2Fscience.1176225 Grund S, Roggendorf M, Schweiger. 2010. Outbreak of influenza virus A/H1n1 in a hospital ward for immunocompromised patients. Archives of Virology 155: 1797-1802 Kilbourne E. 2006. Influenza Pandemics of the 20th Century. Emerg Infect Dis 12(1):9-14. [Cited 2013 Nov/8] Available source at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291411/?report=r eader#!po=81.2500 . http://dx.doi.org/10.3201/eid1201.051254 21. References Michaelis M, Doerr HW, Cinatl J. 2009. An Influenza A H1N1 VirusRevival-Pandemic H1N1/09 Virus. Infection37 5(9): 381-389. Available source at: http://dx.doi.org.uprcdb.cayey.upr.edu:2048/10.1007/s15010-0099181-5 Stuart M, Ross D, Wolf S. Last update: Oct/1/2013. H1N1 Influenza (Swine Flu). [Internet]. [Cited 2013 Nov/8]. Available source at: http://emedicine.medscape.com/article/1807048overview#aw2aab6b2b2 Taubenberger JK, Morens DM. 2006. 1918 influenza: the mother of all pandemics. Emerg Infect Dis 12(1): 1522. [Cited 2013 Nov/8]. Available source at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291398/#__ffn_sectitl. http://dx.doi.org/10.3201/eid1209.05-0979 Thompson D, Jungk J, Hancock E, Smelser C, Landen M, Nichols M, Selvage D, Baumbach J, Sewell M. 2011. Risk Factors for 2009 Pandemic Influenza A (H1N1)-Related Hospitalization and Death among Racial/Ethnic Groups in New Mexico. American Journal of Public Health 101 (9):1776-1784. Available source at: http://search.proquest.com.uprcdb.cayey.upr.edu:2048/docview/8847