甲流h1n1精品课件influenza a（h1n1） （swine flu）

CHOTANI 2009. Rashid A. Chotani, MD, MPH, DTM Adjunct Assistant Professor Uniformed Services University of the Health Sciences (USUHS) 240-367-5370 Just-in-Time Lecture Influenza A(H1N1) (Swine Flu) Pandemic (Version 12, first JIT lecture issued April 26) Tuesday, June 11, 2009 (11:30 PM EST) CHOTANI 2009. The Author acknowledges the efforts, hard work and diligence for hosting this lecture, web-management 146:47-51 Survival of Influenza Virus Surfaces and Affect of Humidity 27 Death; 50 States + District of Columbia + Puetro Rico As of June 11, 2009 (12:30 PM ET) CHOTANI 2009. Swine Influenza A(H1N1) MMRW Report, April 28 MMWR, April 28, 2009 / 58(Dispatch);1-3 47 patients reported to CDC with known ages (out of 64) the median age was 16 years (range: 3-81 years) 38 (81%) were aged 40 kg: 150 mg per day divided into 2 doses 75 mg once per day Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir. Recommended treatment dose for 5 days. 200,000 hospitalizations, costing $37.5 billion in economic cost (influenza & pneumonia) and $10 billion in lost productivity Based upon past experience and the way the current H1N1 pandemic is acting (current wave is contagious, spreading rapidly and in Mexico/Canada based upon preliminary data affecting the healthy), there is a likelihood that come fall there might be a second wave which could be more virulent CHOTANI 2009. Conclusion/Recommendations 2. At present most of the deaths due to H1N1 strain has been reported from Mexico. The disease, though spreading rapidly across the globe, is of a mild form (exception Mexico) Most people do not have immunity to this virus and, as it continues to spread. More cases, more hospitalizations and some more deaths are expected in the coming days and weeks Disease seems to be affecting the healthy strata of the population based upon epidemiological data from Mexico and EU 60 years and above age group seems to show some protection against this strain suggesting past exposure and some immunity Of concern is the disease spread in Australia 3. Each locality/jurisdiction needs to Have enhanced disease and virological surveillance capabilities Develop a plan to house large number of severely sick and provide care if needed to deal with mildly sick at home (voluntary quarantine) Healthcare facilities/hospitals need to focus on increasing surge capacity and stringent infection prevention/control General population needs to follow basic precautions CHOTANI 2009. Conclusion/Recommendations 4. In the Northern Hemisphere influenza viral transmission traditionally stops by the beginning of May but in pandemic years (1957) sporadic outbreaks occurred during summer among young adults Likelihood that This wave will fade in North America by the end of June or will cause disease in a few cases (influenza virus cannot survive high humidity or temperature) Will reappear in autumn in North America with the likelihood of being a highly pathogenic second wave Will continue to circulate and cause disease in the Southern Hemisphere 5. Border Closure and Travel Restrictions: The disease has already crossed all borders and continents, thus, border closure or travel restrictions will not change the course of the spread of disease Most recently, the 2003 experience with SARS demonstrated the ineffectiveness of such measures In China, 14 million people were screened for fever at the airport, train stations, and roadside checkpoints, but only 12 were found to have probable SARS Singapore reported that after screening nearly 500,000 air passengers, none were found to have SARS Passive surveillance methods (in which symptomatic individuals report illness) can be important tools CHOTANI 2009. Conclusion/Recommendations 6. School Closures: Preemptive school closures will merely delay the spread of disease Once schools reopen (as they cannot be closed indefinitely), the disease will be transmitted and spread Furthermore, this would put unbearable pressure on single-working parents and would be devastating to the economy (as children cannot be left alone) Closure after identification of a large cluster would be appropriate as absenteeism rate among students and teachers would be high enough to justify this action 7. High priority should be given to develop and include the present “North American” (swine) influenza A(H1N1) virus in next years vaccine. A critical look at manufacturing capacity is called for 8. It is imperative to appreciate that “times-have-changed” Though this strain has spread very quickly across the globe and seems to be