M. A. El-Farrash

فيروسجديد مرضيسببه هو

A(H1N1)

من وليس انسان وينتقل آخر الي

مناعة ضده. لالنسان

يصيب الجائحة: عندما تحدث

كبيرة بدرجة ومعدي فيروسجديد

مستوى على البشر من هائلة4 أعدادا4

قصيرة زمنية فترة في . العالم

مراتفي ثالث األنفونزا جائحة حدثت

أعوام الماضي ، 1958، 1918القرن

من 1986 كبيرة أعداد في وتسببت

.الوفيات

M. A. El-Farrash

المشتبهة الحالة تعريفA/H1N1 لمرض

الحرارة < بدرجة ارتفاع من م    38شخصيعانياألعراضاآلتية من أي بالجسم : مع كحة – – آالم

قئ – – – – – غثيان صداع بالحلق احتقان رشحإسهال

يلي مما أكثر أو واحد وجود ضرورة :معإصابتها مشتبه أو مؤكدة لحالة القريبة المخالطة

  المستجدة 7خالل A/H1N1بفيروساألنفلونزاسابقة أيام

بفيروس مصابة أكثر أو حالة به تجمع في التواجدالمستجدة سابقة 7خالل  A/H1N1األنفلونزا M. A. El-Farrash أيام

لمرض المؤكدة الحالة تعريفA/H1N1

لفيروس إيجابية أنها ثبت مشتبهة حالة هيالمستجدة استخدام ب A/H1N1األنفلونزا

RT-PCRالفحص

باألنفلونزا الشبيهة الحالة تعريفالحرارة < درجة في حاد درجة     38ارتفاع

احتقان أو للكحة مرضى تاريخ مع مئويةالسابق األسبوع خالل بالحلق

M. A. El-Farrash

Influenza Virus

M. A. El-Farrash

ClassificationClassification of virus strains is done on the basis of

matrix proteins and nucleocapsid into three main types:

Influenza A : Infects many species especially

birds. HA and NA undergo minor and occasional

major changes (shift and drift).

Influenza B: Undergoes relatively slow change

in HA with time. Known only in man and seals.

Influenza C: Uncommon strain, known only in

man and pigs. M. A. El-Farrash

The main human pathogen, associated with

epidemics and pandemics.

There are 16 (H) serotypes and 9 (N) serotypes.

Infect a wide variety of mammals, including man,

horses, pigs, and birds.

Pigs and birds are important reservoirs,

generating pools of genetically diverse viruses

which may cause epidemics in humans.

It caused all flu pandemics known.

Influenza A Virus

M. A. El-Farrash

Influenza is characterized by fever, myalgia,

headache and pharyngitis.

In addition there may be cough, gastrointestinal

symptoms and in severe cases, prostration.

There is usually no coryza (runny nose) which

characterizes common cold infections.

Symptoms may be very mild, even asymptomatic,

moderate or very severe.

Influenza

M. A. El-Farrash

Spread: rapid via aerial droplets (direct or

indirect) with inhalation into the pharynx or

lower respiratory tract.

Contact plays an important role.

Incubation Period: is short (1-5 days).

Rapid spread leads to epidemics.

The patient is infectious during the last part of

the incubation period.

Influenza

M. A. El-Farrash

1. Pneumonia caused by influenza virus itself;

2. Pneumonia caused by bacteria :

Haemophilus influenzae

Staphylococcus aureus

Streptococcus pneuminiae.

Influenza complications (may cause death) tend

to occur in the young, elderly, and persons with

chronic cardio-pulmonary diseases.

Complications of Influenza

M. A. El-Farrash

The most effective strategy for preventing influenza is annual vaccination .

Antiviral drugs used for chemoprophylaxis or treatment of influenza are adjuncts to vaccine but are not substitutes for annual vaccination.

Non pharmacologic interventions (e.g., advising frequent hand washing and improved respiratory hygiene) are reasonable and inexpensive; these strategies have been demonstrated to reduce respiratory diseases.

Options for Controlling Influenza

M. A. El-Farrash

M. A. El-Farrash

Treatment

M. A. El-Farrash

The Vaccine

Flu vaccines are available either as:

TIV : flu shot (injection) of trivalent

inactivated (killed) vaccine, or

LAIV: nasal spray of live attenuated influenza

vaccine.

LAIV is not recommended for individuals under

age 2 or over age 50, but might be comparatively

more effective among children over age 2.

The Vaccine

M. A. El-Farrash

Pandemrix, made by GlaxoSmithKline, and

Focetria, made by Novartis were approved on 25

September 2009.

Both are made by growing the virus in hens' eggs,

then breaking and deactivating the virus.

Celvapan, made by Baxter (made in cell culture,

suitable for those who have an egg allergy) was

approved the following week.

The Swine Flu Vaccines

M. A. El-Farrash

As well as a the active antigen derived from

A/California/7/2009 (H1N1), the vaccine contains

an immunologic adjuvant AS03 (DL-α-tocopherol

(vitamin E), squalene and polysorbate 80).

Thiomersal is added as a preservative.

Being manufactured in chicken eggs, it contains

trace amounts of egg proteins.

Other ingredients are formaldehyde, sodium

deoxycholate, and sucrose.

The Vaccine Pandemrix

M. A. El-Farrash

The vaccine is supplied in 2 separate vials, one

containing the adjuvant, and the other the

inactivated virus, which require mixing before

injection.

Originally it was thought that two doses given 21

days apart would be required for full efficacy.

Subsequent testing has allowed just a single dose for

most people, with a two-dose schedule for

immunocompromised adults.

The Vaccine Pandemrix

M. A. El-Farrash

The vaccine is contraindicated and should not be

administered to persons known to have

anaphylactic hypersensitivity to eggs or to other

components of the influenza vaccine unless the

recipient has been desensitized.

Persons with moderate to severe acute febrile

illness usually should not be vaccinated until their

symptoms have abated.

The Vaccine Contraindications

M. A. El-Farrash

The vaccine is causing cancers!!

The vaccine is causing, neuritis, autism and

Gullian –Barre Syndrome!!

The adjuvant added is causing autoimmunity!!

The vaccine contains a substance that will induce

sterility in male Muslims !!

The Minister of health is taking something and

giving people another thing!!

The Egyptian(s) Reaction

M. A. El-Farrash

Immunologic adjuvants are substances, administered in conjunction with a vaccine, that stimulate the immune system and increase the response to the vaccine.

Squalene is one of those adjuvants.

It is added to improve the efficacy of several vaccines, including pandemic flu and malaria vaccines.

Several European countries, which use it in their 2009 flu pandemic vaccines.

Squalene

M. A. El-Farrash

Squalene is a natural organic compound originally obtained from shark liver oil, though plant sources are used as well, including rice bran, wheat germ, and olives.

Squalene has been proposed to be an important part of the Mediterranean diet as it may be a chemopreventative substance that protects people from cancer.

All higher organisms produce squalene, including humans.

Squalene

M. A. El-Farrash

Newsweek states that "wild rumors" about the

swine flu vaccine are being spread through e-

mails.

Newsweek states that some chain e-mails make

false claims about squalene in vaccines.

The New York Times also notes that anti-vaccine

groups have spread "dire warnings" about

formulations of the vaccine that contain squalene

as an adjuvant.

Squalene

M. A. El-Farrash

A 2009 meta-analysis by published in the journal Vaccine brought together data from 64 clinical trials of influenza vaccines with the squalene-containing adjuvant and compared them to the effects of vaccines with no adjuvant.

The analysis reported that the adjuvanted vaccines were associated with slightly lower risks, but that neither type of vaccines altered the rate of autoimmune diseases; the authors concluded that their data "supports the good safety profile associated with adjuvanted influenza vaccines and suggests there may be a clinical benefit over non-adjuvanted vaccines".

Squalene

There have been attempts to link squalene to Gulf War Syndrome mainly due to the idea that squalene might have been present in an anthrax vaccine given to some military personnel during the 1991 Persian Gulf War.

It has been determined that the anthrax vaccines given to those US military personnel did not use squalene as an adjuvant.

The vaccines were also tested for squalene, and none was detected with standard methods.

Squalene

Multi-dose versions of the vaccine contain the

preservative thiomersal, a mercury compound

that prevents contamination when the vial is used

repeatedly.

The use of thiomersal is controversial, with

claims that it can cause autism and other

neurodevelopmental disorders.

No convincing scientific evidence supports these

claims.

The Vaccine Pandemrix side effects

M. A. El-Farrash

Thiomersal (sodium ethylmercurithiosalicylate),

is an organomercury compound (approximately

49% mercury by weight) used as an antiseptic

and antifungal agent.

it has been used as a preservative in vaccines,

immunoglobulin preparations, skin test antigens,

antivenins, ophthalmic and nasal products, and

tattoo inks.

Thiomersal

M. A. El-Farrash

Thiomersal's safety for its intended uses first

came under question in the 1970s, when case

reports demonstrated potential for neurotoxicity

when given in large volumes as a topical

antiseptic.

At the time, the DPT vaccine was the only

childhood vaccine that contained it; a 1976

United States FDA review concluded that this use

of thiomersal was not dangerous.

Thiomersal

M. A. El-Farrash

In 1999, a new FDA analysis concluded that infants

could receive as much as 187.5 micrograms of

ethylmercury

during the first six months;

One dose from a multi-dose vial

contains approximately 25 micrograms

of mercury, a bit less than a typical tuna fish

sandwich.

Thiomersal

M. A. El-Farrash

Some parents of autistic children adopted

thiomersal as an explanation for the increase in

reported autism cases and sued vaccine makers;

the mercury-autism hypothesis is accepted widely

among parents of autistic children, despite

scientific studies rejecting it.

The WHO has concluded that there is no

evidence of toxicity from thiomersal in vaccines. M. A. El-Farrash

Thiomersal

No scientific evidence indicates that thiomersal in vaccines, including influenza vaccines, is a cause of adverse events other than occasional local hypersensitivity reactions in vaccine recipients.

In addition, no scientific evidence exists that thiomersal-containing vaccines are a cause of adverse events among children born to women who received vaccine during pregnancy. The weight of accumulating evidence does not suggest an increased risk for neurodevelopment disorders from exposure to thiomersal-containing vaccines.

Thiomersal

A review by the U.S. NIH concluded that the 2009

H1N1 ("swine flu") vaccine has a safety profile

similar to that of seasonal vaccine.

As of November 19, 2009, the WHO said that 65

million doses of vaccine had been administered

and that it had a similar safety profile to the

seasonal flu vaccine, with no significant

differences in the adverse events produced by the

different types of vaccine.

The Vaccine Pandemrix side effects

M. A. El-Farrash

Healthcare providers:

Be aware of updates in case

definitions; procedures for

screening, indication of

hospitalization, treatment ,

vaccination and infection control

measures for H1N1 and other novel

influenza viruses. M. A. El-Farrash

Health-care facilities should offer influenza vaccinations to all HCP, including night, weekend, and temporary staff particularly to workers who provide direct care for persons at high risk for influenza complications.

Efforts should be made to educate HCP regarding the benefits of vaccination and the potential health consequences of influenza illness for their patients, themselves, and their family members.

Persons working in health-care settings who

should be vaccinated include physicians, nurses,

and other workers in both hospital and

outpatient-care settings, medical emergency-

response workers, employees of nursing home

and long-term--care facilities who have contact

with patients or residents, and students in these

professions who will have contact with patients.

In case of aerosol generating procedures

(aspiration of respiratory tract, intubation,

resuscitation, bronchoscopy, autopsy) use N-95

masks.

Gloves and gown should be used for all patient contact.

Pay careful attention to hand hygiene before and after all patient contact or contact with items contaminated with respiratory secretions.

M. A. El-Farrash

H1N1 Infection Control

إصابته في مريضيشتبه وصول عندفي تقييمه يجب العيادة أو االستقبال

لتحديد أمكن، للفحصإن منفصل مكانينطبق االشتباه حالة تعريف كان إذا ما

. ال أم عليه وجه على جراحي ماسك وضع يتم

المريض. ذلك أمكن إن

. العادي الجراحي الماسك ارتداء

M. A. El-Farrash

الماء باستخدام األيدي بغسل االهتمامقبل بالكحول، الدلك أو والصابون

المريضأو تالمسمع أي وبعد. القفازات خلع وبعد به المحيطة البيئة

خاصة ومستلزمات أدوات تخصيصعالج عبوات أي استخدام بالمريضوتجنب

المرضى باقي مع مشتركة يعاد التي اآلالت وتعقيم تنظيف

بأنسب طريقة. استخدامها

M. A. El-Farrash

M. A. El-Farrash

) / مشتركة ) فردية تخصيصغرفة. إصابتهم أوالمؤكد المشتبه للمرضى

المشتبه المرضى عزل مكان يكونالمؤكد المرضى مكان عن مستقل فيهم

إصابتهم. باب غلق إحكام مع جيدا4 الغرفة تهوية

إالللضرورة فتحه وعدم .الغرفة داخل المراوح باستخدام غيرمسموح

.الغرفة

M. A. El-Farrash

بالغرفة وحوضخاص حمام وجود يفضلوحوض حمام وجود حالةعدم وفى ،

أقرب باستخدام للمريض يسمح داخلهاأن بشرط الغرفة وحوضخارج حمام

. الجراحي للماسك المريض ارتداء يراعى بين البينية المسافة تقل ال أن ينبغي

وضع مترويفضل واحد عن المرضى أسرةبحيث الجماعي العزل فى األسرة اتجاهقدم اتجاه فى المرضى أحد قدم يكون

.المريضاآلخر

M. A. El-Farrash

على ١مسافة متراألقل

إال الغرفة المريضمن يخرج ال. القصوى للضرورة

الجراحي للماسك المريض ارتداء

الغرفة من خروجه أثناء M. A. El-Farrash

M. A. El-Farrash

ليتم متحرك أشعة جهاز استخدام يفضل

حالة ) فى المريض غرفة داخل استخدامه

متحرك ( جهاز توافر لقسم للذهاب المريض خروج حالة لقسم فى للذهاب المريض خروج حالة فى

: يلي ما يراعى :األشعة يلي ما يراعى األشعة

مثل. ) ١ الذروة أوقات غير فى ذلك يتم أن

) الزيارة وقت

األشعة. ٢ لقسم طريق أقصر اتخاذ يتم

) مختصر) طريق

ماسك. ٣ بارتداء المريض يقوم بأن االلتزام

من ) الخروج حالة فى دائما عادي جراحي

) العزل غرفة

االشعة. ٤ بقسم الصحي الفريق على

جراحي) - ماسك ارتداء االيدي بغسل االلتزام

.) العمل – أسطح تطهير عادي

M. A. El-Farrash

M. A. El-Farrash

وباألخص الزيارة على مشددة فرضقيودالضعيفة المناعة وذوي واألطفال السن كبار

الجراحي الماسك ارتداء الزائرين على يجبالتواجد أثناء النظيفة القفازات إرتداء ويفضل

. الغرفة المريضداخل مع جيدا أيديهم غسل الزائرين على يجب

. الزيارة بعدانتهاء مخاطر تقليل على الزائرين تشجيع يجب

النظافة آداب بإتباع العدوى انتقال. السعال العامةوآداب

الزائرين بين القبالت تبادل نهائيا4 يمنع.والمرضى

M. A. El-Farrash

Prevention and Control of Seasonal Influenza with Vaccines

Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009

Anthony E. Fiore, MD1, David K. Shay, MD1, Karen Broder, MD2 , John K.

Iskander, MD2, Timothy M. Uyeki, MD1, Gina Mootrey, DO3, Joseph S. Bresee,

MD1, Nancy J. Cox, PhD1

1Influenza Division, National Center for Immunization and Respiratory Diseases

2Immunization Safety Office, Division of Healthcare Quality Promotion, National

Center for Preparedness, Detection and Control of Infectious Diseases

3Immunization Services Division, National Center for Immunization and Respiratory

Diseases.

2009 flu pandemic vaccine, From Wikipedia, the free encyclopedia