Swine Flu update

Jacob KoolCommunicable Disease Surveillance and Response

WHO South Pacific

29 April 2009

WHO/WPRO

Influenza

• Symptoms– Sudden onset of high fever (≥ 38 °C)– Cough and/or sore throat– Runny nose, other respiratory symptoms– Body aches, headache, fatigue.

• More severe influenza:– Difficulty breathing, death

• Transmission:– touching, shaking hands, or kissing– coughing, sneezing, or talking, at close distance (< 2

meters)

Swine Influenza A H1N1A new virus

• Reassortment - four different genes:– North America swine– Asia/Europe swine– Human influenza– Avian (Non H5)

• Unique combination that has never been seen before• Human to human transmission confirmed• Level of immunity in general community: Unknown• Effectiveness of seasonal influenza vaccine: Unknown• Antiviral drugs

– Sensitive to Tamiflu and Relenza– Resistant to amantadines

WHO/WPRO

Latest update (29/4/09 AM)• The outbreak started in Mexico in February or March

– 26 confirmed cases, 5 died– >2000 suspected cases, 152 deaths thought linked to swine flu– Many severe cases among young adults– Outbreak may be levelling off

• Confirmed cases in other countries– USA: 67– Canada: 6– Spain: 1– New Zealand: 3– UK: 2– Israel (2)– Not yet in the Pacific?

• All cases outside of Mexico are mild; no deaths• WHO’s Dr Fukuda: this pandemic may be mild

WHO/WPRO

Google map updated 29/4

Clinical Presentation (Mexico)

• Range of symptoms – very mild to severe acute respiratory symptoms

• Vomiting and diarrhoea in some cases

• Incubation period – up to 7 days

• Fatal cases: ill for 6 days, then deteriorate

WHO/WPRO

Why is the illness more severe in Mexico?

• No explanation yet

• Some theories:1. Inaccurate information? Biased by panic?

2. Are many mild cases missed?

3. Did the virus change after it spread to other countries?

4. Multiple different viruses?

Control measures in Mexico• Closed schools, churches, bars, restaurants, etc.• People advised to stay home• Ill people advised to quickly get medical

attention• Handing out of face masks in public places• Intensive surveillance and case investigation

WHO: health emergency

• “Public Health Emergency of International Concern” under the International Health Regulations

• Pandemic alert -> phase 4• All countries must intensify their surveillance

and report to WHO any suspicious cases or clusters

• Surveillance guidelines have been disseminated

Overview of WHO Pandemic Alert Phases

WHO pandemic alert phases

• Phase 4 is characterized by verified human-to-human transmission of a new virus, causing “community-level outbreaks.”– Emphasis on surveillance and rapid containment

• Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. – Focus on (preparing) mitigation efforts

• Phase 6, pandemic phase: outbreaks in at least one other country in a different WHO region in addition to the criteria in Phase 5.– Focus on mitigation and continuation of essential services

Pandemic Response

Non-Medical Non-Medical interventions interventions

MedicalMedicalinterventiinterventi

onsons

Security Security

Food & water supplyFood & water supply

Power supplyPower supply

Transportation Transportation

TelecommunicationTelecommunication

other essential servicesother essential services

Personal hygienePersonal hygiene Travel restrictionTravel restriction Quarantine Quarantine Social distancing Social distancing Risk Communication Risk Communication

Antiviral drugsAntiviral drugs

Vaccines, etcVaccines, etc

Medical care, PPEMedical care, PPE

Social ServicesSocial Services(keep a society running)

Public Health Measures

What needs to be done - NOW

• Intensify surveillance– Report to WHO any cases or unusual outbreaks– Share samples

• Inform clinicians

• Inform travellers– screening was not effective in the past

• Inform the public

When cases are confirmed

• Inform the public, medical staff– How to protect themselves, seek medical care

• Social distancing– School, church closures– No public gatherings– Stay home

Advice to general public

• Wash hands frequently with soap and avoid touching your face.

• Cover your mouth or nose when coughing or sneezing

• Avoid close contact with obviously sick people • Stay at home if you are unwell• See your doctor if you have flu symptoms

Border control & International travel

• Health information and advice to international travellers

– Protect yourself

– Seek health care if you get ill

• Countries may consider entry screening

• Travel restrictions, border closures not recommended

– But islands may benefit from temporary travel ban

WHO/WPRO