1. Influenza A H1N1: Risk factors and
Response Actions
Mónica 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
4. Background information:
Influenza
Influenza- contagious airborne
disease that expresses febrile
illness. (Derlet and Nguyen, 2013)
Symptoms range from fatigue to
respiratory failure or death
Seasonal strains are
common, but deadly ones have
emerged (Derlet and Nguyen, 2013)
Pandemics- influenza virus +
hemagglutinin (Garten et al, 2009)
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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 influenza
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6. Background information: Avian, Swine and
Humans
(Taubenberger and
Morens, 2006)
1918- relation
between avian and
swine was unknown
1930’s- viruses were
isolated
Transmission- pigs to
humans (Stuart et al.
http://www.thepattersonfoundation.org/
2013)
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7. 2009 H1N1
Mix of swine, avian and human
gene segments (Derlet and
Nguyen, 2013)
Start- cases identified in
Mexico (Stuart et al., 2013)
(Michaelis et al. 2009)
The WHO stated that these
viruses were not previously
detected
Majority of cases- healthy
young adults
WHO- pandemic alert level 6
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June 11 2009
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8. Vulnerability and Risk Factors
1918 Spanish flu and the First World War
(Erkoreka, 2009)
Many soldiers living in poor conditions, harsh
climate, wild animals, etc.
Similarity with 2009
9. Vulnerability and Risk Factors
New Mexico study- relation between racial/ethnic
groups 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 and
virus antigen:
Nasopharyngeal swabs
Bronchoalveolar or pharyngeal lavages
Healthcare workers were also tested- if results were
positive control measures would be implemented
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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 for
antibodies against influenza A and B
It is suggested that infection occurred within and
spread through staff
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 behavioral
factors
Strategies:
Actual coverage
Uniform Coverage
Parents and Children
Parents-and-children/Actual sequence
15. Vaccine implementation
Assumed and confirmed: with vaccine there
would be a reduction of 90% risk of infection
Diversifying campaign start dates were tested
Results confirmed vaccine efficacy and strategy
used- relative to moment of campaign
implementation (prior or on peak)
16. Control Measures
CDC (Stuart et al. 20013) makes
recommendations 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 washing
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17. Summary
Out of patterns studied, risk factors can be identified
Social interaction- 1918 and 2009
Age, weight, income, race/ethnicity, and high risk
medical conditions
Vaccine campaign timing varies efficacy
Key control measures- isolation and hand wash
and/or disinfection
18. Conclusion
We can now:
identify some high risk groups to provide them help
with prevention plans and treatments
identify risk factors to either avoid them or be alert
of cases around and reduce chance of infection
be prepared to face the infection with common
hygiene practices and proper vaccine campaigns.
19. References
Anonymous. Influenza-like illness in the United States and
Mexico. 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
(1918–1920) 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 Virus
Revival-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): 15–22. [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