BIRD FLUAVIAN INFLUENZA essential learning

1. BIRD FLUAVIAN INFLUENZA essential learning Dr.T.V.Rao MD

2. An acute respiratory illness resulting from infection with an Influenza virus Highly infectious and can spread rapidly from person to person Some strains cause more severe illness than others What is influenza? Dr.T.V.Rao MD 2

3. History of influenza 412 BC -first mentioned by Hippocrates 1580 -first pandemic described 1580-1900 -28 pandemics

4. Pandemic influenza in the 20thCentury 19201940196019802000 H1N1 H2N2 H3N2 1918 “Spanish Flu” 1957 “Asian Flu” 1968 “Hong Kong Flu” 20-40 million deaths 1 million deaths 1 milliondeaths Dr.T.V.Rao MD 4

5. 1918 Pandemic Highest mortality in people 20-40 years of age -675,000 Americans died of influenza -43,000 U.S. soldiers died of influenza Dr.T.V.Rao MD 5

6. Emergency hospital, Camp Funston, Kansas 1918 Courtesy of National Museum of Health and Medicine Dr.T.V.Rao MD 6

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8. Types of influenza viruses Influenza viruses are divided into three main types: influenza A, B, and C A viruses –infect birds and other animals, as well as humans A viruses –source of seasonal influenza epidemics and all pandemicsBand Cviruses –infect humans only and do not cause pandemics Dr.T.V.Rao MD 8

9. Avian Influenza Avian influenza refers to the disease caused by infection with avian (bird) influenza (flu) Type A viruses. These viruses occur naturally among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species. Avian flu viruses do not normally infect humans. However, sporadic human infections with avian flu viruses have occurred.

10. Migratory water birds Domestic birds Where does influenza A virus come from? Humans and other animals Human influenza A viruses start as avian (bird) influenza viruses Dr.T.V.Rao MD 10

11. Avian Influenza in Birds Avian influenza refers to infection of birds with avian influenza Type A viruses. These viruses occur naturally among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species. Wild aquatic birds can be infected with avian influenza A viruses in their intestines and respiratory tract, but usually do not get sick. However, avian influenza A viruses are very contagious among birds and some of these viruses can sicken and even kill certain domesticated bird species including chickens, ducks, and turkeys.

12. Avian Influenza A Viral disease of Domestic and Wild Birds characterized by the full range of responses from almost no signs of the disease to very high mortality. The incubation period is also highly variable, and ranges from a few days to a week ( 3 to 7 days).

13. Spread of H5 N1 Dr.T.V.Rao MD 13

14. Highly Pathogenic Avian InfluenzaWorldwide Occurrences Dr.T.V.Rao MD 14

15. Intercontinental Spread of Avian Flu Transport of live poultry, frozen poultry meat and untreated hatching eggs over long distances. Trade of poultry by-products unheated and egg products and possibly frozen poultry semen. Least importance are free living migrating birds

16. International Spread of Avian Flu Trade of commercial poultry including liv birds, vehicles, crates, containers. Also, international exhibitions, shows, bird markets and similar events. Least important are birds which displays seasonal migration pattern. Local

17. Local Spread of Avian Flu Farm personnel, technical crew (debeaker, vaccinators, catchers, etc.). Also, contaminated poultry manure and waste stuff as well as airborne particle and dust. Significant are live birds in close vicinity to poultry houses

18. Infected Birds Can Spread the Virus Infected birds can shed avian influenza A viruses in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with the virus as it is shed by infected birds. They can also become infected by coming in contact with surfaces that are contaminated with virus from infected birds. Dr.T.V.Rao MD 18

19. Avian Influenza in Wild Birds Avian influenza A viruses have been isolated from more than 100 different species of wild birds.. The majority of the wild birds from which these viruses have been recovered represent gulls, terns and shorebirds or waterfowl such as ducks, geese and swans. These wild birds are often viewed as reservoirs (hosts) for avian influenza A viruses.

20. Avian Influenza in Poultry (Domesticated Birds) Domesticated birds (chickens, turkeys, etc.) may become infected with avian influenza A viruses through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces that have been contaminated with the viruses.

21. depopulation (or culling, also called “stamping out”) When H5 or H7 avian influenza outbreaks occur in poultry, depopulation (or culling, also called “stamping out”) of infected flocks is usually carried out. In addition surveillance of flocks that are nearby or linked to the infected flock(s), and quarantine of exposed flocks with culling if disease is detected, are the preferred control and eradication methods

22. Avian influenza outbreaks are of concern in domesticated birds for several reasons: The potential for low pathogenic H5 and H7 viruses to evolve into highly pathogenic viruses The potential for rapid spread and significant illness and death among poultry during outbreaks of highly pathogenic avian influenza The economic impact and trade restrictions from a highly pathogenic avian influenza outbreak The possibility that avian influenza A viruses could be transmitted to humans Dr.T.V.Rao MD 22

23. How influenza spreads Spreads easily from person to person through coughing and sneezing Transmitted by: inhaling respiratory aerosols containing the virus, produced when infected person talks, coughs, or sneezes touching an infected person or an item contaminated with the virus and then touching your eyes, nose, or mouth Dr.T.V.Rao MD 23

24. Disease containment measures Isolation:restriction of movement/separation of illinfected persons with a contagious disease Quarantine:restriction of movement/separation of wellpersons presumed exposedto a contagious disease Self-shielding:self-imposed exclusion from infected persons or those who may be infected Social distancing:reducing interactions between people to reduce the risk of disease transmission Snow days:days on which offices, schools, transportation systems are closed or cancelled, as if there were a major snowstorm Dr.T.V.Rao MD 24

25. How can someone with the flu infect someone else? Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Dr.T.V.Rao MD 25

26. In adults, emergency warning signs that need urgent medical attention include: Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Dr.T.V.Rao MD 26

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28. Diagnosis To diagnose swine or Birds influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus Dr.T.V.Ra o MD 28

29. Specimen Collection for Diagnosis Sample Collection and handling is same as for human avian flu or seasonal influenza like illness (Refer CD Alert on AI). Sample Collection: should be labelled clearly and include patient’s complete information and should be sent to designated Laboratory. Laboratory biosafety measures should be followed for collection, storage, packaging and shipping of influenza samples. Dr.T.V.Rao MD 29

30. Currently Available Tests Rapid Antigen Tests: not as sensitive as other available tests. RT–PCR Virus isolation Virus Genome Sequencing Four–fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies. It is important to note that samples from all cases, once the Pandemic starts, are not required to be tested. Dr.T.V.Rao MD 30

31. Diagnosis of Flu For diagnosis of swine influenza A infection, respiratory specimen (NP (nasopharyngeal swab), throat swab , nasal aspirate, nasal washing) would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Dr.T.V.Rao MD 31

33. Rapid Diagnosis RT PCR can make rapid Diagnosis Dr.T.V.Rao MD 33

34. How we control Health care Associated Spread Combination of infection control strategies is recommended to decrease transmission of influenza in health-care settings. These include placing influenza patients in private rooms when possible and having health-care personnel wear masks for close patient contact (i.e., within 3 feet) and gowns and gloves if contact with respiratory secretions is likely . Dr.T.V.Rao MD 34

35. Slide 6- 35 Recommendation for all individuals with respiratory symptoms Cover the nose/mouth when coughing or sneezing Perform hand hygiene if contact respiratory secretions and contaminated objects Put on a surgical mask Respiratory hygiene and cough etiquette • Use tissue paper to contain respiratory secretions and dispose in the waste receptacle Dr.T.V.Rao MD

36. Use of Mask by Patients and Health care Workers The use of surgical or procedure masks by infectious patients may help contain their respiratory secretions and limit exposure to others. Likewise, when a patient is not wearing a mask, as when in an isolation room, having health- care personnel mask for close contact with the patient may prevent nose and mouth contact with respiratory droplets Dr.T.V.Rao MD 36

37. Can the Mask Prevent the Spread of Flu ??? However, no studies have definitively shown that mask use by either infectious patients or health- care personnel prevents influenza transmission Dr.T.V.Rao MD 37

38. Prevention is best option Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Dr.T.V.Rao MD 38

39. Using N95 mask reduces the Risk You can cut your risk of contracting the flu or other respiratory viruses by as much as 80 percent by wearing a mask over your nose and mouth, according to a new study. Emerging Infectious Diseases, the journal of the Centres for Disease Control and Prevention (CDC) . Dr.T.V.Ra o MD 39

40. Health Care Personal Should Protect With During a surgical or procedure mask should be worn by health-care personnel who are in close contact (i.e., within 3 feet) with a patient who has symptoms of a respiratory infection, particularly if fever is present, as recommended for standard and droplet precautions. These precautions should be maintained until the patient has been determined to be non infectious or for the duration recommended for the specific infectious agent. Dr.T.V.Rao MD 40

41. Slide 6- 41 Isolation Precautions Patient Transport Linen & laundry Waste Management Decontamination PPE Hand hygiene Patient placement Isolation Precautions

42. Strategy ofPatient Placement 1.Isolate suspected or confirmed cases in a negative pressure isolation room 2.When single rooms are fully occupied Cohort patients with same confirmed diagnosis in same cubicles, maintaining a minimum of 1 metredistance from each other 3.Confirmed and suspected cases should be nursed in separate cubicle Dr.T.V.Rao MD 42

43. Slide 6- 43 Waste Management 1.All waste generated from room/ area housing suspected or confirmed avian influenza patients should be treated as clinical waste 2.Biohazard labeling 3.Wear appropriate PPE when handling clinical waste Dr.T.V.Rao MD

44. Institutional Measures Use of antiviral drugs for treatment and chemoprophylaxis of influenza is a key component of influenza outbreak control in institutions that house patients at higher risk for influenza complications. In addition to antiviral medications, other outbreak-control measures include instituting droplet and contact precautions and establishing cohorts of patients with confirmed or suspected influenza, re-offering influenza vaccination (if available) to unvaccinated staff and patients, restricting staff movement between wards or buildings, and restricting contact between ill staff or visitors and patients. Dr.T.V.Rao MD 44

45. Dealing Patients with suspected Influenza 1.Follow Respiratory Hygiene and Cough Etiquette precautions 2.Triage: Fever, Travel history, Occupational exposure, Contact history and Cluster of persons with fever and pneumonia symptoms. 3.Designated areas for suspected patients while waiting for referral and arrange speedy consultation and management 4.Wear appropriate PPE 5.Environment and equipment cleaning and disinfection Dr.T.V.Rao MD 45

46. Antiviral Drugs Can Be Used to Treat Illness For treatment (and prevention) of human infection with avian influenza A viruses, CDC and WHO currently recommend oseltamiviror zanamivir, two of four prescription antiviral medications currently licensed for use in the United States. Dr.T.V.Rao MD 46

47. Control with Antiviral Drugs Both adamantine and neuraminidase inhibitors have been used successfully to control outbreaks caused by susceptible strains when antiviral medications are combined with other infection-control measures. Currently Oseltamivirhas gained importance as safe and effective Antiviral agent. Dr.T.V.Rao MD 47

48. •No Visitors •A sign-in log •Clean clothing and sanitized footwear •Properly maintained foot pans with disinfectant solution •Rodent and insect control •No other animals, esp. wild birds •Vaccination •All in, all out •Sanitize hands MINIMUM BIOSECURITY STANDARDS

49. HAND WASHING REDUCES SPREAD OF INFLUENZA Dr.T.V.Rao MD 49

50. Clean Hands –Safe HandsEven Reduces Influenza Washing your hands often with soap and water, especially after you cough or sneeze. You can also use alcohol-based hand cleaners. Dr.T.V.Rao MD 50

51. Avian influenza A(H7N9)virusAn Emerging Strain The latest avian influenza virus strain added to the list of agents causing "bird flu" is called avian influenza A(H7N9) virus - a colourfully exciting reference to its key surface proteins Dr.T.V.Rao MD 51

53. References Centre for Disease Control (CDC) World Health Organization ( WHO) Google Images Dr.T.V.Rao MD 54

54. Visit me for More Articles of Interest on Infectious Diseases at .. Dr.T.V.Rao MD 55

55. Programme Created By Dr.T.V.Rao MD for Medical and Health Care Professionals Email doctortvrao@gmail.com Dr.T.V.Rao MD 56

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