INFLUENZA A (H1N1) OUTBREAK

Infectious Disease Surveillance Section Disease Control Division Ministry of Health

Ministry of Health Malaysia

Dr. Rosemawati Ariffin

Presentation Road Map

Introduction virus, disease What is an influenza pandemic? Influenza A (H1N1) Actions taken by Ministry of Health Actions should be taken by public

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Introduction

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Influenza Virus

RNA virus

Surface glycoproteins:
H / HA- haemagglutinin N / NA - Neuraminidase
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Influenza sub-groups
Influenza A
highly infective infects many species causes frequent widespread epidemics and pandemics

Influenza B
only found in humans capable of producing severe disease cause of regional epidemics

Influenza C
causes mild disease humans are natural hosts but isolates also found in pigs does not cause epidemics
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H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15

N1 N2 N3 N4 N5 N6 N7 N8 N9

Subtypes of Influenza A Virus

(Karl G Nicholson, et al Lancet 2003; 362: 1733-45)

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Influenza Virus - Characteristics

Antigenic drift minor changes in the antigenic composition constantly occurring able to elude host defences Antigenic shift ability to swap or re-assort genetic materials and merge resulting in a novel subtype different from both parent viruses

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Influenza Disease
Seasonal influenza influenza disease in humans due to influenza virus infection that circulating for decades in humans (virus change
slightly from year to year)

Avian influenza - caused by influenza viruses that occur naturally among wild birds, primarily a disease in birds. Sometimes can transmit to humans Swine influenza caused by influenza viruses that naturally among pigs, primarily a disease in pigs. Occasionally can transmit to humans.

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Disease Transmission

Transmission airborne droplets Incubation period: 1-3 days Communicability:- day before & up to 3 5 days after the onset of symptoms. Longer in children, 7 days or more

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Influenza - Symptoms
Fever, cough, sore throat, headache, prostration, mylgia, malaise Clinical presentation - mild to fatal - usually fatal in extreme age group

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Influenza A (H1N1) Outbreak

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Background
24 April 2009 (report from WHO)
USA reported 7 confirmed cases of human Swine Influenza A/H1N1, no deaths. Mexico reported a steady increase in cases since 18 March through April via ILI surveillance As 23 April 2009, 882 cases of pneumonia were diagnosed with 62 deaths from Mexico City, San Luis Potosi & Mexicali. 18 laboratory confirmed cases of Swine Influenza A/H1N1 of which 12 of those genetically identical to Swine Influenza A/H1N1 from California

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Influenza A (H1N1)
New strain detected in California(24 April 2009) Laboratory test showed - mixed genes of human, avian & swine (Influenza virus A/California/04/2009) Everyone is at risk due to absence of immunity Efficient human to human transmission

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Influenza A (H1N1)

Transmission: same as seasonal influenza Symptoms: same as seasonal influenza, range from mild respiratory symptoms to pneumonia.

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Global Situation of Influenza A (H1N1)

till 6 May 2009 18.00 GMT (Malaysia time: 0200 7 May 09)

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Pandemic Phases 5 - Description

Is characterized by human-to-human spread of the virus into at least two countries in one WHO region. Phase 5 since 29 April 2009
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Malaysias Current Situation (16 May 2009)

2 cases of Influenza A H1N1 reported

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Pandemic Influenza

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Pandemic influenza: definition

Pandemic can occur when:

New influenza virus Able to infect humans Transmissible from person to person
pandemic

influenza : wide geographic spread of novel influenza virus

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Past Influenza Pandemics

1850 1847 42 yrs 1889 1900 1918 39 yrs 1950 1957 1968 11 yrs 29 yrs 30

40 years cycle

2000

No Pandemic for > 35 years

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Geographic spread: 1918-19

06/18

03/18

04/18 05/18

06/18

?
01/19 06/18

C.W. Potter, Textbook of Influenza, 1998

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Geographic spread: 1957-58

06/57 06/57 06/57 02/57

08/57 04/57 07/57 05/57 07/57

C.W. Potter, Textbook of Influenza, 1998

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Potential Impact of Pandemic

Livelihood: food & income loss from decreased economic activity Human health: high illness & potential higher death rates Rule of law & governance: increase demand of governance & security Humanitarian needs: interruption in in public services Economic system: trade & commerce disruption

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Potential impacts on Non Health Sectors

Changed Demand
Death Illness

Absenteeism
Care Fear

Military (support for logistics, etc.) Mortuary & burial services Refuse Collection Water & Sanitation Telecommunication (Phone and Internet)

Decreased Supply
Reduced production Disrupted transportation

Decreased Demand
Retail Trade

Cleaning Supplies Cash Withdrawal Protection against insecurity Electricity/Power supply Food Distribution Emergency Services

International trade of commodities Trans-company dependencies

Transportation Leisure Travel Restaurant

Break down of services

Economic and Social Disruption
Lack of maintenance Disrupted supply chain Etc.
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Ministry of Health Malaysia

Pandemic Response
Medical interventional 9 Antiviral drugs 9 Vaccine, etc 9 Medical care, PPE 9 9 9 9 9 Personal hygiene Travel restriction Quarantine Social distancing Risk communication 9 9 9 9 9 9 Security Food & water supply Power supply Transportation Telecommunication Other essential services

Non- Medical Interventions

(keep a society running)

Social Services

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Pandemic Influenza Preparedness Plan

Following outbreak of avian influenza H5N1 outbreak in Hong Kong in 1997, influenza pandemic preparedness plan was produced by WHO In 2003, WHO asked all countries to prepare pandemic preparedness plan following Avian influenza H5N1 outbreaks involved many countries in Asia, Europe & Africa (since end 2003 till now) Since then almost all countries worldwide have prepare preparedness plan
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Prevention & Control Measures Taken by Ministry of Health

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National Influenza Pandemic Preparedness Plan (NIPPP)

Preparation started in 2003 Prepared by National Influenza Pandemic Planning Committee multidisciplinary, interagencies/departmental and experts. Launched on 9 Jan. 2006 by Minister of Health Documents available in website http://www.dph.gov.my/survelans
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NIPPP Strategies

Organizational Response 3 main committees Public Health Response Medical Response Laboratory Response Risk Communication Social Response
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Actions Taken by Ministry of Health

Activate Operations Room for monitoring of Influenza A (H1N1) situation & to ensure all proactive prevention & control measures be carried out Enhance ILI/pneumonia surveillance at all levels of health facilities Conduct screening on arrival at International Ports of Entry temperature check, health declaration and health alert card Health advise to public & travellers via website, TV, radio and telephone (CPRC)
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Actions Taken by Ministry of Health

Designated hospitals on alert & ready to receive suspected cases Antiviral stockpile storage sites alerted for rapid distribution of antivirals when needed Viral laboratory at IMR on alert and ready to receive clinical specimens from suspected cases Development guidelines

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Actions Taken by Ministry of Health

Risk Communication
Health education materials;
hand & good personal hygiene cough etiquette current facts regarding the disease & pandemic travel advisories other FAQs advice to persons with symptoms of disease advice to healthcare personnel involved in prevention & control activities

Daily press statement

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Actions Taken by Ministry of Health

Collaborate with WHO for monitoring & surveillance of the outbreaks

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Actions by Public

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Actions by Public
Follow travel advisory

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Actions by Public
Practice cough etiquette Hand hygiene wash hands with clean water & soap esp. after cough Do not attend gathering if you are having symptoms

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Actions by Industry
Follow preparedness plan prepared by your company Use Recommendations on Influenza Pandemic Preparedness for Industry in Malaysia as a guide.

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Current situation/information & updates, refer to; Website: www.moh.gov.my www.myhealth.gov.my www.infosihat.gov.my

Hotlines:- 03-888810200/300

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THANK YOU

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