SWINE FLU.ppt final

Information about SWINE FLU.ppt final

Published on December 18, 2009

Author: dranishjoshi

Source: authorstream.com

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Slide 1: Swine flu Group 1 presentation ENDEMIC,EPIDEMIC,PANDEMIC : ENDEMIC,EPIDEMIC,PANDEMIC An endemic is an infectious communicable disease (such as colds, influenza, measles, mumps, tuberculosis, pneumonia, smallpox) that exists permanently in a particular region or population. An epidemic occurs when this disease attack "a lot of" people at about the same time and may spread through one or several communities. A pandemic occurs when an epidemic spreads across the world. LEVELS OF PANDEMIC : LEVELS OF PANDEMIC The World Health Organisation has raised the pandemic alert level from phase four to phase five, signalling that a pandemic is "imminent". Here are the six different "pandemic influenza phases" defined by the WHO: Phase 1: A virus circulates among animals but with no cases reported of infections in humans. Phase 2: An animal flu virus is known to have caused infection in humans, and therefore considered a potential pandemic threat. Phase 3: An animal or human-animal flu virus has caused sporadic cases or small outbreaks in humans, but has not resulted in human-to-human transmission that is sufficient to sustain community-level outbreaks. Slide 4: Phase 4: Human-to-human transmission of an animal or human-animal flu virus that is able to cause community-level outbreaks. Significant increase in risk of a pandemic. The focus of this phase is to contain the spread of the virus. Countries would be asked to take action such as issuing travel advice. Countries affected by the disease should also consider deploying a pandemic vaccine, and limiting non-essential movement of people from containment areas. Phase 5: Human-to-human spread of the virus into at least two countries in one region. Strong signal that pandemic is imminent. Countries are required to advise people with respiratory illnesses to stay home. Classes should be suspended and work patterns modified. Phase 6: Pandemic phase, with human-to-human spread of virus in at least two countries in the same geographic region and extending to at least one other country outside the region. Implementation of contingency plans for health systems at all levels. HISTORY : HISTORY Slide 6: 2009 outbreak May 2, 2009, it was reported in pigs at a farm in Alberta, Canada, with a link to the outbreak in Mexico. Analysis suggested it was a reassortment of just two strains, both found in swine. Distribution : Distribution Epidemics of swine influenza occur fairly regularly each winter in North America and Europe. Outbreaks have also been reported in many other parts of the world, including South Africa, Kenya, India, China, Hong Kong, Japan, Singapore and South America. WHO ASSESSMENT : WHO ASSESSMENT World is experiencing 2009 influenza pandemic : World is experiencing 2009 influenza pandemic Status of Influenza A H1N1 : 3 November 2009 : Status of Influenza A H1N1 : 3 November 2009 Pune - 75 Bangalore - 74 Mumbai - 18 Nashik- 9 Ahmedabad - 8 Baroda - 5 Chennai - 4 Delhi - 10 Bilaspur - 2 Dehradun - 2 Aurangabad - 2 Bijapur - 2 Hyderabad - 2 Slide 12: Raipur - 1 Panaji - 1 Trivandrum - 1 Rajkot - 1 Gandhi Nagar - 1 Jaipur - 1 Chandigarh - 1 Dhule - 1 Latur - 1 Mussourie - 1 surat - 2 Nagpur - 1 [edit] Total Deaths till Date November 3rd, 2009 - 477 H1N1 : H1N1 H1N1 refers to the types of hemagglutinin (H) and neuraminidase (N) proteins on the surface of the flu virus strain. Although there are many different HN subtypes, the ones that usually infect people during a typical flu season are the H1N1 and H3N2 Slide 15: Swine influenza (SI) is a virus disease that can cause epidemics of acute respiratory disease in pigs. Orthomyxoviridae family, (there are three types of Orthomyxoviridae, A, B and C). Mainly on two glycoprotein : hemagglutin (H) and neuramidase (N) Slide 16: Swine influenza is known to be caused by influenza subtypes H1N1, H1N2, H3N1, H3N2,and H2N3.  In pigs, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are the most common strains worldwide. DIFFERNCE BETWEEN SEASONAL FLU AND SWINE FLU : DIFFERNCE BETWEEN SEASONAL FLU AND SWINE FLU Seasonal influenza strains tend to be rather similar in genetic composition from year to year. The H1N1 strain of influenza (also known as the "swine flu") is considered a novel strain and is genetically different in comoposition than seasonal flu. This is significant only because many people may not have been exposed to a flu strain like it in the past. Therefore, a greater number of people could be vulnerable to getting the H1N1 type of influenza.All the hype with H1N1 concerns volume, not necessarily severity. Because fewer people have any type of history of exposure to it, we could see a greater total number of sick people and therefore, a greater number of deaths. The CDC is not currently recommending routine testing for influenza type, so most people don't find out exactly what type of flu they have. It's only those who become very ill and require hospitalization who would likely be tested for influenza type. The majority of ill people won't be tested, as it doesn't impact treatment - rest, fluids, and TREATMENT for fever and bodyaches. Antiviral medications (like Tamiflu) can be used, but are of limited use unless they are taken the the early stages of the illness Susceptible species : Susceptible species Main Host : Pigs Strains of swine influenza virus can also be directly transmissible to humans, and reciprocally. Increasing evidence of interchange of influenza viruses between pigs, other mammalian (including marine mammals) and avian hosts. Slide 20: Case definitions for infections Slide 21: Who definitions Acute febrile respiratory illness (fever >38°C ) with the spectrum of disease from influenza like illness to pneumonia Confirmed case of swine influenza A(H1N1) virus infection : Confirmed case of swine influenza A(H1N1) virus infection Defined as: An individual with laboratory confirmed swine influenza A(H1N1) virus infection by one or more of the following tests: • real-time RT-PCR • viral culture • four-fold rise in swine influenza A(H1N1) virus specific neutralizing antibodies. Probable case of swine influenza A(H1N1) virus infection : Probable case of swine influenza A(H1N1) virus infection Defined as : An individual with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection OR A individual with a clinically compatible illness or who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case. A suspected case of S-OIV infection : A suspected case of S-OIV infection Defined as a person with acute febrile respiratory illness with onset within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or within 7 days of travel to community either within the United States or internationally where there are one or more confirmed cases of S-OIV infection, or resides in a community where there are one or more confirmed cases of S-OIV infection. Close contact : Close contact Defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine- origin influenza A (H1N1) virus infection during the case’s infectious period. High-risk groups High-risk groups : High-risk groups A person who is at high-risk for complications of swine influenza A (H1N1) virus infection is defined as the same for seasonal influenza  INCUBATION PERIOD The estimated incubation period is unknown and could range from 1-7 days, and more likely 1-4 days INFECTIOUS PERIOD : INFECTIOUS PERIOD In general, persons with novel influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness onset. Children, especially younger children, might be infectious for up to 10 days.  Case Fatality Rate 0.3% to 1.4%, with 0.4% the most likely value INFECTIVE RATE : INFECTIVE RATE 1 PER 3 INDIVIDUALS EXPOSED Secondary Attack Rate Secondary attack rate of H1N1 range from 22% to 33% How do people die from swine flu? : How do people die from swine flu? babies elderly people people who are already sick, especially with cancer, lung problems, heart disease, or immune system problems. When healthy adults die of the flu, it is usually because it becomes pneumonia. It can develop about 5 days after the flu symptoms of fever, cough, and muscle aches start. There is swelling (inflammation) in the lungs, and the person has trouble breathing that gets worse and worse until they die. Taking antiviral medications within 48 hours of the flu symptoms starting can help reduce the symptoms but may not prevent the person from developing pneumonia. Slide 30: TRANSMISSION PIGS : PIGS Main route of transmission is through direct contact between infected and uninfected animals. The direct transfer of the virus probably occurs either by pigs touching noses, or through dried mucus. Airborne transmission through the aerosols produced by pigs coughing or sneezing. Transmission may also occur through wild animals, such as wild boar, which can spread the disease between farms. Transmission to humans : Transmission to humans People who work with poultry and swine, especially people with intense exposures, are at increased risk. CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. Transmission via large-particle droplets requires close contact between source and recipient persons because droplets do not remain suspended in the air and generally travel only a short distance (< 6 feet). Contact with contaminated surfaces is another possible source of transmission and transmission via droplet nuclei (also called “airborne” transmission) Slide 33: CLINICAL FEATURES PHYSICAL FINDINGS : PHYSICAL FINDINGS Usually minimal in uncomplicated influenza Flushed skin, hot and dry, although diaphoresis and mottled extremities Pharynx : unremarkable/injection of the mucous membranes and postnasal discharge Mild cervical lymphadenopathy -younger individuals Chest examination : rhonchi, wheezes, and scattered crepts. Frank dyspnoea hyperpnoea, cyanosis, diffuse rales, and signs of consolidation are indicative of pulmonary complications. In children emergency warning signs : In children emergency warning signs Fast breathing or trouble breathing Bluish or gray skin color Not drinking enough fluids Severe or persistent vomiting Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms improve but then return with fever and worse cough In adults, emergency warning signs that need urgent medical attention : In adults, emergency warning signs that need urgent medical attention Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Flu-like symptoms improve but then return with fever and worse cough Complications : Complications Insufficient information to date. With previous variants of swine influenza viruses, clinical syndromes have ranged from mild respiratory illness, to lower respiratory tract illness, dehydration, or pneumonia. Clinicians should expect complications to be similar to seasonal influenza: exacerbation of underlying chronic medical conditions, upper respiratory tract disease (sinusitis, otitis media, croup) lower respiratory tract disease (pneumonia, bronchiolitis, status asthmaticus), cardiac (myocarditis, pericarditis), musculoskeletal (myositis, rhabdomyolysis), neurologic (acute and post-infectious encephalopathy, encephalitis, febrile seizures, status epilepticus), toxic shock syndrome, and secondary bacterial pneumonia with or without sepsis Groups at high risk for complications : Groups at high risk for complications Children less than 5 years old; Persons aged 65 years or older; Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection; Pregnant women; Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders; Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV); Residents of nursing homes and other chronic-care facilities. WHO GUIDELINE FOR HIGH RISK HEALTH WORKER : WHO GUIDELINE FOR HIGH RISK HEALTH WORKER Health care workers who are at increased risk of complications from H1N1 Influenza 09 and who are likely to be in direct contact with patients whom have influenza like illness which may possibly be H1N1 influenza 09, should be considered for redeployment to lower risk activities. If redeployment is not possible, health care workers who are at increased risk of complications from H1N1 Influenza 09 should maintain a distance of 1 metre from suspected/confirmed cases and not participate in procedures which may generate small particles or aerosols of respiratory secretions in patients with confirmed or suspected H1N1 Influenza 09. These high risk procedures include: endotracheal intubation, nebulized medication administration, airway suctioning, bronchoscopy, diagnostic sputum induction, positive pressure ventilation via facemask, high frequency oscillatory ventilation. Which patients should be tested for novel influenza A (H1N1) virus : Which patients should be tested for novel influenza A (H1N1) virus Slide 43: Persons having acute febrile respiratory illness or sepsis-like syndrome Certain groups may have atypical presentations including infants, elderly and persons with compromised immune systems Priority for testing includes persons who 1) require hospitalization Or 2) are at high-risk for severe disease (as listed above). Sample : Sample Upper respiratory specimens, such as A nasopharyngeal swab or aspirate, Nasal swab plus a throat swab or nasal wash, Tracheal aspirate Swabs Ideally, swab specimens should be collected using swabs with a synthetic tip (e.g. polyester or Dacron®) and an aluminum or plastic shaft. Swabs with cotton tips and wooden shafts are not recommended. Specimens collected with swabs made of calcium alginate are not acceptable . Slide 45: Specimens should be placed into sterile viral transport media (VTM) and immediately placed on ice or cold packs or at 4°C (refrigerator) for transport to the laboratory. All respiratory specimens should be kept at 4°C until they can be placed at -70°C.  If a -70°C freezer is not available, specimens should be kept at 4°C, preferably no longer than1week LAB SUPPORT IN INDIA : LAB SUPPORT IN INDIA National Institute of Communicable Diseases, Delhi National Institute of Virology, Pune National Institute of Cholera and Enteric Diseases, Kolkata Regional Medical Research Centre, Dibrugarh Haffkine Institute, Mumbai Slide 47: TREATMENT Antiviral Treatment : Antiviral Treatment With zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Recommended duration of treatment is 5 days. Antiviral resistance pandemic (H1N1) virus : Antiviral resistance pandemic (H1N1) virus Resistance to amantadine and rimantadine. A total of six oseltamivir resistant pandemic (H1N1) 2009 influenza viruses have now been detected from Denmark, Hong Kong SAR, Japan and Canada. Of these three were from patients in Japan. All six patients had received oseltamivir with the exception of one and have recovered well. All resistant viruses had the characteristic mutation at position 274/275 associated with resistance. Side Effects and Adverse Reactions : Side Effects and Adverse Reactions Zanamivir : Licensed only for use in persons without underlying respiratory or cardiac disease. Greater than 20% decline in forced expiratory volume in 1 second (FEV1) after treatment. Cases of respiratory function deterioration after inhalation of zanamivir have been reported.  Allergic reactions, including oropharyngeal or facial edema, also have been reported The most common adverse events reported were diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections. Zanamivir Oseltamivir : Oseltamivir Nausea and vomiting were reported more frequently among adults. Among children treated with oseltamivir, 14% had vomiting. Transient neuropsychiatric events (self-injury or delirium) have been reported postmarketing. Five Health Tips to Avoid Swine Flu : Five Health Tips to Avoid Swine Flu Tip #1: Stay home if you're sick. Tip #2: Avoid close contact with people who are sick. Tip #3: Wash your hands often and avoid touching your eyes, nose and mouth. Tip #4: Cover your mouth or nose with a tissue when coughing or sneezing. Tip #5: Keep up with health information in your own community. If you are travelling : If you are travelling Before your trip Monitor the outbreak situation Check updates from these sources: Home pages of the affected state health departments Centers for Disease Control and Prevention Pan American Health Organization World Health Organization During your trip : During your trip Practice healthy habits to help stop the spread of influenza Wash your hands often with soap and water. This removes germs from your skin and helps prevent diseases from spreading. Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap is not available and hands are not visibly dirty. Cover your mouth and nose with a tissue when you cough or sneeze and put your used tissue in a wastebasket. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands. Wash your hands after coughing or sneezing, using soap and water or an alcohol-based hand gel. Follow all local health recommendations. For example, you may be asked to put on a surgical mask to protect others. After your trip : Avoid leaving your home while sick except to get local medical care, or as instructed by your doctor. Do not go to work or school while ill. If you must leave your home (for example, to seek medical care) wear a surgical mask to keep from spreading your illness to others. Always cover your nose and mouth with a tissue when you cough or sneeze. Throw away used tissues in a trash can. Wash your hands with soap and water often and especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand gel containing at least 60% alcohol. Avoid close contact with other people as much as possible. Wear a surgical mask if you are in contact with other people. After your trip Infection Control of Ill Persons in a Healthcare Setting : Infection Control of Ill Persons in a Healthcare Setting Patient placement and transport : Patient placement and transport Any patients who are confirmed, probable or suspected cases and present for care at a healthcare facility should be placed directly into individual rooms with the door kept closed.  Healthcare personnel interacting with the patients should follow the infection control guidance  Procedures that are likely to generate aerosols, should be done in a location with negative pressure air handling whenever feasible.   An airborne infection isolation room (AIIR) with negative pressure air handling with 6 to 12 air changes per hour can be used.  Air can be exhausted directly outside or be recirculated after filtration by a high efficiency particulate air (HEPA) filter.  Facilities should monitor and document the proper negative-pressure function of AIIRs, including those in operating rooms, intensive care units, emergency departments, and procedure rooms. The ill person should wear a surgical mask to contain secretions when outside of the patient room, and should be encouraged to perform hand hygiene frequently and follow respiratory hygiene / cough etiquette practices. Limitation of healthcare personnel entering the isolation room : Limitation of healthcare personnel entering the isolation room Healthcare personnel entering the room of a patient in isolation should be limited to those performing direct patient care. Standard and Contact precautions plus eye protection should be used hand hygiene by washing with soap and water or using alcohol-based hand sanitizer. Respiratory protection : Respiratory protection All healthcare personnel who enter the rooms of patients in isolation for swine influenza should wear a fit-tested disposable N95 respirator or equivalent (e.g., powered air purifying respirator)*. Respiratory protection should be donned upon room entry. Management of visitors : Management of visitors Limit visitors to patients in isolation for swine influenza A virus (H1N1) infection to persons who are necessary for the patient's emotional well-being and care. Visitors should be instructed to limit their movement within the facility. Surveillance of healthcare personnel : Surveillance of healthcare personnel Healthcare personnel should be monitored daily for signs and symptoms of febrile respiratory illness.  Healthcare personnel who develop these symptoms should be instructed not to report to work, or if at work, should cease patient care activities and notify their supervisor and infection control personnel. Healthcare personnel who do not have a febrile respiratory illness may continue to work.  Asymptomatic healthcare personnel who have had an unprotected exposure to swine influenza A (H1N1) also may continue to work if they are started on antiviral prophylaxis. Environmental infection control : Environmental infection control Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of swine influenza.  Management of laundry, utensils and medical waste should also be performed in accordance with procedures followed for seasonal influenza. Interim Recommendations for Facemask : Interim Recommendations for Facemask Post-mortem Care and Safe Autopsy Procedures for Novel H1N1 Influenza : Post-mortem Care and Safe Autopsy Procedures for Novel H1N1 Influenza Transport of Deceased Persons : Transport of Deceased Persons Transport of deceased persons does not require any additional precautions when bodies have been secured in a transport bag. Hand hygiene should be performed after completing transport. Standard precautions should be used when handling deceased individuals, and preparing bodies for autopsy or transfer to mortuary services. Standard Precautions apply, and appropriate use of personal protective equipment (PPE) (e.g., gowns, gloves, masks, and/or eye protection) is recommended. After PPE is removed, hand hygiene should be performed. Slide 72: Novel H1N1 Flu (Swine Flu) and You What can I do to protect myself from getting sick? : What can I do to protect myself from getting sick? Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners* are also effective. Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick. Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. If I have a family member at home who is sick with novel H1N1 flu, should I go to work? : If I have a family member at home who is sick with novel H1N1 flu, should I go to work? Employees who are well but who have an ill family member at home with novel H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners are also effective. *If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers. What should I do if I get sick? : What should I do if I get sick? If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings. If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed. If you become ill and experience any of the following warning signs, seek emergency medical care. Contamination & Cleaning : Contamination & Cleaning How long can influenza virus remain viable on objects (such as books and doorknobs)? : How long can influenza virus remain viable on objects (such as books and doorknobs)? Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface. What kills influenza virus? : What kills influenza virus? Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry. What surfaces are most likely to be sources of contamination? : What surfaces are most likely to be sources of contamination? Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk. For example, and then touches their own eyes, mouth or nose before washing their hands. How should waste disposal be handled to prevent the spread of influenza virus? : How should waste disposal be handled to prevent the spread of influenza virus? To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste. How should linens, eating utensils and dishes of persons infected with influenza virus be handled? : How should linens, eating utensils and dishes of persons infected with influenza virus be handled? Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry. Eating utensils should be washed either in a dishwasher or by hand with water and soap. Exposures Not Thought to Spread Novel H1N1 Flu : Exposures Not Thought to Spread Novel H1N1 Flu Can I get infected with novel H1N1 virus from eating or preparing pork? : Can I get infected with novel H1N1 virus from eating or preparing pork? Novel H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe. Is there a risk from drinking water? : Is there a risk from drinking water? Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water. Can novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues? : Can novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues? Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of novel H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as novel H1N1 virus would also be similarly disinfected by chlorine. Pregnant Women and Swine Influenza : Pregnant Women and Swine Influenza Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of influenza symptoms, with benefits expected to be greatest if started within 48 hours of onset based on date from studies of seasonal influenza. Recommended duration of treatment is five days, and for chemoprophylaxis is 10 days. Oseltamivir and zanamivir treatment and chemoprophylaxis regimens recommended for pregnant women are the same as those recommended for adults who have seasonal influenza. Oseltamivir is preferred for treatment of pregnant women. The drug of choice for prophylaxis is less clear. Breastfeeding considerations : Breastfeeding considerations Women who deliver should be encouraged to initiate breastfeeding early and feed frequently.  Ideally, babies should receive most of their nutrition from breast milk.  Eliminate unnecessary formula supplementation, so the infant can receive as much maternal antibodies as possible. If a woman is ill, she should continue breastfeeding and increase feeding frequency. Interim Guidance for People With Heart Disease, Stroke, or Cardiovascular Disease : Interim Guidance for People With Heart Disease, Stroke, or Cardiovascular Disease Maintain a two week supply of your medications. Do not stop taking your medications without first consulting your health care provider, especially in the event of influenza or a respiratory infection. People with heart failure should be alert to changes in their breathing and should promptly report changes to their health care provider. It is especially important to wash your hands often with soap and water and follow other basic hygiene to avoid infection. TAKE HOME MESSAGE : TAKE HOME MESSAGE

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