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‡ Swine influenza, or flu, is a contagious
respiratory disease that affects pigs. It is
caused by a type-A influenza virus.
‡ Outbreaks in pigs occur year-round.
‡ The current strain is a new variation of an
H1N1 virus, which is a mix of human and
animal versions.
'Patient Zero' in Swine Flu Outbreak
Identified as 5-Year-Old Mexican Boy:
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Incubation period :range from one to seven days (median two
days)
‡ Contact with infected pigs
‡  
 
  
‡ Infected people may be able to infect
others beginning 1 day before symptoms
develop and up to 7 or more days after
becoming sick.
‡ However, based on seasonal flu, most
transmission occurs during the first two
days of illness.
] !!  
 
 


‡ Pregnant women
‡ People who are obese
‡ People with heart disease
‡ People with diabetes
‡ People with asthma or other chronic lung diseases
‡ People with kidney disease
‡ Those with suppressed immune systems, such as
people with HIV
‡ People with neurological and neuromuscular
disorders
 ] 
  

‡ Progressive illness is characterized by typical
symptoms plus :
m chest pain, poor oxygenation (eg, tachypnea,
hypoxia, labored breathing) .
m cardiopulmonary insufficiency (eg, hypotension),
(shock, organ failure), myocarditis or rhabdomyolisis
m During the 2009 pandemic, rapidly progressive
pneumonia, respiratory failure, acute respiratory
distress syndrome, and multisystem organ failure have
been reported.
m CNS impairment (eg, confusion, altered mental
status), (encephalitis, encephalopathy).
 ï 

‡ During the current H1N1 influenza A pandemic there
have been higher mortality rates among patients with
certain underlying medical conditions ,young healthy
and in pregnant women.
‡ As of December 13, 2009, there have been at least
10,500 deaths due to laboratory-confirmed cases of
pandemic H1N1 influenza A worldwide
‡ Approximately 6 percent of deaths caused by
pandemic H1N1 influenza A virus in the US have
occurred in pregnant women.
 ]  
‡ The current swine-origin H1N1 pandemic has
highlighted the fact that pregnant patients are susceptible
to serious disease such as pandemic influenza, varicella
and hepatitis E virus.
‡ This is probably due to pregnancy-induced tolerance,
which is necessary for placentation, without rejection.
‡ Alterations in cellular immunity occurs to protect the
fetus from the mother.
‡ These changes include decreased natural killer cell
activity&decrease in numbers of helper T cells.
 ] 
  :
‡ A cytokine storm is the systemic expression of a
healthy and vigorous immune system resulting in the
release of more than 150 inflammatory mediators .
‡ Both pro-inflammatory cytokines (such as Tumor
Necrosis Factor-alpha, InterLeukin-1, and InterLeukin-
6) and anti-inflammatory cytokines (such as interleukin
10, and interleukin 1 receptor antagonist) are elevated
in the serum, and lethal interplay of these cytokines is
referred to as a "Cytokine Storm".
‡ The cytokine storm must be treated and suppressed or
lethality can result.
    

‡ á
   of swine influenza A
(H1N1):

‡ is positive for influenza A by an influenza rapid

test
‡ is positive for influenza A plus meets criteria
for a suspected case, or
‡ individual with a clinically compatible illness
who died of an unexplained acute respiratory
illness who is considered to be
epidemiologically linked to a probable or
confirmed case.
‡ á 
    of swine influenza A
(H1N1) :
‡ an acute febrile respiratory illness with
laboratory confirmed (H1N1) virus infection
by one or more of the following tests:
m Meal Time PCM
m Viral culture
m Four-fold rise in swine influenza A (H1N1)
virus specific neutralizing antibodies.


  

" 
  


‡ Nasopharyngeal swab
‡ Nasal aspirate, wash, or swab
‡ Endotracheal aspirate (in intubated patients)
‡ Bronchoalveolar lavage (BAL) fluid
‡ Combined nasopharyngeal or nasal swab with
oropharyngeal swab
‡ In patients with severe pneumonia who are suspected of
being infected with influenza and who are intubated or
undergoing bronchoscopy
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‡ Throat swab
‡ Nasal / Nasopharyngeal swab
9
  

‡ Real-time reverse transcriptase (rRT)-PCR is the

most sensitive and specific test for the diagnosis of
pandemic H1N1 influenza A virus infection .
‡ Isolation of pandemic H1N1 influenza A virus using
culture is also diagnostic, but culture is usually too
slow to help guide clinical management.
‡ Several rapid antigen and immunofluorescent
antibody tests.
Ú


   
‡ Elevated alanine aminotransferase
‡ Elevated aspartate aminotransferase
‡ Anemia 
‡ Leukopenia
‡ Leukocytosis
‡ Thrombocytopenia
‡ Thrombocytosis
‡ Elevated total bilirubin

 

   infiltrates suggestive of
pneumonia or acute respiratory distress syndrome
.
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‡ The swine flu nasal spray formulation is a live,
attenuated form of the virus that is sprayed into the
nose.
‡ The nasal spray does not contain thimerosal or other
preservatives.
‡ People who should not get the flu mist vaccine
include:
‡ Pregnant women
‡ Children under two years old
‡ People with asthma
‡ People with a compromised immune system
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‡ The traditional injection method is also available
for immunizing against H1N1.
‡ This type of flu vaccine contains an inactivated or
killed form of the virus, which is injected into the
muscle.
‡ The CDC recommends this formulation for a
larger percentage of the general public.
‡ It is safe for women who are breastfeeding and
pregnant.
‡ The only group who should not receive the flu
shot is babies under six months.
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‡
 
is a preservative that was
routinely included in vaccinations prior to
2001.
‡ The CDC and the FDA have reviewed
published research on the safety of
Thimerosal in vaccines and found no
connection between the use of Thimerosal
and the incidence of autism and many other
neurological diseases.
]&%
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‡ Immediate side effects of the swine flu vaccination
include headaches, muscle aches, feeling run down,
nausea, fever and vomiting.

‡ Nasal spray vaccine reported side effects include

runny nose, nasal congestion, sore throat, headache
and/or general flu symptoms.
ï & # 
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m the possibility of Guillain-Barre syndrome.
m Mercury poisoning is one of the concerns with any
vaccination. In recent years the additive, thimerosal,
which contains mercury, has been removed from
most vaccines.
m However, the H1N1 flu shot still contains a high
level of mercury and this alone is a concern for
children, pregnant women and the elderly.
] 



 
  
 
 
:
‡ True egg allergy
‡ Guillen-Barre Syndrome
‡ Acute Illness at time of vaccination
‡ Concommitant LAIV vaccines .
‡ Cannot use LAIV in Immunecompromised
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People who are allergic to eggs might be at risk for
allergic reactions from receiving any influenza vaccine.
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patients should be skin tested to the flu vaccine. If the test
is positive, the severity of the reaction and the risk/benefits
of administering the vaccine should be evaluated.
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Yes. A high-risk person can use other flu medications
within 24 hours of developing flu symptoms. The
medication alleviates or prevents the progression of the flu
‡ )P

  
 
‡ The seasonal flu shot has been given to millions of
pregnant women over many years. Flu shots have
not been shown to cause harm to pregnant women or
their babies.
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‡ Breastfeeding is fully compatible with flu
vaccination, and preventing the flu in mothers can
reduce the chance that the infant will get the flu.
‡ Also, by breastfeeding, mothers can pass on to the
infant the .
‡ #P

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‡ Both seasonal flu shots and 2009 H1N1 flu shots
are recommended to pregnant women at any time
during pregnancy.
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‡ The U.S. Food and Drug Administration (FDA)
has approved the use of one shot for full
protection for persons 10 years and older.
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As of December 18, 2009, 85.9 million doses of 2009 H1N1

vaccine had been shipped to vaccination providers .
As of December 18, 2009, VAERS had received 6472 adverse
event reports following 2009 monovalent H1N1 vaccination.
The vast majority (94.1%) of adverse are classified as ³non
serious´ (e.g., soreness at the vaccine injection site).
Of the 6472 reports, 380 (5.9%) were reports that were classified
as ³serious´ health events (defined as life threatening or resulting
in death, major disability, abnormal conditions at birth,
hospitalization, or extension of an existing hospitalization).
Among the 380 reports of serious health events, there were 26
reports of death.
Ú *
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‡ Handwashing
‡ Hand sanitizer
‡ Cough etiquette
‡ Mask, glove, gown
‡ Social distancing
‡ Stay home when sick
‡ Isolation/Quarantine
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In 2005,it was claimed there
was a temporary shortage of star
anise due to its use in making
Tamiflu.
CDC's current recommendations
to protect against 2009 H1N1
virus do not include natural
remedies as a sole prevention
method.
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