Swine Flu

Reported by:
7 CARDENAS, Thryssa Johanna B.
35 SANTOS, Gabrielle Luis B.

INFLUENZA

commonly known as "theflu

infectious disease ofbirds andmammals

caused byRNA viruses of the family
Orthomyxoviridae, theinfluenza viruses.

more severe disease than common cold

and other influenza like disease

CLASSIFICATION OF INFLUENZA
Three genera of virus that can cause influenza:
1.
2.

3.

Influenza A most severe

Influenza B less severe but can still cause
outbreaks
Influenza C rare case in swine and only
cause minor symptoms

INFLUENZA
Type A
(Seasonal, avian, swine
influenza,.)

Type B
(Seasonal influenza)

Can cause significant disease

Generally causes milder

disease but may also cause
severe disease

Infects humans and other

species (e.g., birds; H5N1)

Limited to humans

Can cause epidemics and

Generally causes milder
pandemics (worldwide epidemics) epidemics
4

INFLUENZA A
can cause on bird, human and swine influenza
subject to gradual mutations (antigenic drift)
and sudden changes in their surface proteins
(antigenic shift)
because of variability, they cause major
pandemics
Subtypes:

INFLUENZA A
Subtypes:
H1N1 caused 1 death at Fort Dix, 1977-1978
Russian flu epidemic, 2009 pandemic
H1N2 bird flu virus
endemic in human and swine population

H3N1 mostly affects pigs

H3N2 endemic in pigs in China and Vietnam
- evolved from H2N2 by antigenic shift and
caused
the 1968-1969 Hong Kong
pandemic

INFLUENZA B
only known to infect humans and seals
can cause human flu but not reported as
cause of swine flu
limited host and range is responsible for
the lack of Influenza B-caused influenza
pandemics

INFLUENZA C
cause infection on human and pigs but do
not infect on birds
antigenically stable and cause only sporadic
disease
limited host range and lack of genetic
diversity
exhibits zoonosis (transmission of human to
pig or vice versa)
does not cause pandemics

SWINE FLU

Swine Influenza, Pig Influenza, Hog Flu, Pig Flu

infection in the respiratory system caused by any

one of several types of swine influenza viruses

Swine influenza virus(SIV) orswine-origin

influenza
virus(S-OIV)
is
any
strain
of
theinfluenza family virusthat isendemic in pigs

It consists of two genes similar to that found in flu

viruses affecting pigs in Europe and Asia, avian and
human genes.

Circulating Influenza Strains and

Pandemics in The 20th Century

1918: Spanish
Flu

20-40 m deaths
H1N1
1920

1940

1957: Asian
Flu

1-4 m deaths
H2N2
1960

1980

1968: Hong
Kong Flu

1-4 m deaths
H3N2
2000

HISTORY
1918 Flu Pandemic in Humans

associated with H1N1 and influenza appearing in pigs

reflect azoonosis either from swine to humans, or from
humans to swine
swine flu was noted as a new disease after large
outbreaks in human population
exact origin of strain remains elusive
Approximately 20% to 40% of the worldwide population
became ill
50 to 100million people were killed worldwide
the illness and mortality rates were highest among adults
20 to 50 years old

HISTORY
1930

first identification of an influenza virus as

a cause of disease in pigs

HISTORY
1957-1958
In February 1957, a new flu virus was identified in the Far East. Immunity
to this strain was rare in people younger than 65. A pandemic was
predicted. To prepare, health officials closely monitored flu outbreaks.
Vaccine production began in late May 1957 and was available in limited
supply by August 1957.
In the summer of 1957, the virus came to the United States quietly with a
series of small outbreaks. Infection rates peaked among school children,
young adults, and pregnant women in October 1957. By December 1957,
the worst seemed to be over.
However, another wave of illness came in January and February of 1958.
This is an example of the potential "second wave" of infections that can
happen during a pandemic.
Most influenzaand pneumoniarelated deaths occurred between
September 1957 and March 1958. Although the 1957 pandemic was not
as devastating as the 1918 pandemic, about 69,800 people in the United
States died. The elderly had the highest rates of death.

HISTORY
1968-1969
In early 1968, a new flu virus was detected
in Hong Kong. Those over the age of 65
were most likely to die. The number of
deaths between September 1968 and March
1969 was 33,800, making it the mildest flu
pandemic in the 20th century.

HISTORY
1976 U.S. outbreak
February 5, 1976
US army recruit atFort Dix said he felt tired
and weak and died the next day. Four others
were hospitalized
A/New Jersey/1976(a variant of H1N1) a new
strain spread (not beyond Fort Dix) 2 weeks
after and was detected from January 19 to
February 9
A/Victoria/75 (a variant of H3N2) spread
simultaneously causing illness and persisted
until March

HISTORY
1976 U.S. outbreak
October 1, 1976
National Influenza Immunization Program
(NIIP) began in the US but due to deaths and
Guillain-Barr syndrome, it was effectively
halted on December 16, 1976

HISTORY

19971998
H3N2 strains which include genes derived
byre-assortmentfrom human, swine and
avian viruses, have emerged and become
a major cause of swine influenza in North
America
re-assortmentbetween H1N1 andH3N2
producedH1N2

HISTORY
1988 Zoonosis
September 1988 - a swine flu virus killed
one pregnant woman and infected others
after visiting a hog barn at a county fair
inWalworth County, Wisconsin.
H1N1 strain of swine influenza virus was
found
Influenza-like Illness (ILI) was observed
no community outbreak

HISTORY
1998 US outbreak in swine
- swine flu was found in pigs in four U.S. states
- virus had originated in pigs as a recombinant
form of flu strains from birds and humans
- pigs can serve as a crucible where novel
influenza viruses emerge as a result of the
reassortment of genes from different strains
the triple hybrid strains form six out of the
eight viral gene segments in the 2009 flu
outbreak

HISTORY
1999
Canada, a strain ofH4N6 crossed the
species barrier from birds to pigs, but was
contained on a single farm.

HISTORY
2007 Philippine outbreak in swine
August 20, 2007 DA investigated the outbreak
(epizootic)
of
swine
flu
inNueva
Ecija&
CentralLuzon
mortality rate - less than 10% for swine flu, unless
there are complications likehog cholera
July 27, 2007 - the Philippine National Meat
Inspection Service (NMIS) raised a hog cholera "red
alert" warning overMetro Manila and five regions of
Luzon after the disease spread to backyard pig
farms inBulacanand Pampanga, even if these
tested negative for the swine flu virus

HISTORY
June 11, 2009WHO raised the worldwide
pandemic alert level to Phase 6 for swine flu, the
highest alert level which means that the swine flu
had spread worldwide and there were cases of
people with the virus in most countries.
2009 Northern Ireland outbreak in swine
November 2009 - 14 deaths and majority of the
victims were reported to have pre-existing health
conditions which had lowered their immunity. This
closely corresponds to the 19 patients who had
died in the year prior due to swine flu.

HISTORY
The CDC estimates that 43 million to 89
million people had H1N1 between April
2009 and April 2010. They estimate
between 8,870 and 18,300 H1N1 related
deaths.
August 10, 2010
World Health Organization (WHO) declared
an end to the global H1N1 flu pandemic

ETIOLOGY: AGENT

ETIOLOGY: AGENT
Orthymyxovirus
Class V Virus - Negative sense single
stranded RNA used as a template for mRNA
synthesis

ETIOLOGY: AGENT
H1N1 is a newhybridstrain of virus, the
surface hemagglutinin antigen sequences of
which are derived from swine, human, and
avian flu sources.
7 PB1-F2 coding sequence, the
smallestproteinin the influenza virus is
known to be the molecular marker of
pathogenicity which is exclusively absent in
human influenza viruses.

ETIOLOGY: MEANS OF
TRANSMISSION

Large-particle respiratory droplet transmission:

When an infected person coughs or sneezes near a
susceptible person, airborne transmission occurs. It
requires close contact between the infected and
recipient persons because droplets do not remain
suspended in the air and travel short distances not
more than 6 feet.

Respiratory secretions and bodily fluids (diarrheal

stool) of infected cases are potentially infectious.
However, susceptibility of ocular, conjunctival, or
gastrointestinal infection is not yet known.

ETIOLOGY: MEANS OF
TRANSMISSION

Contact with contaminated surface:

Sometimes people may become infected by
touching something with flu viruses on it
and then touching their mouth or nose.
Studies have shown that virus can survive
on environmental surfaces for nearly 2-8
hours after being deposited on the surface
and have the potential for infecting a
person.

MYTHS AND FACTS

People get infected from eating or preparing pork.

Fact- This virus does not spread by food or from eating pork or pork products, if
properly handled and cooked.
There is a risk of virus transmission from drinking water.
Fact- Research on susceptibility of this virus to conventional drinkingwater
treatment processes is not yet completed. However, recent studies have
demonstrated that highly pathogenic H5N1 avian influenza gets inactivated by free
chlorine levels normally used in drinking water treatment. So, it is believed that other
influenza viruses like novel H1N1 can also be inactivated by chlorination. No human
case was documented as caused by exposure to influenza-contaminated drinking
water, till date.
It can spread through water in swimming pools, water parks, spas,
interactive fountains, and other recreational water venues.
Fact- Till now, no case of influenza virus infection has been documented as caused
by water exposure. Recreational water treated with disinfectant at CDC
recommended levels (13 parts per million [ppm or mg/L] for pools and 25 ppm for
spas) does not cause transmission of influenza viruses like avian influenza A (H5N1)
virus. No research is completed on the susceptibility of novel H1N1 virus to chlorine
and other disinfectants used in swimming pools, water parks, spas, interactive
fountains etc. So, it is believed that novel H1N1 might be disinfected similarly.
There is a risk of spread at recreational water venues outside of the water!
Fact- Recreational water venues are not different from other common group setting .

ETIOLOGY: USUAL
RESERVOIRS

Animal reservoir (swine, avian)

PATHOLOGY

Pigs carry the virus and spread it to young

animals. However, there is no evidence that
they remain in true long term carrier state.
After inhalation, the virus gets deposited on
the surface of the lower respiratory tract.

PATHOLOGY
Incubation Period:
The estimated incubation period in humans
could range from 1-7 days, and more
likely1-4 days. Patient may be contagious
from one day before they develop
symptoms to up to 7 days after they get
sick. Younger children might potentially be
contagious for longer periods.

PATHOLOGY

Uncomplicated infections might cause changes in the cranial

ventral lung lobes. Bronchial and mediastinal lymph nodes get
enlarged. The pathological changesthat can be seen as follows:
Sharp line of demarcation between normal and affected lung tissue
can be identified with the affected tissue being purple and firm.
Interlobular edema can be found in few cases.
Airways get filled up with blood-tinged fibrinous exudates with
peribronchial and perivascular cellular infiltration.
Fibrinous pleuritis is seen in severe cases.
Microscopically lesions show airways filled with exudate, with
extensive alveolar atelectasis, interstitial pneumonia and
emphysema.
Research revealed that widespread interstitial pneumonia prevails
up to 21 days after infection and causes hemorrhagic lymph nodes

PATHOLOGY
Anyone at any age can have serious
complications from the flu. Those at highest risk
include:
People over age 65
Children younger than 2 years
Women more than 3 months pregnant during
the flu season
Anyone living in a long-term care facility
Anyone with chronic heart, lung, or kidney
conditions, diabetes, or a weakened immune
system

SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS

SWINE

HUMANS

Fever

Fever

Lethargy

Cough

Sneezing

Sore Throat

Coughing

Body Aches

Difficulty in Breathing

Severe headaches

Decreased appetite

Chills

Abortion (some cases)

Fatigue

Weight loss

Diarrhea

Poor Growth

Vomiting
General Discomfort
Weakness
Muscle Pains

DIAGNOSTIC TESTS
Rapiddiagnostic tests
-help in the diagnosis and management of patients
who present with signs and symptoms
compatible with influenza
-useful for helping to determine
whetheroutbreaksofrespiratory disease, such
as in nursing homes and other settings, might be
due to influenza
-done when the results will affect clinical decision
making.
- not very accurate for the H1N1 virus

DIAGNOSTIC TESTS
The CDC recommendsreal time PCRas the
method of choice for diagnosing H1N1.
The oral or nasal fluid collection and RNA
virus preserving filter paper card is
commercially available. This method allows
a specific diagnosis of novel influenza
(H1N1) as opposed to seasonal influenza.

DIAGNOSTIC TESTS
Sensitivities of rapid diagnostic tests are approximately
50-70% when compared with viral culture or
reversetranscriptionpolymerase chain reaction (RTPCR), and specificities of rapid diagnostic tests for
influenza are approximately 90-95%.
False-positive (and true-negative) results
aremorelikely to occur when disease prevalence in the
community is low, which is generally at the beginning
and end of the influenza seasons.
False-negative (and true-positive) results are more
likely to occur when disease prevalence is high in the
community, which is typically at the height of the
influenza season.

DIAGNOSTIC TESTS
Method

Types
Detected

Acceptable Specimens

Test
Time

CLIA
Waived

Viral cell culture

(conventional)

A and B

NP swab, throat swab, NP or

bronchial wash, nasal or
endotracheal aspirate,
sputum

3-10 days

No

Rapid cell culture

(shell vials; cell
mixtures)

A and B

NP swab, throat swab, NP or

bronchial wash, nasal or
endotracheal aspirate,
sputum

1-3 days

No

Immunofluorescen
ce, Direct (DFA) or
Indirect (IFA)
Antibody Staining

A and B

NP swab or wash, bronchial

wash, nasal or endotracheal
aspirate

1-4 hours

No

RT-PCR(singleplex
and multiplex;
real-time and
other RNA-based)
and other
molecular assays

A and B

NP swab, throat swab, NP or

bronchial wash, nasal or
endotracheal aspirate,
sputum

Varied
(Generally
1-6 hours)

No

Rapid Influenza
Diagnostic Tests

A and B

NP swab, (throat swab),

nasal wash, nasal aspirate

<30 min.

Yes/No

PREVENTION

Influenza is a serious disease that can lead to hospitalization and

sometimes even death. Every flu season is different, and influenza
infection can affect people differently. Evenhealthypeople can get
very sick from the flu and spread it to others.
Flu vaccines cause antibodies to develop in the body about two
weeks aftervaccination. These antibodies provide protection
against infection with the viruses that are in the vaccine.
The seasonal flu vaccine protects against the influenza viruses
that research indicates will be most common during the upcoming
season. Traditional flu vaccines (called trivalent vaccines) are
made to protect against three flu viruses; an influenza A (H1N1)
virus, an influenza A (H3N2) virus, and an influenza B virus. In
addition, there are flu vaccines made to protect against four flu
viruses (called quadrivalent vaccines). These vaccines protect
against the same viruses as the trivalent vaccine and an additional
B virus.

PREVENTION
There are two types of flu vaccines:
Trivalent flu vaccine protects against two influenza A viruses (an
H1N1 and an H3N2) and an influenza B virus.
Quadrivalent flu vaccine protects against two influenza A viruses
and two influenza B viruses

In the Philippines, there are 4 brands of flu vaccine that

are available in the market: Vaxigrip, Fluarix, Agrippal
S1 and Influvac.

PREVENTION
NationalInfluenzaVaccinationWeek (NIVW) is a
national observance that was established to
highlight the importance of continuing
influenza vaccination.
NIVW ison December 7-13, 2014

PREVENTION
washing hands frequently with soap or hand
sanitizer
not touching your nose,mouth, or eyes because the
virus can survive on telephones, tabletops, etc.
staying home from work or school if you are ill to
keep others healthy
avoiding large gatherings when swine flu is in
season. Flu season shifts a little bit from year to
year, but in the United States it generally peaks in
January, although it often starts in October and runs
until as late as May. It is possible to get the flu yearround.

PREVENTION
What works against the transmission?
Influenza A virus can be destroyed by heat
at 167-212F [75-100C].
Detergents (Soap), chemical germicides
including chlorine, hydrogen peroxide,
iodophors (iodine-based antiseptics), and
alcohols are also effective against human
influenza viruses, if used in proper
concentration for a sufficient length of time.

TREATMENT OF SYMPTOMS

TREATMENT
1.

Amantadine and Rimantadine

antiviral drugs known as adamantanes
inhibitors of the viralM2 protein
active against influenza A but not
influenza B
Not recommended for currently
circulating Influenza A due to high
prevalence of virus resistant to
adamantanes

TREATMENT
2.

Oseltamivir (Tamiflu) and Zanamivir

(Relenza)
- chemically related antiviral medications
known as neuraminidase inhibitors that
have activity against both influenza A and
B viruses

HEALTHCARE PROGRAMS IN THE

PHILIPPINES (2009)
1. thermal imaging equipment were installed at major
airports
2. quarantine travelers arriving from Mexico with
fever
3. seminars carried out by schools and universities
4. opening of classes nationwide was moved from
June 8 to June 15
5. communion was only by hand, holding hands
during the Our Father was discouraged, holy water
stoups were emptied
6. Roche Philippines announced a cut down of Tamiflu
from 1,000pesos to 880pesos

REFERENCES
http://en.wikipedia.org/wiki/Influenza
http://en.wikipedia.org/wiki/Swine_influenza
http://www.medicinenet.com/swine_flu/
http://emedicine.medscape.com/article/180
7048-overview
http://www.scientificpsychic.com/health/viru
s.html
http://en.wikipedia.org/wiki/Orthomyxovirid
ae
http://www.healthline.com/health/swine-fl
u#Symptoms4
http://www.cdc.gov/flu/professionals/antivir

REFERENCES
http://www.all-about
swineflu.com/about.html
http://www.cdc.gov/flu/protect/keyfacts.htm
http://en.wikipedia.org/wiki/2009_flu_pande
mic_in_the_Philippines