ΠΦΥ -Εκπαίδευση > Συζητήσεις πάνω σε ιατρικά θέματα

Swine flu (Influenza A- H1N1)

(1/54) > >>

Gatekeeper:
MEXICO CITY (Reuters) Apr 24 - A deadly strain of swine flu never seen before has broken out in Mexico, killing as many as 60 people and raising fears it is spreading across North America.

The World Health Organization said it was concerned about what it called 800 "influenza-like" cases in Mexico, and also about a confirmed outbreak of a new strain of swine flu in the United States. It said about 60 people had died in Mexico.

Mexico's government said it had confirmed that at least 16 people had died of the swine flu in central Mexico and that there could be another 45 fatal victims.

The government canceled classes for millions of children in its sprawling capital city and surrounding areas on Friday after it noticed a higher number of deaths involving flu-like illness than normal in recent weeks.

"It is a virus that mutated from pigs and then at some point was transmitted to humans," Health Minister Jose Angel Cordova told the Televisa network.

He linked the disease in Mexico to the new kind of swine flu that made seven people ill in California and Texas.

The U.S. Centers for Disease Control and Prevention said the virus in the United States was a never-before-seen mixture of viruses typical among pigs, birds and humans. All seven American patients have recovered.

Worldwide, seasonal flu kills between 250,000 and 500,000 people in an average year.

The White House was closely following the new cases in the United States and Mexico, and President Barack Obama has been informed, an administration official said.

The Mexican government warned people not to shake hands or kiss when greeting or share food, glasses or cutlery for fear of contracting the flu.

Mexico City, one of the world's biggest cities and home to some 20 million people, was quieter than usual on Friday morning. Normally choking traffic was less chaotic in the absence of school buses and parents driving kids to school.

Many people waiting to enter subway stations had their faces covered with surgical masks.

The virus is an influenza A virus, carrying the designation H1N1. It contains DNA typical to avian, swine and human viruses, including elements from European and Asian swine viruses, the CDC has said.

The Geneva-based U.N. agency WHO said it was in daily contact with U.S., Canadian and Mexican authorities and had activated its Strategic Health Operations Center (SHOC) -- its command and control center for acute public health events.

Surveillance for and scrutiny of influenza has been stepped up since 2003, when H5N1 bird flu reappeared in Asia. Experts fear this strain, or another strain, could spark a pandemic that could kill millions.

The CDC said it will issue daily updates at Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος


If a swine virus established efficient human-to human transmission, it can cause an influenza pandemic.(WHO)

Gatekeeper:
Update: Swine Influenza A (H1N1) Infections --- California and Texas, April 2009

On April 21, 2009, CDC reported that two recent cases of febrile respiratory illness in children in southern California had been caused by infection with genetically similar swine influenza A (H1N1) viruses. The viruses contained a unique combination of gene segments that had not been reported previously among swine or human influenza viruses in the United States or elsewhere (1). Neither child had known contact with pigs, resulting in concern that human-to-human transmission might have occurred. The seasonal influenza vaccine H1N1 strain is thought to be unlikely to provide protection. This report updates the status of the ongoing investigation and provides preliminary details about six additional persons infected by the same strain of swine influenza A (H1N1) virus identified in the previous cases, as of April 24. The six additional cases were reported in San Diego County, California (three cases), Imperial County, California (one case), and Guadalupe County, Texas (two cases). CDC, the California Department of Public Health, and the Texas Department of Health and Human Services are conducting case investigations, monitoring for illness in contacts of the eight patients, and enhancing surveillance to determine the extent of spread of the virus. CDC continues to recommend that any influenza A viruses that cannot be subtyped be sent promptly for testing to CDC. In addition, swine influenza A (H1N1) viruses of the same strain as those in the U.S. patients have been confirmed by CDC among specimens from patients in Mexico. Clinicians should consider swine influenza as well as seasonal influenza virus infections in the differential diagnosis for patients who have febrile respiratory illness and who 1) live in San Diego and Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset.

Case Reports

San Diego County, California. On April 9, an adolescent girl aged 16 years and her father aged 54 years went to a San Diego County clinic with acute respiratory illness. The youth had onset of illness on April 5. Her symptoms included fever, cough, headache, and rhinorrhea. The father had onset of illness on April 6 with symptoms that included fever, cough, and rhinorrhea. Both had self-limited illnesses and have recovered. The father had received seasonal influenza vaccine in October 2008; the daughter was unvaccinated. Respiratory specimens were obtained from both, tested in the San Diego County Health Department Laboratory, and found to be positive for influenza A using reverse transcription--polymerase chain reaction (RT-PCR), but could not be further subtyped. Two household contacts of the patients have reported recent mild acute respiratory illnesses; specimens have been collected from these household members for testing. One additional case, in a child residing in San Diego County, was identified on April 24; epidemiologic details regarding this case are pending.

Imperial County, California. A woman aged 41 years with an autoimmune illness who resided in Imperial County developed fever, headache, sore throat, diarrhea, vomiting, and myalgias on April 12. She was hospitalized on April 15. She recovered and was discharged on April 22. A respiratory specimen obtained April 16 was found to be influenza A positive by RT-PCR at the San Diego Country Health Department Laboratory, but could not be further subtyped. The woman had not been vaccinated against seasonal influenza viruses during the 2008--09 season. Three household contacts of the woman reported no recent respiratory illness.

Guadalupe County, Texas. Two adolescent boys aged 16 years who resided in Guadalupe County near San Antonio were tested for influenza and found to be positive for influenza A on April 15. The youths had become ill with acute respiratory symptoms on April 10 and April 14, respectively, and both had gone to an outpatient clinic for evaluation on April 15. Identification and tracking of the youths' contacts is under way.

Five of the new cases were identified through diagnostic specimens collected by the health-care facility in which the patients were examined, based on clinical suspicion of influenza; information regarding the sixth case is pending. The positive specimens were sent to public health laboratories for further evaluation as part of routine influenza surveillance in the three counties.

Outbreaks in Mexico

Mexican public health authorities have reported increased levels of respiratory disease, including reports of severe pneumonia cases and deaths, in recent weeks. Most reported disease and outbreaks are reported from central Mexico, but outbreaks and severe respiratory disease cases also have been reported from states along the U.S.-Mexico border. Testing of specimens collected from persons with respiratory disease in Mexico by the CDC laboratory has identified the same strain of swine influenza A (H1N1) as identified in the U.S. cases. However, no clear data are available to assess the link between the increased disease reports in Mexico and the confirmation of swine influenza in a small number of specimens. CDC is assisting public health authorities in Mexico in testing additional specimens and providing epidemiologic support. None of the U.S. patients traveled to Mexico within 7 days of the onset of their illness.

Epidemiologic and Laboratory Investigations

As of April 24, epidemiologic links identified among the new cases included 1) the household of the father and daughter in San Diego County, and 2) the school attended by the two youths in Guadalupe County. As of April 24, no epidemiologic link between the Texas cases and the California cases had been identified, nor between the three new California cases and the two cases previously reported. No recent exposure to pigs has been identified for any of the seven patients. Close contacts of all patients are being investigated to determine whether person-to-person spread has occurred.

Enhanced surveillance for additional cases is ongoing in California and in Texas. Clinicians have been advised to test patients who visit a clinic or hospital with febrile respiratory illness for influenza. Positive samples should be sent to public health laboratories for further characterization. Seasonal influenza activity continues to decline in the United States, including in Texas and California, but remains a cause of influenza-like illness in both areas.

Viruses from six of the eight patients have been tested for resistance to antiviral medications. All six have been found resistant to amantadine and rimantidine but sensitive to zanamivir and oseltamivir.

Reported by: San Diego County Health and Human Svcs; Imperial County Public Health Dept; California Dept of Public Health. Dallas County Health and Human Svcs; Texas Dept of State Health Svcs. Naval Health Research Center; Navy Medical Center, San Diego, California. Animal and Plant Health Inspection Svc, US Dept of Agriculture. Div of Global Migration and Quarantine, National Center for Preparedness, Detection, and Control of Infectious Diseases; National Center for Zoonotic, Vector-Borne, and Enteric Diseases; Influenza Div, National Center for Infectious and Respiratory Diseases, CDC.

Editorial Note:
In the United States, novel influenza A virus infections in humans, including swine influenza A (H1N1) infections, have been nationally notifiable conditions since 2007. Recent pandemic influenza preparedness activities have greatly increased the capacity of public health laboratories in the United States to perform RT-PCR for influenza and to subtype influenza A viruses they receive from their routine surveillance, enhancing the ability of U.S. laboratories to identify novel influenza A virus infections. Before the cases described in this ongoing investigation, recent cases of swine influenza in humans reported to CDC occurred in persons who either had exposure to pigs or to a family member with exposure to pigs. Transmission of swine influenza viruses between persons with no pig exposure has been described previously, but that transmission has been limited (2,3). The lack of a known history of pig exposure for any of the patients in the current cases indicates that they acquired infection through contact with other infected persons.

The spectrum of illness in the current cases is not yet fully defined. In the eight cases identified to date, six patients had self-limited illnesses and were treated as outpatients. One patient was hospitalized. Previous reports of swine influenza, although in strains different from the one identified in the current cases, mostly included mild upper respiratory illness; but severe lower respiratory illness and death also have been reported (2,3).

The extent of spread of the strain of swine influenza virus in this investigation is not known. Ongoing investigations by California and Texas authorities of the two previously reported patients, a boy aged 10 years and a girl aged 9 years, include identification of persons in close contact with the children during the period when they were likely infectious (defined as from 1 day before symptom onset to 7 days after symptom onset). These contacts have included household members, extended family members, clinic staff members who cared for the children, and persons in close contact with the boy during his travel to Texas on April 3. Respiratory specimens are being collected from contacts found to have ongoing illness. In addition, enhanced surveillance for possible cases is under way in clinics and hospitals in the areas where the patients reside. Similar investigations and enhanced surveillance are now under way in the additional six cases.

Clinicians should consider swine influenza infection in the differential diagnosis of patients with febrile respiratory illness and who 1) live in San Diego and Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset. Any unusual clusters of febrile respiratory illness elsewhere in the United States also should be investigated.

Patients who meet these criteria should be tested for influenza, and specimens positive for influenza should be sent to public health laboratories for further characterization. Clinicians who suspect swine influenza virus infections in humans should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, refrigerate the specimen, and then contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. CDC requests that state public health laboratories promptly send all influenza A specimens that cannot be subtyped to the CDC, Influenza Division, Virus Surveillance and Diagnostics Branch Laboratory. As a precautionary step, CDC is working with other partners to develop a vaccine seed strain specific to these recent swine influenza viruses in humans.

As always, persons with febrile respiratory illness should stay home from work or school to avoid spreading infections (including influenza and other respiratory illnesses) to others in their communities. In addition, frequent hand washing can lessen the spread of respiratory illness (5). Interim guidance on infection control, treatment, and chemoprophylaxis for swine influenza is available at Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος. Additional information about swine influenza is available at Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος.

References
CDC. Swine influenza A (H1N1) infection in two children---Southern California, March--April 2009. MMWR 2009;58:400--2.
Myers KP, Olsen CW, Gray GC. Cases of swine influenza in humans: a review of the literature. Clin Infect Dis 2007;44:1084--8.
Wells DL, Hopfensperger DJ, Arden NH, et al. Swine influenza virus infections. Transmission from ill pigs to humans at a Wisconsin agricultural fair and subsequent probable person-to-person transmission. JAMA 1991;265:478--81.
Newman AP, Reisdorf E, Beinemann J, et al. Human case of swine influenza A (H1N1) triple reassortant virus infection, Wisconsin. Emerg Infect Dis 2008;14:1470--2.
Ryan MA, Christian RS, Wohlrabe J. Handwashing and respiratory illness among young adults in military training. Am J Prev Med 2001;21:79--83.

Gatekeeper:
Ελβετία. Διεθνή ανησυχία για την παγκόσμια υγεία προκαλεί η επιδημία της νόσου των χοίρων, κατά την ΠΟΥ

O Παγκόσμιος Οργανισμός Υγείας (ΠΟΥ) ανακοίνωσε το Σάββατο απ΄οτη νέδρα του τη Γενεύη, ότι η επιδημία της γρίπης των χοίρων που έχει ξεσπάσει στις ΗΠΑ και το Μεξικό αποτελεί "ένα γεγονός δημόσιας υγείας που προκαλεί τη διεθνή ανησυχία".

Η γενική διευθύντρια της ΠΟΥ, Μάργκαρετ Χαν προέτρεψε όλες τις χώρες να ενισχύσουν την επόπτευση για κάθε πιθανή εμφάνιση της νόσου που συχνά προκαλεί συμπτώματα πνευμονίας.

Σε ανακοίνωση που βασίζεται στις πληροφορίες που έχει στη διάθεσή της η ΠΟΥ και προέρχονται από επείγουσες επιτροπές ειδικών, ο παγκόσμιος αυτός οργανισμός για την υγεία αναφέρει ότι "τα παρόντα περιστατικά συνιστούν διεθνή ανησυχία όσον αφορά τη δημόσια υγεία".

Στην ίδια ανακοίνωση αναφέρεται ότι η ΠΟΥ χρειάζεται περισσότερη πληροφόρηση πριν αποφασίσει για μια πιθανή αλλαγή του σήματος κινδύνου που τώρα βρίσκεται στο 3 στην σκάλα κινδύνου που ξεκινά από το νούμερο 1 και φτάνει έως το 6.

Σημειώνεται ότι μέχρι τώρα έχουν καταγραφεί 20 περιπτώσεις εμφάνισης της νόσου στο Μεξικό και οκτώ στις ΗΠΑ.

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Gatekeeper:
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Raptor:
Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus

Background
This document provides interim planning guidance for state, territorial, tribal, and local communities that focuses on several nonpharmaceutical measures that might be useful during this outbreak of swine influenza A (H1N1) virus aimed at reducing disease transmission and associated morbidity and mortality.

Human cases of swine influenza A (H1N1) virus infection have been identified in several states and in other countries.  This is a novel influenza A virus that has not been identified in people before, and human-to-human transmission of the virus appears to be ongoing.  Unlike the experience in Mexico, the United States is currently observing a less severe clinical spectrum of disease with infection by the identical virus strain.  As of April 26, 2009, of the confirmed cases of swine influenza A (H1N1) virus infection, only two confirmed case-patients were hospitalized and none have died in the United States.   Mexican health officials have reported several hundred suspect cases, including several deaths associated with confirmed swine influenza A (H1N1) virus infection.  In Mexico, many patients have experienced rapidly progressive pneumonia, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome (ARDS).  Therefore, the experience of these two countries has been markedly different to date.  Getting better information to explain these differences is a high priority for the ongoing investigation.

The previously published United States government guidance on community mitigation relies on knowledge of the Pandemic Severity Index (PSI) to characterize the severity of a pandemic and identify the recommendations for specific interventions that communities may use for a given level of severity, and suggests when these measures should be started and how long they should be used.

The substantial difference in the severity of the illness associated with infections from the same virus, the relatively low number of cases detected in the United States, and insufficient epidemiologic and clinical data to ascribe a PSI, present a formidable challenge in terms of assessing the threat posed by this novel influenza A virus until additional epidemiologic and virologic information is learned. 

Novel influenza A virus infections in humans, including swine influenza A (H1N1) virus, represent a pandemic threat.  Recognizing the historical precedent for the emergence of a pandemic influenza virus which could have waves of disease with different morbidity and mortality and epidemiologic profiles, public health departments in the United States must remain vigilant.

It is prudent for communities to act in the absence of sufficient data to protect their citizens and take advantage of a narrow window of opportunity for intervention.  CDC recommends that affected states with at least one laboratory-confirmed case of swine influenza A (H1N1) virus infection consider activating community mitigation interventions for affected communities.  As public health officials in the United States learn more about this emerging virus, updated guidance will be issued in conjunction with our state, local, tribal and territorial partners.

Recommendations
When Human Infection with Swine Influenza A (H1N1) Virus is Confirmed in a Community

Strongly Recommend Home Isolation of Cases:

Persons who develop influenza-like-illness (ILI) (fever with either cough or sore throat) should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer. Persons who experience ILI and wish to seek medical care should contact their health care providers to report illness (by telephone or other remote means) before seeking care at a clinic, physician’s office, or hospital.  Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention.
If ill persons must go into the community (e.g., to seek medical care) they should wear a face mask to reduce the risk of spreading the virus in the community when they cough, sneeze, talk or breathe.  If a face mask is unavailable, ill persons needing to go into the community should use a handkerchief or tissues to cover any coughing.
Persons in home isolation and their household members should be given infection control instructions: including frequent hand washing with soap and water.  Use alcohol-based hand gels (containing at least 60% alcohol) when soap and water are not available and hands are not visibly dirty.  When the ill person is within 6 feet of others at home, the ill person should wear a face mask if one is available and the ill person is able to tolerate wearing it. 

Regarding Household Contacts:
Household contacts who are well should:
1.remain home at the earliest sign of illness;
2.minimize contact in the community to the extent possible;
3.designate a single household family member as the ill person’s caregiver to minimize interactions with asymptomatic persons.

School Dismissal and Childcare Facility*Closure:
Dismissal of students should be strongly considered in schools with a confirmed or a suspected case epidemiologically linked to a confirmed case.
Decisions regarding broader school dismissal within these communities should be left to local authorities, taking into account the extent of ILI in the community.
If the school dismisses students or a childcare facility closes, they should also cancel all school or childcare related gatherings and encourage parents and students to avoid congregating outside of the school.
Schools and childcare facilities should dismiss students for a time period to be evaluated on an ongoing basis depending upon epidemiological findings.   
Schools and childcare facilities should consult with their local or state health departments for guidance on reopening.  If no additional confirmed or suspected cases are identified among students (or school-based personnel) for a period of 7 days, schools may consider reopening.
Schools and childcare facilities in unaffected areas should begin to prepare for the possibility of school dismissal or childcare facility closure.  This includes asking teachers, parents and officials in charge of critical school-associated programs (such as meal services) to make contingency plans.

Other Social Distancing Interventions:
Large gatherings linked to settings or institutions with laboratory-confirmed cases should be cancelled, for example a school event linked to a school with cases; other large gatherings in the community may not need to be cancelled at this time.
Additional social distancing measures are currently not recommended.
Persons with underlying medical conditions who are at high risk for complications of influenza may wish to consider avoiding large gatherings.
 

These recommendations are subject to change as additional epidemiological and clinical data become available.

*Childcare facility: centers and facilities that provide care to any number of children in a nonresidential setting, large family childcare homes that provide care for seven or more children in the home of the provider and small family childcare homes that provide care to six or fewer children in the home of the provider. 

Πλοήγηση

[0] Λίστα μηνυμάτων

[#] Επόμενη σελίδα