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Influenza A (H1N1)�Team Epidemic

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Seasonal Flu report

Source: GERMIS

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Season wise case and trend

Seasonal flu Cases & Death Year Wise

Sr.no

Month

2020

2021

2022

2023

Positive

Death

Positive

Death

Positive

Death

Positive

Death

1

January

6

0

0

0

0

0

44

0

2

February

15

0

0

0

0

0

30

1

3

March

32

2

0

0

0

0

6

0

4

April

2

0

0

0

1

0

0

0

5

May

0

0

0

0

2

1

0

0

6

June

0

0

0

0

2

0

0

0

7

July

0

0

0

0

200

0

0

0

8

August

0

0

23

1

1315

34

0

0

9

September

0

0

4

0

511

23

0

0

10

October

0

0

5

1

94

5

0

0

11

November

0

0

1

0

14

4

0

0

12

December

0

0

0

0

35

4

0

0

Total

55

2

33

2

2174

71

80

1

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Year wise H1N1 trends

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Background

  • 2009 outbreak started from Mexico.
  • First case reported on 18th March 2009
  • First case reported in May 2009 in

Hyderabad in India

  • WHO declared swine flu as seasonal flu
  • However any fever in people with co-morbid conditions are to be treated carefully

​

* Press release MOHFW website

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Types of Influenza Viruses�

  • There are four types of influenza viruses: A, B, C, and D.
  • Influenza A and B viruses cause seasonal epidemics of disease in people (known as flu season) almost every winter in the United States.
  • Influenza A viruses are the only influenza viruses known to cause flu pandemics (i.e., global epidemics of flu disease). A pandemic can occur when a new and different influenza A virus emerges that infects people, has the ability to spread efficiently among people, and against which people have little or no immunity.
  • Influenza C virus infections generally cause mild illness and are not thought to cause human epidemics.
  • Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people.

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Mode of transmission

  • People become infected by touching

something with live flu viruses on it and then touching their mouth or nose (More than 80%)

  • Viruses are spread from person to person by droplet through coughing or sneezing of

people with influenza.

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​

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Communicability

  • From one day before to 7 days after the onset of symptoms.
  • If illness persists for more than 7 days, communicability may persist.
  • Children, especially younger children, might potentially be contagious for

longer periods.

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Clinical features

Vomiting or diarrhoea (not typical for influenza but reported by recent cases of swine influenza infection)

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Other Manifestations

  • Tachycardia
  • Tachypnoea
  • Low O2 sat.
  • Hypotension
  • Cyanosis
  • Acute myocarditis
  • Cardiopulmonary arrest

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​

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High Risk Groups

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Categorisation of cases

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Category- A

  • Mild fever plus sore throat /cough

with or without body ache, headache,

diarrhea/vomiting.

  • They do not require Oseltamivir
  • The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor.
  • No testing of the patient for Influenza is required

​

​

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Category-B

​

B (i) : A+ High grade fever and severe

sore throat.

B (ii) : A + HIGH RISK GROUPS

Given Oseltamivir to Cat-B patients

No tests for Influenza is required for

Category-B (i) and (ii).

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Category-C

Category A or B with 1 or more of the following

    • Breathlessness,
    • chest pain,
    • drowsiness,
    • hypotension,
    • cyanosis,
    • irritability or worsening of the existing chronic

condition

All these patients mentioned above in

Category-C require testing, immediate hospitalization and treatment.

​

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Investigations

  • Routine investigations for evaluation and management of symptoms
    • Hematological, bio chemical, radiological

and micro biological tests

  • Confirmation of influenza
    • RT – PCR
    • Isolation of virus in culture
    • Four fold rise in virus specific neutralizing

antibodies

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Specimens

  • Nasopharyngeal swab, nasal swab, throat swab, combined oro pharyngeal /

nasopharyngeal swab or nasal aspirate

  • Specimens should be placed in viral transport media and placed on ice (4oC) or

refrigerated immediately for transportation to the laboratory

  • Respiratory specimen should be collected within 4 to 5 days of illness.

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Technique for nasal swab �collection

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Management

  • Early implementation of Infection Control

precautions to minimize spread of disease

  • Prompt treatment to prevent severe illness anddeath
    • Supportive treatment (Antipyretics, antibiotics, IV fluids, Oxygen therapy, nutrition, saline gargling )
    • Specific anti viral treatment (Oseltamivir)
  • Early identification and follow up of persons at risk
  • Contact treatment for primary contacts of laboratory confirmed cases

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Antiviral treatment

  • Oseltamivir is the drug of choice for

treatment and chemoprophylaxis.

  • Available in capsule (75 mg and 30 mg) and

syrup form (75 ml bottle= 12 mg per ml)

  • For treatment, antiviral drugs work best if

started soon after getting sick

  • Reduces the duration of virus excretion and

the severity of illness

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Antiviral treatment for cases

  • Duration of treatment: 5 days BD
  • Dosage schedule

​

​

Weight

Dosage

<15 kg

30 mg BD 5Days

15-23 kg

45 mg BD 5Days

24 to <40kg

60 mg BD 5Days

>40 kg

75 mg BD 5Days

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Antiviral treatment for �cases-Infants

  • Duration of treatment: 5 days BD
  • Available as oral suspension
  • Dosage schedule

​

​

Months

Dosage

<3 months

12mg BD 5Days

3-5 months

20mg BD 5Days

6-11 months

25mg BD 5Days

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Contact tracing and �chemoprophylaxis

  • Powerful public health intervention to interrupt the transmission
  • Close contacts of confirmed cases are to be administered with Oseltamivir
  • Treating doctors and staff are to be

administered

​

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Antiviral dosage for �chemoprophylaxis

  • Duration of treatment: 10 days OD
  • Dosage schedule

​

​

Weight

Dosage

<15 kg

30 mg OD 10 Days

15-23kg

45mg OD 10 Days

24to<40kg

60mg OD 10 Days

>40 kg

75mg OD 10 Days

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Antiviral dosage for chemoprophylaxis -infants

  • Duration of treatment: 10 days OD
  • Chemoprophylaxis not recommended for children below 3 months generally
  • Dosage schedule

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​

Months

Dosage

3-5 months

20 mg OD 10 Days

6-11 months

25 mg OD 10 Days

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Fever surveillance

  • Monitor the contacts for fever

​

  • Look for fever cases in the

neighbourhood

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What should I do?

  • First and most important:

wash your hands

  • Practice cough etiquette
  • Get plenty of sleep
  • Drink plenty of fluids
  • Avoid touching surfaces that may be

contaminated with the flu virus.

  • Avoid close contact with people who

are sick.�

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What should I do?

​

  • Staying at home if you have flu like

symptoms

  • Educating school children and staff,

advising avoidance of mass gatherings

  • Avoid crowded places, avoid hand

shaking

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N95 Mask or triple layered mask

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Health Education Messages

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Don’ts

​

  • Do not take self medication
  • Do not buy drugs without prescription
  • Do not take steroids, brufen, aspirin like tablets
  • Do not ask for injections

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DOs

  • If you have flu like illness stay back at home
  • Any one with fever immediately contact a medical practitioner
  • While coughing and sneezing cover the nose and mouth with hand kerchief
  • Frequently wash hands

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Tracking cases

​

  • Addresses and contact numbers are to be recorded properly
  • Outcome of each case has to be followed and informed to the DPH

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Additional measures

  • Preventing all fevers will help to reduce panic and diagnostic dilemma
  • Water chlorination
  • Food hygiene
  • Aedes mosquito control

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