AVIAN INFLUENZA (H5N1)

SWINE FLU (H1N1)

AVIAN INFLUENZA/H5N1/FLU BURUNG

Avian influenza is an infectious disease of birds caused by

type A strains of the influenza virus. The disease occurs
worldwide. While all birds are thought to be susceptible
to infection with avian influenza viruses, many wild bird
species carry these viruses with no apparent signs of
harm
HISTORY AND EPIDEMIOLOGY.
 Influenza viruses are normally highly species-specific,
meaning that viruses that infect an individual species
(humans, certain species of birds, pigs, horses, and seals)
stay “true” to that species, and only rarely spill over to
cause infection in other species. Since 1959, instances of
human infection with an avian influenza virus have been
documented on only 10 occasions. Of the hundreds of
strains of avian influenza A viruses, only four are known
to have caused human infections: H5N1, H7N3, H7N7,
and H9N2. In general, human infection with these
viruses has resulted in mild symptoms and very little
severe illness, with one notable exception: the highly
pathogenic H5N1 virus.
 Of all influenza viruses that circulate in birds, the H5N1
virus is of greatest present concern for human health for
two main reasons. First, the H5N1 virus has caused by
far the greatest number of human cases of very severe
disease and the greatest number of deaths. It has crossed
the species barrier to infect humans on at least three
occasions in recent years: in Hong Kong in 1997 (18
cases with six deaths), in Hong Kong in 2003 (two cases
with one death) and in the current outbreaks that began
in December 2003 and were first recognized in January
2004.
TRANSMISSION
 The virus can improve its transmissibility among humans via
two principal mechanisms. The first is a “reassortment” event,
in which genetic material is exchanged between human and
avian viruses during co-infection of a human or pig.
Reassortment could result in a fully transmissible pandemic
virus, announced by a sudden surge of cases with explosive
spread.
 The second mechanism is a more gradual process of adaptive
mutation, whereby the capability of the virus to bind to human
cells increases during subsequent infections of humans.
Adaptive mutation, expressed initially as small clusters of
human cases with some evidence of human-to-human
transmission, would probably give the world some time to
take defensive action, if detected sufficiently early.
CLINICAL FEATURES
 Current data for H5N1 infection indicate an incubation
period ranging from two to eight days and possibly as
long as 17 days.
 Initial symptoms include a high fever, usually with a
temperature higher than 38oC, and influenza-like
symptoms. Diarrhoea, vomiting, abdominal pain, chest
pain, and bleeding from the nose and gums have also
been reported as early symptoms in some patients.
Watery diarrhoea without blood appears to be more
common in H5N1 avian influenza than in normal
seasonal influenza. The spectrum of clinical symptoms
may, however, be broader, and not all confirmed patients
have presented with respiratory symptoms.
 http://www.who.int/mediacentre/factsheets/avian_influen
za/en/
February 2006
 SWINE FLU/ HOG FLU/
H1N1 INFLUENZA/ FLU BABI
DEFINITION
Swine influenza, or “Swine Flu” or “Hog Flu” or “H1N1
Influenza” is a highly contagious acute respiratory
disease caused by any strain of the influenza virus
endemic in pigs (swine) that regularly cause outbreaks of
influenza among pigs. Strains endemic in swine are
called swine influenza virus (SIV).
CLASSIFICATION
 Classification SIV strains isolated to date have been
classified either as: Influenza virus A (common): various
subtypes H1N1, H1N2,H3N1,H3N2, & H2N3 In pigs,
three influenza A virus subtypes (H1N1, H3N2, &
H1N2) are the most common strains worldwide. .
Influenza virus C (rare): Due to its limited host range
and the lack of genetic diversity, this form of influenza
does not cause pandemics in humans
Cause By Reassortment Of Different Strains Like all
influenza viruses, swine flu viruses change constantly.
Pigs are distinct from other species in that their cells
possess receptors that can bind to swine, human & avian
influenza viruses; therefore two or more types of viruses
may co-infect swine cells and combine to produce a
novel virus.When influenza viruses from different
species infect pigs, the viruses can reassot (i.e swap
genes ) and a new viruses that are a mix of swine, human
and/or avian influenza viruses can emerge
Present Swine Flu Strains The 2009 flu outbreak is due to a
new strain of influenza, an apparent reassortment of at
least four strains of influenza A virus subtype H1N1,
including one strain endemic in humans, one endemic in
birds & two endemic in swine.
TRANSMISSION TO HUMAN :

 Transmission To Human Direct Transmission Pigs to

Human (people are in close proximity to infected pigs,
such as in pig barns & livestock exhibits housing pigs at
fairs) Human to Pigs .
 Indirect Transmission Human to Human: (via
aerosolized respiratory secretions for e.g. coughing
,sneezing of infected person, touching contaminated
inanimate objects & then touching nose or mouth)
 Swine influenza viruses are not transmitted from eating
pork or pork products. Cooking pork to an internal
temperature of 160°F kills the swine flu virus.
 Incubation Period :
Incubation Period It is usually one to three days Pigs begin
excreting the virus within 24 hours of infection, and may
shed the virus for seven to ten days.

 Infectious Period :
Infectious Period Defined as 1 day prior to the case’s
illness onset to 7 days after onset.Younger children,
might potentially be contagious for longer periods up to
10 days.A carrier state can exist for up to 3 months.The
viruses can live 2 hours or longer outside body.
PATHOPHYSIOLOGY :

 Pathophysiology Influenza viruses enters the respiratory

tract bind through Hemagglutinin onto Sialic acid sugars
on the surfaces of epithelial cells; typically in the nose,
throat and lungs of mammals. The respiratory tract
becomes swollen & inflamed .From the tract it then
enters the blood streams and symptoms begins to show .
SYMPTOMS :

 Symptoms Fever with or without chills Lethargy Lack of

appetite Sore throat Cough Running nose Body ache
Headache Nausea Vomiting Diarrhea 1 According to
Center for disease control & prevention (CDC),
symptoms of swine flu resembles seasonal influenza and
other acute upper respiratory tract infections.
SWINE FLU 2009 :

 Swine Flu 2009 From

December 2005 through
February 2009, a total of 12
human infections with
swine influenza were
reported from 10 states in
the United States. The new
strain of swine flu was first
recognized as such when the
CDC received a sample on
April 14 from a patient who
fell ill on March 30 in San
Diego Country, California
DIAGNOSIS :

 Diagnosis To diagnose swine influenza A infection ,a

respiratory specimen (nasopharyngeal swab/aspirate or
nasal wash/aspirate, combined nasal swab with an
oropharyngeal swab, endotracheal aspirate) would
generally need to be collected within the first 4 to 5 days
of illness (when an infected person is most likely to be
shedding virus). However, some persons, especially
children, may shed virus for 10 days or longer Specimen
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.
DIAGNOSIS
 Real-time RT-PCR :
Real-time RT-PCR Also called quantitative real time polymerase chain reaction is
a laboratory technique based on the polymerase chain reaction, which is used to
amplify & simultaneously quantify a targeted DNA molecule. The CDC
currently recommends real-time RT-PCR for influenza A, B, H1, H3. A positive
test result from the rRT-PCR indicates that the patient is presumably an infected
with swine influenza virus. The test does not indicate the stage of infection.
 Viral Culture :

Viral Culture Isolation of swine-origin influenza A (H1N1) virus is diagnostic of

infection, but may not yield timely results for clinical management. It provides
results in 3-10 days. A negative viral culture does not exclude infection with
swine-origin influenza A (H1N1) virus.
 Rapid Influenza Diagnostic Tests & Immunofluroscence :

Rapid Influenza Diagnostic Tests & Immunofluroscence These tests can

distinguish between influenza A and B viruses. A patient with a positive for
influenza A may meet criteria for a suspected case. But they cannot distinguish
between seasonal influenza A and swine influenza, which is a subtype of A.