M. A. El-Farrash

1. M. A. El-Farrash

3. هو مرض يسببه فيروس جديدA(H1N1) • وينتقل منانسانالي آخر وليس للانسان مناعةضده. • الجائحة: تحدث عندما يصيب فيروس جديد ومعدي بدرجة كبيرة أعداداً هائلةً من البشر على مستوى العالم في فترة زمنية قصيرة. • حدثت جائحة الأنفونزا ثلاث مرات في القرن الماضي أعوام 1918، 1958، 1986وتسببت في أعداد كبيرة من الوفيات. M. A. El-Farrash

4. تعريف الحالة المشتبهة لمرض A/H1N1 • شخص يعاني من ارتفاع بدرجة الحرارة >38 م • مع أي من الأعراض الآتية: آلام بالجسم – كحة – رشح – احتقان بالحلق – صداع – غثيان – قئ – إسهال • مع ضرورة وجود واحد أو أكثر مما يلي: • المخالطة القريبة لحالة مؤكدة أو مشتبه إصابتها بفيروس الأنفلونزا المستجدة  A/H1N1خلال 7 أيام سابقة • التواجد في تجمع به حالة أو أكثر مصابة بفيروس الأنفلونزا المستجدةA/H1N1  خلال 7 أيام سابقة M. A. El-Farrash

5. تعريف الحالة المؤكدة لمرض A/H1N1 • هي حالة مشتبهة ثبت أنها إيجابية لفيروس الأنفلونزا المستجدةA/H1N1باستخدام الفحص RT-PCR • تعريف الحالة الشبيهة بالأنفلونزا • ارتفاع حاد في درجة الحرارة >38 درجة مئوية مع تاريخ مرضى للكحة أو احتقان بالحلق خلال الأسبوع السابق M. A. El-Farrash

6. Influenza Virus M. A. El-Farrash

7. Classification • Classification of virus strains is done on the basis of matrix proteins and nucleocapsid into three main types: • Influenza A : Infects many species especially birds. HA and NA undergo minor and occasional major changes (shift and drift). • Influenza B: Undergoes relatively slow change in HA with time. Known only in man and seals. • Influenza C: Uncommon strain, known only in man and pigs. M. A. El-Farrash

8. Influenza A Virus • The main human pathogen, associated with epidemics and pandemics. • There are 16 (H)serotypes and 9 (N)serotypes. • Infect a wide variety of mammals, including man, horses, pigs, and birds. • Pigs and birds are important reservoirs, generating pools of genetically diverse viruses which may cause epidemics in humans. • It caused all flu pandemics known. M. A. El-Farrash

9. Influenza • Influenza is characterized by fever, myalgia, headache and pharyngitis. • In addition there may be cough, gastrointestinal symptoms and in severe cases, prostration. • There is usually no coryza (runny nose) which characterizes common cold infections. • Symptoms may be very mild, even asymptomatic, moderate or very severe. M. A. El-Farrash

10. Influenza • Spread: rapid via aerial droplets (direct or indirect) with inhalation into the pharynx or lower respiratory tract. • Contactplays an important role. • Incubation Period: is short (1-5 days). • Rapid spread leads to epidemics. • The patient is infectiousduring the last part of the incubation period. M. A. El-Farrash

11. Complications of Influenza • Pneumonia caused by influenza virus itself; • Pneumonia caused by bacteria : Haemophilus influenzaeStaphylococcus aureus Streptococcus pneuminiae. • Influenza complications (may cause death) tend to occur in the young, elderly, and persons with chronic cardio-pulmonary diseases. M. A. El-Farrash

12. Options for Controlling Influenza • The most effective strategy for preventing influenza is annual vaccination . • Antiviral drugs used for chemoprophylaxis or treatment of influenza are adjuncts to vaccine but are not substitutes for annual vaccination. • Non pharmacologic interventions (e.g., advising frequent hand washing and improved respiratory hygiene) are reasonable and inexpensive; these strategies have been demonstrated to reduce respiratory diseases. M. A. El-Farrash

13. Treatment M. A. El-Farrash

14. The Vaccine M. A. El-Farrash

15. The Vaccine • Flu vaccines are available either as: • TIV : flu shot (injection) of trivalent inactivated (killed) vaccine, or • LAIV: nasal spray of live attenuated influenza vaccine. • LAIV is not recommended for individuals under age 2 or over age 50, but might be comparatively more effective among children over age 2. M. A. El-Farrash

16. The Swine Flu Vaccines • Pandemrix, made byGlaxoSmithKline, and • Focetria, made by Novartis were approved on 25 September 2009. • Both are made by growing the virus in hens' eggs, then breaking and deactivating the virus. • Celvapan, made by Baxter (made in cell culture, suitable for those who have an egg allergy) was approved the following week. M. A. El-Farrash

17. The Vaccine Pandemrix • As well as a the active antigen derived from A/California/7/2009 (H1N1), the vaccine contains an immunologic adjuvant AS03 (DL-α-tocopherol (vitamin E), squalene and polysorbate 80). • Thiomersal is added as a preservative. • Being manufactured in chicken eggs, it contains trace amounts of egg proteins. • Other ingredients are formaldehyde, sodium deoxycholate, and sucrose. M. A. El-Farrash

18. The Vaccine Pandemrix • The vaccine is supplied in 2 separate vials, one containing the adjuvant, and the other the inactivated virus, which require mixing before injection. • Originally it was thought that two doses given 21 days apart would be required for full efficacy. • Subsequent testing has allowed just a singledose for most people, with a two-dose schedule for immunocompromised adults. M. A. El-Farrash

19. The Vaccine Contraindications • The vaccine is contraindicated and should not be administered to persons known to have anaphylactic hypersensitivity to eggs or to other components of the influenza vaccine unless the recipient has been desensitized. • Persons with moderate to severe acute febrile illness usually should not be vaccinated until their symptoms have abated. M. A. El-Farrash

20. The Egyptian(s) Reaction • The vaccine is causing cancers!! • The vaccine is causing, neuritis, autism and Gullian –Barre Syndrome!! • The adjuvant added is causing autoimmunity!! • The vaccine contains a substance that will induce sterility in male Muslims !! • The Minister of health is taking something and giving people another thing!! M. A. El-Farrash

21. Squalene • Immunologic adjuvants are substances, administered in conjunction with a vaccine, that stimulate the immune system and increase the response to the vaccine. • Squalene is one of those adjuvants. • It is added to improve the efficacy of several vaccines, including pandemic flu and malaria vaccines. • Several European countries, which use it in their 2009 flu pandemic vaccines. M. A. El-Farrash

22. Squalene • Squalene is a natural organic compound originally obtained from shark liver oil, though plant sources are used as well, including rice bran, wheat germ, and olives. • Squalene has been proposed to be an important part of the Mediterranean diet as it may be a chemopreventative substance that protects people from cancer. • All higher organisms produce squalene, including humans. M. A. El-Farrash

23. Squalene • Newsweek states that "wild rumors" about the swine flu vaccine are being spread through e-mails. • Newsweek states that some chain e-mails make false claims about squalene in vaccines. • The New York Times also notes that anti-vaccine groups have spread "dire warnings" about formulations of the vaccine that contain squalene as an adjuvant. M. A. El-Farrash

24. Squalene • A 2009 meta-analysis by published in the journal Vaccine brought together data from 64 clinical trials of influenza vaccines with the squalene-containing adjuvant and compared them to the effects of vaccines with no adjuvant. • The analysis reported that the adjuvanted vaccines were associated with slightly lower risks, but that neither type of vaccines altered the rate of autoimmune diseases; the authors concluded that their data "supports the good safety profile associated with adjuvanted influenza vaccines and suggests there may be a clinical benefit over non-adjuvanted vaccines".

25. Squalene • There have been attempts to link squalene to Gulf War Syndrome mainly due to the idea that squalene might have been present in an anthrax vaccine given to some military personnel during the 1991 Persian Gulf War. • It has been determined that the anthrax vaccines given to those US military personnel did not use squalene as an adjuvant. • The vaccines were also tested for squalene, and none was detected with standard methods.

26. The Vaccine Pandemrix side effects • Multi-dose versions of the vaccine contain the preservative thiomersal, a mercury compound that prevents contamination when the vial is used repeatedly. • The use of thiomersal is controversial, with claims that it can cause autism and other neurodevelopmental disorders. • No convincing scientific evidence supports these claims. M. A. El-Farrash

27. Thiomersal • Thiomersal(sodium ethylmercurithiosalicylate), is an organomercury compound (approximately 49% mercury by weight) used as an antiseptic and antifungal agent. • it has been used as a preservative in vaccines, immunoglobulin preparations, skin test antigens, antivenins, ophthalmic and nasal products, and tattoo inks. M. A. El-Farrash

28. Thiomersal • Thiomersal's safety for its intended uses first came under question in the 1970s, when case reports demonstrated potential for neurotoxicity when given in large volumes as a topical antiseptic. • At the time, the DPT vaccine was the only childhood vaccine that contained it; a 1976 United States FDA review concluded that this use of thiomersal was not dangerous. M. A. El-Farrash

29. Thiomersal • In 1999, a new FDA analysis concluded that infants could receive as much as 187.5 micrograms of ethylmercury during the first six months; • One dose from a multi-dose vial contains approximately 25 micrograms of mercury, a bit less than a typical tuna fish sandwich. M. A. El-Farrash

30. Thiomersal • Some parents of autistic children adopted thiomersal as an explanation for the increase in reported autism cases and sued vaccine makers; the mercury-autism hypothesis is accepted widely among parents of autistic children, despite scientific studies rejecting it. • The WHO has concluded that there is no • evidence of toxicity from thiomersal in vaccines. M. A. El-Farrash

31. Thiomersal • No scientific evidence indicates that thiomersal in vaccines, including influenza vaccines, is a cause of adverse events other than occasional local hypersensitivity reactions in vaccine recipients. • In addition, no scientific evidence exists that thiomersal-containing vaccines are a cause of adverse events among children born to women who received vaccine during pregnancy. The weight of accumulating evidence does not suggest an increased risk for neurodevelopment disorders from exposure to thiomersal-containing vaccines.

32. The Vaccine Pandemrix side effects • A review by the U.S. NIH concluded that the 2009 H1N1 ("swine flu") vaccine has a safety profile similar to that of seasonal vaccine. • As of November 19, 2009, the WHO said that 65 million doses of vaccine had been administered and that it had a similar safety profile to the seasonal flu vaccine, with no significant differences in the adverse events produced by the different types of vaccine. M. A. El-Farrash

34. Healthcare providers: • Be aware of updates in case definitions; procedures for screening, indication of hospitalization, treatment , vaccination and infection control measures for H1N1 and other novel influenza viruses. M. A. El-Farrash

35. Health-care facilities should offer influenza vaccinations to all HCP, including night, weekend, and temporary staff particularly to workers who provide direct care for persons at high risk for influenza complications. • Efforts should be made to educate HCP regarding the benefits of vaccination and the potential health consequences of influenza illness for their patients, themselves, and their family members.

36. Persons working in health-care settings who should be vaccinated include physicians, nurses, and other workers in both hospital and outpatient-care settings, medical emergency-response workers, employees of nursing home and long-term--care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.

37. H1N1 Infection Control • In case of aerosol generating procedures (aspiration of respiratory tract, intubation, resuscitation, bronchoscopy, autopsy) use N-95 masks. • Gloves and gown should be used for all patient contact. • Pay careful attention to hand hygiene before and after all patient contact or contact with items contaminated with respiratory secretions. M. A. El-Farrash

38. عند وصول مريض يشتبه في إصابته الاستقبال أو العيادة يجب تقييمه في مكان منفصل للفحص إن أمكن، لتحديد ما إذا كان تعريف حالة الاشتباه ينطبق عليه أم لا. • يتم وضع ماسك جراحي على وجه المريض • إن أمكن ذلك. • ارتداء الماسك الجراحي العادي. M. A. El-Farrash

39. الاهتمام بغسل الأيدي باستخدام الماء • والصابون أو الدلك بالكحول، قبل • وبعد أي تلامس مع المريض أو • البيئة المحيطة به وبعد خلع القفازات. • تخصيص أدوات ومستلزمات خاصة بالمريض وتجنب استخدام أي عبوات علاج مشتركة مع باقي المرضى • تنظيف وتعقيم الآلات التي يعاد استخدامها بأنسبطريقة. M. A. El-Farrash

41. M. A. El-Farrash

42. تخصيص غرفة (فردية/مشتركة) للمرضى المشتبه أوالمؤكد إصابتهم. • يكون مكان عزل المرضى المشتبه فيهم مستقل عن مكان المرضى المؤكد إصابتهم. • تهوية الغرفة جيداً مع إحكام غلق باب الغرفة وعدم فتحه إلاللضرورة. • غيرمسموح باستخدام المراوح داخل الغرفة. M. A. El-Farrash

43. يفضل وجود حمام وحوض خاص بالغرفة ، وفى حالةعدم وجود حمام وحوض داخلها يسمح للمريض باستخدام أقرب حمام وحوض خارج الغرفة بشرط أن يراعى ارتداء المريض للماسك الجراحي. • ينبغي أن لا تقل المسافة البينية بين أسرة المرضى عن واحد مترويفضل وضع اتجاه الأسرة فى العزل الجماعي بحيث يكون قدم أحد المرضى فى اتجاه قدم المريض الآخر. M. A. El-Farrash

44. مسافة ١ متر على الأقل

45. لا يخرج المريض من الغرفة إلا للضرورة القصوى. • ارتداء المريض للماسك الجراحي أثناء خروجه من الغرفة M. A. El-Farrash

46. M. A. El-Farrash

47. يفضل استخدام جهاز أشعة متحرك ليتم استخدامه داخل غرفة المريض (فى حالة توافر جهاز متحرك ) • فى حالة خروج المريض للذهاب لقسم الأشعة يراعى ما يلي: • ١. أن يتم ذلك فى غير أوقات الذروة (مثل وقت الزيارة) • ٢. يتم اتخاذ أقصر طريق لقسم الأشعة (طريق مختصر) • ٣. الالتزام بأن يقوم المريض بارتداء ماسك جراحي عادي (دائما فى حالة الخروج من غرفة العزل) • ٤. على الفريق الصحي بقسم الاشعة (الالتزام بغسل الايدي - ارتداء ماسك جراحي عادي – تطهير أسطح العمل). M. A. El-Farrash

48. M. A. El-Farrash

49. فرض قيود مشددة على الزيارة وبالأخص كبار السن والأطفال وذوي المناعة الضعيفة • يجب على الزائرين ارتداء الماسك الجراحي ويفضل إرتداء القفازات النظيفة أثناء التواجد مع المريض داخل الغرفة. • يجب على الزائرين غسل أيديهم جيدا بعدانتهاء الزيارة. • يجب تشجيع الزائرين على تقليل مخاطر انتقال العدوى بإتباع آداب النظافة العامةوآداب السعال. • يمنع نهائياً تبادل القبلات بين الزائرين والمرضى. M. A. El-Farrash

50. Prevention and Control of Seasonal Influenza with Vaccines Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009 Anthony E. Fiore, MD1, David K. Shay, MD1, Karen Broder, MD2 , John K. Iskander, MD2, Timothy M. Uyeki, MD1, Gina Mootrey, DO3, Joseph S. Bresee, MD1, Nancy J. Cox, PhD1 1Influenza Division, National Center for Immunization and Respiratory Diseases 2Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Preparedness, Detection and Control of Infectious Diseases 3Immunization Services Division, National Center for Immunization and Respiratory Diseases. • 2009 flu pandemic vaccine, From Wikipedia, the free encyclopedia