Vaccine India

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SWINE FLU



SWINE FLU OUTBREAK

Recently, human cases of swine influenza A (H1N1) virus infection have been recently reported in several 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 and thus represents a real pandemic threat.

  TRANSMISSION

·         Influenza viruses can be directly transmitted from pigs to people and from people to pigs.

·         Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs.

·         Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu which is mainly person-toperson transmission through coughing or sneezing by people infected with the influenza virus.

 

·         Disease spreads very quickly among the population especially in crowded places.

 

·         Cold and dry weather enables the virus to survive longer outside the body than in other  conditions and, as a consequence, seasonal epidemics in temperate areas appear in winter.

·         People may become infected by touching/handling something contaminated with flu viruses  on it and then touching their mouth or nose.

·         Swine influenza viruses are not transmitted by food.

·         Eating properly handled and cooked pork (at an internal temperature of ≥160°F) and pork products is safe.

 

 

SYMPTOMS

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza like fever, lethargy, lack of appetite and cough. Some people have also reported runny nose, sore throat, nausea, vomiting and diarrhoea.

 

PREVENTIVE MEASURES

There is currently no vaccine available against human swine influenza. One has to follow proper hand hygiene and respiratory etiquettes.

Do’s and Don’ts:

·         Avoid close contact with people who are having respiratory illness.

·         Sick persons should keep distance from others.

·         If possible, stay at home, away from work, school, and public places when you are sick.

·         Cover your mouth and nose with a tissue or handkerchief when coughing or sneezing.

·         If you have no tissue or handkerchief you should not clean the nose with the hands but with the cuff of your shirt or clothes.

·         Washing your hands often with soap or alcohol based hand wash will help protect from germs.

·         Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

·         Persons who develop influenza-like-illness (ILI) (fever with either cough or sore throat) should be strongly encouraged to selfisolate 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 should seek immediate medical attention and report to the nearby hospital.

·         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.

·         If a face mask is unavailable, ill persons needing to go into the community should use a handkerchief or tissues to cover any coughing and sneezing.

·         Persons in home isolation and their household members should be given infection control instructions like frequent hand washing with soap and water; use of alcohol-based hand gels (containing at least 60%alcohol).

·         When the ill person is within 6 feet of others at home, the ill person should wear a face mask, if available or handkerchief or tissues.

·         Household contacts who are well should:

a)      remain home at the earliest sign of illness;

b)      minimize contact in the community to the extent possible;

c)      designate a single household family member as the ill person’s caregiver to minimize interactions with asymptomatic persons.

·         Precautions for School children:

a)      Schools with a confirmed or a suspected case should be considered for closure.

b)      All school or childcare related gatherings should be cancelled and encourage parents and students to avoid congregating outside of the school.

c)      Schools and childcare facilities should bar students for a time period to be evaluated on an ongoing basis depending upon epidemiological findings.

d)     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.

e)      Schools and childcare facilities in unaffected areas should begin to prepare for the possibility of school or childcare facility closure.

 

 

Social Distancing Interventions:

a)      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.

b)      Additional social distancing measures are currently not recommended.

c)      Persons with underlying medical conditions who are at high risk for complications of influenza may wish to

d)     consider avoiding large gatherings.

Important Contact Numbers:

Outbreak Monitoring Cell (Control Room, NICD): 011-23921401

EMR Control room (Ministry of Health and family Welfare: 011- 23061469

 

Case Definition

 

 

 

 

A suspected case of swine influenza A (H1N1) virus infection is defined as a person

with acute febrile respiratory illness (fever ≥ 38 0 C) with onset.:

·   within 7 days of close contact with a person who is a confirmed case of swine influenza A (H1N1) virus infection, or

·    within 7 days of travel to community where there are one or more confirmed swine influenza A(H1N1) cases, or

·   resides in a community where there are one or more confirmed swine influenza cases.

A probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness who: 

·   is positive for influenza A, but unsubtypable for H1 and H3 by influenza RT-PCR or reagents used to detect seasonal influenza virus infection, or

·   is positive for influenza A by an influenza rapid test or an influenza immunofluorescence assay (IFA) plus meets criteria for a suspected case

·   individual with a clinically compatible illness who died of an unexplained acute respiratory –illness who is considered to be epidemiologically linked to a probable or confirmed case.

A confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory

confirmed swine influenza A (H1N1) virus infection at  WHO approved laboratories by one or more of the following tests:

·   Real Time PCR

·   viral culture

·   Four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies.

Hand hygiene guideline

 1. VIRUS SURVIVAL

 • Evidence suggests that the flu virus does not survive for long periods of time on soft items although it can survive up to 24 hours on hard surfaces.

• Hard, non-porous surfaces (e.g. stainless steel counter or plastic bowls): flu virus is able to survive for up to 72 hours but only for 24 hours in large enough quantities to pose a risk of infection

• Soft surfaces/furnishings (e.g. clothes, handkerchiefs, tissues, magazines): flu virus is able to survive for up to 12 hours but only for about 15 minutes in large enough quantities to pose an infection risk

• Once the virus is transferred to hands, it survives for less than five minutes

• Cleaning your hands with soap and water (followed by drying) according to the guidelines is an effective way to kill flu virus on your hands

• The flu virus is killed within 30 seconds by appropriate antiseptic handrub solutions

 2. HYGIENE MEASURES

 2.1 Hand hygiene

 The risk of becoming infected with the virus is effectively reduced by following strict hand hygiene measures. Hands can be cleaned by washing with soap and water according to the guidelines or using appropriate antiseptic handrub solution. Hands must be decontaminated immediately after each and every episode or direct contact to an ill person or someone with flu symptoms and after any activity or contact that potentially results in hands becoming contaminated.

 Hands that are visibly soiled or potentially grossly contaminated with dirt or organic material, e.g. after removal of gloves, must be washed with liquid soap and water. Hands should be decontaminated between caring for different patients and between different care activities for the same patient. For convenience and efficacy, an appropriate antiseptic handrub solution is preferable unless hands are visibly soiled. If antiseptic handrubs are used, hands should be washed with soap and water after several consecutive applications of the handrub.

 Before a shift of work begins it is advisable that all wrist and, ideally, hand jewellery be removed. Cuts and abrasions must be covered with waterproof dressings. Fingernails are advised to be kept short, clean and free of nail polish. False nails and nail extensions must not be worn while attending to sick people.

 An effective hand washing technique involves three stages: preparation, washing and rinsing, and drying.

 Preparation requires wetting hands under running water before applying the recommended amount of liquid soap or an antimicrobial preparation. Soap must come into contact with all the surfaces of the hand.

 The hands must be rubbed together vigorously with soap for a minimum of 10–15 seconds, and particular attention should be paid to the tips of the fingers, the thumbs and the areas between the fingers.

 Hands should be rinsed thoroughly prior to drying with good-quality paper towels. When an antiseptic handrub solution is used to decontaminate hands, hands should be free of dirt and organic material. The handrub solution must come into contact with all surfaces of the hand. The hands must be rubbed together vigorously, with particular attention paid to the tips of the fingers, the thumbs and the areas between the fingers, until the solution has evaporated and the hands are dry or for not less than about 30 seconds.

 It is advisable to use an emollient hand cream regularly, e.g. after washing hands before a break, or when going off duty and when off duty, to maintain the integrity of the skin.

 If a particular soap, antimicrobial hand wash or antiseptic handrub solution causes skin irritation, review the methods described above before consulting a healthcare worker. An appropriate antiseptic handrub solution should be made available at the point of service delivery in all work environments where the hands of the workers could get contaminated. In work environment, hand hygiene resources and individual practice should be audited at regular intervals and the results fed back to working staff. Education and training in risk assessment, effective hand hygiene and glove use should form part of staff education and awareness.

2.2 Hands must be cleaned:

 • When arriving at and leaving the workplace

• When arriving at home from work or outside activities

• Before and after direct contact with contaminated surfaces

• After contact with body secretions

• Before and after removing protective work clothing and gloves

• After handling soiled items

• Before handling food

• Before eating

• Before smoking

• Before touching your mouth, nose or eyes

Guidance on Personal Protection

 PROTECTING YOURSELF AND OTHERS FROM INFLUENZA – A (H1N1)

 Proper hand hygiene and other appropriate protective measures will greatly minimize the spread of virus and help protecting yourself and others. Transmission of virus from an infected person to a non-infected person depends on the closeness of the contact, length of exposure and survival of the virus on hands and the environment.

 VIRUS SURVIVAL

 • Evidence suggests that the flu virus does not survive for long periods of time on soft items although it can survive up to 24 hours on hard surfaces.

• Hard, non-porous surfaces (e.g. stainless steel counter or plastic bowls): flu virus is able to survive for up to 72 hours but only for 24 hours in large enough quantities to pose a risk of infection

• Soft surfaces/furnishings (e.g. clothes, handkerchiefs, tissues, magazines): flu virus is able to survive for up to 12 hours but only for about 15 minutes in large enough quantities to pose an infection risk

• Once the virus is transferred to hands, it survives for less than five minutes

• Cleaning your hands with soap and water (followed by drying) according to the guidelines is an effective way to kill flu virus on your hands

• The flu virus is killed within 30 seconds by appropriate antiseptic handrub solutions

 HYGIENE

 The risk of becoming infected with the virus is effectively reduced by following strict hygiene measures.

Hands can be cleaned by washing with soap and water (followed by drying) according to the guidelines or using antiseptic hand washing solution/appropriate antiseptic handrub solution. If your hands are visibly dirty, soap and water should be used instead of antiseptic handrub solution.

Hands must be cleaned:

• When arriving at and leaving the workplace

• When arriving at home from work or outside activities

• Before and after direct contact with contaminated surfaces

• After contact with body secretions

• Before and after removing protective work clothing and gloves

 Masks should not be seen as a substitute for hand hygiene and other basic precautions

 • After handling soiled items

• Before handling food

• Before eating

• Before smoking

• Before touching your mouth, nose or eyes

Recommended PPEs include surgical mask, high filtration mask, disposable glove, plastic gown/apron and plastic goggle

• Types of PPEs to be used would depend on the circumstances and risks involved.

• Use of PPEs are recommended if you are coming into close contacts (within one metre) of a suspected, probable or confirmed case of influenza A (H1N1)

• Special trainings have to be provided for the use of high filtration masks and other similar PPEs.

• Ensure that you are using the PPE correctly

• Use the PPE (usually aprons, surgical masks and gloves) only when there is a risk of contamination from respiratory secretions.

Whilst the appropriate use of PPE may offer some protection to clothes from contamination, during a pandemic you may wish to consider changing out of your work clothes before going home. Work clothes that are washed at home can be washed in a domestic washing machine. You may soak the cloth in a diluted bleach solution (0.05% bleach solution) if it is likely to be contaminated.

 Disposing off PPEs

 In order to minimize the risk of infecting yourself or your colleagues from used PPE, it is essential that it is removed in a standard manner following these steps:

1. first of all remove your gloves by turning them inside out in one single motion

2. then remove your apron

3. wash your hands and

4. finally remove the surgical mask

Avoid touching the front of the mask. The disposable PPEs should be bagged and disposed of. After disposing of PPE, it is essential that you clean your hands with soap and water. Use an appropriate antiseptic handrub if water is not available.

Used PPE can be disposed of with normal household waste, preferably in tied polythene bags. There is no need for non-healthcare settings to introduce clinical waste procedures for the disposal of PPE during an influenza pandemic.

 STAFF WORKING IN THE TRANSPORTATION VEHICLES

 Staff in a vehicle or vessel transferring a suspected or probable influenza A (H1N1) is advised to use a surgical mask.

Staff in these vehicle or vessel may be involved in carrying a probable or confirmed case of influenza A (H1N1). If a probable or confirmed patient is being carried to a facility, staff in close contact should wear a high filtration mask, plastic apron/gown and gloves.

Follow the hand hygiene measures and general respiratory hygiene etiquettes.

 STAFF WORKING IN QUARANTINE FACILITIES

 When entering a room occupied by a person with suspected or probable influenza A (H1N1)

 Visits to such premises should be restricted to those that are essential or emergencies. If you are required to enter such a premise as part of your duty or otherwise, you are advised to use a surgical mask, plastic apron and gloves.

 Assisting a healthcare worker with an aerosol generating healthcare procedure

 It is very unlikely that MNDF staff will need to wear PPE with high filtration masks. However, if they were asked to assist a healthcare worker in an aerosol generating healthcare procedure they would need to use full PPE with high filtration mask.

During a pandemic, there may be situations where a member of public or someone in custody becomes a suspected case of influenza A (H1N1) or you may be involved in restraining someone or administering first aid to or resuscitating someone who is suspected case of influenza A (H1N1). In these situations, you should follow standard guidance as follows:

• If a person has died at home and is a suspected case of influenza A (H1N1), then surgical mask and disposable gloves should be worn when handling the body or articles in the home. Avoid touching your face or mouth with your gloved hands.

• It is important that you discard the gloves and wash your hands after leaving the premises.

 Dealing with people in custody

 During a pandemic if someone in custody is suspected of having influenza A (H1N1); they (the prisoner) should wear a surgical mask and be medically assessed. In addition, if you enter their cell or are within one metre of the prisoner then you should wear an apron, surgical mask and gloves.

 Dealing with the population at large

 PPE is NOT needed for routine policing activities. You should only use PPE if you have to come into close contact (within one metre) with someone who is a suspected case of influenza A (H1N1). Otherwise general respiratory hygiene etiquettes and measures to reduce contact should be used.

 Assisting a healthcare worker with an aerosol generating healthcare procedure

 It is very unlikely that police officers will need to wear PPE with high filtration masks. However, if they were asked to assist a healthcare worker in an aerosol generating healthcare procedure they would need to use full PPE with high filtration mask.

 

Cleaning and disinfection procedures

 Janitors and refuse collectors are advised to use disposable gloves.

The flu virus is easily killed by commonly available cleaning products and detergents.

Freshly prepared bleach solution (0.05% bleach solution)# should be used for surface cleaning.

Rooms, public premises such as elevators and reception desks should be cleaned at least once a day. Damp rather than dry dusting should be performed.

Hands should be washed immediately after all cleaning procedures even if disposable gloves are used.

 Room decontamination

 There is no need for fumigation or other special measures where a room is occupied or has been vacated after occupation by people who may be infected with influenza A (H1N1).

• Staff who clean rooms occupied by an ill person must wear surgical mask, an apron and gloves (PPE) before cleaning

• Ventilate the room by opening external windows

• Remove the bed linen and towels and place in a bag

• Do not leave loose items in the corridor or common parts

• Dispose of all disposable items such as sachets and toilet rolls

• Clean remaining items such as cups, glasses etc using water and detergent

• Apply Freshly prepared bleach solution (0.05% bleach solution) and allow at least 10 minutes before wiping clean

• Pay particular attention to hand contact surfaces e.g. door handles, taps, flush handle, light switches, telephone handsets, TV remote control, bedside tables, etc.

• Use plenty of cleaning cloths to avoid re-contaminating surfaces

 Rubbish bags

 The risk of infection by contact with tissues or contaminated materials in the rubbish bin is very low but it is recommended that gloves are used if handling soiled tissues.

Hands should be washed immediately after all cleaning procedures even if disposable gloves are used.

Health Workers Personal Protection

 PROTECTING YOURSELF AND OTHERS FROM INFLUENZA – A (H1N1)

Proper hand hygiene and other appropriate protective measures will greatly minimize the spread of virus and help protecting yourself and others. Transmission of virus from an infected person to a non-infected person depends on the closeness of the contact, length of exposure and survival of the virus on hands and the environment.

 VIRUS SURVIVAL

• Evidence suggests that the flu virus does not survive for long periods of time on soft items although it can survive up to 24 hours on hard surfaces.

• Hard, non-porous surfaces (e.g. stainless steel counter or plastic bowls): flu virus is able to survive for up to 72 hours but only for 24 hours in large enough quantities to pose a risk of infection

• Soft surfaces/furnishings (e.g. clothes, handkerchiefs, tissues, magazines): flu virus is able to survive for up to 12 hours but only for about 15 minutes in large enough quantities to pose an infection risk

• Once the virus is transferred to hands, it survives for less than five minutes

• Cleaning your hands with soap and water (followed by drying) according to the guidelines is an effective way to kill flu virus on your hands

• The flu virus is killed within 30 seconds by appropriate antiseptic handrub solutions

 HYGIENE MEASURES

 Hand hygiene

The risk of becoming infected with the virus is effectively reduced by following strict hygiene measures.

Hands can be cleaned by washing with soap and water (followed by drying) according to the guidelines or using antiseptic hand washing solution/appropriate antiseptic handrub solution. If your hands are visibly dirty, soap and water should be used instead of antiseptic handrub solution.

Hands must be cleaned:

• When arriving at and leaving the workplace

• When arriving at home from work or outside activities

• Before and after direct contact with contaminated surfaces

• After contact with body secretions

• Before and after removing protective work clothing and gloves

• After handling soiled items

• Before handling food

• Before eating

• Before smoking

• Before touching your mouth, nose or eyes

 USING PPE (Personal Protective Equipments)

Recommended PPEs include surgical mask, high filtration mask, disposable glove, plastic gown/apron, and plastic goggle

• Types of PPEs to be used would depend on the circumstances and risks involved

• Use of PPEs are recommended if you are coming into close contacts (within one metre) of a suspected, probable or confirmed case of influenza A (H1N1)

• Special trainings have to be provided for the use of high filtration masks and other similar PPEs.

• Ensure that you are using the PPE correctly

• Use the PPE (usually aprons, surgical masks and gloves) only when there is a risk of contamination from respiratory secretions Whilst the appropriate use of PPE may offer some protection to clothes from contamination, during a pandemic you may wish to consider changing out of your work clothes before going home. Work clothes that are washed at home can be washed in a domestic washing machine. You may soak the cloth in a diluted bleach solution (0.05% bleach solution) if it is likely to be contaminated.

 Disposing off PPEs

In order to minimize the risk of infecting yourself or your colleagues from used PPE, it is essential that it is removed in a standard manner following these steps:

1. first of all remove your gloves by turning them inside out in one single motion

2. then remove your apron

3. wash your hands and

4. finally remove the surgical mask

Avoid touching the front of the mask. The disposable PPEs should be bagged and disposed of. After disposing of PPE, it is essential that you clean your hands with soap and water. Use an appropriate antiseptic handrub if water is not available.

Used PPE can be disposed of with normal household waste, preferably in tied polythene bags. There is no need for non-healthcare settings to introduce clinical waste procedures for the disposal of PPE during an influenza pandemic

 AIRSIDE WORKERS

All airside workers are advised to wear surgical mask if they have to be in close contact (within one metre) with the passengers. Use of gloves and aprons are not recommended for this occupational group.

Follow the hand hygiene measures and general respiratory hygiene etiquettes.

 STAFF WORKING IN THE ARRIVAL TERMINAL

All the staffs working in the arrival terminal are advised to wear surgical mask if they have to be in close contact (within one metre) with the passengers. Use of gloves and aprons are not recommended for this occupational group.

Ensure hands are kept clean with frequent use of appropriate antiseptic hand rub. Follow the general respiratory hygiene etiquettes.

 STAFF WORKING IN THE TRANSPORTATION VEHICLES

Staff in a vehicle or vessel transferring a suspected or probable influenza A (H1N1) is advised to use a surgical mask.

Staff in a vehicle or vessel may be involved in carrying a probable or confirmed case of influenza A (H1N1). If a probable or confirmed patient is being carried to a facility, staff in close contact should wear a high filtration mask, plastic apron/gown and gloves.

Follow the hand hygiene measures and general respiratory hygiene etiquettes.

 Masks should not be seen as a substitute for hand hygiene and other basic precautions

 HOSPITALITY INDUSTRY

Staff caring for guests who is a suspected case* of influenza A (H1N1) should wear surgical masks, but only when coming into close contact (within one metre) and only if the guest has flu symptoms. Masks need not be worn continuously by staff and should not be seen as a substitute for hand hygiene and other basic precautions.

If staff is concerned about the condition of a guest, or if a guest requests access to medical advice, advise them to contact the in-house doctor or phone NEOC (hotline: 3304829) for advice.

If staff members need to enter the room where a guest suspected of influenza A (H1N1) is present (e.g. to deliver a room service meal), they should avoid close contact (within one metre) with the guest as far as possible, wear surgical mask and clean their hands with soap and water or clean the hands with appropriate antiseptic handrub solutions immediately afterwards.

Wearing gloves and gowns is not recommended for staff members not in close contact (within one metre) of symptomatic guests.

 JANITORS AND REFUSE COLLECTORS

 Cleaning and disinfection procedures

Janitors and refuse collectors are advised to use disposable gloves.

The flu virus is easily killed by commonly available cleaning products and detergents.

Freshly prepared bleach solution (0.05% bleach solution)# should be used for surface cleaning.

Rooms, public premises such as elevators and reception desks should be cleaned at least once a day. Damp rather than dry dusting should be performed.

Hands should be washed immediately after all cleaning procedures even if disposable gloves are used.

 Room decontamination

There is no need for fumigation or other special measures where a room is occupied or has been vacated after occupation by people who may be infected with influenza A (H1N1).

• Staff who clean rooms occupied by an ill person must wear surgical mask, an apron and gloves (PPE) before cleaning

• Ventilate the room by opening external windows

• Remove the bed linen and towels and place in a bag

• Do not leave loose items in the corridor or common parts

• Dispose of all disposable items such as sachets and toilet rolls

• Clean remaining items such as cups, glasses etc using water and detergent

• Apply Freshly prepared bleach solution (0.05% bleach solution) and allow at least 10 minutes before wiping clean

• Pay particular attention to hand contact surfaces e.g. door handles, taps, flush handle, light switches, telephone handsets, TV remote control, bedside tables, etc.

• Use plenty of cleaning clothes to avoid re-contaminating surfaces

Rubbish bags

The risk of infection by contact with tissues or contaminated materials in the rubbish bin is very low but it is recommended that gloves are used if handling soiled tissues.

Hands should be washed immediately after all cleaning procedures even if disposable gloves are used.