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Interim Guidance for Clinicians on Identifying and Caring for Patients with Swine-origin Influenza A (H1N1) Virus Infection
April 29, 2009 2:00 AM ET

Objective: This document provides interim guidance for clinicians who might provide care for patients with swine-origin influenza A (H1N1) or suspected swine-origin influenza A (H1N1) virus infection.  It will be periodically updated as information becomes available.

Transmission

Transmission of swine-origin influenza A(H1N1) is being studied as part of the ongoing outbreak investigation, but limited data available indicate that this virus is  transmitted in ways similar to other influenza viruses. Seasonal human influenza viruses are spread from person to person primarily through large-particle respiratory droplet transmission (e.g., when an infected person coughs or sneezes near a susceptible person). Transmission via large-particle droplets requires close contact between source and recipient persons, because droplets do not remain suspended in the air and generally travel only a short distance (<1 meter) through the air. Contact with respiratory-droplet contaminated surfaces is another possible source of transmission.  Because data from swine-origin influenza viruses are limited, the potential for ocular, conjunctival, or gastrointestinal infection is unknown. Since this is a novel influenza A virus in humans, transmission from infected persons to close contacts might be common. All respiratory secretions and bodily fluids (diarrheal stool) of swine-origin influenza A (H1N1) cases should be considered potentially infectious.

Incubation period

The estimated incubation period is unknown and could range from 1-7 days, and more likely 1-4 days.

Persons with confirmed Swine-origin influenza A (H1N1) virus infection

A confirmed case of S-OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests:

  1. real-time RT-PCR
  2. viral culture

Case definitions for Probable and Suspected cases can be found at: http://www.cdc.gov/swineflu/casedef_swineflu.htm
Clinicians should suspect swine-origin influenza A (H1N1) in persons with an acute febrile respiratory illness who

  • Have had close contact with a person who is a swine-origin influenza confirmed case or
  • Traveled to a community in the United States or internationally where there are one or more confirmed swine-origin influenza cases (Updated information about areas with confirmed human cases of swine-origin influenza A (H1N1) can be found at  http://www.cdc.gov/swineflu/investigation.htm.) or
  • Reside in a community where there are one or more confirmed swine-origin influenza A (H1N1) cases.

Clinical Findings

Patients with uncomplicated disease due to confirmed swine-origin influenza A (H1N1) virus infection have experienced fever, headache, upper respiratory tract symptoms (cough, sore throat, rhinorrhea), myalgia, fatigue, vomiting, or diarrhea.

Complications

There is insufficient information to date about clinical complications of this variant of swine-origin influenza A (H1N1) virus infection.  Among  persons infected with previous variants of swine influenza virus, clinical syndromes have ranged from mild respiratory illness, to lower respiratory tract illness, dehydration, or pneumonia. Deaths caused by previous variants of swine influenza have occasionally occurred. Although data on the spectrum of illness is not yet available for this new variant of swine-origin influenza A(H1N1), clinicians should expect complications to be similar to seasonal influenza: exacerbation of underlying chronic medical conditions, upper respiratory tract disease (sinusitis, otitis media, croup) lower respiratory tract disease (pneumonia, bronchiolitis, status asthmaticus), cardiac (myocarditis, pericarditis), musculoskeletal (myositis, rhabdomyolysis), neurologic (acute and post-infectious encephalopathy, encephalitis, febrile seizures, status epilepticus), toxic shock syndrome, and secondary bacterial pneumonia with or without sepsis.

Groups at high risk for complications

There are insufficient data available at this point to determine who is at higher risk for complications of swine-origin influenza A (H1N1) virus infection. At this time, the same age and risk groups who are at higher risk for seasonal influenza complications should also beconsidered at higher risk for swine-origin influenza complications .

High risk groups for seasonal influenza complications include: infants aged 12–24 months; HIV-infected persons; adults aged >65 years,  residents of any age of nursing homes or other long-term care institutions; and persons with asthma or other chronic pulmonary diseases, such as cystic fibrosis in children or chronic obstructive pulmonary disease in adults, hemodynamically significant cardiac disease ,immunosuppressive disorders or who are receiving immunosuppressive drugs, sickle cell anemia and other hemoglobinopathies, diseases that requiring long-term aspirin therapy, such as rheumatoid arthritis or Kawasaki disease, chronic renal dysfunction,  cancer, chronic metabolic disease, such as diabetes mellitus, neuromuscular disorders, seizure disorders, or cognitive dysfunction that may compromise the handling of respiratory secretions.

Reporting suspect swine-origin influenza A (H1N1) virus infection

Clinicians should contact their state public health department to report suspected cases of swine-origin influenza A (H1N1) virus infection and to obtain information on what clinical and epidemiological data to collect and specimen shipment protocols in their state.

Testing for swine-origin influenza A (H1N1) virus

Clinicians should consider testing suspected cases of swine-origin influenza A (H1N1), especially those with severe illness, by obtaining an  upper respiratory specimens, such as a nasopharyngeal swab or wash, or nasal wash/aspirate, or tracheal aspirate, to test for swine-origin influenza A (H1N1) virus.   Specimens should be tested by the state public health laboratory.  Interim guidance on specimen collection ,processing, and testing for patients with suspected swine-origin influenza A (H1N1) virus infection can be found at:  http://www.cdc.gov/swineflu/specimencollection.htm

Treatment for swine-origin influenza A (H1N1)

The swine-origin influenza virus is susceptible to both oseltamivir and zanamivir.  It is resistant to amantadine and rimantadine.  Interim guidance on antiviral treatment for swine-origin influenza A (H1N1) can be found at: http://www.cdc.gov/swineflu/recommendations.htm

Additional Therapy
Additional therapy such as antibacterial agents, should be used at the discretion of the clinicians given the patients clinical presentation.  For antibacterial treatment of pneumonia, clinical guidance for community-acquired pneumonia should be followed and can be accessed at  http://www.journals.uchicago.edu/doi/pdf/10.1086/511159?cookieSet=1. External Web Site Policy.

For hospitalized patients with severe community-acquired pneumonia (CAP) requiring intensive care unit admission, menthicillin-resistent Staphylococcus aureus (MRSA) infection should be suspected and treated empirically in addition to other causes of CAP if they have 1) necrotizing or cavitary infiltrates or 2) empyema.

Infectious period

The duration of shedding with swine-origin influenza A (H1N1) virus is unknown. Therefore, until data are available, the estimated duration of viral shedding is based upon seasonal influenza virus infection. Infected persons are assumed to be shedding virus from the day prior to illness onset until resolution of symptoms. Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially contagious for up to 7 days following illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved. Children, especially younger children, might be contagious for longer periods.

Infection Control Measures

Guidance on infection control during care of patients with confirmed or suspected swine-origin influenza A (H1N1) virus infection can be found at: http://www.cdc.gov/swineflu/guidelines_infection_control.htm

Antiviral Chemoprophylaxis

Guidance on pre-exposure and post-exposure chemoprophylaxis with antiviral agents for swine-origin influenza A (H1N1) virus can be found at: http://www.cdc.gov/swineflu/recommendations.htm

Additional Information
Additional information on swine-origin influenza can be found at: http://www.cdc.gov/swineflu/

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This page provides explanations of many terms and acronyms used throughout the site. Select the beginning letter of the word or acronym to go to that portion of the glossary.

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

adjuvant: A substance added to a vaccine to improve the immune response so that less vaccine is needed to provide protection.

antibiotic: A substance produced by bacteria or fungi that destroys or prevents the growth of other bacteria and fungi.

antibody: A protein produced by the body’s immune system in response to a foreign substance (antigen). Our bodies fight off an infection by producing antibodies. An antibody reacts specifically with the antigen that triggered its formation and its function is to inactivate the antigen.

antigen: Any foreign substance, usually a protein, that stimulates the body’s immune system to produce antibodies. (The name antigen reflects its role in stimulating an immune response – antibody generating.)

antiviral: Drug that is used to prevent or cure a disease caused by a virus, by interfering with the ability of the virus to multiply in number or spread from cell to cell.

APHIS: Animal and Plant Health Inspection Service, a part of the U.S. Department of Agriculture that provides leadership in ensuring the health and care of animals and plants.

asymptomatic: Presenting no symptoms of disease.

avian flu: A highly contagious viral disease with up to 100% mortality in domestic fowl caused by influenza A virus subtypes H5 and H7. All types of birds are susceptible to the virus but outbreaks occur most often in chickens and turkeys. The infection may be carried by migratory wild birds, which can carry the virus but show no signs of disease. Humans are only rarely affected.

carrier: A bearer and transmitter of a agent capable of causing infectious disease. An asympotomatic carrier shows no symptoms of carrying an infectious agent.

CDC: Centers for Disease Control and Prevention, the U.S. government agency at the forefront of public health efforts to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. CDC is one of 13 major operating components of the Department of Health and Human Services.

clade: A group of organisms, such as a species, whose members share homologous features derived from a common ancestor. The avian virus H5N1 clade 1 includes human and bird isolates from Vietnam, Thailand, Cambodia, Laos, and Malaysia. Clade 2 viruses have been identified in bird isolates from China, Indonesia, Japan, and South Korea.

contagious: A contagious disease is easily spread from one person to another by contact with the infectious agent that causes the disease. The agent may be in droplets of liquid particles made by coughing or sneezing, contaminated food utensils, water or food.

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DOI: U.S. Department of Interior, the government agency that protects and provides access to our Nation’s natural resources.

drift: One process in which influenza virus undergoes mutation. The amount of change can be subtle or dramatic, but eventually as drift occurs, a new variant strain will become dominant. This process allows influenza viruses to change and re-infect people repeatedly through their lifetime and is the reason influenza virus strains in vaccine must be updated each year. See shift.

enzyme: A substance that speeds up chemical reaction. Every chemical reaction in living organisms is facilitated by an enzyme.

EPA: U.S. Environmental Protection Agency, the government agency that leads the nation’s environmental science, research, education and assessment efforts.

epidemic: A disease occurring suddenly in humans in a community, region or country in numbers clearly in excess of normal. See epizootic and pandemic.

epizootic: A disease occurring suddenly in animals in a community, region or country in numbers clearly in excess of normal. See epidemic and panzootic.

FAO: Food and Agriculture Organization of the United Nations leads international efforts to defeat hunger. FAO serves both developed and developing countries and acts as a neutral forum where all nations meet as equals to negotiate agreements and debate policy.

FDA: U.S. Food and Drug Administration, the government agency responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation. FDA is one of 13 major operating components of the Department of Health and Human Services.

H5N1: A variant of avian influenza, which is a type of influenza virulent in birds. It was first identified in Italy in the early 1900s and is now known to exist worldwide.

HPAI: Highly Pathogenic form of Avian Influenza. Avian flu viruses are classified based upon the severity of the illness and HPAI is extremely infectious among humans. The rapid spread of HPAI, with outbreaks occurring at the same time, is of growing concern for human health as well as for animal health. See LPAI.

homologous: Similar in position, structure, function, or characteristics.

host: An organism on or in which a parasite lives.

hemagglutinin: An important surface structure protein of the influenza virus that is an essential gene for the spread of the virus throughout the respiratory tract. This enables the virus to attach itself to a cell in the respiratory system and penetrate it. Referred to as the “H” in influenza viruses. See neuraminidase.

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immune system: The cells, tissues and organs that help the body to resist infection and disease by producing antibodies and/or altered cells that inhibit the multiplication of the infectious agent.

infectious agent: Any organism, such as a pathogenic virus, parasite, or bacterium, that is capable of invading body tissues, multiplying, and causing disease.

influenza: A serious disease caused by viruses that infect the respiratory tract.

isolate: A pure strain that has been isolated as from diseased tissue, contaminated water, or the air.

isolation: A state of separation between persons or groups to prevent the spread of disease.  The first published recommendations for isolation precautions in United States hospitals appeared as early as 1877, when a handbook recommended placing patients with infectious diseases in separate facilities.  Isolation measures can be undertaken in hospitals or homes, as well as in alternative facilities.

LPAI: Low Pathogenic form of Avian Influenza. Most avian flu strains are classified as LPAI and typically cause little or no clinical signs in infected birds. However, some LPAI virus strains are capable of mutating under field conditions into HPAI viruses. See HPAI.

MRC: The Medical Reserve Corps establishes teams of local volunteer medical and public health professionals who can contribute their skills and expertise throughout the year and during times of community need.

mutation: Any alteration in a gene from its natural state. This change may be disease causing or a benign, normal variant. Specific mutations and evolution in influenza viruses cannot be predicted, making it difficult if not impossible to know if or when a virus such as H5N1 might acquire the properties needed to spread easily among humans.

neuraminidase: An important surface structure protein of the influenza virus that is an essential enzyme for the spread of the virus throughout the respiratory tract. It enables the virus to escape the host cell and infect new cells. Referred to as the “N” in influenza viruses. See hemagglutinin.

NIAID: National Institute of Allergy and Infectious Diseases conducts and supports basic and applied research to better understand, treat, and ultimately prevent infectious, immunologic, and allergic diseases. NIAID research has led to new therapies, vaccines, diagnostic tests, and other technologies that have improved the health of millions. NIAID is one of 13 major operating components of the Department of Health and Human Services.

NVPO: National Vaccine Program Office is responsible for coordinating and ensuring collaboration among the many federal agencies involved in vaccine and immunization activities. It is part of the Department of Health and Human Services.

OIE (Office International des Epizooties): World Organisation for Animal Health, an international organization including 167 member countries that collects, analyses, and reports information on global animal disease situations.

pandemic: The worldwide outbreak of a disease in humans in numbers clearly in excess of normal. See panzootic and epidemic.

panzootic: The worldwide outbreak of a disease in animals in numbers clearly in excess of normal. See pandemic and epizootic.

parasite: An organism living in, with, or on another organism.

pathogenic: Causing disease or capable of doing so.

pre-pandemic vaccine: A vaccine created to protect against currently circulating H5N1 avian influenza virus strains with the expectation that it would provide at least some protection against new virus strains that might evolve. It would likely be the best vaccine defense available until a vaccine specific to the new strain could be developed.

prophylactic: A medical procedure or practice that prevents or protects against a disease or condition (eg, vaccines, antibiotics, drugs).

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quarantine: The period of isolation decreed to control the spread of disease.  Before the era of antibiotics, quarantine was one of the few available means of halting the spread of infectious disease.  It is still employed today as needed.  The list of quarantinable diseases in the U.S. is established by Executive Order of the President, on recommendation of the Secretary of the Department of Health and Human Services, and includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, and viral hemorrhagic fevers (such as Marburg, Ebola, and Congo-Crimean disease).  In 2003, SARS (severe acute respiratory syndrome) was added as a quarantinable disease. In 2005 another disease was added to the list, influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.

reassortment: The rearrangement of genes from two distinct influenza strains to produce a novel viral strain.

seasonal flu: A respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available. This is also known as the common flu or winter flu.

shift: The process in which the existing H (hemagglutinin) and N (neuraminidase) are replaced by significantly different H and Ns. These new H or H/N combinations are perceived by human immune systems as new, so most people do not have pre-existing antibody protection to these novel viruses. This is one of the reasons that pandemic viruses can have such a serve impact on the health of populations. See drift.

species: A class of plants or animals having common attributes and designated by a common name. Theoretically, plants or animals of different species cannot interbreed. However, occasionally this does not hold true.

strain: A group of organisms within a species or variety.

USAID: United States Agency for International Development provides foreign assistance to developing countries in order to further America’s foreign policy interests in expanding democracy and free markets while improving the lives of the citizens of the developing world.

USDA: U.S. Department of Agriculture, the government agency responsible for regulating the safety and development of food, agriculture, and natural resources.

vaccine: A preparation consisting of antigens of a disease-causing organism which, when introduced into the body, stimulates the production of specific antibodies or altered cells. This produces an immunity to the disease-causing organism. The antigen in the preparation can be whole disease-causing organisms (killed or weakened) or parts of these organisms.

virulent: Highly lethal; causing severe illness or death.

virus: Any of various simple submicroscopic parasites of plants, animals, and bacteria that often cause disease and that consist essentially of a core of RNA or DNA surrounded by a protein coat. Unable to replicate without a host cell, viruses are typically not considered living organisms.

waterfowl: Birds that swim and live near water, including ducks, geese, and swans.

WHO: World Health Organization, an agency of the United Nations established in 1948 to further international cooperation in improving health conditions.

zoonoses: Diseases that are transferable from animals to humans.

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Epidemološke aktivnosti – Republika Slovenija

S pandemskim načrtom za RS so predvidene različne aktivnosti.

V četrti fazi, v kateri se trenutno nahajamo, je povečana budnost zdravstvenega osebja, ki podrobno opazuje bolnike z gripoznimi obolenji. Če kažejo simptome prašičje gripe, jih obravnava z osebnim kompletom za zaščito in napoti na infekcijsko kliniko.

V peti fazi so poostreni ukrepi na vstopnih točkah v državo (Brnik in Luka Koper), izvajajo pa se tudi vse ostale aktivnosti.

V šesti fazi se pojavi obveznost tedenskega poročanja o številu mrtvih.

FAZA 4

• Zbiranje podatkov o epidemiološki situaciji v sosednjih državah in v svetu in analiza tamkajšnje epidemiološke situacije

• Obvešcanje primarnega zdravstvenega sistema v regiji o novih podtipih virusa influence

• Identificirati ogrožene populacije

• Na osnovi epidemiološke obravnave in opisa klinicne slike napisati definicijo primera gripe z

novim podtipom virusa,

• Izdelati algoritem za zazanavo in ukrepanje pri obravnavi obolelih z novim podtipom virusa

gripe (seznam prizadetih geografskih obmocji, definicija primera, obravnavo bolnika; napotitev, zdravljenje, odvzem mikrobioloških kužnin in navodila o sodelovanju z epidemiologi obmocnega zavoda za zdravstveno varstvo.

• Izdelati navodila o uporabi osebne varovalne opreme za zdravstvene delavce pri obravnavi

obolelih z novim podtipom virusa gripe

• Svetovanje ustreznih zaščitnih ukrepov potnikom na ogrožena obmocja

• Povecati obseg epidemiološkega spremljanje pri osebah, ki so potovale na ogrožena obmocja

• Sodelovanje v komunikacijskem sistemu zgodnjega zaznavanja influence in hitrega ukrepanja na državnem in evropskem nivoju in še bolj intenzivna izmenjava podatkov zlasti s sosednjimi državami

• Posodobitev definicij, navodil, obrazcev


FAZA 5

• Povecati obseg epidemiološkega spremljanje pri osebah, ki so potovale na ogrožena obmocja

• še bolj intenzivna izmenjava podatkov zlasti s sosednjimi državami

• Sprotno obvešcati zdravstvene delavce regije o epidemioloških in klinicnih podatkih.

• Oceniti tveganje za prenos

• Spremljanje in analiza podatkov:

– oštevilu in obsegu bolnišnicnega zdravljenja zaradi okužb dihal,

– o pojavu povecanega števila okužb dihal pri zdravstvenih delavcih

– splošni tedenski umrljivosti

– druge epidemiološke podatke, ki bodo indikatorji izbruha v doloceni kohorti (npr. šolarji –

odsotnost iz šol, starejše osebe – obolevnost v domovih za starejše itd.)

– izdelali sistem zaznave bolnika, sumljivega na gripo, povzroceno s pandemskim podtipom

na lokacijah kot je mednarodno letališce Brnik in pristanišce Koper

• Posodobitev definicij, navodil, obrazcev in algoritma


FAZA 6

Vzpostavitev mreže za kontingencno in tudi bolj pogosto porocanje o sumljivih in potrjenih

primerih gripe

• Zaznati pojav prvih primerov gripe

• Sledenje širjenja po državi: spremljati širjenje iz obmocja v obmocje in spremljati obolevnost

posameznih starostnih skupin;

• Oceniti obseg in intenziteto obolevanja;

• Spremljati odsotnost z dela in izostanke od pouka

• Spremljati obolevnost zdravstvenih delavcev

• Spremljati število bolnišnicnih zdravljenj;

• Spremljati porabo dolocenih zdravil in cepiv.

• Spremljati tedensko umrljivost v casu epidemije gripe;

• Analizirati prijave gripe – incidenca, prevalenca, morbiditeta, mortaliteta,

• Spremljanje trendov na podrocju epidemiologije gripe in zagotavljanje podatkov razlicnim

uporabnikom

• Zaznati spremembe v epidemiologiji, kliniki in viroloških znacilnostih pandemskega podtipa

virusa gripe.


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Bolezenski znaki in simptomi nove gripe

Bolezen poteka s podobnimi znaki in simptomi kot običajna sezonska gripa, pojavijo se:

  • mrazenje,
  • povišana telesna temperatura,
  • izčrpanost,
  • bolečine v mišicah in kosteh,
  • bolečine v žrelu,
  • suh kašelj.

Vodpod videos no longer available.

more about “Kaj morate vedeti o novi gripi?“, posted with vodpod

Kako ukrepati, če  sumite, da ste se okužili z virusom nove gripe:

  • najprej po telefonu pokličite v ambulanto osebnega zdravnika, kjer boste dobili nadaljnja navodila. Če bo po posvetu z zdravnikom potreben tudi obisk v ambulanti, obiščete zdravnika – seznam zdravstvenih domov.
  • Slabo počutje, zmerno povišana telesna temperatura (do 38 stopinj Celzija), nahod in kašelj, sami po sebi niso vzrok za obisk dežurnega zdravnika.
  • Nujno pomoč na SNMP iščemo samo v primeru, ko imamo resnejše težave z zdravjem, ki zahtevajo takojšen pregled pri zdravniku in ukrepanje. Mednje sodijo:
    • težave z dihanjem, občutek pomanjkanja zraka ali hude bolečine v prsih,
    • glavobol z bruhanjem,
    • poslabšanje kroničnih bolezni.

Večja pozornost je potrebna pri majhnih otrocih– visoka vročina, zaspanost, premajhen vnos tekočin in znaki izsušitve narekujejo obisk pri zdravniku brez odloga.

Za novo vrsto gripe je značilno, da se začne nenadno, s povišano telesno temperaturo, ki je običajno vsaj 39 stopinj Celzija, z glavobolom, oteklim grlom in s slabim počutjem. »Po do zdaj znanih podatkih je potek podoben kot pri običajni gripi,« pravi prof. dr. Franc Strle s Klinike za infekcijske bolezni in vročinska stanja v ljubljanskem Kliničnem centru ter dodaja, da je v tej fazi še vedno premalo podatkov o sami bolezni. Ob tem je dr. Strle opozoril na smotrno uporabo zdravil, ki jih bo predpisal zdravnik na recept.

27.4. – vir: Inštitut za varovanje zdravja

Bolezen, ki jo povzroča nov virus prašičje gripe – vprašanja in odgovori

Kaj je prašičja gripa?

Prašičja gripa je nalezljiva akutna virusna okužba dihal prašičev, ki jo povzroča virus influence A. Oboleli prašiči običajno izgubijo tek, imajo povišano telesno temperaturo in kašljajo. Smrtnost pri prašičih je nizka (1-4 %), največkrat ozdravijo v 7 do 10 dneh. Bolezen se med njimi širi po zraku, z neposrednim in posrednim stikom ter s prašiči-prenašalci, ki ne kažejo značilnih znakov bolezni. Izbruhi med prašiči se lahko pojavijo vse leto, več jih je (v zmernem temperaturnem pasu) jeseni in pozimi. V številnih državah prašiče rutinsko cepijo proti prašičji gripi.

Najpogostejši povzročitelj  prašičje gripe je virus influence A H1N1, med prašiči pa krožijo tudi drugi virusi influence A (npr. H1N2, H3N1, H3N2). Prašiči se lahko okužijo tudi z virusi ptičje gripe in virusi sezonske gripe pri človeku, prvi virus, ki naj bi se s človeka prenesel na prašiča, naj bi bil virus influence A H3N2.  Včasih se lahko prašiči okužijo tudi z več kot enim virusom naenkrat, zaradi česar se lahko geni iz teh virusov pomešajo. Posledica je lahko virus gripe, ki vsebuje gene različnih virusov.

Izjemno redko se bolezen iz obolelih prašičev prenese na ljudi, ki delajo na prašičjih farmah in so z njimi v tesnem stiku.

Katere države je prizadel izbruh prašičje gripe med prašiči?

Prašičje gripe se ne prijavlja mednarodnim organizacijam za nadzor bolezni pri živalih (OIE), zato razširjenost obolenja ni povsem znana. Bolezen naj bi bila endemična v Združenih državah Amerike, izbruhi pa so se pojavili tudi v severni Ameriki, južni Ameriki, Evropi (med njimi v Veliki Britaniji, na Švedskem, v Italiji), Afriki (Kenija) in delih vzhodne Azije, med drugim na Kitajskem in Japonskem.

Ali se prašičja gripa lahko prenaša tudi med ljudmi?

Prašičja gripa se iz obolelih prašičev izjemno redko prenese na ljudi.

CDC (Center za spremljanje nalezljivih bolezni v Atlanti, ZDA) je potrdil, da se nov virus prašičje gripe lahko prenaša s človeka na človeka.

Ali obstaja tveganje za pandemijo prašičje gripe med ljudmi?

Najverjetneje ljudje, zlasti tisti, ki niso v rednem stiku s prašiči, niso imuni za viruse prašičje grupe, da bi tako bili sposobni preprečiti okužbo. Ko se virus prašičje gripe začne prenašati s človeka na človeka, je pandemija možna. Posledice takšne pandemije pa je težko napovedati: odvisna je od nalezljivosti virusa, odpornosti ljudi, navzkrižne zaščite z protitelesci, ki se razvijejo ob sezonski gripi in človeka samega.

Kakšni so znaki in simptomi bolezni, ki jo povzroča nov virus prašičje gripe pri ljudeh?

Bolezen pri ljudeh poteka s podobnimi znaki in simptomi kot običajna, sezonska gripa: pojavijo se mrazenje, povišana telesna temperatura, izčrpanost, bolečine v mišicah in kosteh, bolečine v žrelu, suh kašelj. Poročajo tudi o težjem poteku bolezni s pljučnico, z odpovedjo dihanja in s smrtnim izidom. Podobno kot okužba z virusom »sezonske gripe« tudi okužba s prašičjo gripo lahko poslabša osnovno, kronično bolezen..

Kako se prenaša nov virus prašičje gripe?

Nov virus prašičje gripe se prenaša enako kot virus sezonske gripe s kužnimi kapljicami, ki nastajajo pri kašljanju, kihanju, govorjenju ipd., torej ob tesnem stiku z osebo, ki je okužena z novim virusom prašičje gripe

Ali cepivo za ljudi proti sezonski gripi zaščiti tudi proti novemu virusu prašičje gripe?

Obstaja določena podobnost med virusi sezonske gripe A (H1N1), ki so v običajnem cepivu proti gripi in novim virusom prašičje gripe H1N1. Pri osebah, cepljenih z običajnim cepivom proti sezonski gripi, verjetno obstaja navzkrižna – delna imunost tudi proti novemu virusu prašičje gripe. Omenjeno hipotezo bodo potrdili z raziskavami, ki že potekajo, vendar so dolgotrajne.

Ali obstaja cepivo za človeka, ki bi zaščitilo proti novemu virusu prašičje gripe?

Za zdaj cepiva, ki bi vsebovalo zaščito proti novemu virusu prašičje gripe ni.

Ali so na voljo zdravila za zdravljenje prašičje gripe?

Da. CDC priporoča uporabo oseltamivira ali zanamivira za zdravljenje in ali preprečevanje okužbe. Zdravila zavirajo razmnoževanje virusa. Protivirusna zdravila skrajšajo in omilijo potek bolezni ter preprečujejo zaplete. Z zdravljenjem je treba pričeti 48 ur po začetku simptomov.

Kako dolgo je okužena oseba kužna ?

Bolniki so kužni dokler imajo znake in simptome okužbe oziroma do 7 dni po začetku bolezni. Mlajši otroci so verjetno kužni dlje časa.

Kako se lahko zaščitimo pred okužbo?

Širjenje okužbe preprečujemo z/s:

– higieno kašlja; kadar kašljamo ali kihamo, si usta zakrijemo robcem in po uporabi zavržemo v koš za smeti.

– pogostim umivanjem rok z milom in vodo, učinkoviti so tudi robčki z alkoholnim razkužilom;

– izogibanjem stikov z bolnimi ljudmi;

– če zbolimo, ostanemo doma, da ne širimo okužbe.

Kaj storiti, če zbolimo?

Če opazite znake bolezni, podobne gripi, z mrazenjem, vročino, bolečinami v mišicah in kosteh, nahodom, bolečinami v žrelu pokličite svojega zdravnika, ki vam bo svetoval.

Ali se lahko okužimo z novim virusom prašičje gripe, če uživamo svinjsko meso?
Ne.

Ali je varno potovati v Mehiko in ZDA, kjer so odkrili novi virus prašičje gripe pri ljudeh?

Potovanja v Mehiko ne svetujemo, če potovanje ni nujno. Potnikom svetujemo, da spremljajo v informacije in morebitna nova priporočila. Potniki naj si pred potovanjem preberejo informacije na spletnih straneh Svetovne zdravstvene organizacije, ECDC, CDC, Inštituta za varovanje zdravja. Upoštevajo naj splošna higienska navodila.

Kako naj ravnajo potniki, ki se vračajo iz Mehike ali ZDA , kjer so odkrili novi virus prašičje gripe pri ljudeh?

Potniki iz omenjenih območij naj opazujejo zdravstveno stanje sedem dni po vrnitvi. Če zaznajo zgoraj navedene simptome (glej vprašanji Kakšni so znaki in simptomi bolezni oziroma Kaj storiti, če zbolimo), naj se posvetujejo s svojim zdravnikom po telefonu.

Arhiv novic:

18.7.- ECDC objavil analizo 8.596 primerov nove gripe

5.5. – Neue Zurcher Zeitung poroča, da je posebnost nove gripe pogosta griža

4.5. – nova gripa inkubacijska doba

4.5. – nova navodila IVZ

30.4. – kdaj k dežurnemu zdravniku

29.4. – Swine flu & You , Key Facts , Nasveti za zdarvnike , Navodila za zdravnike (source CDC)

29.4. – zadnja navodila WHO za zdravstveno osebje

28.4.- vir: Inštitut za varovanje zdravja

Vir: http://www.cdc.gov/swineflu/swineflu_you.htm in http://www.who.int/csr/swine_flu/swine_flu_faq_26april.pdf

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Pandemski načrt predvideva ukrepe države za zajezitev pandemije in odpravljanje njenih posledic. Predvideva 25% obolelost, 0,55% stopnjo hospitalizacije in 0,35% stopnjo smrtnosti. Predvideva pa tudi posebne ukrepe kot so izolacija, karantena, prepoved gibanja ipd.

Kazalo:

  • Pandemične faze in načrtovani ukrepi
  • Epidemološke aktivnosti
  • Javno zdravstveni ukrepi
  • Zdravstvena oskrba v primeru pandemije gripe (obolelost in smrtnost)
  • Vloga in pristojnosti posameznih organov in institucij
  • Nacrt ukrepov v posamezni fazi pandemije gripe
  • Pravne podlage za ukrepanje ob pandemiji gripe
    • Posebni ukrepi po 10. clenu ZNB, so:
    • usmerjena vzgoja in svetovanje;
    • zgodnje odkrivanje virov okužbe in bolnikov z nalezljivimi boleznimi in postavitev diagnoze;
    • prijavljanje nalezljivih bolezni in epidemij;
    • epidemiološka preiskava;
    • osamitev (izolacija), karantena, obvezno zdravljenje in prevoz bolnikov;
    • cepljenje (imunizacija in imunoprofilaksa) ter zašcita z zdravili (kemoprofilaksa);
    • dezinfekcija, dezinsekcija, deratizacija;
    • obvezni zdravstveno higienski pregledi s svetovanjem;
    • drugi posebni ukrepi – ukrepi ob vecjih epidemijah – minister za zdravstvo doloci pogoje za potovanje v državo, v kateri obstaja možnost okužbe z nevarno
    • nalezljivo boleznijo in za prihod iz teh držav;

Vir: Min. za zdravstvo

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Danes je bil objavljen pandemski načrt Republike Slovenije z izračunom smrtnosti ob pandemiji gripe (šlo je za modeliranje posledic okužb s ptičjo gripo, ki je bila, kot je videti trenutno, bolj smrtna). Na kratko:

  • načrt predvideva, da bo obolelo 25% Slovencev – 500.000 ljudi
  • 50.000 ljudi bo obiskalo zdravnika
  • v bolnišnici bo sprejetih 2.750 pacientov (0,55%)
  • umrlo jih bo 1.850 (0,35%)

POZOR – to so simulacije narejene za primer pandemije ptičje gripe, kjer je bila smrtnost (vsaj po zadjnšnjih podatkih) zelo visoka. V ZDA za posledicami običajne gripe umre 36.000 ljudi, če isto razmerje velja tudi za Slovenijo, pomeni da vsako leto za posledicami gripe umre 240 prebivalcev. Po scenariju ptičje gripe bi se smrtnost povečaka 7,7-krat. Ker pa bo virus verjetno manj smrtonosen, bo tudi smrtnost manjša.

Pandemski načrt pravi takole:

Zdravstvena oskrba v primeru pandemije gripe

Nacrtovanje obsega zdravstvene oskrbe v primeru pandemije gripe je težavno, ker ne moremo vnaprej predvideti kraja, casa in obsega njenega pojava. Pomagamo si z matematicnimi modeli, ki kot izhodišce uporabljajo izkušnje iz preteklih dogodkov.


Z matematicnimi modeli je mogoce opredeliti možne ucinke bodoce pandemije gripe. Ce kot izhodišce vzamemo britanski vzorec, ki predvideva, da bo obolelo 25% populacije ter nacrtujemo, da bo bolnišnicno zdravljenje potrebovalo 0,55% ljudi in da bo smrtnost 0,37% , dobimo podatke, ki so navedeni v tabeli, ki kaže število obiskov pri osebnem zdravniku, preglede v službi nujne

medicinske pomoci, hospitalizacije in smrti.

model-smrtonosti

Glede na trajanje in valove pandemije so seveda izracuni bolj komplicirani in presegajo vsebino

tega nacrta. Koordinacijske skupine na regijah te izracune, pripravljene v regijskih Zavodih za

zdrastveno varstvo, uskladijo in jih uporabijo kot osnovo za svoje delovanje.

Zdravstveni zavodi bodo ob pandemiji gripe izredno obremenjeni. Zato v sodelovanju z regionalnim Zavodom za zdravstveno varstvo usklajujejo delovanje in predvidijo delo v primeru pandemije predvsem z vidika:

  • obravnave povecanega števila bolnikov,
  • izvedbe cepljenja velikega števila ljudi,
  • oskrbe s protivirusnimi zdravili,
  • velike obremenjenosti osebnih zdravnikov in službe nujne medicinske pomoci,
  • pomanjkanja postelj v bolnišnicah, posebej postelj intenzivne terapije ter
  • izpada zdravstvenih delavcev zaradi obolelosti.

Delovanje zdravstvenih zavodov ob pandemiji gripe temelji na osnovnem nacrtu delovanja zdravstvenih zavodov za delo v primeru nesrec vecjega obsega ali katastrof, ki ga morajo prilagoditi specificnostim pandemije gripe.

Vir: Min. za zdravstvo

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Kako postopamo ob sumu na okužbo z novim virusom prašičje influence A H1N1 pri ljudeh?

Zdravnik osnovnega zdravstvenega varstva, ki postavi sum na okužbo z novim virusom prašičje gripe A H1N1:

1.         Osami bolnika in ga prosi, da si nadene kirurško masko.

Gripa se prenaša kapljično – ob smrkanju, kihanju ali kašljanju, običajno na razdalji do največ enega metra in preko onesnaženih površin. Z nošenjem kirurške maske se zmanjša možnost prenosa z bolnika na zdravstvene delavce in druge osebe, ki so z bolnikom v tesnejšem stiku.

2.         Zdravstveno osebje ob stiku s sumljivim bolnikom uporablja ustrezno osebno varovalno opremo ter poskrbi za izvajanje ukrepov standardne, kapljične in kontaktne izolacije.

3.         O sumu na primer okužbe z novim virusom prašičje influence A H1N1 NEMUDOMA obvesti območnega epidemiologa, ki bo bolnika anketiral, poizvedoval o podobnih primerih v okolici bolnika in predpisal kemoprofilakso tesnim stikom bolnika.

4.         Bolniku, sumljivemu za okužbo z novim virusom prašičje influence A H1N1, odvzame bris nosu in žrela.. Vzorec kužnin s spremnim listom  napoti v Laboratorij za viruse Inštituta za varovanje zdravja RS po predhodnem dogovorom z virologom v pripravljenosti (telefon: 01 4342 613). Vzorce kužnin pošiljamo v transportnih gojiščih za viruse (približno 2 ml). Če virusnega gojišča nimamo na voljo, se pred odvzemom vzorca posvetujemo z virologom Laboratorija za viruse.

5.         Zdravnik oceni potrebo po bolnišničnem zdravljenju. V primeru, da bolnik potrebuje bolnišnično zdravljenje, se zdravnik NAJPREJ posvetuje z infektologom v območni bolnišnici ali na Kliniki za infekcijske bolezni in vročinska stanja, Japljeva 2, Ljubljana (telefon: 01 522 42 40) in bolnika po dogovoru z infektologom napoti na bolnišnično zdravljenje. Pri bolnikih, ki jih napoti v bolnišnico, vzorcev kužnin zgornjih dihal zdravnik osnovnega zdravstvenega varstva ne odvzame – odvzem bo potekal v bolnišnici. Poskrbimo za ustrezno zaščito oseb, ki bodo bolnika prepeljale v bolnišnico.

Po sprejemu v bolnišnico se bolnika namesti v sobo za izolacijo ali kohortno izolacijo. Zdravstveno osebje uporablja osebno varovalno opremo in izvaja ustrezne higienske ukrepe. Ob postopkih, kjer nastaja aerosol, se uporablja zaščitna maska FFP3.

Infektolog oz. lečeči zdravnik v bolnišnici poskrbi za odvzem kužnin za potrditev okužbe z novim virusom prašičje influence A H1N1 in izključi druge možne povzročitelje akutne okužbe dihal. Za izključitev so potrebne naštete mikrobiološke preiskave: kultura izmečka na patogene bakterije, hemokultura, serološke preiskave in/ali verižna reakcija s polimerazo na bakterije Mycoplasma pneumoniae, Chlamydia pneumoniae, Coxiella burnetii, legionele ter viruse: adenovirus, respiratorni sincicijski virus in še druge preiskave po presoji lečečega zdravnika.

6.                  Bolnika, ki NE potrebujejo zdravljenja v bolnišnici, zdravnik:

  • pouči o načinu prenosa virusa influence;
  • mu svetuje, da ostane doma, dokler obstaja možnost prenosa na druge ljudi t.j. prvih sedem dni bolezni, po potrebi še dlje, če simptomi/znaki vztrajajo;
  • mu svetuje, da si pogosto umiva roke z vodo in milom – roke naj si umije vsakič, ko jih ob kihanju, kašljanju ali smrkanju onesnaži z izločki dihal;
  • ob kihanju, smrkanju in kašljanju naj si pokrije usta in nos s papirnatim robčkom, ki ga po uporabi odvrže v koš za smeti;
  • ne deli jedilnega pribora, kozarcev z drugimi osebami oz. česarkoli, kar je onesnaženo s slino in drugimi izločki dihal;

7.         Bolniku, pri katerem je okužba z novim virusom prašičje gripe A H1N1 sumljiva/verjetna ali laboratorijsko potrjena, zdravnik (osnovnega zdravstvenega varstva ali specialist na sekundarni, terciarni ravni) predpiše protivirusno zdravilo oseltamivir v ustreznem odmerku:

Odrasli: Oseltamivir 2 x 1 tableta (tableta vsebuje 75 mg oseltamivira) za 5 dni

Otroci mlajši od 12 let in lažji od 40 kg prejemajo oseltamivir 5 dni:

a.         lažji od 15 kg: 2 x 30 mg
b.         od 15 kg do 23 kg: 2 x 45 mg
c.         od 24 kg do 39 kg: 2 x 60 mg

Predpisovanje oseltamivira ima dva pomena:

  1. oseltamivir, ki ga bolnik prejme v prvih 48 urah, verjetno skrajša potek bolezni;
  2. po vsej verjetnosti se zmanjša  količina izločenega virusa in s tem prenos na druge ljudi.

Zdravnik predpiše oseltamivir na recept. Zdravnik na receptu označi, da bolnik potrebuje oseltamivir za zdravljenje okužbe z novim virusom prašičje influence A H1N1. Če je le možno dvignejo zdravilo v lekarni svojci bolnika in ne bolnik sam.

Kemoprofilaksa

Vsem tesnim stikom bolnika, pri katerem je potrjena okužba z novim virusom prašičje influence A H1N1,  se predpiše kemoprofilaksa.

Kemoprofilakso prejmejo vsi tesni kontakti bolnika, ki so bili izpostavljeni izločkom dihal bolnika. Tesni kontakti so predvsem družinski člani, partnerji itd. in zdravstveni delavci, ki so bili v tesnem, nezaščitenem stiku z bolnikom, pri katerem je bila možnost prenosa.

Družinskim članom predpiše kemoprofilakso epidemiolog.
Zdravstvenim delavcem v bolnišnici kemoprofilakso predpiše odgovorna oseba KOBO.
Za preprečevanje gripe lahko uporabljamo oseltamivir pri otrocih, starih 13 let in pri odraslih. Ni podatkov za varno uporabo v nosečnosti.
Pri postekspozicijski kemoprofilaksi dajemo oseltamivir enkrat dnevno (75 mg/dan) 7 dni.

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