DOMUZ GRİBİ (İnfluenza A/H1 N1) nedir?

S-OIV,
İnfluenza A H1N1
Pandemisi
Finans Bank
Tarih : 04 Kasım 2009, Çarşamba
Saat : 18.00
Yer : Finansbank Genel Müdürlüğü
B1 Konferans Salonu
Dr.Yahya Laleli
Kapsam
• Influenza A H1N1 geçmişi, geleceği
• Epidemiyolojik seminoloji,
• Tanı yöntemleri, antijenler, genetik
materyalin moleküler değerlendirmesi,
• Aşı
• Bildiklerimiz …
Grip A/Grip A, H1N1
Mevsimsel grip nedeniyle Dünya da sene 250.000 ila
500.000 kişi öldüğüne göre aynı düzeyde öldürücü
olmasa da daha bulaşıcı S-OIV (pandemik H1N1) DOMUZ
GRİBİNİN belirli coğrafi bölgeler için daha etkin olmak
üzere yeteri kadar lethal seyredeceği aşikardır. Bu grip
etkeni genetik değişikliğe uğrayıp süper lethal hale
gelmeden hastalığı aktif geçirmek, ama riskli/hassas
kişileri aşılama dahil koruma altına almak, toplumun
sağlıklı yaşam ve hijyenik uygulamalara bağlı kalmasını
sağlamak hepimizin görevidir.
The Persistent Legacy of the 1918 Influenza Virus
David M. Morens, M.D., Jeffery K. Taubenberger, M.D., Ph.D., and Anthony S. Fauci, M.D.
N.Eng.J Med.,July 16, 2009
20. yy’ın pandemileriyle ilgili bazı
“bilinen bilinmeyenler”
•
•
•
•
•
Üç pandemi (1918, 1957, 1968)
Her biri şekil ve dalga olarak birbirinden farklı
Efektif reprodüktif sayıda bazı değişiklikler
Değişik gruplar etkilendi
Vaka ölüm oranı bakımından da hastalık seyrinin
değişik ağırlıkta oluşu
• Hafifletmek için değişik yaklaşımlar gerektiriyor
Beklenmedik enfeksiyonlar!
THE FIRST TURNING POINT
A different virus was the world's wake-up call. SARS (severe acute
respiratory syndrome) started in China, and once it broke out of the
mainland in early 2003, it took just weeks to infect more than 8,000
people from 37 countries. The virus killed more than 770 people
before it disappeared.
Governments started scrambling to put together plans to handle
the next global disease threat. Soon after, bird flu hit Asia,
reinforcing the need.
Avrupa’nın pandemi için gözden geçirilmiş planlama
varsayımları-2009’daki ilk dalga pandemi (H1N1)
Clinical attack rate
(klinik olarak hasta vaka sayısı)
% 30
Peak clinical attack rate
(klinik olarak hastavaka sayısının en
üst oranı)
Haftada % 6,5 (% 4,5’tan % 8’e kadar
değişen oranda)
Complication rate
(komplikasyon oranı)
Klinik vakaların % 15’i
Hospitalisation rate
(hastaneye yatırılma oranı)
Klinik vakaların % 2’si
Case fatalitiy rate
(ölümle sonuşlanan vaka oranı)
Klinik vakaların % 0.1- 0.2’si (%
0.35’e kadar )
Peak absence rate
(iş gücü kaybı oranı)
İş gücünün % 12 kadarı
Grip ve Bizler
Nereden Nereye?
Influenza A
Subtipleri vardır:
• 2 yüzey antijeni vardır;
– Hemagglutinin (HA) – bilinen 16
subtipi var
– Neuraminidase (NA) – bilinen 9
subtipi var
Hemagglutinin
This image is in the public domain in the United States
10
Mutasyon
Antijenik Kayma/Antijenik Degisim
Genetic Relationships among Human and Relevant Swine Influenza Viruses, 1918-2009
Morens D et al. N Engl J Med 2009;361:225-229
Mortality Associated with Influenza Pandemics and Selected Seasonal Epidemic Events, 1918-2009
Morens D et al. N Engl J Med 2009;361:225-229
2009 İnfluenza A/ H1N1 görülen ülkeler
Konfirme İnfluenza A/ H1N1 nedeniyle ölüm vakaları
Konfirme İnfluenza A/ H1N1 vakaları
27.Ekim 2009
Epidemioloji
Low: no influenza activity or influenza activity is
at baseline level*
Medium: level of influenza activity usually seen
when influenza virus is circulating in the country
based on historical data
High: higher than usual influenza activity
compared to historical data
Very high: influenza activity is particularly severe
compared to historical data
Unknown: influenza activity is not known
* Baseline influenza activity is the level that
clinical influenza activity remains in throughout
the summer and most of the winter.
Indicator of the geographical spread of influenza: Each country defines the
geographical spread of influenza according to the definitions outlined below.
The definitions are based on those used by the WHO global influenza
surveillance system – FluNet.
ILI:
influenza-like illness
ARI:
acute respiratory infection
countries may be made up of one or more
regions
The population under surveillance in a defined
geographical sub-division of a country. A region
should not (generally) have a population of less
than 5 million unless the country is large with
geographically distinct regions
Country:
Region:
No report: no report received
No activity: reports indicate no evidence of influenza virus activity. Cases of ILI/ARI
may be reported in the country but the overall level of clinical activity remains at
baseline levels and influenza virus infections are not being laboratory confirmed.
Cases occurring in people recently returned from other countries are excluded
Sporadic: isolated cases of laboratory confirmed influenza infection in a region, or
an outbreak in a single institution (such as a school, nursing home or other
institutional setting), with clinical activity remaining at or below baseline levels. Cases
occurring in people recently returned from other countries are excluded
Local outbreak: increased ILI/ARI activity in local areas (such as a city, county or
district) within a region, or outbreaks in two or more institutions within a region, with
laboratory confirmed cases of influenza infection. Levels of activity in remainder of
region, and other regions of the country, remain at or below baseline levels
Regional activity*: ILI/ARI activity above baseline levels in one or more regions with
a population comprising less than 50% of the country's total population, with
laboratory confirmed influenza infections in the affected region(s). Levels of activity in
other regions of the country remain at or below baseline levels
* This term is not (generally) to be used in countries with a population of less than 5
million unless the country is large with geographically distinct regions
Widespread activity: ILI/ARI activity above baseline levels in one or more regions
with a population comprising 50% or more of the country's population, with laboratory
confirmed influenza infections
Unknown: influenza geographical spread is not known
Aims of community reduction of influenza
transmission — mitigation
 Delay and flatten epidemic peak.
 Reduce peak burden on healthcare system and threat.
 Somewhat reduce total number of cases.
 Buy a little time.
No intervention
Daily
cases
With interventions
Days since first case
Based on an original graph developed by the US CDC, Atlanta
Animated slide: Press key
2009 flu pandemic data
Ölüm
Son 7 gündeki artış
Dünya genelinde
6,021
+686 (11%)†
Avrupa
292
+54 (18%)
Orta asya
6
+6 (100%)
Akdeniz ülkeleri
181
+31 (17%)
afrika
108
+2 (2%)
Kuzey Amerika
1,421
+474 (33%)†
Orta amerika
166
+6 (4%)
Güney Amerika
2,693
+34 (1%)
Asya
586
+54 (9%)
güneydoğu Asya
357
+25 (7%)
Avustralya
211
+0 (0%)
29Ekim, 2009[1]
†The
USA introduced a new reporting system on August 30, 2009.
All lab-confirmed deaths which have occured in the U.S. since
then have been reported together by the ECDC on October 26.
Tani testleri
• Tani Testleri kullanis gayeleri.
Description of the system
According to the nationally defined sampling strategy, sentinel
physicians take nasal or pharyngeal swabs from patients with
influenza-like illness (ILI), acute respiratory infection (ARI) or
both and
send the specimens to influenza-specific reference laboratories
for
a. virus detection,
b.(sub-)typing,
c. antigenic or genetic characterisation and
d. antiviral susceptibility testing.
For details on the current virus strains recommended by WHO
B.Stoneetal./JournalofVirologicalMethods117(2004)103–112
Fig.2.Quantification curves relating cycle number(a) or melting temperature curves(b) and hybridization probe fluorescence signals
obtained in the Light Cycler during real time PCR amplification of influenza A matrix gene with H1N1,H3N2, an equal mix of H1N1 and
H3N2, un infected MDCK cells and sterile water.
B.Stoneetal./JournalofVirologicalMethods117(2004)103–112
Fig.2.Quantification curves relating cycle number(a) or melting temperature curves(b) and hybridization probe fluorescence signals
obtained in the Light Cycler during real time PCR amplification of influenza A matrix gene with H1N1,H3N2, an equal mix of H1N1 and
H3N2, un infected MDCK cells and sterile water.
B.Stoneetal./JournalofVirologicalMethods117(2004)103–112
Table 2: Weekly and cumulative influenza virus detections by type, subtype and
surveillance system, weeks 40/2009–43/2009
Note: A(pandemic H1N1, A(H3) and A(H1) includes both N-subtyped and not N-subtyped
viruses
Table 3: Antiviral resistance by influenza virus type and subtype,
weeks 40/2009–43/2009
ECDC Surveillance Report, Weekly influenza surveillance overview, 30 October 2009
China starts batch production of A/H1N1 vaccine
www.chinaview.cn 2009-06-09 20:36:09
A researcher with Sinovac Biotech Company begins preparation work for producing
A/H1N1 influenza vaccine for human use with the seed lot of flu virus "NYMCX-179A".
China received on Monday, June 8, 2009 the flu strain samples shipped from the United
States, for the mass production of A/H1N1 influenza vaccine. Chinese drug companies
are expected to have the vaccine produced by July.(Xinhua Photo)
1917 ve 1976 Domuz Gribi
nother H1N1 flu jumped from pigs to people in 1976
nd killed an army recruit in New Jersey. The US wen
n high alert and vaccinated thousands of people – b
he virus did not spread readily enough to maintain an
pidemic, and fizzled out
he 1918 flu pandemic, caused by another H1N1 viru
tarted with a mild, early wave in spring and early
ummer. The flu lab at the Los Alamos National
aboratory in the US estimates that the R0 of the 191
irus in spring was only 1.45. That shot up, they
stimate, to 3.75 when the virus began its lethal seco
The FDA has approved 4 vaccine preparations.
• All influenza vaccine preparations in the United States for the 2009-2010 season contain
residual egg protein and none contain adjuvant;
• Children 6 months to 9 years of age who are given influenza A (H1N1) monovalent vaccine
should receive 2 doses separated by about 4 weeks; persons ≥ 10 years of age should receive 1
dose;
• The influenza A (H1N1) monovalent vaccines were made according to standards used for
seasonal and influenza vaccines and have the same age group indications, precautions, and
contraindications as vaccines that are FDA-approved for seasonal flu; preliminary data indicate
that the safety and efficacy of the 2009 Influenza A (H1N1) monoclonal vaccine is the same as
for seasonal flu vaccines;
• Side effects, including local pain at the injection site, were reported in 46% of recipients, and
systemic reactions (headache, malaise or myalgias) were reported in 45%; the safety profile is
consistent with the experience with seasonal flu vaccine;
• Influenza activity due to influenza A (H1N1) increased in September 2009 and is expected to
continue through fall and winter;
• There is minimal evidence of significant antigenic change since the first characterization of the
virus in April 2009, indicating that the virus continues to be well matched with the vaccine
strain; and
• The vaccines of the 4 suppliers have some differences that are important to recognize
MMWR Morb Mortal Wkly Rep. 2009;58:1100-1101.)
The FDA has approved 4 vaccine preparations.
• All influenza vaccine preparations in the United States for the 2009-2010 season contain
residual egg protein and none contain adjuvant;
• Children 6 months to 9 years of age who are given influenza A (H1N1) monovalent vaccine
should receive 2 doses separated by about 4 weeks; persons ≥ 10 years of age should receive 1
dose;
• The influenza A (H1N1) monovalent vaccines were made according to standards used for
seasonal and influenza vaccines and have the same age group indications, precautions, and
contraindications as vaccines that are FDA-approved for seasonal flu; preliminary data indicate
that the safety and efficacy of the 2009 Influenza A (H1N1) monoclonal vaccine is the same as
for seasonal flu vaccines;
• Side effects, including local pain at the injection site, were reported in 46% of recipients, and
systemic reactions (headache, malaise or myalgias) were reported in 45%; the safety profile is
consistent with the experience with seasonal flu vaccine;
• Influenza activity due to influenza A (H1N1) increased in September 2009 and is expected to
continue through fall and winter;
• There is minimal evidence of significant antigenic change since the first characterization of the
virus in April 2009, indicating that the virus continues to be well matched with the vaccine
strain; and
• The vaccines of the 4 suppliers have some differences that are important to recognize
MMWR Morb Mortal Wkly Rep. 2009;58:1100-1101.)
Table 1 Results of haemagglutination inhibition tests of influenza A(H1N1) viruses with
post‐infection ferret seraA
Table 1. FDA-Approved Influenza A (H1N1) Vaccines
Supplier
Vaccine Form
Mercury
µg/0.5 mL
0
Age
2-49 yrsb
MedImmune
(nasal spray)
Live virus 0.2 mL
(nasal spray sprayer)
Sanofi (IM)a
Inactivated
0.25 mL prefilled syringe
0.5 mL prefilled syringe
5 mL multidose vial
0
0
25
6-35 mosb
> 36 mosb
> 6 mosb
Novartis (IM)a
5 mL multidose vial
0.5 mL prefilled syringe
25
< 1.0
≥ 4 yrsb
> 4 yrsb
CSL Biotherapies, Inc
(IM)a
0.5 mL prefilled syringe
5.0 mL multidose vial
0
24.5
> 18 yrs
> 18 yrs
a0.5 mL
bTwo
doses contain 15 µg hemagglutinin of the vaccine strain A/California/7/2009 (H1N1)
doses separated by 4 weeks for children 2-9 years (CDC. Update on influenza A (H1N1) monovalent vaccines.
MMWR Morb Mortal Wkly Rep. 2009;58:1100-1101.)
Influenza A (H1N1) 2009 monovalan aşılar 6 ekim, 2009
Aşı
Üretici
Tanıtım
Civa içeriği
Yaş grubu
(μg Hg/0.5 mL
dose)
Doz
Enjeksiyon
yeri
İnaktive
Sanofi Pasteur
0.25 mL
0
6--35
2†
Kas içine
0.5 mL
0
≥36
1 veya 2†
Kas içine
5.0 mL
25.0
≥6
1 veya 2†
Kas içine
Novartis Vaccines
and Diagnostics
Limited
5.0 mL
25.0
≥4 yaş
1 veya 2†
Kas içine
0.5 mL
<1.0
≥4 yaş
1 veya 2†
Kas içine
CSL Limited
0.5 mL
0
≥18 yaş
1
Kas içine
5.0 mL
24.5
≥18 yaş
1
Kas içine
0.2--mL
0
2--49 yaş
1 veya 2††
İntranasal
İnaktive
İnaktive
LAIV (Canlı aşı)¶
MedImmune LLC
FDA/ Influenza A (H1N1) 2009 Monovalent Vaccines Descriptions and Ingredients
The FDA has approved 4 vaccine preparations.
• All influenza vaccine preparations in the United States for the 2009-2010 season contain
residual egg protein and none contain adjuvant;
• Children 6 months to 9 years of age who are given influenza A (H1N1) monovalent vaccine
should receive 2 doses separated by about 4 weeks; persons ≥ 10 years of age should receive 1
dose;
• The influenza A (H1N1) monovalent vaccines were made according to standards used for
seasonal and influenza vaccines and have the same age group indications, precautions, and
contraindications as vaccines that are FDA-approved for seasonal flu; preliminary data indicate
that the safety and efficacy of the 2009 Influenza A (H1N1) monoclonal vaccine is the same as
for seasonal flu vaccines;
• Side effects, including local pain at the injection site, were reported in 46% of recipients, and
systemic reactions (headache, malaise or myalgias) were reported in 45%; the safety profile is
consistent with the experience with seasonal flu vaccine;
• Influenza activity due to influenza A (H1N1) increased in September 2009 and is expected to
continue through fall and winter;
• There is minimal evidence of significant antigenic change since the first characterization of the
virus in April 2009, indicating that the virus continues to be well matched with the vaccine
strain; and
• The vaccines of the 4 suppliers have some differences that are important to recognize
MMWR Morb Mortal Wkly Rep. 2009;58:1100-1101.)
Influenza A (H1N1) 2009 Monovalan aşı
• İnfluenza A (H1N1) 2009 Monovalan aşılar tek
bir influenza suşu (İnfluenza /California/7/09like virus) içermektedir.
• Enjektable olan aşılar inaktivedir.
• İntranasal kullanılacak olan aşı ise canlı
attenue virüs aşısıdır.
Information on the Influenza A (H1N1)2009 Monovalent Vaccine approvals.
FDA kullanılabilirliğine nasıl karar verdi ?
• Tüm aşıların ABD de kullanılabilmesi için FDA onayı gereklidir.
• FDA her sene farklı firmalarca üretilen farklı suşlardan oluşan
mevsimsel grip aşısı onayını verir.
• Her üreticinin yaptığı monovolan Influenza A (H1N1) 2009 aşısı da
mevsimsel grip aşısında olduğu gibi yerleşik yumurta-temelli üretim
proçesi kullanılarak verilmiştir.
• Mevsimsel influenza aşı üretimi ve geliştirilmesi , aşının güvenirliği ile
ilgili çalışmalar konusunda birçok deneyim vardır.
• Güvenlik ve etkinlik için mevsimsel grip aşısında yapılan çalışmalar
Influenza A (H1N1) 2009 Monovalan aşısı içinde başarılı bir şekilde
yapılmıştır.
• Influenza A (H1N1) 2009 Monovalan aşısının klinik çalışmaları devam
etmektedir. Bu çalışmaların verilerini de immunojenite oluşumu için
gereken uygun dozun kararı FDA tarafından takip edilecektir.
• Influenza A (H1N1) 2009 Monovalan aşıları mevsimsel grip aşısı için
yapılan prosedürlerin aynısından geçmiştir.
Influenza A (H1N1) 2009 Monovalan aşının
güvenliği nasıl takip edilecek?
• FDA ve CDC çok yakından takip ediyorlar ,
• FDA, CDC, HHS laboratuvarları ile beraber
çalışarak, influenza A/H1N1 2009 aşılama
programını takip edecektir.
• Laboratuvarlar arası bilgiler bir internet ağı ile
takip edilecektir.
• Ayrıca FDA belirlediği uluslararası partnerlerle
daha geniş bir ağ oluşturarak aşı güvenliğini takip
edecektir.
Geometric Mean Titer of Hemagglutination-Inhibition Antibodies among Subjects Receiving
Nonadjuvanted Vaccine, According to Age Group
Zhu F et al. N Engl J Med 2009;10.1056/NEJMoa0908535
GlaxoSmithKline PLC (GSK), H1N1 aşısının H5N1 aşısı ile benzer toleribilite
göstermiş olduğunu açıkladı.
TEMEL NOKTALAR :
-Geçen hafta 150,000 den fazla insan H1N1 aşısı ile aşılanmış,
-Ek olarak 2,000 den fazla kişiyle ilgili klinik çalışma devam etmektedir.
-İspanya da 200 çocuk üzerinde yapılan İlk pediatrik (devam etmekte olan)
klinik çalışma sonuçlarına göre aşının ilk dozundan sonra kuvvetli yanıt
alınmış. H1N5 aşısına karşı alınan tolaribilitesi benzer bulunmuş.
-Çalışmada kullanılan aşı yarım doz H1N1 antijeni (1.9 μg) ve yarım doz
adjuvant içeriyor, yetişkin aşısı ile karşılaştırılmış.
1. ÜRETİCİ: GlaxoSmithKline
2. İÇERİK:
3.75 micrograms**İnaktive, A/California/7/2009 (H1N1)v-like strain (X-179A)
(WHO ve EU decision for the pandemic ).
10.69 milligrams AS03 adjuvant squalene
11.86 milligrams DL-α-tocopherol
4.86 milligrams polysorbate 80
5 micrograms thiomersal
Posology
18-60 yaş :
0.5 ml ilk doz
2. doz; en az 3 hafta sonra
60 yaş üstü :
0.5 ml ilk doz
2. doz; en az 3 hafta sonra
10-17 yaş:
Aşının gerekli olduğu düşünülüyorsa
0.5 ml ilk doz
2. doz; en az 3 hafta sonra
If vaccination is considered to be necessary, consideration may be given
to dosing in accordance with the recommendations for adults. However,
the choice of dose for this age group should take into account the
available data on safety and immunogenicity in adults and in children
aged from 3-9 years.
3-9 yaş:
Eğer gerek duyulursa,
İlk doz 0.25 ml ,2. doz 3 hafta sonra
If vaccination is considered to be necessary, the available data suggest that
administration of 0.25 ml of vaccine (i.e. half of the adult dose) at an elected
date and a second dose administered at least three weeks later may be
sufficient. There are very limited safety and immunogenicity data available on
the administration of AS03- adjuvanted vaccine containing 3.75 μg HA derived
from A/Vietnam/1194/2004 (H5N1) and on administration of half a dose of the
same vaccine (i.e. 1.875 μg HA and half the amount of AS03 adjuvant in 0.25 ml
) at 0 and 21 days in this age group.
6 ay – 3 yaş
If vaccination is considered to be necessary, consideration may be given to
dosing in accordance with
the recommendation in children aged 3-9 years. See sections 4.8 and 5.1.
Children aged less than 6 months
Vaccination is not currently recommended in this age group.
Genetic and
phylogenetic characterization
• Mutations previously identified to confer resistance
to oseltamivir or zanamivir have not been observed
in the NA gene of the viruses characterized to date.
The novel influenza A(H1N1) viruses tested so far in
functional assays were sensitive to both these
antiviral drugs.
• An asparagine at position 31 of the M2 protein,
associated with resistance to amantadine and
rimantadine, has been observed in all the viruses
analysed to date.
Studies with inactivated seasonal influenza virus
vaccines
Although cross‐immunogenicity studies with seasonal
influenza vaccines are still ongoing,
preliminary data indicate that immunization
with seasonal vaccines induces little or no
crossreactive
antibody to the novel influenza A (H1N1) viruses.
Recommended virus for novel influenza A (H1N1)
vaccines
The majority of the novel influenza A (H1N1) isolates
are antigenically and genetically
related to the A/California/7/2009 (H1N1)v virus.
Should vaccines be prepared against the
novel influenza A (H1N1) virus, it is therefore
recommended that vaccines contain the
following:
An A/California/7/2009 (H1N1)v ‐like virus
WHO
FDA
• Elde edilen veriler 6 aydan 9 yaşa kadar olan
çocuklarda influenza A/ H1N1 2009 monovalan aşı ile
antikor oluşumunun çok az veya hiç olmadığını
göstermiştir.
• 9 yaş ve altındaki çocuklarda monovalan influenzaA
/H1N1 2009 aşısının 2 doz yapılması gerekmektedir.
• Erişkinlerde ve 10 yaş üstündeki çocuklarda ise tek doz
aşı yeterlidir. Klinik çalışmalar tamamlandığında
optimal doz için ek bilgiler edinilecektir.
(MMWR 2009; 58(19) 521-524,
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a1.htm).
Aşıda koruyucu
• Mevsimsel grip aşısı gibi, Influenza A (H1N1)
2009 Monovalan aşıları thimerosal, civa
koruyucuları eklendiğinde de en az koruyucu
olmayan formları kadar etkindir.
• 2001 yılından beri, FDA thimersol içeren yeni
aşılara izin vermiyor. Eskiden üretilmiş olup
izin almış aşılarda ise CDC çocuklarda hiç
thimersol içermeyen veya eser düzeyde
thimersol içeren aşıları öneriyorlar.
Weekly Influenza Surveillance Report Published for the EU/EEA Countries
Week 43/2009 October 30th
• The number of countries with medium to very high intensity influenza activity
continues to increase.
• Seventeen out of 27 countries report a rising trend.
• In sentinel samples, the proportion of influenza-like illness that tested
positive for influenza has risen to 40%—a remarkably high percentage.
• Among positive sentinel isolates, influenza A(H1N1)v accounts for 82%.
• In 18–59 year-old patients with severe acute respiratory infection (SARI),
females were overrepresented.
• In almost 40% of reported SARI cases, no underlying condition was identified.
http://www.ecdc.europa.eu/en/activities/surveillance/EISN/Newsletter/091030_EISN_Weekly_Influenza_Surveillance_Overview.pdf
HASTALIK BULGULARI NELERDİR?
Semptom
Sayı (%)
Ateş *
249 (93%)
Öksürük
223 (83%)
Nefes darlığı
145 (54%)
Uyuşukluk
108 (40%)
Titreme
99 (37%)
Myalji
96 (36%)
Rinore
96 (36%)
Boğaz ağrısı
84 (31%)
Başağrısı
83 (31%)
Kusma
78 (29%)
Wheezing
64 (24%)
Diare
64 (24%)
Durum Avrupa için daha kötü olabilirdi!
Ne olabilirdi ve hala neler olabilir-bir karşılaştırma!
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•
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•
Amerika’da ortaya çıkan pandemik bir suş  Güneydoğu Asya’da ortaya
çıkan bir pandemi
Virüsle ilgili acil veri paylaşımı, çok hızlı tanı ve aşılar  gecikmiş veri
paylaşımı
Pandemi (H1N1) henüz çok patojen değil  daha patojen olan A(H5N1)
suşuna kıyasla
Majör risk grubunda (yaşlılar) görünüşte rezidüel immünite  rezidüel
immünite yok
Bilinen patojenizite belirteçleri yok  artmış patojenizite
Başlangıçta oseltamivire duyarlı  virüsün geliştirdiği antiviral direnç
Kuzey Amerika’dan iyi veri ve bilgi gelişi  Avrupa’ya gelene kadar minimal
düzeyde veri
Avrupa’ya yazın ulaşacak  Geç sonbahar ve kışın ulaşacak
Çoğu vakada hafifi seyirli  hemen ağır seyirli
KENDİMİ VE ÇEVREMİ NASIL KORURUM ? KORUMALIYIM?
TEK KULLANIMLIK MENDIL
KULLANDIĞINI ÇÖPE AT
BELİRTİLERDE DOKTORA GİT
İNSANLARA BULAŞTIRMA
YAKIN TEMASTAN KAÇIN
ELLERİNİ YIKA
KALABALIKTAN UZAK DUR
ELLERİNİ YIKA! BURUN AĞIZ
SÜRME
VE GÖZLERİNE
KORUNMA

El yıkamanın etkin yöntemini öğrenin, uygulayın ve
bilhassa çocuklarınıza öğretin.

Sosyal kontaklardan (el sıkma, öpüşme gibi) sakının.

Kalabalık ortamlardan kaçının, yaşam alanınızı sıkça
havalandırın.

Immun sisteminizi ayakta tutmak için; yeteri kadar uyuyun,
dengeli ve etkin (antioksida yönünden güçlü) beslenin ve
egzersiz yapın, egzersiz düzeyini ve vücut temizliğinizi
daha etkin sürdürün.

Riskli şahıslar (hamileler, kronik hastalığı olanlar, hizmet
üretiminde yoğun insan teması olanlar) aşılanmalıdır.
Bir kac ay icinde ne olacak?
Will it sweep through impoverished Southern
Hemisphere countries in the next few months?
Will it roar back in the rest of the world in the fall?
And who will be vaccinated if it does?
In the weeks since swine flu grabbed international
attention, and even years before that, some
important actions have helped shape the course
of this outbreak and the ways the world will
handle future epidemics. The big worry is that the
virus will mutate, becoming more severe.
Ne kadar gucluyuz?
You may only have one chance to get out ahead
of it," Dr. Richard Besser, acting chief of the
Centers for Disease Control and Prevention, told
The Associated Press. "It's important for people
to understand that all of these decisions will
need to be made with incomplete science.“
The last mass vaccination against a different swine flu, in the U.S. in 1976, was marred by
reports of a paralyzing side effect — and that time the flu didn't return.
___
20. Yüzyıl pandemileri ve
mevsimsel grip
Pandemi
Yıl
Influenza
virus
İnfekte insan
sayısı
Ölü sayısı
Ölüm
oranı
İspanyol
gribi
1918
–19
A/H1N1
33% (500
milyon)
20 to 100
[23][24][25]
million
>2.5%
Asya gribi
1956
–58
A/H2N2
2 million
Hong
Kong gribi
1968
–69
A/H3N2
1 million
Mevsimsel
grip
Her
yıl
A/H3N2,
A/H1N1,
ve B
5–15% (340
milyon – 1
milyar)
[25]
[25]
250,000–
500,000/ yıl
<0.1%
<0.1%
<0.1%
KORUNMA
• avoid touching your mouth and nose;
• clean hands thoroughly with soap and water, or cleanse them
with an alcohol-based hand rub on a regular basis (especially
if touching the mouth and nose, or surfaces that are
potentially contaminated);
• avoid close contact with people who might be ill;
• reduce the time spent in crowded settings if possible;
• improve airflow in your living space by opening windows;
• practise good health habits including adequate sleep, eating
nutritious food, and keeping physically active.
The levels of influenza activity in European countries
reported by EISN members during the influenza season
are based on two assessments of influenza activity:
1. An indicator of the overall intensity of influenza
activity in the country;
2. An indicator of the geographical spread of influenza
in the country.
Each of these assessments is described below.
Low: no influenza activity or influenza activity is
at baseline level*
Medium: level of influenza activity usually seen
when influenza virus is circulating in the country
based on historical data
High: higher than usual influenza activity
compared to historical data
Very high: influenza activity is particularly severe
compared to historical data
Unknown: influenza activity is not known
* Baseline influenza activity is the level that
clinical influenza activity remains in throughout
the summer and most of the winter.
Influenza A/H1N1 dahil tüm grip olguları için;
― Mutlaka evde istirahat ediniz, dengeli besleniniz bol su içiniz
― Ağız burun ifrazatınızı çevreye bulaşmayacak şekilde kapalı hacimlere
depolayın
― Diğer şahıslar ve bilhassa çocuklar ile temasınızı kısıtlayınız
― Sosyal ziyaretlere müsaade etmeyin
― Bulunduğunuz mekanların sık ve etkin havalandırılmasını sağlayın
― Bir doktor ile görüşmeden herhangi bir ilaç almayınız (İnfluenza A/H1 N1
gribinde genelde hafif seyrettiği için altta yatan bir sebep yoksa tedavi
önerilmemektedir.)
― Eğer, ateşiniz 38 oC üzerine çıkarsa, solunum güçlüğü, nefes darlığı gibi
belirtiler varsa vakit geçirmeden doktorunuzu bilgilendirin.
For the treatment of pandemic (H1N1) 2009,
how many antiviral drugs are there?
There are two approved antiviral drugs for influenza that
are available for treatment of pandemic influenza. These
are the neuraminidase inhibitors oseltamivir and
zanamivir, more commonly known by their trade names
Tamiflu and Relenza.
Another class of approved antiviral drugs known as M2
inhibitors (amantadine and rimantadine) can be effective
for treating seasonal influenza. However, the pandemic
(H1N1) 2009 virus has been shown to be resistant to
these particular antiviral drugs
•
Çinde uygulanan aşı onaylama süreci ‘’The State Food and Drug Administration’’ (SFDA)
Tanı
Belde hastaneleri veya
Özel laboratuvarlar
“mevsimsel influenza hızlı tarama “
testini kullanabilirler.
DOMUZ GRİBİ
(İnfluenza A/H1 N1) nedir?
 İnsandan insana geçen yeni tip bir virüse bağlı oluşan griptir.
 İnsandan insana öksürük, aksırık sırasında damlacık yoluyla
bulaşır.
 Virüs bulaştığı yüzeyde 48 saat canlı kalabilir.
 İnkübasyon süresi 5-10 gündür.
 Bilinen insan gribine göre daha hızlı yayılır, hastalık seyri ve riski
farklı değildir.
 (İnfluenza A/H1 N1 gribine bağlı ölüm mevsimsel griptende azdır.)