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INFLUENZA A (H1N1)
SWINE FLU :
EVOLUTION OF
THE PROBLEM
BY
DR ESSAM EL-GAMAL
Professor of Chest Diseases
Mansoura Faculty of Medicine
Tuesday May, 5, 2009
Introduction

Swine Influenza
(swine flu) is a
respiratory disease of
pigs caused by type
A influenza that
regularly cause
outbreaks among
pigs.
Introduction

Swine flu viruses do not normally
infect humans,

However, human infections with
swine flu do occur affecting people
who are around pigs.

it’s possible for swine flu viruses to
spread from person to person also.
Influenza Pandemics of the
past 100 years
Year of Origin
1890
1900
1918
1957
1968
1977
Sub-Type in Circulation
H2N8
H3N8
H1N1 (Spanish Flu)
H2N2 (Asian Flu)
H3N2 (Hong Kong Flu)
HIN1 (Russian Flu)
Spread in less than 30 days!
Source: PBS, WGBH American Experience :Influenza 1918
www.pbs.org/wgbh/amex/influenza/maps
Hospital Response
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Shifts are extended.
Least ill are discharged.
Urgent patients only are
admitted.
Severe shortages of
linens, bedpans, gowns,
mattresses.
Offices, gymnasiums,
warehouses, tent cities
used to isolate and care
for the sick.
Emergency Hospital During Influenza Epidemic,
Source: National Museum of Health and Medicine
An Emergency Hospital for
Influenza Patients 1918
Mass Burials
Source: Crosby, Alfred W. Jr., Epidemic and Peace 1918,
Why The Current Swine Flu is
Terrible ???

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The 1918 flu pandemic (Spanish flu)
that spread to every part of the world,
was caused by a virulent and deadly
Influenza A virus of the same strain
(H1N1).
It lasted from March 1918 to June 1920
and affected up to one billion people
( > ½ world's population at that time).
Why The Current Swine Flu is
Terrible ???

It is cosidered to be the most
devastating epidemic in recorded world
history.

Around 70 - 100 million people were
killed worldwide (equivalent of ⅓ of
population of Europe) and > double the
No killed in World War I.
Swine Flu Outbreaks in USA

An outbreak ccurred in New
Jersey, 1976 and caused > 200
cases with serious illness and
one death.
 > 40 million were vaccinated
and 30 died as a direct result
of vaccination.
 The program was stopped after
over 500 cases of GPS, were
reported.
12 human infections with swine flu
were reported (from 10 US states)
between Dec 2005 - Feb 2009.
Current Situation in the US

Now : since March
2009, 160 of confirmed
cases with one death from
21 States are reported.

Virus is described as a new
subtype of A/H1N1 not
previously detected in
swine or humans.

Samples from Mexico
outbreak match swine
influenza isolates from
patients in USA.
Source: CDC
Current Situation in the US

CDC has determined
that this virus is
contagious and is
spreading from human
to human.

April 27, 2009 : CDC
recommends against
all non-essential travels
to Mexico.
Source: CDC
MMRW Report, April 30, 2009
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April 23-24, in NYC : 222 high school
students visited the nursing office and
left school because of illness.

April 24 (Friday)
Nasopharyngeal swabs were collected
from 9 newly symptomatic students
Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0428a2.htm
April 26, 2009 :
7 of 9 specimens collected
were positive for the new
strain of influenza.
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April 27, School closed.
MMRW Report, April 30, 2009
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April 26-28, 2009 :
37 (88%) of 42 specimens collected tested
positive, bringing the total number of
confirmed cases to 44 of which :
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Median age was 15 years (range: 14-21 ys)
Thirty-one (70%) were females.
• 5 patients reported travel outside NYC
within US states in the week before
symptom onset.
•None of the 44 patients reported recent
travel to California, Texas, or Mexico.
5 May 2009 -- As of 06:00 GMT :
USA has reported 286 lab
confirmed human cases,
including one death.
Current Situation in Mexico
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A total of ~ 2,498 suspected
cases,165 deaths and 1311
hospitalizations (for
pneumonia) have been
reported in 31 of 32 Mexico
States (Ministry of Health).
443 Lab confirmed

1st case discovered in Oaxaca,
April 13, 2009, a woman died of
pneumonia.
Source: Mexican Ministry of Health, WHO, CDC, PAHO & ProMED
Current Situation in Mexico

The illness outbreak in Mexico City
prompted the country's health minister
to :
- cancel classes in Mexico City.
- advise students and adults to avoid
crowded public places.
Current Situation in Mexico
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CDC's lab analyzed 14 samples
from severely ill Mexican pts :
7 of them had the same swine
flu mix as the virus that
infected the US patient.
Canada's national lab has
confirmed swine flu A/H1N1 in
18 isolates from Mexican pts :
12 of which were identical to
the swine flu viruses from
California.
Source: WHO, CDC & ProMED
Current Situation in Mexico
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The virus in Mexico differs from
seasonal influenza in that it affects
otherwise healthy young adults, (20- 50
years) however, seasonal influenza
typically affects the very young and
very old (Ministry of Health).
MMWR, April 30, 2009
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March 2009 :
Mexico experienced outbreaks of influenza-like
illness (ILI).
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April 12, 2009 :
the General Directorate of Epidemiology (DGE)
reported an outbreak of ILI in a small community in
the state of Veracruz to the Pan American Health
Organization (PAHO)
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April 17, 2009 :
a case of atypical pneumonia in Oaxaca State
aroused enhanced surveillance throughout Mexico
Source: CDC
MMWR, April 30, 2009
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April 23, 2009 :
several cases of severe respiratory illness, lab
confirmed as influenza A(H1N1) virus infection were
communicated to the PAHO.
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Sequence analysis revealed that the patients were
infected with the same strain detected in 2 children
living in California.
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April 30, 2009 :
a total of 1,918 suspected cases were reported,
including 286 probable and 97 confirmed cases
including 7 persons who had died
MMWR, April 30, 2009
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Of the 24 patients for whom demographic
and clinical information was available,
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20 (83%) were hospitalized, 3 were examined
in outpatient settings, and 1 had illness that
was not medically attended.
79% of patients aged 5 - 59 years.
62 % (15 patients) were females.
Source: CDC
Last News : 5 May 2009 -- As
of 06:00 GMT
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21 countries have officially reported 1124 cases
of influenza A (H1N1) infection.
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Mexico has reported 590 laboratory confirmed
human cases of infection, including 25 deaths.
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The United States has reported 286 laboratory
confirmed human cases, including one death.
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Canada: 140 confirmed cases, Spain: 54
confirmed cases, UK: 18 confirmed cases.
Situation in EGYPT:
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Egypt started a mass slaughter of
thousands of pigs in an effort to
prevent swine flu spreading,
although flu cannot be caught
from eating pig meat, and there is
no scientific rationale for
slaughtering pig.
Situation in EGYPT:
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The authorities have increased
numbers of medical staff at Cairo
airport to check passengers arriving
from Mexico and will monitor them
during their stay.
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Up till now, no cases of swine flu in
Egypt. However, neighbouring Israel
has 2 confirmed cases in humans.
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DOHMH : New York City Department of
Health and Mental Hygiene.
CDC : center of disease control and
prevention.
MMWR : Morbidity and mortality weekly
report.