Control of Seasonal Flu in Corona

Era

Nagwa KHAMIS, MD

Professor of Clinical Pathology, Microbiology division, ASU

CEO Consultant and Head of IPC Department, CCHE-57357
(Immediate ex-Head of IPC Unit ASUSH)
Board Member of IFIC for EMRO (2011 to 2021)
(Immediate ex-Secretary of IFIC)
Advisor WHO Headquarter of Geneva
(Ebola mission, December 2014 through January 2015, Mali, West Africa)
IAEA Expert for Emerging Zoonotic Diseases
SHEA Ambassador 2017
President SPIC-Egypt
Control of Seasonal Flu in Corona Era
Control of Seasonal Flu in Corona Era

The pathogen
There are 4 types of seasonal influenza viruses, types A, B, C and D. Influenza
A and B viruses circulate and cause seasonal epidemics of disease.

 Influenza A viruses are further classified into subtypes according to the

combinations of the hemagglutinin (HA) and the neuraminidase (NA), the
proteins on the surface of the virus.
 The A(H1N1) is also written as A(H1N1)pdm09 as it caused the
pandemic in 2009 and subsequently replaced the seasonal influenza
A(H1N1) virus which had circulated prior to 2009.
 Only influenza type A viruses are known to have caused pandemics.
Control of Seasonal Flu in Corona Era

 Influenza B viruses are not classified into subtypes, but can be

broken down into lineages. Currently circulating influenza type B viruses
belong to either B/Yamagata or B/Victoria lineage.
 Influenza C virus is detected less frequently and usually causes mild
infections, thus does not present public health importance.
 Influenza D viruses primarily affect cattle and are not known to
infect or cause illness in people
Control of Seasonal Flu in Corona Era

Epidemiology
All age groups can be affected but there are groups that are more at
risk than others.
 People at greater risk of severe disease or complications when
infected are: pregnant women, children under 59 months, the elderly,
individuals with chronic medical conditions (such as chronic cardiac,
pulmonary, renal, metabolic, neurodevelopmental, liver or hematologic
diseases) and individuals with immunosuppressive conditions
(such as HIV/AIDS, receiving chemotherapy or steroids, or
malignancy).
 Health care workers are at high risk acquiring influenza virus infection
due to increased exposure to the patients and risk further spread
particularly to vulnerable individuals.
Control of Seasonal Flu in Corona Era

 The time from infection to illness, known as the

incubation period, is about 2 days, but ranges from
one to four days.
 In temperate climates, seasonal epidemics occur
mainly during winter, while in tropical regions,
influenza may occur throughout the year, causing
outbreaks more irregularly.
 Control of Seasonal Flu in Corona Era

Transmission,
 Seasonal influenza spreads easily, with rapid transmission in crowded
areas.
ir e c t-
D  When an infected person coughs or sneezes, droplets containing viruses
r o plet
d (infectious droplets) are dispersed into the air and can spread up to one
meter, and infect persons in close proximity who breathe these droplets
i r ect- in.
Ind act
t
con  The virus can also be spread by hands contaminated with influenza
viruses.
gh
Cou tte  To prevent transmission, people should cover their mouth and nose with
t i que
E a tissue when coughing, and wash their hands regularly or apply the
“Cough Etiquette”.
Control of Seasonal Flu in Corona Era
Control of Seasonal Flu in Corona Era

Signs and symptoms

 Seasonal influenza is characterized by a sudden onset of fever, cough
(usually dry), headache, muscle and joint pain, severe malaise (feeling
unwell), sore throat and a runny nose.
 But influenza can cause severe illness or death especially in people at
high risk: illnesses range from mild to severe and even death.
 Hospitalization and death occur mainly among high risk groups.
 Worldwide, these annual epidemics are estimated to result in about 3 to
5 million cases of severe illness, and about 290 000 to 650 000
respiratory deaths.
Control of Seasonal Flu in Corona Era

 In industrialized countries most deaths associated with influenza occur

among people age 65 or older
 Epidemics can result in high levels of worker/school absenteeism and
productivity losses. Clinics and hospitals can be overwhelmed during
peak illness periods.
 The effects of seasonal influenza epidemics in developing countries:
research estimates that 99% of deaths in children under 5 years of age
with influenza related lower respiratory tract infections are found in
developing countries.
Control of Seasonal Flu in Corona Era

Diagnosis
 The majority of cases of human influenza are
clinically diagnosed.
 However, during periods of low influenza activity and
outside of epidemics situations, the infection of other
respiratory viruses e.g. rhinovirus, respiratory
syncytial virus, parainfluenza and adenovirus can also
present as Influenza-like Illness (ILI) which makes the
clinical differentiation of influenza from other
pathogens difficult.
Control of Seasonal Flu in Corona Era
 Control of Seasonal Flu in Corona Era

The following are key differences between cold

and flu symptoms in children:
Speed of onset: If symptoms come on very
quickly, it is more likely to be the flu.
Fever and chills: A high fever and chills are
more likely to be signs of the flu.
Muscle aches: Aching muscles are more
common in children with the flu.
Headache: Headaches are more frequently
with the flu than with a cold.
Low energy and appetite: Children are
typically more lethargic and less hungry with
the flu than a cold.
Control of Seasonal Flu in Corona Era

 Collection of appropriate respiratory samples and the application of a

laboratory diagnostic test is required to establish a definitive diagnosis.
 Proper collection, storage and transport of respiratory specimens is the
essential first step for laboratory detection of influenza virus infections.
 Laboratory confirmation of influenza virus from throat, nasal and
nasopharyngeal secretions or tracheal aspirate or washings is commonly
performed using direct antigen detection, virus isolation, or detection of
influenza-specific RNA by reverse transcriptase-polymerase chain
reaction (RT-PCR).
 Various guidance on the laboratory techniques is published and updated
by WHO.
Control of Seasonal Flu in Corona Era

 WHO/Harold Ruiz
 Despite many advances, influenza is still a challenge for scientists
Control of Seasonal Flu in Corona Era

Treatment
Patients with uncomplicated seasonal influenza:
 Patients that are not from a high risk group should be managed with
symptomatic treatment and are advised, if symptomatic, to stay home in
order to minimize the risk of infecting others in the community.
 Treatment focuses on relieving symptoms of influenza such as fever.
 Patients should monitor themselves to detect if their condition deteriorates
and seek medical attention.

 Patients that are known to be in a group at high risk for developing severe
or complicated illness, should be treated with antivirals in addition to
symptomatic treatment as soon as possible.
Control of Seasonal Flu in Corona Era

Patients with severe or progressive clinical illness associated with suspected or

confirmed influenza virus infection (i.e. clinical syndromes of pneumonia, sepsis or
exacerbation of chronic underling diseases) should be treated with antiviral drug as soon as
possible.
 Neuraminidase inhibitors (i.e. oseltamivir) should be prescribed as soon as possible (ideally,
within 48 hours following symptom onset) to maximize therapeutic benefits. Administration
of the drug should also be considered in patients presenting later in the course of illness.
 Treatment is recommended for a minimum of 5 days, but can be extended until there is
satisfactory clinical improvement.
 Corticosteroids should not be used routinely,, unless indicated for other reasons (eg:
asthma and other specific conditions); as it has been associated with prolonged viral
clearance, immunosuppression leading to bacterial or fungal superinfection.
 All currently circulating influenza viruses are resistant to adamantane antiviral drugs (such
as amantadine and rimantadine), and these are therefore not recommended for
monotherapy.
Control of Seasonal Flu in Corona Era

WHO GISRS monitors resistance to antivirals among circulating influenza

viruses to provide timely guidance for antiviral use in clinical management
and potential chemoprophylaxis.
Control of Seasonal Flu in Corona Era
Control of Seasonal Flu in Corona Era

Prevention
 The most effective way to prevent the disease is vaccination. Safe and
effective vaccines are available and have been used for more than 60
years. Immunity from vaccination wanes over time so annual vaccination is
recommended to protect against influenza. Injected inactivated influenza
vaccines are most commonly used throughout the world.
 Among healthy adults, influenza vaccine provides protection, even when
circulating viruses do not exactly match the vaccine viruses. However,
among the elderly, influenza vaccination may be less effective in
preventing illness but reduces severity of disease and incidence of
complications and deaths. Vaccination is especially important for people at
high risk of influenza complications, and for people who live with or care
for the people at high risk.
Control of Seasonal Flu in Corona Era

WHO recommends annual vaccination for:

 pregnant women at any stage of pregnancy
 children aged between 6 months to 5 years
 elderly individuals (aged more than 65 years)
 individuals with chronic medical conditions
 health-care workers.
Control of Seasonal Flu in Corona Era

 Influenza vaccine is most effective when circulating viruses are well-

matched with viruses contained in vaccines. Due to the constant
evolving nature of influenza viruses, the WHO Global Influenza
Surveillance and Response System (GISRS) – a system of National
Influenza Centres and WHO Collaborating Centres around the world –
continuously monitors the influenza viruses circulating in humans and
updates the composition of influenza vaccines twice a year.
Control of Seasonal Flu in Corona Era

 For many years, WHO has updated its recommendation on the

composition of the vaccine (trivalent) that targets the 3 most
representative virus types in circulation (two subtypes of influenza A
viruses and one influenza B virus). Starting with the 2013–2014 northern
hemisphere influenza season, a 4th component is recommended to
support quadrivalent vaccine development. Quadrivalent vaccines
include a 2nd influenza B virus in addition to the viruses in trivalent
vaccines, and are expected to provide wider protection against influenza
B virus infections. A number of inactivated influenza vaccines and
recombinant influenza vaccines are available in injectable form. Live
attenuated influenza vaccine is available as a nasal spray.
Control of Seasonal Flu in Corona Era

Pre-exposure or post-exposure prophylaxis with antivirals is possible but

depends on several factors e.g. individual factors, type of exposure, and risk
associated with the exposure.
 Apart from vaccination and antiviral treatment, the public health
management includes personal protective measures like:
 Regular hand washing with proper drying of the hands
 Good respiratory hygiene – covering mouth and nose when coughing or
sneezing, using tissues and disposing of them correctly
 Early self-isolation of those feeling unwell, feverish and having other
symptoms of influenza
 Avoiding close contact with sick people
 Avoiding touching one’s eyes, nose or mouth
Control of Seasonal Flu in Corona Era

WHO response
 WHO, through the WHO GISRS system, in collaboration with other
partners, monitors influenza activity globally, recommends seasonal
influenza vaccine compositions twice a year for the Northern and
Southern hemisphere influenza seasons, guides countries in tropical and
subtropical areas to choose vaccine formulations (Northern hemisphere
vs. Southern hemisphere), to support decisions for timing of vaccination
campaigns, and to support Member States to develop prevention and
control strategies.
 WHO works to strengthen national, regional and global influenza
response capacities including diagnostics, antiviral susceptibility
monitoring, disease surveillance and outbreak responses, and to
increase vaccine coverage among high risk groups and prepare for the
next influenza pandemic.
Control of Seasonal Flu in Corona Era
This is our “Why”
Control of Seasonal Flu in Corona Era
Control of Seasonal Flu in Corona Era
Control of Seasonal Flu in Corona Era
Control of Seasonal Flu in Corona Era

 According to the CDC, like seasonal flu, symptoms of swine

flu infections can include:

- fever, which is usually high, but unlike seasonal flu, is

sometimes absent
- cough
- runny nose or stuffy nose
- sore throat
- body aches
- headache
- chills
- fatigue or tiredness, which can be extreme
- diarrhea and vomiting, sometimes, but more commonly
seen than with seasonal flu
 Signs of a more serious swine flu infection might include
pneumonia and respiratory failure
 Control of Seasonal Flu in Corona Era
Swine Flu High Risk Groups

With regular seasonal flu, infants and the

elderly are usually thought to be most at
risk for serious infections, in addition to
people with chronic medical problems.
Swine flu high risk groups, people who are
thought to be at risk for serious, life-
threatening infections, are a little different
and can include:
1- pregnant women
2- people with chronic medical problems
such as: chronic lung disease, like asthma,
cardiovascular disease,
diabetes, and
Immunosuppression children and adults
with obesity
 Control of Seasonal Flu in Corona Era
More serious symptoms that would
indicate that a child with swine flu would
need urgent medical attention include:

> Fast breathing or trouble breathing

> Bluish or gray skin color
> Not drinking enough fluids
> Severe or persistent vomiting
> Not waking up or not interacting
> Being so irritable that the child does
not want to be held
> Flu-like symptoms improve but then
return with fever and worse cough

> Swine Flu Symptoms vs. a Cold or Sinus

Infection
 Control of Seasonal Flu in Corona Era

It is important to keep in mind

most children with a runny nose
or cough will not have swine flu
and will not have to see their
pediatrician for swine flu
testing.
Control of Seasonal Flu in Corona Era
 IPC Manual Index of Policies
General:
1- Infection prevention and control program
2- Surveillance of hospital acquired infections
3- Outbreak investigations and management
4- Standard precautions
5- Hand hygiene
6- Personal protective equipment
7- Waste management
8- Antiseptics and disinfectants
9- Isolation
10- Reporting of infectious disease
11- Management of influx of communicable and contagious disease

IPC Policies
12- Invasive devices and bundles of care
13- Prevention of infection associated with vascular devices
14- Preventing healthcare associated pneumonia
15- Prevention of surgical site infections

and
16- Blood sampling
17- Management of biological spills
18- Management of needle stick injury and exposure to blood and body
fluids
19- Occupational exposures of staff to pathogens other than blood borne

Procedures
viruses
20- Employees health and immunization
21- Multi-dose and single dose medications
22- Expired medical supplies
23- Environmental services
24- Heating, ventilation, and air conditioning (HVAC)
25- Water system
26- Construction, renovation, repair, and demolition
27- Animal assisted therapy
Specific:
28- Inpatients
29- Out patients
30- Day care
31- Procedure room
32- Intensive care unit
33- Bone marrow transplantation
34- Surgical operations suite
35- Central sterilization supply department (CSSD)
36- Anesthesia
37- Endoscopy unit
38- Pharmacy
39- Central lab
40- Blood bank
41- Radiology
42- Playing rooms
43- Food services
Global Communicable Diseases’
Program
2018
Control of Seasonal Flu in Corona Era
Control of Seasonal Flu in Corona Era
Respiratory Screen Report from November 1st till 30 November
Total +ve Inpatient H1N1 Other Res.
23 91

251 177 HAI POA HAI POA

6 17 33 58

HAI Rate for H1N1

6/777*100=0.77%
6/8204*1000=0.7/1000 hospitalization days
HAI Rate for other Respiratory viruses
33/777*100=4.2 %
33/8204*1000=4 /1000 hospitalization days.
Control of Seasonal Flu in Corona Era

Respiratory Screen Report from December 1st till 31 December

Total +ve Inpatient H1N1 Other Res.
85 206

598 291 HAI POA HAI POA

15 70 32 174

HAI Rate for H1N1

15/ 862*100=1.7%
15/8328 *1000=1.8/1000 hospitalization days
HAI Rate for other Respiratory viruses
32/862*100=3.7 %
32/8328 *1000=3.8/1000 hospitalization days.
Control of Seasonal Flu in Corona Era Children's Cancer Hospital

Infection Control Unit

Respiratory Screen Report from January 1st till 31january 2020

Total +ve Inpatient H1N1 Other Res.
14 273

315 287 HAI POA HAI POA

4 10 28 245

HAI Rate for H1N1

4/851*100=0.5%

4/8466*1000=0.5/1000 hospitalization days

HAI Rate for other Respiratory viruses

28/851*100=3.3%

28/8466*1000=3.3/1000 hospitalization days.

Control of Seasonal Flu in Corona Era
Control of Seasonal Flu in Corona Era
Thank You