Παρουσίαση με θέμα: "Κλινική διάγνωση και πορεία νόσου"— Μεταγράφημα παρουσίασης:
1 Κλινική διάγνωση και πορεία νόσου “ΛΟΙΜΩΞΗ ΑΠΟ ΤΟΝ ΙΟ ΓΡΙΠΗΣ A H1N1 ΝΕΩΤΕΡΑ ΔΕΔΟΜΕΝΑ”22/09/2009, Δώμα, ΓΝΑ «Ευαγγελισμός»Κλινική διάγνωση και πορεία νόσουKαθ. Αθ.Σκουτέλης Ε΄Παθολογική Κλινική & Μονάδα ΛοιμώξεωνΓΝΑ «Ευαγγελισμός»
2 The Normal Burden of Disease InfluenzaThe Normal Burden of DiseaseSeasonal InfluenzaGlobally: 250,000 to 500,000 deaths per yearIn the US (per year)~35,000 deaths>200,000 Hospitalizations$37.5 billion in economic cost (influenza & pneumonia)>$10 billion in lost productivityPandemic InfluenzaAn ever present threat
4 The situation could be a lot worse for Europe The situation could be a lot worse for Europe! (Situation circa summer 2009)Contrast with what might have happened — and might still happen!A pandemic emerging in SE AsiaA pandemic strain emerging in the Americas.Immediate virus sharing so rapid diagnostic and vaccines.Pandemic (H1N1) currently not that pathogenic.Some seeming residual immunity in a major large risk group (older people).No known pathogenicity markers.Initially susceptible to oseltamivir.Good data and information coming out of North America.Arriving in Europe in the summer.Mild presentation in most.Delayed virus sharingBased on a more pathogenic strain, e.g. A(H5N1)No residual immunityHeightened pathogenicityInbuilt antiviral resistanceMinimal data until transmission reached EuropePandemics come in all shapes and sizes and are highly unpredictable. This slide should be looked at with a later one – on Known Knowns and Known Unknowns – this slide in particular shows how fortunate we have been so far with this pandemicArriving in the late autumn or winterSevere presentation immediately
11 Requiring hospitalisation Seasonal influenza compared to pandemic — proportions of types of casesDeathsRequiring hospitalisationClinical symptomsDeathsAsymptomaticClinical symptomsRequiring hospitalisationBut remember this is idealised – and in 2009 in North America this is not putting as many people into Hospital as you would expect from the above. In the 2009 pandemic it is not clear yet what percentage are asymptomatic. Two reasonable estimates are 33% and 50% of the total infected. [Note to Uwe – can you increase the asymptomatic fraction in both to make them look about 33% of the total]AsymptomaticSeasonal influenzaPandemic
12 Laboratory findings Both leukocytosis and leukopenia have been observed among hospitalized patients. In Mexico, many hospitalized patients have had leukopenia, elevated aminotransferases, elevated lactate dehydrogenase, and elevated creatinine phosphokinase. Some patients have also had renal insufficiency.World Health Organization. Human infection with new influenza A (H1N1) virus: clinical observations from Mexico and other affected countries, May Weekly epidemiological record 2009; 84:185.
13 ΔΙΑΓΝΩΣΗΗ κλινικη διαγνωση εχει αυξημενη προγνωστικη αξια, οσο αυξανεται η επιπτωση της νοσουΕργαστηριακη διαγνωση χρειαζεται για:- διαχειριση κρούσματος- αντιιικη θεραπεια- αποφυγη ασκοπης χρησης αντιβιοτικωνWHO, Aug. 9, 2009
14 Rapid antigen tests sensitivity 51-63% specificity 99 % Clinicians may consider using rapid influenza antigen tests as part of their evaluation of patients suspected of having pandemic H1N1 influenza A, but results should be interpreted with caution . Confirmation of pandemic H1N1 influenza A infection can only be made by real-time reverse-transcriptase (RT)-PCR or culture.sensitivity 51-63%specificity 99 %
16 Swine Influenza A(H1N1) US Case Definitions A confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests:real-time RT-PCRviral cultureA probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness who is:positive for influenza A, but negative for H1 and H3 by influenza RT-PCR, orpositive for influenza A by an influenza rapid test or an influenza immunofluorescence assay (IFA) plus meets criteria for a suspected caseA suspected case of swine influenza A (H1N1) virus infection is defined as a person with acute febrile respiratory illness with onsetwithin 7 days of close contact with a person who is a confirmed case of swine influenza A (H1N1) virus infection, orwithin 7 days of travel to community either within the United States or internationally where there are one or more confirmed swine influenza A(H1N1) cases, orresides in a community where there are one or more confirmed swine influenza cases.Source: CDC
18 Risk groups for the A(H1N1) pandemic 2009 The following groups are considered more at risk of experiencing severe disease than the general population should they become infected with the pandemic A(H1N1) virus 2009:People with chronic conditions in the following categories:chronic respiratory diseases;chronic cardiovascular diseases (though not isolated mild hypertension);chronic metabolic disorders (notably diabetes);chronic renal and hepatic diseases;persons with deficient immunity (congenital or acquired);chronic neurological or neuromuscular conditions; andany other condition that impairs a person’s immunity or prejudices their respiratory (breathing) function, including severe or morbid obesity.Note: These categories will be subject to amendment and development as more data become available. These are very similar underlying conditions that serve as risk factors for seasonal influenza. What is especially different from seasonal influenza is that the older age groups (over the age of 60 years) without underlying conditions are relatively unaffected by the pandemic strain.Pregnant women.Young children (especially those under two years).ECDC Pandemic 2009 Risk Assessment. Available from:Finelli L. CDC Influenza Surveillance. Available from:Nicoll A et al. Eurosurveillance, Volume 13, Issue 43, 23 October Available from:Jamieson D et al. Lancet 2009; July 29, 2009 DOI: /S (09)CDC 2009 ACIP Meeting, 31 July Novel influenza A(H1N1) epidemiology update. Available from:CDC 2009 ACIP Meeting, 31 July Vaccine workgroup considerations. Available from:
22 Swine Influenza A(H1N1) Mexico Confirmed Cases & Death, by Age Groups As of June 09, 2009Total Number of Confirmed Cases = 6,241*Deaths = 10871.3% DeathsHighest % Case-Fatality (77.5%) was observed in the year age group.*NOTE: 43 confirmed cases not includedSource: Secretaria de Salud, Mexico
31 Ορισμός ύποπτου κρούσματος για νέα γρίπη Α (Η1Ν1) σε ασθενείς που εισάγονται στο Νοσοκομείο για διερεύνηση ή αντιμετώπιση.Οξύ εμπύρετο (>37,7 o C) χωρίς εστία λοίμωξης από την αντικειμενική εξέταση και τα πρώτα εργαστηριακά. Ασθενείς με συμπτωματολογία από το γαστρεντερικό και εμπύρετο θεωρούνται ύποπτα κρούσματα. Η κλινική κρίση του θεράποντος βαραίνει κατά περίπτωση.Στους παραπάνω κρίνεται σκόπιμη η λήψη δείγματος για τον αποκλεισμό της νόσου και τη μείωση του κινδύνου της ενδονοσοκομειακής διασποράς
32 BAΡΕΙΑ ΠΕΡΙΣΤΑΤΙΚΑ ΚΑΤΑ ΚΑΝΟΝΑ ΓΙΑΤΙ ΟΙ ΝΟΣΗΛΕΥΟΜΕΝΟΙ ΑΠΟΤΕΛΟΥΝ ΠΡΟΚΛΗΣΗ ΣΤΗΝ ΑΣΚΗΣΗ ΜΕΤΡΩΝ ΠΡΟΣΤΑΣΙΑΣ;ΑΠΟΦΥΓΗ ΕΝΔΟΝΟΣΟΚΟΜΕΙΑΚΗΣ ΔΙΑΣΠΟΡΑΣ ΠΟΥ ΜΠΟΡΕΙ ΝΑ ΕΧΕΙ ΤΡΑΓΙΚΕΣ ΣΥΝΕΠΕΙΕΣBAΡΕΙΑ ΠΕΡΙΣΤΑΤΙΚΑ ΚΑΤΑ ΚΑΝΟΝΑ
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