Kamis, 28 Mei 2009
In House Training surveilans
Selasa, 12 Mei 2009
WHO : Assessing the severity of an influenza pandemic
Even a pandemic virus that initially causes mild symptoms in otherwise healthy people can be disruptive, especially under the conditions of today’s highly mobile and closely interdependent societies. Moreover, the same virus that causes mild illness in one country can result in much higher morbidity and mortality in another. In addition, the inherent virulence of the virus can change over time as the pandemic goes through subsequent waves of national and international spread.
Properties of the virus
An influenza pandemic is caused by a virus that is either entirely new or has not circulated recently and widely in the human population. This creates an almost universal vulnerability to infection. While not all people ever become infected during a pandemic, nearly all people are susceptible to infection.
The occurrence of large numbers of people falling ill at or around the same time is one reason why pandemics are socially and economically disruptive, with a potential to temporarily overburden health services.
The contagiousness of the virus also influences the severity of a pandemic’s impact, as it can increase the number of people falling ill and needing care within a short timeframe in a given geographical area. On the positive side, not all parts of the world, or all parts of a country, are affected at the same time.
The contagiousness of the virus will influence the speed of spread, both within countries and internationally. This, too, can influence severity, as very rapid spread can undermine the capacity of governments and health services to cope.
Pandemics usually have a concentrated adverse impact in specific age groups. Concentrated illnesses and deaths in a young, economically productive age group will be more disruptive to societies and economies than when the very young or very old are most severely affected, as seen during epidemics of seasonal influenza.
Population vulnerability
The overall vulnerability of the population can play a major role. For example, people with underlying chronic conditions, such as cardiovascular disease, hypertension, asthma, diabetes, rheumatoid arthritis, and several others, are more likely to experience severe or lethal infections. The prevalence of these conditions, combined with other factors such as nutritional status, can influence the severity of a pandemic in a significant way.
Subsequent waves of spread
The overall severity of a pandemic is further influenced by the tendency of pandemics to encircle the globe in at least two, sometimes three, waves. For many reasons, the severity of subsequent waves can differ dramatically in some or even most countries.
A distinctive feature of influenza viruses is that mutations occur frequently and unpredictably in the eight gene segments, and especially in the haemagglutinin gene. The emergence of an inherently more virulent virus during the course of a pandemic can never be ruled out.
Different patterns of spread can also influence the severity of subsequent waves. For example, if schoolchildren are mainly affected in the first wave, the elderly can bear the brunt of illness during the second wave, with higher mortality seen because of the greater vulnerability of elderly people.
During the previous century, the 1918 pandemic began mild and returned, within six months, in a much more lethal form. The pandemic that began in 1957 started mild, and returned in a somewhat more severe form, though significantly less devastating than seen in 1918. The 1968 pandemic began relatively mild, with sporadic cases prior to the first wave, and remained mild in its second wave in most, but not all, countries.
Capacity to respond
Finally, the quality of health services influences the impact of any pandemic. The same virus that causes only mild symptoms in countries with strong health systems can be devastating in other countries where health systems are weak, supplies of medicines, including antibiotics, are limited or frequently interrupted, and hospitals are crowded, poorly equipped, and under-staffed.
Assessment of the current situation
To date, the following observations can be made, specifically about the H1N1 virus, and more generally about the vulnerability of the world population. Observations specific to H1N1 are preliminary, based on limited data in only a few countries.
The H1N1 virus strain causing the current outbreaks is a new virus that has not been seen previously in either humans or animals. Although firm conclusions cannot be reached at present, scientists anticipate that pre-existing immunity to the virus will be low or non-existent, or largely confined to older population groups.
H1N1 appears to be more contagious than seasonal influenza. The secondary attack rate of seasonal influenza ranges from 5% to 15%. Current estimates of the secondary attack rate of H1N1 range from 22% to 33%.
With the exception of the outbreak in Mexico, which is still not fully understood, the H1N1 virus tends to cause very mild illness in otherwise healthy people. Outside Mexico, nearly all cases of illness, and all deaths, have been detected in people with underlying chronic conditions.
In the two largest and best documented outbreaks to date, in Mexico and the United States of America, a younger age group has been affected than seen during seasonal epidemics of influenza. Though cases have been confirmed in all age groups, from infants to the elderly, the youth of patients with severe or lethal infections is a striking feature of these early outbreaks.
In terms of population vulnerability, the tendency of the H1N1 virus to cause more severe and lethal infections in people with underlying conditions is of particular concern.
For several reasons, the prevalence of chronic diseases has risen dramatically since 1968, when the last pandemic of the previous century occurred. The geographical distribution of these diseases, once considered the close companions of affluent societies, has likewise shifted dramatically. Today, WHO estimates that 85% of the burden of chronic diseases is now concentrated in low- and middle-income countries. In these countries, chronic diseases show an earlier average age of onset than seen in more affluent parts of the world.
In these early days of the outbreaks, some scientists speculate that the full clinical spectrum of disease caused by H1N1 will not become apparent until the virus is more widespread. This, too, could alter the current disease picture, which is overwhelmingly mild outside Mexico.
Apart from the intrinsic mutability of influenza viruses, other factors could alter the severity of current disease patterns, though in completely unknowable ways, if the virus continues to spread.
Scientists are concerned about possible changes that could take place as the virus spreads to the southern hemisphere and encounters currently circulating human viruses as the normal influenza season in that hemisphere begins.
The fact that the H5N1 avian influenza virus is firmly established in poultry in some parts of the world is another cause for concern. No one can predict how the H5N1 virus will behave under the pressure of a pandemic. At present, H5N1 is an animal virus that does not spread easily to humans and only very rarely transmits directly from one person to another.
Selasa, 05 Mei 2009
Sebagian Besar Kasus Flu Meksiko Tak Perlu Rawat Inap
Demikian disampaikan Prof Tjandra Yoga Aditama, Dirjen Pengendalian Penyakit & Penyehatan Lingkungan Departemen Kesehatan RI, di Jakarta, Selasa (5/5), kepada Kompas.com lewat surat elektronik mengutip publikasi terbaru di Physician's First Watch pada 4 Mei .
Menurut Tjandra, data terakhir, menurut WHO, sudah ada 21 negara melaporkan kasus dengan total 1.085 kasus dan 26 (2,3 persen) meninggal.
Sampai Minggu (3/5) ada 226 pasien flu meksiko H1N1 di Amerika Serikat. Dari 226 itu hanya 30 (13,2 persen) yang dirawat inap di rumah sakit. Sisanya sekitar 87 persen dapat sembuh tanpa harus masuk rumah sakit.
Angka ini tentu jauh berbeda dengan kasus flu burung, di mana 100 persen pasiennya dirawat inap di rumah sakit dengan angka kematian (CFR) sekitar 80 persen.
Senin, 04 Mei 2009
Vaccines for the new influenza A(H1N1)
Is an effective vaccine already available against the new influenza A(H1N1) virus?
No, but work is already under way to develop such a vaccine. Influenza vaccines generally contain a dead or weakened form of a circulating virus. The vaccine prepares the body’s immune system to defend against a true infection. For the vaccine to protect as well as possible, the virus in it should match the circulating “wild-type” virus relatively closely. Since this H1N1 virus is new, there is no vaccine currently available made with this particular virus. Making a completely new influenza vaccine can take five to six months.
What implications does the declaration of a pandemic have on influenza vaccine production?
Declaration by WHO of phase 6 of pandemic alert does not by itself automatically translate into a request for vaccine manufacturers to immediately stop production of seasonal influenza vaccine and to start production of a pandemic vaccine. Since seasonal influenza can also cause severe disease, WHO will take several important considerations such as the epidemiology and the severity of the disease when deciding when to formally make recommendations on this matter. In the meantime, WHO will continue to interact very closely with regulatory and other agencies and influenza vaccine manufacturers.
How important will influenza A(H1N1) vaccines be for reducing pandemic disease?
Vaccines are one of the most valuable ways to protect people during influenza epidemics and pandemics. Other measures include anti-viral drugs, social distancing and personal hygiene.
Will currently available seasonal vaccine confer protection against influenza A(H1N1)?
The best scientific evidence available today is incomplete but suggests that seasonal vaccines will confer little or no protection against influenza A(H1N1).
What is WHO doing to facilitate production of influenza A(H1N1) vaccines?
As soon as the first human cases of new influenza A(H1N1) infection became known to WHO, the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America) took immediate action and began the work to develop candidate vaccine viruses. WHO also initiated consultations with vaccine manufacturers worldwide to facilitate the availability of all necessary material to start production of influenza A(H1N1) vaccine. In parallel, WHO is working with national regulatory authorities to ensure that the new influenza A(H1N1) vaccine will meet all safety criteria and be made available as soon as possible.
Why is WHO not asking vaccine manufacturers to switch production from seasonal vaccine to a influenza A(H1N1) vaccine yet?
WHO has not recommended stopping production of seasonal influenza vaccine because this seasonal influenza causes 3 million to 5 million cases of severe illness each year, and kills from 250 000 to 500 000 people. Continued immunization against seasonal influenza is therefore important. Moreover, stopping seasonal vaccine production immediately would not allow a pandemic vaccine to be made quicker. At this time, WHO is liaising closely with vaccine manufacturers so large-scale vaccine production can start as soon as indicated.
Is it possible that manufacturers produce both seasonal and pandemic vaccines at the same time?
There are several potential options which must be considered based on all available evidence.
What is the process for developing a pandemic vaccine? Has a vaccine strain been identified, and if so by whom?
A vaccine for the Influenza A(H1N1) virus will be produced using licensed influenza vaccine processes in which the vaccine viruses are grown either in eggs or cells. Candidate vaccine strains have been identified and prepared by the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America)1. These strains have now been received by the other WHO Collaborating Centers which have also started preparation of vaccine candidate viruses. Once developed, these strains will be distributed to all interested manufacturers on request. Availability is anticipated by mid-May.
How quickly will influenza A(H1N1) vaccines be available?
The first doses of Influenza A(H1N1) vaccine could be available in five to six months from identification of the pandemic strain. The regulatory approval will be conducted in parallel with the manufacturing process. Regulatory authorities have put into place expedited processes that do not compromise on the quality and safety of the vaccine. Delays in production could result from poor growth of the virus strain used to make the vaccine.
How would manufacturers be selected?
There are currently more than a dozen vaccine manufacturers with licenses to produce influenza vaccines. Upon request, the vaccine strain will be available to each of them, as well as to other qualified vaccine manufacturers who are preparing to make influenza vaccine but do not yet have a licensed influenza vaccine.
What is the global manufacturing capacity for a potential influenza A(H1N1) pandemic vaccine? Is this the same as the global manufacturing capacity for H5N1?
The projections made for the production capacity of an vaccine for H5N1 cannot be automatically assumed to be the capacity to make an H1N1 vaccine. H5N1 and H1N1 viruses are different and the amount of antigen needed to make an effective H1N1 vaccines may be different than for H5N1. Therefore it is not possible to make a precise estimate. However, given these considerations, a conservative estimate of global capacity is at least 1 to 2 billion doses per year.
How is production capacity for influenza vaccines distributed geographically?
More that 90% of the global capacity today is located in Europe and in North America. However, during the past five years, other regions have begun to acquire the technology to produce influenza vaccines. Six manufacturers in developing countries have done so with technical and financial support from WHO.
What will be the storage requirements for influenza A(H1N1) vaccine?
The vaccine should be stored under refrigerated conditions at between 2°C and 8°C.
It has been impossible so far to develop vaccines for major killers such as HIV and malaria. How sure are we that there will not be scientific or other hurdles in developing an effective influenza A(H1N1) vaccine?
Typically, development of influenza vaccines has not posed a problem. Influenza vaccines have been used in humans for many years and are known to be immunogenic and effective. Each year seasonal influenza vaccines with varying composition are produced for the northern and southern hemisphere influenza seasons. Vaccine manufacturers will employ a number of different technologies to develop their vaccines. They will take advantage, notably, of novel approaches that were developed over the past years for H5N1 avian influenza vaccines. One key unknown is yield of vaccine virus production, since some strains grow better than others and the behavior of the new influenza A(H1N1) strain in manufacturers’ systems is not yet known. New recombinant technologies are under development, but have not yet been approved for use.
Will influenza A(H1N1) vaccines be effective in all population groups?
There are not data on this but there also is no reason to expect that they would not, given current information.
Will the influenza A(H1N1) vaccine be safe?
Licensed vaccines are held to a very high standard of safety. All possible precautions will be taken to ensure safety of new influenza A(H1N1) vaccines.
How can a repeat of the 1976 swine flu vaccine complications (Guillain-Barré syndrome) experienced in the United States of America be avoided?
Guillain-Barré syndrome is an acute disorder of the nervous system. It is observed following a variety of infections, including influenza. Studies suggest that regular seasonal influenza vaccines could be associated with an increased risk of Guillain-Barré syndrome on the order of one to two cases per million vaccinated persons. During the 1976 influenza vaccination campaign, this risk increased to around 10 cases per million vaccinated persons which led to the withdrawal of the vaccine.
Pandemic vaccines will be manufactured according to established standards. However, they are new products so there is an inherent risk that they will cause slightly differently reactions in humans. Close monitoring and investigation of all serious adverse events following administration of vaccine is essential. The systems for monitoring safety are an integral part of the strategies for the implementation of the new pandemic influenza vaccines. Quality control for the production of influenza vaccines has improved substantially since the 1970s.
Will it be possible to deliver new influenza A(H1N1) vaccine simultaneously with other vaccines?
Inactivated influenza vaccine can be given at the same time as other injectable vaccines, but the vaccines should be administered at different injection sites.
If the virus causes a mild pandemic in the warmer months and changes into something much more severe in, say, 6 months, will vaccines being developed now be effective?
It is too early to be able to predict changes in the influenza A(H1N1) virus as it continues to circulate in humans or how similar a mutated virus might be to the current virus. Careful surveillance for changes in the influenza A(H1N1) virus is ongoing. This close and constant monitoring will support a quick response should important changes in the virus be detected.
Will there be enough influenza A(H1N1) vaccine for everyone?
The estimated time to make enough vaccine to vaccinate the world's population against pandemic influenza will not be known until vaccine manufacturers will have been able to determine how much active ingredient (antigen) is needed to make one dose of effective influenza A(H1N1) vaccine.
In the past two years, influenza vaccine production capacity has increased sharply due to expansion of production facilities as well as advances in research, including the discovery and use of adjuvants. Adjuvants are substances added to a vaccine to make it more effective, thus conserving the active ingredient (antigen).
What is WHO's perspective on fairness and equity for vaccine availability?
The WHO Director-General has called for international solidarity in the response to the current situation. WHO regards the goal of ensuring fair and equitable access by all countries to response measures to be among the highest priorities. WHO is working very closely with partners including the vaccine manufacturing industry on this.
Who is likely to receive priority for vaccination with a future pandemic vaccine?
This decision is made by national authorities. As guidance, WHO will be tracking the evolution of the pandemic in real-time and making its findings public. As information becomes available, it may be possible to better define high-risk groups and to target vaccination for those groups, thus ensuring that limited supplies are used to greatest effect.
Will WHO be conducting mass influenza A(H1N1) vaccination campaigns?
No. National authorities will implement vaccination campaigns according to their national pandemic preparedness plans. WHO is exploring whether the vaccine can be packaged, for example, in multi-dose vials, to facilitate the rapid and efficient vaccination of large numbers of people.
Developing countries are very experienced in administering population-wide vaccination campaigns during public health emergencies caused by infectious diseases, including diseases like epidemic meningitis and yellow fever, as well as for polio eradication and measles control programmes.
How feasible will it be to immunize large numbers of people in developing countries against a pandemic virus?
Developing countries have considerable strategic and practical experience in delivering vaccines in mass campaigns. The main issue is not feasibility, but how to ensure timely access to adequate quantities of vaccine.
What is the estimated global number of doses of seasonal vaccine used annually?
The current annual demand is for less than 500 million doses per year.
Will seasonal influenza vaccine continue to be available?
At this time there is no recommendation to stop production of seasonal influenza vaccine.
1National Institute for Biological Standards and Control (UK), Food and Drug Administration/Center for Biologics Evaluation and Research (USA), New York Medical College (USA), Victorian Infectious Diseases Research Laboratory (Australia)
Influenza A(H1N1) - update 11 (WHO)
Influenza A(H1N1) - update 11
3 May 2009 -- As of 0600 GMT, 3 May 2009, 17 countries have officially reported 787 cases of influenza A(H1N1) infection.
Mexico has reported 506 confirmed human cases of infection, including 19 deaths. The higher number of cases from Mexico in the past 48 hours reflects ongoing testing of previously collected specimens. The United States Government has reported 160 laboratory confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (70), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Denmark (1), France (2), Germany (6), Ireland (1), Israel (3), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (13), Switzerland (1) and the United Kingdom (15).
Further information on the situation will be available on the WHO website on a regular basis.
WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.
Canada on 2 May reported the identification of the A(H1N1) virus in a swine herd in Alberta. It is highly probable that the pigs were exposed to the virus from a Canadian farm worker recently returned from Mexico, who had exhibited flu-like symptoms and had contact with the pigs. There is no indication of virus adaptation through transfer from human to pigs at this time.
There is no risk of infection from this virus from consumption of well-cooked pork and pork products.
Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
Minggu, 03 Mei 2009
Jumlah Kasus Flu Babi Terinfeksi 615 Orang
Liputan6.com, Jenewa: Badan Kesehatan Dunia (WHO), baru-baru ini, kembali mengumumkan jumlah kasus flu H1N1 di seluruh dunia telah meningkat menjadi 615 dengan 17 angka kematian. WHO masih berjaga-jaga apabila level flu babi terus meningkat ke level maksimumnya, yaitu level enam.
Sementara itu, Meksiko masih menjadi negara dengan jumlah kasus terbanyak. Namun, pemerintah Meksiko optimis kondisi wabah flu di negaranya mulai membaik setelah tidak ada laporan baru korban tewas akibat flu babi.
Sedangkan di Amerika Serikat, kondisi penyebaran flu babi di negara itu belum membaik. Hingga pekan ini, sebanyak 161 kasus flu babi telah dikonfirmasi. Satu di antaranya telah dilaporkan meninggal.
Di Italia, seorang pria dipastikan positif terinfeksi flu H1N1. Dia mendapat gejala flu setelah pulang dari Meksiko bersama dengan istrinya. Namun, dilaporkan pria itu berangsur pulih setelah mendapatkan perawatan di rumah sakit.
Sementara di kawasan Asia, pemerintah Hongkong mengumumkan kondisi darurat setelah seorang wisatawan asal Meksiko dinyatakan positif terjangkit flu babi. Kondisi tersebut membuat ratusan wisatawan dan pegawai hotel Metropark Hongkong, tempat tinggal wisatawan itu, dikarantina di sebuah rumah sakit. Polisi tengah melacak ratusan penumpang pesawat yang bersamaan dengan pria itu, termasuk sopir taksi yang mengantarnya ke hotel.
Di Korea Selatan, dilaporkan seorang perempuan positif menderita flu babi. Saat ini, lebih dari 170 orang diduga terjangkit flu babi dilaporkan telah meninggal di Meksiko.(BOG/Tim Liputan 6 SCTV)
Infection prevention and control in health care in providing care for confirmed or suspected A(H1N1) swine influenza patients
confirmed or suspected A(H1N1) swine influenza patients
The current situation regarding the outbreaks of A(H1N1) swine influenza is evolving rapidly, and countries from different regions of the globe have been affected.
mainly through droplets. Therefore, the infection control precautions for patients with suspected
or confirmed A(H1N1) swine influenza and those with influenza-like symptoms should prioritize
the control of the spread of respiratory droplets. The precautions for influenza virus with sustained human-to-human transmission (e.g. pandemic-prone influenza) are described in detail in the document “Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care WHO Interim Guidelines” 1.
This guidance may change as new information becomes available.
Fundamentals of infection prevention strategies
- Administrative controls are key components, including: implementation of Standard and Droplet Precautions; avoid crowding, promote distance between patients (≥ 1 m); patienttriage for early detection, patient placement and reporting; organization of services; policies on rational use of available supplies; policies on patient procedures; strengthening of infection control infrastructure.
- Environmental/engineering controls, such as basic health-care facility infrastructure 2 , adequate ventilation, proper patient placement, and adequate environmental cleaning can help reduce the spread of some respiratory pathogens during health care.
- Rational use of available personal protective equipment (PPE) and appropriate hand hygiene.
- Avoid crowding patients together, promote distance between patients
- Protect mucosa of mouth and nose
- Perform hand hygiene
Summary Precautions
For staff providing care to patients with suspected or confirmed A(H1N1) swine influenza infection and for patients with influenza-like symptoms. Standard and Droplet Precautions should be strengthened when working in direct contact with suspected or confirmed A(H1N1) swine influenza infected patients. Key elements:
- use a medical or surgical mask
- emphasize hand hygiene and provide hand hygiene facilities and supplies.
- use face protection! Use either (1) a medical or surgical mask and eye-visor or goggles, or a face shield and,
- use a gown and clean gloves.
- DO NOT FORGET HAND HYGIENE AFTER PPE REMOVAL!
- particulate respirator (e.g. EU FFP2, US NIOSH-certified N95);
- eye protection (i.e. goggles);
- a clean, non-sterile, long-sleeved gown;
- gloves (some of these procedures require sterile gloves).
1. Basic infection control recommendations for all health-care facilities.
respiratory illness.
2. Respiratory hygiene/cough etiquette.
Health-care workers, patients and family members should cover mouth and nose with a
tissue when coughing and perform hand hygiene afterwards.
infection.
Place patient in adequately-ventilated room. If single rooms are not available, cohort
patients in wards keeping at least 1 metre distance between beds. Standard, and
Droplet Precautions for all persons entering the isolation room.
4. Triage, early recognition and reporting of A(H1N1) swine influenza infection.
Consider A(H1N1) swine influenza infection in patients with acute, febrile, respiratory
illness who have been in an affected region within the one week prior to symptom onset
and who have had exposure to an A(H1N1) swine influenza infected patient or animal.
5. Additional measures to reduce nosocomial A(H1N1) swine influenza virus transmission
Limit numbers of health-care workers/family members/visitors exposed to the A(H1N1)
swine influenza patient.
6. Specimen collection/transport/handling within health-care facilities
Use Standard, and Droplet Precautions for specimen collection. Use Standard Precautions
for specimen transport to the laboratory. Health-care facility laboratories should follow
good biosafety practices.
7. Family member/visitor recommendations
Family members/visitors should be limited to those essential for patient support and
should use the same infection control precautions as health-care workers.
8. Patient transport within health-care facilities
Suspect or confirmed A(H1N1) swine influenza patients should wear a medical/surgical
mask.
9. Pre-hospital care
Infection control precautions are similar to those practiced during hospital care for all
involved in the care of suspected A(H1N1) swine influenza patients. (e.g. transportation
to hospital).
10. Occupational health
Monitor health of health-care workers exposed to A(H1N1) swine influenza patients.
Antiviral prophylaxis should follow local policy. Health-care workers with symptoms
should stay at home.
11. Waste disposal
Treat any waste that could be contaminated with A(H1N1) swine influenza virus as
infectious clinical waste, e.g. used masks.
12. Dishes/eating utensils
Wash using routine procedures with water and detergent. Use non-sterile rubber gloves.
13. Linen and laundry
Wash with routine procedures, water and detergent; avoid shaking linen/laundry during
handling before washing. Use non-sterile rubber gloves.
14. Environmental cleaning and disinfection
Clean soiled and/or frequently touched surfaces regularly with a disinfectant. e.g. door
handles.
15. Patient care equipment
Dedicate separate equipment to A(H1N1) swine influenza patients. If not possible, clean
and disinfect before reuse in another patient.
16. Duration of A(H1N1) swine influenza infection control precautions For the duration of
symptoms.
17. Patient discharge
If the A(H1N1) swine influenza patient is discharged while still infectious (i.e. discharged
within the period of infection control precautions: see 16 above), instruct family members
on appropriate infection control precautions in the home.
18. Prioritization of PPE when supplies are limited Medical/surgical mask for the care of all
A(H1N1) swine influenza patients and hand hygiene are priorities.
19. Health-care facility engineering controls
If available, A(H1N1) swine influenza patients must be placed in adequately-ventilated
single rooms. Aerosol-generating procedures should be performed in well ventilated spaces.
20. Mortuary care
Mortuary staff and the burial team should apply Standard Precautions i.e. perform proper
hand hygiene and use appropriate PPE (use of gown, gloves, facial protection if there is a
risk of splashes from patient's body fluids/secretions onto staff member's body or face).
21. Health-care facility managerial activities
Education, training, and risk communication. Adequate staffing and supplies.
22. Health care in the community
Limit contact with the ill person as much as possible. If close contact is unavoidable, use the
best available protection against respiratory droplets and perform hand hygiene.
Sabtu, 02 Mei 2009
Virus H1N1 pernah Ditemukan di Bali
Namun hasil analisis Dinas Kesehatan Bali virus H1N1 yang terdeteksi di Bali hanya memiliki persamaan sub tipe dengan virus H1N1 yang dikenal dengan flu babi di Mexico.
Kasi Pelayanan Medik RSUP Sanglah Denpasar Ken Wirasandhi pada keterangannya di Denpasar (29/4) menyatakan secara struktur atau bentuk DNA virus H1N1 yang terdeteksi di Bali berbeda dengan virus flu babi.
“H1N1 yang sudah umum ada di masyarakat itu memang sudah ada dan itu yang disebut camon cool, hampir semua orang pernah kena, hanya sekarang strain yang bagaimana dari H1N1 yang bersifat virulens dapat menimbulkan kematian 7 sampai 8 persen” papar Ken Wirasandhi.
Sementara, Kepala Dinas Kesehatan Bali Nyoman Sutedja, memprediksikan flu babi merupakan hasil mutasi dari virus H1N1 yang terdeteksi di Bali. Guna memastikan penyebaran flu babi, Dinas Kesehatan Bali berencana akan kembali bekerjasama dengan badan kesehatan dunia (WHO) untuk melakukan uji sample darah baik terhadap manusia ataupun hewan.
Jumat, 01 Mei 2009
Flu Babi Naik Level 5
Badan Kesehatan Dunia (WHO) kembali menaikkan level peringatan bahaya terhadap penyakit flu babi, dari level empat ke level
Penyakit flu babi memang terus meluas dan menelan korban jiwa. Di Meksiko, negara asal penyakit ini, korban tewas telah mencapai 159 jiwa. Sedangkan jumlah penderita nyaris menembus angka 2.500 orang.
Anak ini merupakan satu dari 16 kasus positif flu babi di
Tak hanya di AS, kasus positif flu babi juga ditemukan di Eropa. Setelah Inggris dan Spanyol, giliran pemerintah Jerman melaporkan adanya penyebaran virus H1N1 di negara mereka.
Kini, setiap negara harus segera mengaktifkan rencana penanganan darurat pandemi. WHO menyerukan agar mewaspadai penyebaran penyakit mirip flu dan radang paru-paru berat. Selain itu, persiapkan obat antiviral dan penanganan jika sewaktu-waktu dibutuhkan.
FLU Babi diganti Namanya
Hal senada disampaikan Menteri Pertanian AS Tom Vilsack. "Ini bukan penyakit yang ditularkan oleh makanan, tapi virus. Tidak tepat merujuknya sebagai flu babi karena sungguh bukan itu masalahnya," kata Vilsack. Bagi produsen daging babi di AS, nama flu babi telah merugikan.
Info Gunung Slamet-Hujan Abu
BREBES, KOMPAS.com, 29 April 2009
Hujan abu vulkanik dari Gunung Slamet, Jawa Tengah yang melanda sejumlah wilayah di Kabupaten Tegal dan Brebes saat ini mulai berkurang. Berdasarkan arah angin, diperkirakan pergerakan abu lebih cenderung ke arah tenggara atau Banyumas.
Sudiryo HS, tokoh masyarakat Desa Kaligiri, Kecamatan Sirampog, Kabupaten Brebes, Rabu (29/4) mengatakan, sesekali hujan abu masih ada, tetapi tipis dan hampir tidak terasa. Abu muncul bersamaan dengan letusan dari Gunung Slamet. "Kalau cuaca terang, abu sampai ke desa yang masuk dalam range II, tapi kalau hujan ya tidak sampai,"ujarnya.
Sebelumnya, hujan abu memang sempat turun cukup tebal. Namun, hal tersebut hanya terjadi selama tiga hari, pada Minggu hingga Selasa, pekan lalu. Selain abu, saat itu juga tercium bau belerang, yang diduga berasal dari dalam tanah.
Kepala Stasiun Meteorologi Tegal, Sartono mengatakan, saat ini angin timur sudah mulai dominan. Angin cenderung bergerak dari arah timur laut ke tenggara. Oleh karena itu, arah abu letusan juga cenderung ke arah tenggara atau Banyumas, mengikuti arah angin.
Meskipun demikian, wilayah lain yang berada di sekitar Gunung Slamet, seperti Kabupaten Tegal, Brebes, dan Pemalang juga masih berpotensi terkena hujan abu. Pasalnya abu meletus ke atas, sehingga akan tetap menyebar ke daerah-daerah sekitarnya, sebelum terbawa angin.
Menurut dia, radius hujan abu tergantung pada kekuatan letusan. Semakin tinggi letusan, tekanan semakin kuat, sehingga abu semakin jauh terhembus.
Pengamat pada Pos Pengamatan Gunung Api Slamet di Gambuhan, Kecamatan Pulosari, Pemalang, Nurcholis mengatakan, hujan abu di sekitar pos pengamatan sudah tidak ada. Wilayah yang diketahui masih terlanda hujan abu, di sekitar Sirampog, Brebes.
Menurut dia, pada Rabu terjadi kenaikan suhu air panas. Suhu air di Pandansari, Guci mencapai 46 derajat celsius, naik dari hari sebelumnya yang hanya 44,9 derajat celsius. Sementara, suhu air di Kasepuhan, Guci naik dari sehari sebelumnya 64,8 derajat celcius menjadi 65,8 derajat celsius.
Jumlah gempa letusan mulai pukul 00.00 hingga 18.00 mencapai 230 kali. Selain itu terjadi gempa tremor vulkanik secara terus-menerus, dengan amplitudo satu hingga 10 milimeter. Hingga saat ini, Gunung Slamet masih berstatus siaga.
Pasang Tenda
Sementara itu, Tim SAR Kabupaten Brebes telah memasang lima tenda pengungsian, untuk mengantisipasi apabila terjadi evakuasi warga. Koordinator Tim SAR Brebes, Adhe Dani Raharjo mengatakan, lima tenda sudah dipasang di Dukuh Cilik dan Dukuh Tengah di Desa Dawuhan, Desa Igir Klanceng, ibukota Kecamatan Sirampog, dan Desa Pandansari, Kecamatan Paguyangan.
Masing-masing tenda memiliki kapasitas 200 orang. Selain itu, terdapat posko induk yang didirikan di Desa Dawuhan, Kecamatan Sirampog. Desa yang berjarak sekitar 50 kilometer dari puncak Gunung Slamet tersebut merupakan titik aman pertama, karena di atasn ya terdapat bukit.
