Communicable Diseases

​Definition of the Disease:

It is a respiratory disease endemic in pigs; it is caused by the type A of influenza family which triggers the outbreak of influenza among pigs. The Swine influenza virus (SIV) is instrumental in widely spreading the disease among pigs but swine influenza-related death is few.
 
Swine influenza viruses afflicting pigs all year round could trigger outbreaks during autumn and winter time just as the seasonal influenza causes among humans. 
 
Swine influenza virus is the H1N1and the virus was isolated in 1930.
 
How many viruses does the swine influenza include?

Swine influenza viruses continuously change just like the rest of the influenza viruses. In addition to this, the pigs could get injured with the bird flu and human flu viruses, as well as the swine influenza viruses.
 
When the other types of the influenza viruses afflict the pigs, they help the genes revolve and new viruses emerge. Four basic types of the swine influenza viruses were isolated; they are "H1N, H1N2, H3N1, and H3N2. Most of the viruses isolated in the present time are of H1N1 type. 
 
How is swine influenza transmitted to the humans?

Usually, humans can pick up swine influenza when directly exposing to the pigs, while raising pigs or living nearby the sheds where the pigs are raised.
 
How does the swine influenza spread among humans?
In the last years, the US-based CDC Center received a report on the swine influenza incidence rate among humans. The report reveals that there is a swine-influenza-infected case in every year or two years in the United States of America. But since December, 2005 and until February, 2009, the U.S. registers twelve swine influenza-infected cases. 
 
Human-related swine influenza symptoms:

The swine influenza symptoms in humans are akin to the seasonal influenza symptoms. They are fever, weakness, lack of appetite, and coughing. Some swine influenza-infected person reported suffering from runny nose, nausea, vomiting, diarrhea, and sore throat.
 
Is it possible that the virus can be transmitted through eating pig meat?
Infection cannot be transmitted through eating the pig meat or its products. The swine flu influenza is killed at 71 degrees Celsius just as the case is with the other viruses and bacteria.
 
Can the swine flu transmit from one person to another?

The virus can be transmitted from a person to another, and it is thought that transmitting among humans takes place in the same way the seasonal flu does. This is through touching swine flu-infected place then touching the mouth or nose or through soughing and sneezing. 
 
How is the disease diagnosed?

The disease should be diagnosed within 3-4 days. This is through taking a sample of the phlegm to be examined. And sometimes the disease incubation period of the children is almost ten days longer and this requires sending the sample to the Center for Disease Control (CDC) to be checked.  
 
Does the swine flu virus have treatment or available drugs?

 
There are four anti-viral drugs authorized to be used in the U.S. for treatment. They are Rimantadine, Oseltamivi, and Zanaivir – Amantadine. On the other hand, there are four viruses resisting for some drugs: Rimantadine and Amantadine. At the same time, the CDC recommended using Zanaivir and Oseltamivir for treating or preventing the infection with the swine flu viruses.     
 
Is there a vaccine for the swine flu?

The vaccines are available to be given to the pigs in order not to get afflicted with the swine flu. But there are no vaccines protecting the human against getting infected with swine flu. The seasonal flu vaccine could help provide partial protection against H3N2 bit not against H1N1 virus. 
 
How can infection be averted?

•   Washing hands continuously with warm water and soap after sneezing or shaking hands with a swine flu-infected person.
• Using handkerchiefs when sneezing and throwing them away.
• Using masks which can prevent transmitting the viruses while in crowded places. They are available abroad and can be used on planes and trains as well. 

• Tightness of time in terms of applying the procedures required; with the aim of putting the disease under control as the disease spread at wide-scale worldwide.
• Worsening the need to the medical facilities that can cope with the increase in demand for the medical service.
• Damaging the basic infrastructure and services and the inability of the commercial and governmental sectors to continue performing their job due to experiencing sharp shortage in the workers and products.
• Delaying and limitedness of the availability of the influenza vaccine, antiviral drugs, as well as antibiotics; in addition to the general medical accessories used for treating the other diseases.
• Leaving a negative impact on the social and economic activities in the societies which can last for so long after the pandemic has finished.
• Having a passive effect on the extent of the national preparation in terms of dealing with the pandemic as a result of the complacency of the audience, the governmental agencies, and mass media.
• Lessening the possibility of receiving international aids as a result of the world emergency state.

• Reforming the genes of the virus: it is a process during which interfering and mixing between the genes of the animal and human flu virus occur producing the animal-human flu virus.
• Genetic mutation: it is a process in which the animal flu virus mutates in a way that renders it able to infect human and transmit among them.

•  Integrating the preparatory plan for fighting the flu epidemic into the frameworks and activities of the national plan for coping with the emergency cases.
• Using the activities of the preparatory plan with the aim of enhancing the capacities of the basic health and emergency such as primary healthcare, monitoring the respiratory diseases, and laboratory diagnosis.
• Drawing on the activities of the preparatory plan; in order to activate the communication channels between the health sectors and society.
• Developing and modifying the ongoing action plans, intended for the flu epidemic.
• Ongoing evaluating and updating the current plans in line with the latest information.
• Given these considerations, the governmental bodies and the concerned health institutions possess the opportunity of boosting these preparations for any future epidemic, Allah forbids, and adopting the capabilities of dealing with the national, local, and world emergency. 

Epidemiological requirements for the world flu epidemic outbreak: 

• Emerging a new virus strain afflicting the humans.
• The virus acquiring the ability to propagate within the human body and bringing about the illness image.
• The virus easily transmitting among humans: a regular transmission series leading to the disease outbreak.

Following up the situation, since 1997, we find that the first and second factors materialized four times in Hong Kong (H5N1) in 1997 and 2003, Holland (H7N7) in 2003, Vietnam and Thailand (H5N1) 2004. The H5N1 outbreak distinguished with the severity of the disease and high death rates. In addition to this, it has never occurred before that some bird flu virus with the ability to infect humans spread at wide-scale in a number of states. 
  
The above-mentioned demonstrates the real risks of the emergence of a world flu epidemic and affirms that the world is under real threat that could last for years. But this creates the appropriate opportunity for the early preparation and anticipation which is instrumental in diminishing the negative impacts for the expected epidemic.  
 
 
Preparation plan phases of fighting the flu epidemic

World epidemic phases for the flu pandemic:
 

• First phase:
  No flu virus transmission took place from an animal to human.
• Second phase:
  Viruses transmitting among the domesticated and wild animals
• Third phase:
  Viruses or mutated human-animal viruses instrumental in causing separate injuries or limited groups among the humans. But there is no infection from a human to another or in the rare cases.
• Fourth phase:
  Infection transmission by the new virus strain is possible among humans and it can trigger limited outbreaks. Consequently,   it remains locally restricted, meaning that the virus doses not develop in a way that could infect humans.
• Fifth phase:
  There is an infection among humans at least in two states from the same region of the World Health Organization's (WHO) regions. And the rest of states have not been affected by the outbreak.
• Sixth Phase: (Pandemic Phase)
  Infection spreading among huge numbers of people in at least two regions related to the World Health Organization (WHO) with the existence of indicators of a world epidemic outbreak.
• Past epidemic peak phase:
  It is a phase when the number of cases and the incidence rate, with the existence of epidemiological survey system, starts to decline. And this phase may be followed by more waves of the pandemic.
• Past epidemic phase:
  It is the phase when the cases and incidence rate get back to normal.
• First phase- Third
   The goal of the practical procedures in these phases is to boost the preparation for the pandemic and fight it worldly, regionally, and locally. 
   
  
• Planning and Coordination: 

1. Developing and activating a national plan including a committee formed by each of the governmental sectors.
2. Arranging priorities of the pandemic fighting plan.
3. Providing consultation for the officials in the regions and governorates in terms of crafting the practical plans.
4. Evaluating their work.
5. Updating and revising the plan at the central level and the level of the regions and governorates, and collaborating with the other bodies interested in the animal health (Ministry of Agriculture) and the private sector  in light of the WHO's  recommendations.
6. Taking and working out the legal procedures in case of any intervention requires that.
7. Crafting the pandemic fighting plan and its applying must take into account the human rules.
8. Transforming the flu pandemic fighting plan into an emergency national plan and an early preparation program for facing it.
9. Providing the governmental and private utilities with the information to have them participate in the plan.
10. Knowing the duties of working for the ports and the preventive procedures that must be put into effect.
11. Taking part as much as possible in the regional and world events and meetings on the flu pandemic.

•  Monitoring the flu epidemic status 

1. Epidemiological monitoring at the national level and gathering the instant and epidemiological information about the human and seasonal flu types.
2. Detecting the flu cases among animals and humans and pinpointing the animal infection source for the humans, and reporting to the WHO.
3. Detecting and epidemiological survey for the uncustomary flu cases groups or death cases.
4. Sharing the results of the human or animal flu samples with the WHO, Food and Agriculture Organization (FAO), and Centre for Animal Disease Control; in order to help make detectors and vaccines and monitor the virus resistance.
5. Advancing the flu diagnosis national laboratories.
6. Designating permanent officials that can act at any time in case human or animal flu outbreaks or epidemic happen to emerge.

• Necessary procedures for curbing the disease spread and stopping the transmission of infection from an animal to human

1. Lowering the rate of infection transmission from an animal to human in case of outbreaks among animals, through educating on the ways of transmission, training, protection devices, and prevention by the medical drugs.
2. Avoiding as much as possible the humans' mingling with the injured animals.
3. Developing a plan with the bodies meant for controlling the flu spread among animals (Ministry of Agriculture) for the animal food safety.   
    
   

As far as family members are concerned: 
Washing hands with water and soap.

As far as society is concerned: 

1. Striking agreement closing schools when the pandemic breaks out.
2. Cutting back on unnecessary travelling and riding the crowded means of transportation.
3. Making the legal procedures to call off or restrict any crowded events such as gatherings in playgrounds when the pandemic breaks out.    
    
   

Travelling overseas:

According to the international health regulations: the decision of banning or permitting the international travelling is left for the WHO.
 

Antiviral Drugs and other Medications:

• Estimating the amounts of antiviral drugs assigned for treatment or prevention.
• Crafting a plan for testing and distributing the antiviral drugs in line with the national goals.
• Preparing all the other needs such as antibiotics, intravenous fluids, oxygen, artificial respiratory devices, and among others of what the cases need.
• Measuring how effective the treatment is.

Vaccine:

• Increasing the coverage of the seasonal human flu vaccine for the most vulnerable groups.
• Working out the vaccine distribution plan: the pandemic vaccine if available in a seven days' period.
• Taking into consideration using the pneumococcal vaccine as part of the traditional vaccine according to the guidelines of the WHO.

Sustainability of providing the health services: 

•  Determining how prepared and ready the governmental and private health facilities are for this pandemic.
• Revising and updating the strategies of the health facilities at the national level.
• Setting strategies and plans for training all the medical and non-medical cadres on the response to the epidemiological outbreaks among animals and pandemic flu.
• Crafting a plan for detecting cases, treatment, and prevention.
• Crafting a strategy for fighting the infection.
• Developing a protocol for taking samples and sending and examining them with the biological safety taken into consideration when dealing with the samples.
• Providing treatment for free; in order to encourage reporting the animal or human flu cases.
• Providing a swift examination for the patient.
• Epidemiological survey at the level of hospitals to detect the human flu outbreaks.

• Communication:
• Forming emergency committee with the necessities of the swift communications included.
• Providing the senior health officials with information on the world status on the spot.
• Building strong relationships with the mass media.
• Communicating with the society.
• Developing a media strategy focusing on educating individuals and families, to be able to cope with pandemic.
• Raising the health awareness of the society in terms of the preventive procedures of the disease.
• Sending awareness messages to the inhabitants of the remote areas.
• Conducting simulations for mass communication.
• Updating means of communication and feedback from the citizens and analyzing them. 
   
  Fourth phase:
  The goal of this phase is to contain the novel virus in a specific area or delaying its spreading to gain time through making interventions such as giving the vaccine.
   

1. Planning and coordinating 
   In the affected States:

• Coordinating directly and swiftly for the activities containing the outbreak in cooperation with the WHO; to limit the spread of the human injures.
• Activating the national committee for facing disasters and emergency cases.
• Putting into effect the procedures intended for implementing and mobilizing the additional human and materialistic capabilities.
• Deploying the operation teams and swift supply.
• Determining the needs for the international aids.
• Setting models for the special states according to the need such as "emergency state" with the aim of facilitating the swift containment procedures.
• Providing the WHO with regular updates on the situation in line with the international health regulation 2005 and the other parties; to make coordination easier in terms of response.
• Encouraging cross-border cooperation with the neighboring states through exchanging information and coordinating cooperation.
• Activating plans for the expected outbreaks for all   the sectors seen as vital for necessary back-up services.
• Completing preparations for the expected outbreak with the equipping plans for the necessary drugs included.  
   
  In the non-affected states:
  • Completing the preparations for the expected outbreak through activating the internal regular arrangements through the leadership and control system and recruiting the field workers in the emergency services.
• Responding, if possible, to the international aid requests organized by the WHO.
   

      2.  Monitoring the epidemiological flu status in the affected states:

• Strengthening the epidemiological monitoring system for the early detection and reporting the new cases.
• Gathering samples and classifying them in line with the WHO's protocols.
• Exchanging samples and types with the aim of developing the diagnosis detectors, vaccines, and antiviral aptitudes.
• Collecting the epidemiological and clinical information as time and resources go.
• Evaluating the response, safety level, and impact of the implemented procedures; and exchanging results with the international community and WHO.   
   
  In the non-affected states: 
• Enhancing the epidemiological and viral monitoring system for detecting the suspected cases, especially when travelling or trading with the affected states.
• Reporting any suspected cases for the national bodies and WHO.  
   
  

       3. Necessary procedures for lessening the disease spread regarding those travelling overseas:

• Taking into consideration conducting screening to travellers as part of the world procedures for early responding to the epidemic (in the first few affected states).
• Providing consultation for those flying to the affected states.
• Activating the surveillance with the aim of quick detecting, surveying, and making reports for the individual and mass new cases.
• Gathering samples for the laboratory examination and virus identifying by drawing on protocols and procedures in cooperation with the WHO.
• Exchanging samples or/and virus types with the aim of preparing the diagnosis detectors, vaccines, and effective antiviral drugs.
• Collecting more detailed epidemiological and clinical information according to time and available capabilities.
• Activating the response, safety level, and loosening procedures effectiveness; and sharing givens with the international community and WHO.     
   
  In the Non-affected states:
• Jump-starting the viral and epidemiological surveillance for detecting the expected individual and mass cases, especially if they had link to the affected areas.
• Quickly containing the pandemic in coordination and cooperation with the WHO and international community.
• Requesting and distributing the antiviral drugs from the WHO's stockpile or national or regional stockpile; for treating cases and protecting against the disease.
• Taking into consideration using the vaccine when available.
• Carrying out the prevention and fighting procedures for the disease at the individual, family, and society level.
• Only restricting travelling for necessity along with applying the screening system at cross-points.
   

       4.  Continuing providing the health services in the affected states:

• Providing the health workers with guidelines on the flu for the patients suffering from the bronchilitis; and testing the suspected cases.
• Implementing proper procedures for fighting the infection and circulating the use of personal protection means.
• Putting into effect the emergency plans and laboratories for providing help in case of the working hands shortage.
• Activating the emergency strategies with the aim of isolating cases and treating them when necessary.    
   
  In the affected states:
• Breathing life into the arrangements of the health sector in terms of the alternative planning for the pandemic.
• Advising the health workers taking into consideration the possibility of those suffering from the respiratory diseases  developing the flu those; especially travellers and those who have contacted with the injured in the affected states. 
   

        5.  Communicating with all the states:

• Activating the communication mechanism for making sure of wide-scale distributing for the information.
• Updating and distributing the agreed-upon scientific points on the purpose of unifying the information in terms of all the speakers.
• Releasing repeated statements through the different media bodies without causing panic or fear.

          Regular communication by specific mechanisms:

• The available information on the virus, outbreak status, implemented procedures, and the procedures that must be made.
• The importance of pinpointing the people unnecessary moving to the containment places and screening points.
• The importance of responding to the procedures recommended for preventing another spread for the disease.
• Ways of obtaining the drugs, necessary services, and logistics in the areas set for containment.
• Communication and feedback of the public and the communities vulnerable for infection towards the procedures recommended; with the aim of determining their desire and aptitude for response; and including the results in the communications and health awareness campaigns targeting the set groups.
• Cooperating and coordinating with the neighboring countries with the aim of exchanging information.
   
  Fifth-sixth phase:
  In this phase, the procedures transforms from preparation to response at the international level; and the aim of these recommended procedures is to diminish the impact of the outbreak on the society.
   

1. Planning and coordination in the affected states: 
   

• Keeping up the confidence among all the bodies, organizations, and society through adhering to transparency and credibility.
• Declaring emergency state when needed.
• Recruiting officials having the ability to coordinate among the different sectors with the aim of relieving the economic and social burden of the epidemic.
• Working in line with the ethical ends and transparency for dealing with capabilities.
• Evaluating the need for foreign aids and human needs from the unaffected states.
• Finishing preparing the equipment for the imminent epidemic with activating the emergency committees and national systems for control included.
• Updating, if necessary, the national guidelines and recommendations, taking into consideration the information provided by the affected states.  

      2. Monitoring the epidemiological flu status in the affected states:

• Conducting a comprehensive evaluation for the first cases of the epidemic.
  • Documenting the evolved epidemic with the geographical distribution, attitudes, and impact.
• Documenting any epidemiological and clinical changes in terms of the epidemic virus.
• Maintaining the epidemiological virus monitoring on the purpose of detecting any genetic changes, as well as the aptitude for the antiviral drugs and disease causatives.
• Modifying the case identification, and updating the clinical and laboratory symptoms of the diagnosis whenever necessary.
• Monitoring and evaluating the impact resulting from the epidemic.
• Monitoring the health-related resources: such as  medical logistics, antiviral drugs, vaccines and other pharmaceutical needs, health workers, hospitals' capacity, bed availability, using alternative health facilities, laboratory materials stockpile, and volume of the morgue.
• Monitoring and evaluating the national impact by using some standards such as work and school absence, the most affected areas and groups, and existence of the basic workers.
• Predicting the economic impacts for the epidemic if possible.        
  

• Considering the WHO's guidelines when releasing the world travelling     recommendations and health warnings

          The affected states:

          Procedures at the individual and family level:

• Advising those suffering from acute respiratory diseases to hold their homes and reduce mingling with the family members.
• Advising the family members mingling with the infected member to reduce socializing outside home and isolating themselves when the first flu symptoms emerge.
• Providing those delivering service to the family with the infection control instructions in accordance with the WHO's guidelines.   

          Procedures at the society levels:

• Carrying out distance expanding procedures among the society members as approved in the national plans such as shutting schools and modifying work hours and system.
• Encouraging lessening travelling and crowding in the public mean of transportation.
• Evaluating and pinpointing if there are any activities with the aim of preventing, restricting, or modifying the huge gatherings in accordance with what is required.    

          International travelling procedures:

• Taking into account conducting the health screening when travelling as part of the early world response.
• Giving pieces of advice to the travellers.

          Pharmaceutical procedures: 

• Distributing the antiviral drugs and medical logistics in line with the national plan.
• Developing plans for buying the vaccine
• Setting plans for distributing the vaccine and preparing for wide-scale vaccination campaigns.
• Modifying or approving strategies for the antiviral drugs and vaccine based upon the follow-up information and epidemiological monitoring.
• Carrying out preventive medical campaigns using the antiviral drugs or vaccine according to the priorities and availability in the national plan.
• Following up the safety and efficiency of the pharmaceutical interventions.

          The non-affected states:

• Ready to carry out the intervention plans with the aim of reducing the epidemic spread.
• Updating the recommendations on drawing on the interventions according to the experience and information of the affected states.
• Distributing the pharmaceutical plans and other resources.
• Screening those coming through ports.

      4. Keeping the health services on: 

• Implementing the emergency plans with the aim of fully mobilizing the health system, health facilities, and workers at the central and peripheral level.
• Strengthening the infection fighting system in the health facilities and laboratories, and distributing the protective equipment in line with the national plan.
• Providing medical and non-medical support for the patients and those mingling with them within family and health facilities.
• Providing psychological and social support for the health workers, patients, and society.

         Non-affected states:

         Preparing for moving to the pandemic consequences

      5.  Communication:

• Communicating with the society in a periodical way for providing them with information about the pandemic such as ways of disease of disease transmission, severity of symptoms, and treatment and ways of prevention.
• Preparing ways for the usual communication with the aim of addressing the needs of the society's interests such as travelling-based recommendations, closing borders and schools, and what is related to the economy and society in general.
• Communicating with the society periodically in terms of the emergency sources, medical care, and resources for dealing with the illness cases unrelated to the epidemic, and sources for the self-medical care.

          Past epidemic peak period:

• The goal of the past-epidemic peak procedures is to study the impact of the outbreak on the health, society, and preparing for the next wave of the outbreak. 

1. Planning and Coordination:

• Determining the needs to additional resources and capabilities during the future expected outbreak periods.
• Starting rebuilding the basic services.
• Paying attention to the psychological impact of the pandemic on the health workers
• Taking into consideration delivering aids to the states where the outbreak persists.
• Reconsidering the case rebuilding and distributing the drug and equipment stockpile.
• Revising and evaluating the national plans.

     2. Monitoring the epidemiological flu status:

• Activating the work of the positive surveillance necessary for revealing the next outbreak periods.
• Evaluating the necessary resources for following up the outbreaks.

     3. Procedures necessary for reducing the disease spread:

• Measuring the effectiveness of the procedures taken, having them updated, and pinpointing the guidelines and plans according to the existing status.
• Following up the vaccine programs in line with the national plans and priorities, and providing the vaccines.

     4. Keeping the health services on: 

• Making sure of the health workers getting a deal of rest and reactivating.
• Ensuring boosting the drug, medical equipment, and services,; and modernizing the basic tools.
• Revising and updating the preparations for the pandemic and responding to the other waves of the outbreak.
• Revising the case identification and treatment ways when necessary.

     5. Communication:

• Providing the society and workers regularly with the latest on the epidemiological status.
• Communicating with the society and ensuring the necessity of commitment to the preventive procedures with the aim of avoiding other waves of the outbreak.
• Continuing providing the health sector with the latest developments and the latest information that may affect the level of the injury: symptoms and signs, case identification, and therapeutic protocols. 

         Past-epidemic period:

• The aim of the activities of the past-epidemic period is to study the long-term effects on the health, impact of the outbreak on the society, and bringing the health, social, and natural services back to normal.

1. Planning and Coordination: 

• Evaluating the effectiveness of the responses and interventions set, and letting the international community know their results.
• Revising the lessons learnt and applying them to the response and emergency facing plans.
• Revising the national plans for responding and facing the outbreak. 

      2.  Monitoring the epidemiological flu status:

• Gathering and analyzing the available information on the purpose of evaluating the clinical, viral, and epidemiological characteristics of the outbreak.
• Revising, updating, and following up the epidemic and the outbreak evaluation means and the next health emergency.
• Re-applying the epidemiological monitoring of the seasonal flu taking into consideration the virus triggering the outbreak as part of the routine work of the surveillance.   

      3. Procedures necessary for reducing the disease spread:

• Conducting accurate evaluation for carrying out the interventions at the individual, family, and society level.
• Making a precise evaluation for the pharmaceutical interventions  used which include the following:

1. Effectiveness, safety, and resistance of the antiviral drugs.
2. Effectiveness, safety, and the level of vaccine coverage.
3. Revising and updating the related issues when necessary.

• Continuing conducting the immunity programs according to the national plan and priorities; and delivering vaccines.

      4.  Keeping the health services on:

• Collecting and analyzing the available information on the purpose of evaluating the health system in terms of the response to the outbreak.
• Revising the lessons learnt, and exchanging experience with the international community.
• Modifying the plans and procedures including the lessons learnt. 

     5. Communication:

• Extending thanks to the participation of all sections and societies.
• Communicating with the society and other sectors on the lessons learn for the effective response during the outbreak; period.
• Encouraging those participating from all the governmental and private sectors in revising the outbreak emergency plans by referring the lessons learnt.
• Expanding the planning and communication activities with the aim of detecting the other epidemiological diseases, and using the communication principles regarding the risk factors.
• Developing the communication plan on the purpose of reading the next important health event.

1. Epidemiological surveillance.
2. Laboratory surveillance.
3. Vaccination.
4. Using medicine for protection and treatment of influenza.
5. Health regions' role.
6. Health awareness.
7. Societal participation.
8. Infection control in hospitals.
9. Non-curative intervention aimed to limit the spread of the disease.
10. Other procedures.

• Epidemiological Surveillance:

1. Conducting epidemiological surveillance throughout the year.
2. Immediately reporting any suspected cases in both governmental and private hospitals (in accordance with the scientific material included, through which suspected and potential cases could be identified as well as forms used for reporting and surveillance) to the health affairs directorate to which the hospital belongs, so as for these cases to be instantly reported to the MOH Communicable Diseases Department.
3. Conducting epidemiological surveillance in the nearest hospital, and sending the surveillance form to the health affairs directorate, and then to the Communicable Diseases Department.
4. Referring any suspected cases at any of the Kingdom's ports to the nearest MOH hospital.

• Laboratory Surveillance:
  
• Three referential laboratories in the main regions have been assigned for examining samples:
  A. Central Laboratory, Riyadh
  B. Regional Laboratory, Jeddah
  C. Regional Laboratory, Dammam

• Specialists from these laboratories have been trained in NAMRU-3 laboratories, in coordination with the WHO Regional Office for the Eastern Mediterranean Region.
• The needed reagents necessary for laboratory diagnosis should be provided.
• The suspected cases and contacts of a confirmed case, who suffer from symptoms of a suspected infection, are examined as instructed by the attached guide.
  

Human Influenza Vaccination:

A human vaccine is available for protection against the seasonal flu. This vaccine is annually renewed by the World Health Organization for the three widely-spread types of influenza. In case a new pandemic occurred and the WHO decided to develop a new vaccine, necessary precautions should be taken to curb the spread of the pandemic till the new vaccine is developed in two or three months.

• Persons working in the health field, especially those responsible for treating suspected or confirmed influenza cases among humans.
• Patients with chronic heart and respiratory diseases, whose health status requires taking aspirins for a long period of time.
• Old people (aged over 60 years).
• Pregnant women.
• This is aside from giving the human influenza vaccine for the other known medical causes of human influenza.

Using Medicine for Protection and Treatment of Influenza:

There are 4 types of anti-influenza vaccines (Zanamivir, Amantidine, Rimantidine and Oseltamivir). Their usage is varied according to the sensitivity of the virus to the drug as instructed by the World Health Organization and the US-based Centers for Disease Control and Prevention.
The Ministry of Health (MOH) has provided two drugs (Oseltamivir and Zanamivir) for use by the confirmed cases and their contacts.

• Implementing the MOH plan concerning the influenza prevention and control.
• Activating the role of the committee tasked with fighting the virus in regions and submitting reports in this regard.
• Participating with early preparations committees in their endeavors to control the disease and implement the MOH plan.
• Ascertaining reporting all the suspected cases, recorded in any of the region's health facilities.
• Distributing the scientific material circulated by the Ministry to all the governmental and private health facilities, with the aim to provide doctors with the necessary information on the disease, and immediately reporting any suspected cases.
• Implementing the health awareness program, for the purpose of raising citizens' awareness with regard to heading for any of the MOH facilities on the appearance of influenza symptoms, as well as the ways of prevention.

      6. Health Awareness:

• Raising the health awareness of all health staff working in all health sectors, both governmental and private; with the aim to immediately report any suspected cases, in addition to the ways of prevention of the disease.
• Raising the awareness of the public (both citizens and residents) on the disease, and the ways of prevention.
• It is of pivotal importance to build confidence among citizens and the competent authorities responsible for distributing information on the disease regularly, through a team of proficient experts in this domain.

      7. Precautions recommended for travelers to stricken places:

• The WHO has issued travel ban decisions against some countries affected by influenza.
• The WHO has recommended measures to be applied on those coming from the countries affected by influenza.
• It is advisable for travelers to see their doctors prior to heading for any of the countries affected by influenza. On arrival, it is advisable to be aware of any health information or instructions concerning the infection, as well as any developments taking place during his stay.

• When traveling to any of the countries affected by influenza, it is recommended to:
• Keep away from the places with high infection probability, like markets and crowded places.
• Wash your hands well, using water and soap.
• Visit the doctor once the symptoms appear. 

• Societal Participation:
• Enlisting the community leaders (such as Islamic clerics and preachers, teachers, etc.) for raising the awareness of citizens and residents.
• Reporting any suspected cases among humans.

• Infection Control in Hospitals:
  Following are the instructions aiming at infection control in laboratories and hospitals as mentioned in the attached guide:
  

1. Washing the hands.
2. Taking the necessary precautionary measures with regard to the respiratory secretions.
3. Assigning an isolated room with negative pressure for the patient.
4. Taking precautions against droplet infection.

• Non-curative Intervention Aimed to Limit the Spread of the Disease, including:
• Quarantining those in contact with influenza patients for 7-10 days.
• Closing schools.
• Preventing big agglomerations in narrow places.
• Reducing traveling.
   
  
• Other Procedures:
  Calling upon the other governmental health authorities to implement the national plan.
  
• Guide of health providers to prevent and handle influenza outbreaks