Influenza A / H1N1

Characteristics
Morphology	Family Orthomyxoviridae. Negative sense single-stranded RNA Virus. Virus capsid is enveloped and are spherical to pleomorphic. Reassortment of the Influenza A / H1N1 genome between strains of avian, porcine and human origin occurs regularly in nature. Type A influenza viruses are subdivided on the basis of the antigenic nature of their membrane-bound surface glycoproteins, hemagglutinin (HA) and neuraminidase (NA). To date, 16 HA, and 9 NA subtypes have been detected in wild birds and poultry, of which subtypes H1N1 and H3N2 are currently circulating among humans in seasonal influenza outbreaks
Growth Conditions	Influenza viruses are cultured in chick embryos and cell culture (MDCK)

Characteristics

Morphology

Family Orthomyxoviridae. Negative sense single-stranded RNA Virus. Virus capsid is enveloped and are spherical to pleomorphic. Reassortment of the Influenza A / H1N1 genome between strains of avian, porcine and human origin occurs regularly in nature. Type A influenza viruses are subdivided on the basis of the antigenic nature of their membrane-bound surface glycoproteins, hemagglutinin (HA) and neuraminidase (NA). To date, 16 HA, and 9 NA subtypes have been detected in wild birds and poultry, of which subtypes H1N1 and H3N2 are currently circulating among humans in seasonal influenza outbreaks

Growth
Conditions

Influenza viruses are cultured in chick embryos and cell culture (MDCK)

Health Hazards
Host Range	Humans, birds and other mammals (ex. Porcine)
Modes of Transmission	Droplet infection, fomites, saliva, nasal secretions, feces, aerosol and blood.
Signs and Symptoms	Fever, runny nose, sore throat, diarrhea, coughing, vomiting, nausea, lethargy, myalgia, anorexia and dyspnea.
Infectious Dose	Unknown and will vary depending on the influenza A subtype
Incubation Period	Short, usually 1 to 3 days, but can reach 7 days in some cases

Medical Precautions/Treatment
Prophylaxis	Antiviral chemoprophylaxis with antiviral drugs. Must be initiated within 3 days of the detected illness of the index cases to be effective in slowing transmission
Vaccines	Many are available, but the strain must be known to provide adequate protection
Treatment	Antiviral agents are available and can be taken in more severe cases, but often taking in fluids, resting, and treating the symptoms will be sufficient
Surveillance	Monitor for symptoms of influenza. Confirm diagnosis with RT-PCR (favored) or point-of-care testing.
GWU Requirements	Report all incidents to the Office of Risk Management as well as the Office of Research Safety (ORS) IMMEDIATELY FOLLOWING THE OCCURRENCE.

Containment
BSL-2	Risk Group 2 classification is applied to influenza A. Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious material. All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC).
BSL-2+	Viral isolation on clinical specimens from suspected cases should be performed in a BSL-2 laboratory with BSL-3 practices.
ABSL-2	All animal work with Influenza A / H1N1
BSL-3/ABSL-3	Highly pathogenic influenza A viruses, BSL-3 and ABSL-3 with enhanced practices, procedures, and facilities, as directed by regulatory authorities, are required, including clothing change and personal showering protocols.

Spill Procedures
Small Spills (<1 liter)	If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup. Influenza A is primarily transmitted via aerosols, so spills present an increased risk of exposure. Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against enveloped viruses (ethanol, bleach, glutaraldehyde, and phenol), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.
Large Spills	Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Spill Procedures

Small Spills (<1 liter)

If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup.

Influenza A is primarily transmitted via aerosols, so spills present an increased risk of exposure. Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against enveloped viruses (ethanol, bleach, glutaraldehyde, and phenol), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.

Large Spills

Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Exposure Procedures
Mucus Membrane	Flush eyes, mouth or nose for 15 minutes at eyewash station.
Other Exposure	Wash area with soap and water for 15 minutes.
Reporting	Report ALL injuries to the PI immediately and reported to the Office of Risk Management at [email protected] IMMEDIATELY FOLLOWING THE OCCURRENCE. Exposures that involve a bloodborne-pathogen or recombinant DNA also need to be reported to the Office of Research Safety at [email protected]. If the injury requires immediate medical attention, call GWPD at 202-994-6111 or call 911.
Medical Monitoring	Seek immediate medical evaluation, treatment, and post exposure follow-up at the Employee Health Office at GWU Hospital (900 23rd St., NW, Suite G-1090, Phone: 202-715-4275). Students should go to the Students Health Office at Marvin Center. After hours treatment can be received at the GWU hospital emergency room.

Stability
Disinfection	Susceptible 10% bleach, and 2% glutaraldehyde, 60-90% Ethanol, and 5% phenol
Inactivation	Susceptible to moist heat at 121ºC for 20 minutes or dry heat at 170ºC for 1 hour, 160ºC for 2 hours, or 121ºC for at least 16 hours
Survival Outside Host	Influenza A virus can survive for 24 to 48 hours on hard, nonporous surfaces such as stainless steel and plastic and for approximately 8 to 12 hours on cloth, paper and tissues

Personal Protective Equipment (PPE)
Minimum PPE Requirements	At minimum, personnel are required to don gloves, closed toed shoes, lab coat, and appropriate face and eye protection prior to working with influenza A. Additional PPE may be required depending on lab specific SOPs.
Additional Precautions	Negative pressure, HEPA-filtered respirators and eye protection, or positive air-purifying respirators are recommended for highly pathogenic influenza A viruses

References
CDC (https://www.cdc.gov/flu/index.html) BMBL 6th Edition (https://www.cdc.gov/labs/BMBL.html) Canadian PHAC (https://www.canada.ca/en/public-health/services/laboratory-biosafety-bi…)