SWINE FLU –THE FACTS

SWINE FLU –THE FACTS

With the dengue virus scare just ended, the swine flu incidence has flared up in the city. Figure of swine flu cases in Karachi has reached to 10 in recent outbreak. All 5 new confirmed patients are children.Sindh health minister has directed all the doctors to inform health department about these new cases of swine flu. He also directed the authorities concerned to make swine flu Surveillance Cell more.

Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses. The virus is spread among pigs by aerosols, direct and indirect contact, and asymptomatic carrier pigs. Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones.   Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, and H3N2).   

Pandemic risk.
It is likely that most of people, especially those who do not have regular contact with pigs, do not have immunity to swine influenza viruses that can prevent the virus infection. If a swine virus establishes efficient human-to human transmission, it can cause an influenza pandemic. The impact of a pandemic caused by such a virus is difficult to predict: it depends on virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection and host factors.

Symptoms.

Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death. Since typical clinical presentation of swine influenza infection in humans resembles seasonal influenza and other acute upper respiratory tract infections, most of the cases have been detected by chance through seasonal influenza surveillance. Mild or asymptomatic cases may have escaped from recognition; therefore the true extent of this disease among humans is unknown. The main symptoms are –

·        Headache.

·        Fever.

·        Soaring Throat.

·        Troublesome breathing.

·        Cough and body ache.

·        Chill, fatigue.

·        Abdominal pain.

·        Diarrhea.

·        Severe vomiting as shown in common flu.

Serious signs of Swine Flu –

·        Worse cough.

·        Pneumonia.

·        Pain or Pressure in Chest.

·        Rapid breathing.

·        Number of heart beats – 100 ore more.

·        Bluish or grey skin colour.

·        Low blood pressure due to dehydration.

·        No desire of liquid intake.

·        Unable to interact.

·        Dizziness and confusion.

·        Very high body temperature.

·        Respiratory failure.

Precaution

It is a communicable disease which spreads through sputum, saliva, nasal discharge and sneezing of confirmed infected person.

The following precautionary measures must be taken, to minimize the chances of getting infected with Swine flu;

1. People showing flu like symptoms such as fever, cough, running nose and
difficulty in breathing should be allowed to stay at home for a period of 7 to 10 days and
consult your nearest medical practitioner.

2. Avoid contact with the pigs (swine). If you have pigs in your area then please inform the local municipal office so that they can take care of those pigs by keeping them isolated.

3. Keep a distance of minimum 6 feet from people affected with Catarrh, Cough and Fever.

4. Swine flu is communicable disease, so use the face masks to protect from
the swine flu antigens.

5. Cover your nose and mouth when coughing or sneezing, using one time disposable
tissue paper when possible.

6. Avoid shaking hands, embracing and visiting the congested places and also
crowded places like theaters, this can be a cause of spreading ground for Swine flu.

7. Wash your hands frequently with soap or diluted water of dettol at least 6-8
times a day to reduce the spread of virus.

8. Instruct the above points to children as they may be victimized easily with the Swine flu.

9. Avoid eating outside food because it may be contaminated and may make you
infected with the virus.

10. Don’t use the public urinals because many people spit there,
which could lead to the spreading of the disease.

11. Use boiled water only to Drink.

12. Good food, clean living, rest and exercise are the basic ingredients.
There are certain nutrients that have been shown to strengthen immune system,
such as echinacea, vitamins C, E, beta carotene, zinc, and elderberries.

Swine flu threat to Pakistan  

During the resent outbreak Pakistan has started taking preventive measures to turn away the threat of Swine flu. Airport authorities are at high-alert and NIH (National Institute of Health) is constantly updating itself, by keeping in-touch with WHO, regarding this issue. Airport authorities have been directed to conduct screening of passengers.
The Executive Director of National Institutes of Health (NIH) Dr. Birjees Mazhar Kazi told Geo News that in accordance with WHO guidelines, countrywide preventative measures have been taken against all types of influenza, Congo virus and other diseases. 
Surveillance cells

The provincial health department has established two surveillance cells, one in Civil Hospital Karachi and other in Hyderabad to monitor the cases of swine flu and collecting data. 

Transmission

Transmission between pigs

Influenza is quite common in pigs. The main route of transmission is through direct contact between infected and uninfected animals. These close contacts are particularly common during animal transport. The direct transfer of the virus probably occurs either by pigs touching noses, or through dried mucus. Airborne transmissions through the aerosols produced by pigs coughing or sneezing are also an important means of infection.  

Transmission to humans

People who work with poultry and swine, especially people with intense exposures, are at increased risk.Other professions at particular risk of infection are veterinarians and meat processing workers, although the risk of infection for both of these groups is lower than that of farm workers.

 Prevention of swine influenza

Prevention of swine influenza has three components:

·        Prevention in swine,

·        Prevention of transmission to humans,

·          Prevention of its spread among humans.

 In swine

Methods of preventing the spread of influenza among swine include

·        Facility management,

·        Herd management,

·        Vaccination   

Facility management includes using disinfectants and ambient temperature to control virus in the environment. The virus is unlikely to survive outside living cells for more than two weeks, except in cold (but above freezing) conditions and it is readily inactivated by disinfectants. Herd management includes not adding pigs carrying influenza to herds that have not been exposed to the virus.

Prevention of pig to human transmission

The transmission from swine to human is believed to occur mainly in swine farms where farmers are in close contact with live pigs. Although strains of swine influenza are usually not able to infect humans this may occasionally happen, so farmers and veterinarians are encouraged to use a facemask when dealing with infected animals.   Risk factors that may contribute to swine-to-human transmission include smoking and, especially, not wearing gloves when working with sick animals—thereby increasing the likelihood of subsequent hand-to-eye, hand-to-nose or hand-to-mouth transmission

Prevention of human to human transmission

Influenza spreads between humans when infected people cough or sneeze, then other people breathe in the virus or touch something with the virus on it and then touch their own face “Avoid touching your eyes, nose or mouth. Germs spread this way."  Swine flu cannot be spread by pork products, since the virus is not transmitted through food. The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days.  

 

High-risk groups 

Some people are more at risk of complications if they catch flu. People are particularly vulnerable if they have:

·         Chronic (long-term) lung disease.

·         Chronic heart disease.

·         Chronic kidney disease.

·         Chronic liver disease.

·         Chronic neurological disease (neurological disorders include motor neurone disease, multiple sclerosis and Parkinson's disease).

·         Immunosuppressant (whether caused by disease or treatment).

·         Diabetes mellitus.

Also at risk are:

·         patients who have had drug treatment for asthma in the past three years

·         pregnant women

·         people aged 65 and over

 Advice to school

·        Stay home when sick.

·        Separate ill students and staff.  

·        Hand hygiene and respiratory etiquette.

·        Routine cleaning.  

·        Early treatment of high-risk students and staff.  

·        Consideration of selective school dismissal.  

 The CDC may recommend additional measures to help protect students and staff if global and national assessments indicate that influenza is causing more severe disease. In addition, local health and education officials may elect to implement some of these additional measures.  

·                          Active screening.  

·                          High-risk students and staff members stay home.    

·                          Students with ill household members stay home.

·                          Increase distance between people at schools.

·                          Extend the period for ill people to stay home .

Infectious Period

Persons with swine influenza A (H1N1) virus infection should be considered potentially contagious for up to 7 days following illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved. Children, especially younger children, might potentially be contagious for longer periods. The duration of infectiousness might vary by swine influenza A (H1N1) virus strain. Non-hospitalized ill persons who are a confirmed or suspected case of swine influenza A (H1N1) virus infection are recommended to stay at home (voluntary isolation) for at least the first 7 days after illness onset except to seek medical care.

Recommendations for public health personnel

For interviews of healthy individuals (i.e. without a current respiratory illness), including close contacts of cases of confirmed swine influenza virus infection, no personal protective equipment or antiviral chemoprophylaxis is needed.  

For interviews of  ill, suspected or confirmed swine influenza A virus case, the following is recommended:

·                          Keep a distance of at least 6 feet from the ill person; or

·                          Personal protective equipment: fit-tested N95 respirator [if unavailable, wear a medical (surgical mask)].

For collecting respiratory specimens from ill confirmed or suspected swine influenza A virus case, the following is recommended:

·                          Personal protective equipment: fit-tested disposable N95 respirator [if unavailable, wear a medical (surgical mask)], disposable gloves, gown, and goggles.

·                          When completed, place all PPE in a biohazard bag for appropriate disposal.

·                          Wash hands thoroughly with soap and water or alcohol-based hand gel.

Swine Flu Vaccine

As the swine influenza A (H1N1) virus is a new virus, no swine flu vaccine was immediately available to prevent infections.

And unfortunately, the seasonal flu vaccine that many of us receive will not provide any protection against the swine flu virus.

A vaccine has been developed, tested, and now FDA approved and an increasing supply of doses are arriving at doctor's office and clinics to help prevent infections from the 2009 H1N1 strain of the flu.

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that swine flu vaccine should first go to:

·                         Pregnant women

·                         Household contacts and caregivers for children younger than 6 months of age

·                         Healthcare and emergency medical services personnel

·                         All children and young adults from 6 months through 24 years of age, and

·                         Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

CONCLUSION

People showing flu like symptoms such as fever, cough, running nose and difficulty in breathing should be allowed to stay at home for a period of 7 to 10 days.

There is no need to worry a lot as the Swine flu is curable. As suggested by elders that prevention is better than cure, so the  precautionary measures must be  followed strictly to minimize the chances of getting infected with Swine flu.