Swine flu (H1n1) emerging threat and its impact on public health

   Dr. K. Pewezo Khalo, MD, Microbiologist, Naga Hospital, Authority Kohima, Nagaland

[dropcap]I[/dropcap]n view of the present H1N1 outbreak and death toll over 800 and more than 13,000 infected across the country being reported in India is causing panic among the public. Since 16th century the influenza virus is known to be circulating in the human population and causing recurrent outbreaks upto extends of pandemics. No doubt 4 (four) confirmed cases has been reported in Nagaland till date. It is for sure that H1N1 is never a local health issue until it is imported from other areas of outbreak outside the state by someone who happens to visit to an outbreak areas and imported infection to our home. In this modern world, for one reason or another, we travel to other part of the world and accidentally acquire the diseases/infection and imported the same unknowingly. Infection has no limit or boundary but it is international which is beyond our control. It is beyond the scope of medical fraternity to totally stop infectious diseases from its outbreak/spread. Medical fraternity is always under the threat of infectious diseases inspite of our present skill and knowledge on germs. Germs are such a tiny creature unable to see with our naked eye yet so dangerous that it kill mankind without mercy. When we are least prepared or not aware at all, infectious diseases sometime strike us hardest. In this regard, we should stay alert always and concerned authority in collaboration with allied departments should be prepared to face any eventuality.
In 2009, there was a pandemic of influenza A (H1N1) outbreak, which is now the most common circulating strain of influenza virus globally. It first caused illness in Mexico and the United States in March and April 2009 and continued to spread globally to more than 214 countries worldwide with more than 340,000 laboratory confirmed cases and over 20,000 deaths reported to WHO as of 2010 (WHO report). Looking back into history, in 1918 pandemic humans was associated with Influenza A (H1N1). An estimated one third of the world’s population (or H~500 million persons) were infected and total deaths were estimated at H~50 million and were arguably as high as 100 million. Then in 1957 (Asian Flu) the pandemic occurred due to Influenza A (H2N2) and caused 1-2 million deaths worldwide. Again in 1968 (Hong Kong Flu), it was associated with Influenza A (H3N2) and 700,000 deaths were reported worldwide. Of 2004-09 till date, Outbreak of H5N1 was reported in 2003 and has affected poultry in 50 countries and caused human infections in 15 countries with 262 deaths and 442 cases as of 24 September 2009. The current H1N1 pandemic (2009) outbreak in humans has implicated among humans and continues till date, the World Health Organization 2009 declared a “Public Health Emergency of International Concern – pandemic phase 6 of new influenza A (H1N1) virus”.
Current H1N1 outbreak has certain pre-requisites; emergence of this novel virus to which all are susceptible, new virus is able to replicate and cause disease in humans and new virus is transmitted efficiently from human-to-human.
To make people more aware on H1N1 infection and to cause low state of panic, here is the means to understand the signs and symptoms and more about H1N1 virus infection.
Swine flu is spread directly from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission can also occur through droplets while coughing or sneezing. This is thought to occur in the same way as seasonal flu which is mainly person-to-person transmission through coughing or sneezing by people infected with the influenza virus. Un-etiquettes coughs, sneezes of people who are sick with the virus, touching infected objects and then touching nose or mouth etc. are the main mode of its spread randomly.
The Pandemic H1N1 influenza virus can survive on different items for different periods. The virus can survive on hard and nonporous surfaces for 24-48 Hours. On plastic & stainless steel, it is survive upto 24 hours and can be transferred to hands up to 24 hours. On cloth, paper and tissue, the virus is recoverable for 8-12 hours and transferable to hands up to 15 minutes. The virus can survive at humidity of 35-40% and a temperature of 280C.
Definitely H1N1 infection mimics regular human seasonal influenza flu. It is very difficult to say that a person is suffering from H1N1 until a laboratory report confirm. All influenza is not H1N1 influenza. Some of the ways one can suspect that a person is suffering from H1N1 influenza are; if a person is living with/expose/travel to an outbreak places or having close contact with H1N1 patient without any protective gears then the chances of getting infection is high.
H1N1 influenza is presented in the following ways like seasonal common flu; fever, cough, sore throat, weakness and headache; vomiting and diarrhoea. Usually children are less likely to have the usual influenza signs and symptoms like adult. Symptoms of severe infection in infants and young children may include difficulty in breathing, fast breathing, bluish colour of face/skin, dry skin, changes in mental status, and extreme irritability. Unless one is expose to infected person or travel to an outbreak area, it may be seasonal common flu unless laboratory report confirm. The most common cause of death is respiratory failure. Other causes of death are pneumonia (leading to sepsis), high fever (leading to neurological problems), dehydration (from excessive vomiting and diarrhea) and electrolyte imbalance. Fatalities are more likely in young children, high risks people and the elderly.
Certain risk group of people should take special care and attention to prevent getting infection from H1N1 flu or any other infectious diseases. Like who are younger than 5 years old, adults 65 years of age and older, patient of chronic lung diseases (including asthma), heart diseases (except high blood pressure), chronic kidney, liver, blood (including sickle cell disease), nerve, or metabolic disorders (including diabetes mellitus), poor immune system, including that caused by medications or by HIV/AIDS, pregnant mother are at risk of this infection.
Many a times, an outbreak of any infectious disease cause worry and panic. Sometimes due to negligence, over-reaction, wrong information and publicity etc. it create unnecessary worry to people that make one wonder and react to the situation wrongly causing social fear psychosis. Likewise, it is for sure that the present H1N1 swine flu outbreak probably creates many to wonder whether one is suffering from H1N1 influenza or it is just a common cold. Thus, it is important to create proper awareness among the community through various media so as to prevent panic in this type of situation. One should seek medical attention early without any hesitation as and when such situation arise and get timely medical treatment and prevent further spread. General public have been advised to follow certain precautions if they are suspected/confirmed case of H1N1 by wearing three-layered face mask (commercially available in any chemist shop), to maintain proper cough/sneeze etiquette, remain confine and calm for at least 7 days with good hygiene and diet etc. so as to prevent worsening of disease and further spread of infection to others. Avoid travelling to any outbreak place, get medical advice before journey and get flu shot if indicated.
A simple preventive measures to stop getting infection is to follow proper hand hygiene and respiratory etiquettes, remain indoor and avoid close contact with people suffering from H1N1, if a person is already expose to an outbreak places and return or expose to already infected person for at least 7 days.
Infection spreads very quickly among the population especially in crowded places. Cold and dry weather enables the virus to survive longer outside the body than in other conditions and, as a consequence, seasonal epidemics in temperate areas appear in winter. People may become infected by touching/handling contaminated materials with flu viruses on it and then touching their mouth or nose. Swine influenza viruses are not transmitted by food. Eating properly handled and cooked pork (at an internal temperature of ≥160°F) and pork products is safe.
Do’s and Don’ts in H1N1 outbreak;
• Avoid close contact with people who are suffering from H1N1.
• If possible, stay at home keeping body and room temperature warm.
• Cover your mouth and nose with a tissue or handkerchief when coughing or sneezing.
• Washing your hands often with soap or antiseptic hand wash is the single best way to prevent the spread of H1N1.
• Get plenty of sleep, be physically active, manage your stress, drink plenty of warm fluids, and eat nutritious food.
• Persons who develop influenza-like-illness (ILI) (fever with either cough or sore throat) should be strongly encouraged to stay in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer.
• Persons who experience ILI and wish to seek medical care should contact their health care providers (by telephone or other remote means) before seeking care at a clinic/hospital.
• If ill persons must go into the community (e.g., to seek medical care) they should wear a face mask (three layer/pieces).
• Assign a single household family member to assist the sick person in order to minimize contact with asymptomatic persons.
• Special attention should be given to school children by the authority in case of any suspect case/outbreak.
• Large gathering of social activities, event, marriage etc. should take special precaution or averted in times of outbreak of H1N1.
There is an effective antiviral drug – Oseltamivir against H1N1. Administration of this drug depends on protocol of management of H1N1 which will be decided by doctor. If timely medication is given, it makes your illness milder and you feel better faster. They may also prevent serious flu complications. For treatment purpose, patients who are hospitalized and/or have underlying conditions that place them at higher risk for complications and have laboratory evidence of influenza should be treated with antiviral medicine as early in their course of illness as possible, ideally within 48 hours of onset. With the availability of vaccine and medicine, we are better prepared with an affordable therapy and prevent further loss of lives due to this infectious disease.
Although the flu is infectious, it is not as deadly as we think, says health officer Guidry. “Many of us will get it eventually, but you will survive it, just like you do the flu. It’s those people who really have medical conditions that put them at risk, that’s who we worry about,” clarified Guidry.
In this type of situation, one should not be panic but stay alert and keep in touch with the health workers and stay safe. Keep yourself away from outbreak areas and avoid travel to such areas, get timely vaccination (depend upon indication). If you are coming home from any outbreak areas, take safety precaution at home, seek early medical attention, remain indoor for at least 7 days, avoid creating panic, and report to health authority at the earliest if at all you have any signs and symptoms of infection. Keeping in mind the vulnerability of infection, it is always safe to stay alert for your own safety and for the cause of humanity in regard to H1N1 flu.