SWINE FLU (INFLUENZA)

                             Management

Swine flu update : Mortality  

Introduction
H1N1 virus is a new type of Influenza virus affecting pigs, humans and maybe some other animals. Humans do not yet have herd immunity to it as they do to other types of flu viruses. Hence, it is spreading like wildfire and at a rate faster than any other virus epidemic we can recall. By itself and at present, it is a very low mortality viral infection and the risk of death (in kids who have low immunity, and adults at old age especially when weakened by diabetes or other debilitating disorders) is pale in comparison to childhood diarrhea, typhoid, bronchopneumonia at extremes of age, and many other diseases that we are used to.
The main worry is that the next mutated form of this virus, expected within a year, may acquire higher levels of virulence to cause death and or severe complications. To preempt that state of risk, we have to build the overall level of immunity in the general population (herd immunity) either by infection or with the help of a vaccine.

To reduce risks of vaccine-mediated injury, the R & D of Panacea Biotec has been on the forefront in India in developing vaccines without the use of adjuvants and preservatives which are theoretically suspected in some quarters to be potentially toxic especially to infants. In a pandemic of this nature, there is neither time nor requirement to do large safety studies that are mandatory to get any new vaccine approved.

Computational Models show Spanish HINI with no drugs bound, Avian H5NI with Tamiflu bound and Swine A/HINI with Relenza bound

Symptoms:
Just like any another flu, predominantly upper respiratory symptoms like cough, cold accompanied by the usual fever, headache, body ache, loss of appetite, sore throat, weakness, and sometimes uneasy stomach has been reported in many cases. Mild respiratory illness (nasal congestion, rhinorrhea) without fever and occasional severe disease also has been reported. Other symptoms reported with swine influenza A virus infection include vomiting, diarrhea, myalgia, headache, chills, fatigue, and dyspnea. Conjunctivitis is rare, but has been reported. Severe disease (pneumonia, respiratory failure) and fatal outcomes have been reported with swine influenza A virus infection. The potential for exacerbation of underlying chronic medical conditions or invasive bacterial infection with swine influenza A virus infection should be considered. People at higher risk of serious complications from seasonal flu include people age 65 years and older, younger than 18 years, pregnant women, people of any age with chronic medical conditions (such as asthma, diabetes, or heart disease), and people who are immuno-compromised (e.g., taking immunosuppressive medications, infected with HIV).Mortality rate due to the infection is about half of one percent, which is much lower compared to many infective diseases common in day to day life. 

Management
Whenever any of above symptoms start, go to nearest Government approved laboratories for checkup and testing for H1N1 infection. Most private laboratories check for influenza A and B virus infection. Such test kits are not highly specific or sensitive to catch H1N1 virus infection in time.
The antiviral drugs (oseltamivir and zanamivir) which are highly effective against H1N1 infection are available from Government sources and must not be used indiscriminately as it may cause resistance against virus.  

If any person tests positive, all household members and close contacts should to be treated simultaneously and kept under watch for seven days, the time taken to build up body immunity.

For symptomatic relief:
For relief of fever, anti-pyretic medications such as acetaminophen or non steroidal anti-inflammatory drugs including Nimesulide are recommended. Aspirin or aspirin-containing products should not be administered to any confirmed or suspected case of influenza A (H1N1) virus infection in subjects aged 18 years or younger due to the risk of Reye’s syndrome.  

In children, emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing

• Bluish or gray skin color

• Not drinking enough fluids

• Severe or persistent vomiting

• Not waking up or not interacting

• Being so irritable that the child does not want to be held

• Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath

• Pain or pressure in the chest or abdomen

• Sudden dizziness

• Confusion

• Severe or persistent vomiting

• Flu-like symptoms improve but then return with fever and worse cough

Protect Yourself, Your Family, and Community

• Stay informed.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

• Avoid touching your eyes, nose and mouth. Germs spread this way.

• Try to avoid close contact with sick people.

• If you are sick, you may be ill for a week or longer. You should stay home and keep away from others as much as possible. Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of fever-reducing medicine.) Keep away from others as much as possible. This is to keep from making others sick.

• If you are sick and sharing a common space with other household members in your home, wear a facemask, if available and tolerable, to help prevent spreading the virus to others.

• With seasonal flu, people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. 

• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable.  Infants and pregnant women should not be cared for by sick family members.

• Follow public health advice regarding school closures, avoiding crowds, and other social distancing measures.

WINFLU MEASURES

Swine flu is essentially a viral (H1N1 virus) infection affecting respiratory tract like any other flu. It is to be understood that even though pandemics occur, only people with weak immunity tend to succumb which is true of any viral infection. During monsoons respiratory infections are in any case common but only few of them could be swine flu, if adequate measures are taken.

The following measures would be helpful:

• Wash your hands with soap and water frequently

• Sleep should be adequate (at least 8 hours) for boosting immunity

• Drink at least 10 glasses of water daily. This will not only keep you hydrated but also help in getting rid of toxins in the body.

• Take colored fruits & vegetables, whole grains & nuts as they are known to enhance immunity.

• One can also take antioxidants, multivitamin tablets, Colostrum-lactoferrin preparations, Tinea cordifolia extracts, Tulsi  in consultation with physicians.

• 45 minutes of brisk walking, yoga & exercise regularly can elevate body resistance.

• Keep away from rumors.

• Stay aware of official authority announcements (guidelines) from time to time.

• Surgical masks can provide a mechanical barrier against droplet infection. However it should cover both mouth & nose & should be disposed off after single use. Also if the mask is damp, discard it immediately. In case masks are not available, a cotton handkerchief can be used.

• Stay away from crowded places as far as possible.

• Avoid eating exposed food, salads & street stuff especially during monsoons.

• Be completely sure of where Swine flu lab tests are being done (& that is in government centers).

Monitor yourself and household members for flu symptoms and contact a health care provider if symptoms occur.