KNOW SWINE FLU


Dr Surya Kant,MD
Vice President, Indian Chest Society, 2012-2013
Prof. and Head
Dept. of Pulmonary Medicine
CSM Medical University (UP)
Lucknow


(On June 11, 2009, the World Health Organization raised the worldwide pandemic alert level to Phase 6 for swine flu which is the highest alert level. This alert level means that the swine flu had spread worldwide and there were cases of people with the virus in most countries. The pandemic level identifies the spread of the disease or virus and not necessarily the severity of the disease. Swine flu spread very rapidly worldwide due to its high human to human transmission rate and due to the frequency of air travel. Although in August 2010, WHO declared the swine flu pandemic officially over but still patients are reported from different part of India. Dr. Suryakant has given valuable informations in this article; will definitely help in raising awareness about Swine Flue amongst common public

Editor)       


Now days, Swine flu is transmitting due to a novel influenza virus AH1N1. This virus is among one of few viruses which are found in swine. First of all this novel influenza virus AH1N1 was traced from South America in March 2009.This virus is developed into highly fatal and contagious due to some changes in its genetic structure. Genetic changes are a regular event in viruses. It causes modification in outer structure of viruses. These modifications, if little, do not change antigenic and infectious power of these viruses. Larger changes may convert these viruses unidentifiable for our immune system. It happens because our body does not have specific antibodies against these novel viruses. Novel influenza virus AH1N1 has evolved due to mixing of genetic material of swine, human and avian flu viruses. This transformation had become a unpredicable mystery for our human immune system.
This new virus strain novel influenza virus AH1N1 2009 is cause of transmission of Swine flu in Mexico, America and other part of the globe. WHO had to declare pandemic on 18 may 2009, after transmission of this virus into thousands of people worldwide within few months of its origin. In India, First case of novel influenza virus AH1N1 2009 was diagnosed in May, 16, 2009, two days before declaration of Pandemic. In India, thousands of people have got infected and more than 1300 have died due to infection of this virus.

Historic background


Flu Pandemics emerged in its deadly appearance thrice (1918, 1957 and 1969) at regular intervals in 20th century. In 1918, Swine were the source (host) of flu viruses. This flu is popularly known as Spanish Flu. This fatal pandemic ended after finishing 50 million lives. Second and third Pandemics, known as Asian and Hong Kong respectively were spread by Avian Flu viruses. Asian and Hong Kong flu pandemic had engulfed 70,000 and 34,000 lives respectively.

Symptoms


Symptoms are like seasonal flu and include Fever, Cough, Sore throat, Body aches, Headaches, Chills and fatigue Sometimes, diarrhea and vomiting. Some times common cold symptoms may mimic flu but differentiation is easy as cold related symptoms are milder. Flu related symptoms aggravates within two days and limited itself within some time. These symptoms may worsen in few cases with other complications. Some cases may feel breathing related problems. Coughing without or with blood may be seen sometimes. In fact novel influenza virus AH1N1 2009 is a subtype of seasonal flu which is representing itself with increased lethality and transmission rate.

Symptoms Common cold Flu
Fever Grade Low High
Headeche Mild Severe
Bodyache Rarely Mostly Severe
Weakness Mild Remains 2-3 weeks
ore throat Normal Occasionally
Breathing problems Mild Moderate to severe
How Flu Spreads


The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

High Risk Group


Groups of people at higher risk for severe illness from novel influenza A (H1N1) infections and complications are thought to be the same as those people at higher risk for severe illness from seasonal influenza. These groups include: children younger than 5 years old and persons aged 65 years or older , pregnant women , adults and children who have asthma; chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, metabolic disorders (such as diabetes) and immunocomporomized individuals ( immunosuppresion caused by medications, HIV or any other reason)

Complications


Clinical syndromes ranges from mild respiratory illness to lower respiratory tract illness, dehydration, or pneumonia, Deaths occur occasionally, Exacerbation of underlying chronic medical conditions, Upper respiratory tract disease (sinusitis, otitis media, and croup)
Lower respiratory tract disease (pneumonia, bronchiolitis, asthma),Cardiac (myocarditis, pericarditis),Musculoskeletal (myositis, rhabdomyolysis),Neurologic (acute and post-infectious encephalopathy, encephalitis, febrile seizures, status epilepticus),Toxic shock syndrome, and secondary bacterial pneumonia with or without sepsis.

Mortality


Till date mortality rate is found to be in between 0.5-1%, so it need not to worry too much, but this condition may take a worse turn if this virus transfom further. In that situation, transmisión and mortality rate may increased to 5 times of the present rate. So it is important for high risk population group to get vaccinated as soon as posible.

Suspected Case


It is a popular myth that inhalation therapy is habit forming and it should be A suspected case of swine influenza A (H1N1) virus infection is defined as a person with acute febrile respiratory illness (fever ≥ 380 C) with onset.
1. within 7 days of close contact with a person who is a confirmed case of swine influenza A (H1N1)virus infection, or
2. within 7 days of travel to areas where there are one or more confirmed swine influenza A(H1N1)cases, or
3. Resides in a community where there are one or more confirmed swine influenza cases.

Probable Case


A probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness who:
1. is positive for influenza A, but unsubtypable for H1 and H3 by influenza RT-PCR or reagents used to detect seasonal influenza virus infection, or
2. is positive for influenza A by an influenza rapid test or an influenza immunofluorescence assay (IFA) plus meets criteria for a suspected case, or
3. Individual with a clinically compatible illness who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case.

Diagnosed Case


A confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at WHO approved laboratories by one or more of the following tests:
1. Real Time PCR
2. Viral culture
3. Four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies

Tretment


Swine flu should be treated with consultation of Doctor on the basis of Symptoms including Paracetamol for Fever, Cough syrup for cough and anti allergic medications for cold related symptoms.
A. Anti Viral Drugs
Oseltamavir is very effective in controlling Novel influenza virus AH1N1. Beside this Zanamivir is also applied for treatment of swine flu. These antiviral drugs should be taken in prescription and supervision of expert clinician. These drugs help in reducing intensity and duration of symptoms and reduce chances of complications.
B. Alternative Treatment and Other Remedies
Proper rest is essential for rapid relieving of symptoms. Sufficient amount of liquid should be taken to avoid dehydration. It also helps in improvement of diseases symptoms. Kadha of ginger, holy basil (Tulsi), cloves, black pepper and guduchi were found useful as alternative treatment. Drinking of lukewarm water and mild tea improves symptoms. Light, easily digestable small meals should be taken at frequent intervals.

Prevention


A. Mask: It is seen that use of mask reduces virus transmission But effective use of mask is depend on efficient application, continuous supply and proper disposal. That’s why excessive use of mask is unnecessary beside few specific conditions.
B. Other measures: Swine flu virus transmits with droplet nuclei at a time of coughing and sneezing of the infected person. One drop of that droplet nucleus may contain one lakh to one million viruses. Beside it, objects used or touched by infected person may transmit virus from one person to others. These viruses may remain viable on any surface for 10 to 72 hours. Following measures will help in protection from swine flu.
Do’s
• Always keep your mouth covered with napkin at the time of coughing and sneezing.
• Used bed-sheets and other clothes of infected should only be used after proper cleaning.
• Wash hands by soap before eating.
• If you get infected by flu virus consult your doctor immediately and stay at home.
• Keep at least one meter distance from infected person.
Don’ts
• Do not visit crowded place.
• Avoid hand shake and close hug.
• Don’t touch your eyes, nose and mouth without proper hand wash.
C. Vaccination:
Flu vaccine is the best preventive strategy for flu. Currently flu vaccine is easily available in market. Now swine flu strain vaccine is included in routine flu vaccine. This vaccine is safe for pregnant women and children. Vaccine is essential for high risk population.

Dr Surya Kant