H1N1 Swine Virus

1 As you are aware, the A/H1N1 Swine Influenza virus has struck several countries and is spreading across the globe. The WHO, who is coordinating the global response to the outbreak as well as monitoring the situation, has raised its alert level to Phase 4 (highest level is Phase 6) - characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

2 In its latest update No.4, the WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities. There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

3 It is useful for us to be aware of what we are facing, what we can do to reduce the possibility of contracting it and if we did, what we should do. There is no need to panic. I have extracted some useful information about the swine influenza from the WHO’s website for your information and I would encourage you to constantly visit WHO’s website for updates:

Is there a human vaccine to protect from swine influenza?

There are no vaccines that contain the current swine influenza virus causing illness in humans. It is not known whether current human seasonal influenza vaccines can provide any protection. Influenza viruses change very quickly. It is important to develop a vaccine against the currently circulating virus strain for it to provide maximum protection to the vaccinated people. This is why WHO needs access to as many viruses as possible in order to select the most appropriate candidate vaccine virus.

What drugs are available for treatment?

There are two classes of such medicines, 1) adamantanes (amantadine and remantadine), and 2) inhibitors of influenza neuraminidase (oseltamivir and zanamivir).

Most of the previously reported swine influenza cases recovered fully from the disease without requiring medical attention and without antiviral medicines.

Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of treatment. The viruses obtained from the recent human cases with swine influenza in the United States are sensitive to oselatmivir and zanamivir but resistant to amantadine and remantadine.

Information is insufficient to make recommendation on the use of the antivirals in treatment of swine influenza virus infection. Clinicians have to make decisions based on the clinical and epidemiological assessment and harms and benefit of the treatment of the patient2. For the ongoing outbreak of the swine influenza infection in the United States and Mexico , the national and the local authorities are recommending to use oseltamivir or zanamivir for treatment of the disease based on the virus’s susceptibility profile.


How can I protect myself from getting swine influenza from infected people?

In the past, human infection with swine influenza was generally mild but is known to have caused severe illness such as pneumonia For the current outbreaks in the United States and Mexico however, the clinical pictures have been different. None of the confirmed cases in the United States have had the severe form of the disease and the patients recovered from illness without requiring medical care. In Mexico , some patients reportedly had the severe form of the disease.

To protect yourself, practice general preventive measures for influenza:
· Avoid close contact with people who appear unwell and who have fever and cough.
· Wash your hands with soap and water frequently and thoroughly.
· Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active.

If there is an ill person at home:
· Try to provide the ill person a separate section in the house. If this is not possible, keep the patient at least 1 meter in distance from others.
· Cover mouth and nose when caring for the ill person. Masks can be bought commercially or made using the readily available materials as long as they are disposed of or cleaned properly.
· Wash your hands with soap and water thoroughly after each contact with the ill person.
· Try to improve the air flow in the area where the ill person stays. Use doors and windows to take advantage of breezes.
· Keep the environment clean with readily available household cleaning agents.
· If you are living in a country where swine influenza has caused disease in humans, follow additional advice from national and local health authorities.

What should I do if I think I have swine influenza?

If you feel unwell, have high fever, cough and/or sore throat:
· Stay at home and keep away from work, school or crowds as much as possible.
· Rest and take plenty of fluids.
· Cover your mouth and nose with disposable tissues when coughing and sneezing and dispose of the used tissues properly.
· Wash your hands with soap and water frequently and thoroughly, especially after coughing or sneezing.
· Inform family and friends about your illness and seek help for household chores that require contact with other people such as shopping.

If you need medical attention:
· Contact your doctor or healthcare provider before travelling to see them and report your symptoms. Explain why you think you have swine influenza (for example, if you have recently travelled to a country where there is a swine influenza outbreak in humans). Follow the advice given to you for care.
· If it is not possible to contact your healthcare provider in advance, communicate your suspicion of having swine influenza immediately upon arrival at the healthcare facility.
· Take care to cover your nose and mouth