Swine flu: truth behind a terror:
Swine flu (swine influenza) is a respiratory disease of pigs caused by type A influenza virus (subtype H1N1) that regularly causes outbreaks of influenza in pigs. Influenza viruses are small RNA viruses that infect many mammals, including humans, birds, and swine. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (influenza type A H1N1 virus) was first isolated from a pig in 1930.
How does swine flu spread?
Influenza viruses can be directly transmitted 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 of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people. Swine influenza (novel H1N1) spreads from person to person, either by inhaling the virus or touching surfaces contaminated with the virus, then touching the mouth or nose. Infected droplets are expelled into the air through coughing or sneezing.
Early information suggests that swine influenza is about as contagious as the usual human influenza. If one person in a household gets swine flu, from 8%-19% of household contacts will get infected. Reports suggest that swine influenza is causing slightly more infections than would be normal for an influenza season. Based on its wide spread, the World Health Organization has declared the 2009 outbreak of the new H1N1 flu a global pandemic.
People at higher risk: People at higher risk of serious complications include:
• Young children, especially those under 12 months of age
• Elderly people are at high risk of severe flu disease. But relatively few swine flu cases have been seen in people over age 65.
• Pregnant women.
• People with cardiovascular conditions (except high blood pressure)
• People with liver problems
• People with kidney problems
• People with blood disorders, including sickle cell disease
• People with neurologic disorders
• People with neuromuscular disorders
• People with metabolic disorders, including diabetes
• People with immune suppression, including HIV infection and medications that suppress the immune system, such as cancer chemotherapy or anti-rejection drugs for transplants
• Residents of a nursing home or other chronic-care facility
People in these groups should seek medical care as soon as they get flu symptoms.
Symptoms and signs of swine flu:
Symptoms of swine flu are like regular flu symptoms and includes-
- Fever
- Cough
- Sore throat
- Runny nose
- Body aches, fatigue
- Pain in the muscles or joints
- Headache
- Chills
- Many people with swine flu have had diarrhea and vomiting.
- Swine flu can cause neurologic symptoms in children. These events are rare, but, as cases associated with seasonal flu have shown, they can be very severe and often fatal. Symptoms include seizures or changes in mental status (confusion or sudden cognitive or behavioral changes).
Nearly everyone with flu has at least two of these symptoms. But these symptoms can also be caused by many other conditions. So it can’t be diagnosed only on the basis of symptoms. Only lab tests can definitively show whether you’ve got swine flu, although a negative result doesn’t necessarily mean you don’t have the flu.
Emergency warning signs – As with the seasonal flu, certain symptoms may have required emergency medical attention.
Children should be given urgent medical attention if they:
• Have fast breathing or trouble breathing
• Have bluish or gray skin color
• Are not drinking enough fluid
• Are not waking up or not interacting
• Have severe or persistent vomiting
• Are so irritable that the child does not want to be held
• Have flu-like symptoms that improve but then return with fever and a worse cough
• Have fever with a rash
• Have a fever and then have a seizure or sudden mental or behavioral change.
Adults should seek urgent medical attention if they have:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve, but then come back with worsening fever or cough
A striking number of adults who developed severe swine flu complications have been morbidly obese. However, obesity itself does not seem to be the issue. The vast majority of extremely obese people suffer respiratory problems and/or diabetes, which seem to be the underlying reason for their severe flu complications. People with “underlying conditions” who come down with flu symptoms should consult their doctors first before visiting an “emergency room full of sick people may actually put them in more danger.”
This was especially true of pregnant women. Flu infections can also cause pneumonia, a life-threatening illness. Reports of deaths among healthy young people during the first weeks of the 2009 flu pandemic were attributed to pneumonia.
Diagnosis of swine flu:
To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to laboratory testing.
Swine influenza can be confirmed by culturing respiratory secretions such as sputum or nasal/throat secretions. Rapid tests are available to give a general idea if an influenza strain is present. If influenza is found, more specific testing may be done to determine either the strain is swine flu or regular seasonal flu. Specific testing to identify swine flu is usually done at state health departments.
Treatment of swine flu:
There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: ‘amantadine’, ‘rimantadine’, ‘oseltamivir’ and ‘zanamivir’. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to ‘amantadine’ and ‘rimantadine’. This variety of swine flu is sensitive to the antiviral drugs ‘oseltamivir’ (Tamiflu) and ‘zanamivir’ (Relenza), but the Centers for Disease Control and Prevention has recommended that these drugs be used only for people who:
• Have confirmed, probable or suspected swine influenza, especially if they are at higher risk of complications.
• Have household contacts who are at high risk of complications of influenza for example, people with certain chronic medical conditions, people 65 or older, and children younger than 5 years old and pregnant women of a confirmed, probable or suspected case.
• Schoolchildren who are at high risk of complications of influenza for example, children with certain chronic medical conditions and had close contact (face-to-face) with someone with a confirmed, probable or suspected case.
• Have recently traveled or live in an area where cases of swine flu have been confirmed, if they are at high risk of complications.
• People work in certain health care settings.
WHO recommended that ‘Tamiflu’ only be given to particularly vulnerable people and noted that healthy people who catch mild to moderate cases of swine flu didn’t need the drug at all. Self recovery from flu is very commom.
Both above medicines can cause side effects, including lightheadedness, nausea, vomiting, loss of appetite and trouble breathing and it was recommended that patients discuss possible side effects with their doctor before starting any antiviral medication. Children may be at increased risk of self-injury and confusion after taking ‘Tamiflu’. WHO warns against buying anti-viral medications from online sources, estimating that half the drugs sold by online pharmacies without a physical address are counterfeit.
Health authorities warned that the indiscriminate use of antiviral medications to prevent and treat influenza could ease the way for drug-resistant strains to emerge which would make the fight against the pandemic much harder. In addition, a British report found that people often failed to complete a full course of the drug which encouraged resistance.
When to Seek Medical Care?
People with fever and mild respiratory symptoms should call their physician for guidance. If you live in an area that is not currently reporting any cases of swine influenza, your physician may direct you to come into the clinic to be evaluated. If you live in an area where swine influenza is circulating already, your physician may decide to treat you over the phone. This is to minimize the number of sick people who go out into the community or into a clinic once cases have been confirmed.
Self-Care at Home:
People who are suspected of having swine influenza should stay home from work and not go into the community, including attending school or going to work. It is recommended that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (<100 F) or signs of a fever without the use of fever-reducing medicines. There are special precautions for health-care settings; people should not return to work in a health-care setting for at least seven days from symptom onset or until resolution of symptoms (whichever is longer).
Over-the-counter medicines like ibuprofen (Brufen) or paracetamol (Crocin, Calpal and Metacin) may be used to reduce fever or aches. Aspirin or aspirin-containing products should not be given to children 18 years of age or younger, due to the risk of liver damage (Reye syndrome). Always follow the package directions for any over-the-counter cold or flu remedy.
There are many homeopathic medicines (Influenzinum, Gelsemium, Eucalyptus, Eupatorium etc.) which are effective against swine flu, and should be taken only after consulting a homeopathic physician.
Prevention
Simple measures have been shown to reduce the risk of transmission of influenza. These include:
- Frequent hand washing with soap and water or disinfection with alcohol / alcohol-based sanitizing gels.
- People should try to avoid touching their face or mucous membranes.
- The influenza virus can live about two hours on surfaces that become contaminated.
- During coughs and sneezes, the mouth should be covered with a tissue or hand.
- In areas with large numbers of cases, it is best to minimize nonessential exposure to crowds.
- Sick people should stay home whenever possible.
- Children who are sick should be kept home, especially if they’re running flu-like symptoms such as high fever, vomiting or diarrhea. They should also be kept away from other children.
- Not to take children with flu-like symptoms to the emergency department. That’s the worst thing. They may not have swine flu but they could get it there.
- Child who has been sick should be fever-free for at least 24 hours (without the aid of medications) before returning to school.
- Cooking to an internal temperature of 160 F (71 C) kills the virus. So eating properly cooked pork is safe.
There is general uncertainty among health professionals about the value of wearing either facial masks or more expensive respirators to prevent infection. Some experts stated that “masks may give people a false sense of security” and shouldn’t replace other precautions. Masks may benefit people in close contact with infected persons but it was unknown whether they prevented swine flu infection. According to mask manufacturer 3M, masks will filter out particles in industrial settings, but “there are no established exposure limits for biological agents such as swine flu virus.”
Vaccination:
A vaccine against swine influenza is being tested and will likely be available for the end of 2009. The vaccine will be given in two doses (shots).Two injections will be required three weeks apart for the swine flu and a third will be needed for seasonal flu to provide maximum immunity.
Author: Dr. R. Kumar
B.H.M.S., M.D. ( Hom.) Psychiatry
Email:dr_ramk@yahoo.com
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