INFLUENZA A H1N1 - The facts #2

High risk groups:

· Less than 5 years old
· More than 65 years old
· Pregnant
· Obese with chronic illnesses such as asthma, chronic lung disease, heart disease, diabetes or kidney disease
· On long term aspirin therapy
· On drugs that will suppress your immune system eg. steroids, oral chemotherapeutic drugs, azathioprine, cyclophosphamide
· Undergoing cancer treatment


Treatment of H1N1:

Vaccines

Vaccines are usually given to prevent infections. Influenza vaccines are made from either pieces of the killed influenza virus or weakened versions of the live virus that will not lead to disease. When vaccinated, the body’s immune system makes antibodies which will fight off infection if exposure to the virus occurs. However, the influenza virus has the ability to mutate. The latest strain is H1N1. So we will have to wait for the specific vaccine to be available.

Antivirals [Tamiflu (Oseltamivir), Relenza (Zanamivir)]

Antivirals are drugs that can treat people who have already been infected by a virus. Currently, two anti-virals are available which are Tamiflu and Relenza. These drugs are able to stop the virus from replicating in the body and has to be taken within two days after symptoms appear. However, it is not indicated for everybody with flu as the disease is mostly self-limiting. People who are in the high-risk group should be given the anti-virals if they have flu-like illness.
Tamiflu is a neuraminidase inhibitor. It is effective against both type A and B strains of flu.There is no generic version of Tamiflu available. 10 capsules (minimum amount) can cost around RM80 – RM100. Tamiflu helps to reduce your time with flu symptoms by about 1.3 days.

Dosage of Tamiflu:
Oseltamivir is marketed by Roche under the trade name Tamiflu, as capsules (containing oseltamivir phosphate 98.5 mg equivalent to oseltamivir 75 mg). Adults take 75mg twice a day for 5 days.

Side Effects:
The most common side effects of Tamiflu are nausea, vomiting, diarrhea, and conjunctivitis (pinkeye). Sometimes people report getting headaches after taking Tamiflu. There are concerns that oseltamivir may cause dangerous psychological, neuropsychiatric side effects including self harm in some users. These dangerous side effects occur more commonly in children than in adults.


Prevention

The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:
- avoid touching your mouth and nose;
- clean hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated);
- avoid close contact with people who might be ill;
- reduce the time spent in crowded settings if possible;
- improve airflow in your living space by opening windows;
- practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.


The status of H1N1 now:

The WHO considers the overall severity of the influenza pandemic to be moderate. This assessment is based on scientific evidence available to WHO, as well as input from its Member States on the pandemic's impact on their health systems, and their social and economic functioning.

The moderate assessment reflects that:
- Most people recover from infection without the need for hospitalization or medical care.
- Overall, national levels of severe illness from influenza A(H1N1) appear similar to levels seen during local seasonal influenza periods, although high levels of disease have occurred in some local areas and institutions.
- Overall, hospitals and health care systems in most countries have been able to cope with the numbers of people seeking care, although some facilities and systems have been stressed in some localities.

WHO is concerned about current patterns of serious cases and deaths that are occurring primarily among young persons, including the previously healthy and those with pre-existing medical conditions or pregnancy.
Large outbreaks of disease have not yet been reported in many countries, and the full clinical spectrum of disease is not yet known.

For more info:
Malaysia: http://h1n1.moh.gov.my/
USA: http://flu.gov/
WHO: http://www.who.int/csr/disease/swineflu/en/index.html

INFLUENZA A (H1N1) – The Facts

What is it?

H1N1 (previously known as “swine flu”) is a new influenza virus causing illness in people. This new virus was first detected in people in Mexico in April 2009. Now many other countries around the world have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread. This is a new influenza A(H1N1) virus that has never before circulated among humans. This virus is not related to previous or current human seasonal influenza viruses.

History

Over the years, different variations of flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Signs & symptoms

The symptoms of H1N1 flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 infection. Severe illness (pneumonia and respiratory failure) and deaths have been reported with H1N1 (swine) flu infection in people. Like seasonal flu, H1N1 (swine) flu may cause a worsening of underlying chronic medical conditions. You will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help. Only your medical practitioner and local health authority can confirm a case of influenza A(H1N1) with a throat swab.

Emergency warning signs in children 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

Emergency warning signs in adults 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
- Continuous fever for more than three days

Guidelines if you are feeling unwell:
If you feel unwell, have high fever, cough or sore throat:

- stay at home and keep away from work, school or crowds;
- rest and take plenty of fluids;
- cover your nose and mouth when coughing and sneezing and, if using tissues, make sure you dispose of them carefully. Clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub;
- if you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;
- use a mask to help you contain the spread of droplets when you are around others, but be sure to do so correctly;
- inform family and friends about your illness and try to avoid contact with other people;
- If possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.
- Do not go to work. You should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your colleagues and others.
- Avoid travelling

For more info:
Malaysia: http://h1n1.moh.gov.my
USA: http://flu.gov/
WHO: http://www.who.int/csr/disease/swineflu/en/index.html

Next: Treatment, prevention & WHO guidance on clinical management of H1N1