Niramaya Hospitals

HISTORY
1918 pandemic in humans
1976 U.S. outbreak
1988 zoonosis
1998 US outbreak in swine
2007 Philippine outbreak in swine
2009 outbreak in humans

H1N1 Flu (Swine Flu) Information (Updated on August 7, 2009):

The World Health Organization (WHO) has raised the pandemic alert level to Phase 6 in response to the global spread of the H1N1 (swine flu) virus. This reflects that the virus has spread to other parts of the world, but it does not mean that the virus has changed or become more severe.

LIFE - CYCLE
Typically, influenza is transmitted from infected mammals through the air by coughs or sneezes, creating aerosols containing the virus, and from infected birds through their droppings and handling.
Influenza can also be transmitted by saliva, nasal secretions, faeces and blood. Infections occur through contact with these bodily fluids or with contaminated surfaces.
The virus attacks the tracheal and alveolar epithelium in human
Flu viruses can remain infectious for about one week at human body temperature, over 30 days at 0 °C (32 °F), and indefinitely at very low temperatures (such as lakes in northeast Siberia).
They can be inactivated easily by disinfectants and detergents.
New influenza A(H1N1) - How do people become infected?
This is a new influenza A(H1N1) virus that has never before circulated among humans.
The virus is spread from person-to-person. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.
To prevent spread, people who are ill should cover their mouth and nose when coughing or sneezing, stay home when they are unwell, clean their hands regularly, and keep some distance from healthy people, as much as possible.

SYMPTOMS
The incubation period seems to be approximately 12 hours to 24 hours before symptoms appear.
Like any flu, the symptoms can range from mild to severe, and include:

How is it Diagnosed?
A respiratory specimen must be collected within the first four to five days of illness,
However, some patients (such as children), may shed the virus for 10 days or longer, according to the CDC.
Tests done – screening and diagnostic ie RT PCR

How Can You Catch Swine Flu?
Typically swine flu is spread through contact with infected pigs or environments contaminated with swine flu viruses. However, human-to-human spread has also been documented, which means you can catch it through others’ coughing or sneezing but most likely by directly touching an infected person or by indirectly touching something they touched recently that left the flu viruses on it and then touching or rubbing your eyes, mouth or nose (or possibly even your ears).
You cannot get swine flu from eating pork or pork products, as the virus isn’t transmitted in food.
People with swine flu remain potentially contagious one day prior to while symptoms are present and for up to seven days following the illness, although children can be contagious for even longer.

WHAT YOU CAN DO…

Keep Potential Contagions Out of Your Home. A chief way microorganisms and other contaminants enter your home is through dust and dirt you track in on the bottom of your shoes. It's then circulated directly into the air you and your family breathe.
Eliminate Contagions in Your Home. Of course, you can't possibly keep all organisms from entering your home. Those that do get in can be effectively removed by using the proper cleaning tools.
Boost Your Body's First Line of Defense. Your Immune System. If you are exposed to a contagious disease, a strong immune system is key to fighting it off. You can keep your immune system strong by getting plenty of sleep, eating healthy foods including vegetables and fruits, and keeping stress under control.

Do’s….
Washing your hands with soap and water often.
Covering your mouth and nose with a tissue when you cough or sneeze, then throwing away the tissue.
Surgical masks, can add a level of protection as you have likely seen on the news.
Reducing, where possible, being in contact with masses of people in public places.
Avoiding close contact with sick people.
If feeling sick with what are above symptoms then go immediately to your doctor, clinic or hospital. Stay home from work or school, and limit close contact with others and wear a surgical mask especially in public places, as you don’t want to pass along the flu if you do get sick.

Do's and Don't's
There are several things you should do if you develop symptoms:

Avoid contact with other infected people as much as possible.
Cover your nose and mouth while coughing or sneezing. Use a tissue when possible.
Dispose of dirty tissues promptly and carefully.
Wash your hands frequently with soap and water to reduce the spread of the virus from your hands to your face or to other people.
Clean hard surfaces such as door handles or telephones, regularly using a normal cleaning product.
Contact your nearby Swine flu screening centre.

Cover your nose and mouth with a tissue when you cough or sneeze.
If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands
Put used tissues in the trash.
Clean your hands after coughing or sneezing. Wash with soap and water, or with alcohol-based hand cleaner.
Avoid touching your eyes, nose and mouth.
If you get sick, stay home from work or school, and limit your contact with others to keep from infecting them. People should stay home at least 24 hours after they are free of fever (100°F), or signs of a fever without the use of fever-reducing medications.

Keep activities as consistent and normal as possible even if your normal routine changes.
Ask your children what they have heard about novel H1N1 flu. Answer questions openly and honestly, at a level they can understand. Be concrete and do not avoid difficult questions.
Allow your children to express their feelings and concerns. Let them know it is okay to be afraid or mad. Ask questions so you can help them identify and cope with their feelings.
Children always need to feel safe and loved. When they are uncertain about situations and afraid they may need even more affection and attention.
Limit exposure to media and adult conversations about novel H1N1 flu . If your children are watching T.V. try to watch with them or make sure you are available to answer questions about what they have heard.
As appropriate, encourage healthy behaviors: eating well, sleeping well, playing outside.
Use their questions as an opportunity to let them know what they can do to avoid getting novel H1N1 flu.

Wash hands frequently with soap and water for 20 seconds (long enough for children to sing the “Happy Birthday” song twice). Be sure to set a good example by doing this yourself.
Cough and sneeze into a tissue. (If a tissue is used, throw the tissue away immediately).
Be sure to set a good example by doing this yourself.
Stay at least six feet away from people who are sick.
Stay home from school if sick, and stay away from sick people until they are better.

Maintain distance of at least 1 metre from any individual with influenza-like symptoms,
refrain from touching mouth and nose;
perform hand hygiene frequently, by washing with soap and water or using an alcohol based handrub, especially if touching the mouth and nose and surfaces that are potentially contaminated;
reduce as much as possible the time spent in close contact with people who might be ill;
reduce as much as possible the time spent in crowded settings;
improve airflow in your living space by opening windows as much as possible.

stay at home if you feel unwell and follow the local public health recommendations
keep distance from well individuals as much as possible (at least 1 metre)
cover your mouth and nose when coughing or sneezing, with tissues or other suitable materials, to contain respiratory secretions.
Dispose of the material immediately after use or wash it.
Clean hands immediately after contact with respiratory secretions!
improve airflow in your living space by opening windows as much as possible.

Place mask carefully to cover mouth and nose and tie securely to minimise any gaps between the face and the mask
While in use, avoid touching the mask
Whenever you touch a used mask, for example when removing or washing, clean hands by washing with soap and water or using an alcohol-based handrub
Replace masks with a new clean, dry mask as soon as they become damp or humid
Do not re-use single-use masks
Discard single-use masks after each use and dispose of them immediately upon removing.

Care of alternatives to mask:
Although some alternative barriers to standard medical masks are frequently used (e.g. cloth mask, scarf, paper masks, rags tied over the nose and mouth),
If such alternative barriers are used, they should only be used once or, in the case of cloth masks, should be cleaned thoroughly between each use (i.e. wash with normal household detergent at normal temperature).
They should be removed immediately after caring for the ill. Hands should be washed immediately after removal of the mask.

How to Handwash?
Duration of the entire procedure: 40-60 seconds
Apply enough soap to cover all hand surfaces; Rub hands palm to palm; Wet hands with water; Right palm over left dorsum with interlaced fingers and vice versa; Palm to palm with fingers interlaced; Backs of fingers to opposing palms with fingers interlocked; Rotational rubbing of left thumb clasped in right palm and vice versa; Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa; Rinse hands with water; Dry hands thoroughly with a single use towel; Use towel to turn off faucet; Your hands are now safe.

Why are we so worried about this flu when hundreds of thousands die every year from seasonal epidemics?
Seasonal influenza occurs every year and the viruses change each year - but many people have some immunity to the circulating virus which helps limit infections. Some countries also use seasonal influenza vaccines to reduce illness and deaths.
But influenza A(H1N1) is a new virus and one to which most people have no or little immunity and, therefore, this virus could cause more infections than are seen with seasonal flu.
The new influenza A(H1N1) appears to be as contagious as seasonal influenza, and is spreading fast particularly among young people (from ages 10 to 45). The severity of the disease ranges from very mild symptoms to severe illnesses that can result in death.
The majority of people who contract the virus experience the milder disease and recover without antiviral treatment or medical care. Of the more serious cases, more than half of hospitalized people had underlying health conditions or weak immune systems.

ANTI-VIRAL DRUGS
There are two classes of antiviral drugs for influenza: inhibitors of neuraminidase such as oseltamivir and zanamivir; and adamantanes, such as amantadine and rimantadine. Tests on viruses obtained from patients in Mexico and the United States have indicated that current new H1N1 viruses are sensitive to neuraminidase inhibitors, but that the viruses are resistant to the other class, the adamantanes.
Drug resistance…
Resistance can develop to antiviral drugs used for influenza. Therefore, WHO and its partners are monitoring antiviral drug resistance.
When to use…
Antiviral drugs are to be used according to national pandemic influenza preparedness plans
Where antiviral drugs are available for treatment, clinicians should make decisions based on assessment of the individual patient's risk. Risks versus benefits should also be evaluated on a case by case basis.