Tag Archive: H1N1


The A (HINI) flu is a viral disease that is amenable to treatment if anti-virals are administered early. However, I feel that the recommendations for treatment by the Health Ministry are too tight.

A number of households within the past two weeks, especially those that are in contact with the public such as medical personnel, students and teachers, have had members of the family down with flu.

Any flu-like illness, especially among those already vaccinated with flu vaccine, within the last two weeks is most probably HINI unless proven otherwise.

The disease has become too widespread to be contained, and steps taken to prevent the spread may prove ineffective. Hence, the next option is to deal with the situation in the most appropriate manner. And that is to administer treatment to the appropriate group early.

Those who get the infection will become immune, and when enough of the population has acquired the infection and become immune, then we get herd immunity and the disease can be contained.

Looking at the symptoms, they are fairly consistent. Most of them start with sore throat and dry cough associated with fatigue and cold intolerance for a few days followed by cyclical fever which usually occurs in the evening. Watery runny nose occurs about one day after the onset of fever and is usually transient unless there is a secondary bacterial infection.

Some patients may have diarrhoea at this stage. Some have milder disease with low grade fever. Note that there is no bone or joint pain or severe headache as opposed to dengue, and that in dengue, there is usually no symptoms of runny nose.

While a nasal swab is helpful with the diagnosis, it has a high false negative rate, hence patients may be wrongly diagnosed. Therefore, clinical judgement is more important.

As we are all aware, the disease does not only cause fatality among the immuno-suppresed, but also healthy individuals, and if we follow closely, we will see that some of those who died had received outpatient treatment for flu prior to their death.

The current recommendation for treatment with anti-virals (http://h1n1.moh.gov.my/caseManagement.php) is too rigid and may be too late because the anti-viral is most effective if given within 48 hours of the onset of symptoms. Often, those who came early for treatment with flu-like illnesses were sent home with antibiotics which gave a false sense of security not only to the patient but also to the doctor.

According to the Health Ministry’s recommendations, if patients have no risk factor, they have to become moderately ill before they can be admitted and receive treatment with anti-virals. By that time it may be too late or the anti-viral may not be as effective or they may already be dead!

A few fatal cases were in fact relatively well at presentation but deteriorated very fast. Within hours the patient succumbed to the illness.

Patients who have high grade fever and are unwell for more than one day associated with flu-like illness should be given the option of receiving treatment with anti-virals.

The British Medical Journal research is correct to say that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them.

“But for those who experience severe symptoms, the best scientific advice tells us that anti-virals should still be taken as soon as possible — and to suggest otherwise is potentially dangerous”.

No doubt, there are concerns about side effects and resistance to anti-virals, but at this point in time, it is not justified whatsoever to let them run the risk of fatal complications since more than 10% of mortality were from among previously healthy individuals. I repeat, the mistake is withholding anti-viral treatment for patients who deserve it. We have to be less stringent in our criteria to treat.

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Getting a grip on what the A (H1N1) pandemic is all about is key to devising a proper approach to handle the disease.

Sometimes we get frightened to death and paralysed by stories of a pandemic from diseases overseas and ignore the real danger literally lurking and killing in our very own backyards.

The Influenza A (H1N1), known in some parts of the world as swine flu, has been classified as Phase 6, the highest, in the World Health Organisation classification of pandemics, sparking off a panic of sorts, especially among Asian countries which have had to deal with SARS and avian flu among others.

While one should not underestimate the need to be careful and proactive with the outbreak, there is a need to be very circumspect about what Influenza A (H1N1) – the WHO-given name for this strain of the flu – is.

First, what is a pandemic? According to the WHO, a disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic of a disease.

An influenza pandemic may occur when a new influenza virus appears, against which the human population has no immunity.

And what does Phase 6 mean?  Phase 6, the pandemic phase, is characterised by community-level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5, the WHO says. Designation of this phase will indicate that a global pandemic is under way.

Phase 5 is characterised by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent.

The WHO cautions that with the increase in global transport, as well as urbanisation and overcrowded conditions in some areas, epidemics due to a new influenza virus are likely to take hold around the world and become pandemics faster than before.

What this basically establishes is that the latest flu strain is very contagious and is spreading very rapidly throughout the world. That is only to be expected from any new strain of flu and the WHO is only doing its duty when it points this out. But the alert level does not relate to danger.

As the US Centers for Disease Control and Prevention says: “A Phase 6 pandemic declaration is based on the sustained worldwide spread of Influenza A (H1N1), not the severity of illness caused by the virus.”

The rapidity with which the virus is spreading is very evident in Malaysia, too. On May 15, Malaysia reported its first case, a student back home from the US. A month later, it reported the first case of a Malaysian catching the flu from another infected Malaysian.

Two days ago, it reported 38 new cases, the biggest one-day jump in cases, bringing the total to 196. But there has been no death yet. From here on, one has to expect that the cases will jump and we will find records being broken daily. (There were 48 cases yesterday.)

But what one must remember is that this strain of the flu is not as deadly as some of the infections that we have had before, such as SARS or avian flu. Worldwide, some 77,201 cases have been reported with 332 deaths, a fatality rate of 0.43% or less than one in 200 people infected.

That’s less dangerous than most other strains of flu. Some say the common cold may be killing more people than A (H1N1)! The people who are most likely to succumb to the disease are those with pre-existing conditions where their systems have already been weakened.

The question we must ask ourselves is whether we are overreacting given that it is not a severe illness. That in no way implies that we drop our state of alertness and preparedness, but that our response should be commensurate with the severity of the disease.

Take dengue for instance. Up to June 13 this year, there had been 23,056 cases with 57 deaths. Certainly more can be done to curb this backyard killer, which is carried by mosquitoes.

Cool heads must prevail to find appropriate solutions to the Influenza A (H1N1) problem. We need to look at what can be reasonably done.

Some countries, such as Australia and New Zealand, are already taking a different approach and dealing with the disease directly instead of trying to test for all suspected cases, which takes up a lot of resources.

There is no one-size solution that will fit all countries, but it is perhaps high time we try out some other outfits and let our lives return to normalcy. Undue fear about Influenza  A (H1N1) can be rather disruptive for business – and leisure.

H1N1 Flu Guidance

Guidance for Schools, Colleges and Universities

Guidance for Pregnant and Breastfeeding Women

Guidance for Public Gatherings

Clinician Guidance for Patients

Clinician Guidance for Specific Audiences

Screening & Specimen Collection

Treatment Guidance

Laboratories

Travel & Travel Industry Guidance

Emergency Personnel Guidance

Protection of Migrant Farm Workers

Source: CDC  of USA   http://www.cdc.gov/h1n1flu/guidance/

Questions are grouped by subject.

:: About the disease

:: Levels of pandemic alert

:: Vaccines for the new influenza A(H1N1)

:: Travel

:: The safety of pork

:: What can I do?

:: Are some people more at risk?

ARE SOME PEOPLE MORE AT RISK?

Are some people more at risk?

More study is needed to determine if some populations (i.e. younger or older people, or people with other medical conditions) could be affected by the outbreak, of if they are at higher risk for severe illness. WHO recommends that everyone take precautions to prevent the spread of infection.

Are there any special recommendations for pregnant women?

Yes, they are vulnerable. Like everyone, they should take all the necessary precautions.

WHAT CAN I DO?

What are the recommendations for face masks?

If you are not sick you do not have to wear a mask. If you are caring for a sick person you should wear a mask. All home made masks should be cleansed regularly.

If you are sick, stay at home and avoid contact with people.

How can I protect myself and prevent illness?

Practise general preventive measures for influenza to prevent infection:

  • avoid close contact with people who appear unwell and have fever and cough;
  • wash your hands with soap and water thoroughly and often;
  • practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.

How do I care for an ill person at home?

  • Separate the ill person from others, keeping the person at least 1 metre in distance from others.
  • Cover your mouth and nose when caring for the ill person. Either commercial or homemade materials are fine, as long as they are disposed of or cleaned properly after use.
  • Wash your hands with soap and water thoroughly after each contact with the ill person.
  • Improve the air flow 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 there are infections follow additional advice from your national and local health authorities.

What should I do if I think I have the illness?

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 mouth and nose with disposable tissues when coughing and sneezing, and dispose of the used tissues properly.
  • Wash your hands with soap and water often and thoroughly, especially after coughing or sneezing.
  • Inform family and friends about your illness and try to avoid contact with other people.

What should I do if I need medical attention?

  • Contact your doctor or healthcare provider before travelling to a health facility, and report your symptoms. Explain why you think you have influenza A(H1N1) (if you have recently travelled to a country where there is an outbreak in humans). Follow the advice given to you.
  • If it is not possible to contact your healthcare provider in advance, communicate your suspicion of infection as soon as you arrive at the facility.
  • Cover your nose and mouth during travel.

THE SAFETY OF PORK

Is it safe to eat pork and pork products?

Yes. influenza A(H1N1) has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat.

Related link

Influenza A(H1N1) and the safety of pork

Travel

Is it safe to travel?

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Today, international travel moves rapidly, with large numbers of individuals visiting various parts the world. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.

Influenza A(H1N1) has already been confirmed in many parts of the world. The focus now is on minimizing the impact of the virus through the rapid identification of cases and providing patients with appropriate medical care, rather than on stopping its spread internationally. Furthermore, although identifying the signs and symptoms of influenza in travellers can be an effective monitoring technique, it is not effective in reducing the spread of influenza as the virus can be transmitted from person to person before the onset of symptoms. Scientific research based on mathematical modelling indicates that restricting travel will be of limited or no benefit in stopping the spread of disease.

Historical records of previous influenza pandemics, as well as experience with SARS, have validated this point.

Travellers can protect themselves and others by following simple recommendations related to travel aimed at preventing the spread of infection. Individuals who are ill should delay travel plans and returning travellers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases and not only Influenza A(H1N1).