Preventive measures ease problem; Proper steps to tackle swine flu

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"I have discussed measures in dealing with swine flu in my previous posts. Here's to update you. Read on carefully.."

THE 2009 H1N1 influenza is caused by a new strain of influenza virus. This virus was originally called “swine flu” because laboratory testing showed that many genes in the virus were similar to the virus found in the North American pigs. But further testing showed it is a new virus which also has two genes from the virus found in European and Asian pigs, avian (bird) and human genes. It is therefore a ‘quadruple reassortant’ virus.

It is recognized as a pandemic, meaning it has spread to many countries in many different parts of the world. The incidence in Kuwait seems to be on the rise as higher numbers of confirmed cases are being reported. Like other flu viruses, H1N1 spreads from person to person through droplet infection which occurs on coughing, sneezing, and touching nose or mouth after touching contaminated objects. The virus can survive up to 2 to 8 hours on a contaminated object.

Symptoms of H1N1 usually include two or more of fever (38 C or more), sore throat, cough, sneezing, headache, body pain, chills, tiredness and sometimes diarrhea and vomiting. Some have respiratory symptoms without fever. It is to be noted that one does not get the infection by eating properly handled pork or pork products.

Since the 2009 H1N1 is a new flu virus and very different from seasonal flu viruses, all children and most adults do not have immunity to it and can get infected. Most people feel better within a week. But some get pneumonia or other serious complications.

Those who have a weak immune system or are on medicines like steroids that suppress immunity, pregnant women, children below the age of 4 years, people with diseases like diabetes, heart disease, kidney disease, cancer, blood diseases, asthma and COPD (mainly in chronic smokers), neurological and neuromuscular diseases have a higher risk of catching the infection and complications. People above 65 years are less likely to be infected by H1N1 but become more sick if they catch the infection. Children and teenagers who are on continuous aspirin therapy have higher chance of complications. Those who are very sick or have high risk of complications may have to be hospitalized and some of the seriously affected may die.

What is to be done if you catch ‘flu’.

H1N1 and seasonal flu have the same symptoms initially and it is difficult to differentiate between the two without special tests. Remain calm as the vast majority of those infected recover without any complication. It is important to follow certain steps for quick recovery and to prevent infection of others.

1. Stay home if possible till you have recovered from fever. If this is not possible wear a mask when in contact with other people. The droplet infection can reach people who are up to 6 feet away from you. Practice good hygiene; cover nose and mouth with tissue while coughing or sneezing and dispose the tissue in the waste bin, wash hands with soap for 20 to 30 seconds before shaking hands with others, avoid kissing as greeting, do not share cups and utensils without washing etc.

2. Antibiotics have no effect on the virus. Many people including some health care workers feel antibiotics are required for all sore throats. Unless there is a secondary bacterial infection avoid use of antibiotics. It is not advisable to use antibiotics in the hope of preventing a bacterial infection. One can use an antiseptic or salt water gargle, paracetamol, antihistamines or simple cough syrups as required for relief. Antibiotics are required if there is a bacterial infection. Let your doctor, supported by appropriate tests, decide on that.

3. People with good immunity recover faster and have less complications. Some of the ways to boost your immunity are
a) Eat wholesome healthy food with plenty of fruits and vegetables and avoid junk foods.
b) Drink plenty of warm fluids. Soups and green tea are good.
c) Take adequate rest and sleep.
c) Use of food supplements and herbs like Vitamin C, Vitamin E, Selenium, Zinc, Omega 3 fatty acids, Turmeric, Garlic, Ginger, Echinacea , Aloe Vera and bioflavonoids may help. Please check with your doctor if you are on medications.

4. Anti-viral medicines: The antiviral medicine commonly available in Kuwait is Oseltamir ( Tamiflu and generics). Most healthy people except the ones at high risk for complications recover and do not require antiviral medicine. Anti-virals are advisable in the very sick and who are at a higher risk of complication. To be most effective the medicine has to be started within 2 days of getting the infection and should be continued for 5 days. Some people recommend taking the medicine for those who had a close contact with infected people to prevent the infection. This, in our personal opinion, is not advisable as these medicines are effective only as long as they are taken and has to be taken for 10 days to prevent an infection. In the usual circumstances in Kuwait a person might have multiple exposures and a course of medication is required each time and these medicines are not without side effects. A better option would be that people who are at high risk of complication should keep a course of Oseltamir with them and should take the medicine for 5 days starting on the first day of symptoms. Please follow your physician’s advice on this.

Medicines for relief of fever and related symptoms: Paracetamol is the best choice. Aspirin should be avoided in children and adolescents as there is a risk of Reye’s syndrome.
Emergency warning signs to seek urgent medical care

In children:
Fast breathing or troubled breathing
Bluish skin color
Not drinking enough fluids
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 a worse cough
Fever with a rash

In adults:
Breathing difficulty or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting

How can we protect ourselves from getting the infection?
* Try to avoid close contact with sick people. Wear a protective mask when one has to get closer than 6 feet to a possibly infected person.
* Cover nose and mouth with a tissue or kerchief while coughing or sneezing. Throw the tissue in the trash after using it. Do not cough or sneeze into the hands.
* After touching contaminated objects, coughing or sneezing wash hands under warm running water, scrub with soap for 20 to 30 seconds, rinse thoroughly. Dry hands with a paper towel and use the paper towel to turn off the tap. Alcohol-based hand cleaners can be used when washing is not possible.
* Avoid touching eyes, nose or mouth after shaking hands or touching objects which may be contaminated. Avoid kissing an infected person. Germs spread this way.
* All those who have symptoms of flu should stay away from school or work.
* Practice healthy nutrition and healthy habits.

Influenza virus is destroyed by heat at 75-100ºC. Several chemical germicides like chlorine, hydrogen peroxide, detergents (soap), iodine-based antiseptics and alcohols are also effective.
Linens, eating utensils, and dishes belonging to those who are sick need not be cleaned separately, but it is important that these items should not be shared without washing thoroughly first.

Tap water that has been treated by conventional disinfection processes is not likely to transmit the viruses. H1N1 virus is unlikely to spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues as the recommended free chlorine levels 1-3 parts per million for pools and 2-5 ppm for spas are believed to be adequate to kill the virus.

Vaccination: Vaccination is considered to be the best way to protect against the virus.

There are two types of vaccines.
* Inactivated vaccine containing killed virus which is given as injection
* Live attenuated (live, weakened) virus vaccine as nasal spray.

About 2 weeks after vaccination the protective antibodies will develop in the body.
Depending on the availability of the vaccine, priority may be given to
* pregnant women,
* those who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
* health-care and emergency medical services personnel,
* those aged 6 months-24 years with higher priority for children aged 6 months—4 years, children and adolescents aged 5-18 years with medical conditions which increase the risk for flu complications.
* those aged 25-64 years who have such medical conditions.

This is to be followed by vaccination of all in the 25-64 age group when available.
People who should not be vaccinated without the doctor’s recommendation.
* People who have a severe allergy to chicken eggs.
* People who have had a severe reaction to an influenza vaccination.
* People who developed Guillian- Barre Syndrome within 6 weeks of getting an influenza vaccine previously.

Influenza vaccine is not approved in children less than 6 months. People with moderate-to-severe fever should wait until they recover to get vaccinated.
Vaccine Side Effects to be expected

The flu injection: The viruses are killed (inactivated), so one cannot get the flu from it.
Some minor side effects that may occur are:
Soreness, redness, or swelling at the injection site, mild fever and body pain.
The symptoms are usually mild and last 1 to 2 days. Very rarely flu vaccination can cause serious problems, such as severe allergic reactions.

The nasal spray: This contains weakened viruses which may cause mild symptoms like running nose ,sore throat, cough or wheezing, headache, muscle aches, vomiting and fever.
One should follow the guidelines from the Kuwait Governmental authorities regarding vaccination.

In conclusion, H1N1 influenza is likely to be with us for several months and with adequate preventive measures and proper care, it is not as much a problem as many fear.

Please note: The above article has been compiled from a number of sources for the benefit of the community.

By Dr Daisy Noble and Dr Noble Zachariah

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