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

Source:

Kuwait records 6th swine flu death

"Now, another one on 6th."

September 14, 2009
KUWAIT: Minister of Health Dr Hilal Al-Sayer announced the sixth H1N1 (swine flu virus) death in Kuwait. The deceased is a Kuwaiti woman in her fifties who was suffering from kidney failure, heart disease and other chronic diseases. She had been hospitalized for five days.

The Ministry of Health will hold regular press conferences every three weeks with the media to keep it updated, officials said. "We will provide the media with the latest news about the H1N1 virus through regular meetings with the media," said Dr Hilal Al-Sayer during the press conference yesterday.

The conference was attended by the Minister of Education and the undersecretaries and assisting undersecretaries from both ministries. The regulations and instructions made by the World Health Organization (WHO) regarding the closure of schools are not random.

The WHO gave the choice to each country to decide its own regulations of closing its schools according to its local circumstances and in the case that one percent of its population was infected. I assure you that Kuwait will never reach this stage of the disease. It is not true that there are 30 or 40,000 H1N1 infected persons in Kuwait. Kuwait will apply the recommendations of the health, education, and university experts meeting that will be held as well," Al-Sayer further said.

Meanwhile, news spread about the increased price of a vaccine. "I care most about protecting the country from the H1N1 virus and not the price of the vaccine. Also, no vaccine will be imported to the country unless it was approved by the WHO," he pointed out. According to the Minister of Education, Dr Moudhi Al-Humoud, there are three H1N1 infected cases in private schools, of which two were cured already.

The third is now receiving treatment. "About 120 school clinics were divided into the different education areas. There will be 20 clinics in each educational area in cooperation with the Ministry of Health," said Al-Humoud. The Ministry of Education increased it efforts due to the emergency situation of the H1N1 virus.

We must follow procedures to decrease the danger of this disease, including the meetings with the Ministry of Health. Based on the recommendation of the Ministry of Health and the WHO about the danger of this disease on the life of students who are under 5-years-old and who have weak immune systems and the handicapped, the Ministry of Education issued a decision previously to delay the school year for the kindergarten and the schools with special needs in both the private and public sectors, but it has no
t been applied yet.

In addition, awareness instructions were given to the teachers for such situations," Al-Homoud concluded. Regarding the news about the need for two vaccines to cure the H1N1 virus, the spokesman of the Ministry of Health, Faisal Al-Dosary, told the Kuwait Times that it was not true. "Only one vaccine is enough. According to all the research conducted, one vaccine will cover 96 percent of the disease," he stated.

Source:

Kuwait delays kindergarten by two months over swine flu

"For those with preschoolers, foreign kindergarten schools will have its opening by September 13."

August 30, 2009
Kuwait has decided to delay the reopening of kindergartens for two months for fear of the spread of swine flu after the Gulf emirate reported over 1,000 cases, the education minister said on Sunday.

The cabinet decided at an emergency meeting on Saturday night that the measure will also affect schools for students with special needs and nurseries, while other schools will reopen on schedule in the last week of September, Mudhi al-Homud told the official Kuna news agency.

Kuwait has reported 1,336 cases of A (H1N1) influenza, four of whom have died, including a two-and-a-half-year-old girl and a pregnant woman.

The decision came after pressure from lawmakers who called on the government to delay reopening of all schools for two months after the rate of infection in the emirate picked up rapidly in the past few weeks.

About 30 MPs have signed a request to convene an emergency session of parliament next week to discuss government preparations to face the disease. They must secure the support of 33 MPs for the session to take place.

Authorities last week decided to delay reopening of kindergartens at foreign schools by two weeks until September 13.

Kuwait has invited experts from the World Health Organisation (WHO) to assess the situation, health ministry undersecretary Ibrahim al-Abdulhadi said, adding that the ministry has set up a special hotline and beefed up preparations for the start of the school year.

Kuwait has ample stocks of the anti-flu drug Tamiflu and has ordered 45,000 vaccines for October and another one million by the end of the year.

Source:

Delaying schools reopening… not effective solutions; Coordinated efforts needed to stop spread of ‘swine flu’

"For those concerned, information about school opening is here including measures to prevent spread of swine flu among students."

“CLASSES in government schools will start as scheduled on Sept 27... meanwhile, asked about measures taken to combat swine flu, Minister of Education and Higher Education Dr Moudhi Al-Humoud said the joint committee of the Ministries of Health and Education had placed an effective plan to counter the spread of swine flu in schools. She explained workshops have been held for administrative staff and teachers to train them on how to measure a child’s temperature and take preventive measures. She said 120 fully-equipped clinics had been established in schools and the ministry will hold intensive swine flu awareness campaigns for parents.” (Arab Times, Aug 26, 2009).

Using rational methods such as starting awareness campaigns for students’ families, school clinics, and administrative staff are steps in the right direction. Doing otherwise, for example postponing the start of school to an indefinite time does not seem to provide effective solutions to stop the spread of swine flu. Our only option in this regard should take the form of a coordinated effort by families, schools, and relevant government departments.

Full story from source:

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264 swine-flu cases reported during the week

"This is what I am talking about. Everyone must be sort of paranoid in public places. But then again an ounce of prevention is better than a pound of cure. Good thing information dissemination is being given importance for the public's health awareness i.e., awareness campaigns, billboards and advertisements on streets, plus sending out letters as health instructions."

"Again, I will repeat from my previous posts as a reminder. Symptoms of swine flu are similar to the regular seasonal flu - high fever over 37.8, running nose, aching body, headache, sore throat, upset stomach and difficulty in breathing. People with swine flu are likely to be contagious one day before and up to seven days after they begin to show swine flu symptoms, Dr. Musaad Al-Attiyah, Head of the Pharmaceutical Department at the Contagious Diseases Hospital, told Kuwait News Agency (KUNA)."

Published Date: August 28, 2009
KUWAIT: The Health Ministry revealed 264 new cases of swine flu during the week, according to a health official yesterday. The number is lower than when compared to the earlier week, ministry spokesperson Yousif Al-Nisf said, indicating to a total number of 1,336, most of which have been treated. The ministry operates under the guidelines of the World Health Organization (WHO) and the US Center for Disease Control and Prevention (CDC), he said.

Al-Nisf stressed the need for residents to wash hands regularly, cover their mouths and noses when sneezing or coughing, to get lots of rest, to avoid unnecessary contact with others at diwaniyas, mosques or shopping centres, and to visit the doctor when experiencing any flu-like symptoms.

Full story on source:

Kuwait's swine flu numbers rise to 111, teens susceptible

"As you can see, almost all new reported cases of swine flu in Kuwait are from individuals going to and returning from trips abroad. Well, in the heat of the moment let's continue to keep our chin up. Good hygiene measures."

Published Date: July 30, 2009
KUWAIT: Kuwait's health authorities are closely monitoring cases diagnosed with the H1N1 virus, amid warnings from the World Health Organization (WHO) that most of those infected worldwide are teenagers, aged between 12 and 17, and that swine flu could spread among school children. The Ministry of Health is working around the clock, especially after the number of cases reported in the country rose to 111, with the global total currently standing at around 80,000, of whom 359 have died, according to the WHO.

Mohsen Burguba, director of the Ministry of Education's (MoE) Public Relations and Media Department, said that the health and education ministries were working closely to take the necessary precautions to safeguard pupils, and are launching an awareness campaign about the nature of the virus and ways of dealing of it before the beginning of the next academic year sees schools reopening.

Full story from source:

**LET'S FACE IT SQUARELY - THE SWINE FLU SCARE

Whether it is by a quirk of fate or carelessness that individuals get infected by swine flu and with all the news and hearsay dominating around Kuwait, should anyone get scared? Uh-oh, I don't think so.

From my readings, swine flu has been controlled since last month after the recovery of infected 18 US soldiers who already left the country. It's good to learn that strict precautions have been enforced by the Health Ministry. Though there is yet no specific vaccine available for the new strain of influenza virus, flu shots are readily available.

So anyone, how should we deal with the swine flu scare in Kuwait? Here are some tips I believe are crucial to those concerned. In no particular order:

• Tip #1: For Pete's sake, rule out panic. It will make matters worst anyway. Find healthy ways to deal with it.

• Tip #2: Be a germ buster. Make it a point to avoid catching the so-called A-H1N1 virus. How? Proper hand washing should be done frequently especially after coughing or sneezing and when coming home from outdoors (I strictly instill this rule on my hubby especially when handling our kids after coming from work). Avoid contact with people manifesting flu-like signs and symptoms (fever, headache, chills, sore throat, cough, runny or stuffy nose, fatigue and body aches).

• Tip #3: Avoid spreading germs yourself by covering your mouth and nose when sneezing or coughing. Avoid touching your eyes, nose or mouth because these are ways of spreading germs.

• Tip #4: When sick, pleeaaaase stay home and isolate. Well, only for awhile until you get better. For those working, call in sick quick.
  

• Tip #5: Be well-versed. Increase health awareness. Keep track of health advise from your local government.
  

• Tip #6: Comply to proper health care for you and your family. Or get a flu shot if you must.
  

• Tip #7: Stay well hydrated especially during hot dry summer season. Eat fruits and take Vitamin C and other essential vitamins and minerals as advised by your doctor.

The diagram below shows the proper technique in hand washing (a universal precaution) of at least 15 seconds, part and parcel in avoiding spread of A-H1N1 virus as well as other harmful microorganisms. It's plain simple, isn't it?

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