Monday, June 15, 2009

2009-H1N1 Influenza Pandemic

The World Health Organisation (WHO) has declared Swine Flu--2009-H1N1 Influenza--a global pandemic. Although such a declaration has been made after 41 years (the last flu pandemic H3N1 virus strain killed nearly 1 million people in 1968), it is not related to the scare or severity of the flu. Pandemic means global and it does not have any connotation of severity or mildness. Its implication is that there is an apprehension of its spreading across the world. It has spread to 74 countries, claimed 144 lives, and it has been confirmed that 27,737 people have been infected by the flu.

A pandemic at this level means that the virus is not confined to a particular country, region or continent, and has reached a stage where it is being passed on freely between people everywhere and has reached the stage of community-level transmission. In short, WHO is asking all 194 of its member-states to look out for themselves.

The Symptoms
The symptoms of patients infected with 2009-H1N1 Influenza are constant fever, cough, and an abnormal taste on tongue. They also suffer from vomiting and loose motion, and have a runny nose and a sore throat. The infection develops from the virus in the sputum of the patient. The symptoms are similar to that of seasonal fever during summer months. Sound arrangements should be made for the prevention, treatment, diagnose, and monitoring of patients. These should be completed without any delay because complacency can prove dearly.

Since the symptoms of swine flu are similar to those of an ordinary flu, there is an urgent need to educate the public. Blue lips and skin, dehydration, irritability, excessive sleeping among children and shortness of breath, sudden dizziness and pain in the chest or abdomen in adults could be the warning signals that may require immediate medical attention. The media must vigorously pursue public awareness drives that focus on both curative and preventive measures.

That potentially leaves a large part of the Indian population exposed, possibly as high as 40 per cent. Lest anyone think we should not worry ourselves sick, the first of the three pandemics of the 20th century — the Spanish flu outbreak of 1918-1919 — took a staggering 50 million lives. The Asian flu episode in the 1950s and the Hong Kong flu spread of 1968 did not prove so dangerous. But this can hardly provide any comfort
because there is no known vaccine against the H1N1 so far

The Source Country
The flu, which began in Mexico, has spread to five continents. Fifteen cases in India have been confirmed. Most patients in India have come from abroad. Two persons caught the infection from their family members infected with the virus. It has been claimed that precautionary measures have been taken at airports, seaports, and international highways. Necessary arrangements have been made for quarantine of affected people. These steps are based on personal queries.

Passengers can carry the infection to other people. During the past one-month, 1.6 million passengers have landed at various airports of the country. Out of these, 600,000 people have come from flu-affected countries. In North America and European countries where universities are closed due to vacations, students have returned to their countries. In such a situation, there is the possibility of students suffering from the flu coming to India.

Special steps were called for to check such a possibility. In the initial stages when reports of the flu outbreak started pouring in, the entire international community could have taken precautionary measures but due to delay in the precautionary steps, the opportunity is lost now.

Stages of Swine Flu
Phase 1: No animal influenza virus circulating among animals have been reported to cause infection in humans.

Phase 2: An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is, therefore, considered a specific potential pandemic threat.

Phase 3: An animal or human-animal influenza reassortant virus has caused specific cases or small clusters of disease in people but not resulted in human to human transmission sufficient to sustain community level outbreaks.

Phase 4: Human to human transmission of an animal or human-animal influenza reassortant virus able to sustain community level outbreaks is verified.

Phase 5: Same identified virus has caused sustained community-level outbreaks in two or more countries in one WHO region.

Phase 6: In addition to the criteria defined in phase 5, the same virus has caused sustained community-level outbreaks in at least one more country of another WHO region.

Rate of Community Level Transmission
The human-to-human transmission route could prove devastating. This rate of community level transmission of the virus has made WHO to move the pandemic to Phase 6. It may be pointed out that it took only two days to move from Phase 4 to 5 in April (27-29) 2009.

Compared to the bird flu (H5N1) virus that killed 60 per cent of the infected people in early 2000, this triple reassortant swine flu virus will appear harmless and benign only when the number of deaths is considered.

The economic losses, however, are in the same order of magnitude. The loss of young ones in the age group 20-40 years, as is the case in A (H1N1) virus, is certainly irreparable.

Though it is not known as yet how the new variant of virus mutates and travels across geographies, the available information and signals do point towards extreme vulnerabilities of the young in the age group 20-40 years, the youth.

Indian Government’s Alertness
Approximately 15 cases of A (H1N1) virus positive cases have been reported in India as WHO has raised the alert for swine flu to the pandemic level. The detection of a human-to-human route of infection indeed is serious as it may lead to major economic losses.

The public health pivoted mitigation strategy will not suffice as the root cause of the flu virus A (H1N1) lies in the process and production methods (PPMs) that is the sole operating procedure in the factory farms in all piggeries across the developed world.

With the WHO declaration, Governments of all countries have been alerted. The implication of such a declaration for Governments is that production of anti-pandemic medicines should be stepped up, and preventive steps expedited at the governmental level. Under these measures, treatment of affected people should be undertaken and the disease should be prevented from spreading further. For this purpose, an awareness drive should also be started in which all members of society are encouraged to participate. In India, two control rooms have been set up at Hyderabad and Delhi, where arrangements for the treatment of 100,000 patients have been made. The State Governments should also follow suit on the federal pattern by taking necessary initiatives.

A large number of Punjabis lives in affected countries, and they continue to travel to and fro Punjab. Punjabis coming from these countries should ensure that they should not travel if they are suffering from the flu. They should not conceal if they are having symptoms of the disease. They should earnestly cooperate with the inspecting medical teams. This is in the interest of all.

Every citizen should participate in the anti-flu drive. Whenever people come into contact with infected patients, they should report to the State Health Department at the earliest. The health department should, instead of believing the verbal statement of the suspect patient, undertake a regular medical checkup. It is imperative to ensure coordination between staff members of the health department at the Central, State, and local level. The coordination among various countries at the international level can help prevent the flu at the global level.

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