Swine flu: Dry spell saves Hyderabad from novel pandemic influenza H1N1

By Syed Akbar
Hyderabad, Aug 11: The continued dry spell and above normal temperatures so far this rainy season have saved Hyderabad from the wrath of swine flu, while low temperatures played havoc in Pune.

Hyderabad initially led the swine flu cases in the country but the prolonged dry spell helped in the containment of the novel H1N1 virus that causes human influenza. Above normal temperatures coupled with proper planning by health authorities arrested the spread of the virus in the community. Unlike in Pune, the human influenza virus has not penetrated into the local community. Hyderabad has thus far recorded 74 positive cases and only a couple of them are locally contacted cases.

While day temperatures hovered between 33 and 37 degrees C in Hyderabad, the mercury did not cross 28 degrees C in the last 10 days in Pune. Added to the low temperature was the cloudy sky. In Pune the virus has penetrated into the community as all the fresh cases reported from there have been local residents.

"The climate has been cold in Pune and for several days we have not seen the sun in full brightness. The day temperature was also below normal," said G Dayanidhi, who frequents between Pune and Hyderabad on business.

Pune now leads the swine flu cases with about 270 positive cases and five of the 10 deaths reported in the country. In cold climate, the aerosols stay longer carrying the virus and thus the chances of infection are high during winter and rainy seasons.

"While environmental factors like low temperatures help in the fast spread of influenza virus, the host and viral factors determine the survival or otherwise of the patient. In case of Hyderabad, above normal temperatures helped in the containment of the virus. Since Pune has the maximum number of cases, it also
leads in terms of fatalities. The immunity of a patient (host) and the potent of the virus decide the fate," said senior physician Dr Aftab Ahmed of Apollo Hospitals.

Location of international airport in Hyderabad has also helped in the arrest of the virus from spreading to the locals. Those with swine flu symptoms were quarantined at the airport level itself and those who came into close contact with them had been kept under medical surveillance. But in the case of Pune, the international passengers, with the virus, landed in Mumbai airport and later spread the disease in the community.

Hyderabad district medical and health officer Dr Ch Jayakumari said they had prevented the virus from going to the secondary level in Hyderabad. "Had it gone into the community, it would have been catastrophic. Moreover, those in Hyderabad are nutritionally in an advantageous stage as compared to those living in western India," she said.

Human influenza: What can I do?

By Syed Akbar

The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing.

You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:

• avoid touching your mouth and nose;

• clean hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated);

• avoid close contact with people who might be ill;

• reduce the time spent in crowded settings if possible;

• improve airflow in your living space by opening windows;

• practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.

What about using a mask? What does WHO recommend?

If you are not sick you do not have to wear a mask.
If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards.

If you are sick and must travel or be around others, cover your mouth and nose.
Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.

How do I know if I have influenza A(H1N1)?

You will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A(H1N1).

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 nose and mouth when coughing and sneezing and, if using tissues, make sure you dispose of them carefully. Clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub;

• if you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;

• use a mask to help you contain the spread of droplets when you are around others, but be sure to do so correctly;

• inform family and friends about your illness and try to avoid contact with other people;

• If possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.

Should I take an antiviral now just in case I catch the new virus?

No. You should only take an antiviral, such as oseltamivir or zanamivir, if your health care provider advises you to do so. Individuals should not buy medicines to prevent or fight this new influenza without a prescription, and they should exercise caution in buying antivirals over the Internet.

What about breastfeeding? Should I stop if I am ill?

No, not unless your health care provider advises it. Studies on other influenza infections show that breastfeeding is most likely protective for babies - it passes on helpful maternal immunities and lowers the risk of respiratory disease. Breastfeeding provides the best overall nutrition for babies and increases their defense factors to fight illness.

When should someone seek medical care?

A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).

Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.)

Should I go to work if I have the flu but am feeling OK?

No. Whether you have influenza A(H1N1) or a seasonal influenza, you should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your work colleagues and others.

Can I travel?

If you are feeling unwell or have symptoms of influenza, you should not travel. If you have any doubts about your health, you should check with your health care provider.

Swine flu: Clean hands protect against human influenza H1N1 infection

By Syed Akbar
Here are some of the suggestions by the World Health Organisation on prevention of the pandemic flu virus.

To protect yourself:

* Clean your hands regularly.
* Wash your hands with soap and water, and dry them thoroughly.
* Use alcohol-based handrub if you don’t have immediate access to soap and water.

You may ask, "how do I wash my hands properly?"

Washing your hands properly takes about as long as singing "Happy Birthday" twice,
using the images below.

Swine flu: Some guidelines on novel H1N1 human influenza

By Syed Akbar
The world health organisation has come out with a set of guidelines on prevention of the pandemic flu virus currently creating havoc in parts of the world, including India.

At present, evidence suggests that the main route of human-to-human transmission of the new Influenza A (H1N1) virus is via respiratory droplets, which are expelled by speaking, sneezing or coughing.

Any person who is in close contact (approximately 1 metre) with someone who has influenza-like symptoms (fever, sneezing, coughing, running nose, chills, muscle ache etc) is at risk of being exposed to potentially infective respiratory droplets.
In health-care settings, studies evaluating measures to reduce the spread of respiratory viruses suggest that the use of masks could reduce the transmission of influenza.

Advice on the use of masks in health-care settings is accompanied by information on additional measures that may have impact on its effectiveness, such as training on correct use, regular supplies and proper disposal facilities. In the community, however, the benefits of wearing masks has not been established, especially in open areas, as opposed to enclosed spaces while in close contact with a person with influenza-like symptoms.

Nonetheless, many individuals may wish to wear masks in the home or community setting, particularly if they are in close contact with a person with influenza-like symptoms, for example while providing care to family members. Furthermore, using a mask can enable an individual with influenza-like symptoms to cover their mouth and nose to help contain respiratory droplets, a measure that is part of cough etiquette.

Using a mask incorrectly however, may actually increase the risk of transmission, rather than reduce it. If masks are to be used, this measure should be combined with other general measures to help prevent the human-to-human transmission of influenza, training on the correct use of masks and consideration of cultural and personal values.

It is important to remember that in the community setting the following general measures may be more important than wearing a mask in preventing the spread of influenza.

For individuals who are well:

Maintain distance of at least 1 metre from any individual with influenza-like symptoms, and:
• refrain from touching mouth and nose;
• perform hand hygiene frequently, by washing with soap and water or using an alcoholbased 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.
For individuals with influenza-like symptoms:
• 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.
If masks are worn, proper use and disposal is essential to ensure they are potentially effective and to avoid any increase in risk of transmission associated with the incorrect use of masks. The following information on correct use of masks derives from the practices in health-care settings:
• 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/humid
• do not re-use single-use masks
− discard single-use masks after each use and dispose of them immediately upon
removing.

H1N1 novel strain: Pandemic influenza in pregnant women

By Syed Akbar
Hyderabad, Aug 12: Researchers and health experts have warned of an increased risk of severe or fatal illness in pregnant women when infected with the novel strain of H1N1 human influenza virus.

According to a report by the World Health Organisation, several countries including the USA that have been experiencing widespread transmission of the pandemic virus have reported an increased risk in pregnant women, particularly during the second and third trimesters of pregnancy.

An increased risk of fetal death or spontaneous abortions in infected women has also been reported.


Evidence from previous pandemics further supports the conclusion that pregnant women are at heightened risk.

While pregnant women are also at increased risk during epidemics of seasonal influenza, the risk takes on added importance in the current pandemic, which continues to affect a younger age group than that seen during seasonal epidemics.

WHO strongly recommends that, in areas where infection with the H1N1 virus is widespread, pregnant women, and the clinicians treating them, be alert to symptoms of influenza-like illness.

The following are the recommendations of the WHO for treatment:

Treatment with the antiviral drug oseltamivir should be administered as soon as possible after symptom onset. As the benefits of oseltamivir are greatest when administered within 48 hours after symptom onset, clinicians should initiate treatment immediately and not wait for the results of laboratory tests.

While treatment within 48 hours of symptom onset brings the greatest benefits, later initiation of treatment may also be beneficial. Clinical benefits associated with oseltamivir treatment include a reduced risk of pneumonia (one of the most frequently reported causes of death in infected people) and a reduced need for hospitalization.

WHO has further recommended that, when pandemic vaccines become available, health authorities should consider making pregnant women a priority group for immunization.
Danger signs in all patients

Worldwide, the majority of patients infected with the pandemic virus continue to experience mild symptoms and recover fully within a week, even in the absence of any medical treatment. Monitoring of viruses from multiple outbreaks has detected no evidence of change in the ability of the virus to spread or to cause severe illness.

In addition to the enhanced risk documented in pregnant women, groups at increased risk of severe or fatal illness include people with underlying medical conditions, most notably chronic lung disease (including asthma), cardiovascular disease, diabetes, and immunosuppression. Some preliminary studies suggest that obesity, and especially extreme obesity, may be a risk factor for more severe disease.

Within this largely reassuring picture, a small number of otherwise healthy people, usually under the age of 50 years, experience very rapid progression to severe and often fatal illness, characterized by severe pneumonia that destroys the lung tissue, and the failure of multiple organs. No factors that can predict this pattern of severe disease have yet been identified, though studies are under way.

Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:

* shortness of breath, either during physical activity or while resting
* difficulty in breathing
* turning blue
* bloody or coloured sputum
* chest pain
* altered mental status
* high fever that persists beyond 3 days
* low blood pressure.

In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.