Swine Flu is a disease caused by one of the virus which is H1N1 virus and this virus is a combination of hybrid of bird flu and Swine Flu. So this is called H1N1 virus.  In 2009-10, it had come in winter and at that time it was predicted that it would again come within two or three years in a full form that’s how it has come. Previously it came initially in the winter season and it was in a milder form of Pandemic. But when it comes after two to three years in the winter season it came in a more virulent form what we are seeing in India also. So we are facing a rather higher percentage of problems of the burden of H1N1 as compared to what we saw in 2009-10. 

 

 

This virus has come in Ladakh through people who have been in fluxing in Ladakh via Jammu, Kashmir or Delhi. This virus has been recently introduced in the Ladakh’s atmosphere.  There are reported cases initially and we had many suspected cases and among them are one child and one adult. And we have sent the samples from nose & throat and they were positive for H1N1. There may be many other cases also, but we are not sending samples because as per the criteria of sending the samples, serious patients have to be taken for sampling for H1N1 because the test is very costly. Otherwise, all the other cases have to be taken as an H1N1 Flu unless proved otherwise. The cost of the test in the market will be around ₹ 9,000-10,000 but now the govt . have regulated it to 4.5 thousand for the H1N1 testing. And otherwise, this test is being done by Communicable Disease Centre, Delhi and it can be done at Sher-re –Kashmir institute also.

 

 

A spread of the H1N1 virus is thought to occur, in the same way, that seasonal flu spreads. It gets transmitted from person to person through coughing, sneezing mainly the droplets (fomites) which are coming from the mouth during the respiration. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.

 

 

Just like common flu the symptoms of H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including H1N1 and have respiratory symptoms without a fever. 

 

 

There are three types of flu viruses: A, B, and C. Type A and B cause the annual influenza epidemics that have up to 20% of the population sniffling, aching, coughing, and running high fevers. Type C also causes flu; however, type C flu symptoms are much less severe. 

 

 

The person who is infected with H1N1 can transmit the virus until 10 days. H1N1 virus particles remained infectious for 48 hours on a wooden surface, for 24 hours on stainless steel and plastic surfaces, and for 8 hours on a cloth surface H1N1 can survive on common household fomites for extended periods of time, and that good hand hygiene and regular disinfection of commonly touched surfaces should be practiced during the influenza season to help reduce transmission.. The spread of the disease can be up to 15 days also. Normally a common flu virus gets eliminated from the body within 6 to 7 days by producing an antiviral which is produced by the immune system of the body which is called interferon and this is the antiviral which is produced by the body which eliminates the virus just like in the common flu.  However, the person can remain infected up to 10-15 days.

 

 

The sudden outbreak can be very fatal specially for the people who are at the extreme age (60-70) years of age, infants, children who have very low immunity, pregnant women, people with low immune system and the people who are on cancer therapy, immunotherapy, immune suppression therapy and there are many people in our society who are having rheumatic arthritis, SLE, Many other suppressive, immunological disorders, in these people it can be deleterious. Thus, H1N1 infection is more virulent than the common flu. Common flu can also be more harming for a person who has already respiratory track diseases like chronic obstructive lung diseases, chronic bronchitis or a person who is already sick. The common flu can sometimes cause decomposition of the disease in that person who has morbidity in the earlier state.

 

 

The infected person should be kept 1mtr away from other people while talking, he should wear a mask, should not cough with hand covering his mouth rather he should sneeze in his own armpit. Every now and then one should wash their hand and use hand sanitizers. One should gargle with warm water.

 

 

•    Fast breathing or trouble 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 worse cough

•    Fever with a rash

 

•    Difficulty breathing or shortness of breath

•    Pain or pressure in the chest or abdomen

•    Sudden dizziness

•    Confusion

•    Severe or persistent vomiting

•    Flu-like symptoms that improve but then return with fever and worse cough

 

 

Viruses can only live on surfaces for about two hours. Hand sanitizers are quite effective in killing the germs but it takes a little time and it is better to wash your hand frequently. 

 

 

For the parents, it is necessary that a child who is infected from Flu should be taken care of.

 

The first and the foremost thing is that we should let the child take the rest minimum for 3 to 4 days. And we hope that the child by taking rest will produce the antiviral from the body immune system. 

Children who are having an excessive fever in the evening they should be taken care of giving Antipyretic. Those drugs which reduced the temperature because the temperature should not be allowed to rise more than 102, 103 if it rises more than that the baby is going to get convulsion. So they shouldn’t be kept fasting they should be fed with some fruits at least if they are not taking meals. They should be given fruits that contain more sugar like juices, milk with sugar and they shouldn’t be dumped with an excessive amount of clothes also. They should be exposed to dissipate their temperature or the fever outside by sweating by exposing to a little bit colder atmosphere. 

 

Those children who do not have the flu and to protect them from other infected children:

 

The person taking care of the children in school finds that if someone is having flu should be separated or isolated. And in medical terminology, we call it ‘Quarantine’ means separate the baby till he is no more infectious. Now, in doing so, the chances of getting the infection to the other children will be reduced. Especially H1N1 influenza comes in a pandemic form in the community like boarding, schools, big institution, factories where people come in close contact and they come in the epidemic form. And that’s why we recommended extending the school for one or two weeks till the winter season goes. Because in winter due to the cold atmosphere children will be sitting very close to each other in one room and they won’t be sitting outside and won’t be taking a class in the sun. So the chances of infectivity are more in the cold and the chances of infection of H1N1 influenza in the summer decreases.

 

1.    Make sure that your children are not coming in contact with H1N1 infected people.

2.    They should always carry a hand sanitizer in the pocket.

3.    The child above two years should be vaccinated with triple Flu vaccine which gets immunization for three types, Type A, Type B and H1N1 also.  

So, what we are seeing presently is not only H1N1 but we are seeing Type A and Type B that is a common flu. Those who come in contact with confirmed cases of H1N1 should get Tamiflu tablets for about five days. 

 

 

There are no veridical medicines available at present for any type of virus which may be Hepatitis B virus, Poliovirus but we have some virostatic medicines like Oseltamivir (Tamiflu) which causes the proliferation of the virus to the halt. Thus, Tamiflu is one of the medicines for it and this reduces the proliferation of the virus in the body and the intensity of the diseases decreased because the viral load in the body comes to low levels, as the way, we take ENTACAVIR, a virostatic medicine in Hepatitis B carriers.  It does not eliminate the virus from the body but assists in decreasing the symptoms and virulence of the disease. The elimination of the virus has to be made by the body within the time span of 6-7 days. Any Flu, which may be a common flu or H1N1will have a course of six to seven days

 

 

Any mask cannot prevent transmission of H1N1, but few specific masks are their like N95 which is a barrier for viral transmission, but the mask will get contaminated and it has to be discarded after use preferably with every suspected case but this mask cannot be worn by the person all the time because of suffocation. It is important to note that while masks are useful, they are not a guarantee against infection, so it is important to “try to protect yourself in other ways too.”

 

 

Regular flu or common cold/ influenza or seasonal flu is less virulent and less complicated as compared to swine flu.

 

 

The Flu vaccine is presently recommended for the people who are at high risks like medical staffs and volunteers. The vaccine falls in category C and mass vaccination is not recommended because a long-term study needs to be there to satisfy its safety. It is not to be given to infants, pregnant women. However, over the counter in drugs store vaccine is available with discretion of the individual to receive it as Category C vaccine.

 

We do not have vaccine facilities in the hospital for the staff of swine flu clinic even although we do have personal protection equipments like masks, goggles, headcover, gowns, shoe cover, gloves, personal sanitizers. Also, we have tablet Oseltamivir ( Tamiflu) for those individuals who come in contact with infected person or staff who are treating the person. Tamiflu has to be taken by a patient who has contacted flu from a confirmed case of H1N1 flu. This is done to prevent resistance development to the medicine. 

 

Q. Who is more at risk of severe illness? What about other risks?

 

Most people who get the H1N1 flu will have mild illness, will not need medical care or antiviral drugs, and will recover in less than two weeks.  Some people, however, are more likely to get flu complications that result in being hospitalized. Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications. The flu can also make chronic health problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may have worsening of this condition that is triggered by the flu.  The list below includes the groups of people more likely to get flu-related complications if they get sick from influenza.

 

People at High Risk for Developing Flu-Related Complications

•    Children younger than 5, but especially children younger than 2 years old

•    Adults 65 years of age and older

•    Pregnant women

 

People who have medical conditions including:

•    Asthma

•    Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].  

•    Chronic lung disease   (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)

•    Heart disease (such as congenital heart disease, congestive heart failure, and coronary artery disease)  

•    Blood disorders (such as sickle cell disease)

•    Endocrine disorders (such as diabetes mellitus)

•    Kidney disorders

•    Liver disorders

•    Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)

•    Weakened immune system due to disease or medication (such as people with HIV or AIDS or cancer, or those on chronic steroids) 

•    People younger than 19 years of age who are receiving long-term aspirin therapy

 

 

Three cases have been detected so far, but these are the test done on severely ill patients that are how the criteria of taking a specimen from nose and throat as per the guidelines. So far 15 cases had been taken for a test and three cases were of H1N1, positive indicating that the population of the H1N1 infected cases is expected to be high. 

 

 

•    Wash your hands properly

•    Avoid crowded places

•    Wear mask