Friday, 25 August 2017 16:39

Swine Flu Outbreak Kills Close to 1100 in India

Written by Dr. Daliah Wachs
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22,186 cases of swine flu have been reported in India, with the death toll reaching 1094.  This is a four-fold rise in deaths from last year.

 

The hardest hit areas appear to be Maharashtra with 437 deaths followed by Gujarat with 297 casualties.

What is the Swine Flu?

 

Swine Flu is the H1N1 Influenza A virus.  It originated in pigs before infecting humans. Current swine flu is not contracted from swine but passed between humans.

How deadly is Swine Flu?

 

The 2009 Swine Flu pandemic killed over 12,000 people in the US, and 200,000 people worldwide.  Many who die, do so from viral or bacterial pneumonia, although dehydration can also play a role.

Is the current outbreak in India the same virus that caused the 2009 pandemic?

 

No.  In 2009 the predominant strain of H1N1 was the California strain. This was replaced last year with the Michigan strain.

Do we have a vaccine against the Swine Flu?

 

Yes.  In the US, the trivalent and quadrivalent flu vaccines have included H1N1 since 2010.  These vaccines would include the following strains (according to the CDC):

 

  • an A/California/7/2009 (H1N1)–like virus,

  • an A/Hong Kong/ 4801/2014 (H3N2)–like virus, and

  • a B/Brisbane/60/2008–like virus (Victoria lineage)

with an additional B virus called B/Phuket/3073/2013-like virus (B/Yamagata lineage) for the quadrivalent vaccine.

 

Currently the World Health Organization (WHO) recommends changing the Northern Hemisphere flu vaccine to:

 

  • For H1N1, an A/Michigan/45/2015-like virus

  • For H3N2, an A/Hong Hong/4801/2014-like virus

  • For B, Brisbane/60/2008-like virus (belonging to the Victoria lineage)

with an additional B virus called B/Phuket/3073/2013-like virus (B/Yamagata lineage) for the quadrivalent vaccine.

What are symptoms of the Swine Flu?

Symptoms can include:

 

  • Fever

  • Cough

  • Chills

  • Sore Throat

  • Headache

  • Body Aches

  • Diarrhea

  • Vomiting

 

Who is at risk for Swine Flu?

 

Any child or adult could be at risk for H1N1 infection. However, the 2009 outbreak appeared to predominantly affect younger adults. One theory proposed for why this occurred was older individuals might have been immune having been exposed to the H1N1 during the 1950’s and when it reemerged in the 1970s.  Moreover 40 million Americans were vaccinated against swine flu in the 1970’s.

 

Those, however, at high risk for a severe Swine Flu infection include those who are pregnant, children under 2, asthmatic or other lung conditions, diabetic, immunocompromised (HIV, transplant recipient), sickle-cell, elderly, those in a nursing home, and patients with heart, liver or kidney disease.

How is Swine Flu treated?

 

Many times the H1N1 flu symptoms will last a week and then subside on their own. Some patients will need antivirals such as Tamiflu or Relenza. Any worsening symptoms (persistent fever, vomiting, diarrhea, chest pain, dizziness, confusion, lethargy), should prompt immediate evaluation by one’s medical provider.

How can we avoid Swine Flu?  Do face masks work?

 

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Prevention of swine flu is best accomplished through vaccination, avoidance of affected individuals and good hand washing. Face masks generally are not recommended, but the CDC provides some guidance with these tables:




            Setting

Persons not at increased risk of severe illness from influenza

(Non-high risk persons)

Persons at increased risk of severe illness from influenza (High-Risk Persons) 3

Community

No 2009 H1N1 in community

Facemask/respirator not recommended

Facemask/respirator not recommended

2009 H1N1 in community: not crowded setting

Facemask/respirator not recommended

Facemask/respirator not recommended

2009 H1N1 in community: crowded setting

Facemask/respirator not recommended

Avoid setting.

If unavoidable, consider facemask or respirator 45

Home

Caregiver to person with influenza-like illness

Facemask/respirator not recommended

Avoid being caregiver. If unavoidable, use facemask or respirator

Other household members in home

Facemask/respirator not recommended

Facemask/respirator not recommended

Occupational (non-health care)

No 2009 H1N1 in community

Facemask/respirator not recommended

Facemask/respirator not recommended

2009 H1N1 in community

Facemask/respirator not recommended but could be considered under certain circumstances

Facemask/respirator not recommended but could be considered under certain circumstances

Occupational (health care)6

Caring 7 for persons with known, probable or suspected 2009 H1N1 or influenza-like illness

Respirator

Consider temporary reassignment. Respirator





  1. The effectiveness of respirators and facemasks in preventing transmission of 2009 H1N1 (or seasonal influenza) in various settings is not known. Use of a facemask or respirator is likely to be of most benefit if used correctly and consistently when exposed to an ill person.  (Ref. a) MacIntyre CR, et al.  EID 2009;15:233-41. b) Cowling BJ, et al. Non-pharmaceutical interventions to prevent household transmission of influenza. The 8th Asia Pacific Congress of Medical Virology, Hong Kong, 26-28 February 2009.)

  2. For the purpose of this document, respirator refers to N95 or any other NIOSH-certified filtering facepiece respirator.

  3. Persons at increased risk of severe illness from influenza (i.e. high-risk persons) include those groups at higher risk for severe illness from seasonal influenza, including:  children younger than 5 years old;  persons aged 65 years or older;  children and adolescents (younger than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;  pregnant women;  adults and children who have pulmonary, including asthma, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders, such as diabetes; adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV); and, residents of nursing homes and other chronic-care facilities.

  4. The optimal use of respirators requires fit testing, training and medical clearance. Proper use is recommended to maximize effectiveness. The use of facemasks may be considered as an alternative to respirators, although they are not as effective as respirators in preventing inhalation of small particles, which is one potential route of influenza transmission.  There is limited evidence available to suggest that use of a respirator without fit-testing may still provide better protection than a facemask against inhalation of small particles. Respirators are not recommended for children or persons who have facial hair (see FDA websiteExternal Web Site Icon).

  5. Use of N95 respirators or facemasks generally is not recommended for workers in non-healthcare occupational settings for general work activities.  For specific work activities that involve contact with people who have influenza-like illness (ILI) (fever plus at least either cough or sore throat and possibly other symptoms like runny nose, body aches, headaches, chills, fatigue, vomiting and diarrhea), such as escorting a person with ILI, interviewing a person with ILI, providing assistance to an individual with ILI, the following are recommended: a) workers should try to maintain a distance of 6 feet or more from the person with ILI; b) workers should keep their interactions with the ill person as brief as possible; c) the ill person should be asked to follow good cough etiquette and hand hygiene and to wear a facemask, if able, and one is available; d) workers at increased risk of severe illness from influenza infection (see footnote 3) should avoid people with ILI (possibly by temporary reassignment); and, e) where workers cannot avoid close contact with persons with ILI, some workers may choose to wear a facemask or N95 respirator on a voluntary basis  (See footnote 1). When respirators are used on a voluntary basis in an occupational work setting, requirements for voluntary use of respirators in work sites can be found on the OSHA websiteExternal Web Site Icon.

  6. See case definitions of confirmed, probable, and suspected 2009 influenza A (H1N1). Also see infection control in the health care setting. When respiratory protection is required in an occupational setting, respirators must be used in the context of a comprehensive respiratory protection program as required under OSHA’s Respiratory Protection standard (29 CFR 1910.134). This includes fit testing, medical evaluation and training of the worker.

  7. “Caring” includes all activities that bring a worker into proximity to a patient with known, probable, or suspected 2009 H1N1 or ILI, including both providing direct medical care and support activities like delivering a meal tray or cleaning a patient’s room.

 

Setting

Recommendation

Home (when sharing common spaces with other household members)

Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze

Health care settings (when outside of patient room)

Facemask, if tolerable

Non-health care setting

Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze

Breastfeeding

Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze



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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.