swine flu, h1n1

As mentioned on the page about influenza the type A virus is unstable and undergoes mutation every now and then.

During the first half of the year 2009 it underwent a mutation resulting in a pandemic affecting people in all continents.

This variant of the influenza A virus is officially known as H1N1. The disease has caused deaths in many countries.

The illness caused by the H1N1 virus was earlier called as swine flu as the virus shared many features with the virus causing disease in pigs. But subsequently the virus was found to be different from the pig virus in many ways. Hence the word swine flu is not used now.

Mode of transmission: The virus spreads from one person to the other through droplets of respiratory secretions from sneezing or coughing. A person can also be infected if he touches his mouth, nose or eyes after touching some object or surface having the virus on it.

The flu symptoms caused by the H1N1 virus is clinically not distinguishable from the seasonal flu caused by the Influenza virus. The virus mainly affects the respiratory system. Affected people may suffer from fever, cold, cough, body ache, sore throat and fatigue.

Some patients may have diarrhea with or without vomiting. Some people who are infected with the virus never suffer from any symptoms. They can be identified only by screening for the infection.

Many people have only mild illness and recover with only symptomatic treatment for fever, cold and body ache without specific drug for the virus. Only a small percentage of people develop complications. The mortality rate is low and is not different from that of the usual flu.

As the name is new and laboratory test is needed to confirm the disease people in many places are getting scared and rushing to hospitals to get themselves tested without knowing all the facts about the tests for this virus.

While it makes sense to take precautions to limit the spread of the disease, diagnose it at the earliest and ensure timely treatment of affected people, nothing worthwhile can be gained by getting panicky and testing all indiscriminately.

Tests to diagnose any viral infection including swine flu (H1N1 flu) detect either the viral antigen or the antibodies produced in the body against the virus. Both have certain limitations and no test is absolutely foolproof.

Highly specific tests which detect the antigen unique to the virus are very costly and even in developed countries all the labs do not perform such tests. Viral culture which can confirm the disease takes lot of time but a negative test does not rule out H1N1 infection.

The test which is currently accepted as the standard is the Reverse Transcription Polymerase Chain Reaction test (RT-PCR).

Polymerase Chain Reaction is a technique by which several copies (even millions) of a specific sequence of DNA can be produced within a few hours. Hence it can also be called as genetic photocopying.

Hence this test enables us to detect even minute quantities any sequence of DNA including that of any virus. As the H1N1 virus is a RNA virus the DNA sequence which is complementary to that of the viral RNA is first prepared using an enzyme called Reverse Transcriptase.

Then the complimentary DNA sequence is multiplied using the PCR technique. Hence the test is highly sensitive and can detect the infection very early. But it is important to remember that a negative test does not completely rule out the infection.

Doing a test for antibodies very early in the course of the illness can give negative result even if the patient is having the infection. People vary in their immune response and it is not easy to say when a person has the antibodies against a particular virus.

Hence tests based on antibody detection have to be repeated after one week to find out whether the antibody level is increasing.

It is important to remember that the practice of medicine is a combination of science and art. It is not easy to clearly say when a test for H1N1 should be ordered.

Hence we cannot rely solely on lab tests to diagnose the infection. Overburdening the laboratories may also compromise the quality of the tests resulting in wrong results.

Based on available information doctors formulate certain protocols for diagnosing and treating a particular disease. It is essential to have some faith in the doctors if the system has to function smoothly.

Treatment of swine flu: The antiviral drugs found to be effective in the treatment of swine flu are Oseltamivir (Tamiflu) and Zanamivir (Relenza). Oseltamivir has been approved for use in children above one year of age. Zanamivir has been approved for use above seven years.

The safety of these drugs in pregnant women has not been established. Hence they should only be used if the benefits outweigh the possible risk to the fetus.

Preventive treatment with these drugs is not routinely recommended as there is a risk of development of resistance. It is advised only under certain special circumstances.

It is wrong to blame doctors for deaths due to swine flu flu without ascertaining all the facts. Just because a person dies one should not assume that the doctor has not exercised due precaution. Occasionally other coexisting diseases contribute for death. Even with timely diagnosis and prompt treatment deaths do occur.

The spectrum of many viral infections including swine flu can vary from asymptomatic subclinical infection to fatal disease.

This means many people are able to destroy the viruses which enter their bodies. Their immune systems are strong enough to fight the viruses. It is commonly seen that during any epidemic some close contacts of patients do not suffer from the disease.

This observation gives rise to an interesting and important question-why do some people have stronger immune systems compared to others? Modern medicine is not yet able to answer this question. The answer may perhaps be beyond the realm of science.

We should also start thinking whether we can do anything to strengthen our immune systems. Both genetic and environmental factors interact with each other to make a human being what he is.

Mind has immense influence over the body. Psychological factor is known to influence the course of many diseases like cardiac diseases, asthma and peptic ulcer.

Hence people should strive to develop strong and healthy minds. Today people are leading highly unbalanced lives and suffering from lot of psychological stress. Regular meditation helps to develop strong mind, overcome anxiety and may strengthen the immune system.

Negative emotions destroy the peace of mind and adversely affect many organ systems of the body. It need not be surprising if the immune system also is affected by mental disturbances. Fear is perhaps is more dangerous than the H1N1 virus.

While scientists may succeed in developing an effective vaccine against swine flu there is no guarantee that the virus will not mutate again thus rendering the vaccine either partly or totally ineffective.

Hence people should give more importance to maintaining optimal health by cultivating right attitude, eating healthy diet, regular exercises, avoiding those activities which harm health (like cigarette smoking and alcohol abuse) and by keeping the mind free of negative emotions.

Microorganisms like bacteria and viruses are part of nature. Man should learn to live in harmony with nature. He should not treat any part of nature with contempt. Indiscriminate use of anti-microbials will only result in development of resistant strains which can cause more harm.

Precautions which can be taken

Certain precautions can be taken to minimize the risk of getting swine flu. If there are many patients of swine flu in your area avoid crowed places like theaters and public functions as far as possible.

Wash your hands frequently with soap and water or with an alcohol based cleaner.

Do not touch the inner lining (mucous membrane) of mouth, nose or eyes without washing the hands.

While sneezing or coughing always cover your mouth and nostrils with tissue and discard the tissue in the trash.

If you get sick stay at home unless absolutely essential to avoid infecting other people. It is advisable to stay indoors tell you are free from fever for at least one day without taking any medicine to bring down fever.

Do not worry unnecessarily. Most of the people who get infected with the H1N1 virus recover completely. Many do so even without specific treatment. If you have any doubt, consult your doctor.

SBI!

Swine flu - the right approach to management and prevention

Precautions which can be taken