We are a group of students of HICT and this blog is specially created to fulfill our assignment, subject SCI 211, Survey of Biological Science. Our group consist of 3 people which are
Steffanie Grace Kuake, B0803784
Lee Peay Ling , B0801007
Yeoh Guan Sun , B0802536
What Is Happening?
H1N1, known as swine flu has alarm the whole world in the year 2009. H1N1 which was first discovered in Mexico has spread to borders and oceans and then infecting to many countries and continents. H1N1 is a combination virus of swine, bird flu (avian) and human influenza. The flu is transmitted from pigs to humans. The virus is contagious as it can spread from human to human. How then the flu is spread? It is spread via droplet infection through sneezing, coughing and in halations of infected nearby person. The virus can survive up to two days. The virus can also spread through body contact. Crowded place can increased the possiblity of being infected especially if one touches uncleaned hands to rub the eyes, mouth and nose. It is very important to take care of cleanliness to lessen the risk of passing or accquiring the infection.
Causes of H1N1
H1N1 virus is identified to be related with pigs. There are reports that show the virus spread from water pollution that is caused by a large hog processing company in the State of Veracruz in Perote, Mexico. Travel far to air, a total of twenty seven million hogs are being slaughtered in this facility annually and spread out to countries like Australia, New York and California.
The influenza H1N1 virus is causing the infection. The H and N letter refers to the proteins of the virus which differentiates a specific virus from the other subtypes. While influenza virus is not a new, the previous virus has mutated and has changed its genes. The new virus is able to pass to other person.
The virus is passed on from one person to another through coughing and sneezing. The germ which is released into the air can be transmitted to another person through the air they breathe and enter the body through the mouth, nose and eyes.
The influenza H1N1 virus is causing the infection. The H and N letter refers to the proteins of the virus which differentiates a specific virus from the other subtypes. While influenza virus is not a new, the previous virus has mutated and has changed its genes. The new virus is able to pass to other person.
The virus is passed on from one person to another through coughing and sneezing. The germ which is released into the air can be transmitted to another person through the air they breathe and enter the body through the mouth, nose and eyes.
- What are the symptom for H1N1 ? -
Although the name 'swine flu' brings up a lot of extra fear and worry, it is important to note that swine flu is just an influenza A H1N1 virus.
That means that it is just another type of flu virus, just like that causes our typical seasonal flu symptoms. The big difference is that the current swine influenza A (H1N1) virus is new and most of us don't have any immunity to it. That is why it so easily became a pandemic virus (with the ability to cause a global outbreak), because it could easily spread from person to another person.
Swine Flu Symptoms
Symptoms of swine flu infections can include:
• fever, which is usually high, but unlike seasonal flu, is sometimes absent
• cough
• runny nose or stuffy nose
• sore throat
• body aches
• headache
• chills
• fatigue or tiredness, which can be extreme
• diarrhea and vomiting, sometimes, but more commonly seen than with seasonal flu
Signs of a more serious swine flu infection might include pneumonia and respiratory failure.
If your child has symptoms of swine flu, you should avoid other people and call your pediatrician who might do a rapid flu test to see if he has an influenza A infection. Further testing can then be done to see if it is a swine flu infection. (Samples can be sent to local and state health departments and the CDC for confirmation of swine flu, especially if a child is in the hospital.)
Swine Flu High Risk Groups
With regular seasonal flu, young children and the elderly are usually thought to be most at risk for serious infections, in addition to people with chronic medical problems. Swine flu high risk groups, people who are thought to be at risk for serious, life-threatening infections, are a little different and can include:
• pregnant women
• children under age two years old
• people with chronic medical problems, such as chronic lung disease, like asthma, cardiovascular disease, diabetes, and immunosuppression
• children and adults with obesity
It is important to keep in mind that unlike seasonal flu, more than half of the hospitalizations and a quarter of the deaths from swine flu are in young people under the age of 25.
Serious Swine Flu Symptoms
More serious symptoms that would indicate that a child with swine flu would need urgent medical attention include:
• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• 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
Swine Flu Symptoms vs. a Cold or Sinus Infection
It is important to keep in mind most children with a runny nose or cough will not have swine flu and will not have to see their pediatrician for swine flu testing.
This time of year, many other childhood conditions are common, including:
• Fall allergies- runny nose, congestion, and cough
• Common cold- runny nose, cough, and low grade fever
• Sinus inflection- lingering runny nose, cough, and fever
• Strep throat- sore throat, fever, and a positive strep test
What You Need To Know
• Swine flu likely spreads by direct contact with respiratory secretions of someone that is sick with swine flu, like if they were coughing and sneezing close to you.
• People with swine flu are likely contagious for one day before and up to seven days after they began to get sick with swine flu symptoms.
• Droplets from a cough or sneeze can also contaminate surfaces, such as a doorknob, drinking glass, or kitchen counter, although these germs likely don't survive for more than a few hours.
• Anti-flu medications, including Tamiful (oseltamivir) and Relenza (zanamivir), are available to prevent and treat swine flu in high risk children.
• The latest swine flu news from the CDC includes advice that daycare centers should do daily health checks, separate ill children until they can go home, encourage kids to stay home until they are free of fever for at least 24 hours, encourage proper hand-washing, and teach kids to properly cover their coughs and sneezes to help everyone avoid the flu.
That means that it is just another type of flu virus, just like that causes our typical seasonal flu symptoms. The big difference is that the current swine influenza A (H1N1) virus is new and most of us don't have any immunity to it. That is why it so easily became a pandemic virus (with the ability to cause a global outbreak), because it could easily spread from person to another person.
Swine Flu Symptoms
Symptoms of swine flu infections can include:
• fever, which is usually high, but unlike seasonal flu, is sometimes absent
• cough
• runny nose or stuffy nose
• sore throat
• body aches
• headache
• chills
• fatigue or tiredness, which can be extreme
• diarrhea and vomiting, sometimes, but more commonly seen than with seasonal flu
Signs of a more serious swine flu infection might include pneumonia and respiratory failure.
If your child has symptoms of swine flu, you should avoid other people and call your pediatrician who might do a rapid flu test to see if he has an influenza A infection. Further testing can then be done to see if it is a swine flu infection. (Samples can be sent to local and state health departments and the CDC for confirmation of swine flu, especially if a child is in the hospital.)
Swine Flu High Risk Groups
With regular seasonal flu, young children and the elderly are usually thought to be most at risk for serious infections, in addition to people with chronic medical problems. Swine flu high risk groups, people who are thought to be at risk for serious, life-threatening infections, are a little different and can include:
• pregnant women
• children under age two years old
• people with chronic medical problems, such as chronic lung disease, like asthma, cardiovascular disease, diabetes, and immunosuppression
• children and adults with obesity
It is important to keep in mind that unlike seasonal flu, more than half of the hospitalizations and a quarter of the deaths from swine flu are in young people under the age of 25.
Serious Swine Flu Symptoms
More serious symptoms that would indicate that a child with swine flu would need urgent medical attention include:
• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• 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
Swine Flu Symptoms vs. a Cold or Sinus Infection
It is important to keep in mind most children with a runny nose or cough will not have swine flu and will not have to see their pediatrician for swine flu testing.
This time of year, many other childhood conditions are common, including:
• Fall allergies- runny nose, congestion, and cough
• Common cold- runny nose, cough, and low grade fever
• Sinus inflection- lingering runny nose, cough, and fever
• Strep throat- sore throat, fever, and a positive strep test
What You Need To Know
• Swine flu likely spreads by direct contact with respiratory secretions of someone that is sick with swine flu, like if they were coughing and sneezing close to you.
• People with swine flu are likely contagious for one day before and up to seven days after they began to get sick with swine flu symptoms.
• Droplets from a cough or sneeze can also contaminate surfaces, such as a doorknob, drinking glass, or kitchen counter, although these germs likely don't survive for more than a few hours.
• Anti-flu medications, including Tamiful (oseltamivir) and Relenza (zanamivir), are available to prevent and treat swine flu in high risk children.
• The latest swine flu news from the CDC includes advice that daycare centers should do daily health checks, separate ill children until they can go home, encourage kids to stay home until they are free of fever for at least 24 hours, encourage proper hand-washing, and teach kids to properly cover their coughs and sneezes to help everyone avoid the flu.
- What treatment is available for swine flu (H1N1)? -
The best treatment for influenza infections in humans is prevention by vaccination. Work by several laboratories has recently produced vaccines. The first vaccine released in early October 2009 was a nasal spray vaccine. It is approved for use in healthy individuals ages 2 through 49. This vaccine consists of a live attenuated H1N1 virus and should not be used in anyone who is pregnant or immunocompromised. The injectable vaccine, made from killed H1N1, became available in the second week of October. This vaccine is approved for use in ages 6 months to the elderly, including pregnant females. Both of these vaccines have been approved by the CDC only after they had conducted clinical trials to prove that the vaccines were safe and effective.
However, caregivers should be aware of the vaccine guidelines that come with the vaccines, as occasionally, the guidelines change. Please see the sections below titled "Can novel H1N1 swine flu be prevented with a vaccine?" and the timeline update for the current information on the vaccines.
Two antiviral agents have been reported to help prevent or reduce the effects of swine flu. They are Zanamivir (Relenza) and Oseltamivir (Tamiflu), both of which are also used to prevent or reduce influenza A and B symptoms. These drugs should not be used indiscriminately, because viral resistance to them can and has occurred. Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the 48-hour guideline. Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection. The CDC has suggested in their interim guidelines that pregnant females can be treated with the two antiviral agents.
Oseltamivir (Tamiflu) is an antiviral agent that may prevent or reduce influenza A and B symptoms. Photo courtesy of the CDC
Zanamivir (Relenza) has been reported to help prevent or reduce the effects of swine flu. Photo courtesy of the CDC
However, caregivers should be aware of the vaccine guidelines that come with the vaccines, as occasionally, the guidelines change. Please see the sections below titled "Can novel H1N1 swine flu be prevented with a vaccine?" and the timeline update for the current information on the vaccines.
Two antiviral agents have been reported to help prevent or reduce the effects of swine flu. They are Zanamivir (Relenza) and Oseltamivir (Tamiflu), both of which are also used to prevent or reduce influenza A and B symptoms. These drugs should not be used indiscriminately, because viral resistance to them can and has occurred. Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the 48-hour guideline. Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection. The CDC has suggested in their interim guidelines that pregnant females can be treated with the two antiviral agents.
Oseltamivir (Tamiflu) is an antiviral agent that may prevent or reduce influenza A and B symptoms. Photo courtesy of the CDC
Zanamivir (Relenza) has been reported to help prevent or reduce the effects of swine flu. Photo courtesy of the CDC
Chronological Events of H1N1
In the “Swine Influenza A (H1N1) Infection in Two Children --- Southern California, March-April 2009” article published in the Morbidity and Mortality Weekly Report (MMWR) on April 21, 2009, Center for Disease Control and Prevention (CDC) asked the state public health laboratories to send in all influenza A specimens that could not be subtyped. And three samples of a virus were identified in Imperial County California and San Diego County hospitals and sent to CDC laboratory for further testing and they confirmed that these samples were positive for the virus that would be called “2009 H1N1.”
On April 22, 2009 the Emergency Operations Center (EOC) was activated by CDC, to coordinate the public’s response to this emerging virus. Response activities were organized in team structures according to the National Incident Management System (NIMS). The teams had different concentration area such as antiviral medications, at-risk populations, communications, laboratory issues, surveillance, traveler’s health issues and vaccine. As the outbreak occurred continuously, these structures and team staffing were occasionally evaluated for functionality and utility.
On April 22, 2009 the Emergency Operations Center (EOC) was activated by CDC, to coordinate the public’s response to this emerging virus. Response activities were organized in team structures according to the National Incident Management System (NIMS). The teams had different concentration area such as antiviral medications, at-risk populations, communications, laboratory issues, surveillance, traveler’s health issues and vaccine. As the outbreak occurred continuously, these structures and team staffing were occasionally evaluated for functionality and utility.
Guiding the Public on Protective Measures
CDC held the first formal press briefing on April 23, 2009 to inform the media and guide the health care respond and the public with the rapidly changing situation and they have held almost 60 press briefings during the entire 2009 H1N1 response. On April 24, 2009, CDC uploaded complete gene sequences of the 2009 H1N1 virus in a publicly-accessible influenza database and updated reports on the outbreak also became available online in the MMWR. This helped scientists around the world to use the sequences for health research and comparison against influenza viruses collected other places.
The Director-General of WHO declared the 2009 H1N1 outbreak as a Public Health Emergency of International Concern on Saturday, April 25, 2009, under the rules of the International Health Regulations. They also suggested countries to increase surveillance for unusual occurrence of influenza-like infection and severe pneumonia. Then CDC confirmed two cases of 2009 H1N1 influenza infection in Kansas and another in Ohio shortly after April.
CDC’s Strategic National Stockpile (SNS) began releasing 25% of the supplies in the stockpile that is used to protect from and treat influenza to all states on April 26, 2009. This included 11 million antiviral drugs treatment and personal protective tools, which was over 39 million respiratory protection equipments such as masks and respirators, face shields, gowns and gloves; the amount distributed was based on each state’s population. By April 2009 the Federal Government had bought 50 million treatment of antiviral drugs, in particularly oseltamivir and zanamivir, as part of the nation’s pre-pandemic planning. The Emergency Use Authorizations (EUAs) used the products in a way different from what they were FDA-approved for. This includes:
oseltamivir is used to treat children younger than 1 year old by preventing influenza in children 3 months to 1 year old;
oseltamivir and zanamivir are used to treat patients who are symptomatic for more than two days before starting the treatment or for those who had complication of illness that requires hospitalization.
The WHO Director-General raised the level of influenza pandemic alert from phase 3 to phase 4 on April 27, due to the increasing reports of influenza-like-illness and deaths in Mexico. Hence CDC released a travel health warning stating that United States travelers should postpone all non-essential travel to Mexico. CDC advice the public and particularly those at higher risk of influenza-related infection, to take every day preventive actions like covering mouth and nose while coughing and sneezing and staying home from school or work if they’re ill to reduce spreading of illness.
Then WHO raised the influenza virus alert to phase 5 on April 29, 2009, and recommended all countries to immediately start their virus awareness plans and watch out for unusual occurance of influenza-like illness and severe pneumonia. By then CDC continued to post and update regulation for clinicians, laboratories, schools, partners and the public on topics such as non-pharmaceutical actions that limits the spread of illness, how to assess a patient for possible infection with 2009 H1N1 influenza and how to treat children who is infected with 2009 H1N1 influenza.
CDC also released an MMWR Dispatch on the outbreak of 2009 H1N1 influenza illness in a New York City high school, on April 30, 2009, which was the largest cluster of 2009 H1N1 cases in the United States at that time. The Dispatch stated that the high school students had fever and respiratory symptoms similar to the seasonal flu, additionally around half the students had diarrhea.
As the illness spread, CDC began receiving reports of school closures where school administrators and public health officials followed the prescribed virus prevention plans. And the public even implement community-level social distancing such as increasing distance between people, staying at home when ill unless for medical needs, avoiding large gatherings, by telecommuting. And then CDC’s Travel Health Warning advising people to avoid non-essential travel to Mexico which was in effect since April 27, 2009, was downgraded to a Travel Health Precaution on May 15, 2009.
The Director-General of WHO declared the 2009 H1N1 outbreak as a Public Health Emergency of International Concern on Saturday, April 25, 2009, under the rules of the International Health Regulations. They also suggested countries to increase surveillance for unusual occurrence of influenza-like infection and severe pneumonia. Then CDC confirmed two cases of 2009 H1N1 influenza infection in Kansas and another in Ohio shortly after April.
CDC’s Strategic National Stockpile (SNS) began releasing 25% of the supplies in the stockpile that is used to protect from and treat influenza to all states on April 26, 2009. This included 11 million antiviral drugs treatment and personal protective tools, which was over 39 million respiratory protection equipments such as masks and respirators, face shields, gowns and gloves; the amount distributed was based on each state’s population. By April 2009 the Federal Government had bought 50 million treatment of antiviral drugs, in particularly oseltamivir and zanamivir, as part of the nation’s pre-pandemic planning. The Emergency Use Authorizations (EUAs) used the products in a way different from what they were FDA-approved for. This includes:
oseltamivir is used to treat children younger than 1 year old by preventing influenza in children 3 months to 1 year old;
oseltamivir and zanamivir are used to treat patients who are symptomatic for more than two days before starting the treatment or for those who had complication of illness that requires hospitalization.
The WHO Director-General raised the level of influenza pandemic alert from phase 3 to phase 4 on April 27, due to the increasing reports of influenza-like-illness and deaths in Mexico. Hence CDC released a travel health warning stating that United States travelers should postpone all non-essential travel to Mexico. CDC advice the public and particularly those at higher risk of influenza-related infection, to take every day preventive actions like covering mouth and nose while coughing and sneezing and staying home from school or work if they’re ill to reduce spreading of illness.
Then WHO raised the influenza virus alert to phase 5 on April 29, 2009, and recommended all countries to immediately start their virus awareness plans and watch out for unusual occurance of influenza-like illness and severe pneumonia. By then CDC continued to post and update regulation for clinicians, laboratories, schools, partners and the public on topics such as non-pharmaceutical actions that limits the spread of illness, how to assess a patient for possible infection with 2009 H1N1 influenza and how to treat children who is infected with 2009 H1N1 influenza.
CDC also released an MMWR Dispatch on the outbreak of 2009 H1N1 influenza illness in a New York City high school, on April 30, 2009, which was the largest cluster of 2009 H1N1 cases in the United States at that time. The Dispatch stated that the high school students had fever and respiratory symptoms similar to the seasonal flu, additionally around half the students had diarrhea.
As the illness spread, CDC began receiving reports of school closures where school administrators and public health officials followed the prescribed virus prevention plans. And the public even implement community-level social distancing such as increasing distance between people, staying at home when ill unless for medical needs, avoiding large gatherings, by telecommuting. And then CDC’s Travel Health Warning advising people to avoid non-essential travel to Mexico which was in effect since April 27, 2009, was downgraded to a Travel Health Precaution on May 15, 2009.
Deduction Made Based on Reports
Surveillance reports revealed that the highest number of 2009 H1N1 influenza confirmed and probable cases which is around 57% were occurring among people between 5 and 24 years old and that makes 41% hospitalizations of older children and young adults. Based on previous records of influenza outbreaks and seasonal flu, pregnant women had been identified as a high-risk group early in the outbreak, on May 12, 2009. Based on all the reported deaths, it most often occurred in people from 22 months old to 57 years old. Yet the puzzling fact is that there are only 13% hospitalizations of people at 50 years of age and older, not to mention there were fewer cases and almost no deaths occurring in people older than 65 years unlike the seasonal flu, which was unusual.
The following are the statistical reports of 2009 H1N1 cases in the most affected countries, the partially affected ones and lastly the least affected.
source
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