Swine flu’s re-emergence: Questions and answers

Swine flu is expected to re-emerge potent and pervasive this fall, infecting as much as half the U.S. population, hospitalizing 2 million people and killing up to 90,000, according to federal officials.

Like pandemic strains of the past, H1N1 has a predilection for infecting young people. And because schools and colleges have long served as veritable cauldrons of flu activity, the combination of a new strain and the opportunity for its spread pose new concerns.

Yet neither state nor federal health officials are recommending surgical masks be added to backpacks when kids return to school. Instead, experts are urging a swine flu vaccination when it’s ready, a seasonal flu vaccination now, and developing a family pandemic plan.

Public health experts say preparedness is the best weapon against an infection that has already hit more than 1 million people in the United States, hospitalized 7,983 and killed 522. Yet given influenza’s extraordinary unpredictability, flu scientists can’t say for sure what the upcoming season will be like.

Is it certain H1N1 will recur in the fall?

Yes. Worldwide surveillance shows H1N1 as the predominant strain circling the globe. Low levels of flu activity are being reported nationwide and all of it is H1N1. Usually at this time of year, there is virtually no flu present, so even low-level activity is uncommon. With so much H1N1 in circulation globally, computer modeling suggests the potential for a strong resurgence.

Will H1N1 become more virulent?

No one can say with certainty. Influenza — especially pandemic flu — is highly unpredictable. Based on what physicians have seen to date, the majority of cases have been mild illnesses of only a few days’ duration.

What are the symptoms?

Identical to seasonal flu: high fever, muscle aches, dry cough and general malaise. Anyone with the flu is urged to stay home during the illness. State and federal health guidelines recommend not returning to school until 24 hours after fever has subsided without the aid of fever-reducing medication.

How does H1N1 differ from seasonal flu?

The virus has a novel gene arrangement that is new to human populations worldwide. It also behaves differently from seasonal flu, which has its greatest impact on the elderly. H1N1 disproportionately affects young people, particularly pregnant women, newborns and people up to 24 years old.

Why are people of school and college age so vulnerable?

It is a new virus that has never been encountered by the human immune system, which means no natural defense. Pandemic strains historically have a greater impact on young, robust people. Opportunity also plays a role. Flu strains tend to proliferate in schools and colleges because people are in close contact. Poor hygiene — coughing, sneezing into a hand — then touching objects that others handle helps spread the virus.

How can parents help children guard against swine flu?

Stress the importance of hygiene. Frequent hand washing and/or use of alcohol-based hand sanitizers are helpful. Public health experts recommend packing a container of hand sanitizer, which can be used when students can’t be excused to use soap and water.

Will schools close when one or two cases are confirmed?

No. New federal guidelines stress the importance of keeping schools open. Long Island school district officials say their aim is to keep schools running as usual. Less H1N1 data was available during the spring when several school closures were ordered. Scientists have since learned H1N1’s infectiousness is comparable to seasonal flu and that the vast majority of people who contract it recover quickly.

Should medically fragile children avoid school entirely this year?

Children who are ventilator-dependent, or who have muscular dystrophy, cerebral palsy or other medical conditions, are being encouraged to attend school. Schools for these children as well as those for pregnant teens face different school-closure recommendations. Unlike mainstream schools, state and federal guidelines recommend closure of schools for medically fragile children when even a single case emerges.

Will there be a vaccine?

Yes. A vaccine is in clinical trials at several centers around the country and is expected by mid-October. Flu scientists are testing the vaccine in pediatric populations.

Will there be enough vaccine for everybody?

No. Health authorities originally had hoped for 120 million doses, but the five manufacturers supplying the United States estimate about 45 million will be available by October. However, manufacturers will continue producing H1N1 vaccines throughout the fall and winter.

Why is the vaccine in short supply?

Flu vaccine production is a long, laborious process. Generally, it requires about nine months to produce seasonal flu vaccines. The H1N1 vaccine is new and requires clinical safety and efficacy testing, which takes time. However, because scientists were able to quickly identify the virus, which is needed as “seed stock” to make the doses, it is helping manufacturers fast-track production even as clinical testing is under way.

Are children and young adults first in line for vaccination?

Yes. Priority groups include: pregnant women; household contacts of infants younger than 6 months old; children and young adults 6 months to 24 years; health care and emergency service workers; and people 25-64 with medical problems, such as asthma, heart disease, diabetes, cancer, etc. Government health officials estimate those groups total 159 million people.

How safe is the vaccine?

Data emerging from clinical trials suggest the vaccine is both safe and effective.

How many doses are required?

The H1N1 flu vaccine is a two-dose immunization taken three weeks apart. Full immunity occurs about two weeks after the second dose. For most people receiving the vaccine, immunity probably won’t be achieved until Thanksgiving or later.

Will the vaccine contain the preservative thimerosal?

Some H1N1 vaccines will contain thimerosal, a chemical preservative activists have linked to autism. However, there is no scientific basis for that claim. Manufacturers are also producing thimerosal-free doses. If you have concerns, ask your child’s physician for a thimerosal-free vaccine.

Once you are exposed to swine flu or already sick, are antiviral drugs effective?

Yes. They can shorten the course of influenza. But they have to be judiciously prescribed. Currently, there are no dramatic signs of drug resistance. But public health agencies urge caution because only two medications are available to treat swine flu: Tamiflu (oseltamivir) and Relenza (zanamivir). Tamiflu when taken within 48 hours of flu exposure can prevent infection. Misuse of either medication can lead to resistance, making the drugs useless.

Who should take an antiviral?

The World Health Organization says otherwise healthy people with mild to moderate cases of swine flu do not need an antiviral. But anyone who is young, old, pregnant or has an underlying health problem can benefit.

If you had swine flu during the outbreak last spring, should you get the new vaccine?

No. If you had a confirmed diagnosis of H1N1, that infection should provide immunity.

What about if the case was not confirmed?

If you fall into one of the targeted groups, but the case wasn’t confirmed, you should consult a physician.


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Swine Flu - What You Need to Know

"Information is the best prevention".

This pandemic is still a very serious threat to the people. Medical companies are racing against time to combat this dreaded disease which already claimed thousands.

As the government scrambles to provide vaccine for Swine Flu and contain the spread of the disease, perhaps the best tool available for you is the right information.

What is Swine Flu and how is it different from varieties of influenza we've seen before?

H1N1, or "Swine Flu" contains genetic material from swine, avian and human flu viruses. H1N1 viruses often circulate harmlessly, but since it's a new type of virus, humans don't normally have immunity to it. There are predictions worldwide about the spread of Swine Flu, but nobody is sure how far the disease will spread.

What are the symptoms?

These include:

* Fever
* Cough
* Sore throat
* Runny nose
* Body aches
* Chills
* Fatigue

Some cases also involve diarrhea and vomiting.

These symptoms are relatively common in most types of influenza. Your doctor can give you a Swine Flu test, though the results are not always definitive.

A fever is defined as having a body temperature of 100 degrees or greater.

Swine flu can also cause neurological problems in children, as do other types of flu. The disease is fatal in rare cases.

Who's at the highest risk?

Most U.S. cases have involved young adults and older children. A large number have involved those with morbid obesity.

Experts still caution that those at the highest risk from Swine Flu are young children, the elderly, those with immune disorders and other chronic illnesses.

How can I tell of co-workers, family members or others have Swine Flu?

It's virtually impossible to tell, as Swine Flu symptoms are similar to those of other types of flu. Still, experts advise you to stay six feet from those who appear sick. It's not necessary to wear a face mask, but it can help prevent you from spreading your flu virus to others.

How can I avoid infection

The CDC says hand washing is one of the best ways to reduce your risk of infection. Also, staying away from those who exhibit symptoms is also effective. A personal distance of six feet is recommended.

All household surfaces should be kept clean. Experts say the flu virus (H1N1 included) can stay alive on doorknobs, books, counters, sinks and desks for up to 8 hours.

What vaccines are available?

Vaccines are being prepared in large numbers. Millions of doses will be available in October with more being distributed each month thereafter. The CDC says children ages 6 months to 19 should get a flu shot each year.

What medications are effective?

Tamiflu (oseltamivir) and Relenza (zanamivir) are thought to be the most effective medications to combat H1N1. Doctors advise taking these drugs as soon as possible after symptoms are exhibited. The CDC adds that those who have been to areas with widespread infection should talk to their doctors about taking one of these antiviral medicines.

Health officials don't advise stockpiling Tamiflu and Relenza, though there have been reports in recent years about public health workers doing just that. Still, the government recommends leaving available medicines for those truly in need.

How do I prepare my family for a possible major outbreak?

The government web site Flu.gov advises that you keep a two week supply of food and water in the house. You should also make sure you have a large supply of any prescription drugs on hand. Make sure your children know to always wash their hands and stay away from others who are sick. Parents should cover coughs and sneezes with tissues and model that behavior for the children.

Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home. Parents should make plans for child care in the event they themselves become sick.

What if a family member becomes sick?

Call your doctor. If you, your spouse or the kids are coughing and sneezing it could just be a cold. But if there's a fever, headache and other flu symptoms, that's an indication that it could be Swine Flu or some other strain of season influenza.

Also, anyone who's sick should stay home and avoid public areas.

What about travel? Is it safe?

Experts advise caution when traveling to Mexico since there have been large numbers of people infected with Swine Flu there. But you should check with your airline, and websites for the CDC and WHO before traveling since new advisories are constantly posted.

Why have so many people died from Swine Flu in Mexico but not in the U.S.?

Nobody is excactly sure, but it's possible that Americans generally get better, faster medical care. But some experts worry that the number of U.S. deaths could increase as the disease spreads.

Should we avoid pork?

That's not necessary. Swine Flu or H1N1 virus is spread between individuals or by touching surfaces contaminated with the virus. Pork has nothing to do with it.


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WHO Warns Of Severe Form Of Swine Flu

WASHINGTON (Reuters) - Doctors are reporting a severe form of swine flu that goes straight to the lungs, causing severe illness in otherwise healthy young people and requiring expensive hospital treatment, the World Health Organisation said Friday.

Some countries are reporting that as many as 15 percent of patients hospitalized with the new H1N1 pandemic virus need intensive care, further straining already overburdened healthcare systems, WHO said in an update on the pandemic.

"During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services," it said.

"Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases."

Earlier, WHO reported that H1N1 had reached epidemic levels in Japan, signalling an early start to what may be a long influenza season this year, and that it was also worsening in tropical regions.

"Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections," WHO said.

"In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays."


MINORITIES AT RISK

Minority groups and indigenous populations may also have a higher risk of being severely ill with H1N1.

"In some studies, the risk in these groups is four to five times higher than in the general population," WHO said.

"Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension."

WHO said it was advising countries in the Northern Hemisphere to prepare for a second wave of pandemic spread. "Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases," it said.

Every year, seasonal flu infects between 5 percent and 20 percent of a given population and kills between 250,000 and 500,000 people globally. Because hardly anyone has immunity to the new H1N1 virus, experts believe it will infect far more people than usual, as much as a third of the population.

It also disproportionately affects younger people, unlike seasonal flu which mainly burdens the elderly, and thus may cause more severe illness and deaths among young adults and children than seasonal flu does.

"Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression," WHO said.

"When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people."

WHO estimates that more than 230 million people globally have asthma, and more than 220 million have diabetes. Obesity may also worsen the risk of severe infection, WHO said.

The good news -- people infected with AIDS virus do not seem to be at special risk from H1N1, WHO said.


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Vaccinate kids, parents to manage flu spread: study

WASHINGTON — Targeting vaccines to school-age children and their parents could help manage potential outbreaks of swine and seasonal flu and avert worrisome vaccine shortages, researchers suggested on Thursday.

The study in the August 21 issue of the journal Science comes as the Northern Hemisphere braces for the start of its influenza season in the coming months, while deaths from swine flu mount in countries where it is winter.

The approach runs counter to typical recommendations to battle seasonal flu, which urge the vaccination of children under five as well as all people over the age of 50, noted study co-author Jan Medlock, a mathematician at Clemson University in South Carolina.

But "vaccines would be better used to prevent transmission within schools and out to parents, who then spread the flu to the rest of the population," Medlock said.

His research used a mathematical model to demonstrate cases of flu spreading in which limited vaccine doses were given to school-aged children and adults age 30-39 -- parents in contact with the students.

Looking at the influenza pandemics of 1918 and 1957, researchers determined that even with just 63 million doses of vaccine, they could be given first to children 5-19, the group in which the greatest amount of spreading takes place, and adults 30-39, most often infected by their children.

Following the traditional protocols, the United States uses more than 80 million doses of seasonal flu vaccine every year to combat influenza, which kills about 36,000 Americans annually.

But faced with the swine flu, or (A)H1N1 global pandemic, which has already killed 1,799 people worldwide according to the World Health Organization, experts have raised concerns about the availability of enough vaccine to administer to at-risk groups.

In July, the Centers for Disease Control (CDC) said children and pregnant women should be among the first to receive a swine flu vaccine, and warned that the total at-risk population would number around 160 million.

Those targets also include caretakers and others in contact with children under six months old, healthcare workers, youths between the ages of six months and 24 years, and adults with underlying medical conditions.

Officials at that time forecast a shortage of vaccines, with only 120 million doses likely to be available by October.

But in August, US health officials issued a more dire warning that only 45 million swine flu doses would be ready by mid-October, with 20 million doses delivered each week thereafter.

The WHO has forecast possible shortages in the production of (A)H1N1 vaccines this year due to the slow growth of the swine-origin (A)H1N1 in chicken eggs.

Unlike seasonal flu, which usually hits elderly people the hardest, the (A)H1N1 virus has mostly infected the young. It emerged in Mexico in April and has since spread to 170 countries.

Deaths from swine flu in Latin America -- the worst-hit region in the world -- rose to more than 1,300 this week after governments added to tolls from the disease.

South America has seen the (A)H1N1 flu spread widely during its southern hemisphere winter. In several countries, it has overtaken ordinary seasonal flu.

And with vaccines against swine flu still more than a month away from being available -- and wealthy countries snapping up all available pre-orders from the big drug companies -- Latin American nations are looking at ignoring patents to produce their own.

Worldwide, there have been 177,457 confirmed cases of swine flu, according to the World Health Organization.

More than two million people have probably been infected by the swine flu virus in the United States, including 7,511 who have been hospitalized and 477 who have died, according to the most recent figures of the Centers for Disease Control and Prevention.

NBI seizes P4M worth of fake flu vaccines

The scare over A(H1N1) had prompted some traders to cash in by selling vaccines that they claim to cure the disease. In mid-July, the National Bureau of Investigation arrested a businesswoman in Laguna province for selling what she claimed to be A(H1N1) vaccines.

Amid the scramble for immunity against the dreaded A(H1N1) virus, government agents seized some P4 million worth of fake flu vaccines in a sting operation targeting a businesswoman in Laguna province last week.

The National Bureau of Investigation (NBI) has said its agents nabbed the suspect Jennifer Cristobal, 28, in her home at 19 Lily St., Sampaguita Village in San Pedro City in Laguna.

Radio dzBB reported Wednesday that Cristobal sold the vaccines at P3,000 per vial, about P1,000 cheaper than the genuine product.

NBI Anti-Fraud and Computer Crimes Division agents seized several cardboard boxes of fake flu vaccines, which turned out to contain water, during the raid on Cristobal's house.

A press statement on the NBI Web site said Cristobal's arrest stemmed from a complaint lodged by Sanofi Pasteur, maker of the Vaxigrip (inactivated influenza vaccine).

Investigation showed Cristobal's KNJ Marketing was selling fake products and passing them off as products of Sanofi Pasteur.

After a test-buy of Cristobal's vaccines proved positive, the NBI obtained a search warrant from San Pedro Regional Trial Court Branch 31.

Last Friday, the NBI arrested Cristobal and raided her house, where they found 180 vials of Vaxigrip vaccines, 10 boxes of syringes, official and delivery receipts, certificate of product registration, labels, marketing paraphernalia, computers, a telefax machine, and printers.

Cristobal is being detained at the NBI jail and is facing charges of sale of counterfeit drugs.


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A(H1N1) vaccine to be made available to Filipinos in October

The vaccine against the A(H1N1) virus will finally be made available to Filipinos in October, the local distributor has said.

An information officer of distributor Vaxcen told GMANews.TV on Monday that they have yet to receive a go ahead from their head office to release the name of the pharmaceutical company that would produce the vaccine.

What is sure is that the vaccine will be made available through the company’s vaccine centers starting October, said the Vaxcen officer who refused to be named, citing company policy.

“We assure you it’s from a reputable company," said the officer.

National Epidemiology Center head Dr. Eric Tayag said in a separate interview that they have already received reports regarding such announcements from Vaxcen.

“We’re looking into it, we still have to check and verify these orders. The problem is that we still have no guidelines or policies regarding the distribution of the vaccines," said Tayag.

A previous announcement made by the Department of Health said that health care workers would be the first recipients of some 100,000 A(H1N1) vaccines ordered by the Philippine government from the World Health Organization (WHO). [See: DOH: Health workers to get first batch of A(H1N1) vaccines]

Health Secretary Francisco Duque III also said that the WHO will “draw up" a formula of how to allocate the vaccines to each country.

But Vaxcen said that it is now accepting reservations for the vaccine for P750. The worth of the vaccine is P1,500. It added that interested buyers may call their centers in Quezon City at 421-2493 or in Pasay City at 556-0414.

Tayag said it is possible that the vaccine manufacturers are taking orders through Vaxcen.

“Kung matutuloy yan, chances are hiwalay sila sa guidelines (If their vaccine distribution goes through, then they must be exempted from the guidelines," he said.

As of early July, more than 2,688 cases of A(H1N1) had been recorded in the country with a 95 percent rate of recovery. Since July 9, the DOH has stopped daily updates on the cases of A(H1N1) in the country and instead focused its resources on mitigating the spread of the disease.

In its July 27 update, WHO recorded 134,503 confirmed cases worldwide with 816 deaths. Of these figures, 87,965 or 65 percent of the infections and 707 deaths (86 percent) were recorded in the Americas.


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Swine Flu: Why You Should Still Be Worried

Swine flu is spreading faster than ever — so much so that the World Health Organization has decided to stop tracking cases. All over the world almost everyday, we hear of swine flu cases and deaths. Medical companies are racing against time to come up with a vaccine to prevent the spread and cure existing swine flu illnesses.

Read full story.


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