August 2009


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What distinguishes the H1N1 from other influenzas?

In many respects, the Novel Influenza A/H1N1 virus is similar to other “flu” viruses that are responsible for seasonal flu epidemics. It causes similar symptoms: fever, cough, sorethroat, runny nose, body pains, headache, general malaise (feeling poorly) and, in some cases, vomiting and diarrhoea. In this regard, it is almost completely indistinguishable from seasonal flu.

What makes this virus different—and by extension a cause for concern—is that it has a completely novel genetic structure of combined porcine (pig), avian (bird) and human origin; therefore the specific genetic makeup of this pandemic strain of the flu was never before seen in viruses circulating among human beings. This presented two concurrent potential problems:

• No one in the world would have immunity to this new virus; meaning that everyone on the planet would be susceptible to being made ill by this new strain of Influenza A.
• No one knew how this new virus would behave—would it be as deadly as the 1918 pandemic? Would it be as deadly as the Avian Flu? (Still currently being monitored globally.) Would it spread quickly or slowly?

Is its rapid spread a result of some innate quality, or is it largely a reflection of the interconnectedness of the planet?

Its spread is a combination of those two factors: The new genetic makeup of this virus does seem to favour high transmissibility, but the ubiquity of global travel has accelerated the spread to a large extent.

Are local physicians adequately prepared in terms of information and medication to diagnose H1N1, and to treat patients with it?

Local physicians have been adequately informed of the existing protocols for diagnosis and treatment of the new pandemic flu. Information has gone out to the medical profession through several channels designed to reach both the public and the private physician population.

In terms of treatment, it is necessary to point out that in most cases, disease has been very mild and no specific/special treatment beyond supportive therapy has been needed. In cases where more serious disease was noted or where other risk factors were present, the treating physicians have been advised to refer to the public facilities where specialist teams were assembled to guide care of the higher-risk patients.

Several public service messages have been broadcast in various media with advice on hygienic and other preventive measures to help contain the spread, are these adequate?

These messages are accurate, informative and “onpoint” with regard to their content, their focus and the channels of communication being used to spread them.

However, there is only so much that can be done by the Ministry of Health or other authorities in spreading information. There is always the element of personal responsibility. Members of the public have an important role to play in informing themselves by listening to the official information released by the respective authorities, reading the fliers, checking the website, reading the papers and heeding the instructions given.

One or two cases have been reported where the influenza seemed resistant to medication, what complications can arise by a virus’ mutation?

Mutation refers to random changes in the genetic makeup of the virus. By nature, this process is completely unpredictable. It is therefore difficult to say with any degree of certainty what complications can arise if the virus mutates.

One of the possible outcomes is that it can become adapted to the medications used to treat the flu. This most commonly happens when persons start a course of antiviral medications but do not take ALL of the medication (usually because they have started to feel better). This gives some “stronger” viruses the chance to survive and to reproduce, leading to a new batch of “stronger” viruses than the originals. In a short time, those stronger viruses can replace the originals and become the dominant circulating virus, which is more difficult to treat.

Another outcome is that viruses may become more “virulent” meaning capable of causing worse illness. Large numbers of persons may become severely ill if this happens—a situation which can put great strain on the workforce and the health care system.

GUIDELINES FOR H1N1

The public needs to know and follow the guidelines currently being issued by the Ministry of Health with regard to:

Respiratory etiquette

• T he flu is spread by germ-carrying droplets from the mouth/nose that are produced when people talk, cough and sneeze
• Cover coughs and sneezes with disposable tissue or with the sleeve of your shirt/blouse: NOT WITH YOUR HANDS
• Dispose of the tissue in a bin after use

Hand hygiene

• Germ-carrying respiratory droplets can contaminate common surfaces like door-knobs and counter-tops.
• Wash hands thoroughly and frequently with soap and water or use alcohol-based (70%) hand sanitizers to keep hands clean

Social distancing behaviours

• If you are ill with the flu, the best thing to do is to remain away from work or school Go to your doctor if you feel very unwell e.g.
• Very high fever that won’t break
• Shortness of breath/ difficulty breathing
• Chest pain when breathing
• Dizziness or confusion
• Severe vomiting or diarrhoea

In children, also be aware of:

• listlessness or lethargy (abnormal quietness or inactivity)
• decreased fluid intake
• rapid breathing

Do you need a mask?

Masks are needed in specific situations:

• Health care settings where personnel are directly involved in close range interaction with persons who have respiratory illness
• In home settings where ill persons are at home and are likely to interact with other family members at distances of less than 6 feet (in which case the ill person should wear a mask)
• In home settings where family members are caring for ill persons who cannot perform normal self-care activities (in which case the caregiver should wear a mask)
• In situations where there is widespread, high intensity disease transmission (as occurred in Mexico) where social distancing is employed, mass gatherings are banned etc. In these cases the public is advised to remain indoors and ESSENTIAL excursions into the public domain are accompanied by use of masks to reduce risk of spreading or coming into contact with infectious respiratory droplets

In the local setting masks are not needed and, in fact, their improper use can increase risk of infection by lulling persons into a false sense of security. Please note the following:

• Masks need to be fitted to the face so that no air can seep around the edges of the mask (otherwise they really serve no purpose in this setting)
• Masks need to be changed every 4-6 hours, or if they become damp from breathing through them
• If a mask is worn beyond the advised time, it becomes a germ trap (due to the humidity) and can increase risk of infection
• Precautions need to be taken when masks are removed to avoid contamination of hands and surfaces, if these are not followed, using a mask can again increase risk of transmission of respiratory illness by self contamination and contamination of the environment.