Everything you’ve always wanted to know about H1N1 but were afraid to ask

The casualties are increasing around the world and tension has reached fever pitch. Even church authorities have declared a holy war against this modern-day evil. Now, you don’t have to hold hands with the persons next to you when you pray or sing Our Father during Mass.

It may soon become a social no-no to make beso-beso. And wearing a surgical mask when you step out of the house may be de rigueur.

But how much do we really know about H1N1 and how do we protect ourselves from it? Dr. Ruby Mendoza-Dizon, medical director of Sanofi Pasteur, answers oft-asked questions on H1N1.

Philippine STAR: H1N1 has caused worldwide panic. A lot of this fear stems from the fact that people know little about this virus. Could you enlighten us on the type of H1N1 virus that’s spreading around the world?

Dr. Rubai Dizon: A new Influenza A (H1N1) virus was first identified by US CDC on April 17, 2009 in samples from two Californian children. As of 06:00 GMT, 3 June 2009, 66 countries have officially reported 19,273 cases of Influenza A (H1N1) infection, including 117 deaths. The virus has genetic components from swine, avian, and human influenza viruses. This is thus a “quadruple” recombinant virus. This strain is genetically different from the A (H1N1) strain included in the recent seasonal trivalent influenza vaccine.

Is a pandemic expected anytime soon? What does this mean? And are the medical experts prepared to handle such a crisis?

The WHO pandemic alert has been raised to Phase 5.

Phase 5 is characterized by human-to-human spread of the virus in at least two countries in one WHO region. While most countries might not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic might be imminent

Phases 5 and 6 are virtually identical in terms of the actions they launch like intensified preparedness measures.

The decision to declare Phase 6 should no longer be triggered by the geographical extension of the epidemic but should be based on scientific advice made by relevant scientific bodies which could include data on severity of the disease and spread, and ease of transmission from one person to another. Most parts/governments of the world have been planning for this very situation for several years now and are more prepared to handle this challenge than at any time in history.

Since there is yet no vaccine for H1N1, how important is it to have a flu shot? What are the side effects? Will this protect you from H1N1?

Seasonal influenza is in itself a very serious illness causing 250,000-500,000 deaths worldwide every year so seasonal influenza vaccination with or without the threat of a pandemic is always of utmost importance, particularly in groups recommended to receive the vaccine (reference: DOH-Technical Working Group on Influenza).

Persons at increased risk for complications include:

• Those aged 50 years old and above.

• Children from six to 23 months old.

• Adults and children with the following risk factors: chronic cardiovascular disease; chronic lung disease; chronic metabolic disease (diabetes mellitus); chronic renal dysfunction; hemoglobinopathies; immunosuppressed (HIV, malignancies, immunosuppressive drugs, radiation therapy, transplant patients); children and adolescents who are receiving long-term aspirin therapy; residents of nursing homes and other chronic care facilities; pregnant women on their 2ndor 3rd trimester who have not received their flu vaccine within the last 12 months.

Persons who can transmit influenza to those at high risk:

• Health care workers and other personnel.

• Household contacts (including children) and caregivers of persons at high risk.

Vaccination of other groups:

• Persons who provide essential and emergency community services.

• Students and other persons in institutional settings.

• Any person who desires to reduce the likelihood of becoming ill with influenza.

The new Influenza A (H1N1) virus has mainly circulated in the northern hemisphere, but as countries with the southern hemisphere pattern (like the Philippines) will soon enter the peak of their flu season, they might encounter other influenza viruses that can lead to the possibility of genetic reassortments. The Philippines’ peak in seasonal influenza begins in June.

The current seasonal human influenza vaccine will not protect humans from infection with the new Influenza H1N1 but rather will help prevent simultaneous infections that may result into reassortment and eventual emergence of a totally new virus with a pandemic potential.

The expected adverse events with influenza vaccination are generally local reactions (pain, swelling, and redness at injection site) and very rarely systemic reactions (fever, allergic reactions) that spontaneously resolve within 24-48 hours. It is important to advise patients on what to expect after vaccination, to observe them for at least 15-30 minutes after administration, and to advise them on who to contact should they experience any of the above.

Since cough and colds are in season now, how can one tell between an ordinary flu and H1NI?

You will not be able to tell the difference between seasonal flu and Influenza A (H1N1) without medical help. Only your medical practitioner and local health authority can confirm a case of Influenza A (H1N1).

Early signs of Influenza A (H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat, runny nose, and sometimes vomiting or diarrhea.

At the onset, from clinical symptoms alone, you cannot distinguish between ordinary seasonal flu and H1N1 although you should have a higher index of suspicion for the new H1N1 in patients coming from countries with confirmed H1N1 cases or those who have contacts with confirmed cases of H1N1.

This is another reason why it is important to receive your seasonal influenza vaccine. As you cannot distinguish clinically alone the difference between the two, receiving seasonal influenza vaccine can help reduce the number of people being “suspected” of having the new A (H1N1) virus when what they have is seasonal influenza. This also translates to reduction in the use of manpower and financial resources in analyzing cases that would have been prevented if patients received their seasonal influenza vaccine.

What should you do if you suspect you have something more than a flu?

You should have a high index of suspicion and report immediately to the Department of Health (DOH) if you are a person with influenza-like illness (ILI) who has close contact with a confirmed case of Influenza A (H1N1) virus infection while the case was ill or a person who has traveled to an area where there are confirmed cases of Influenza A (H1N1) infection within 10 days preceding the onset of ILI.

If you feel unwell, have high fever, cough or sore throat: Stay at home and keep away from work, school or crowds; rest and take plenty of fluids; cover your nose and mouth when coughing and sneezing, and if using tissues, make sure you dispose of them carefully. Clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub; use a mask to help contain the spread of droplets when you are around others, but be sure to do so correctly; inform family and friends about your illness and try to avoid contact with other people; if possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.

What is the incubation period for H1N1?

Currently, the estimated incubation period is unknown and could range from one to seven days, more likely one to four days, and is considered to be the same as that of the seasonal influenza virus.

For the seasonal flu virus, studies have shown that people may be contagious from one day before they develop symptoms to up to seven days after they get sick. Children, especially younger children, might potentially be contagious for longer periods.

Studies are still ongoing for this new A (H1N1) virus.

How soon will a vaccine for H1N1 be made available to the public?

The first doses of Influenza A (H1N1) vaccine could be available within four to six months after identification of the new virus.

Can one be actually a carrier of H1N1 and not manifest symptoms?

There is no chronic carrier state for seasonal influenza and it is believed that the new A (H1N1) virus has the same properties in terms of spread as seasonal flu viruses.

If, for instance, a member of the family or an officemate or people you deal with on a daily basis is found to have H1N1, what’s the possibility of you getting infected?

Staying in the same office or building with a confirmed case will not automatically mean that you will get the disease as this is thought to be via droplet spread. Your exposure has to be clearly assessed by a qualified practitioner.

Early surveillance data though suggests that the novel Influenza A (H1N1) virus has the potential for efficient, rapid spread and appears to be more contagious than seasonal influenza with current estimates of the secondary attack rate at a range of 22-33 percent.

Hand washing is the best defense against viruses. But how should we wash our hands? Do we have to use anti-bacterial soap or is ordinary soap good enough?

It is recommended to wash hands with soap and running water for about 40-60 seconds, ensuring all parts are completely clean.

In the event water supply or soap is not available, 70% alcohol or alcohol-based hand rubs are an alternative.

How do you protect yourself against H1N1 when you’re in a crowd or when you use public facilities like the toilets in malls, for instance? Experts particularly warn against touching doorknobs that could harbor illness-causing bacteria.

Public gatherings refer to a congregation or grouping of several people in an area or activity, examples of which include social and cultural celebrations such as conferences, sports events, fiestas, and other comparable indoor and outdoor activities.

If you have to be in a gathering of people:

• Practice cough manners and cover mouth and nose when coughing or sneezing and wash hands after doing so.

• Maintain personal hygiene, especially regular hand washing with soap and water or sanitizer.

• At the first sign and symptom of flu-like illness, defer from attending a public gathering and seek medical consultation.

• Persons who are at high risk of complications from Influenza A (H1N1) should avoid exposure to this virus by reconsidering attendance at public gatherings.

All organizers of public events or mall owners should ensure that frequently touched objects (like doorknobs) and surfaces have been adequately disinfected to avoid spread of disease

What about making beso-beso (cheek-bussing). Should that now be a social no-no?

Public gatherings are usually festive and personal contact like handshaking and kissing or cheek-bussing likely occur, thereby increasing the risk for spread of Influenza A (H1N1) virus.

How do you protect yourself from H1N1 if you’re traveling?

People who are ill should delay travel plans.

Returning travelers who become ill should contact their health care provider.

Travelers can protect themselves and others by following simple prevention practices that apply while traveling and in daily life.–Ching M. Alano, Philippine Star

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For more information, log on to www.who.int, www.doh.gov.ph, www.cdc.gov.

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