SWINE FLU- A ZOONOTIC DISEASE

Swine influenza (also called swine flu, hog flu, and pig flu) . Swine flu in another name is known as H1N1 virus flu detected in 2009. It is actually a respiratory disorder, symptom of pigs that is caused by ‘type A’ influenza viruses. Influenza viruses that are commonly circulating among pigs/swine are actually the ‘swine influenza viruses’ or the ‘swine flu viruses’.

As there are many subtypes and strains in these particular flu viruses, there are three types as the major virus causing factors – which was found in the US in the recent years:

1. Swine triple reasserting (tr) H1N1 Influenza Virus

2. trH3N2 Virus

3. trH1N2 Virus

Normally, swine flu will not affect humans, however, few sporadic human infections caused by this deadly virus may occur. Science calls such viruses as variant viruses. In the US, human infections with H1N1v, H3N2v, and H1N2v viruses have been detected. Swine influenza virus (SIV) is any strain of the influenza family of viruses that is endemic in pigs. As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H3N1, H3N2, and H2N3.

The disease has been termed as swine flu because of the virus and the germs being spread from those who are in direct contact with pigs and those who have pig farms. As years rolled on, few new virus got spread among the people those who never been near pigs. As per the news report, this is one such infection that spread very fast in 2009 as everyone had scared about it a lot, thus the WHO called it a pandemic.

Swine influenza virus is common throughout pig populations worldwide. Transmission of the virus from pigs to humans is not common and does not always lead to human influenza often resulting only in the production of antibodies in the blood. If transmission does cause human influenza, it is called zoonotic swine flu. People with regular exposure to pigs are at increased risk of swine flu infection. The meat of an infected animal poses no risk of infection when properly cooked.

As per the medical research, the society is getting sick from then onwards. Though it was considered as a scaring ailment some few years ago, it is now considered as an illness that can be prevented by appropriate vaccination and treatment. It is one of the viruses that are included in the vaccine, swine flu prevention is very important as it causes serious health issues by seasonal effects.

Swine Flu basically originated in swine or pigs, as SIV generally affects pigs. Human got infected by this virus by consuming infected pig meat or coming in direct contact with infected swines. Mean it is transferred, when virus enters the body through eyes, nose or mouth. And then human to human transfer occurs. This human to human transfer takes place by coming in direct contact with infected person or sharing same clothes and other belongings with that person. Its mode of transfer is via air and virus particles travel through air and thus making it more contagious.

It gets transmitted as like seasonal & common flu. When an H1N1 virus affected person coughs and sneezes, the virus get sprayed out as tiny drops into the air. The other common human gets contact with those tiny drops, say for being near to the affected individual or touching the surface that the affected person has used (for e.g. door knobs) chances are indeed heavy to catch H1N1 infection immediately. The virus from the affected individuals can get spread out in a day and the symptoms for an adult will reveal out only after 7 days wherein the symptoms can be found only after 10 days for kids.

Studies say to avoid in taking of bacon, ham and any other pork related food stuff could be one of the best swine flu prevention apart from vaccination. But few other researchers find that by having pork & pork related eatables will not lead to such infection. However, the completely boiled and cooked pork food is completely safe on either of the sides.

Humans are being affected by influenza illness on a major cause. As per science, the influenza viruses of type A, B & C have actually encased RNA viruses with a segmented genome of 8 (eight) different RNA segments. An influenza virus that affects humans might cause & affect the respiratory system of swine actually as swine influenza virus. That is with reproduced RNA strands from the humans affecting virus which got enclosed by mistaken inside the encased swine influenza virus. For better understanding, it is that of one cell can hold 8 (eight) numbers of swine flu and human flu RNA segments. There are actually 16 types of RNA variations, hence four for each swine and the humans – which could find incorporated into one single particle.

Various RNA segment combinations can result in new subtypes (antigenic shift) wherein the higher possibilities to affect humans. And on the other part, pigs play a big role as transitional host to catch hold of new varieties of bird flu causes (pigs respiratory cells are down with immune power hence the get infected by the bird flu easily and almost easily get infected by other mammalian flu viruses even). Its respiratory bag will look like a pot with mixed viruses; hence, it transmits the disease to the humans easily when anyone gets in direct handling of swine.

The incubation period for swine flu (time between infection and appearance of symptoms) can be up to seven days, but is most likely to be between two and five days. It is, however, at this stage there is no certainty about the incubation period.

The symptoms of H1N1 flu might actually develop within 1 to 3 days of being infected. Most of the people will show in a day as we discussed early. However, when you notice any a persistent cough, with prolonging tiredness for more than a week, then you have to be serious in taking care of you. The symptoms of HIN1 flu virus (human swine flu) are very similar to those of seasonal human influenza.

Appending below are few of the core symptoms of swine flu infection.

1. A sudden fever with increasing temperature, generally more than 39 C and/or 103 F

2. Dry and chest a persisting cough

3. Lingering headache

4. Prolonging tiredness & weakness

5. Feeling very chill in the palms and the toes

6. Pain in muscles and bones

7. Joints pain and limbs pain

8. Diarrhea with abdominal pain

9. Vomiting and nausea

10. Sore throat

11. Running nose or blocked nose

12. Unremitting sneezes

13. Disturbed sleep

14. Loss of appetite

The severity of symptoms can vary from mild to severe and sometimes require hospitalization. In some cases, severe complications such as pneumonia and respiratory failure can cause death. Like the seasonal flu, swine flu may worsen existing chronic medical conditions. The symptoms that occur commonly among flu infection and cold are the following:

There are quite a few of these that occur in the human bodies and finding out whether it is just cold or is it flu is a challenging factor. Appending below are the main differences:

1. Come on immediately

2. Unusual increasing of fever temperature and pain muscles & joints

3. Feeling damn tired that will not let the infected individual to carry on his/her daily routine simple jobs

1. Come on gradually but not often and a persistent one

2. Particularly affect the nose and throat areas

3. The cold infected individual can get around once after taking necessary mild treatments

Swine flu complication

Most probably, tricky situations of swine flu can be seen on the people with higher medical risks, say for instance; pregnant women, elderly citizens, those who have weakened the immune system and those who are all under long-term medications. It is highly recommended and important that the above groups must go for annual vaccination without any excuses.

1. Chest complication: The most commonly seen swine flu chest complications are bronchitis and pneumonia on the serious condition. A course of heavy dosage will treat bronchitis; however the other one is indeed risk curing off, wherein it is life-threatening on few factors especially for the ages of weak and elderly ones. Thus, the likely cause of pneumonia can be prevented by proper vaccination on right age.

2. Pregnancy complication: Swine flu infection during pregnancy is highly risk factor, wherein it can affect the pregnancy which will lead to miscarriage, stillbirth, or premature labor and might result in low birth weight during delivery. Hence, the medical foundation is insisting the pregnant women go for annual vaccination without missing.

3. Deteriorating of current health conditions: People who are under long-term medical supervision are at high risk when they are affected by swine flu, in which it will worsen their current health condition very badly.When people with lung diseases say for asthma or chronic obstructive pulmonary disease might find their health condition very bad when they got affected by swine flu infection.People with diabetes, when get affected by swine flu might see increasing blood sugar levels which will then lead to hyperglycemia (risks of higher blood sugar) and for those who are all in type 1 diabetes might affect from diabetic ketoacidosis (a fatal condition caused by swine flu infection where insulin level in their body might go very down).

4. Other complications: Appending below are a list of medical worries that happen rarely but of very serious and dangerous.

Encephalitis: Inflammation of the brain

Febrile Seizures (convulsions): Fits that can affect children when having high temperature

Meningitis: An infection that affect the spinal cord and the brain

Otitis media: An infection that affect the ear (especially that worsening the middle part of the ear)

Tonsillitis: Inflammation of tonsils, which is uncommon from the normal tonsil infection

Sinusitis: Inflammation in the sinus (tiny & air filled cavities found behind the cheekbones and the forehead part on the human body) linings

Thus, swine flu prevention is highly recommended to avoid suffering from the worsened situations. Sometimes, it leads to fatal conditions, which happen from the cause of secondary bacterial infection of the lungs disorders. As per the reported study, the mortality rate on type A virus infection was off 0.1%, H1N1 virus infection was of about 160 fatal circumstances with 2500 confirmed conditions & the mortality rate was of 0.6%. And as per the President’s Advisory Committee, the average conventional flu mortality circumstances is about 36144 per year.

Fortunately, the mortality rates and the fatal syndromes are lowered down by proper awareness of vaccination, increased hygiene level, the rapid development of a new vaccine, and well-understood self-isolation by affected individuals.

Prevention is better that cure is a rightly said maxim. It gets transmitted as we have discussed earlier in this topic. The major measures to stay away from even the common cold are off:

Washing hands by using any of the antibiotic liquid/soap/gel and/or bar in warm water

Do clean the surfaces that the affected individual uses; say for door knobs, balcony chairs, keyboard & the mouse, and all the surfaces that the swine flu-infected person touches & uses

Cover mouth & nose areas when sneezing or coughing

Throwing away the used tips into trash bins properly

Swine flu vaccine: Taking up of annual swine flu vaccine will help to fight against such H1N1 type of virus and will reduce the risk of being affected by this disease.

A swine flu vaccine is open for the below-appended persons:

Any individual who is more than 60 years of old

Any individual who is of overweight

Pregnant ladies

Adults and children who are all with underlying health condition

Adults and children with weakened immune system

Adults above 18 and children aged between 6 months to 2 years are generally given an annual vaccine injection, wherein children below 2 years are given annual nasal spray. The right time to go for swine flu vaccination is that autumn (September to November). Taking up of the vaccination is very important in each year, as the virus of winter may vary & change from last winter’s. Hence by annual vaccination, you can stay safe.

Side-effects: Almost all the vaccinations are accompanied with minimal side effects. Common side effects of H1N1 vaccines both single or with a combination of other flu viral strands show below appending side effects.

Flu vaccination:

In another term as known as flu shots show redness, soreness, mild swelling on the injected area, muscle pain, the low-grade temperature for less than 24 hours.

Nasal spray: Nasal spray for children below 2 years will show the side effect signs of a runny nose, low-level temperature, cough, sore throat, vomiting for not more than 1 day.

Intradermal vaccination: Redness, soreness, muscle pain, headache accompanied by fatigue can be seen as side effects.

Antiviral treatment: To prevent from being affected by the flu in the following conditions, antiviral medicines of Oseltamivir (for Tamiflu) or Zanamivir (for Relenza) are to be taken necessarily.

When there is flu infection in the society

When you are pregnant, or age of 65+

When you are under any such medical circumstances that left you at the risk of flu complications, which include but not just limited to diabetes, lung diseases, heart diseases, neurological diseases et al

When you have contact with the individuals having flu & flu kind illness (must start the anti-viral treatment within 36-48 hours)

When you are not taken any set of effective vaccination so far

Signs to be noticed when you are effectually safe by swine flu vaccination are as appending below:

If you are not vaccinated in the last winter

Though you took the vaccination but of not effective

Circumstance that you cannot be vaccinated

If you took any set of flu vaccination, which is different from the type that is being spread in the society currently

Swine flu detecting tests: Whether any individual show symptoms of H1N1 disease that we discussed early in the above paragraphs must go for swine flu test. The lab doctor will run a swab – inside of your bathroom and the other one inside of the nasal part (around the back of the throat) to collect samples for the test. The tests are highly advised to those who are in the hospital, and those who have higher risks of life-threatening illness. Appending below are the situations to go test immediately:

1. Kids those are of less than 5 years old

2. Elderly group of 65 & 65+

3. Teens under 18 and especially those who are taking long-term treatment of aspirin therapy, and who are at risks of Reye’s syndrome. Reye’s syndrome is the cause of a life-threatening illness that comes once after a heavy swine flu infection.

4. Adults and children with chronic lung disease, lingering heart problems, liver issues, blood system difficulties, nervous disorders, neuromuscular and metabolic problems

5. Those who are with weakened immune system

6. Individuals who are under HIV treatment

7. People who work in hospitals & nursing homes and especially those who work longer years in care facilities

Maintaining a sound hygiene

Apart from vaccination and antiviral medication treatment, swine flu can be well prevented by maintaining a good hygiene. To avoid the chances of getting catch by this ailment is stop spreading the virus at first.

Maintaining good hygiene is that not doing one whole complete day but only once. It is a regular one, where you have to clean your surface always clean, hence adequate cleaning is required. The Health & Hygiene expert Professor Sally Bloomfield, London School of Hygiene & Tropical Medicine states that “”Good hygiene is not a once-weekly, deep-down clean. Hygienic cleaning needs to be an ongoing part of our daily lives, where hygiene measures are targeted where and when necessary.”

She adds that germs and virus can multiply fast. Within 8 hours of the time period, one bacterium on a soggy cloth can multiply into 6 million in numbers. Germs, when to grow and stick with the cloth, is hard to shoo away, hence hard washing by using disinfectants must be required which are then required to dry off in hot sunlight. In addition, clean your surface with anti-disinfectant liquids and once after cleaning, make sure to clean off the cleaning aids such as mops, cloths to be germ-free to avoid germs & virus multiplication.

Appending below are few of the hygiene tips that to be must follow all round the clock but especially in the autumn, where the power of swine flu spread happens more.

Use disposable tissues and cloths to clean and trash them properly

Wash the brush cleaners by using a hard detergent with hot water after every use

Use lavatory cleaner and brush wash it every alternate day

Don’t store water, clean and keep the water filling utensils & buckets empty once after every use

Clean the shower trays often

Ensure the kitchen area to be very tidy

Dispose of the wastages properly

Keep pets away from households

When as swine flu infection is among one of your family:

Separate the clothes while washing theirs

Just do maintain the above-given points on each use

Hence,

Be sure not touching any surfaces that are being used by other people in the public

Make sure of yourself to wash your hands often with antibiotic hand-wash or bar with hot water

Clean all the surfaces that you have used and touched

Use tissues and napkins to cover your mouth & nose well while coughing and sneezing

Dispose of the used tissues in the trash bin covered properly

We have a specialized test for Swine flu. This test is recommended by NICD (National Institute Of Communicable Diseases)

Respiratory specimens including throat swab, and nasopharyngeal /nasal swabs are taken from ambulatory patients..

From incubated patients admitted in the ICU the sample is bronchoalveolar lavage or tracheal aspirates. Samples are transported in special viral transport medium which is packed in such a way that there is no chance of contaminating the environment or it being a risk to those handling the box.

The methodology being used is real time detection and identification of the swine flu virus using the protocol from CDC Atlanta (USA).

The first step is RNA extraction of the virus. The target sequences are amplified and the detection occurs simultaneously.

The CDC realtime RT‐PCR (rRTPCR) protocol for the detection and characterization of Swine Influenza includes a panel of oligonucleotide primers and dual labeled probes to be used in real time RT‐PCR assays for the invitro qualtitative detection and characterization of swine influenza viruses in respiratory specimens and viral cultures. The first primer‐probe set, Influenza A is designed for universal detection of type A influenza viruses. The swInfA primer and probe set is designed specifically to detect all swine influenza A viruses. The swH1 set is designed specifically to detect swine H1 influenza. The fourth set detects the human Rnase P gene and reflects that the assay has been carried out properly without any inhibition of PCR.

A sample is said to be positive for Swine flu (H1N1) if all three targets i.e. Influenza A, H1N1 Influenza A, and H1N1 Influenza A subtype H1 are detected. If a sample is positive for only two of the above targets a repeat sample is recommended. If all four targets are negative, a repeat sample should be done.

A negative result does not preclude the presence of Influenza A H1N1 infection because results depend on adequate specimen collection, absence of inhibitors, and sufficient RNA to be detected.

Treatment

After testing positive for swine flu , patient should immediately quarantined in an isolated room or in hospital . National institute of communicable disease(NICD) information says that the swine flu can be treated if caught very early with two of the anti‐viral medications oseltamivir (Tamiflu/Fluvir) and zanamivir (Relenza). Tamiflu is for treatment in adults and children aged 1 year and older, and must be taken within 48 hours of the first symptom.

Till now this strain of influenza virus is in a dynamic state means there is no consistency( in scientific terms it keeps on mutating) in its level of occurrence because evidently in some patients its being treated successfully with Tamilflu and in some tamilflu is ineffective. And moreover at present there is no effective vaccine present.

So basically precaution is the best treatment.

As the flu is now spreading via person ‐to‐person contact; the infection primarily spreads when a person comes in close contact with an infected person. The simple way to minimize the risk is by covering the mouth and nose while coughing and sneezing and wearing a mask while going close to the infected person.

Maintaining high level of hygiene is also important and one should always wash hands frequently with soap and water.

Since influenza spreads through both air and contact with contaminated surfaces, surface sanitizing may help prevent some infections. For that alcohol is an effective sanitizer, bleach can also be used to sanitize rooms or equipment that have been occupied by patients with influenza symptoms.

Reference-on request