Swine Flu
Cases of Influenza A (H1N1) pdm 2009 also known as “Swine Flu” have been reported in the neighboring country India for the past several months. The number of cases has crossed 20,000 and nearly 1300 have lost their lives in the recent outbreak. Swine Flu was reported this year in Nepal on February 22, 2015. Over four dozen patients are found to have contracted the disease, triggering public panic.
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Swine Flu was first reported in Mexico in 2009 which later spread to North America. The disease consists of triple reassortant genes from avian, human and swine influenza viruses. However, most genes are very similar to swine (pig) influenza, hence the name Swine Flu. But there is no need to panic. Swine Flu is much like a seasonal flu and can be cured if precautions are taken on time.
Fever, cough, sore throat, body ache, running nose and diarrhea are its major symptoms. The incubation period (the time period between infection and symptoms appearing) could range from one to four days, sometimes up to seven days. The virus shed begins one day before the onset of illness and lasts for seven days on particularly young children and immune compromised persons. Swine Flu transmits in two ways: through person to person contact and the surface where infected person has left viral droplets while coughing or sneezing. Once this droplet reaches a healthy person through eye, mouth or nose, s/he can be infected.
Symptoms alone do not help diagnosis because other infections can have similar symptoms. Therefore laboratory confirmation is required. Patients with Influenza like Illness (ILI) can have laboratory testing for influenza virus. Rapid Influenza Diagnostic Test (RIDT) differentiates influenza type A and B, and is best when done within 48 to 72 hours after the symptom onset. Swine Flu virus belongs to influenza virus type A. When influenza A positive is detected, further analysis is required through PCR method to identify Swine Flu. However, negative RIDT result does not exclude a diagnosis of Swine Flu in a patient because of its poor detection rate or low sensitivity level. For example, one patient who visited Teku Hospital after his arrival from India showed RIDT negative but PCR method confirmed positive. PCR method is a reliable method for detecting influenza virus and is currently available in National Public Health Laboratory, Teku.
Swine Flu cases are on the rise and it has been found in people of all age groups. Patients with flu like symptoms are increasing in Sukraraj Tropical and Infectious Disease Hospital as well, especially after one patient reportedly died of it in Kathmandu. This must have made the public believe Swine Flu results in death. Not necessarily.
Swine Flu can result in deaths or may lead to serious complications mainly in people of high-risk groups such as young children, people with chronic illness (especially those with asthma, COPD, chronic bronchitis etc), elderly and pregnant women. People of this category should avoid attending mass gatherings, public transportation, shopping malls, wedding ceremonies or other such crowded places. Majority of Swine Flu affected people do not usually require hospital admission. They should get rest and drink plenty of fluids and stay at least one meter away especially from the children and the elderly because they are vulnerable to infection. However, patients who develop warning signs such as difficulty in breathing, pain or pressure in the chest or abdomen, sudden dizziness and/or persistent vomiting should seek medical attention as early as possible.
There is no specific treatment for Swine Flu, though Tamiflu, an antiviral drug, is being recommended for the confirmed cases. It is beneficial when used within the 48 hours of symptom onset. Tamiflu (75mg) is given in two-divided doses every 12 hours for five days, while those who come into contact with infected persons may take a single dose for 10 days. Vaccine against Swine Flu is available in the global market but not in Nepal.
Despite the growing cases, our government has not yet provided Swine Flu vaccine to the health workers, who are at the forefront of the battle and thus are at high risks. World Health Organization (WHO) could play a key role in providing flu vaccine and building infrastructures in Sukraraj Tropical and Infectious Disease Hospital, the only central referral hospital for infectious diseases in Nepal.
WHO had shown a great interest in establishing isolation and ICU wards sometimes ago but there has been little progress. The government can seek help from collaborative partners such as I/NGOs or international institutions such as Centers for Disease Control and Prevention (CDC, US) to equip infectious disease hospital or share their experiences to fight the contagious infectious diseases. Establishing a separate CDC model institution could be a permanent solution to tackle potential infectious disease outbreak in the future. It is, however, essential for Nepal to have its own well-equipped hospitals, strong surveillance networks, and enough infectious disease specialists to fight all viral diseases.
Swine Flu outbreak cannot be controlled without public cooperation. People with Swine Flu infection should strictly follow preventive measures issued by Ministry of Health. This can help to stabilize current outbreak or minimize the risk of further transmission. International studies show Swine Flu has mortality rate of 0.02 percent (approximately 26 deaths per 100,000 person, worldwide), while seasonal flu claims up to 10 percent (1000 deaths per 100,000 person annually) worldwide.
More than 200,000 people are hospitalized and up to 49,000 are estimated to have died of seasonal flu related complications each year in the US. This means risks of complications are higher in seasonal flu than in Swine Flu. Over attention may have created mass panic in Nepal.
Sukraraj Tropical and Infectious Disease Hospital (STIDH) is ready to treat any contagious infectious diseases. The government turns to this hospital with greater expectations, when the country needs to control highly contagious infectious disease outbreaks. But it neglects the hospital once the outbreak comes under control.
Since it is a single central referral hospital for infectious diseases in Nepal, time has come to invest more in this hospital so that it could act promptly, properly, effectively, and timely whenever there is outbreak of infectious diseases. We lack permanent quarantine system at the entry ports and strong surveillance network. We also need to install this system.
The author is medical officer at Sukraraj Tropical and Infectious Disease Hospital, Kathmandu
