WORLD BATTLES SWINE FLU AS DEATH TOLL RISES giant
headlines scream ...SHUTDOWN or ...UNPREPARED saying the
World health Organisation has raised the "Threat Level"
(when it should say phase alert). Other articles talk
of ...readiness for the worst, ... increasing global
anxiety, ... Australians rushing to buy surgical makes
as fears grow, ... Tassie braces for swine flu..., and even...
Wolverine film postponed over swine flu.
Reports give numbers like over 2000 infected and 150
deaths in Mexico - when the fine print from World health
organisation says ... Mexico has reported 26 confirmed human
cases of infection including 8 deaths - so it's hard not
to get swept along in this wave of drama.
A few points:
- Swine flu IS a new strain of influenza ... but it is
still influenza.
- Influenza infects many animals - even snakes.
- Influenza is not too deadly in its own animal host, but
when it jumps between species, it can sometimes be more
deadly. This is why the bird flu was and still is so
serious. Bird flu is dangerous, but it is not very
efficient at spreading from person to person.
- Over mankind's history many human viruses originated in
domestic animals and' jumped' into people. e.g. that most
famous recent new disease AIDS is thought to have jumped
from monkeys. It is interesting to note that this new
virus has not yet been isolated in samples taken from
pigs in Mexico or elsewhere.
- Influenza has the ability to mutate. Influenza viruses
can swap bits of genetic material between different
influenza viruses. If this happened we could be faced
with a super influenza germ that spreads easily but is
more deadly than current influenza germs...... that
would be a much bigger problem. Currently this is not
the case. However, dealing with this swine flu is good
practice for us all ... preparing for the day when the
superflu does appear.
Influenza is serious ALREADY -
most people don't realize
how serious 'regular' influenza can be. Many travellers
decline flu vaccination because it is 'just the flu', or
they have heard the MYTH that somehow the vaccine can
give you the flu. The flu vaccine is dead - it cannot
give you the flu, - not unless the laws of physics and
chemistry suddenly change.
Each year an estimated 2,500 Australians die from
'normal' influenza and its complications. The World
Health Organization (WHO) estimates that worldwide 5-15%
of the population are affected by influenza each year,
there are between three and five million cases of
serious illness and between 250,000 and 500,000 deaths.
(see
www.influenzaspecialistgroup.org.au).
WHO raising the pandemic phase alert caused a lot of
excited reporting. The WHO pandemic Phase Alert process
is an administrative tool. It reflects how the virus is
spreading, regardless of how virulent (deadly) or
otherwise the virus may be. it is a tool to help advise
nations about the precautions they need to take. Some
nations do strange things. (e.g. There are reports from
Egypt that authorities are killing every pig in the
country - This action is of course most unlikely to stop
swine flu spreading from Mexican airline passengers to
the local population).
Each strain of influenza usually takes the name of the
city where it was found. This years Southern hemisphere
flu vaccine contains three strains:
A/(H1N1): an A/Brisbane/59/2007 (H1N1) - like strain
A/(H3N2): an A/Brisbane/10/2007 (H3N2) - like strain
B/Florida/4/2006 - like strain
You will notice that the first strain is an influenza A
H1N1 strain called Brisbane - it is not that different
to the swine flu.
People are starting to discuss a new name for this
virus. e.g. this disease could be called A(H1N1) Mexican
flu - at least that might help the pigs.
Mask sales have skyrocketed, and mask manufacturers must
be rubbing their hands in glee. I do not recommend
travellers carry or wear normal surgical masks. Surgical
masks are designed to be worn for short periods, and
basically they are designed to stop surgeons and nurses
etc accidentally coughing into a wound when they are
scrubbed and sterile and unable to use tissues etc.
Wearing a mask looks very dramatic on a news snippet on
TV but that does not mean it is recommended. Wearers of
masks may feel warm and fuzzy that they are 'doing
something' but really these surgical masks are next to
useless. Wearers often also feel constricted and stuffy,
and take their noses out of the top which further
defeats the purpose. Unless a mask is sealed onto the
face, the viral particles will enter via the side of the
mask. Once the mask becomes moist from breathing, it
becomes less effective. And what about if you want to
take your mask off to eat your pork sausage?. it is
relatively easy to contaminate your mask when putting
the mask on, and taking the mask off. Wearers can
accidentally get viral particles onto the eyes, nose or
mouth, and illness will result. You would need to keep
changing the mask.
The other type of mask (N95 or P2 which are basically
the same thing) are high tech masks designed to be used
for brief periods in a hospital setting, when treating a
single patient with an infectious disease, in
conjunction with gown, gloves, cap etc. They do work
very well, but they are very uncomfortable to wear for
even short periods, and must be worn correctly and fit
perfectly to be any use.
They have been trialled in a family setting but even
though they work, they are still difficult to use (see
ABC news story on masks). Remember that aircraft air
whilst the plane is flying, is safer than air at your
local shopping centre.
Everyone asks me what do I think will happen. I don't
know, but the northern hemisphere flu season is now
coming to a close, so climatic conditions should slow
the spread of the virus in the northern hemisphere. More
cases will be confirmed as the definitive test kits are
distributed more widely. There will probably (and sadly)
be more deaths. We do not have the medical information
yet as to why the persons in Mexico seem to be dying
from this flu, whilst persons in the USA and other
developed countries experience only a minor illness.
Everyone is waiting for this information.
As it stands at the moment - travellers do NOT need to
cancel their overseas journeys. it is wise to avoid
Mexico because of the guidelines, but also because
potential disruption to your travel plans is probably a
greater threat than catching swine flu. Travellers
should have the regular flu vaccine, wash hands
regularly, carry and use hand sanitisers and be alert
for symptoms. They should discuss the use of tamiflu etc
with their travel doctor. Everyone should stay at home
if they are sick, and practice cough etiquette - whether
there is a flu alert or not.
If you feel well after getting off a plane from
somewhere (e.g. New Zealand) - you are well. If you feel
well for 7 days, you are not going to get swine flu from
your aircraft journey. If you feel sick, see a doctor.
if you have a fever, cough, aches in joints, runny nose
etc, call your doctor before you attend the surgery. If
you feel well you do not have to quarantine yourself.
You do not need to see a doctor to prove you are well -
doctors are really too busy dealing with sick people. If
you incubating the virus, and don't have any symptoms,
the doctor won't be able to tell if you are going to get
the flu tomorrow. There are no tests they can do. Work
places that have staff that might hide their illness,
could get a thermometer and thermally screen all staff
on arrival at work.
Travellers should be aware of this disease, but the risk
of having a motor vehicle accident is likely to be
greater than your risk of contracting the 'Mexican flu'.
As it says ... in large friendly letters ... on the cover
of the famous book, Don't Panic.
This situation is evolving. Tomorrow it could all be
different - see updates at:
http://www.thetraveldoctor.com.au/swine_flu.html
FURTHER INFORMATION
What do travellers need to do?
Discuss your particular situation with your travel
doctor, but in essence:
-
Carry hand sanitiser and use it regularly.
-
Face Masks are of limited value.
-
If you develop any symptoms (cough, fever etc) seek
medical attention, and practice cough etiquette.
-
Monitor the WHO and CDC sites for the latest
information
Incubation and period of contagion?
-
Incubation period of swine flu is usually a few
days.
-
People are contagious from 1 day before symptoms to
7 days after symptoms develop.
-
If you feel well and you have been in a country
where the disease is confirmed, you do not have to
do anything in particular.
-
If you feel well up to 8 days after return, you are
'in the clear'
-
If you feel unwell after visiting an affected
country, call the medical clinic before you attend,
and tell them your symptoms and where you have been.
Antiviral drugs (e.g. Oseltamivir/Tamiflu)
Antiviral drugs are PRESCRIPTION medicines with
activity against influenza viruses, including swine
influenza viruses.
They can be taken in two different ways
-
Prevention: High risk persons in infected
areas may be recommended to take one daily to help
prevent infection. They are 70% to 90% effective.
Usually this group includes persons whose immune
system is not working properly ( chronic medical
conditions, elderly), household contacts of a case,
or health care workers treating cases. it is taken
for the risk period and 7 days after the risk
period.
-
Treatment: Low risk travellers to infected
areas may be recommended to carry the medication in
case they develop symptoms. The drugs must be
commenced within 48 hours of symptoms, so it is
useful to have the medication in your medical kit in
case it is needed. It is usually taken for 5 days.
Information about the medication is available at
www.cdc.gov/swineflu/antiviral_swine.htm
Read more updates as they arrive:
http://www.thetraveldoctor.com.au/swine_flu.html
...prepared by Dr Deb Mills, Travel
Medical Alliance, Brisbane, Queensland
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