By : Priyanka RandhirBSc.Nursing Intern

INTRODUCTION

Swine flu (swine Influenza) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs.

Swine influenza (also called swine flu, hog flu, and pig flu) is an infection by any one of several types of swine influenza virus.

It is pandemic flu. Its first case was detected in United states.

SWINE FLU IN INDIA

According to mass media the first cases of swine [h1N1] flu in India was found in Maharashtra and the reality is this that it was carried by the persons staying in the infected countries.

From then till now, many a peoples were infected by this hazardous disease and just because this virus frequently travels in air and affects through respiratory system, most of all India is now became infected by this virus….

WHAT DO YOU MEAN BY SWINE?

Any of various omnivorous, even-toed roughly pawed of the family Suidae, including pigs, hogs, and boars, having a stout body with thick skin, a short neck, and a movable snout.

WHAT IS SWINE FLU ?

Swine Flu, is highly contagious acute respiratory disease caused by type A H1N1 virus.

In1918, its first case was detected. In 1918 pandemic received its nickname "Spanish flu“ .

Recently, it has re-appeared in April,2009 in United States, and another countries like India, Mexico, Canada etc.

WHY THIS NEW INFLUENZA (H1N1) VIRUS IS SOMETIMES CALLED “SWINE FLU”?

This virus was originally referred to as “swine flu” because laboratory tests showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America.

But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian genes and human genes. Scientists call this a “quadruple reassortant” virus.

REASSORTMENT

SWINE FLU VIRUS

H1N1 virus is the causative agent of swine flu. The words ‘H’ and ‘N’ in the H1N1 stand for two proteins found on the surface of the swine flu virus: hemagglutinin (H) and neuraminidase (N). All influenza viruses possess hemagglutinin and neuraminidase, but the structures of these proteins are different from strain to strain, due to rapid genetic mutation in the viral genome.

Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine through out the year, but most outbreaks occur during the months of April and May. The classical swine flu virus (H1N1) was first isolated from pig in 1930.

OUTBREAK OF SWINE FLU 2009

0

500

1000

1500

2000

2500

Laboratory Confirmed Cases

Other Suspected Cases

Deaths

WHY THERE ARE NO CASES OF SWINE FLU IN ARAB COUNTRIES????

They do not eat pork (pig meat) as they believe that “Allah” will punish those who eat pork.

They are dressed in such a way that their whole body is covered, therefore less chances of getting infection.

Arab's usually avoid travelling to other countries.

The climate in Arab country is dry.

CHARACTERISTICSOF DISEASE

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include shortness of breath,bodyaches, headache, chills and fatigue.

Symptoms of swine flu are more severe than seasonal flu.Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

SIGN AND SYMPTOMS

HOW DOES SWINE FLU SPREAD?

Spread mainly from person

to person through droplets from nose, mouth, and by coughing or sneezing .

Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Among animals (pigs, wild animals and birds) it spreads through DIRECT CONTACT between infected and uninfected animals.

HOW LONG CAN AN INFECTED PERSON SPREAD SWINE FLU TO OTHERS?

People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for 7 days following illness onset.

Children, especially younger children, might potentially be contagious for longer periods.

WHO ARE AT RISK ??????

Chronic respiratory disease such as COPD, asthma.

Chronic heart diseases such as heart failure.

Chronic Kidney diseases such as Kidney Failure.

Chronic liver diseases such as chronic hepatitis.

Chronic neurological disease such as Parkinson's disease.

Immunosuppression Diabetes Pregnant women Older people 65 or above Young children under 5

HOW ARE HUMAN INFECTIONS WITH SWINE INFLUENZA DIAGNOSED?

To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus).

However, some persons, especially children, may shed virus for 10 days or longer.

Identification as a swine flu influenza A virus requires sending the specimen to a hospital laboratory for testing.

IN CHILDREN EMERGENCY WARNING SIGNS THAT NEED URGENT MEDICAL ATTENTION INCLUDE:

Fast breathing or trouble breathing Bluish or grey skin color Not drinking enough fluids Not waking up or not interacting Being so irritable that the child

does not want to be held Flu-like symptoms improve but

then return with fever and worse cough

Fever with a rash

IN ADULTS, EMERGENCY WARNING SIGNS THAT NEED URGENT MEDICAL ATTENTION INCLUDE:

Difficulty breathing or shortness of breath

Pain or pressure in the chest or abdomen

Sudden dizziness Confusion Severe or persistent vomiting Severe symptoms like high

fever and worsening of cough.

IMMEDIATE ACTION WHEN PERSON FEELS SICK

COMPLICATIONS

Respiratory failure Pneumonia High fever leading to

neurological problems Dehydration and

electrolyte imbalance Fatalities are common

in young

PREVENTION OF SWINE FLU

WHAT SHOULD I DO TO KEEP FROM GETTING THE FLU ?

Wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active,

manage your stress. Drink plenty of fluids. Eat nutritious food. Try not to touch surfaces that may be

contaminated with the flu virus. Avoid close contact with people who are

sick.

WHAT SHOULD I DO TO KEEP FROM GETTING THE FLU ?

SAFETY PRECAUTIONS 9 Avoid live animal markets, poultry and pig

farms in affected countries 9 Always maintain high levels of personal

hygiene, especially before and after food preparation and in-out of toilets. Regular wash your hands

9 Cook pork thoroughly 9 Do not consume half-cooked pork 9 While in an affected region, seek immediate

medical attention if you develop influenza-like symptoms. (High Fever, body pain, coughing and red nose)

• Frequent hand washing

• Covering coughs and sneezes

• Avoidance of crowded settings when possible

• Advising ill persons to stay home (except to seek medical care) and minimize contact with others in household

• Voluntary home quarantine of members of households with confirmed or probable swine influenza cases

WHAT IS THE BEST WAY TO KEEP FROM SPREADING THE VIRUS THROUGH COUGHING OR SNEEZING ?

If you are sick, limit your contact with other people as much as possible.

Do not go to work , stay at home

or in your hotel room.

Cover your mouth and nose with a mask when coughing or sneezing.

Put your used tissue in the waste

basket.

Cover your cough or sneeze if you do not have a mask.

Clean your hands, and do so

every time you cough or sneeze.

FOOD SAFETY ISSUES

Cook food thoroughly

Follow good hygienic practices

No “pink” parts for meat

Buy food from safe and established supermarkets

Check the expiry date (if any)

Choose a clean and known restaurant for dining

IS IT SAFE TO EAT PORK ?

X Swine influenza viruses does not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

TRAVEL HEALTH

9 WHO does not recommend any travel restrictions to areas experiencing outbreaks, including countries, which have reported, associated cases of human infection.

9 WHO does not, at present recommend the routine screening of travelers coming from affected areas.

IS THERE A VACCINE FOR PANDEMIC FLU?

Because the virus is new, there will be no vaccine ready to protect against pandemic flu.

Vaccine against Swine Flu virus H1N1 needs at least 6-12 months to be produced.

Seasonal flu vaccine or past flu immunization will not provide protection.

Vaccine for human seasonal influenza does not protect against H1N1 swine flu viruses due to antigenic differences, but may provide partial protection against swine H3N2 virusA vaccine has been developed, tested, and now FDA approved and an increasing supply of doses are arriving at doctor's office and clinics to help prevent infections from the 2009 H1N1 strain of the flu.

These vaccines either contain inactivated (killed) influenza virus, or weakened live virus that cannot cause influenza. The killed vaccine is injected, while the live vaccine is given as a nasal spray. Both these types of vaccine are usually produced by growing the virus in chicken eggs. Around three billion doses will be produced annually, with delivery from November 2009.

Vaccination

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that swine flu vaccine should first go to:

Pregnant women Household contacts and caregivers for children younger than 6 months of age Healthcare and emergency medical services personnel All children and young adults from 6 months through 24 years of age, and Persons aged 25 through 64 years.

Who will get the swine flu vaccine?

* consider Facemasks (disposable, single use masks) for persons who enter crowded settings

* consider Respirators (N95 or higher filtering face piece respirator) for persons who have unavoidable close contact with infectious person

No clear scientific evidence regarding the effectiveness of facemasks and respirators in protecting against influenza

INDICATIONS * Household close contacts (of confirmed, probable, or suspected case) at high-risk for complications of influenza + chronic medical conditions + aged ≥ 65 years + aged ≤ 5 years + pregnant women

* School children or children in daycare at high-risk for complications of influenza (certain chronic medical conditions) who had close contact (face-to-face) with confirmed, probable, or suspected case

TREATMENT

* Any healthcare worker at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) working in area with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness

* Non-high risk travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection

INDICATIONS

• Pre-exposure – Treat during exposure period and for 10 days after last known exposure to ill confirmed case of swine influenza A (H1N1) virus infection

• Post-exposure – Treat for 10 days after last known exposure to ill confirmed case of swine influenza A (H1N1) virus infection

CHEMOPROPHYLAXIS

Zanamivir ( Relenza ) 10 mg (2 inhalations) once daily for adults and children ≥ 5 years old

Oseltamivir ( Tamiflu ) orally adults and children ≥ 13 years old - 75 mg once daily children aged 1-12 years - dose based on weight

≤ 15 kg 30 mg once daily 15-23 kg 45 mg once daily 23-40 kg 60 mg once daily > 40 kg 75 mg once daily

DOSING OF ANTIVIRALS

AYURVEDIC TREATMENT FOR SWINE FLU

According to “baba ramdev” treatment for swine flu includes : INGREDIENTS :Take GILOY, one foot long branch and 7 leaves of TULSI.

PROCEDURE :Mix it and collect juice of this mixture in a pot. Now boil the juice and drink it. This herbal juice increases our body’s resistance up to 3 times.

NURSING RESPONSIBILITIES Educating themselves and their

communities about the disease and its prevention.

Each nurse must have capability to develop comprehensive plans and interventions to tackle the disease.

Nurses should update their knowledge from time to time.

Nursing superintendent should motivate and facilitate their staff to get pertinent information, clinical guidance and recommendations to handle disease.

Follow strict standard infection control measures while attending the confirmed and suspected cases of swine flu.

Isolating the suspected and confirmed cases.

Nurse should prepare themselves not only for patients with illness but also for questions and concerns from public.

NURSING RESPONSIBILITIES Keep practicing same precautions. Instruct the clients for who are coughing

and sneezing to wear mask, wiping down surfaces and frequent hand washing.

Nurses should collect detailed history. Attend the suspected or confirmed client

in isolated rooms. Nurses should protect themselves by

personal protective equipments (PPE) like mask, gloves , gown and eye protection goggles while attending clients.

Collect the sample for examination of suspected cases with caution.

Nurses who are not using PPE should take antiviral drugs as prophylaxis.

Nurses should be aware of plans of their institutions.

Nurses should have knowledge of microbiology.