Swine Influenza Virus - Research Paper Example

 Abstract Swine influenza virus (SIV) is the influenza type A virus which is responsible for respiratory disease ‘swine flu’. The dynamic and complex nature of influenza virus had resulted in three pandemics and several "pandemic scares". The year 2009 began with a new influenza pandemic form a strain of Influenza A virus subtype H1N1. At the end of April, the World Health Organization's pandemic alert level went to phase 5, and raised to highest level at 6 in June 2009. The treatment strategy and the second line of defense to prohibit spread of virus is the use of antiviral drugs such as oseltamivir and zanamivir. To reduce the enormous global burden and long-term goal of better control of communicable diseases, there is a need for international surveillance, timely vaccine development and production, and the ability to administer vaccine to large numbers of people in a short amount of time. The coordinated efforts and commitment of government resources with synergistic national strategy contributions from non-governmental organizations, academic institutions, public-spirited individuals, the community and the devotion and dedication of the staff and availability of ample resources should deliver positive control in swine flu. Introduction The communicable diseases have undergone many transformations over human history. As the life expectancy is increased in developed countries, along with it new infectious diseases also have emerged. As the global environment is changing at fast pace due to various issues such as migration, famine, fire, war, and terrorism the paths of disease transmission of infectious diseases are also varying and therefore, offering more challenges. The dynamic and complex nature of influenza virus had resulted in three pandemics and several "pandemic scares" during the 20th century alone. A respiratory disease ‘swine influenza’ is caused due to any strain of the influenza family of viruses. The pigs are host animals and therefore it is called ‘swine flu, hog flu or pig flu’ and the infection is generally not transmitted to humans. But, the disease has jumped from animals to humans and has become zoonotic. Initially they were restricted initially to small population, but due to modernization and shrinking of the world, the transmission became epidemic, and then pandemic. The year 2009 began with a new influenza pandemic form a strain of Influenza A virus subtype H1N1. At the end of April, the World Health Organization's pandemic alert level went to phase 5, and raised to highest level at 6 in June 2009 (BBC News, June 11, 2009). On 11 June 2009 Dr Margaret Chan, Director-General of the World Health Organization (WHO), declared this as first pandemic of the 21st Century which is detected early verifying 30,000 cases globally. Swine influenza virus (SIV) is an orthomyxovirus of the influenza type A with hemagglutinating antigen H1 and neuraminidase antigen N1 (ie, H1N1). Other subtypes of SIV include H3N2 and H1N2. Influenza type B and C viruses have not reported for any outbreak uptil now (The Merck Veterinary Manual, 2008). This is an airborne disease and people exposed to infected droplet nuclei get easily infected. It spreads through activities like cough, sneeze, etc. of the disease carrying person. The entire influenza pandemic showed characteristic symptoms like fever, extreme chills, and fatigue were often accompanied by cough, sore throat, runny or stuffy nose, body aches, headache, and sometimes, diarrhea and vomiting (CDC, September 29, 2009). The person also has a greater chance of serious flu complications. The person also shows manifestations such as shortness of breath, chest pain/pressure, dizziness, or confusion as the disease proceeds (CDC, September 29, 2009). High risk individuals who are highly susceptible to swine influenza include: children less than 2 years old, elderly population having age greater than 65 years, pregnant women and women up to 2 weeks after delivery, individuals with certain chronic disorders or ailments (such as asthma, heart failure, chronic lung disease) and people having immunocompromised system (such as diabetes, HIV), people younger than 19 years of age who are receiving long-term aspirin therapy. In addition to this, the children between 2 to 4 years of age also have a higher rate of complications compared to older children (CDC, October 8, 2009). The special influenza diagnostic tests are performed in specialized laboratories and state public health laboratories by health care provider relying on the clinical judgment of the doctor and the patient’s symptoms. The swab samples are collected from the inside of the nose or the back of the throat of the suspected individual. These tests are much more accurate and sensitive than “rapid influenza diagnostic tests” which are performed in outpatient settings. The diagnosis with the help of as real-time reverse transcriptase polymerase chain reaction (rRT-PCR) gave the most accurate results but takes longer duration to yield result (CDC, September 29, 2009). Stages of a pandemic The Centers of Disease Control and Prevention (CDC) has categorized pandemic into three stages: interpandemic (IP), pandemic alert period (PAP), pandemic period (PP). IP is the phase in which new disease is detected in population, in PAP the disease gets transmitted from one individual to another, PP is the widespread phase of the disease (Segall, 2007, p. 10). In 2009, WHO has further divided these into a six-phased approach for influenza pandemic: phases 1-3 (mainly animal infections and few human infections), phases 4 (sustained human to human transmission, phases 5-6 pandemic (widespread human infection), post peak (recurring events), post pandemic (disease activity at seasonal levels). These phases show stepwise approach for preparing, planning, and development activities for the response, mitigation efforts in the pandemic phase and then recovery period to maintain surveillance (WHO, 2009). The Worldwide H1N1 (Swine Flu) Infection Data is tabulated in the Table 1 (flucount.org, 2009). Table 1 Worldwide H1N1 (Swine Flu) Infection Data Summary of Statistics Official US Total: (According to CDC) 44555 cases, 4008 deaths Unofficial US Total: (Other Reliable Sources) 90735 cases, 4008 deaths Worldwide Total: (Various Reliable Sources) 702086 cases, 11073 deaths Most Infected States: (According to CDC) Wisconsin: 6222 cases Texas: 5151 cases Illinois: 3404 cases Most Infected Countries: (Various Reliable Sources) China (Mainland): 64296 cases Mexico: 61633 cases Germany: 53957 cases Preparation, Control and Prevention Inspite of the developments in drug treatment and strategies, pandemic offers unmet challenges. To reduce the enormous global burden and long-term goal of better control of communicable diseases, there is a need for international surveillance, timely vaccine development and production, and the ability to administer vaccine to large numbers of people in a short amount of time. Moreover, the strategies regarding effective communication systems and emergency response systems should be properly designed and administered for managing a pandemic (HHS, 2006). There is a need to focus on many vital aspects of responding to the next pandemic (HHS, 2006). The objective of prevention technique should be reducing an individual's susceptibility to disease by teaching people, vulnerable groups and health care providers about the disease and transmission. Therefore, it is necessary to identify and focus high risk group population for targeting prevention programs. Special precautionary measures should be employed such as prohibition of overcrowding, maintenance of good ventilation, isolation of infectious individual to avoid transmission to others (Alves-Dunkerson J. & Dunkerson D.). Early symptoms awareness should be created through health education promoting activities like campaigns, mass media, internet, pamphlets, poster, slide etc. Health talks should be given to public about adequate exercise, enough rest and sleep, balanced diet, avoidance of smoking and alcohol, breathing fresh air and maintaining good indoor ventilation, good personal hygiene in order to improve and enjoy the positive health and psychological benefits throughout their lives. To reduce propagation of pandemic, legislative, political, and cultural factors should be considered to fund educational programs and improve living conditions of the most vulnerable population. Financial and nutritional back up, HIV counseling, enhancing the public health infrastructure to effectively implement pandemic-affiliated programs (HHS, 2006), and to reduce obstacles in prevention and treatment programs are also considered very important issues (Alves-Dunkerson J. & Dunkerson D.). The U.S. Food and Drug Administration has approved five vaccines to combat with 2009 H1N1 influenza virus as the first and most important step in preventing flu. These vaccines are being manufactured by companies such as CSL Limited, MedImmune LLC, Novartis Vaccines and Diagnostics Limited, sanofi pasteur Inc,. ID Biomedical Corp. of Quebec (FDA News Release, September 15, 2009; FDA Note To Correspondents, November 16, 2009). After vaccination, soreness might appear at the innoculation site and the person might show mild manifestations like mild fever, body aches and fatigue for a few days. The patients are monitored by U.S. Department of Health and Human Services and government agencies for any adverse events. The second line of defense to prohibit spread of virus is the use of antiviral drugs such as oseltamivir and zanamivir. They are available in the market as Tamiflu® as a tablet or liquid and Relenza® in the form of powder which can be inhaled (CDC, October 8, 2009). The treatment should be started within 2 days after showing symptoms of swine flu and should be taken for 5 days or more in some patients. Tamiflu® and Relenza® display adverse effects like dizziness, nausea or vomiting, and therefore have to be taken with food to decrease the intensity of the symptoms. It has been recommended that some precautionary measures can reduce the likelihood of transmission. These include: washing hands frequently with soap and water or sanitizing with an alcohol-based hand rub, covering the mouth and nose with a tissue when coughing or sneezing, avoiding touching the eyes, nose and mouth, staying at home if influenza-like illness (ILI) are there, maintain at least 6 feet distance from individuals suffering from ILI. Use of N95 respirators or facemasks is advised for the persons who are in close contact with the individuals suffering from ILI (CDC, September 24, 2009). Conclusion A respiratory disease ‘swine influenza’ is zoonotic and caused due to any strain of the influenza family of viruses. Inspite of the developments in drug treatment and strategies, pandemic offers unmet challenges. It is necessary to identify and focus high risk group population for targeting prevention programs. Special precautionary measures should be employed such as prohibition of overcrowding, maintenance of good ventilation, isolation of infectious individual to avoid transmission to others. In order to be better prepared for the future, there must be continuous commitment from the government to develop an effective health care system, to give greater emphasis to health promotion and disease prevention, and to strengthen partnerships at regional and international levels. The coordinated efforts of local, state, and federal action with synergistic national as well as global strategy and availability of ample resources can deliver dramatic reduction in swine flu cases and better equipped for the future. References Alves-Dunkerson J. & Dunkerson D. The dental learning network, Chapter 8: Prevention and Treatment of Tuberculosis http://www.dentallearning.org/course/fde0014/c8/index.htm. AWHO 'declares swine flu pandemic BBC News. June 11, 2009. Available at: http://news.bbc.co.uk/2/hi/health/8094655.stm Centers for Disease Control and Prevention (CDC) 2009 H1N1 and Seasonal Flu: What You Should Know About Flu Antiviral Drugs. Updated on October 8, 2009. From: http://www.cdc.gov/H1N1flu/antivirals/geninfo.htm Centers for Disease Control and Prevention (CDC) 2009. Influenza Diagnostic Testing During the 2009-2010 Flu Season. Updated on September 29, 2009. From: http://www.cdc.gov/h1n1flu/diagnostic_testing_public_qa.htm Centers for Disease Control and Prevention (CDC) 2009. Interim Recommendations for Facemask and Respirator Use to Reduce 2009 Influenza A (H1N1) Virus Transmission. Updated on September 24, 2009. From: http://www.cdc.gov/h1n1flu/masks.htm FDA Note To Correspondents, November 16, 2009. FDA Approves Additional Vaccine for 2009 H1N1 Influenza Virus http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190783.htm FDA News Release, September 15, 2009. FDA Approves Vaccines for 2009 H1N1 Influenza Virus. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm182399.htm The Merck Veterinary Manual. 2008. Swine Influenza http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/121407.htm Segall, M., 2007. Pandemics: Epidemics in a Shrinking World. Illustrated, The Rosen Publishing Group. U.S. Department of Health & Human Services (HHS) 2004, February 12. National Vaccine Program Office: Pandemics and Pandemic Scares in the 20th Century http://www.hhs.gov/nvpo/pandemics/flu3.htm U.S. Department of Health & Human Services (HHS), 2006. National Vaccine Program Office: Preparing for the Next Pandemic. December 4. Available at: http://www.hhs.gov/nvpo/pandemics/flu5.htm WHO, 2009. Current WHO phase of pandemic alert Available at: http://www.who.int/csr/disease/avian_influenza/phase/en/index.html flucount.org, 2009. http://www.flucount.org/ updated on 11/19/09 Read More