H1N1 Swine Flu

In late March and early April 2009, an outbreak of H1N1 influenza A virus infection was detected in Mexico, with subsequent cases observed in many other countries, including the United States.

As the H1N1 swine flu sweeps across the world, it is important to keep several things in mind. First of all, while all flu is deadly, this one appears milder in symptoms and duration than the common flu. What distinguishes H1N1 is that it is highly contagious, and those who are getting sick are children and young adults.
It seems to be epidemic in the middle- and high-school age range. This flu easily develops into a harsh-cough stage.
Like other influenza viruses, this H1N1 strain is spread by coughing, sneezing or touching contaminated surfaces, and then touching the nose or mouth. Symptoms, which last up to a week, are similar to those of seasonal flu, and can include fever, sneezing, sore throat, cough, headache, and muscle or joint pains. The main symptoms are fever (101-103°F) with chills or shivering, and headache.

The following case definitions have been provided by the United States Centers for Disease Control and Prevention:
* Influenza-like illness (ILI) is defined as fever (temperature of 100ºF [37.8ºC] or greater) with cough or sore throat in the absence of a known cause other than influenza.
* A confirmed case of pandemic H1N1 influenza A is defined as an individual with an ILI with laboratory-confirmed H1N1 influenza A virus detected by real-time reverse transcriptase (rRT)-PCR or culture.
* Pandemic H1N1 influenza A may be suspected in an individual who does not meet the definition of confirmed pandemic H1N1 influenza A, but has an ILI and an epidemiologic link.

High risk groups for the development of complications of pandemic H1N1 influenza A are thought to be similar to those defined for seasonal influenza.

High risk groups include:
* Children younger than 5 years of age, but especially those younger than 2
* Individuals 65 years of age or older
* Pregnant women and women up to two weeks postpartum (including those who have had pregnancy loss)
* Individuals younger than 19 years of age who are receiving long-term aspirin therapy and who therefore might be at risk for Reye syndrome after influenza virus infection
* Individuals of any age with chronic medical conditions requiring ongoing medical care, including:
- Chronic pulmonary disease, including asthma (particularly if systemic glucocorticoids have been required during the past year)
- Cardiovascular disease, except isolated hypertension
- Active malignancy
- Chronic renal insufficiency
- Chronic liver disease
- Diabetes mellitus

MEDICAL CARE FOR SUSPECTED CASES
Not all individuals with suspected pandemic H1N1 influenza A infection need to be seen by a health care provider or treated.
Patients with severe illness and those at high risk of complications from influenza should contact their health care provider or seek medical care.

Homeopathy can prevent, cure swine flu:
Homeopathy can both prevent and cure swine flu, sans any side effects, say doctors who practice this alternative medicine system in India where over 700 people have been diagnosed with the disease.

Amid panic over the spread of influenza A (H1N1) virus, homeopaths are now drafting a proposal for the health ministry to offer their services in tackling the crisis.

"Based on the symptoms, homeopathy can offer an effective cure to swine flu. Moreover, it does not have any side effects,"Harcharanjeet Kaur, a homeopath at Baksons homeopathy clinic, told IANS.

Well-known Delhi-based homeopath Mukesh Batra cited the instance of the Spanish flu epidemic of 1918 in which more than 50 million people were killed worldwide. He said the mortality rate of people given allopathic treatment was 28.2 percent, while those given homeopathic treatment was 1.05 percent at that time.

"Gelsemium and Bryonia were the two homeopathic remedies that proved to be effective against the H1N1 strain back then. These could be of great use even today," Batra said.

Explaining the way homeopathy works, Jaipur-based homeopath Manish Bhatia said this form of medicine works on the basis of symptoms and not the disease.

"In homeopathy, there is a concept called Genus epidemicus. This means if there is an epidemic and you take the symptoms of say 15 ailing people of an area, you will notice a common trend. Based on that you give medication - for the symptoms. This same medication then, if given to people of that area, can act as a preventive medicine," Bhatia said phone.

Besides symptoms like running nose, fever, sneezing and dullness that are the same for common flu and swine flu patients, those suffering from the latter may also have gastric problems like nausea and vomiting, Bhatia said.
"Based on the symptoms, there may be different curative medications for different cases of swine flu. One or two of these medications will be used more frequently than the others and this can then be given to others as preventive medication," Bhatia said.

Ayurvedic centre claims it has cure for swine flu:
An Ayurvedic research centre specializing in medicines derived from cow products and derivatives Monday claimed that its formulations can prevent and "possibly" cure swine flu and similar contagious diseases.

"Panchgavya", a formulation comprising cow milk, cow urine and cow dung as well as ghee and curd made from cow milk can prevent flu-like infections including swine flu by acting as an immuno-modulator, Meera Aurangabadkar, a senior Ayurvedic teacher associated with the Go-Vigyan Anusandhan Kendra here, told reporters.

"Various Ayurvedic medicines, particularly those prepared from cow products, have for centuries proved potent to build resistance against infectious diseases like flu. We would advise people to take the same along with modern medicines prescribed by experts," Aurangabadkar said.

She said cow urine concentrate, called "Kamdhenu Ark", could be extremely useful in protecting people against the virus and "probably" also in providing relief to those who have already caught the infection.

Tapan Chakravarty, director of the National Environmental Engineering Research Institute (NEERI), who is closely associated with the Go-Vigyan Kendra, said both "Panchgavya" and "Kamdhenu Ark" contain volatile fatty acids and have at the same time anti-oxidant properties.
They can help reduce the virulence and multiplication of the viruses such as the one causing swine flu.

"The centre is willing to work in concert with the medical establishment engaged in combating the disease," said its director Sunil Mansinghka.

Symptoms of Swine Flu

Symptoms in children, emergency warning signs that need urgent medical attention include:

* Fast breathing or trouble breathing
* Bluish or gray skin color
* Not drinking enough fluids
* Severe or persistent vomiting
* 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

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
* Flu-like symptoms improve but then return with fever and worse cough


Steps to lessen the spread of Flu in the home

Placement of the sick person:

* Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed.
* Unless necessary for medical care, persons with the flu should not leave the home when they have a fever or during the time that they are most likely to spread their infection to others.
* If persons with the flu need to leave the home (for example, for medical care), they should cover their nose and mouth when coughing or sneezing and wear a loose-fitting (surgical) mask if available.
* Have the sick person wear a surgical mask if they need to be in a common area of the house near other persons.
* If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant.

Protect other persons in the home:

* The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
* If possible, have only one adult in the home take care of the sick person.
* Avoid having pregnant women care for the sick person.
* All persons in the household should clean their hands with soap and water or an alcohol-based hand rub frequently, including after every contact with the sick person or the person’s room or bathroom.
* Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
* If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).

If you are the caregiver:

* Avoid being face-to-face with the sick person. When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
* Clean your hands with soap and water or use an alcohol-based hand rub after you touch the sick person or handle used tissues, or laundry.
* Talk to your Doctor about taking antiviral medication to prevent the caregiver from getting the flu.
* Monitor yourself and household members for flu symptoms and contact the local H1N1 Command Center if the symptoms occur.


Below are the list of Hospitals identified by Government of India as the facilities for Swine Flu isolation and critical care.

1. General Hospital, Thiruvanathanapuram, Kerala-695025
[Dr. Suresh - 09447030291] {Isolation and Critical care}

2. District Hospital, Manjeri; District-Malappuram, Kerala
[Dr. Ramani – 09447157128, Krishna – 9388014526] {Isolation}

3. Taluk Head Quarter Hospital, Perumbavoor, Ernakulum District, Kerala-683542 {Isolation}
[Dr. Rosy Sebastian - 09846948926, Dr. Sudha Karan – 9446505990]

Checklist:
This checklist is intended for use by hospital staff treating anyone with a medically suspected or confirmed case of new influenza
A (H1N1) per local definition. This checklist highlights areas of care critical for the management of new influenza A (H1N1).

It is not intended to replace routine care

UPON ARRIVAL TO CLINICAL SETTING/TRIAGE

* Direct patient with flu-like symptoms to designated waiting area
* Provide instruction and materials to patient on respiratory hygiene/cough etiquette
* Put medical/surgical mask on patient if available and tolerable to patient

UPON INITIAL ASSESSMENT

* Record respiratory rate over one full minute and oxygen saturation if possible
* If respiratory rate is high or oxygen saturation is below 90% alert senior care staff for action
* Record history, including flu-like symptoms, date of onset, travel, contact with people who have flu-like symptoms, co-morbidities
* Consider specialized diagnostic tests (e.g. RT-PCR)
* Use medical/surgical mask, eye protection, gloves when taking respiratory samples
* Label specimen correctly and send as per local regulations with biohazard precautions
* Consider alternative or additional diagnoses
* Report suspected case to local authority

INITIAL AND ONGOING PATIENT MANAGEMENT

Supportive therapy for new influenza A (H1N1) patient as for any influenza patient including:

* Give oxygen to maintain oxygen saturation above 90% or if respiratory rate is elevated (when oxygen saturation monitor not available)
* Give paracetamol/acetaminophen if considering an antipyretic for patients less than 18 years old
* Give appropriate antibiotic if evidence of secondary bacterial infection (e.g. pneumonia)
* Consider alternative or additional diagnoses
* Decide on need for antivirals (oseltamivir or zanamivir), considering contra-indications and drug interactions.

BEFORE PATIENT TRANSPORT/TRANSFER

Put medical/surgical mask on patient if available and tolerable to patient

BEFORE EVERY PATIENT CONTACT

* Put on medical/surgical mask
* Clean hands
* Put on eye protection, gown and gloves if there is risk of exposure to body fluids/splashes
* Clean and disinfect personal/dedicated patient equipment between patients
* Change gloves (if applicable) and clean hands between patients

IF USING AEROSOL-GENERATING PROCEDURES

* ALSO (e.g. intubations, bronchoscope, CPR, suction)
* Allow entry of essential staff only
* Put on gown
* Put on particulate respirator if available
* Put on eye protection, and then put on gloves
* Perform planned procedure in an adequately ventilated room

BEFORE PATIENT ENTRY TO DESIGNATED AREA (isolation room or cohort)

* Post restricted entry and infection control signs
* Provide dedicated patient equipment if available
* Ensure at least 1 meter (3.3 feet) between patients in cohort area
* Ensure local protocol for frequent linen and surface cleaning in place

BEFORE ENTERING DESIGNATED AREA (isolation room or cohort)

* Put on medical/surgical mask
* Clean hands

BEFORE LEAVING DESIGNATED AREA (isolation room or cohort)

* Remove any personal protective equipment (gloves, gown, mask, eye protection)
* Dispose of disposable items as per local protocol
* Clean hands
* Clean and disinfect dedicated patient equipment and personal equipment that has been in contact with patient
* Dispose of viral-contaminated waste as clinical waste
* The above applies to visitors also

BEFORE DISCHARGE OF CONFIRMED OR SUSPECTED CASE

* Provide instruction and materials to patient/caregiver on respiratory hygiene/cough etiquette
* Provide advice on home isolation, infection control and limiting social contact
* Record patient address and telephone number

AFTER DISCHARGE

* Dispose of or clean and disinfect dedicated patient equipment as per local protocol
* Change and launder linen without shaking
* Clean surfaces as per local protocol
* Dispose of viral-contaminated waste as clinical waste