Archive for the ‘Influenza A’ Tag

Swine Flu Influenza: Questions & Answers

What are the symptoms of swine influenza?
The symptoms of swine influenza in people are similar to the symptoms of common human seasonal influenza infection and include fever, fatigue, lack of appetite, coughing and sore throat. Some people with swine flu have also reported vomiting and diarrhoea.

Swine flu is only diagnosed currently with a fever (or fever history) and flu symptoms and travel (within 7 days) to Mexico or parts of the US and Canada. This remains unlikely for most people.

If someone who has been to affected areas is feeling sick what should they do?
Follow the guidance issued to each household this week and call the NHS helpline or local NHS direct.  People are advised NOT to go to their GP but to stay indoors and get a ‘Flu Friend’ to do the running around for them.

Anyone who has recently travelled to the affected areas and is experiencing influenza-like illness should stay at home to limit contact with others, and seek medical advice from a local health professional or by contacting NHS Direct on 0845 46 47.  Anyone returning from infected areas who is otherwise well should contact Occupational Health through their line manager for advice on returning to work.  Most people will be fit for work if they are feeling well and have not come into contact with anyone proven to have caught Influenza type A H1N1(Swine Flu).

Is treatment available?
Testing has shown that the effect of the human influenza H1N1 can be modified with the antiviral medication.  Most of the previously reported swine influenza cases recovered fully from the disease with simple medical attention and antiviral medicines.

The UK is well prepared with pandemic action plans, flu vaccination and antiviral stocks.

Is this swine flu virus contagious?
It has been determined that this virus is contagious and it spreads between people, although it is not known how easily.  Cases in the UK have been mild and many suspected cases have proven negative so far. The public are being advised to follow the advice in the leaflet distributed to all households (wc 11 May 2009).

How common are cases of swine influenza?
Cases of swine influenza in humans initially occured after direct or close contact with infected pigs. The person-to-person transmission has now been reported and is the main method of spread to humans. However, the number of cases in the UK is still small at the moment and the symptoms in most cases are mild.

What measures can I take to protect against infection?
Advice is given in the leaflet distributed to all households (wc 11 May 2009). General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including the human swine influenza. This includes:

  1. Covering your nose and mouth when coughing or sneezing, using a tissue when possible
  2. Disposing of dirty tissues promptly and carefully
  3. Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people
  4. Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product
  5. Making sure your children follow this advice

What level of alert have we reached and what does this mean?
The World Health Organization (WHO) raised its pandemic alert level to Phase 5 on Tuesday 29 April 2009. The Director-General of WHO is the decision maker in terms of elevating the global stages of pandemic alert.  Experts from around the world are working in close collaboration with WHO to help determine what risk this situation poses to global public health.

The current phase 5 is characterised by consistent ‘human-to-human’ spread of the virus in at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a severe pandemic could be imminent and that the time to finalise the organisation, communication and implementation of the planned mitigation measures is short.

Equally this does not mean that a severe pandemic will definitely occur or define its severity.

What is the difference between seasonal influenza, avian influenza, swine influenza and an influenza pandemic?
Influenza viruses are commonly circulating in the human and animal environment. Different strains can cause illness in humans, bird and pigs.

Seasonal influenza is caused by influenza viruses that are adapted to spread between humans (human influenza). Humans have some natural immunity to the strains that are in common circulation, and this immunity can be boosted by immunisation with a seasonal influenza vaccine.

Avian influenza is caused by influenza viruses adapted for infection in birds. Similarly, swine influenza is caused by influenza viruses adapted for infection in pigs.  These illnesses all elicit the same respiratory symptoms in their hosts. Sometimes, humans and animals can pass strains of influenza back and forth to one another, such as when humans become ill with avian or swine influenza, usually from direct contact with animals who are ill.

Mixing of human and animal influenza viruses can lead to the development of changed viruses with the ability to cause infection and spread in the human population. There may be little or no immunity in the human population to these new viruses.

An influenza pandemic is defined as a new or novel influenza virus that spreads easily between humans. When new influenza viruses are introduced into the environment, humans don’t have any natural immunity to protect against them. Therefore, there is a risk that that new influenza viruses could develop into a pandemic if the newly adapted virus starts to pass easily from human to human.

Can I catch Swine Flu from pork products?
People will not get swine flu from eating pork or pork products

It is important to stress that swine influenza viruses are not transmitted by food. There is no risk of catching the illness from eating properly handled and cooked pork or pork products.

Can I do anything to prepare?
Sensible personal steps might include thinking about;

    • Emergency contact numbers for medical services
    • Ordering repeat prescriptions if you have a pre-existing medical condition
    • Avoiding large public gatherings
    • Thinking about what strain on national infrastructure might mean for you and your family
    • Increased hygiene measures and infection prevention measures at home and at work.

How is this likely to develop? Will it come back?

Clinical professionals are tracking the numbers of cases being tested and confirmed diagnoses.  The virus is not spreading as fast or with the severity that was first predicted in Mexico.  It is important that the UK maintains its state of planning should the virus change or cases rise with seasonal influenza in the Autumn.

When did Nuffield Health start mobilising for a pandemic?
Nuffield Health has prepared fully for this event over the past 3 years through our clinical and occupational health teams to ensure we have prudent business plans in place for pandemic flu which fits into our Group approach to crisis management.

What is Nuffield Health doing currently?
We are prepared as a business.  In essence, we are following the HPA guidance and working closely with local PCTs.

A pandemic influenza team is leading our business continuity plans with regular meetings and communication to our hospitals and centres as things develop internationally. The team is being led by the Group Medical Director supported by an external consultant microbiologist. Nuffield Health holds good stocks of antiviral and antibacterial medication and infection prevention equipment, our staff have been highly trained in infection prevention procedures. We are in regular contact with local and national public organisations coordinating influenza planning.

At what point will Nuffield Health start treating people for swine flu?
When they meet the criteria as outlined by the HPA for treatment (includes actual & prophylactic treatment).

What has and is happening to us, our patients and customers?
At present, as an organisation, we are in a planning phase.  Services to patients and customers have not been directly affected although information is exchanged on a daily basis with our 200 business units and we have recommended to our staff and customers that now is the right opportunity to familiarise themselves with national procedures and policies.

What trends is Nuffield Health seeing?
Nationally the trend has been one of mild illness with no real impact on day to day activities for the average person and in the UK we are not seeing the number of deaths feared at the beginning.

Is Nuffield Health in communication with the HPA / DH? If so, to what level?
Yes, via our Group Consultant Microbiologist & Group Medical Director who both do work for and have contact with the Department. Our Occupational Health manager has been part of the DH pandemic flu planning committee.

Is Nuffield Health helping local PCTs deal with swine flu? If so, how?
All hospitals are involved in their local emergency planning teams that are PCT co-ordinated.

If a pandemic does become reality and deaths occur all healthcare facilities will work together to assist with public health and business continuity.

If a pandemic does become reality and deaths occur, the HPA have the power to commandeer our hospitals and staff for whatever purpose they see fit.

Where does Nuffield Health stand now with regard to the development of a possible pandemic?
We stand concerned that there will be a second wave in the Autumn that will be more virulent (stronger and more likely to kill).

Is the organization less or more nervous than before?
Nuffield Health is well prepared for any escalation in the present situation but overall we are probably not as nervous as at the outset although we are aware that things may change in the Autumn.

How well do you think the Government / authorities have performed?
As well as can be expected and rapidly in response to developments – this is new to all of us worldwide but internationally it is very joined up and efficient.

Do you think the threat of a pandemic has been overstated by the authorities/media?
At present the trend appears to be one of mild illness with no real impact and the number of deaths in the UK is not as many as had been feared.  However, it is better to plan for the worst and hope for the best and Nuffield Health is taking the prudent approach and planning for all eventualities. It’s all too easy to judge with hindsight but no-one knows for certain how things will develop. The public is being given information and practical advice from the relevant authorities.


Classification of Swine Flu

Of the three genera of influenza viruses that cause human flu, two also cause influenza in pigs, with Influenza virus A being common in pigs and Influenza virus C being rare. Influenza virus B has not been reported in pigs. Within Influenzavirus A and Influenzavirus C, the strains found in pigs and humans are largely distinct, although due to reassortment there have been transfers of genes among strains crossing swine, avian, and human species boundaries.

Influenza C

Influenza C viruses infect both humans and pigs, but do not infect birds. Transmission between pigs and humans have occurred in the past. For example, influenza C caused a small outbreaks of a mild form of influenza amongst children in Japan, and California. Due to its limited host range and the lack of genetic diversity in influenza C, this form of influenza does not cause pandemics in humans.

Influenza A

Swine influenza is known to be caused by influenza A subtypes H1N1, H1N2, H3N1, H3N2 and H2N3. In pigs, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are the most common strains worldwide. In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.

A/Veracruz/2009 (H1N1)

A/Veracruz/2009 (H1N1), the new strain of swine influenza A (H1N1) involved in the 2009 flu outbreak in humans, is a reassortment of several strains of influenza A virus subtype H1N1 that are usually found separately, in humans, birds, and pigs. Preliminary data suggest that the hemagglutinin (HA) gene was similar to that of swine flu viruses present in United States pigs since 1999, but the neuraminidase (NA) and matrix protein (M) genes resembled viruses present in European pigs. Viruses with this genetic makeup had not previously been found to be circulating in humans or pigs, although there is no formal national surveillance system to determine what viruses are circulating in pigs in the United States.