For the past decade, one pandemic after another has gripped the world, putting us in a state of panic. First it was SARS, then Bird Flu and now the Swine flu. To date more than 800 people have died, with the virus having spread the world over. What was detected in March as an outbreak in Mexico was declared a pandemic of Alert Level six (the maximum) by the World Health Organisation (WHO) in June. On a separate scale for severity it is assessed as moderate.

Swine influenza virus infecting pigs is common throughout pig population. Transmission of the virus from pigs to humans is not common, but is occasionally possible, especially in swine farms where farmers are in close contact with pigs.

The swine flu pandemic is the result of a new strain of influenza-A (H1N1) — a re-assortment of four known strains of influenza A virus one endemic in humans, one in birds and two in pigs. It began to infect people who worked with pigs but is now transmitting from human to human. Swine flu spreads by coughing or sneezing or direct contact with respiratory secretions of an infected person. The virus can linger on surfaces like a doorknob, telephone, etc. touched by someone who had sneezed in his hands, and be transferred to people who touch their mouth or nose with unwashed hands after touching contaminated surfaces.

People with swine flu are contagious for one day before and up to seven days after they begin to get sick with symptoms. It is most contagious during the first five days of the illness although some people, most commonly children, remain contagious for up to ten days.

Since the main route of transmission seems to be similar to seasonal influenza, i.e. via droplets that are expelled by speaking, sneezing or coughing, prevention include standard infection control measures for influenza. This includes avoiding close contact with people who show influenza like symptoms, washing hands with soap and water or with sanitisers, especially after being in crowded public areas, or touching surfaces that are potentially contaminated; avoid touching one's nose or mouth and improving airflow in one's living space by opening windows. Healthy habits including adequate sleep, eating a balanced nutritious food and being physically active are also helpful. The symptoms of swine flu are similar to those of other forms of influenza and include fever, cough, sore throat, body ache, headache, chills, pain in the muscles or joints, runny nose and fatigue. Diarrhoea and vomiting have also been reported in some cases. People at high risk of serious complications include people aged 65 and older, children younger than five years of age, pregnant women, and people with underlying medical conditions such as asthma, diabetes, obesity, heart disease or a weakened immune system.

Certain symptoms may require emergency medical attention, like signs of respiratory distress, dehydration, rapid breathing, excessive sleeping, seizures and significant irritability in children, and shortness of breath, pain in the chest or abdomen, sudden dizziness or confusion may indicate the need for emergency care in adults. Persistent vomiting or the return of flu like symptoms also requires medical attention.

The most common cause of death is respiratory failure; other causes of death are pneumonia, high fever (leading to neurological problems), dehydration and electrolyte imbalance. Fatalities are more likely in young children and the elderly.

Swine flu should be considered in people with sudden feverish illness who got ill within seven days of returning from an area with swine flu, or live in an area where a case of swine flu has been confirmed.

Treatment of swine flu focuses on controlling fever, relieving pain, taking plenty of fluids to maintain fluid balance as well as identifying and treating any secondary infections or other medical problems. Antiviral drugs work best if started soon after getting sick (with two days of symptoms).

The majority of people who contact the virus experience the milder disease and recover with antiviral treatment and rest. Of the more serious cases, which needed hospitalisation, more than half had underlying conditions or weak immune systems.

As yet no vaccine is available to provide protection against the new strain of swine flu, though it is being developed but it would not be widely available until the end of 2009. Hence, the only means of protection is taking preventive steps.

The impression that Pakistan has no potential threat from the disease since pigs are not farmed here has to be dispelled as the virus is being transferred from human to human.

With the virus spreading in our neighbouring countries, and a case already detected in the country, we have to be vigilant and take appropriate measures to combat any outbreak. The best option is to create awareness among the population to take protective measures.



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