H1N1 flu :: Pandemic swine flu – H1N1 Influenza

Novel H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans.

The 2009 flu outbreak in humans is due to a new strain of influenza A virus subtype H1N1 that derives in part from human influenza, avian influenza, and two separate strains of swine influenza. The origins of this new strain are unknown. It passes with apparent ease from human to human, an ability attributed to an as-yet unidentified mutation. The strain in most cases causes only mild symptoms and the infected person makes a full recovery without requiring medical attention and without the use of antiviral

H1N1 Influenza virus imageWhy is novel H1N1 virus sometimes called “swine flu”?

This virus was originally referred to as “swine flu” because laboratory testing 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.

Classification

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

Influenza A

Swine influenza is known to be caused by influenza- A, and its 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.

History

Swine influenza was first proposed to be a disease related to human influenza during the 1918 flu pandemic, when pigs became sick at the same time as humans. The first identification of an influenza virus as a cause of disease in pigs occurred about ten years later, in 1930. For the following 60 years, swine influenza strains were almost exclusively H1N1. Then, between 1997 and 2002, new strains of three different subtypes and five different genotypes emerged as causes of influenza among pigs in North America. In 1997-1998, H3N2 strains emerged. These strains, which include genes derived by re-assortment from human, swine and avian viruses, have become a major cause of swine influenza in North America. Re-combining between H1N1 and H3N2 produced H1N2 In 1999 in Canada; a strain of H4N6 crossed the species barrier from birds to pigs, but was contained on a single farm.

The H1N1 form of swine flu is one of the descendants of the strain that caused the 1918 flu pandemic As well as persisting in pigs, the descendants of the 1918 virus have also circulated in humans through the 20th century, contributing to the normal seasonal epidemics of influenza. However, direct transmission from pigs to humans is rare, with only 12 cases in the U.S. since 2005 Nevertheless, the retention of influenza strains in pigs after these strains have disappeared from the human population might make pigs a reservoir where influenza viruses could persist, later emerging to reinfect humans once human immunity to these strains has waned.

Swine flu has been reported numerous times as a zoonosis in humans, usually with limited distribution, rarely with a widespread distribution. Outbreaks in swine are common and cause significant economic losses in industry, primarily by causing stunting and extended time to market. For example, this disease costs the British meat industry about £65 million every year.

Why is swine flu now infecting humans?

Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu becoming a major cause for influenza illness in humans.

First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (known as antigenic shift that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes in an individual RNA segment in flu viruses are termed antigenic drift and result in minor changes in the virus. However, these can accumulate over time to produce enough minor changes that cumulatively change the virus’ antigenic makeup over time (usually years).

Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a “mixing pot” for flu RNA segments Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment and seem to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.

Are there human infections with novel H1N1 virus in the U.S.?

Yes. Cases of human infection with novel H1N1 influenza virus were first confirmed in the U.S. in Southern California and near Guadalupe County, Texas. The outbreak intensified rapidly from that time and more and more states have been reporting cases of illness from this virus. An updated case count of confirmed novel H1N1 flu infections in the United States is kept at http://www.cdc.gov/h1n1flu/update.htm. CDC and local and state health agencies are working together to investigate this situation.

Is novel H1N1 virus contagious?

CDC has determined that novel H1N1 virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

Why is there so much panic about Swine Flu? After all it’s just a flu!

The most significant flu pandemic occurred in 1918/1919. The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of those who were infected died. With 20% or more of the world population suffering from the disease to some extent, a case-fatality ratio this high would mean that about 0.5-1% or 50 million to 100 million people worldwide were killed. In 1957, an Asian flu pandemic infected some 45 million Americans and killed 70,000. Eleven years later, lasting from 1968 to 1969, the Hong Kong flu pandemic afflicted 50 million Americans and caused 33,000 deaths, costing approximately $3.9 billion. In 1976, about 500 soldiers became infected with swine flu over a period of a few weeks.

The scare and panic about the bird flu and swine flu have occurred because people now know what a simple flu can lead to and are afraid of the consequences – not just to the human capital but also to the global financial health.

What are the signs and symptoms of this virus in people?

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Symptoms of Swine flu may include all or some of the following:

1. Fever
2. Muscle aches
3. Lethargy
4. Coughing
5. Headache
6. Sore throat
7. Runny nose
8. Nausea
9. Vomiting
10. Diarrhea
11. Lack of appetite

Complications of Swine Influenza:

Those at higher risk of catching influenza in general include those with the following:

1. Age of 65 years or older
2. Chronic health problems (such as asthma, diabetes, heart disease)
3. Pregnant women
4. Young children

But the past epidemics and pandemics of flu have shown that during pandemics most people who succumb are healthy young adults.

Complications of Swine Flu can include:

1. Pneumonia
2. Bronchitis
3. Sinus infections
4. Ear infections
5. Death

How severe is illness associated with novel H1N1 flu virus?

Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.

In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this novel H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.

One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of novel H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to novel H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against novel H1N1 flu by any existing antibody.

How does novel H1N1 flu compare to seasonal flu in terms of its severity and infection rates?

With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.

When the novel H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the novel H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that novel H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this novel H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neuro-cognitive and neuromuscular disorders and pregnancy.

How long can an infected person spread this virus to others?

People infected with seasonal and novel H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

Transmission of Swine Flu

As with other flu like illnesses, Swine influenza is spread as follows:

1. Coughing
2. Sneezing
3. Kissing
4. Touching infected objects
5. Touching nose, mouth and/or eyes with infected hands
6. Swine flu does not spread by eating pork.

Prevention & Treatment

What can I do to protect myself from getting sick?

There is no vaccine available right now to protect against novel H1N1 virus. However, a novel H1N1 vaccine is currently in production and may be ready for the public in the fall. As always, a vaccine will be available to protect against seasonal influenza

There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

Take these everyday steps to protect your health:

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread this way.
* Try to avoid close contact with sick people.
* If you are sick with flu-like illness,
* CDC (Center for Disease Control and Prevention) recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.

Other important actions that you can take are:

* Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
* Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs, tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)

Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. CDC recommends that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?

If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.

If you become ill and experience any of the following warning signs, seek emergency medical care.

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

Are there medicines to treat novel H1N1 infection?

Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with novel H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza.

Are there medicines to treat novel H1N1 infection?

CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with novel H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs during is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.

What is CDC’s recommendation regarding “swine flu parties”?

“Swine flu parties” are gatherings during which people have close contact with a person who has novel H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity novel H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend “swine flu parties” as a way to protect against novel H1N1 flu in the future. While the disease seen in the current novel H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with novel H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.

Influenza antiviral drugs during is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.

What is CDC’s recommendation regarding “swine flu parties”?

“Swine flu parties” are gatherings during which people have close contact with a person who has novel H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity novel H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend “swine flu parties” as a way to protect against novel H1N1 flu in the future. While the disease seen in the current novel H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with novel H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.

Contamination & Cleaning

How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.

What kills influenza virus?

Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

*What if soap and water are not available and alcohol-based products are not allowed in my facility?

Though the scientific evidence is not as extensive as that on hand washing and alcohol-based sanitizers, other hand sanitizers that do not contain alcohol may be useful for killing flu germs on hands.

What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

How should waste disposal be handled to prevent the spread of influenza virus?

To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.

What household cleaning should be done to prevent the spread of influenza virus?

To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

How should linens, eating utensils and dishes of persons infected with influenza virus be handled?

Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.

Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.

Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Exposures Not Thought to Spread Novel H1N1 Flu

Can I get infected with novel H1N1 virus from eating or preparing pork?

Novel H1N1 viruses are not spread by food. Nobody can get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.

Is there a risk from drinking water?

Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.

Can novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?

Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of novel H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as novel H1N1 virus would also be similarly disinfected by chlorine.

Can novel H1N1 influenza virus be spread at recreational water venues outside of the water?

Yes, recreational water venues are no different than any other group setting. The spread of this novel H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Differential Diagnosis

1. Dengue Fever

Dengue fever is the most common among all the arthropod- borne viral diseases. This infection may be asymptomatic or may lead to:

1. Classical Dengue Fever
2 .Dengue Haemorrhagic fever without shock
3. Dengue Haemorrhagic fever with shock

The main vector is Aedes aegypti mosquito. The illness is characterized by a incubation period of 3 to 10 days. The onset is sudden with chills and high fever, intense headache, muscle and joint pains which prevent all movement. Within 24 hrs retro-orbital pain and photophobia develops. Other symptoms include extreme weakness, anorexia, constipation, colicky pain and abdominal tenderness. Fever is typically but not inevitably followed by a remission of a few hrs to2 days. The rash may be diffuse flushing, mottling, or fleeting pin point eruptions on face, neck and chest during the first half of the febrile period and a conspicuous rash that may be maculopapular or scarlatiform on 3rd or 4th day. Fever lasts for about 5 days.

Dengue haemorrhagic fever is confined exclusively to children less than 15 yrs of age. There may be plasma leakage and abnormal haemostasis, as manifested by a rising haematocrit value and moderate to marked thrombocytopenia.The fever may rise again producing a saddle-back fever curve. There may be generalised lymphadenopathy.

In dengue shock syndrome shock is present along with all the above criteria.

2. Yellow fever

It is a zoonotic disease affecting principally monkeys and other vertebrates. It shares clinical features of dengue fever but is characterised by more severe hepatic and renal involvement.. So death is more common in yellow fever than chikungunya.

3. Other viral fevers

Many of the viruses produce encephalitis, haemorrhagic fever or arthritis in various combinations. There may be high fever with backache and joint pain. Clinical features depend upon the type of virus causing infection.

a. SINDBIS virus infection: Transmitted among birds by mosquitoes. The disease begins with rash and arthralgia. Constitutional symptoms are not marked and fever is modest or lacking altogether.

b. MAYARO fever: Transmitted by Haemagogus mosquitoes. It causes a frequently endemic or epidemic infection of humans and appears to produce a syndrome resembling Chikungunya.

c. Epidemic Polyarthritis (ROSS RIVER virus infection): Constitutional symptoms are absent in many cases. Many patients are incapacitated by joint involvement.

d. Influenza: It is an acute respiratory illness caused by infection with influenza virus. Respiratory tract infection is accompanied by systemic signs and symptoms such as fever, headache and myalgia

4. Eruptive fevers like measles and German measles

5. West Nile Fever: West Nile Virus was recovered from the blood of a fever patient in Uganda in 1937. This virus is transmitted by Culex mosquitoes among wild birds. Humans are incidental hosts. Human infections are usually asymptomatic. Disease may present as a dengue like febrile illness with or without rash. Headache, myalgia, anorexia, nausea, epigastric pain, diarrhoea, lymphadenopathy may accompany the fever which lasts up to a week. The rash is maculopapular and non pruritic; unlike dengue. In its severe form it may cause aseptic meningitis or encephalitis especially in elder people and children. Rare complications include myocarditis, hepatits and pancreatitis.

6. Japanese Encephalitis: First occurred in Japan as asevere epidemic in 1924. Japanese Encephalitis virus has been isolated from the culex mosquitoes and mansonia. Onset is rapid. Encephalomyelitis develops within 2-4 days. There may be fever, headache, altered sensorium, coma, convulsions, neck rigidity, C S F pleocytosis etc

Natural Remedy

Homeopathic Approach for Swine Flu / H1N1 Influenza

Aphorism 100-102 is dealing with the treatment of epidemic diseases. According to Dr.Hahnemann, a carefully observing physician can arrive so nearly at knowledge of the true state of the epidemic from the examination of even the first and second patients and can even find a suitable homoeopathic remedy for it. Dr. Hahnemann recommends investigating each epidemic disease as a new and unknown case and selecting medicine according to its symptom similarity.

Swine flu can be considered as an acute epidemic disease

Aphorism 73 — Organon of Medicine by Dr.samuel Hahnemann

they are of such a kind as attack several persons at the same time, here and there (sporadically), by means of meteoric or telluric influences and injurious agents, the susceptibility for being morbidly affected by which is possessed by only a few persons at one time.

Allied to these are those diseases in which many persons are attacked with very similar sufferings from the same cause (epidemically); these diseases generally become infectious (contagious) when they prevail among thickly congregated masses of human beings.

Case taking in epidemic diseases

Aphorism 100 — In investigating the totality of the symptoms of epidemic and sporadic diseases it is quite immaterial whether or not something similar has ever appeared in the world before under the same name or any other name.

The novelty or peculiarity of a disease of that kind makes no difference either in the mode of examining or of treating it, as the physician must anyway regard the pure picture of every prevailing disease as if it were something new and unknown, and investigate it thoroughly for itself, if he desire to practise medicine in a real and radical manner, never substituting conjecture for actual observation, never taking for granted that the case of disease before him is already or partially known, but always carefully examining it in all its phases; and this mode of procedure is all the more requisite in such cases, as a careful examination will show that every prevailing disease is in many respects a phenomenon of a unique character, differing vastly from all previous epidemics, to which certain names have been falsely applied – with the exception of those epidemics resulting from a contagious principle that always remains the same, such as smallpox, measles, &c.

APHORISM 101

It may easily happen that in the first case of an epidemic disease that presents itself to the physician’s notice he does not at once obtain a knowledge off its complete picture, as it is only by a close observation of several cases of every such collective disease that he can become conversant with the totality of its signs and symptoms.

Aphorism 102

In the course of writing down the symptoms of several cases of this kind the sketch of the disease picture becomes ever more and more complete, not more spun out and verbose, but more significant (more characteristic), and including more of the peculiarities of this collective disease; on the one hand, the general symptoms (e.g., loss of appetite, sleeplessness, &c.)becomes precisely defined as to their peculiarities; and on the other, the more marked and special symptoms which are peculiar to but few diseases and of rarer occurrence, at least in the same combination, become prominent and constitute what is characteristic of this malady.

All those affected with the disease prevailing at a given time have certainly contracted it from one and the same source and hence are suffering from the same disease; but the whole extent of such an epidemic disease and the totality of its symptoms (the knowledge whereof, which is essential for enabling us to choose the most suitable homoeopathic remedy for this array of symptoms, is obtained by a complete survey of the morbid picture) cannot be learned from one single patient, but is only to be perfectly deduced(abstracted) and ascertained from the sufferings of several patients of different constitutions.

Footnote

The physician who has already, in the first cases, been able to choose a remedy approximating to the homoeopathic specific, will, from the subsequent cases, be enabled either to verify the suitableness of the medicine chosen, or to discover a more appropriate, the most appropriate homoeopathic remedy.

Kent’s Approach

1. Epidemic cases are dealt in the III lecture ‘what the physician must perceive’

2. After visiting many patients symptoms are written in an schematic form arranging in different headings

3. Essential features of case is obtained.ie symptoms found in majority cases

4. Symptoms are classified in to pathognomonic & peculiar symptoms

Why Homeopathy?

Homeopathy was very successful in dealing with the 1918-19 flu pandemic. Here is a quote from the famous historian Julian Winston:

Perhaps the most recent use of homeopathy in a major epidemic was during the Influenza Pandemic of 1918. The Journal of the American Institute for Homeopathy, May, 1921, had a long article about the use of homeopathy in the flu epidemic. Dr. T A McCann, from Dayton, Ohio, reported that 24,000 cases of flu treated allopathically had a mortality rate of 28.2% while 26,000 cases of flu treated homeopathically had a mortality rate of 1.05%. This last figure was supported by Dean W.A. Pearson of Philadelphia (Hahnemann College) who collected 26,795 cases of flu treated with homeopathy with the above result.

The most common remedy used was Gelsemium, with occasional cases needing Bryonia and Eupatorium reported. Dr. Herbert A. Roberts from Derby, CT, said that 30 physicians in Connecticut responded to his request for data. They reported 6,602 cases with 55 deaths, which is less than 1%. Dr. Roberts was working as a physician on a troop ship during WWI. He had 81 cases of flu on the way over to Europe. He reported, “All recovered and were landed. Every man received homeopathic treatment. One ship lost 31 on the way.”

Homeopathic Remedies

Considering that the Swine Flu virus produces symptoms similar to the human influenza virus, the following homeopathy medicines may prove useful in cases of swine influenza:

Aconite Napellus

[Please note that Aconite is usually indicated in the early stage when within minutes or hours of exposure to dry, cold, north wind a patient comes with acute cold rhinitis, laryngitis or pharyngitis. It is also useful for complaints from very hot weather. Suddenness is its characteristic symptoms. The symptoms are accompanied by fear and anxiety. Music is unbearable and makes him / her sad one of the valuable mental symptoms. Physician should remember that aconite should not be prescribed to check the cold unless some mental symptoms like fear, restlessness and anxiety are accompanied. T. F. Allen says, “It is found valuable for the remote as well as recent effects of fright and other shocks to the nervous system.” According to Hahnemann, “Whenever Aconite is chosen homeopathically, you must, above all, observe the moral symptoms and be careful that it closely resembles them; the restlessness, the disquiet not to be alleyed.” A physician should remember when prescribing it that it may causes only functional disturbances and no evidence that it can produce tissue changes—its action is brief and shows no periodicity. Its sphere is in the beginning of an acute disease and not to be continued after pathological changes comes.]

General symptoms:

1. Physical and Mental restlessness.
2. Acute, suddenness and violent invasion with fever.
3. Sudden and great sinking of strength.
4. Complaints of gastro-intestinal organs rise from very hot weather.
5. Inflammatory fevers and all inflammation, remember it in early stages.
6. Serous membranes and muscular tissues affected markedly.
7. Burning in internal parts of body.
8. Tensions of arteries.
9. Acute Influenzas.
10. Tingling, coldness and numbness.
11. Haematemesis.
12. Hot, tense and tympanitic abdomen. Sensitive to touch the abdomen. Colic, no position to relieves. Burning in umbilical region.
13. Shortness of breath.
14. Larynx sensitive.
15. Stitches through chest.
16. Hot feeling in lungs.
17. Blood comes up with hawking.
18. Tingling in chest after cough.
19. Hoarseness, dry, croupy cough.
20. Very sensitive to inspired air.
21. Constant pressure in left chest, oppressed breathing on least motion.
22. Children grasps at throat every time he coughs.
23. Fever—hot, chilliness.
24. Respiratory organs—-

1) Oppressed breathing on least motion;
2) Hoarse, dry, croopy cough;
3) Constant pressure in left chest;
4) Loud, labored breathing;
5) Shortness of breath,
6) Larynx sensitive,
7) Stitches through chest;
8) Cough dry, short, hacking,
9) Bloods comes up with hawking,
10) Hot feeling in lung,
11) Tingling in chest after cough,
12) Worse at night and after midnight.

Gelsemium. [Gels]

This remedy corresponds to the commencement of the trouble, when the patient is weak, tired and aches throughout the body. It removes speedily the intense aching and muscular soreness. There is constant chilliness and the patient hugs the fire; the fever is less acute than that of Aconite, and the cough is hard and painful. There are paroxysms of sneezing with excoriating discharge, and great torpor and apathy. Extensive experience with this remedy in the great Epidemic of 1918 proved its usefulness. Simple cases were speedily cured. Aconite will sometimes prove the better remedy for children, but the drug will never be a prominent one in influenza. Still it may be prescribed when indicated; it will, perhaps, soothe and moderate the subsequent attack, but its action is not quick here as in simple fevers, as we have to deal with a blood affection.

Baptisia.

Influenza with marked gastro-intestinal symptoms may need this remedy, especially when there are putrid diarrhoea stools. Clarke considers this remedy the nearest specific for the disease; he prefers the 30th potency. Hughes also praises it, but uses it in the 1x and 2x dilutions, which seem to have more extensive testimony as to their efficacy.

Eupatorium perfoliatum.

This remedy has much soreness and aching of the entire body; hoarseness and cough, with great soreness of the larynx and upper respiratory tract. Coryza with thirst. Drinking causes vomiting. The cough is a very shattering one, hurts the head and chest, and as in Drosera, the patient holds the chest with the hands. The breakbone pains are characteristic of the remedy. Add to these symptoms acute bilious derangements, and it is all the more indicated. Many physicians rely on this remedy in influenza / flu almost exclusively in the early stages.

Sabadilla. [Sabad]

Sneezing is the great keynote of this remedy. Sneezing and lachrymation on going into the open air. The throat is swollen and the pain is worse on empty swallowing; the sneezing is excessive, shaking the whole body. Shudderings, with gooseflesh chills creeping upwards, are also prominent symptoms. Frontal headache, dryness of mouth, without thirst and cough, worse on lying down, are additional symptoms. It suits well many cases of the catarrhal form of flu; other remedies having sneezing are Cyclamen and Euphorbia.

Arsenicum. [Ars]

This remedy covers more phases of flu than perhaps any other remedy. Hughes believes that it will cut short an attack, especially when there is a copious flow, prostration and paroxysmal coryza. Its periodicity makes it suitable to epidemics, and it suits the early symptoms when the affection is in the upper portion of the respiratory tract. The burning dryness and copious watery excoriating secretion and the involvement of the conjunctiva are unmistakable indications. Langour and prostration are prominent symptoms.

Arsenicum iodide.

Chills, flushes of heat and severe fluent coryza, discharge irritating and corrosive, sneezing and prostration. It corresponds to true influenza and is highly recommended by Hale. Sanguinaria nitrate is especially valuable when the trachea and larynx are affected. Phytolacca is specific when the throat is inflamed and spotty, with great hardness and tenderness of the glands.

Dulcamara. [Dulc]

This is one of our best remedies in the acute form; the eyes are suffused, the throat is sore and the cough hurts because of the muscular soreness. If brought on by damp, cold changes in the weather, so much the surer is Dulcamara indicated.

Bryonia.

The trouble here is largely bronchial and going downward. When a person is very grumpy and feels miserable with the flu, wanting only to lie still and be left alone, this remedy is likely to be useful. Headache, muscle aches, and cough or stomach pain may be the major symptoms. Everything feels worse from even the slightest motion. The person’s mouth usually is dry, with a thirst for large cold drinks.

Phosphorus may be indicated, especially when the trouble moves towards the chest. It is a very useful remedy for the debility following la grippe, as it is usually of the pure nervous type. It is the great post-influenza “tonic.”

Rhus toxicodendron. [Rhus-t]

Influenza, with severe aching in all the bones, sneezing and coughing. The cough is worse evenings and is caused by a tickling behind the upper part of the sternum. Especially is it useful in cases brought on by exposure to dampness. There is much prostration and depression, and the patient may have some symptoms which are suspicious as pointing towards typhoid fever, such as burning tongue, stupor and delirium. Aching pains and nightly restlessness are keynotes symptoms. Causticum, like both Rhus and Eupatorium, has a tired, sore, bruised sensation all over the body and soreness in the chest when coughing, but it has in addition involuntary urination when coughing.

Allium cepa. [All-c]

Profuse catarrhal coryza; the nose runs freely, there is sneezing, irritability cough, the face is swollen and looks inflamed. Camphora. This remedy is often sufficient at the outset to cut short an attack, or at least modify the severity.

Sticta. [Stict]

Nasal catarrh; headache, thirst, nightly expectoration, great watering of eyes, running at nose, hoarseness of voice, frontal headache and depression of whole system. Tuberculous subjects attacked by influenza. “There is no better remedy,” says Dr. Fornias,”for the incessant wearing, racking cough of this class of patients.” Tuberculinum is an excellent prevention of recurring attacks of influenza / flu in those who have annual attacks.

Ipecac

Adapted to cases where the gastric symptoms predominate; tongue clean or slightly coated. Nausea: with profuse saliva; vomiting of white, glairy mucus in large quantities, without relief; sleepy afterwards; worse from stooping. Low thirst. Cough: dry spasmodic, constricted, asthmatic. Difficult breathing from least exercise; violent dyspnoea, with wheezing and anxiety about the stomach. Cough, with rattling of mucus in bronchi when inspiring; threatened suffocation from mucus. Pains as if bones were all torn to pieces.

Veratrum album

Adapted to diseases with rapid sinking of the vital forces; complete prostration; collapse. Cold perspiration on the forehead (over entire body, Tab. ) with nearly all complaints. Thirst: intense, unquenchable, for large quantities of very cold water and acid drinks; wants everything cold. Diarrhoea: frequent, greenish, watery, gushing: mixed with flakes: cutting colic, with cramps commencing in hands and feet and spreading all over; prostrating, after fright;

Nux vomica –

Cold stage predominates. Paroxysms anticipate in morning. Excessive rigor, with blueness of finger-nails. Aching

in limbs and back, and gastric symptoms. Chilly; must be covered in every stage of fever. Perspiration sour; only one side of body.Chilliness on being uncovered, yet he does not allow being covered. Dry heat of the body.After drinking shivering & chilliness immediately.Chillines on slightest movement.

Indian Basil 8 leaves daily chewing can prevent all types of flu. Also Indian Homlata/ Giloy/Amrita can prevent and cure the pandemic H1N1 influenza. Basil=Ocimum Santum, Homlata/ Giloy..= Tinospora Cordifolia. These are also available in MT form at Homeopathic store.

Influenzinum

It is a nosode. If it is taken 4 globules of 200 attenuation for 5 days it may be preventive of all flu. Further research (like H1N1-INFLUENZINUM) on it may help us.

Rare remedies

Influenzinum, Eryngium, Lobelia cerulia, Antimonium iodatum, Asclepias tuberosa, canchalagua, glycerinum, gymnocladus, lobelia purpurescens, natrum salicylicum, sanguinaria nitrica

Swine Flu Vaccination / Swine Flu Shot

The protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, so the presence of non reactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses. The current vaccine against the seasonal influenza strain H1N1 is thought unlikely to provide protection. The director of CDC’s National Center for Immunization and Respiratory Diseases said that the United States’ cases were found to be made up of genetic elements from four different flu viruses—North American swine influenza, North American avian influenza, human influenza-A virus subtype H1N1, and swine influenza virus typically found in Asia and Europe.

NOTE: Victim patients are requested to consult / Contact your qualified physician or immediate contact nearest PHC/CHC/FRU/DISTRICT HOSPITALS for needy treatment and not take any medicines at your own choice.

Reference:

Organon of medicine – 6th edition
Lectures on philosophy – J.T kent
Pointers to common remedies – M L Tyler
Boericke’s pocket manual of materia medica
www.wikipedia.com
Centre for disease control and research.
Social and preventive medicine-Park and Park.
http://cdc.gov/h1n1flu/swineflu_you.htm
http://h1n1.nejm.org/
www.swinefluindia.com
http://www.hpathy.com/papersnew/winston-homeopathy-epidemics.asp

DR L B ROY PhD(USA)
HOMEO AROGYA SADAN
JAKHALABANDHA/ NAGAON /ASSAM. PIN-782136

Dr. LB Roy

H1N1 flu :: Pandemic swine flu – H1N1 Influenza
by ( Author at Spirit India )
Posted on at 1:07 pm.
Last updated on April 15th, 2014 at 3:54 pm.
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