Swine Flu (H1N1 Influenza A): A Recent Pandemic and Future Threat
Ms. Indu Rathore
Lecturer, Murari Lal Memorial School and College of Nursing, Village- Nagali, P.O. Oachghat, Solan (HP)- 173223
*Corresponding Author Email: rathor.indu@gmail.com
ABSTRACT:
Swine flu is one of the most recent pandemic that have created a global health threat. It is also known as "Swine Influenza" or "H1N1 Influenza A" due to a new H1N1 strain of influenza virus. World Health Organization (WHO) has announced it as a Public Health Emergency in April 2009. The transmission of Swine flu in human beings occurs as normal influenza either through droplet infection or by contaminated hands. Swine flu mainly affects the respiratory tract and characterized by sudden onset of chills, malaise, fever, body ache, headache, throat pain, cough and common cold. Sometimes symptoms may worsen leading to respiratory failure and death. The incubation period is of 2-3 days but could range up to 7 days. For lab diagnosis, respiratory tract specimen should be collected through the swabs from nose, nasopharynx or throat. The live attenuated vaccines and inactivated vaccines are available worldwide to control the pandemic. Patient at higher risk of developing severe or complicated illness and presenting with uncomplicated illness should be treated with Tamiflu (Oseltamivir) or Relenza (Zanamivir) following onset of illness. Nursing management includes isolation, use of mask, lukewarm water sponging, saline gargles, steam inhalation, maintaining adequate hydration, personal hygiene including frequent hand washing, ensuring adequate rest and sleep in a well-ventilated room and disinfection of contaminated articles .Vitamin-C rich diet, herbal remedies and yoga boosts the body’s immune system and helps to prevent the Swine flu.
KEYWORDS: Swine Flu, Sign and Symptoms, Prevention, Management, Herbal Remedies.
INTRODUCTION:
Swine flu is one of the most recent pandemic that have drawn the public health attention globally. It is also known as "swine influenza" or "H1N1 influenza A" due to a new H1N1 strain of influenza virus. The virus is mixture of four known strains of influenza-A virus in which one is endemic in humans, one is endemic in birds, and two others are endemic in pigs. This reassortment occurred due to transfers of genes among strains causing infections in swine, avian and human species. Subsequent analysis suggested that it was a reassortment of only two strains, both are found in swine.
The exact origin of virus is still a controversial topic among the scientists. However, the transmission of Swine flu is in human beings occurs as normal influenza.1 The first human-to-human infections with influenza A (H1N1) virus was reported in Mexico and the United States in April 2009. Then World Health Organization (WHO) announced it as a Public Health Emergency of International Concern. As influenza pandemic was spreading globally at an alarming rate, WHO raised the Influenza Pandemic Alert level to Phase 6, on 11 June 2009. Till 1 August 2010, more than 18449 deaths and laboratory-confirmed cases of pandemic influenza H1N1 were reported from 214 countries and territories worldwide. When the H1N1 Virus activity largely returned to levels of seasonal Flu in early August 2010, the WHO ended the Phase 6 Influenza Pandemic Alert, with a worldwide shift into the post-pandemic Period2.
Mortality and Morbidity in India:
India is ranked third among the most affected countries for cases and deaths of swine flu globally 3The first case of Swine flu was reported in May, 2009. After that it spread very quickly to all over of the country. The highest number of swine flu deaths took place in 2010 (1,763 out of 20604 cases), followed by 2009 (981 out of 27236 cases), 2015 (774 out of 12963 cases) and 2013 (699 out of 5253 cases). The mortality decreased in 2011 (75 out of 603 cases), followed by 2014 (218 out of 937 cases) and 2012 (405 out of 5044 cases). A total of 72640 cases and 4915 deaths had been reported by 2015.4
Definition, Reservoir, Mode of Transmission and Incubation Period:
Swine flu is an acute respiratory tract infection caused by influenza virus H1N1 characterized by sudden onset of chills, malaise, fever, body ache, headache, throat pain, cough and common cold. Its major reservoir exists in animals and birds (e.g. swine, horses, dogs, cats, wild birds)5The virus spreads very rapidly form one person to another person due to its unique genetic and antigenic nature.2 Influenza A H1N1 virus can be spread in three main ways: by direct transmission when an infected person sneezes mucus into the eyes, mouth or nose of another healthy person; by inhaling the droplets produced by an infected person through coughing, sneezing and spitting; and by contaminated hands to mouth from contaminated surfaces or direct personal contact, such as a handshake6 The incubation period is of 2-3 days but could range up to 7 days.7Virus often remains in nasopharynx from 1 to 2 days before and 1 to 2 days after onset of symptoms5
People at Risk:
Persons at greater risk are infant and young children especially those under 2 years of age, children receiving chronic aspirin therapy, elderly above 65 years, pregnant women, people with chronic disease of lungs (e.g. asthma, COPD), heart (e.g. congestive cardiac failure), kidneys, liver, brain (including neuromuscular, neurocognitive and seizure disorders), metabolism (e.g. diabetes) and immunosuppressive conditions (HIV infection or malignancy).
Sign and Symptom:
Infected person may be presented with a wide range of clinical spectrum of disease. Febrile influenza like illness (ILI) produces the symptoms such as fever, cough, sore throat, headache, rhinorrhoea, muscle pain and malaise, without shortness of breath and dyspnoea in an infected person. The children may also suffer from diarrhoea and/or vomiting, but without evidence of dehydration. Complicated or severe influenza presents clinical (e.g. shortness of breath, tachypnea, dyspnoea, hypoxia) and/or lower respiratory tract infection (e.g pneumonia) with radiological evidence, central nervous system (CNS) involvement (e.g. encephalitis, encephalopathy), severe dehydration, or presenting secondary complications such as renal failure, septic shock, multi-organ failure etc. Other complication can include myocarditis and rhabdomyolysis. There may be exacerbation of underlying chronic disease, including asthma, COPD, chronic renal or hepatic failure, diabetes or other cardiovascular conditions. Sometimes any other conditions or clinical presentation may worsen and require hospitalization for clinical management. It may also result in severe pneumonia and Acute Respiratory Distress Syndrome leading to respiratory failure and death. 7
Lab Diagnosis:
For lab diagnosis, upper respiratory tract specimens should be taken through the swabs from the deep nostrils, nasopharynx, throat and also through nasopharyngeal or bronchial aspirate. Reverse-transcriptase polymerase chain reaction (RT-PCR) provides the most sensitive test for the timely detection of infection.8
Management:
Vaccines and Drugs:
The vaccines that are licensed worldwide to control the pandemic includes live attenuated vaccines, inactivated adjuvanted vaccines (split or subunit virion) and inactivated unadjuvanted vaccines (split, whole virion or subunit virion). Patient at higher risk of developing severe or complicated illness and presenting with uncomplicated illness should be treated with Tamiflu (Oseltamivir) or Relenza (Zanamivir) following onset of illness.
Standard Antiviral Treatment Regimen:
A) Oseltamivir:
Oseltamivir is indicated for treatment for influenza. Adult oral dose is 75mg Oseltamivir twice daily for 5 days. For infant less than 1 year of age recommended oral dose are as follows:
|
>3months-12months |
3mg per kg twice daily for 5 days |
|
>1month-3months |
2.5mg per kg twice daily for 5 days |
|
0-1 months* |
2mg per kg twice daily for 5 days |
*There is no data for the administration of Oseltamavir to infants less than 1 month of age.
For older children the recommendation oral dose according to body weight is as follows:
|
15kg or less |
30mg twice a day for 5 days |
|
15-23kg |
45mg twice a day for 5 days |
|
24-40kg |
60mg twice a day for 5 days |
|
>40kg |
75mg twice a day for 5 days |
It is indicated for treatment for influenza in adults and children (>5years). Recommendation dose for treatment of adults and children from the age of 5 years is two inhalations (2 X 5mg) twice daily for 5 days.
Chemoprophylaxis-:
Oseltamivir is the drug for chemoprophylaxis to health care personnels and close contact of suspected, probable or confirmed cases of pandemic influenza A (H1N1) 2009. It should be given till 10 days after last exposure. The dose by the body weight is as follows:-
Weight less than 15kg - 30mg Once Daily
Between 15kg-23kg - 45mg Once Daily
Between 24 kg-40kg - 60mg Once Daily
Above 40kg - 75mg Once Daily
For infants
· Below3months -not recommended unless situation is critical
· Between 3-5 months -20mg Once Daily
· Between 6-11months- 25mg Once Daily 7
Nursing Management:
Prompt nursing management of Swine flu not only helps in quick recovery of the patients but also prevents the complications like pneumonia, respiratory failure etc. Isolate the person in a separate room up to 7 days after the onset of illness while they are infectious to others.5 Keep all the necessary articles such as mask, hand sanitizer, medicine, water bottle etc in the sick person room. The infected person should wear a face mask or cover mouth and nose with a clean cloth/handkerchief. In case of fever, lukewarm water (85° to 90° F) sponging should be done until temperature has reached an acceptable level. Provide warm liquids (like soup) or gargles with warm salt water to treat sore throat. Use honey to soothe the throat for coughs.
A warm shower bath and analgesics as prescribed by physician may help to reduce bodyache. Steam inhalation helps to relieve nasal and chest congestion. Offer liquids or ORS as soon as tolerated after each episode of vomiting or diarrhea. Maintain personal hygiene with daily warm water bath and soap. Provide clean cotton clothes. A calm and quiet environment will ensure adequate rest and sleep. Room must be comfortably warm, humid and well- ventilated. Easily digestible, palatable and high calorie diet should be provided to affected person. Increase fluid intake in the form of warm fluids (fruit juices, vegetable soups). There must be the routine disinfection of contaminated articles and commonly touched surfaces with soap, detergent, phenyl and hot water.11 in hospitalized patients, vital signs and hydration level should be monitored. Administer analgesics, antipyretics, decongestants, antiviral drugs, I.V. fluids and oxygen therapy as prescribed. Monitor the patient for signs and symptoms of disease progression such as shortness of breath, difficulty in breathing, bloody or colored sputum, turning blue, chest pain, and low blood pressure (due to oxygen impairment or cardiopulmonary insufficiency). The other symptoms and sign suggesting CNS complications such as altered mental status, unconsciousness, drowsiness, or convulsions, confusion, severe weakness, or paralysis should also be monitored. Immunosuppressed patients may need special attention as they shed off the virus for a longer duration and are at risk of antiviral resistance.7
Prevention:
As the golden rule, prevention is better than cure as the available drugs have only limited success and there are the risks of drug resistance, emergence of mutant and more virulent strains of the virus.9 Cough etiquettes such as covering the nose and mouth with a clean cloth while coughing or sneezing, frequent hand washing and staying at home are very effective in preventing the spread of the virus.7 There should be avoidance of overcrowded places, hugging and shaking hands with infected or suspected person. Nose, eyes and mouth should not be touched without hand washing. Travelling to states with high prevalence of influenza A (H1N1) infection during epidemic should be avoided. The patients with flu-like symptoms must be quarantined.10 Health personnel while performing bronchoscopy or any other procedure involving aspiration of the respiratory tract, must use a particulate respirator (N95, FFP2 or equivalent), eye protection, gown, and gloves. All the consulting rooms, nursing stations, procedure rooms, labs, wards and waiting halls must be well - ventilated by natural and mechanical ventilation. All the medical equipments and potential fomites should be disinfected with alcohol-based disinfectant or with soap and water.7
Herbal Home Remedies and Yoga:
A wide variety of herbs can also do the wonders for Swine flu prevention because of their unique anti-viral and anti-flu properties. Tulsi helps to keep swine flu away because of its anti-flu property. Ginger and Garlic boosts the body's immunity and helps to fight cold, fever and flu. Indian gooseberry or Amla which is rich in Vitamin C helps to raise the body's resistance to flu viruses. Steam inhalation with few drops of Eucalyptus oil and lukewarm water is beneficial for the health of the respiratory tract. Other herbs such as Giloy, Ashwagandha, Turmeric, Neem, Aloevera are also found to be effective for the prevention of viral infections of respiratory tract. Vitamin-C rich fruits (Amla, Guava, Oranges etc.) help to build body resistance to infections. Coupled with this, yoga pranayam and morning walk in daily routine keeps the throat, lungs and body in good condition. 5,6,12
CONCLUSION:
Swine flu has been declared as an epidemic and public health emergency in past years and is a future threat. Lessons learnt from this have suggested that lack of awareness and knowledge regarding early recognition of symptoms, prevention and management has created the fear among people. Nurses are the backbone of health care delivery system. They have enormous opportunities in all the aspects to educate and take care of their communities in different settings such as families, schools, Anganwadis, Mahila Mandals, youth clubs, work places, health centers etc.
REFERENCES:
Received on 26.06.2016 Modified on 20.01.2017
Accepted on 06.02.2017 © A&V Publications all right reserved
Asian J. Nur. Edu. and Research.2017; 7(2): 239-242.
DOI: 10.5958/2349-2996.2017.00050.7