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PostPosted: 25 Feb 2019 12:46 
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OVERVIEW
H1N1 influenza, also referred to as swine flu and caused by H1N1 virus, is a relatively new strain of an influenza virus and usually causes a mild acute upper respiratory illness. It originated in pigs but human spread is usually from person to person

It is a highly contagious illness caused by type A influenza virus that has regularly caused outbreaks in pigs

It gained prominence in 2009 when it was first noticed in humans and spread widely and was declared a global pandemic by the WHO. Interestingly, the 2009 pandemic virus was not entirely derived from pigs. The virus contained a combination of flu genes from pigs, birds as well as humans

DISEASE TRANSMISSION
Person to person spread is through aerosol droplets released into the atmosphere when an infected person sneezes or coughs. It can also be found on surfaces such as tables and door handles and spread by contact with these surfaces

RISK FACTORS OF SEVERE ILLNESS/COMPLICATIONS
• Older adults 65 years and above
• Children under 5 years old
• Pregnant women
• Persons with impaired immunity such as those receiving immunosuppressive therapy, cancer treatment, AIDS patients
• Persons working with animals such as farmers, animal handlers and vets
• Persons with chronic underlying illness such as heart disease, COPD, diabetes or neuromuscular disease
• Young adults and children under age 19 who are receiving long-term aspirin therapy

CLINICAL FEATURES OF H1N1 INFLUENZA
• Fever and runny nose
• Cough and sore throat
• Extreme fatigue
• Headache
• Red and watery eyes
• Muscle and joint pains
• Nausea and vomiting
• Loss of appetite
• Diarrhea

COMPLICATIONS OF H1N1 INFLUENZA
In most persons, H1N1 influenza is a mild upper respiratory tract illness that resolves spontaneously with rest and symptomatic treatment. However in persons at risk (see above), serious complications may occur such as
• Worsening of chronic pre-existent conditions, such as COPD and heart disease
• Secondary bacterial infection and pneumonia
• Respiratory failure
• Neurological symptoms such as confusion, fits and stupor

DIAGNOSIS OF H1N1 INFLUENZA
• Swine flu can be diagnosed by patient history and examination of the patient by the doctor. The diagnosis may be confirmed by a throat or nasal swab to demonstrate the viral antigen
• However not everyone who suffers from these symptoms needs to have the test
• In fact current guidelines advise empirical treatment with appropriate antiviral drugs in persons who present with moderately severe influenza symptoms, rather than basing treatment on positive results
• Confirmation of diagnosis may be necessary only in persons belonging to high risk groups, patients admitted to hospital
• The test may also be done to rule out other causes for the symptoms such as heart failure, chronic obstructive pulmonary disease (COPD), sepsis and brain infections
• In mechanically ventilated patients, endotracheal aspirates can e obtained. Sputum samples may be useful. If the patient is having a bronchoscopy, a bronchoalveolar lavage specimen should be obtained.

Rapid H1N1 Diagnostic Test
The most commonly used test is called a rapid influenza diagnostic test, in which a throat or nasal swab is obtained from the patient and tested for the presence of viral proteins or antigens. These results are ready in about 15 minutes. However, results vary greatly and are not always accurate

Molecular Tests – Polymerase Chain Reaction (PCR) Test
Specialized molecular tests may be available in certain centers and diagnostic facilities. The test detects the presence of the virus in the sample. Swabs to obtain samples for molecular tests should have synthetic tips (Dacron or polyester) with either an aluminum or plastic shaft. Swabs with cotton tips and wooden shafts are not acceptable because they will affect the results of molecular tests

TREATMENT OF H1N1 INFLUENZA
• Most people with flu or swine flu, require only symptomatic treatment. Additional medications may be prescribed in patients with chronic respiratory disease
• Four antiviral drugs are currently approved by the FDA to reduce the severity of symptoms at the start of illness and to reduce complications. These include Oseltamivir (Tamiflu) Zanamivir (Relenza), Peramivir (Rapivab) and Baloxavir (Xofluza)
• To reduce the possibility of drug resistance, the antiviral drugs are prescribed only for patients who are at high risk of complications or persons living in close contact with high risk individuals
• Nasal oxygen or oxygen mask for persons with breathing difficulties

Home Remedies for H1N1 Influenza
• Plenty of rest and sleep to help the immune system fight the infection
• Staying well hydrated – water, warm liquids and soups to avoid dehydration
• Pain and fever medications
• Antitussives and nasal decongestants

PREVENTION OF H1N1 INFLUENZA
• The best way to prevent swine flu is to get the yearly flu vaccination. Other easy ways to prevent swine flu include
• Good personal hygiene with frequent hand washing using soap or hand sanitizer
• Avoid touching your nose, mouth, or eyes with since the virus may get deposited on the hands while touching infected surfaces such as door handles and tabletops
• Staying home from work or school if you are unwell to prevent spread
• Avoid crowds and large gatherings during the flu season

QUICK RECAP
• H1N1 influenza also known as swine flu is a highly contagious upper respiratory illness
• Caused by type A influenza virus and originated in pigs
• Human infection is from person to person and persons working closely with pigs eg farmers
• Infected persons can spread the infection from one day before onset of symptoms to upto a week after symptom onset
• Usually a mild self limiting illness but can be severe with serious complications in high risk groups (see above)
• Diagnosis is usually based on patient history and confirmed if needed by the rapid test
• Treatment is usually rest, plenty of fluids and symptomatic treatment
• Antiviral drugs are usually reserved for the high risk groups and include oseltamivir or zanamivir for the treatment and/or prevention of infection
• H1N1 influenza can be prevented by the annual flu vaccination


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