As the latest pandemic flu virus spread rapidly across the world and two more infected people arrived here from neighbouring India bringing the affected number to 75, Sri Lanka reinforced measures to brace itself against this bug.
Surveillance at the ports of entry, facilities to isolate infected patients, diagnostic capabilities and a treatment regimen are all in place, with isolation units being opened in selected hospitals around the country, in addition to the unit at the Infectious Diseases Hospital (IDH) at Angoda.
Twenty hospitals across the country are setting up isolation facilities, said the Deputy Director-General of Public Health Services, Dr. Palitha Mahipala, explaining that they included the National Hospital and the Lady Ridgeway Hospital for Children in Colombo and others such as Ragama, Kalubowila, Kurunegala and Karapitiya. A majority of districts will have at least one hospital with isolation capability, according to the DDG.
| H1N1 vaccine ready
next month |
A vaccine for H1N1 under preparation by global manufacturers should be ready by September, with clinical trials already underway in five countries.
The WHO is negotiating a reduced rate to enable developing countries to buy the vaccine, it is understood.Sri Lankan authorities have already discussed the importation of the vaccine with the WHO which has assured them of all assistance in this regard, it is learnt. |
“Just last Monday, three isolation rooms were opened at the Batticaloa Hospital,” he said, stressing that if Novel Influenza H1N1 patient numbers increase, doctors have been instructed on a referral system whereby they would direct them to the hospital with isolation facilities, closest to that point.
Up to now H1N1 patients have been treated at the IDH which has 42 isolation rooms and two step-down wards. Seventy-five people have tested positive for H1N1 since the first patient, an eight-year-old boy who had “travelled from Australia” was admitted to the IDH on June 15, while the last two admitted on August 18 had “travelled from India”.
According to the Epidemiology Unit website, of 72 patients reported as of early last week, 63 had travelled to Sri Lanka from abroad while nine had contracted the virus through “close contact” with some of those who had come from abroad.
In the global arena, since the first case of H1N1 was reported in Mexico in March, 177 countries and territories have fallen like dominoes and “containment of the virus” has become a phrase of the past. While there have been no deaths in Sri Lanka, 1,799 have succumbed worldwide, according to data collated by the World Health Organization (WHO) which has estimated that by the end of the pandemic 15-45% (1 billion to 3 billion) of the global population would have been infected. In India too, where the virus has begun to spread not only through “close contact” but in the community among people who have had no “close contact” with a patient, there have been several deaths and the Union Health Minister was recently quoted in newspapers as saying that 33% of Indians are likely to get H1N1. This was as Delhi, Pune, Mumbai, Chennai, Goa and several more areas recorded the virus. Many other Asian countries such as Thailand are also experiencing “community spread” which has led to the closure of schools etc.
The WHO pandemic update stated that areas of tropical Asia are reporting increasing rates of illness as they enter the monsoon season, as represented by India, Thailand, Malaysia and Hong Kong, four places in the region which have active surveillance programmes.
However, the positive side of the H1N1 virus so far is that, except for certain vulnerable groups – very young children including infants, children with chronic diseases, adults with respiratory ailments, expectant mothers and the elderly -- it has not severely affected people who are generally healthy. This new influenza virus dubbed “novel” because it has never before circulated among humans, is spread from person-to-person as easily as the normal flu. It can be passed to other people by exposure to infected droplets expelled by coughing or sneezing, that can be inhaled or that can contaminate hands or other surfaces.
The signs and symptoms of H1N1 are flu-like and include fever, cough, headache, muscle and joint pain, sore throat and runny nose, accompanied sometimes by vomiting and diarrhoea.
Although the H1N1 virus has not been as deadly as the Avian flu virus, the danger lies in a change in the virulence of the virus due to a re-assortment or mutation because of its unstable genetic make-up. The four components of the H1N1 virus are the American swine flu, the Eurasian swine flu, the human flu and the North American avian flu.
Travel only if essential |
With prevention always being better than cure, people should curb unnecessary travel within and outside the country, urged several doctors.
Limit travel to essential trips. Avoid pilgrimages, shopping sprees and holidays in other countries, was the view of one doctor echoed by many others, who pointed to the fact that H1N1 was spreading rapidly in India, Thailand, etc.
It is also better to avoid crowded places and large public gatherings, they said. |
Mankind has had bitter experience with the scourge of influenza – the 1918 Spanish flu pandemic is estimated to have killed between 20 to 100 million people; the 1957 Asian flu between 1-1.5 million; and the 1968 Hong Kong flu up to one million.Dealing with other measures taken by the Sri Lankan health authorities to keep H1N1 at bay, Dr. Mahipala said surveillance was being carried out at the main port of entry, the Bandaranaike International Airport with thermal scanners and 30 Public Health Inspectors working at the Health Desk round-the-clock on a roster basis.
Health declaration forms along with information leaflets on the signs and symptoms of H1N1 and whom to contact and where to go to, if travellers developed symptoms a few days after arrival, are being distributed on-board the flights. Six thousand passengers come through the airport daily, he said.
The Medical Research Institute, meanwhile, has all the diagnostic facilities, said the DDG, adding that the virology laboratory has been provided the necessary equipment and re-agents to test specimens and the staff trained as well. “The MRI has tested 234 throat swabs of which 227 were found to be positive,” he said, stressing that if not for the facilities at the MRI, the specimens would have had to be sent abroad.
Dealing with the treatment aspect, Dr. Mahipala assured that Sri Lanka has a large stock of Tamiflu, 30,000 doses both in tablet form for adults and paediatric suspension for children. It was easy to switch gear when the WHO sounded the pandemic alert for H1N1, because the systems were in place after the avian influenza alarm some years ago, says the DDG, adding that a technical committee headed by him and the Director-General of Animal Production and Health was set up then under a World Bank project to deal with such emergencies. Comprising officials from all relevant sectors including epidemiology and veterinary, the committee implemented an action plan which covered all aspects such as lab improvements, human and animal surveillance, isolation facilities and drills at hospitals when patients with an infectious disease are brought in.
While stressing that the health authorities are in close contact not only with the WHO office in Colombo but also in Geneva, the strong message from Dr. Mahipala to the public is: Be alert but there is no need to panic. Take precautions not to catch the virus. If you think that you have H1N1 go to the nearest hospital.
Important facts to remember
Dr. Enoka Corea, Senior Lecturer in Microbiology, Faculty of Medicine, Colombo University explains what pandemic influenza is
Influenza is a viral fever of sudden onset, with fever, sore throat, cold and cough, body aches and loss of appetite and is caused by the Influenza virus. It is the same illness that is commonly known as the “flu”. Influenza or flu is present all year round. In addition, every year, there are outbreaks of influenza during the winter, known as “seasonal” flu.
Recently, a novel (never seen before) strain of Influenza virus emerged, that is spreading very rapidly throughout the world. It has been given the term “pandemic” influenza because of its rapid global spread and the large number of cases.
What is” pandemic” influenza caused by?
Influenza is caused by the Influenza virus. There are three groups of Influenza virus -- A, B and C, but only Influenza A gives rise to influenza epidemics that spread rapidly as a pandemic. This is because Influenza A virus has the tendency to change the genes coding for its outer proteins or antigens. This gives rise to a novel virus with novel antigens. Since there is no immunity in the human population to this novel virus the infection tends to spread rapidly. Influenza pandemics occur when human populations are infected by a variant virus to which the population has no prior immunity.
How does pandemic influenza spread?
Pandemic influenza spreads in the same way as seasonal influenza. The virus is transmitted from human to human by respiratory secretions of infected persons. The person with influenza is infectious from one day before the symptoms develop up to seven or more days after the onset of the flu. They shed the virus in respiratory droplets when they sneeze or cough and also when they talk. So they are able to infect people who are standing within a distance of one metre from them. The respiratory secretions on their hands, tissues, handkerchiefs, clothes or towels also contain the virus.
Therefore the items they use or touch (which become contaminated with respiratory secretions) can be infectious for several minutes to hours till the virus dies. When another person touches these contaminated items, such as door handles, table tops, computer keyboards, money etc., the virus may be picked up and introduced to that person’s body by touching the face, nose or mouth.
Therefore, you can get the virus by inhalation of respiratory droplets or by direct contact (touching) of objects contaminated by respiratory secretions.
You do not get pandemic influenza by eating pork or other products derived from pigs.
Where did this new strain of
Influenza A virus come from?
The novel virus was probably created in a pig. That is why it was initially given the name “Swine flu”. Now it is called “pandemic H1N1 influenza”.
There are many strains of Influenza viruses that infect humans, animals and birds. The strains vary depending on their surface proteins or antigens. These antigens are called H for Haemagglutinin and N for Neuraminidase. There are 16 types of H and 9 types of N. Therefore, a virus strain could be H1N1, H2N2, H1N2 or H3N2 etc. Fortunately only H1, H2 & H3 and N1 & N2 infect humans. The other strains infect animals and birds and only very rarely infect humans. This happened recently with the H5N1 avian (bird) flu virus but, because this does not spread from human to human, it did not give rise to a pandemic. The common strains that have been circulating in the human population in the 20th century have been H1N1, H2N2 and H3N2 strains.
The genetic material (RNA) of the Influenza A virus is in segments. Therefore, segments from two viruses can mix and get repackaged to give rise to a novel virus. This is called genetic reassortment. Because pigs can be co-infected with human viruses, swine viruses and bird viruses they form a kind of incubator for the production of novel viruses by the process of mixing of the genetic material of bird, animal and human viruses. This is probably how the novel virus was created.
This new Influenza A virus is an H1N1 virus strain with genetic material from human, bird and swine viruses. But it is a human influenza virus, fully capable of being transmitted from person to person. The term Swine flu was used to show the origin of the virus but should not be used any more as many people mistakenly think the virus is transmitted by pigs.
When does influenza
become a pandemic?
When a novel influenza virus is introduced into a susceptible population (one which has no immunity to the virus) it spreads rapidly from person to person causing an epidemic. In modern times where people frequently travel across the world these infections are carried by infected patients across the globe. Once the WHO detects that the virus is spread in more than one “WHO region” it declares a pandemic.
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