In June 2009, the World Health Organization (WHO) determined that H1N1 2009 influenza A swine flu reached WHO level 6 criteria (person- to-person transmission in two separate WHO-determined world regions) and declared it as the first flu pandemic in 41 years. The flu reached over 74 different countries on every continent except Antarctica in about three month’s time. Fortunately, the severity of the disease was controlled soon after.

Swine influenza virus was first isolated from pigs in 1930 in the US and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with Pigs, for example, farmers and pork processors. In most instances, the cross-species infections swine virus to man and human flu virus to Pigs have remained in local areas and have not caused national or worldwide infections in either pigs or humans.

Unfortunately, the 2009 swine flu strain, first seen in Mexico, spread to humans as never before. It exhibited two main surface antigens. Hi (hemagglutinin type 1) and N1 (neuraminidase type 1). Further investigations showed the eight RNA strands from H1N1 flu had one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains.

The usual mortality (death) rate for typical influenza A is about 0.1 per cent, while the 1918 ‘Spanish flu’ epidemic had an estimated mortality rate ranging from 2-20 per cent. In Mexico, many of the patients were young adults, which made some investigators speculate that a strong immune response may cause some collateral tissue damage.

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Symptoms of swine flu are similar to most influenza infections, i.e. fever (100° F or greater), cough, nasal secretions, fatigue, and headache Some patients also get nausea, vomiting, and diarrhea. Swine flu is presumptively diagnosed clinically by the patient’s history of association with people known to have the disease and their symptoms. Usually, a quick test nasopharyngeal swab sample is done to see if the patient is infected with influenza A or B virus. Most of the tests can distinguish between A and B types.

The test can be negative (no flu infection) or positive for type A and B. If the test is positive for type B, the flu is not likely to be swine flu (H1N1). If it is positive for type A, the person could have a conventional flu strain or swine flu (H1N1). However, the accuracy of these tests is questionable. Another method of definitively diagnosing Swine flu is by identifying the particular antigens associated with the virus type. In general, this test is done in a specialized laboratory.

Two antiviral agents’ zanamivir (Relenza) and oseltamivir (Tamiflu) have been reported to help prevent or reduce the effects of swine flu. However, it is not advisable to use these drugs indiscriminately, because viral resistance to them can and has occurred. Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the 48- hour guideline.

Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection.

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The best treatment for influenza infections in humans is prevention by vaccination. In early October 2009, a nasal spray vaccine was released. It is approved for use in healthy individuals ages 2 through 49. This vaccine consists of a live attenuated H1N1 virus and should not be used in anyone who is pregnant or immuno-compromised.

Subsequently, the injectable vaccine, made from killed H1N1, also became available in the second week of October. This vaccine is approved for use in ages 6 months to the elderly, including pregnant females. Both these vaccines have been approved only after they had conducted clinical trials to prove that the vaccines were safe and effective.

Vaccination to prevent H1N1 swine flu is suggested for pregnant women, people who live with or provide care for children younger than 6 months of age, health-care and emergency medical services personnel, people between 6 months and 24 years of age, and people from the ages of 25 through 64 who are at higher risk because of chronic health disorders such as asthma, diabetes, or a weakened immune system.

Another type of vaccine, named Influenza A [H1N1] 2009 Monovalent Vaccine Live, Intranasal, made available during the first week in October 2009, is a live attenuated H1N1 flu vaccine that contains no thimerosal, and is sprayed into the nostrils. This vaccine is only for healthy people 2-49 years of age.

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Symptomatic people should stay at home, avoid crowds, and take off from work or school until the disease is no longer transmittable (about two to three weeks) or until medical help and advice is sought. Sneezing, coughing, and nasal secretions need to be kept away from other people. Quarantining patients is usually not warranted, but such measures depend on the severity of the disease. Infected people can wear surgical masks to reduce the amount of droplet spray from coughs and sneezes and throw away contaminated tissues.

A good way to prevent any flu disease is to avoid exposure to the virus. It can be done by frequent hand washing, avoiding touching your hands to your face, and avoiding any close proximity to or touching any person who may have flu symptoms. Since the virus can remain viable and infectious for about 48 hours on many surfaces, good hygiene and cleaning with soap and water or alcohol-based hand disinfectants is also advisable. Face masks also help prevent getting airborne flu viruses from a cough or sneeze.

In situations where it is absolutely necessary to enter a crowded setting or to have close contact with persons who might be ill, the time spent in that setting should be as short as possible. If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time.

Perhaps the best way for individuals to try to prevent H1N1 infection is a combination of methods that are aimed at fulfilling the very basic principle that if H1N1 doesn’t reach an individual’s mucus membrane cells, infection will be prevented.