What can be done to prevent the spread of A(H1N1)?

WHO graph shows the number of cases is rising

First, the good news: the number of people dying from A(H1N1) is less than one percent. The not-so-good news is that one third of the deaths were young and healthy people. The bad news? Some cases MIGHT BE asymptomatic: there MIGHT be people who didn’t get sick at all, but who MIGHT have passed on the new flu virus — A(H1N1) — to others. The silver lining is that that would further lower the mortality rate, which as of now stands at less than one percent.

In a briefing last Friday (May 22, 2009), the World Health Organization (WHO) said there might be asymptomatic cases, or people who have the virus but have no symptoms, such as fever or cough. They could pass on the virus without even knowing that they had it.
This means contact tracing and thermal screening — measures which helped control SARS — might not be as effective.

How, then, to prevent the spread of this new flu virus? The most basic is handwashing, says Julie Hall, WHO expert on emerging infectious diseases.
The virus spreads through droplets, Hall says, as when one sneezes or coughs. It does not survive long after it leaves the body and falls to the ground. The problem is when one sneezes or coughs into one’s hand, and then touches another, or when the droplets fall on another person’s hand, and that hand then touches that other person’s eyes or mouth. Observe personal hygiene, and respiratory etiquette, as the health department has been saying over and over again. When you cough or sneeze, do it in a handkerchief. Wash your hands as often as possible.

In situations such as in Mexico, where the virus was spreading rapidly, closure of schools and public places might help because it would lessen the chances of passing on the virus.

***EMPHASIS ON THE “MIGHT.” The WHO says that “based on early data from Mexico it seems likely that some people will be infected but not show any symptoms. It is currently unknown if people who are infected but do not show any symptoms can infect other people or not.”

Notes on the WHO technical briefing about the A(H1N1): (again, for background info only)

Clinical illness very similar to the regular influenza…fever, body aches, headaches, feeling quite fatigued. Quite a number of cases around the world are suffering from diarrhea and vomiting. We don’t know whether having diarrhea is means of spreading virus…most features similar to regular influenza…

Being described as mild illness, but if you look at recent papers,
there’s really quite a marked range in symptoms from virtually nothing, asymptomatic but may be infectious…only mild symptoms, range to quite severe illness, those 86 deaths have been reported. Of cases being reported, the deaths work out at .8%. Less than one percent of people who become infected are dying from it. Quite a number are not being reported…total number much larger than being reported, if that is case then death rate lower..this virus does kill. Exactly how many and who are risk groups remain to be seen.

Of the severe cases, around 1 in 20 of reported cases have had hospital care for more than 24 hours…hospital needs of patients for hospital care higher than expected for seasonal influenza. Majority are young, between 25-44, the working age population, requiring inpatient hospital care more than older population. One third of them said they had no medical conditions, were healthy before caught virus. Unlike seasonal influenza, for a small number of people, we’re seeing that young and healthy people are being affected at rate higher than we would expect for seasonal influenza.

For majority of cases they do have mild illness, might still be infectious to others…which is why we’re seeing spread…those infected, taking two weeks…if large outbreaks, expect people to be away from
work for certain period of time…why we’re calling on gov’t to be vigilant. If we were to see big outbreaks, large levels of absenteeism, puts strain on health services, functioning of society…

Very few people over age of 50 are becoming infected with virus. Probably because they were exposed to something similar 50 years ago…little children unlike seasonal influenza are not being affected as well.

Much same data from us. The biggest number of cases between 10 and 50, very few cases over 50, before 5.

What does pandemic mean? phase 6 would mean sustained community transition in yet another region in the world. Phases don’t give indication of severity…haven’t yet seen sustained community transition outside of those regions…if we were to move up to phase 6, simply mean spread much further in world, not give indication of how severe it would be or how individual country wld be affected. Likely to affect different countries in different ways, young people, chronic underlying conditions…quite different impact in one country compared to another, and different speeds around the world and in different countries.

We’re concerned because of this rapid spread, virus able to transmit from one human to next. Early days from mexico more transmissible than
seasonal influenza…can spread as easily as seasonal influenza, maybe a little bit more easily than that. Many countries in southern hemisphere about to enter influenza season…whatever factors help this virus are likely to help virus spread as well. We can have seasonal influenza circulating at around the same time. People can get both infections…if that were to occur with large outbreaks, can put strain on health…rapid spread, may yet change…

Borders should remain open, international travel should not be restricted. Border control measurs or reducing travel would not stop movements of virus. Spreading because there are many people who are asymptomatic…people who are ill should delay travel until feeling better. Recommending to countries that they should remain vigilant, prepare helath sector for influx of cases if they were to see outbreak of virus. That countries review pandemic preparedness that have gone on for past years…seeing something slightly different from what we were expecting before. More importantly, find ways of enjoying that life and go on.

(how long does virus survive after it is ejected from the body) we don’t know for this particular virus. Those studies going on. But slight seasonal influenza, only for short time, depends on how dry it is.

Normal seasonal influenza tends to go away in summer time for temporal climates but not seeing for this virus. May is usually end, japan said normal seasonal influenza went away few weeks ago. But this virus is able to stay.

(carrier without being sick) simply assumptions we’re working on. We’re assuming that people for 24hours could be infectious to other people. 7 days but if they remain asymptomatic, probably show…people heavily symptomatic likely to spread. Children can remain infectious to other people for quite a long time, maybe 30. School breaks outbreaks…that first with idea that children are more confortabel.

Dr. soo: want to emphasize. By end of may beginning of june they will have a vaccine strain. Maybe beginning of august may be possible to sart production of new vaccine.

This region has had sars, bird flu. More ready than it would have been
a few years ago. Region lot more preparation than before.

Why not seen Africa and middle east? Lot of travel from north America to Europe, after that south america and then into asia. The pattern is really following the pattern of international travel. Might take some time to get to middle east and travel.

if you look at what’s happening in japan, predominantly around the school setting at this point in time…some cases in which difficult to have link back to school…vast majority high school cases, majority linked in some way to the school…some cases in which they’re finding it difficult to make link back to school.

Biggest concern is many people being affected, for a short period of
time..puts strain on people working…

(how compare with sars and bird flu) bird flu is quite different although it’s an influenza virus..predominantly affects poultry. Rare cases where human to human transmission of virus. Does not know how to infect humans. Death rate is significantly higher, 60-70%. Compared to sars this is a virus you can spread to others before you get symptoms, that makes it more difficult to control. Only after people developed fever, and more infectious during second week of illness…gave public health authorities to do prevent, do contact tracing…people can be infectious, fever not good indication of having disease, people able to spread more quickly than sars. Border screening, contact tracing is going to be a lot less effective than in sars.

Soo: patient traveled us Canada with family. If exposed to virus, plausible for rest of family members while in america to be exposed to same virus. In other countries, from this one case we cannot say this would stop at one case. Possibilities…even if we excluse no guarantee this would be the last case. Might be possibility of future introduction of travelers coming from countries without signs and symptoms…


One Response

  1. A woman at work has a daughter at college that was just diagnosed with H1N1. This woman is usually healthy but she will come into work with or without symptoms. I am obese, and have many auto-immune diseases, and are currently weaning off prednisone. I am 60 years old. Can you gauge how susceptible I could be in this situation

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