Alarming news reports on A (H1N1) flu, previously known as swine flu, have broken fast and hard this week. So fast, that you might have lost sight of how you fit into the big picture of pandemic preparedness. In part one of this two-part feature, we would like to provide a healthy sense of perspective on A (H1N1) flu and how it affects you at home. Look out for part two tomorrow – A (H1N1) Flu & Everyone Else – for a dose of good sense on A (H1N1) flu and how if affects your interactions with everyone else.

A (H1N1) FLU EXPLAINED

What is flu?

• An infection caused by influenza viruses
• Three types of flu viruses: A, B and C, all infect humans
• Current subtype highlighted in the news: A (H1N1)
• H refers to Haemagglutinin, N to Neuraminidase – both are proteins found on all flu virus coats and are used to characterise subtypes of flu

How does flu make me ill?

• Viruses replicate by entering healthy cells and copying themselves with the host cells’ resources
• Once the copies are ready, they burst forth to infect more cells, often destroying the host cell in the process
• Flu viruses do this in the cells of the nose, throat and lungs, causing respiratory illness, inflammation and complications like bronchitis and pneumonia

Do I have a cold or flu?

• Fever and headache are common in flu, rare in colds
• Aches and pains are severe in flu, mild in colds
• Fatigue, weakness and exhaustion are common in flu, occasional in colds

What is a suspected case?

Someone with:

• High fever (more than 38°C)
• AND dry cough
• AND one or more of the following: sore throat, nasal congestion/blockage, muscle pain, joint pain, headache, vomiting (infants), or fits (infants)

With or without:

• Recent history of travel to affected areas and/or close contact* with a person diagnosed with A (H1N1) flu

within 10 days of the onset of symptoms * Having cared for, lived with or had direct contact with the sections or body fluids of a suspect or probable case of A (H1N1) flu.

Where does flu come from?

• Flu viruses never go away – they are naturally present in wild fowl, for example
• Humans, birds and swine are viral “reservoirs” and “mixing vessels”, in which different viruses can mix and mutate
• When flu viruses mutate (change) enough to overwhelm our immune systems, outbreaks of infection occur

How does A (H1N1) flu compare to seasonal flu?

Annually around the world, seasonal flu (the “normal” flu against which you can be vaccinated):

• Affects 5-15% of populations
• Results in 3-5 million cases of severe illness
• Causes 250,0000-500,000 deaths

Can I get A (H1N1) flu from pigs/pork?

• A (H1N1) can pass from human to human because it has mutated sufficiently
• That means it is no longer similar to the type that usually spreads from swine to humans
• And that means you cannot catch A (H1N1) from exposure to live swine or pork
• That said, spending time with livestock increases your chances of becoming a “mixing vessel” and it is never a good idea to eat undercooked pork (so cook it to an internal temperature of at least 70°C)

PREVENTION: WHAT YOU CAN DO

Decreasing transmission is the best strategy for preventing a A (H1N1) flu outbreak. The more everyone follows the practices below, the safer YOU are from A (H1N1) flu.

Keep hands clean

• Wash hands after contact with common surfaces and utensils

• Don’t rub/touch your eyes, nose or mouth with unclean hands

To wash hands properly

1. Remove jewellery before handwashing
2. Rinse hands under warm running water, apply 3-5ml soap
3. Lather and rub hands together for at least 10-15 seconds
4. Scrub thumbs, under nails, between fingers, the back of fingers and hands
5. Rinse under running water
6. Dry thoroughly with single-use towel
7. Use the same towel to turn off the faucet

You can use a hand sanitiser if hands are not visibly soiled

1. Apply 1.5-3ml hand sanitiser
2. Rub to cover all surfaces of hands as per handwashing
3. Continue rubbing until solution dries completely

Practise couth/sneeze etiquette

• Cough/sneeze into a tissue
• Wash your hands after throwing it away
• If you have an upper respiratory tract infection (a cold, the sniffles etc) and need to be in crowded, public areas, wear a mask
• Wash hands before and after putting on/taking off a mask

3-ply surgical mask (oblong in shape, flexible)

• helps prevent you from spreading droplets from your mouth and nose to others
• does not protect you from breathing in small particles like viruses
• less expensive, easier to breathe through

N95 respirator mask (inflexible, hemisphere-shaped)

• provides 95% filtration from contamination
• proven to prevent transmission of airborne viruses
• used by those in close contact with infected persons e.g. healthcare providers
• more expensive, less comfortable
• needs to be face-fitted to be effective

Stay at home if you are ill with flu-like symptoms

• Seek medical attention if symptoms escalate
• Minimise contact with friends and relatives
• Maintain good indoor ventilation so airborne infectious particles do not build up
• Maintain good home hygiene – keep surfaces clean,clean mucous/phlegm spills with bleach solutions
• Make a note of guests who visit during this observation period
• Try to arrange for chores (eg grocery shopping) to be done for you

PHASES OF A FLU PANDEMIC

Period between pandemics

1.
• No new flu virus subtypes detected in humans
• Previous infectious subtypes may be present in animals
• Risk of human infection or disease low

Health authorities strengthen pandemic preparedness at all levels

2.
• No new flu virus subtypes detected in humans, BUT
• Circulating animal subtype poses substantial risk of human disease

Health authorities minimise risk of transmission to humans, detect and report cases rapidly, stockpile antivirals and strengthen collaborations with WHO/OIE/FAO

Pandemic Alert

3.
• Human infections with new flu subtype, BUT
• No human-to-human transmission, or rare cases of transmission with close contact

Health authorities characterise new subtype, and detect, notify and respond to new infection cases.

Public advised through effective risk communication.

4.
Declared 27 April
• Community-level outbreaks: sustained human-to-human transmission in small, localised clusters
• Significantly increased pandemic risk Health authorities continue to contain virus,delay spread (screen travellers, quarantine suspected cases, treat confirmed cases)

Public advised through effective risk management (avoid crowded areas, international travel, and people with flu-like symptoms; maintain good hygiene; isolate and observe suspected cases).

Pandemic

5.
Declared 29 April
• Sustained human-tohuman transmission in large clusters and many countries
• Strong risk of pandemic

6.
• Global pandemic in full swing
• Sustained and increased transmission in general population

Public advised through effective risk communication and requested to comply with instructions from medical officers.

Period after pandemic

POST PEAK

• Still on alert in case of recurrent events

POST PANDEMIC

• Flu activity returns to seasonal levels

Health authorities maintain surveillance, evaluate and update preparedness planning

DESIGNATED HOSPITALS

Perlis Hosp Tuanku Fauziah (04-976 3333)
Kedah Hosp Alor Setar (04-730 3333)
Hosp Kulim (04-490 3333)
Hosp Langkawi (04-966 3333)
Penang Hosp Pulau Pinang (04-229 3333)
Perak Hosp Ipoh (05-253 3333)
Hosp Slim River (05-4526 467)
Selangor Hosp Tengku Ampuan Rahimah, Klang (03-3375 7000)
Klang Valley Hosp Sungai Buloh (03-6145 4333)
WP KL Hosp Kuala Lumpur (03-2615 5555)
UM Medical Centre (603-7949 4422)
N Sembilan Hosp Seremban (06-762 3333)
Malacca Hosp Melaka (06-2822 344)
Johor Hosp Sultanah Aminah (07-225 7000)
Hosp Batu Pahat (07-4341 999)
Pahang Hospital Tengku Ampuan Afzan (09-513 3333)
Hosp Temerloh (09-295 5333)
Terengganu Hosp Kuala Terengganu (09-623 3333)
Kelantan Hosp Kota Bharu (09-745 2000)
Hosp Tumpat (09-7257 533)
Sarawak Sarawak General Hospital (082-276666)
Hosp Sibu (084-343333)
Hosp Miri (085-420033)
Hosp Bintulu (086-255899)
Sabah Hosp Queen Elizabeth (088-218166)
Hosp Duchess of Kent (089-212111)
Hosp Tawau (089-773533)
WP Labuan Hosp Labuan (087-423919)
MOH hotline: 03-8881 0200 / 0300
MOH website: www.moh.gov.my

SWINE INFLUENZA A/H1N1 VIRUS CASE DEFINITIONS

The following case definitions are for the purpose of reporting, suspected, probable and confirmed cases of Swine Influenza A/H1N1 virus infection to CPRC, Disease Control Division.

1. A Suspected Case of Swine Influenza virus infection is defined as an individual after 17th of April 2009, presenting with
• high fever >38°C, AND
• One or more of the following respiratory symptoms: cough, shortness of breath, body ache, difficulty in breathing, AND
• One or more of the following: close contact with a person diagnosed as Swine Influenza OR recent travel to an area reporting cases of confirmed Swine Influenza
(Acute febrile respiratory illness (fever > 38 °C) with the spectrum of disease from influenza-like illness to pneumonia)

2. A Probable Case of Swine Influenza A/H1 virus infection is defined as an individual that fulfill the criteria for a suspected case, with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection

OR

An individual with a clinically compatible illness or who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case.

3. A Confirmed Case of Swine Influenza A/H1N1 virus infection is defined as an individual with laboratory confirmed Swine Influenza A/H1N1 virus infection by one or more of the following tests*:
• real-time RT-PCR
• viral culture
• four-fold rise in swine influenza A(H1N1) virus specific neutralizing antibodies

* Note: The test(s) should be performed according to the most currently available guidance on testing.

Definition of cluster
A cluster is defined as two or more persons presenting with manifestations of unexplained, acute respiratory illness with fever > 38ºC or who died of an unexplained respiratory illness that are detected with onset of illness within a period of 14 days and in the same geographical area and/or are epidemiologically linked.

Triggers/signals
The primary focus of early investigation is to trigger the initial investigation. Specific triggers include:
• Clusters of cases of unexplained ILI or acute lower respiratory disease
• Severe, unexplained respiratory illness occurring in one or more health care workers who provide care for patients with respiratory disease
• Changes in the epidemiology of mortality associated with the occurrence of ILI or lower respiratory tract illness, an increase in deaths observed from respiratory illness or an increase in the occurrence of severe respiratory disease in previously healthy adults or adolescents
• Persistent changes noted in the treatment response or outcome of severe lower respiratory illness.

#Close contact: having cared for, lived with, or had direct contact with respiratory secretions or body fluids of a probable or confirmed case of swine influenza A (H1N1).

Where can I get more information?

For more information, go to the Health Ministry (www.moh.gov.my) or call the Ministry’s hotline at (03) 8881-0200/300.

Useful Links:
World Health Organization: www.who.int
Centers for Disease Control and Prevention: www.cdc.gov
Homeland Security Department: www.dhs.gov
WHO swine flu page: http://www.who.int/csr/disease/swineflu/en/index.html

Swine Flu FAQs

What is swine influenza?

It is a respiratory disease of pigs caused by type A strains of the influenza virus. It regularly causes high flu outbreaks in pigs but with low death rates. There are four main sub-types of the virus, but the most recent isolated influenza viruses from pigs have been H1N1 viruses.

How does it spread?

Swine flu viruses do not typically infect humans though they do occur through close proximity or contact with infected pigs or contaminated areas. Cases of human-to-human spread have been documented.

What are the symptoms?

The symptoms are similar to those of regular flu:
- Fever
- Lethargy
- Runny nose
- Cough
- Sore throat
- Lack of appetite
- Vomiting and diarrhoea in some cases.

How common is swine flu infection in humans?

In the past reports of about one human swine flu virus infection had been received every one to two years in the United States. From December 2005 till February 2009, 12 cases have been reported.

Has this strain of flu been seen before?

No. Flu mutates constantly, so it is common for new strains to emerge. Pigs can also be infected with both human and avian influenza, and the current circulating swine flu strain appears to contain genetic elements from all three.

Can swine flu be treated with antiviral drugs and flu vaccine?

The swine flu is resistant to two common drugs – Amantadine and Rimantadine. The H1N1 swine flu viruses are very different from human H1N1 viruses. Therefore, vaccines for human seasonal flu would not provide protection. However, a “seed vaccine” has been specifically tailored to this swine flu and will be manufactured if officials deem it necessary.

Can people catch swine flu by eating pork?

No. Swine influenza viruses are not transmitted by food. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 70ºC and above kills the swine flu virus.

How long is someone with swine flu considered contagious?

People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic; possibly for up to seven days following the onset of the illness. Children, especially younger children, might potentially be contagious for longer periods.

What can I do to protect myself from the swine flu?

There is no vaccine available right now to protect against the swine flu.

However, you can help prevent the spread of germs that cause respiratory illnesses like influenza by:

- Covering your nose and mouth with a disposable tissue or handkerchief when you cough or sneeze. Throw the tissue in the waste basket after you use it.

- Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also helpful

- Try to avoid close contact with sick people. – If you get sick with influenza, stay at home and limit contact with others to keep from infecting them.

- Avoid touching your eyes, nose or mouth.

- Consult your nearest healthcare facility if you think you have any of the symptoms.

Which countries have had cases of the swine flu?

The World Health Organisation (WHO) has confirmed human cases of swine flu in Mexico, the United States, Canada and Spain. Only Mexico has reported deaths from the new strain.

Are there any travel restrictions or advisories for Malaysians?

The Health Ministry on April 27 advised Malaysians against travelling to certain places in the United States, Mexico and Canada which have been affected by the swine flu.

What precautions are in place in Malaysia?

- The Health Ministry’s operations room in Putrajaya has started a 24-hour monitoring of the situation. The public can call 03-8881 0200/300 for enquiries.

- Those returning from Latin American countries and found to have flu-like symptoms will be quarantined.

- Health Ministry officials are conducting health screenings on passengers arriving from the United States.

- Thermal scanners will be placed at international airports to speed up the screening process for swine flu.

- Public and private medical practitioners have been instructed to report to the district health office any patient with influenza-like illnesses or severe pneumonia symptoms and who had travelled to the affected countries after April 17.

- Owners of the 797 pig farms nationwide have been ordered to immediately contact the nearest Veterinary Services Department office or the Animal Disease Control Centre if their workers or animals show symptoms linked to the swine flu.

Where can I get more information?

For more information, go to the Health Ministry (www.moh.gov.my) or call the Ministry’s hotline at (03) 8881-0200/300.

Useful Links:
World Health Organization: www.who.int
Centers for Disease Control and Prevention: www.cdc.gov
Homeland Security Department: www.dhs.gov
WHO swine flu page: http://www.who.int/csr/disease/swineflu/en/index.html

This is the official classification of the Body Mass Index from the WHO.

Think Health Be Healthy

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Mobile: +6013-2060130
Email: newbi3s@yahoo.com

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Benefits of laughter
* Eases depression and insomnia
* Reduces tension and stress
* Promotes relaxation
* Increases oxygen level in blood and enhan­ces energy
* Removes boredom and anxiety
* Attracts more friends
* Increases joy
* Improves bonding
* Controls high blood pressure
* Create happy cells
* Discharge nervous energy

Activities that can create humour
* Sharing a joke
* Going for a party
* Reading comics
* Watching a comedy
* Viewing a hilarious movie
* Talking to humorists
* Being in the company of funny people
* Attending happy occasions like wedding, birthday and anniversary celebrations

“He who has health has hope, and he who has hope has everything.” -Arabian Proverb

1. Move More
Make it a daily challenge to find ways to move your body. Climb stairs if given a choice between that and escalators or elevators. Walk your dog; chase your kids; toss balls with friends, mow the lawn. Anything that moves your limbs is not only a fitness tool, it’s a stress buster. Think ‘move’ in small increments of time. It doesn’t have to be an hour in the gym or a 45-minute aerobic dance class or tai chi or kickboxing. But that’s great when you’re up to it. Meanwhile, move more. Thought for the day: Cha, Cha, Cha…. Then do it!

2. Cut Fat
Avoid the obvious such as fried foods, burgers and other fatty meats (i.e. pork, bacon, ham, salami, ribs and sausage). Dairy products such as cheese, cottage cheese, milk and cream should be eaten in low fat versions. Nuts and sandwich meats, mayonnaise, margarine, butter and sauces should be eaten in limited amounts. Most are available in lower fat versions such as substitute butter, fat free cheeses and mayonnaise. Thought for the day: Lean, mean, fat-burning machine…. Then be one!

3. Quit Smoking
The jury is definitely in on this verdict. Ever since 1960 when the Surgeon General announced that smoking was harmful to your health, Americans have been reducing their use of tobacco products that kill. Just recently, we’ve seen a surge in smoking in adolescents and teens. Could it be the Hollywood influence? It seems the stars in every movie of late smoke cigarettes. Beware. Warn your children of the false romance or ‘tough guy’ stance of Hollywood smokers. Thought for the day: Give up just one cigarette…. the next one.

4. Reduce Stress
Easier said than done, stress busters come in many forms. Some techniques recommended by experts are to think positive thoughts. Spend 30 minutes a day doing something you like. (i.e.,Soak in a hot tub; walk on the beach or in a park; read a good book; visit a friend; play with your dog; listen to soothing music; watch a funny movie. Get a massage, a facial or a haircut. Meditate. Count to ten before losing your temper or getting aggravated. Avoid difficult people when possible. Thought for the day: When seeing red, think pink clouds….then float on them.

5. Protect Yourself from Pollution
If you can’t live in a smog-free environment, at least avoid smoke-filled rooms, high traffic areas, breathing in highway fumes and exercising near busy thoroughfares. Exercise outside when the smog rating is low. Exercise indoors in air conditioning when air quality is good. Plant lots of shrubbery in your yard. It’s a good pollution and dirt from the street deterrent. Thought for the day: ‘Smoke gets in your eyes’…and your mouth, and your nose and your lungs as do pollutants….hum the tune daily.

6. Wear Your Seat Belt
Statistics show that seat belts add to longevity and help alleviate potential injuries in car crashes. Thought for the day: Buckle down and buckle up.

7. Floss Your Teeth
Recent studies make a direct connection between longevity and teeth flossing. Nobody knows exactly why. Perhaps it’s because people who floss tend to be more health conscious than people who don’t? Thought for the day: Floss and be your body’s boss.

8. Avoid Excessive Drinking
While recent studies show a glass of wine or one drink a day (two for men) can help protect against heart disease, more than that can cause other health problems such as liver and kidney disease and cancer. Thought for the day: A jug of wine should last a long time.

9. Keep a Positive Mental Outlook
There’s a definitive connection between living well and healthfully and having a cheerful outlook on life. Thought for the day: You can’t be unhappy when you’re smiling or singing.

10. Choose Your Parents Well
The link between genetics and health is a powerful one. But just because one or both of your parents died young in ill health doesn’t mean you cannot counteract the genetic pool handed you. Thought for the day: Follow these basic tips for healthy living and you can better control your own destiny.