Title: H1N1 flu pandemic
Author:
Md. Arifuzzaman Faisal
Department of Electrical And Electronic Engineering
Bangladesh University of Engineering and University

H1N1 flu pandemic

Generally we know Influenza viruses cause annual endemics and infrequent endemics that have asserted the lives of many peoples. Appreciating the function of particular awareness in encouraging people to engage in preventive activities may help health communicators to progress their messages about epidemics of new contagious infection usually and swine flu in particular. Due to the swine-flu virus called novel swine-origin influenza A (H1N1) the eruption of human infection began all over the world in spring 2009. "H1N1 emerged in February 2009 in Mexico and swept around the globe within 6 months." ( - Professor Hans Dieter Klenk; Philipps-Universität Marburg). Though flu epidemic began in 1918 and it becomes blast as a great epidemic in 2009.[See Table-1] In more than 214 countries during that times swine-flu virus (H1N1) was a severe epidemic public health problem. A laboratory confirmation was required to differ novel influenza virus from seasonal human influenza as all clinical symptoms of novel swine-flu’s infection were similar to seasonal human influenza. Swine-flu Influenza A (H1N1) is a subtype of virus called influenza A and it was common cause of human swine-flu in 2009. H1N1 influenza swine-flu virus now named as novel H1N1 and this influenza virus normally found in pigs. In 1930 in the U.S. swine influenza virus was first isolated from pigs. As the eruption of human infection due to H1N1 influenza virus began all over the world in spring 2009, WHO (World Health Organization) declared swine-flu as a pandemic. Often public media call this strain of swine-origin H1N1 as swine-flu. As swine-flu spread worldwide it caused 1700 peoples death. In 26th April 2011, the World Health Organization (WHO) has issued an H1N1 epidemic preparation alert for all Americans. Chihuahua of Mexico also have included in affected region as here severity of H1N1 influenza-virus have been high.

H1N1 influenza virus has serious impact on the individual health especially on those older than 65, younger than 5 years [See Table-2], children with conditions of neurodevelopment, women who are pregnant (mainly during 3rd trimester) and those who are underlying in many disease like a weakened immune system, diabetes, asthma, obesity, weaken heart. The symptoms of H1N1 flu are similar to other influenzas. Symptoms like fever, joint pain, cough, muscle pain, headache, vomiting and diarrhea has been reported. The CDC reported In September, 2009 that the H1N1 flu "seems to be taking a heavier toll among chronically ill children than the seasonal flu usually does." The CDC had received 36 reports of pediatric deaths associated with swine-flu symptoms and clinically-confirmed through 8 August 2009.
Some symptoms of H1N1, swine flu influenza virus are given below:-
Symptoms found in children: * Breathing problem * Having no tears when crying * skin color become bluish * less interacting * not enough drinking fluids * Being so irritable that the child does not want to be held * fever and bad cough * Rash fever * Being unable to eat
Symptoms found in adults: * breathing difficulty or less of breath * stress in the chest or pain in stomach * abrupt dizziness * Few mental disorder * Highly vomiting * Temperature become low
Most complication will occur for a man/woman who is overweight. Primary influenza generally occurs in adults but among children bacterial influenza is more common. An investigation in United Kingdom reported that about 631 patients become ill with epidemic influenza virus A H1N1 and 55 patients admitted in hospitals confirmed with clinical-proven from April through 2010. Among them 13% admitted in hospitals under doctor’s high investigation and end of all 5% died. 36% were aged under 16and 5% were above 65 [See Table-1]. At least one prevailing condition like asthma sustain among 45% patients. On 14 April 2009 CDC had identified this new strain swine-flu virus in two children and also confirmed they never had been gotten in touch with any pigs. The patient had swine-flu symptoms including cough and fever were first confirmed by clinical examination. 2009 flu pandemic death first confirmed by CDC occurred at Texas Children's Hospital situated in Houston, Texas.
In United States 22 children having neurodevelopment conditions such as fever, muscular dystrophy, cerebral palsy or delay on their developmental condition."Children with nerve and muscle problems may be at especially high risk for complications because they cannot cough hard enough to clear their airways". Grady, Denise (3 September 2009). "Report Finds Swine Flu Has Killed 36 Children", The New York Times, Retrieved 17 September 2009. In the United States from 26 April 2009 to 13 February 2010, the CDC also had received a report about the deaths of 277 children with clinically-confirmed that it was occurred as a cause of swine-flu virus influenza A (H1N1). In September 2010 a Wisconsin study published in the Journal of the American Medical Association that the 2009 H1N1 flu swine-flu virus was no more rigorous than the cyclic flu virus. "The risk of most serious complications was not elevated in adults or children", written by the study's authors. "Children were disproportionately affected by 2009 H1N1 infection, but the perceived severity of symptoms and risks of serious outcomes were not increased."
Many overseas communities or districts and More than 214 countries had reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 18,449 deaths (World Health Organization, August 6, 2010) [See Table 1 & 2]. In 2009 WHO was indicated that a full global epidemic was under way as there was a huge lacking of choosing specific vaccine against swine flu, educating people individually about reduction the risk of transmission and also isolating and treating people who have suffered from swine-flu (H1N1). The swine-flu virus (H1N1) isolated from patients in United States in the 2009 swine-flu pandemic and founded four different flu viruses – human influenza, swine influenza, North American avian influenza and North American swine influenza virus typically found in Europe and Asia. This new strain appears to be a result of reclassification of swine influenza and human influenza viruses, in all four different strains of subtype swine-flu (H1N1) virus.
Infection with swine-flu virus has varied from mild to severe. Many people had been sick then had recovered without medical-treatment or hospitalization. Also many had died from the infection of swine-flu virus. So infections of swine-flu May mild, sometime become sever. In cyclic swine-flu, definite people are at “high risk” of severe difficulties. As mentioned earlier that this consist of pregnant women, older than 65 years, younger than five years old children and people of any age with assured unrelieved medical circumstances. About 70 percent adult people who have been hospitalized with the swine-flu (H1N1) virus have had one or more medical situations formerly documented as insertion people at “high risk” of severe seasonal flu-interconnected difficulties. These take account of asthma diabetes, pregnancy, heart disease and many others disease. A revision on the effect of swine-flu august 2009, 57 percent of children who had been hospitalized as an effect of swine-flu have had one or further “high risk” medicinal circumstances. Children who are under 10 years are also at far above the ground risk of severe complications from swine-flu, just as they are far above the ground risk of severe complications from seasonal flu. For adult people older than 65 years are less possible to be contaminated with swine-flu, if they get sick, they are also at “high risk” of increasing severe difficulties from their sickness. CDC laboratory statistics have exposed that no children bodies contain antibody to the swine-flu and some adults younger than 65 years old have containing antibody to the swine flu virus.

People’s body will improve for immune resistance to swine flu virus (A H1N1) if you get infected with any influenza virus like swine flu (2009 H1N1) virus, so it's not possible that a person would be infected with the same influenza virus more than one time. But people with weak systems might not improve full immunity after disease and might be more possible to get infected with the similar influenza virus more than one time. However, it is also feasible that more than once infected by influenza virus a person could have a positive test result for flu infection in same influenza season. Two main reasons behind this flu occurrence: 1. A person may be infected with different flu viruses. For instance time may infect with a regular seasonal flu virus than May infected by with swine-flu (2009 H1N1) virus. But most quick tests cannot make a distinction which influenza virus is accountable for the illness. 2. Sometimes Influenza tests can infrequently give false negative and false positive domino effect so it's likely that one of the test outcomes were wrong. This is more possible to occur when the analysis is made with the quick flu tests. Now information about flu identification is obtainable.
During 2009 flu pandemic the there were a short supply of H1N1 vaccine, and so US government recommended to provide vaccine to urgent people like children, pregnant women, who caring baby under 1 year, health care working people. As there was a limitation to provide sufficient vaccine to all people it was reported that for adult need twice vaccine for prevention. As the virus was new and many people were affected by H1N1 it became a hard task for US government to prevail against such 2009 flu pandemic immediately. On the other side, studying on many hospital’s health care providers it was reported that about seventy-five percent of the health care providers were conscious about the symptoms of H1N1 flu. Mostly, all study subjects were conscious that it is spread from first to last droplet disease. As exact knowledge of swine-flu infection and what to do was known to 85% of the doctors and 71% of the nurses, infection of swine-flu (2009 A H1N1) had become pandemic. This study and knowledge about that situation may help us to prevent such future epidemic. If we concern about this statistics we take measure to prevent future epidemic like swine-flu.

As the limitation of vaccine during that emergency period many doctor and other health organization like WHO came to a point that to reduce the threat of catching swine-flu virus people should take some measurements which are given below:- * Wearing mask * Before eating Poultry food need to be aware of its necessary information like the poultry is affected by flu or not. * covering mouth and nose when sneezing or coughing with tissue * The tissue should give away safely and most carefully, firing that would better. * Washing hands with shop regularly * Clean up house regularly * Using antiseptic for cleaning house * Cleaning cloth * Cover mouth and nose with a tissue after cough or sneeze. * Wash your hands frequently with soap and water. * Without washing hand avoid touching your mouth, eyes or nose or. * Avoid get in touch with sick people. * If you are sick with flu-like illness, CDC suggested that patient should stay at home at least 24 hours after your fever is gone except to take medical concern or for other urgent requirements.
Other significant procedures that you can take are: * Always try to follow public health recommendation as regards avoiding crowds, school closure and other social activities. * If getting sick you should be prepared to improve your condition and need to stay home for some days. * After getting sick, clean all used cloths and other accessories and communicate with your doctor immediately.

Now preventing transmission of influenza virus and other infectious agents dependent on the incidence of strong administrative policies and directorial leadership which endorse and facilitate adherence to some administrative strategies like implementing ecological and engineering infection control measures, suitable management of ill HCP, organizing of influenza vaccine etc amongst the different kind of people within the healthcare providing, including visitors, HCP and patients. These administrative measures are included within each recommendation where appropriate. Furthermore, this guidance may be implemented in the context of a wide-ranging infection prevention program to prevent transmission of all infectious viruses like swine-flu among people.
After 2009 flu pandemic USA and public health policies became aware about swine flu expansion among people. Public health is the most important for its economic growth and development. Every health organization should be aware about any kind of pandemic expansion among general people. Government should make some rules for any kind of birds or animals firm so that any unexpected infections will not occur again. Like US government can take some step to maintain any kind of import specially poultry feed. As it is one of the main reasons for expansion of virus from one country to another. As H1N1 appeared like a giant problem worldwide and many deaths occur for some careless activities, political and public efforts may effective to prevent such epidemic disease.
It’s time for raising awareness among people to prevent such sudden pandemic which may result in many deaths. Public awareness, governmental steps for prevention, health organization’s research and measurements for upcoming disease, providing vaccination, available medicine and health awareness may prevent such upcoming pandemic. And by taking all the roles of particular perceptions in propelling people to engage in forethought behavior may help health communicators to deliver their messages about eruptions of new contagious disease like swine-flu (H1N1).
Appropriate training of the Health Care Provider may fill up with momentous gaps seen between knowledge and practical application of the Health Care Providers concerning 2009 H1N1. All data and studies point out that the health care providers are always intellectual, but they do not practice themselves what they discourse. On another side victims are also not so serious about what to do is such situation like pandemic swine-flu (H1N1). Raising awareness among people, taking leadership and political sincerity, practical activities of all health organizations and being prepared about upcoming any pandemic infection like swine-flu may helpful for this purpose.

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Table 1: 20th century flu pandemics Pandemic | Year | Influenza virus type | People infected (approximate) | Estimated deaths worldwide | Case fatality rate | Spanish Flu | 1918-1919 | A/H1N1 | 33% (500 million) | 20–100 million | >2.5% | Asian Flu | 1956-1958 | A/H2N2 | - | 2 million | <0.1% | Hong King Flu | 1968-1969 | A/H3N2 | - | 1 million | <0.1% | Seasonal Flu | Every Year | mainly A/H3N2, A/H1N1, and B | 5–15% (340 million – 1 billion) | 250,000–500,000 per year | <0.1% | Swine Flu | 2009-2010 | Pandemic H1N1/09 | > 622,482 (lab-confirmed) | 14,286 (lab-confirmed; ECDC)18,036 (lab-confirmed; WHO) | 0.03% |
Source: "Pandemic (H1N1) 2009 – update 100". Disease Outbreak News (World Health Organization (WHO)). 14 May 2010. Archived from the original on 18 May 2010. Retrieved 14 May 2010. Sternberg, Steve (26 May 2009). "CDC expert says flu outbreak is dying down – for now". USA Today. Retrieved 17 September 2009.

Table 2: Impact of 2009 H1N1 flu | | | Outcome and age group | Mid-level Range | Estimated Range | Illness | | | 0-17 years | 20,000,000 | 14-28 million | 18-64 years | 35,000,000 | 25-52 million | 65 and older | 6,000,000 | 4-9 million | Total illness | 61,000,000 | 43-89 million | Hospitalization | | | 0-17 years | 20,000,000 | 14-28 thousand | 18-64 years | 35,000,000 | 25-52 thousand | 65 and older | 6,000,000 | 4-9 thousand | Total Hospitalization | 274,000 | 195-403 thousand | Deaths | | | 0-17 years | 1,280 | 910-1880 | 18-64 years | 9,570 | 6.800-14,040 | 65 and older | 1,620 | 1,160-2,380 | Total deaths | 12,470 | 8,870-18,300 |
Source: CDC Estimates of 2009 H1N1 cases and Related Hospitalizations and Deaths from April 2009 – April 2010, by age Group.