HEALTHY LIFE STYLE

Swine influenza (also swine flu) refers to influenza caused by any strain of the influenza virus endemic in pigs (swine). Strains endemic in swine are called swine influenza virus (SIV).

Of the three genera of human flu, two are endemic also in swine: Influenzavirus A is common and Influenzavirus C is rare.^[1] Influenzavirus B has not been reported in swine. Within Influenzavirus A and Influenzavirus C, the strains endemic to swine and humans are largely distinct.

Swine flu is common in swine and rare in humans. People who work with swine, especially people with intense exposures, are at risk of catching swine influenza if the swine carry a strain able to infect humans. However, these strains rarely are able to pass from human to human. Rarely, SIV mutates into a form able to pass easily from human to human. In humans, the symptoms of swine flu are similar to those of influenza and of influenza-like illness in general, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.

The 2009 flu outbreak in humans is due to a new strain of influenza A virus subtype H1N1 that derives in part from human influenza, avian influenza, and two separate strains of swine influenza. The origins of this new strain are unknown, and the World Organization for Animal Health (OIE) reports that it has not been isolated in swine.^[2] It passes with apparent ease from human to human, an ability attributed to an as-yet unidentified mutation.^[3] The strain in most cases causes only mild symptoms and the infected person makes a full recovery without requiring medical attention and without the use of antiviral medicines.^[4]

Background

The H1N1 form of swine flu is one of the descendants of the Spanish flu that caused a devastating pandemic in humans in 1918–1919.^[5][6] As well as persisting in pigs, the descendants of the 1918 virus have also circulated in humans through the 20th century, contributing to the normal seasonal epidemics of influenza.^[5] However, direct transmission from pigs to humans is rare, with 12 cases in the U.S. since 2005.^[7]

The flu virus is perhaps the trickiest known to medical science; it constantly changes form to elude the protective antibodies that the body has developed in response to previous exposures to influenza or to influenza vaccines. Every two or three years the virus undergoes minor changes. Then, at intervals of roughly a decade, after the bulk of the world's population has developed some level of resistance to these minor changes, it undergoes a major shift that enables it to tear off on yet another pandemic sweep around the world, infecting hundreds of millions of people who suddenly find their antibody defenses outflanked.^[8] Even during the Spanish flu pandemic, the initial wave of the disease was relatively mild, while the second wave was highly lethal.^[6]

In 1957, an Asian flu pandemic infected some 45 million Americans and killed 70,000. Eleven years later, lasting from 1968 to 1969, the Hong Kong flu pandemic afflicted 50 million Americans and caused 33,000 deaths, costing approximately $3.9 billion. In 1976, about 500 soldiers became infected with swine flu over a period of a few weeks. However, by the end of the month investigators found that the virus had "mysteriously disappeared", and there were no more signs of swine flu anywhere on the post.^[6] There were isolated cases around the U.S., but those cases were supposedly to individuals who caught the virus from pigs.

Medical researchers worldwide, recognizing that the swine flu virus might again mutate into something as deadly as the Spanish flu, were carefully watching the latest 2009 outbreak of swine flu and making contingency plans for a possible global pandemic.

Classification

SIV strains isolated to date have been classified either as Influenzavirus C or one of the various subtypes of the genus Influenzavirus A.^[9]

Influenza A

Swine influenza is known to be caused by influenza A subtypes H1N1,^[10] H1N2,^[10] H3N1,^[11] H3N2,^[10] and H2N3.^[12]

In swine, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are circulating throughout the world. In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.^[13]

Interaction with H5N1

Avian influenza virus H3N2 is endemic in pigs in China and has been detected in pigs in Vietnam, increasing fears of the emergence of new variant strains.^[14] Health experts^[who?] say pigs can carry human influenza viruses, which can combine (i.e. exchange homologous genome sub-units by genetic reassortment) with H5N1, passing genes and mutating into a form which can pass easily among humans.^[15] H3N2 evolved from H2N2 by antigenic shift.^[16] In August 2004, researchers in China found H5N1 in pigs.^[17]

Nature magazine reported that Chairul Nidom, a virologist at Airlangga University's tropical disease center in Surabaya, East Java, conducted a survey of swine infections with H5N1 in 2005. He tested the blood of 10 apparently healthy pigs housed near poultry farms in West Java where avian flu had broken out. Five of the pig samples contained the H5N1 virus. The Indonesian government has since found similar results in the same region. Additional tests of 150 pigs outside the area were negative.^[18][19]

Signs and symptoms

Main symptoms of swine flu in humans.^[20]
See also:The Centers for Disease Control and Prevention (CDC): Symptoms of Swine Flu in YouTube

According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of swine flu are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. The 2009 outbreak has shown an increased percentage of patients reporting diarrhea and vomiting.^[21]

Because these symptoms are not specific to swine flu, a differential diagnosis of probable swine flu requires not only symptoms but also a high likelihood of swine flu due to the person's recent history. For example, during the 2009 swine flu outbreak in the United States, CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset."^[22] A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).^[22]

Prevention

Prevention of swine influenza has three components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans.

Prevention in swine

Swine influenza has become a greater problem in recent decades as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases.^[23][24]

Present vaccination strategies for SIV control and prevention in swine farms, typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses.^[25][26]

Prevention of transmission to humans

This section requires expansion.

Prevention of spread in humans

Influenza spreads between humans through coughing or sneezing and people touching something with the virus on it and then touching their own nose or mouth.^[27] Swine flu cannot be spread by pork products, since the virus is not transmitted through food.^[27] The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. Diagnosis can be made by sending a specimen, collected during the first five days, to the CDC for analysis.^[28]

Recommendations to prevent spread of the virus among humans include using standard infection control against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public.^[29] Although the current trivalent influenza vaccine is unlikely to provide protection against the new 2009 H1N1 strain,^[30] vaccines against the new strain are being developed and could be ready as early as June 2009.^[31]

Experts agree that hand-washing can help prevent viral infections, including ordinary influenza and the new swine flu virus. Influenza can spread in coughs or sneezes, but an increasing body of evidence shows little particles of virus can linger on tabletops, telephones and other surfaces and be transferred via the fingers to the mouth, nose or eyes. Alcohol-based gel or foam hand sanitizers work well to destroy viruses and bacteria. Anyone with flu-like symptoms such as a sudden fever, cough or muscle aches should stay away from work or public transportation and should see a doctor to be tested.

Social distancing is another tactic. It means staying away from other people who might be infected and can include avoiding large gatherings, spreading out a little at work, or perhaps staying home and lying low if an infection is spreading in a community.

Treatment

In response to requests from the U.S. Centers for Disease Control and Prevention, on April 27, 2009 the FDA issued Emergency Use Authorizations to make available diagnostic and therapeutic tools to identify and respond to the swine influenza virus under certain circumstances. The agency issued these EUAs for the use of certain Relenza and Tamiflu antiviral drugs, and for the rRT-PCR Swine Flu Panel diagnostic test.^[32]

The CDC recommends the use of Tamiflu (oseltamivir) or Relenza (zanamivir) for the treatment and/or prevention of infection with swine influenza viruses, however, the majority of people infected with the virus make a full recovery without requiring medical attention or antiviral drugs.^[33] The virus isolates that have been tested from the US and Mexico are however resistant to amantadine and rimantadine.^[34] If a person gets sick, antiviral drugs can make the illness milder and make the patient feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

Antiviral Stockpiles

Some countries have issued orders to stockpile antivirals. These typically have an expiry date of five years after manufacturing.

Preparedness