SHAMSUL GHANI (shams_ghani@hotmail.com)
Dec 28, 2009 - Jan 03, 2010

The whole world today is feeling threatened by a relatively new kind of ailment, with a high level of fatality, commonly known as Swine Flu. Its most notorious inflictor is known as the H1N1 virus. Extensive preventive measures are sought globally, to evade the potential of the Swine influenza pandemic.

The Swine flu started as a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza viruses. Among pigs, the virus spreads by aerosols, direct and indirect contact, and asymptomatic carrier pigs. Over the years, the H1N1 virus has mutated, to develop capabilities of infecting humans also. Fortunately, so far the mortality among human populations has been low (1-4%), yet the morbidity rate is extremely high with a WHO declaration stating that Swine Flu has the potential of spreading in pandemic proportions.

Reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death. Infection in humans resembles seasonal influenza and other acute upper respiratory tract infections. Mild or non-symptomatic cases may have escaped from recognition; therefore, the true extent of this disease among humans is unknown.

The swine virus has now established efficient human-to-human transmission. The impact of a pandemic caused by such a virus is difficult to predict: it depends on virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection and host factors.

Recently preventive vaccines are made available by WHO for extensive use among human populations, especially those who are living in the underdeveloped regions of the world.

Initially, the viruses obtained from the human cases with swine influenza in the United States were sensitive to Oseltamavir (Tamiflu), a traditional and widely used antiviral drug. These two drugs were used for treatment and prevention based on the virus's susceptibility profile. However more recently, in the beginning of December 2009, WHO was informed of two clusters of patients infected with H1N1 virus that have developed resistance against Oseltamivir (Tami Flu).

Both clusters detected in Wales-UK and North Carolina-USA, occurred in a single ward in a hospital, and both involved patients whose immune systems were severely compromised or suppressed. Transmission of resistant virus from one patient to another is suspected in both outbreaks.

Patients with severe immuno-suppressed or immuno-compromised states are recommended to be put on Zanamavir (Relenza) by the WHO.

It is really comforting to note that, no illness among the staff caring for these drug resistant patients have been detected in both the clusters, suggesting that the resistant virus does not spread easily to otherwise healthy people, especially when good measures for infection control are in place. Moreover, intensified surveillance has found no spread to other wards within the two hospitals or into the wider community.

In any case, the medical experts recommend that health care staff, caretakers of patients, family contacts, pregnant women, children, physically weak persons and patients of other diseases, should be given priority during mass vaccination programs against Swine flu, all over the globe, especially the underdeveloped countries with poor health and sanitation conditions and inappropriate medical infrastructures.

It is also observed that Zanamivir, when administered early, reduces the risk of complication and may also improve the clinical outcome in patients with severe disease. Thus, the effectiveness of these drugs can be protected and prolonged, by minimizing the occurrence and impact of drug resistance.

As of December 13, 2009, worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of H1N1 infection, including at least 10582 deaths. WHO is actively monitoring the progress of the pandemic through frequent consultations with its regional offices and with multiple sources of data.

The government of Pakistan is also taking measures to control the spread and mortality of Swine flu, but the common people of the country are advised to personally enhance their knowledge about this disease and adopt all preventive measures to safeguard their family and loved ones from this global threat.

The Health Department Punjab at King Edward Medical University (KEMU) organized an awareness seminar on 'Swine Flu' recently. The PML-N leader Sardar Ayaz Sadiq MNA the vice-chancellor KEMU Prof. Zafar Ullah Khan, Director General Health Punjab Muhammad Aslam Chudhary, Registrar Prof. Mehmood Shoukat, Medical Superintendent Mayo Hospital Dr. Zahid Pervez, Additional Director Health (CDC) Dr. Islam Zafar and Community Health Consultant from UK Dr. Muhammad Abid addressed the seminar.

Sardar Ayaz Sadiq MNA said the Punjab government had taken concrete steps for providing quality healthcare facilities to the people and to resolve the problems confronting the doctor's community while diagnostic and treatment facilities for Swine flu have been provided in the government hospitals. He said that the Chief Minister paid special attention to resolve the problems of young doctors and besides increasing their salaries, services of thousands of contractual doctors have been regularized. He said that consultation on the proposed 'Healthcare Bill' with all the stakeholders was in progress and the interest of doctor's community would be safeguarded in the bill.

Medical Superintendent Mayo Hospital Dr Zahid Pervez said that Swine flu is not a big issue and it has been exaggerated. He advised the doctors, nurses and the paramedical staff to adopt safety measures while dealing with the patients. He said that by ensuring personal hygiene people could protect themselves from Swine flu. He further said that as professional, doctors have to face these challenges. He also said that so far no Swine flu case has been registered in Mayo Hospital; however, arrangements for the treatment of such patients including "Isolation Ward" have been finalized.

Community Health Consultant from UK Dr. Muhammad Abid highlighted complexities, prevention, control and treatment of Swine flu. He said that the Swine flu is a mixture of bird, animal and human influenza. Elaborating the hundred year's history of influenza, he told the gathering that all over the world, seven million Swine flu cases have been registered.

In Afghanistan there were 837 people affected of this virus whereas 14 people died. Similarly, in Iran 3672 cases registered while 140 deaths occurred. In India, there were 19632 Swine flu cases registered while 621 people died.

In Pakistan, only 11 cases have so far been registered and one confirmed death has been reported from Swine flu, he added.

The vice-chancellor KEMU Dr. Zafar Ullah Khan, Director Health (CDC), Dr. Islam Zafar and other health professionals advised the doctors, nurses, and paramedical staff to use mouth mask, gloves during interaction with the patients.

Dr. Islam Zafar stated that free of cost diagnostic facilities for Swine flu patients have been made available in the Institute of Public Health and Jinnah Hospital Lahore and Viral Transport Media (VTM) have also been supplied to the hospitals. He said that Swine flu is a curable disease and there is no need of any panic.