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Influenza A (H1N1) virus.

Date: 11-09-2009

Influenza A (H1N1) virus.

I- General Overview

The novel H1N1 virus is a new influenza A virus that has never circulated among humans before and that is currently causing disease in people.

It was first detected in people in the United States in April 2009. Currently, cases due to this virus are being reported in many countries.

It was referred to initially as “swine flu “because original laboratory testing showed that this new virus had many genes similar to influenza viruses occurring normally in pigs (swine) in North America. But now, it is believed that this new virus has 2 genes from influenza viruses that normally circulate in pigs as well as bird (avian) and human influenza genes.


II- Transmission

Novel influenza H1N1 virus is contagious and it spreads from person-to person in respiratory droplets of coughs and sneezes. This can happen in 2 ways:

 Droplets from a cough or a sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby.
 A person touches respiratory droplets on another person or object (ex: toy, desk...) and then touches his own (or someone else’s) nose, mouth or eye before washing his hands.

People infected can shed the virus and are able to infect other people 1 day prior to getting sick to 5-7 days after. For some people, especially those with weakened immune system, the period can be longer.

Studies have shown that influenza virus can survive on environmental surfaces and can infect people 2 -8 hours after being deposited on the surface.

However, eating properly handled and cooked pork products and drinking tap water treated with conventional disinfecting processes are safe.

III- Manifestations

It can cause a wide variety of symptoms that can resemble those caused by seasonal flu:

 Fever
 Chills
 Runny or stuffy nose
 Sore throat
 Cough
 Body aches
 Headache
 Fatigue
 Vomiting and diarrhea were also reported by many.

IV- Spectrum of Severity:

The disease can vary in severity depending on the person affected:

Most people who have been sick recovered without medical intervention.

Some had a more severe course, with complications and need for hospitalization.

Few deaths were reported

Sometimes, bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.

V- People at risk for complications

 People aged 65 and older
 Children less than 5 years of age
 Pregnant women
 People at any age with chronic medical problems such as asthma, diabetes, heart disease, renal disease, weak immune system.


VI- Warning signs of serious illness

A- In children emergency warning signs that need urgent medical attention include:
• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting ( less responsive than usual )
• Being so irritable that the child does not want to be held
• Signs of dehydration such as absence of urination , or in infants lack of tears when they cry
• Flu-like symptoms improve but then return with fever and worse cough

B- In adults, emergency warning signs that need urgent medical attention include:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough


VII- Prevention

A 2009 H1N1 vaccine is currently under production and may be available for the public in the fall. We don’t know yet when it will be available in Lebanon.
As usual, there will be a vaccine to protect against seasonal influenza (already available in the Lebanese market): so check with your doctor if you can take it
However, there are everyday actions that can help minimize the spread of germs and protect yourself and others from respiratory illness such as influenza:

 Cover the nose and mouth with a tissue when coughing or sneezing. Throw the tissue in the trash after using it
 Wash your hands often with soap and water ,for around 15 to 20 seconds , especially after coughing or sneezing
 Alcohol based hand sanitizers can be used also: rub your hands until the gel dries.
 Avoid touching your eyes, nose or mouth.
 Try to avoid close contact with sick people
 Be prepared in case you get sick and need to stay home for a week or so.
If a person gets sick, he should be isolated and kept away from other people.
These are some isolation guidelines:
 Keep the sick person in a room separate from the common areas of the house. Keep the sickroom door closed.
 Keep the sick person home and minimize their contact with others, unless necessary for medical care.
 Have the sick person wear a facemask, if he needs to leave the home, or is near other people. Let him cover his nose and mouth when coughing or sneezing.
 Have the sick person use a separate bathroom if possible .It should be cleaned regularly with a disinfectant

Protection of Other Persons at home
It is advisable to consider the following:
 Avoid having the sick person receive visitors other than the caregivers
 If possible, one adult in the home should take care of the sick person. This adult should not have medical conditions that put him at risk for severe flu illness
 People at high risk for complications from influenza should attempt to avoid close contact with household members sick with influenza. If this is unavoidable, they should wear a face mask.
 Make sure all persons in the household clean their hands with soap and water or alcohol-based hand rub frequently , especially after every contact with the sick person or the person’s room and bathroom
 Use paper towels for drying hands or dedicate cloth towels to each person
 Maintain good aeration in shared household areas
 Check with the doctor to see if some persons at home should use antiviral medications to prevent the flu

Tips for the caregiver
The caregiver should:
 Avoid being face –to-face with the sick person
 hold sick small children with their chin on his shoulder , so they will not cough in his face
 clean hands frequently , especially after touching the sick person or handling used tissues or laundry
 wear a face max, latex gloves and apron when in close contact with the sick
 should not have a medical condition that puts him at high risk of severe flu
 Check with his doctor if he needs to take an antiviral medicine to prevent getting the flu.



VIII- Treatment
1- Antiviral medications: such as “Tamiflu” .They can help fighting the influenza illness. Most people do not need them to recover from the flu. They can be given to people at high risk for flu complications or for those with a severe flu illness. Your doctor will decide if you need an antiviral drug
2- Antibiotics: they may be needed if there is a bacterial infection occurring with or after the flu illness. More severe or prolonged illness or illness that seems to get better but then gets worse again may be an indication of a bacterial infection.
3- Fever –reducing drugs: such as acetaminophen (Panadol), Ibuprofen (Advil). Do not use aspirin (acetylsalicylic acid) in children and adolescents with flu-like illness.

The above information is taken from various medical websites and is intended as general guidelines. Always, check with your health care provider about treatment and plan of action.

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