INTRODUCTION

 Novel H1N1 (aka “swine flu”) is a new influenza virus causing illness in people.

 First detected in people in the United States in April 2009.

 Spreading from person-to-person worldwide, probably in much the same way that regular seasonal
influenza virus spread.

 On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of novel H1N1
flu was underway.

DEFINITION

Influenza A of humans that is caused by a different strain of an orthomyxovirus subtype (H1N1) from
those found in swine and that is marked especially by fever, sore throat, cough, chills, body aches, fatigue,
and sometimes diarrhea and vomiting.

OR

Swine flu (H1N1) is an infection that a type of flu (influenza) virus causes. It’s called swine flu because it’s
similar to a flu virus that affects pigs (swine). The virus leads to a lung (respiratory) disease in pigs. Swine
flu (H1N1) is a respiratory infection in humans.

EPIDEMIOLOGY

 The agent: Genetic sequencing shows a new sub type of influenza A (H1N1) virus with segments
from four influenza viruses: North American Swine, North American Avian, Human Influenza and
Eurasian Swine.
 Host factors: The majority of these cases have occurred in otherwise healthy young adults.
 Transmission: The transmission is by droplet infection and fomites.
 Incubation period: 1-7 days.
 Communicability: From 1 day before to 7 days after the onset of symptoms. If illness persist for
more than 7 days, chances of communicability may persist till resolution of illness. Children may
spread the virus for a longer period.

CLINICAL MANIFESTATION
The symptoms of swine flu (H1N1) are similar to the symptoms of regular flu. The symptoms may start
three to five days after exposure to the virus. Symptoms may include:
 Fever.
 Chills.
 Cough.
 Sore throat.
 Body or muscle aches.
  Headache.
 Fatigue.
 Miscarriage.
Symptoms in babies and children may be different. If your baby or child has any of the following
symptoms, call their healthcare provider right away:
 Trouble breathing.
 Trouble waking up.
 Not drinking enough fluids.
 Fever with rash.
 Confusion.

DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Routine blood tests
Viral infections usually do not cause many changes in the routine blood picture.
A bacterial infection leading to flu-like features may be ruled out using a routine blood test with
hemoglobin, complete blood counts including white blood cells, red blood cells and platelet counts.

 Chest X-ray
Chest X-rays and other imaging tests are suggested in individuals at risk of complications like
pneumonia.

 Nose or throat swab

To test for swine flu a nose or throat swab is taken. Within 15 minutes, the laboratory may tell if
influenza type A or B is present.
The specimen of the infected material from the patient’s throat or nose is collected within the first 4
to 5 days of illness. This is the most infectious period of the disease and the infected person is most
likely to be shedding the virus. Children, however, may shed the virus for 10 days or longer.

 Kit to diagnose influenza

The CDC developed a new kit to diagnose seasonal flu as well as the flu viruses that could become
pandemic. This was approved by the FDA (Food and Drugs Administration, USA) in September
2011.
It is called the Human Influenza Virus Real-Time RT-PCR (Polymerase chain reaction) Detection
and Characterization Panel (rRT-PCR Flu Panel) and gives results in 4 hours.
The kit can identify and differentiate between influenza A and B viruses, further classify influenza A
viruses by subtype, and also detect highly infectious avian or bird influenza A (H5N1) virus infection
in human samples.
MANAGEMENT
Pharmacological
Most people with flu, including H1N1 flu (swine flu), require only symptom relief. Supportive care such
as drinking liquids, taking pain relievers for fever and headache, and resting may be helpful. If you have a
chronic respiratory disease, your doctor may prescribe additional medications to help relieve your
symptoms.

Antiviral drugs are sometimes prescribed within the first day or two of symptoms. They can reduce the
severity of symptoms and possibly the risk of complications. The U.S. Food and Drug Administration
have approved these four drugs:

 Oseltamivir (Tamiflu)

 Zanamivir (Relenza)

 Peramivir (Rapivab)

 Baloxavir (Xofluza)

But flu viruses can develop resistance to these drugs.

To make development of resistance less likely and maintain supplies of these drugs for those who need
them most, doctors reserve antivirals for people at high risk of complications and those who are in close
contact with people who have high risk of complications.

People at higher risk of flu complications include people who:

 Are in a hospital, nursing home or other long-term care facility.

 Are younger than 5 years of age, particularly children younger than 2 years.

 Are 65 years old or older.

 Are pregnant or within two weeks of delivery, including women who have had pregnancy loss.

 Are younger than 19 years of age and are receiving long-term aspirin therapy. Using aspirin during a
viral illness increases the risk of developing Reye's syndrome, a rare but potentially life-threatening
condition, in these individuals.

 Have a body mass index above 40, which is defined as morbid obesity.
 Have certain chronic medical conditions, such as asthma, emphysema, heart disease, diabetes,
neuromuscular disease, or kidney, liver or blood disease.

 Are immunosuppressed due to certain medications or HIV.

 Are of American Indian or Alaska Native heritage.

Lifestyle and home remedies

 Drink plenty of liquids. Choose water, juice and warm soups to prevent dehydration.

 Rest. Get more sleep to help immune system fight infection.

 Consider pain relievers. Use an over-the-counter pain reliever, such as acetaminophen (Tylenol,

others) or ibuprofen (Advil, Motrin IB, others).

PREVENTION

The best way to prevent swine flu (H1N1) is to get annual flu vaccine. The flu vaccine has helped protect
against swine flu since 2010.

Vaccination (H1N1)
– The groups recommended to receive the novel H1N1 influenza vaccine include:
– Pregnant women

– Household contacts and caregivers for children younger than 6 months of age

– Healthcare and emergency medical services personnel

– All people from 6 months through 24 years of age

– Persons aged 25 through 64 years who have health conditions associated with higher risk of
medical complications from influenza.

Other ways to prevent getting and spreading swine flu (H1N1) include:

 Cover nose and mouth with a tissue while sneezing or coughing.

 If don’t have a tissue, sneeze or cough into elbow.
 Wash hands with soap and water.
 Don’t touch eyes, nose or mouth.
 Avoid people who are sick.
 Stay home if sick.
 Don’t share personal items such as cups, straws and utensils.