Swine influenza frequently asked questions – source: WHO

Swine influenza frequently asked questions:

• more information about swine flu epidemics – več informacij o epidemiji prašičje gripe

26 April 2009

1. What is swine influenza?
2. What are the implications for human health?
3. Where have human cases occurred?
4. How do people become infected?
5. Is it safe to eat pork meet and products?
6. What about the pandemic risk?
7. Is there a human vaccine to protect swine influenza?
8. What drugs are available for treatment?
9. Swine Influenza Glossary

What is swine influenza?
Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses. Morbidity tends to be high and mortality low (1-4%). The virus is spread among pigs by aerosols, direct and indirect contact, and asymptomatic carrier pigs. Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones. Many countries routinely vaccinate swine populations against swine influenza.
Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, H3N2). Pigs can also be infected with avian influenza viruses and human seasonal influenza viruses as well as swine influenza viruses. The H3N2 swine virus was thought to have been originally introduced into pigs by humans. Sometimes pigs can be infected with more than one virus type at a time, which can allow the genes from these viruses to mix. This can result in an influenza virus containing genes from a number of sources, called a “reassortant” virus. Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans.

What are the implications for human health?
Outbreaks and sporadic human infection with swine influenza have been occasionally reported. Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges
broadly from asymptomatic infection to severe pneumonia resulting in death. Since typical clinical presentation of swine influenza infection in humans resembles seasonal influenza and other acute upper respiratory tract infections, most of the cases have been detected by chance through seasonal influenza surveillance. Mild or asymptomatic cases may have escaped from recognition; therefore the true extent of this disease among humans is unknown.

Where have human cases occurred?
Since the implementation of IHR(2005)1 in 2007, WHO has been notified of swine influenza cases from the United States and Spain.

Map of confirmed and suspected swine influenza cases.

How do people become infected?
People usually get swine influenza from infected pigs, however, some human cases lack contact history with pigs or environments where pigs have been located. Human-to-human transmission has
occurred in some instances but was limited to close contacts and closed groups of people.

Is it safe to eat pork and pork products?

Yes. Swine influenza has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The swine influenza virus
is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat.

Which countries have been affected by outbreaks in pigs?
Swine influenza is not notifiable to international animal health authorities (OIE, www.oie.int), therefore its international distribution in animals is not well known. The disease is considered endemic
in the United States. Outbreaks in pigs are also known to have occurred in North America, South America, Europe (including the UK, Sweden, and Italy), Africa (Kenya), and in parts of eastern Asia
including China and Japan.

Map of confirmed and suspected swine influenza cases.

What about the pandemic risk?
It is likely that most of people, especially those who do not have regular contact with pigs, do not have immunity to swine influenza viruses that can prevent the virus infection. If a swine virus establishes efficient human-to human transmission, it can cause an influenza pandemic. 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.

Is there a human vaccine to protect from swine influenza?
There are no vaccines that contain the current swine influenza virus causing illness in humans. It is not known whether current human seasonal influenza vaccines can provide any protection. Influenza
viruses change very quickly. It is important to develop a vaccine against the currently circulating virus strain for it to provide maximum protection to the vaccinated people. This is why WHO needs access to as many viruses as possible in order to select the most appropriate candidate vaccine virus.

What drugs are available for treatment?
Antiviral drugs for seasonal influenza are available in some countries and effectively prevent and treat the illness. There are two classes of such medicines, 1) adamantanes (amantadine and remantadine), and 2) inhibitors of influenza neuraminidase (oseltamivir and zanamivir). Most of the previously reported swine influenza cases recovered fully from the disease without

requiring medical attention and without antiviral medicines. Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of chemoprophylaxis and treatment. The viruses obtained from the recent human cases with swine influenza in the United States were sensitive to oselatmivir and zanamivir but resistant to amantadine and  remantadine. Information is insufficient to make recommendation on the use of the antivirals in prevention and treatment of swine influenza virus infection. Clinicians have to make decisions based on the clinical
and epidemiological assessment and harms and benefit of the prophylaxis/treatment of the patient2.
For the ongoing outbreak of the swine influenza infection in the United States and Mexico, the national and the local authorities are recommending to use oseltamivir or zanamivir for treatment and
prevention of the disease based on the virus’s susceptibility profile.

More about Swine Influenza on Wordld Health Organisation’s web page.

Swine Influenza Glossary / Dictionary / Terms

Map of confirmed and suspected swine influenza cases

more about swine flu pandemic – več: pandemija prašičja gripa

Acute: Of abrupt onset, in reference to a disease. Acute often also connotes an illness that is of short duration, rapidly progressive, and in need of urgent care.

Antiviral: An agent that kills a virus or that suppresses its ability to replicate and, hence, inhibits its capability to multiply and reproduce.

Asymptomatic: Without symptoms. For example, an asymptomatic infection is an infection with no symptoms.

Bacterial: Of or pertaining to bacteria. For example, a bacterial lung infection.

Bronchoscopy : A procedure that permits the doctor to see the breathing passages through a lighted tube.

CDC: The Centers for Disease Control and Prevention , the US agency charged with tracking and investigating public health trends. The stated mission of the CDC is “To promote health and quality of life by preventing and controlling disease, injury, and disability.” The CDC is a part of the U.S. Public Health Services (PHS) under the Department of Health and Human Services (HHS).

Chemoprophylaxis: The use of a chemical agent to prevent the development of a disease.

Chills: feelings of coldness accompanied by shivering. Chills may develop after exposure to a cold environment or may accompany a fever.

Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time.

Congestion: An abnormal or excessive accumulation of a body fluid. The term is used broadly in medicine. Examples include nasal congestion (excess mucus and secretions in the air passages of the nose) seen with a common cold and congestion of blood in the lower extremities seen with some types of heart failure.

Conjunctivitis: Inflammation of the conjunctiva, the membrane on the inner part of the eyelids and the membrane covering the white of the eye. The conjunctival membranes react to a wide range of bacteria , viruses , allergy-provoking agents, irritants and toxic agents. Viral and bacterial forms of conjunctivitis are common in childhood. Conjunctivitis is also called pinkeye and red eye.

Cough: A rapid expulsion of air from the lungs typically in order to clear the lung airways of fluids, mucus, or material. Also called tussis.

Diarrhea : A familiar phenomenon with unusually frequent or unusually liquid bowel movements, excessive watery evacuations of fecal material. The opposite of constipation . The word “diarrhea” with its odd spelling is a near steal from the Greek “diarrhoia” meaning “a flowing through.” Plato and Aristotle may have had diarrhoia while today we have diarrhea. There are myriad infectious and noninfectious causes of diarrhea.

Dyspnea: Difficult or labored breathing; shortness of breath.

Exacerbation: A worsening. In medicine, exacerbation may refer to an increase in the severity of a disease or its signs and symptoms. For example, exacerbation of asthma is one of the serious effects of air pollution..

Fatigue: A condition characterized by a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of weariness and tiredness. Fatigue can be acute and come on suddenly or chronic and persist.

Fever : Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.).

Flu: Short for influenza. The flu is caused by viruses that infect the respiratory tract which are divided into three types, designated A, B, and C. Most people who get the flu recover completely in 1 to 2 weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia. Much of the illness and death caused by influenza can be prevented by annual influenza vaccination.

Headache : A pain in the head with the pain being above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headache, like chest pain or back ache, has many causes.

Hygiene: The science of preventive medicine and the preservation of health. From the name of Hygeia, the daughter of Asklepios, the Greek god of medicine (whose staff with entwined snake is the symbol of medicine). Asklepios (known to the Romans as Aesculapius) had a number of children including not only Hygeia but also Panaceia, the patroness of clinical medicine. Hygeia also followed her father into medicine. As the patroness of health, Hygeia was charged with providing a healthy environment to prevent illness. In Greek, “hygieia” means health.

Infection: The growth of a parasitic organism within the body. (A parasitic organism is one that lives on or in another organism and draws its nourishment therefrom.) A person with an infection has another organism (a “germ”) growing within him, drawing its nourishment from the person.

Influenza: The flu is caused by viruses that infect the respiratory tract which are divided into three types, designated A, B, and C. Most people who get the flu recover completely in 1 to 2 weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia. Much of the illness and death caused by influenza can be prevented by annual influenza vaccination.

Intubation: The process of putting a tube into a hollow organ or passageway, often into the airway . The opposite of intubation is extubation.

Laboratory: A place for doing tests and research procedures and preparing chemicals, etc. Although “laboratory” looks very like the Latin “laboratorium” (a place to labor, a work place), the word “laboratory” came from the Latin “elaborare” (to work out, as a problem, and with great pains), as evidenced by the Old English spelling “elaboratory” designating “a place where learned effort was applied to the solution of scientific problems.”

Mouth: 1. The upper opening of the digestive tract, beginning with the lips and containing the teeth, gums, and tongue. Foodstuffs are broken down mechanically in the mouth by chewing and saliva is added as a lubricant. Saliva contains amylase, an enzyme that digests starch. 2. Any opening or aperture in the body. The mouth in both senses of the word is also called the os, the Latin word for an opening, or mouth. The o in os is pronounced as in hope. The genitive form of os is oris from which comes the word oral.

Myalgia: Pain in a muscle; or pain in multiple muscles. Myalgia means muscle pain. There are many specific causes of various types of myalgia. Myalgia can be temporary or chronic. Myalgia can be a result of a mild conditions, such as a virus infection, or from a more serious illness. Examples include epidemic myalgia and polymyalgia rheumatica .

Nasal: Having to do with the nose. Nasal drops are intended for the nose, not (for example) the eyes. The word “nasal” came from the Latin “nasus” meaning the nose or snout.

Onset: In medicine, the first appearance of the signs or symptoms of an illness as, for example, the onset of rheumatoid arthritis . There is always an onset to a disease but never to the return to good health. The default setting is good health.

Pneumonia: Inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.

Public health: The approach to medicine that is concerned with the health of the community as a whole. Public health is community health. It has been said that: “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.”

Respiratory: Having to do with respiration, the exchange of oxygen and carbon dioxide. From the Latin re- (again) + spirare (to breathe) = to breathe again.

Respiratory failure: Inability of the lungs to perform their basic task of gas exchange , the transfer of oxygen from inhaled air into the blood and the transfer of carbon dioxide from the blood into exhaled air. The basis of respiratory failure may be failure of the exchange of oxygen and carbon dioxide within the tiny air sacs (alveoli) in the lungs; failure of the muscles required to expand the lungs; or failure of the brain centers controlling respiration.

Rhinorrhea: Medical term for a runny nose. From the Greek words “rhinos” meaning “of the nose” and “rhoia” meaning “a flowing.”

Sore: 1. (adjective) A popular term for painful. I have sore fingers from typing dictionary terms. She has a sore throat . 2. (noun) A nondescript term for nearly any lesion of the skin or mucous membranes. He has a number of sores in his mouth.

Sore throat : Pain in the throat. Sore throat may be caused by many different causes, including inflammation of the larynx, pharynx, or tonsils.

Sporadic: Occurring upon occasion or in a scattered, isolated or seemingly random way.

Strain: 1. An injury to a tendon or muscle resulting from overuse or trauma. 2. A hereditary tendency that originated from a common ancestor. 3. To exert maximum effort. 4. To filter.

Symptomatic: 1 With symptoms, as a symptomatic infection. 2 Characteristic, as behavior symptomatic of Huntington disease. 3 Directed at the symptoms, as symptomatic treatment.

Throat: The throat is the anterior (front) portion of the neck beginning at the back of the mouth , consisting anatomically of the pharynx and larynx . The throat contains the trachea and a portion of the esophagus .

Viral: Of or pertaining to a virus. For example, “My daughter has a viral rash .”

Virus: A microorganism smaller than a bacteria, which cannot grow or reproduce apart from a living cell. A virus invades living cells and uses their chemical machinery to keep itself alive and to replicate itself. It may reproduce with fidelity or with errors (mutations)-this ability to mutate is responsible for the ability of some viruses to change slightly in each infected person, making treatment more difficult.

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