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WHO Raises Flu Pandemic Alert Level

Ruzanna Harutyunyan's picture

On Monday April 27 2009 the World Health Organization (WHO) raised its pandemic alert level to Phase 4. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

The first confirmed cases of swine influenza have been seen in Europe – one case in Spain and two in Scotland. The Health Protection Agency is continuing to monitor events and work closely alongside the UK government, to review the ongoing events and assess any threat they pose to UK public health.

The appearance of confirmed cases in the UK and Europe is not unexpected. In addition to the Mexican cases there have been cases reported in various parts of the US, Canada and New Zealand so the likelihood that it would come here was always high.

Outside of Mexico the majority of cases have been mild and cases have responded positively to antiviral treatment. Although there has been a high number of a deaths associated with the Mexican outbreak there have not so far been any deaths reported elsewhere.

Individuals returning from affected areas who become unwell within seven days of their return should stay at home and contact their GP or NHS Direct. They will be assessed and, if necessary, testing and treatment will be provided.

Clinicians have been asked to consider swine influenza A (H1N1) virus infection when assessing returning travellers and visitors to the UK who present with flu-like symptoms AND have a history of travel to affected areas in the 7 days preceding illness onset.

The World Health Organization (WHO) has requested that all countries strengthen their flu surveillance to provide more information on this infection.

There are currently very low levels of flu activity in the UK but the Agency and the NHS have ongoing surveillance systems in place, which will alert public health authorities of any unusual strain circulating in the UK.

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Advice for returning travellers

If you have recently visited one of the countries or areas where human cases of influenza have been identified, it is important for you to monitor your health closely for seven days after your visit to the affected area. There is no need for you to isolate yourself from other people as long as you remain well.

If during this period you develop a feverish illness accompanied by one or more of cough, sore throat, headache and muscle aches, you should stay at home and contact your GP by phone or seek advice from NHS Direct (0845 4647). You should make sure that you tell those from whom you are seeking advice about your recent travel to an area affected. Depending on your symptoms you may be advised that further investigations may be necessary.

General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including the human swine influenza. This includes:

* Covering your nose and mouth when coughing or sneezing, using a tissue when possible

* Disposing of dirty tissues promptly and carefully

* Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people

* Cleaning hard surfaces (eg door handles) frequently using a normal cleaning product

* Making sure your children follow this advice



In 1918: In large U.S cities, more than 10,000 deaths per week were attributed to the virus. It is estimated that as many as 50% of the population was infected, and ~1% died. To compare, in "normal" (interpandemic) years, it is estimated that between 10-20% of the population is infected, with a .008% mortality. The fact the current 'swine flu' has shown to be contagious is alarming. So far the virus has shown to have a 6% to 6.3% mortality rate. It may not seem like much, but please consider the following: The deadly influenza panic in 1918 had a mortality rate of under 1%. This virus went on to kill tens of thousands of healthy people a day in large cities and up to 100 million people world wide. Viruses, like this strain of swine flu, kill their host by over-stimulating active immune systems that are robust and healthy. That is why the victims in Mexico were between the ages of 20 and 45. Some have said that no one in the United States have died from the virus, so we need not worry. Experts say it is only a matter of time. The virus is not prevalent enough to reach statistical significance in the United States, with only a handful of confirmed cases. 93.7% of all Mexicans with the virus recovered. More cause for worry: The 1918 virus started off 'mild' before it mutated into a raging storm. It also does not mean we will see millions of deaths. It is too early to draw sweeping conclusions. Nevertheless, there is potential for a disastrous pandemic. If 50% of Americans catch this flu in the next two years, and the mortality rate stays at 6.3%, we would witness 20+ million deaths. This strain of virus is more potent and more deadly than the virus that hammered the world in 1918 and 1919. Viruses come in waves. There are striking similarities to this virus and the virus that killed up to 100 million people in 1918. The first wave is historically more mild than the later waves. In addition to this virus becoming more severe, it is mutating faster than previous virus that we have seen. In addition, this virus is nothing like we have ever seen before because it combines features from viruses natural in different parts of the globe. We are in uncharted territory. If it follows the same path as the 1918 flu, we will see very damaging results. However, we must remember we are a global society now and the virus can spread quicker than we have ever witnessed in history. This is very concerning especially since the drugs we have now seem resistant. While there have been no deaths in America, it is shadowed by the fact the common variable among the deaths seem to be age. While most American cases have involved the very young and very old (under 10 and over 50) the Mexican cases that ended fatally involved the robust and healthy (over 20 and under 45). This virus kills the host by over-stimulating the immune system. The term that is used when the immune system over reacts is called a Cytokine Storm. It is usually fatal. During this “Storm” over 150 inflammatory mediators are released. This would account for the high mortality rate in 1918-19. <a href="http://tinyurl.com/d2te2f">http://tinyurl.com/d2te2f</a>