syafeerul: H1N1 part II

i came across two most referred websites on H1N1 cases.

  1. World Health Organization
  2. Centers for Disease Control and Prevention (CDC)

both sites provides tons of info. visit them to learn more on this outbreak. here are some that i chose to pull out from their respective sites.

from WHO..

What can I do to protect myself from catching influenza A(H1N1)?

The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:

  • avoid touching your mouth and nose;
  • clean hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated);
  • avoid close contact with people who might be ill;
  • reduce the time spent in crowded settings if possible;
  • improve airflow in your living space by opening windows;
  • practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.

What about using a mask? What does WHO recommend?

  • If you are not sick you do not have to wear a mask.
  • If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards.
  • If you are sick and must travel or be around others, cover your mouth and nose.
  • Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.

What should I do if I think I have the illness?

If you feel unwell, have high fever, cough or sore throat:

  • stay at home and keep away from work, school or crowds;
  • rest and take plenty of fluids;
  • cover your nose and mouth when coughing and sneezing and, if using tissues, make sure you dispose of them carefully. Clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub;
  • if you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;
  • use a mask to help you contain the spread of droplets when you are around others, but be sure to do so correctly;
  • inform family and friends about your illness and try to avoid contact with other people;
  • If possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.

Should I take an antiviral now just in case I catch the new virus?

No. You should only take an antiviral, such as oseltamivir or zanamivir, if your health care provider advises you to do so. Individuals should not buy medicines to prevent or fight this new influenza without a prescription, and they should exercise caution in buying antivirals over the Internet.

What about breastfeeding? Should I stop if I am ill?

No, not unless your health care provider advises it. Studies on other influenza infections show that breastfeeding is most likely protective for babies – it passes on helpful maternal immunities and lowers the risk of respiratory disease. Breastfeeding provides the best overall nutrition for babies and increases their defense factors to fight illness.

Clean hands protect against infection

Protect yourself

  • Clean your hands regularly.
  • Wash your hands with soap and water, and dry them thoroughly.
  • Use alcohol-based handrub if you don’t have immediate access to soap and water.

How do I wash my hands properly?

Washing your hands properly takes about as long as singing “Happy Birthday” twice,
using the images below.

How to handwash

Advice on the use of masks in the community setting in Influenza A (H1N1) outbreaks

In health-care settings, studies evaluating measures to reduce the spread of respiratory viruses suggest that the use of masks could reduce the transmission of influenza. In the  community,  however,  the  benefits  of  wearing  masks  has  not  been established, especially in open areas, as opposed to enclosed spaces while in close contact with a person with influenza-like symptoms.

Using a mask incorrectly however, may actually increase the risk of transmission, rather than  reduce  it.    If  masks  are  to  be  used,  this  measure  should  be  combined with  other general measures to help prevent the human-to-human transmission of influenza, training on the correct use of masks and consideration of cultural and personal values.

If  masks  are  worn,  proper  use  and  disposal  is  essential  to  ensure  they  are  potentially effective and to avoid any increase in risk of transmission associated with the incorrect use of masks.  The following information on correct use of masks derives from the practices in health-care settings:

  • place mask carefully to cover mouth  and  nose and tie securely to minimise any gaps between the face and the mask
  • while in use, avoid touching the mask
    • whenever you touch a used mask, for example when removing or washing, clean hands by washing with soap and water or using an alcohol-based handrub
  • replace masks with a new clean, dry mask as soon as they become damp/humid
  • do not re-use single-use masks
    • discard  single-use  masks  after  each  use  and  dispose  of  them  immediately  upon removing.

Although  some  alternative  barriers  to  standard  medical  masks  are  frequently  used  (e.g.  cloth mask, scarf, paper masks, rags tied over the nose and mouth), there is insufficient information available on their effectiveness. If such alternative barriers are used, they should only be used once or, in the case of cloth masks, should be cleaned thoroughly between each use (i.e. wash with normal household detergent at normal temperature).  They should be removed immediately after caring for the ill.  Hands should be washed immediately after removal of the mask.

from CDC..

How does novel H1N1 virus spread?

Spread of novel H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.

What are the signs and symptoms of this virus in people?

The symptoms of novel H1N1 flu virus in people include:

  • fever
  • cough
  • sore throat
  • runny or stuffy nose
  • body aches
  • headache
  • chills
  • fatigue

A significant number of people who have been infected with this virus also have reported:

  • diarrhea
  • vomiting

Severe illnesses and death has occurred as a result of illness associated with this virus.

High risk groups

for this part, i took from UpToDate as its info seems more in-depth.

High risk groups for the development of complications of pandemic H1N1 influenza A are thought to be similar to those defined for seasonal influenza. High risk groups include:

  • Children younger than 5 years of age (particularly those less than 2 years of age)
  • Individuals 65 years of age or older
  • Individuals younger than 19 years of age who are receiving long-term aspirin therapy and who therefore might be at risk for Reye syndrome after influenza virus infection
  • Pregnant women
  • Individuals with chronic medical conditions requiring ongoing medical care, including:
    • Chronic pulmonary disease, including asthma (particularly if systemic glucocorticoids have been required during the past year)
    • Cardiovascular disease, except isolated hypertension
    • Active malignancy
    • Chronic renal insufficiency
    • Chronic liver disease
    • Diabetes mellitus
    • Hemoglobinopathies such as sickle cell disease
    • Immunosuppression, including HIV infection (particularly if CD4 <200 cells/microL), organ or hematopoietic stem cell transplantation, inflammatory disorders treated with immunosuppressants
    • Individuals who have any condition that can compromise handling of respiratory secretions (eg, cognitive dysfunction, spinal cord injuries, seizure disorders, neuromuscular disorders, cerebral palsy, metabolic conditions)
    • Children with an underlying metabolic disorder, such as medium-chain acyl-CoA dehydrogenase deficiency, who are unable to tolerate prolonged fasting
  • Children with poor nutritional and fluid intake because of prolonged vomiting and diarrhea
  • Residents of nursing homes and other chronic care facilities

Although there are no data regarding the risk for severe or complicated influenza among asplenic individuals, influenza is a risk factor for secondary bacterial infections that can cause severe disease among such patients.

Obesity has not been recognized as a risk factor for severe seasonal influenza, but cases of severe pandemic H1N1 influenza A, including pneumonia and acute respiratory distress syndrome, have been reported in obese individuals without known underlying conditions.

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
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough

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

How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.

What kills influenza virus?

Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

i guess this two posts on this H1N1 should be sufficient for us to protect ourselves and our family. do add infos if u have any. in summary:

  • H1N1 spreads through water droplets i.e sneeze, spitting, coughing.
  • H1N1 can infect through nose or mouth – upper respiratory system.
  • best way to protect is to avoid close contact with sick people. if that can’t be avoided, don’t touch either nose or mouth after making contact. wash hands properly.
  • face mask serves as an extra protection. its best used by sick people as that prevents them from infecting others.

syafeerul: H1N1

The pandemic influenza H1N1 have been here for quite a while now. i have not posted any articles on this. however looking at this current situation, i would like to take this chance to at least educate myself and readers on this outbreak.

first article from News Straits Times.

Influenza A(H1N1): 80,000 Malaysians may be infected

2009/08/16 by Annie Freeda Cruez

KUALA LUMPUR: An estimated 80,000 Malaysians may have been infected with influenza A (H1N1). According to the World Health Organisation, this is based on the number of confirmed cases reported by the Health Ministry since May.

Health Minister Datuk Seri Liow Tiong Lai, in revealing the startling figure, said to determine the number of cases in the community, the number of confirmed cases are multiplied by 20. He acknowledged that health services were straining under the weight of an increasing number of infected patients, with hospitals around the country seeing triple the number of patients compared with before the outbreak. Waiting time at some hospitals is up to four hours. Liow said doctors and healthcare staff were working around the clock to clear queues. “People have to wait for hours to be treated. It’s really congested.” He said the ministry could not reduce waiting time because of the high number of patients down with influenza-like illnesses. “What we have done is deploy more staff to outpatient departments and clinics to ease the congestion. “Doctors are trying their best to clear patients as quickly as possible but the number of people turning up every day is high, between 900 and 1,000.”

Liow said WHO had estimated that some 0.1 to 0.4 per cent of the population would die as a result of H1N1. “However, most deaths will be due to complications of underlying diseases in people with chronic cardiovascular, pulmonary, diabetes, renal disease and immunosuppression,” he told the New Sunday Times. He said 20 per cent of the population could be infected within a year. “The situation is serious. We have reached a stage where the virus cannot be stopped. It is spreading rapidly and many Malaysians are infected. It is now in the hands of people to stop the spread. “That people are flocking to hospitals and clinics show that Malaysians are now aware of H1N1 and its symptoms. People now seek treatment quickly.” Many private hospitals and clinics are performing rapid tests to determine if patients have H1N1. “We have provided anti-viral drugs to all private hospitals to treat patients with H1N1, those who are in the high-risk category, or had high fever continuously for two to three days.”

The ministry has issued clear guidelines to doctors in the public and private sectors as to whom they should prescribe the anti-viral drug Tamiflu, and who should be admitted and isolated and placed in intensive care units. “Doctors no longer have to do throat swabs to treat people with Tamiflu. If they have the symptoms and fall into the high-risk category, have underlying symptoms and co-morbid conditions, they can be put on the drug immediately. “We are also acquiring more Tamiflu to cater for another 10 per cent of the population. We will make sure there are sufficient anti-viral drugs to treat 20 per cent of the population. We are also replenishing the stock of seasonal flu vaccines.”

The ministry has also drawn up a contingency plan for the second wave of the pandemic. It is looking into more manpower, staff, ICU beds and drugs besides ensuring more hospitals have the laboratory facilities to test for H1N1. Liow said the ministry would put in place all the contingency plans as stipulated in the National Influenza Pandemic Preparedness Plan and be prepared for a worst-case scenario.


alarming.. yup.. it is. 20% to be infected is a big number. all of us must be able to defend ourselves from being infected. not only that, we need to know when not to infect others.

first off we may start reading this article from UpToDate.com. here i pasted the summary. quite a lengthy read there. it’s quite useful if you would like to know more about this. it’s all on a single page so readers don’t have to open new window to read further..

Treatment of pandemic H1N1 influenza (“swine influenza”)

SUMMARY AND RECOMMENDATIONS — In late March and early April 2009, an outbreak of H1N1 influenza A virus infection was detected in Mexico, with subsequent cases observed in many other countries including the United States. On June 11, 2009, the World Health Organization raised its pandemic alert level to the highest level, phase 6, indicating widespread community transmission on at least two continents. (See “Introduction”).

  • Case definitions of suspected, probable, and confirmed pandemic H1N1 influenza A virus infection are based on symptoms, signs, and epidemiologic information. (See “Case definitions”).
  • The vast majority of strains of pandemic H1N1 influenza A virus circulating in 2009 appear sensitive in vitro to the neuraminidase inhibitors, oseltamivir and zanamivir, but all strains tested have been resistant to amantadine and rimantadine. No clinical studies have confirmed the benefit of therapy, however. (See “Antiviral therapy”).
  • Not all individuals with suspected pandemic H1N1 influenza A infection need to be seen by a health care provider or treated. Patients with severe illness and those at high risk for complications from influenza should contact their health care provider or seek medical care. (See “Medical care for suspected cases”).
  • We recommend antiviral therapy (with zanamivir or oseltamivir) for all hospitalized patients with confirmed, probable, or suspected pandemic H1N1 influenza A virus infection and for patients at increased risk for complications (Grade 1B). During the current pandemic, patients with mild illness do not need to be tested or treated unless they have risk factors for complications. (See “Adults”).
  • In locations where oseltamivir-resistant seasonal H1N1 influenza A virus is circulating, zanamivir is the preferred antiviral. Patients who are unable to take zanamivir in such a setting can be given the combination of an adamantane (rimantadine or amantadine) with oseltamivir. (See “Choice of antiviral”).
  • Treatment should be initiated as soon as possible. In patients who are more than mildly ill, we would initiate therapy even past 48 hours of symptoms. (See “Antiviral therapy”).


next read this from H1N1 Treatment. this website supplies tons of informations on H1N1. from the mainpage, jump around to find informations that u might be interested in. i’m posting some here..

H1N1 Flu Virus

The H1N1 Flu Virus is composed of genetic elements from different flu viruses – avian influenza (bird flu), human influenza, and swine influenza virus.  The virus is thought to have originated from Mexico. Although it was previously known as swine flu, it is not contracted from pigs or by eating pork.

This new strain of the human influenza virus is highly contagious and is spread rapidly by people worldwide. Approximately 1 in 4 people who come into contact with the H1N1 flu virus will contract it. The World Health Organization (WHO) has declared it a pandemic influenza virus.

At this time, no vaccine is available although a vaccine is currently under development.  In terms of treatment, antiviral medications are available to treat Influenza A(H1N1-2009), such as oseltamivir (Tamiflu®) and zanamivir (Relenza®). Indiscriminate use of these drugs, such as not following the prescription instructions, may limit their effectiveness as drug-resistant viruses may develop.

Similar to the seasonal flu, the H1N1 flu begins with high fever, fatigue and muscle aches, accompanied by a cough, sore throat and stuffy nose. Patients have also reported nausea, vomiting and diarrhoea.  Early detection of the illness will most likely result in a full recovery upon proper treatment; therefore it is important to seek medical attention immediately.

What you can do to protect yourself and others against the flu?

  • Practise a high level of personal hygiene and be responsible towards others:
    • Wash your hands regularly and thoroughly with soap and warm water, or use hand sanitizer.
  • Do not touch your eyes, nose or mouth without washing your hands thoroughly.
    • Turn away from anyone near you quickly if you are about to cough or sneeze, and cough or sneeze into your arm or sleeve.
    • Avoid crowded places if you are unwell and wear a surgical mask to cover your nose and mouth.
    • Stay home  and refrain from working at the office when you are sick.
    • Use a serving spoon when sharing food at meal times.
    • See your family doctor if you are feeling unwell.
  • Lead a healthy lifestyle to strengthen your immunity and protect yourself against infection.
    • Eat a balanced diet, including plenty of fruit and vegetables.
    • Be active. Do 30 minutes of physical activity at least 5 days a week.
    • Have enough sleep, rest and relaxation.
    • Do not smoke.

How Important and effective is a face mask or respirator against H1N1?

Information on the effectiveness  of facemasks and respirators for the control of influenza in community settings is highly limited. So , it is tough to assess their potential efficiency in controlling swine influenza A ( H1N1 ) virus  transmission in these settings. Face masks and respirators may offer extra protection, but should not be your first line of defense against the virus.

There’s a difference between a face mask and a respirator. A face mask does not seal tightly to the face. Face masks include masks labeled as surgical, dental, medical procedure, isolation, or laser masks. Respirators are N95- or higher-rated filtering face pieces that fit snugly to the face. Respirators filter out virus particles when correctly adjusted — which is not as simple as it sounds. But it’s hard to breathe through them for extended periods, and they cannot be worn by children or by people with facial hair.

Lacking the presence of clear scientific information, the interim suggestions below have been developed on the principle of public health judgment and the historic use of facemasks and respirators in other settings. In areas with confirmed human cases of swine influenza A virus infection, the chance for infection can be reduced through a mix of actions. No single action will supply complete protection, but an approach combining these steps can help decrease the chance of transmission.

These actions include frequent handwashing, covering coughs, and having unwell people stay at home, except to find hospital treatment, and minimize contact with others in the household. Extra measures that may limit transmission of a new influenza strain include voluntary home quarantine of members of homes with confirmed or possible swine influenza cases, reduction of needless social contacts, and avoidance when possible of crowded settings.

When it is totally critical to enter a crowded setting or to have close contact with people who could be unwell, the time expended in that setting should be as short as possible. If used properly, facemasks and respirators may help to reduce the chance of getting influenza, but they deserve to be used together with other preventive measures, like avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on your face can clear out little particles that may be breathed round the edges of a facemask, but compared to a facemask it is harder to breath through a respirator for long periods.

When crowded settings or close contact with others cannot be avoided, the use of facemasks or respirators in areas where transmission of swine influenza A (H1N1) virus has been confirmed should be considered as follows:

  1. Whenever possible, rather than relying on the use of facemasks or respirators, close contact with people who might be ill and being in crowded settings should be avoided.
  2. Facemasks should be considered for use by persons who enter crowded settings, both to protect their nose and mouth from other people’s coughs and to reduce the wearers’ likelihood of coughing on others; the time spent in crowded settings should remain as short as possible.
  3. Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (e.g., family member with a respiratory infection) at home.

These interim recommendations will be revised as new information about the use of facemasks and respirators in the current setting becomes available.


it’s interesting how facemasks are becoming a business opportunity for some. they’re taking this opportunity to sell those masks at high price. i’m not against them or anything, it is just that people should be told that wearing facemasks won’t be sufficient to protect them from H1N1. it is best used for those sick ones as that prevents them from infecting others. if the person is healthy, wearing that won’t help much. best way is to avoid close contact as stated in this article.