INTRODUCTION:

Swine flu¹ also called pig influenza, swine influenza, hog flu and pig flu. Swine influenza virus (SIV) or S-OIV (swine-origin influenza virus) is any strain of the influenza family of viruses that is endemic in pigs. It infects the respiratory tract and results in nasal secretions, a barking like cough, decreased appetite and listless behaviour. It has been found that this new virus has gene segments from the avian and human flu virus genes, hence named “swine flu”. Due to the nature of respiratory virus, the transmission of this pathogenic virus is air borne transmission. Hence, the rapid spreading and difficulty in control of this infection can be expected.

In 1918², flu virus became pandemic because during World War – I, the normal host-pathogen relationship was abandoned when young men crowded into geographical confinement. “Till date, samples of 76, 922 people have been tested for influenza A (H1N1) in government laboratories and a few private laboratories across the country and 14, 481 of them have been found positive”. It is now up to the research and administration to ensure that some of this propose new finding is devoted to basic scientific health research that can unlock growing threats around the world.

India is ranked third³ among the most affected countries for cases and deaths of swine flu globally ³The first case of Swine flu was reported in May, 2009. After that it spread very quickly to all over of the country. The highest number of swine flu deaths took place in 2010 (1,763 out of 20604 cases), followed by 2009 (981 out of 27236 cases), 2015 (774 out of 12963 cases) and 2013 (699 out of 5253 cases). The mortality decreased in 2011 (75 out of 603 cases), followed by 2014 (218 out of 937 cases) and 2012 (405 out of 5044 cases). A total of 72640 cases and 4915 deaths had been reported by 2015.

Prevalence⁴ of swine flu is highly contagious and has spread very fast to 191 countries. It Starts from America to Europe, Asia to Africa. The Number of cases confirmed and death as on 18^th September 2009. In India 7374 number of confirmed deaths 225. Incidence Globally 2, 96,471 and deaths globally 3,486.

2015 Indian⁵ swine flu outbreak refers to an outbreak of the 2009 pandemic H1N1 virus in India, which is still ongoing as of March 2015. The states of Gujarat and Rajasthan are the worst affected. India had reported 937 cases and 218 deaths from swine flu in the year 2014. The total number of laboratory confirmed cases crossed 33000 marks with death of more than 2000 people.

Swine flu is rare in humans⁶. People who work with swine, especially people with intense exposures, are at risk of catching swine influenza if the swine carry a strain able to infect humans. However, these strains infrequently circulate between humans as SIV rarely mutates into a form able to pass easily from human to human. Swine influenza virus is common throughout pig populations worldwide.

The 2009 flu⁷ outbreak in humans that is widely known as "swine flu" is due to an apparently virulent new strain of influenza A virus subtype H1N1 that was produced by reassortment from one strain of human influenza virus, one strain of avian influenza virus, and two separate strains of swine influenza. The origin of this new strain is unknown, and the World Organization for Animal Health (OIE) reports that this strain has not been isolated in pigs². It passes with apparent ease from human to human, an ability attributed to an as-yet unidentified mutation. This 2009 H1N1 strain causes the normal symptoms of influenza, such as fever, coughing and headache.

The 1918 flu pandemic in human was associated with influenza A (H1N1). An estimated⁸ one third of the world’s population was infected and had clinically apparent illnesses during the 1918-1919 influenza pandemic. The disease was exceptionally severe. Swine influenza was first proposed to be disease related to human influenza during the 1918 flu pandemic when pigs became sick at the same time a humans.

Swine Flu⁹ or the Influenza A (H1N1) flu, an highly contagious acute respiratory disease of the pigs, is caused by one of the numerous swine influenza A strains and is highly contagious. The transmission of the virus is from person-to-person and is similar to the manner in which seasonal influenza spreads. The typical incubation period found for influenza is 1 to 4 days, with an average of 2 to 3 days. The symptoms of this form of virus includes sore throat, chills severe headache, coughing, weakness and general discomfort like those of influenza. However, some individuals with swine flu have shown serious respiratory illness, including pneumonia or respiratory failure leading to death. Persons suffering from chronic medical conditions like heart disease, diabetes etc., and pregnant women are at higher risk for complications from swine flu. On June 11, 2009, the World Health Organization (WHO) raised its pandemic alert level to the highest one indicating that a pandemic of H1N1 flu was underway. Occurrence of swine flu has been reported form every part of the globe like mid-western United States, Canada, Mexico, South America, Kenya, China, Taiwan, Japan, and several parts of Eastern Asia including India. Rajasthan and Gujarat are the worst affected regions in India. In the year 2014, 937 cases of swine flu were reported in India and out of which the death toll was 218. According to latest reports, swine flu has already claimed more than 90 lives in states of Punjab, Gujarat and Rajasthan since January 2016. The main aim of the health care workers should be to prevent or limit the transmission of H1NI virus to other health care workers as well to patients. Dental professionals are exposed to numerous micro-organisms present in the dental operatory which are transmitted via blood, respiratory and oral secretions. According to Centre for Disease Control and Prevention, the virus can infect a person for up to 2 to 8 hours after being left on items like wooden tables, doorknobs and desks which are also a part of the dental operatory. Therefore, dental professionals are exposed to a greater extent via aerosol spread of this deadly virus. Hence, they should have sound knowledge regarding the mode of symptoms, mode of transmission and preventive measures so that there would be no infection spreading through the dental operatory. Therefore the present study was conducted to assess the knowledge and awareness of dental professionals towards swine flu in India.

The virus¹⁰ is spread among pigs by aerosols, through direct and indirect contact, and also by asymptomatic carrier pigs. Swine influenza seen predominantly in the mid-western United States (and occasionally in other states), Mexico, Canada, South America, Europe (including UK, Sweden, and Italy), Kenya, Mainland China, Taiwan, Japan, and other parts of eastern Asia and in various parts of India. In humans, the symptoms of swine flu are similar to those of influenza namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness, and general discomfort. WHO says that no previous pandemic disease has been detected so early or watched so closely, in real-time, right at the very beginning The world can now reap the benefits of investments, over the last 5 years, in pandemic preparedness.

ABOUT SWINE FLU¹¹:

Swine flu is an emerging viral infection that is a present global public health problem. There are many thousands cases of swine flu in the present day. This new infection can be seen around the world in the present day. This infection is a kind of variant of H1N1 influenza infection (Figure 1). The problematic virus was firstly detected in America in 2009 and this virus is the most widely studied virus in the present day. Due to the nature of respiratory virus, the transmission of this pathogenic virus is air borne transmission. Hence, the rapid spreading and difficulty in control of this infection can be expected. Swine flu, also called pig influenza, swine influenza, hog flu and pig flu. Swine influenza virus (SIV) or S-OIV (swine-origin influenza virus) is any strain of the influenza family of viruses that is endemic in pigs.

Fig 1: Electron microscope image of the reasserted H1N1 influenza virus

INFLUENZA¹¹:

Commonly, referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses), that affects birds and mammals. The most common symptoms of the disease are chills, fever, sore throat, muscle pains, severe headache, coughing, weakness/fatigue and general discomfort. Sore throat, fever and coughs are the most frequent symptoms. In more serious cases, influenza causes pneumonia, which can be fatal, particularly for the young and the elderly. Although it is often confused with other influenza like illnesses, especially the common cold, influenza is a more severe disease than the common cold and is caused by a different type of virus. Influenza may produce nausea and vomiting, particularly in children, but these symptoms are more common in the unrelated gastroenteritis, which is sometimes called "stomach flu" or "24 hour flu". Typically, influenza is transmitted through the air by coughs or sneezes creating aerosols containing virus.

STRUCTURE OF INFLUENZA¹¹:

Fig 2: Influenza Virus with its parts

Influenza¹¹ can also be transmitted by direct contact with bird droppings or nasal secretions, or through contact with contaminated surfaces. Airborne aerosols have been thought to cause most infections, although which means of transmission is most important is not absolutely clear. Influenza viruses can be inactivated by sunlight, disinfectants and detergents. As the virus can be inactivated by soap, frequent hand washing reduces the risk of infection

CLASSIFICATION¹²:

The three genera of influenza viruses that cause human flu, two also cause influenza in pigs, with influenza-A being common in pigs and influenza-C being rare 3. Influenza-B has not been reported in pigs. Within influenza-A and influenza-C, the strains found in pigs and humans are largely distinct, although due to reassortment there have been transfers of genes among strains crossing swine, avian and human species boundaries. Influenza- A Swine influenza is known to be caused by influenza –a subtype H1N1, H1N2 4, H2N35, H3N16, in pig three influenza- A virus subtype’s worldwide7. In the United States, the h1n1 subtype was exclusively prevalent among swine populations before 1998; however, since late august 1998, h3n2 subtypes have been isolated from pigs. As of 2004, h3n2 virus isolates in US and turkey stocks were triple reassortants, containing genes from human, swine and avian lineages Influenza –C Influenza-c virus infects both humans and pigs, but do not infect birds 9 . Transmissions between pigs and human have occurred in the past 10. For example, influenza-c caused small outbreaks of a mild form of influenza amongst children in Japan.

INFLUENZA IS SEASONAL, PANDEMIC AND ZOONOTIC FORM¹³:

Influenza infection in humans can be classified into seasonal, pandemic, and zoonotic form. Seasonal flu is caused by influenza A, B, and C viruses and accounts for about 3 to 5 million cases of severe illness, and about 250,000 to 500,000 of deaths annually worldwide. It has been estimated that the total annual economic burdens of seasonal influenza epidemics amounted to $87.1 billion. Of three types of influenza, type A is known most virulent. Genetic subtypes of currently circulating seasonal IAV strains are H1N1 and H3N2 and the epidemics have been dominated by H3N2 since 1968 when the “Hong Kong flu” occurred. Influenza pandemic occurs when people are immunologically naïve to a newly emerged IAV and the virus exhibits sustainable transmissibility between humans. A total of four influenza pandemics have occurred since the 20th century: Spanish flu pandemic (H1N1, 1918–1920), Asian flu pandemic (H2N2, 1957–1958), Hong Kong flu pandemic (H3N2, 1968–1969), and swine flu pandemic (H1N1pdm09, 2009–2010).

The Spanish flu¹⁴ is among the most devastating pandemic, having killed at least 50 million people. Subsequent pandemics have resulted in many fewer fatalities: the Asian flu (1.5 million), the Hong Kong flu (1 million), the swine flu (>18,500). The causative viral strain for each epidemic has been emerged from genomic reasserting within avian host (Asian flu and Hong Kong flu) or porcine host (swine flu). In case of Spanish flu, it is still controversial whether the virus had been a reasserting generated in mammals or a directly adapted avian influenza that crossed the species barrier from birds to human. The several descendants of pandemic influenza virus strains have established a novel lineage in humans and become a regularly circulating seasonal flu virus (e.g., H1N1, H3N2, and H1N1pdm09). Zoonotic influenza viruses are similar to pandemic influenza viruses in the immune status of human populations against the newly emerged viruses, except that the infections by those viruses end as sporadic individual events with very limited transmission to others.

Although avian or pig influenza¹⁴ viruses do not infect humans in general, sporadic human infection can be made via direct contact with infected animals or contaminated environments. Until now, human infections by avian influenza (H5N1, H5N6, H7N7, H7N9, H9N2, and H10N8) and swine influenza (variant H1N1, H1N2, and H3N2) have been reported. The disease severity in human varies according to viral strain; high lethality has been recorded in H7N9 (612 deaths among 1,565 infected patients since 2008), H5N1 (454 deaths among 860 infected patients since 2003), and H5N6 (7 deaths among 17 infected patients since 2016). H5N1 cases have been reported in 16 different countries distributed across Southeast Asia to Eastern Europe with Egypt and Indonesia reporting most of the infections.

On the other hand¹⁴, most reports of human infections by H7N9 and H5N6 have been limited in China. Despite the mild clinical illness and rapid recover in infected humans, H9N2 seems to have immense importance in terms of epidemiology of zoonotic influenza because the virus has been recognized as a potential enabler virus. The hypothesis was originated from the finding that H9N2 was a common denominator contributing to the genesis of H5N1, H5N6, H7N7, and H10N8, zoonotic viral strains as mentioned above, by providing whole sets of internal gene (PB2, PB1, PA, NP, M, and NS). It has been reported that human infections by variant swine influenza viruses (SIVs) tend to result in mild clinical illness

PAST VIEW OF SWINE FLU¹⁵:

Swine influenza was first proposed to be a disease related to human flu during the 1918 flu pandemic, when pigs became sick at the same time as humans. The first identification of an influenza virus as a cause of disease in pigs occurred about ten years later, in 1930. For the following 60 years, swine influenza strains were almost exclusively H1N1. Then, between 1997 and 2002 new strains of three different subtypes and five different geno type emerged as cause of influenza major cause of swine influenza in North America. In 1997-1998 h3n2 emerged. These strains, which include genes derived by reassortment from human, swine and avian viruses, have become a major cause of swine influenza in North America. Reassortment between H1N1 and H3N2 produced H1N2. In 1999 in Canada, a strain of H4N6 crossed the species barrier from birds to pigs, but was contained on a single farm. The phylogenetic origin of the flu virus that caused the 2009 pandemics can be traced before 1918. Around 1918, the ancestral virus of avian origin, crossed the species boundaries and infected humans as human H1N1. The same phenomenon took place soon after in America, where the human virus was infecting pigs; it lead the emergence of the H1N1 swine strain, which later became the classic swine flu. The new human H1N1 flu strain of avian origin, was kept transmitting among human populations until around 1957, when there was a co infection between this strain and the avian H1N1 in humans. There was a reassortment event leading to the development of a new strain (H2N2). New events of reassortment were not reported until 1968, when the avian strain H1N1 infected humans again; this time the virus met the strain H2N2, and the reassortment originated the strain H3N1.

1889: Prior to 1889¹⁶, the main flu virus circulating in humans has been from the H1 family. But this year, a new strain of H2 flu emerges in Russia and spreads around the world, killing about 1 million people. Afterwards, H2 replaces H1 in humans. Such replacements seem to be a regular feature of flu pandemics. People who are born before 1889, which have been exposed to H1 flu, have some immunity to it. This affords them some protection in the deadly H1N1 epidemic of 1918. Those born after 1889 do not have any immunity to H1. 1918: The “Spanish flu” epidemic of 1918 kills at least 50 million people worldwide. It is caused by an H1N1 virus which evolves directly from bird flu into a human flu. After a mild wave of infections in the summer, the epidemic goes global: one-third of the population eventually get sick. Although most cases are mild, many sufferers develop a rapidly fatal infection deep in their lungs. People born before 1889 are less susceptible, thanks to their previous exposure to H1N1. Most deaths are caused by bacterial lung infections that move in after the virus. Modern antibiotics might mean that a re-run of the 1918 pandemic would be less dangerous. After 1919, the descendants of the H1N1 virus continue to circulate and cause seasonal flu outbreaks in humans and pigs. 1931: Swine flu is first isolated from a pig in Iowa.

1933¹⁶: The first human flu virus is isolated at Mill Hill in London. When given to ferrets, it produces a disease whose symptoms are all but identical to the Iowan pig virus. But ferrets that have had the human virus are not fully immune to the pig virus, showing that the two viruses have already started to evolve apart. 1957: An H2N2 virus causes the “Asian” flu pandemic, completely displacing the H1N1 viruses that have been circulating in humans since 1918. The pandemic is fairly mild, killing 1 to 1.5 million people worldwide. The virus is produced by a reassortment, in which human-adapted H1N1 swaps genes with H2N2 bird flu. The new H and N surface proteins mean most people do not have antibodies to the virus, allowing it to go pandemic. However, its human-adapted genes mean it is not as lethal to humans as the 1918 virus, which came, with few changes, from birds. People tend to mount the best immune response to the first kind of flu virus they experience. Because of this, people born before 1957, whose first experience of flu would have been the H1N1 viruses then in circulation, have some immunity to the 2009 H1N1 strain causing the current pandemic. People born after the 1957 pandemic do not have this immunity. 1968: An H3N2 virus causes the “Hong Kong” flu pandemic, which is even milder than the Asian flu, killing an estimated 0.75 million to 1 million people worldwide. The virus only differs from H2N2 in one of its surface proteins, the H; since many people still have antibodies to the unchanged N2 protein, its effects are less severe. But because H3N2 completely replaces H2N2 in people, no one born since 1968 has any immunity to H2.

1972¹⁶: Researchers Graham Laver and Robert Webster discover that waterfowl are the natural hosts of influenza viruses. The birds harbor strains unknown in humans that could reassert with human strains and give rise to new human pandemics. 1976: An H1N1 virus jumps from pigs to humans and kills a US army recruit. However the virus does not spread beyond the army base and fizzles out without triggering a pandemic. Nevertheless, fears of a replay of the 1918 pandemic lead to 48 million people being hastily vaccinated against the swine flu virus. The vaccine is associated with an unusual number of cases of Guillain-Barré syndrome: 532 people get it, and 25 die. 1977: An H1N1 virus appears in north-east China and starts circulating in humans. It causes seasonal flu in every subsequent year. No one knows where it came from, though it looks like an H1N1 that circulated in the Soviet Union in 1950 and some suspect it escaped in a laboratory accident.

The virus¹⁶ causes a mild flu pandemic, which mainly affects people born after H1N1 flu disappeared in 1957. However, the real surprise is that it does not displace the previous, and more virulent, seasonal flu, H3N2. Instead, it continues circulating alongside it. The antibodies people produce after being infected by this new seasonal H1N1 do not protect against 2009 H1N1. However, infections also trigger another reaction called cell-mediated immunity, in which certain white blood cells target and destroy infected cells. Tests of the 2009 H1N1 pandemic vaccine shows that, unlike antibodies, cell-mediated immunity to seasonal H1N1 may help protect against the pandemic virus. This does not prevent disease altogether, but can reduce its severity.

1998¹⁶: The predecessor of the 2009 H1N1 swine flu virus emerges in the US. It is a hybrid of human, bird and swine flu viruses, and by 1999 it is the dominant flu strain in US pigs. US pig farms try to control it with vaccines, but these attempts are largely ineffective because the virus evolves too rapidly, changing the surface proteins targeted by the vaccine while keeping its internal genes unchanged. The 2009 pandemic virus is a variant on this 1998 flu, and behaves the same way. 2004-2006 H5N1 flu, first identified as a threat to humans in Hong Kong in 1997, spreads from Asia around the world, apparently carried by wild birds. While this “bird flu” proves deadly to humans, killing more than half of its victims, it is kept in check by its inability to spread readily from human to human. H5N1 is also found in pigs in Indonesia, raising fears that it might reassert with other human flu viruses that pigs can harbor. The threat posed by bird flu leads to the first real efforts to be made at pandemic planning: governments start to stockpile antiviral drugs, and the world’s drug companies start doing serious research on pandemic vaccines.

These plans¹⁶ are made with the highly lethal H5N1 in mind, meaning that they are not always appropriate for the 2009 pandemic. 2007-2008 Pandemic fears boost spending on flu research. European scientists start organizing to track flu in wild birds, Vietnamese scientists find that antibodies from bird flu victims can cure other cases of the virus (a technique used in Hong Kong in 2009), the risk of dying of flu is found to be partly genetic, and it turns out that your mother was right to warn you about catching the flu when it’s cold out. However, Indonesia, where most H5N1 outbreaks are happening, refuses to share samples of the virus, arguing that it will not benefit in return from any vaccines developed as a result. This means scientists cannot monitor the virus’s evolution. But worries about H5N1 subside as it fails to become contagious in people – although virologists continue to warn that it is not the only threatening flu virus out there. Viruses from the H9, H7 and H2 families all give cause for concern.

March¹⁶ 2009 the first cases of a new type of swine flu are reported in California and Texas in late March. Subsequent genetic analysis suggests that it may have started circulating in humans in January. April 2009 On 27 April, with 900 cases of suspected swine flu reported in Mexico, the World Health Organization (WHO) upgrades the pandemic warning level from 3 to 4 on a six-point scale. Intensive efforts to understand the virus and develop a vaccine begin immediately. The US government advises against travel to Mexico, although research suggests that travel bans will not stop the virus spreading. May 2009 although swine flu seems to be spreading slowly, it is still progressing quickly enough to justify preparing for a pandemic. However, the WHO delays declaring a pandemic, partly because there is not enough evidence that the virus is spreading in the general population outside the Americas, where it originated. New Scientist reveals that Europe is not testing people with flu symptoms unless they have recently travelled to an affected area in the Americas, or have had close contact with someone who did. As a result, Europe cannot detect spread in the general population. These restrictions may be making the pandemic “invisible” to the monitoring authorities. As concerns mount, it transpires that many countries are poorly prepared for this scenario and that supplies of H1N1 vaccine cannot be prepared in time to catch the second wave. June 2009 The UK and other countries change their rules and start testing people who have flu but no North American contacts. Cases of swine flu are soon detected. On 11 June the WHO officially declares swine flu to be a pandemic. This is the signal for the vaccine industry to start making pandemic vaccine (paid for by governments), rather than conventional flu vaccine (paid for by ordinary health services).

July¹⁶ 2009 Treatment plans are shaken by the discovery of swine flu that is resistant to the antiviral drug Tami flu and the realization that the H1N1 vaccine is growing only half as fast as the ordinary flu vaccine. The US decides to use its standard formulation for flu vaccine, so no new regulatory tests will be needed. This will allow it to authorize pandemic vaccine before September, when a renewed wave of the pandemic is expected. But this formulation uses a lot of virus, and so reduces the number of doses that can be made. Researchers discover that the swine flu virus binds far deeper in the lungs than ordinary flu, possibly explaining why it is sometimes fatal. However, the majority of cases are still mild, and it appears that many of the people with severe cases have an underlying health problem although some of these “problems” are no more remarkable than being overweight, pregnant or unborn. In the southern hemisphere, where it is winter, swine flu apparently replaces the usual seasonal flu. This suggests that the pandemic virus will displace the two previous seasonal flu strains, as previous pandemics have done. However, after the experience of 1977, when this did not happen, scientists do not rule out the return of H3N2 after the autumn wave of swine flu.

August¹⁶ 2009 A New Scientist poll reveals widespread concern about swine flu among public health officials and epidemiologists, many of whom have obtained supplies of antiviral drugs for their own families. September 2009 four major vaccine manufacturers report that their swine flu vaccines work with only one shot. This is good news, given that vaccine is in short supply despite researchers’ success in finding faster-growing strains. The vaccine’s effectiveness suggests there must be pre-existing cell-mediated immunity, possibly because of similarities between the surface proteins on swine flu and the seasonal H1N1 flu that emerged in 1977. As autumn arrives in the northern hemisphere, experts are on tenterhooks: a particular worry is that swine flu will hybridize with bird flu to create a readily contagious human flu armed with a lethal H5 surface protein. At time of writing, the virus had not become more severe, causing mild disease in most sufferers but making a small number – probably less than 1 per cent – extremely ill. October 2009 Vaccination programmes begin in the US and Europe, but many healthcare workers are reluctant to have the vaccine, even though it is virtually identical to the seasonal vaccines used in previous years, which have a good safety record. Production delays also continue to plague the deployment of vaccine. By 22 October, the US has only 27 million doses available, compared with the expected 45 million. Researchers show that this much vaccine will reduce the number of cases in the second wave by less than 6 per cent – but that is still enough to save 2000 lives. Six months after swine flu first shot to world attention, US President Barack Obama declares the virus a national emergency.

PRESENT VIEW OF SWINE FLU¹⁷:

According to global status of influenza in 2010, 12 cases of swine influenza in Ethiopia were reported. Ministry of Health (MOH), Ethiopian Health and Nutrition Research Institute (EHNRI) and CDC-Ethiopia jointly conducted a national workshop on influenza surveillance systems, functions and its operational components in such a way that able to implement influenza surveillance in different regions. In March 2016, a total of 13 patients complaining of Influenza-like Illness (ILI) or Severe Acute Respiratory Infections (SARI) were reported with throat swab samples from predesigned influenza sentinel sites. Among them four were tested positive for Influenza a H1N1 2009 pandemic and three were positive for seasonal influenza A (H3N2). Starting from October 2015, the positivity rate of Pandemic Influenza H1N1 is increasing. In Ethiopia, currently there are confirmed cases with no death associated with the condition. The virus has been detected on February 4, in different hospitals. However, sources in the Ministry of Health say the subtype of the influenza detected in Addis Ababa is less dangerous than others and Ethiopia has testing and treating capabilities. Test samples are sent to the Center for Disease Control (CDC) of United States for further investigation as a matter precaution.

Recent studies⁷ also indicate that the swine flu H1N1 pandemic would have killed many a thousands more since all the cases were not reported and many would have went undiagnosed and was estimated to be nearly 200,000 human casualties around the world. H3N2 which is new subtype has accounted for 145 cases. High risk persons are those affected with chronic diseases of liver, lung, heart, kidney; and having diabetes, immunosuppressant and neurological diseases.

INDIAN SCENARIO¹⁸:

In India, swine flu has resulted in human casualties of 981 in 2009, 1,763 in 2010 and 75 in 2011. Swine flu is back in India on May 2012 resulting 129 cases with 12 deaths reported during this period of time. The major sufferer of this attack is Maharashtra with 69 cases and 6 deaths, followed by Rajasthan 28 cases and 5 deaths. One death has been reported from Andhra Pradesh as well. No deaths from Karnataka though there were affected cases. Recently in 2013, 456 cases along with 94 deaths have been reported so far in various states including, Rajasthan, Punjab, Haryana, Delhi, Himachal Pradesh.

WHAT WOULD A MODERN PANDEMIC LOOK LIKE¹⁹:

According to the WHO, if influenza pandemic were to emerge today, we could expect the following to occur: As people today are highly internationally mobile, the pandemic virus would spread rapidly around the world. Vaccines, antiviral agents, and antibiotics to treat secondary infections would rapidly be in short supply several months would be needed before any vaccine became available; this is because pandemic viruses are novel agents, Medical facilities would be overwhelmed. There would be sudden and potentially considerable shortages of personnel to provide vital community services as the illness became widespread.

FUTURE PANDEMIC CONCERNS¹⁹:

Although medical science is constantly making leaps and bounds in our defense against disease, because of the novel nature of pandemics, we will never be fully protected. The categories below all hold a certain level of concern for experts.

VIRAL HEMORRHAGIC FEVERS¹⁹:

Viral hemorrhagic fevers, including Ebola and Marburg Virus, have the potential to turn into pandemics. However, these types of disease are not easily spread. These diseases require being close to an infected person, and, as the infected individual tends not to live particularly long after infection, their spread is naturally curbed. Additionally, the short time interval between infection and symptoms allows health care professionals to quarantine new cases swiftly.

ANTIBIOTIC RESISTANCE¹⁹:

Antibiotic resistance is never far from the front page of medical news; it is a genuine, major concern. Resistant strains of tuberculosis are among the most worrying. Each year, almost half a million new cases of multidrug-resistant tuberculosis (MDR-TB) are estimated to occur globally. SARS: SARS, caused by the corona virus, recently came close to generating a pandemic. Health agencies and government bodies prevented the disease from becoming more than localized epidemics. SARS has not been eradicated, however, and may return.

INFLUENZA¹⁹:

Wild aquatic birds are a natural host for a variety of influenza strains. In rare cases these influenza species can pass from bird to human, sparking epidemics with the potential to turn into pandemics, if left unchecked. The recent discovery of the H5N1 (Avian Flu) is an example of this. The strain was spotted in Vietnam in 2004 and, although it never reached even epidemic levels, the ability of the virus to potentially combine with human flu viruses is a concern to scientists. Ebola The largest Ebola epidemic the world has ever seen is still ongoing. Huge efforts to contain the problem have prevented it from turning into a pandemic.

HOME REMEDIES²⁰:

As there is no known single cure, steps can be taken at home to prevent swine flu and reduce symptoms if a person does contract the virus. These include: washing hands regularly with soap, getting plenty of sleep, exercising often, managing stress, drinking liquids, eating a balanced diet, refraining from touching surfaces that may have the virus, Do not get close to people who are sick. Be sure to stay away from crowds if there is a swine flu outbreak in your area. How to reduce the spread of infection: If a person is infected, it is important they follow these rules to prevent any further spread, Limit contact with other people, do not go to work or school, when coughing or sneezing cover the mouth with a tissue. If there is no tissue available, cover the mouth and nose, Put used tissues in a trash can, Wash the hands and face regularly, Keep all surfaces that are touched clean, Follow all doctors' instructions.

TREATMENT²¹:

Vaccination and animal management techniques are most important in these efforts. Antibiotics are also used to treat this disease, which although they have no effect against the influenza virus, do help prevent bacterial pneumonia and other secondary infections in influenza weakened herds. In humans the antiviral drugs can make the better faster.

SUMMARY:

The virus is contagious and can spread from human to human. Symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. There are antiviral medicines you can take to prevent or treat swine flu. There is a vaccine available to protect against swine flu. You can help prevent the spread of germs that cause respiratory illnesses like influenza by Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water. Especially after you cough or sneeze. You can also use alcohol-based hand cleaners. Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. Stay home from work or school if you are sick.

CONCLUSION:

Swine Flu or the Influenza A (H1N1) flu, an highly contagious acute respiratory disease of the pigs, is caused by one of the numerous swine influenza A strains and is highly contagious. The transmission of the virus is from person-to-person and is similar to the manner in which seasonal influenza spreads. Swine flu is a viral infection. It is a present public health problem globally. In the present situation many people infected by swine flu. Occurrence of swine flu has been reported form every part of the globe like mid-western United States, Canada, Mexico, South America, Kenya, China, Taiwan, Japan, and several parts of Eastern Asia including India. Seasonal flu is caused by influenza A, B, and C viruses and accounts for about 3 to 5 million cases of severe illness, and about 250,000 to 500,000 of deaths annually worldwide. It has been estimated that the total annual economic burdens of seasonal influenza epidemics amounted to $87.1 billion. In swine, multiple A (H1N2) virus reassortment have included genetic material from avian, swine, and human influenza viruses and have formed multiple A (H1N2) reasserting viruses with differing genetic compositions over time. In humans, the A (H1N2) virus has also arisen as a result of the reassortment of human A (H1N1) and A (H3N2) strains, leading to circulation of A (H1N2) viruses. There is a vaccine available to protect against swine flu. You can help prevent the spread of germs that cause respiratory illnesses like influenza by Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water. Especially after you cough or sneeze. You can also use alcohol-based hand cleaners. Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. Stay home from work or school if you are sick.

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Received on 07.03.2018 Modified on 12.05.2018

Res. J. Pharma. Dosage Forms and Tech.2018; 10(2): 70-78.

DOI: 10.5958/0975-4377.2018.00011.3

ABOUT SWINE FLU11:

Fig 1: Electron microscope image of the reasserted H1N1 influenza virus

REFERENCES:

ABOUT SWINE FLU¹¹: