Swine Flu: History, Types, Symptoms, Causes, Diagnosis, and Treatment

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The flu pandemic or swine flu in 2009 was an influenza pandemic that lasted from early 2009 to late 2010, and the second of the two pandemics involving H1N1 influenza virus (the first of which was the Spanish flu pandemic in 1918–1920), though in a new version. First identified in April 2009, the virus appeared to be a new strain of H1N1, resulting in a previous triple reassortment of dog, swine and human flu viruses further combined with a Eurasian pig flu virus leading to the word ‘swine flu’ It is estimated that 11–21 per cent of the world’s population (about 6.8 billion), or about 700 million–1.4 billion people, contracted the disease— more in absolute terms than the Spanish flu pandemic.

History

Initially referred to as an ‘outbreak’, the widespread H1N1 infection was first identified in the state of Veracruz, Mexico, with evidence that the virus had been present for months before it was officially referred to as an ‘epidemic’. The Mexican government closed most of the public and private facilities in Mexico City to limit the spread of the virus; however, it continued to spread globally, and in some cases the hospitals were too overwhelmed by infected people. American and Canadian laboratories first isolated the new virus from samples collected from people with flu in Mexico, Southern California and Texas in late April. The earliest known human case was soon traced to a case in a 5-year-old boy in La Gloria, Mexico, a rural town in Veracruz from March 9. In late April the World Health Organization (WHO) announced its first ever ‘public health emergency of international concern,’ or PHEIC, and in June the WHO and the U.S. CDC stopped reporting cases and announced the outbreak to be a pandemic. In November 2009, the pandemic began to taper, and by May 2010, the number of cases was in rapid decline. WHO Director-General Margaret Chan announced the end of the H1N1 pandemic on 10 August 2010 and announced that the H1N1 influenza outbreak has passed into the post- pandemic phase. According to the latest WHO estimates (as of July 2010), since it emerged in April 2009, the virus has killed more than 18,000 people, but they note that the estimated mortality (including unconfirmed or unreported deaths) from the H1N1 strain is ‘unquestionably higher’.

Classification

American media called the initial epidemic the ‘H1N1 influenza’ or ‘Swine Flu’. It is called the H1N1/09 pandemic virus by the WHO, while in the U.S. it is referred to as ‘novel influenza A (H1N1)’ or ‘2009 H1N1 flu’ by disease control and prevention centres. In the Netherlands, it was initially named ‘Pig Flu’ but is now called by the national health institution ‘New Influenza A (H1N1)’, while the media and the general public use the term ‘Mexican Flu’. South Korea and Israel thought briefly of naming it the ‘Mexican virus’. The term ‘North American influenza’ was introduced by the World Health Organization for Animals, and the European Commission has adopted the phrase ‘novel flu virus’.

Signs and Symptoms

H1N1 flu symptoms are like those of other influenzas, and may include fever, cough (usually a ‘dry cough’), headache, muscle or joint pain, sore throat, chills, exhaustion, and runny nose. In some cases, even diarrhea, vomiting, and neurological problems were reported. People at higher risk of serious complications include those over the age of 65, children under the age of 5, children with neurodevelopmental disorders, pregnant women (especially during the third trimester) and those of any age with underlying medical conditions such as asthma, diabetes, obesity, heart disease or a weakened immune system (e.g., immunosuppressive or HIV-infected medications).

Cause

The virus has been found to be a novel influenza strain for which current seasonal flu vaccines provide no protection. One U.S. research centre for disease control and prevention reported in May 2009 found that children do not have pre-existing immunity to the new strain, but that adults, particularly those over the age of 60, do have some immunity. Children had no cross-reactive antibody reaction to the new strain, adults between the ages of 18 and 60 had 6–9%, and older adults 33%.

Analysis of the genetic sequences of the first isolates, immediately shared by Nature and WHO on the GISAID site, soon found that the strain includes genes from five distinct flu viruses: North American swine influenza, North American avian influenza, human influenza and two typically found in Asia and Europe. More research has shown that some virus proteins are most like strains that cause mild symptoms in humans, leading virologist Wendy Barclay on 1 May 2009 to conclude that the initial signs are that the virus was unlikely to cause severe symptoms in most people.

In June 2010, Hong Kong scientists announced discovery of a new swine flu virus that is a combination of the H1N1 pandemic virus and viruses previously found in pigs. Pigs have been named the flu mixing device because they can be infected both by avian flu viruses, which never affect people directly, and by human viruses. If pigs are infected with more than one virus concurrently, the viruses will exchange genes, creating new variants that they pass on to humans and even spread among them.

Diagnosis

Confirmed diagnosis of H1N1 flu pandemic requires testing of the patient’s nasopharyngeal, nasal or oropharyngeal tissue swab. Real-time RT-PCR is the preferred study, as some cannot differentiate between H1N1 pandemic and normal seasonal flu. However, most people with flu symptoms do not need a specific H1N1 flu pandemic test because the test results do not usually affect the recommended course of treatment. The U.S. CDC suggests monitoring only for those with suspected flu, pregnant women and those with compromised immune systems who are hospitalized. The CDC announced a new test ‘CDC Influenza 2009 A (H1N1) pdm Real-Time RT-PCR Panel (IVD)’ on 22 June 2010. It uses a technique of molecular biology to identify influenza A viruses, and specifically the H1N1 virus of 2009. The new test would replace the previous RT-PCR real-time diagnostic test used during the 2009 H1N1 pandemic, which earned U.S. permission for emergency use. In April 2009 the Food and Drug Administration. Test reports are available within four hours and are reliable at 96 per cent.

Treatment

A variety of approaches were prescribed to help relieve symptoms, including adequate consumption and rest of the liquids. Over – the counter pain medications such as acetaminophen and ibuprofen do not kill the virus but can be effective in reducing symptoms. Those under 16 with any flu-type symptoms should not use aspirin and other salicylate drugs because of the possibility of developing Reye’s syndrome. If the fever is mild and there are no other complications it is not recommended to take fever medication.

References

https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html
https://www.who.int/csr/disease/swineflu/frequently_asked_questions/about_disease/en/
https://www.statnews.com/2019/06/11/h1n1-swine-flu-10-years-later/
https://www.nhs.uk/conditions/swine-flu/
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001558
https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html
https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html
https://www.who.int/csr/disease/swineflu/frequently_asked_questions/about_disease/en/
https://www.who.int/csr/disease/swineflu/frequently_asked_questions/about_disease/en/
https://www.statnews.com/2019/06/11/h1n1-swine-flu-10-years-later/
https://www.statnews.com/2019/06/11/h1n1-swine-flu-10-years-later/
https://www.nhs.uk/conditions/swine-flu/
https://www.nhs.uk/conditions/swine-flu/
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001558
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001558

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