Top 10 Travel Tips to Protect You from the H1N1 Swine Flu Pandemic

At last, you have some well-earned leave for a winter vacation. Perhaps it’s your last opportunity to take advantage of those recession-buster bargain flight deals.

There’s just one major problem to consider. Whether you’re planning a family ski venture in a winter wonderland, or escaping to sunnier climates in the Southern Hemisphere, you’ll need to take special care when travelling...

Because this winter, the H1N1 swine flu is also enjoying a successful world tour – of pandemic proportions. And you could be on its hit list!

So here’s your instant top 10 travel-tip checklist, to help you and your loved ones enjoy a happy and healthy vacation, while reducing your risk of infection by the H1N1 virus.

1. If you exhibit possible H1N1 symptoms close to your departure date, STAY AT HOME! Don’t put others at risk. Should you fall ill while abroad, contact your Embassy, High Commission or Consulate for advice on English-speaking doctors and local medical services.
2. Check out the health status of your destined country – before you depart. You can do this online, via the World Health Organisation website. On arrival, some countries screen passengers for H1N1 symptoms and quarantine suspected cases. Get all appropriate vaccinations required for your destination (including seasonal flu).
3. Make sure you have comprehensive travel/health insurance, check for exclusions and special clauses. Also find out your tour operator’s policy for assisting clients exposed to the H1N1 virus.
4. Prepare an emergency flu prevention and medical travel kit, small and light enough to pack into your luggage. If you’re flying, check the current airport security restrictions for items you can carry in hand luggage – particularly liquids. Include adequate supplies of alcohol-wipes, hand cleaning gel, disposable tissues, basic medical supplies for flu symptoms (ibuprofen, etc.)
5. While en-route, by plane: use antibacterial wipes to clean surrounding surfaces (chair-arms, seatbelt, light button, etc.) Avoid touching shared magazines. Take your own pillow and blanket. By train/bus, try to keep windows open for maximum ventilation. (Likewise hotel rooms or apartments.)
6. KEEP WASHING YOUR HANDS, properly and frequently. Ideally use warm, running water and soap. When travelling, this isn’t always an option. So keep a supply of antibacterial wipes and hand cleaning gels. Shower regularly, especially after journeys. Change into fresh clothes and discard or wash worn garments. When washing is unavailable, refrain from touching eyes, nose and mouth.
7. Drink lots of bottled water, it’s essential you keep your body rehydrated.
8. Avoid crowded gatherings or close confinement with other people – especially anyone showing flu-like symptoms. Wipe public surfaces before touching (like door handles, counters, washroom seats, etc.)
9. Avoid contact with animals – particularly on livestock markets. Animal to human transmission is extremely rare, perhaps impossible at present. But animals may carry the virus. So the less you expose yourself to it, the better.
10. After returning from an affected area, closely monitor your health for one to two weeks for flu-like symptoms (sore throat, cough, runny nose, headache, muscle aches, etc.) Should you show symptoms, contact your physician or local hospital – by phone, immediately.

All of these tips are recommended by health officials. Although there is no magic formula that can protect you from swine flu, by following these recommendations, you’ll reduce the chance of infection significantly.

Enjoy a fun and relaxing vacation, and stay healthy.

Analyzing the Effects of Swine Flu in the Southern Hemisphere

"We need to be prepared for whatever surprises this capricious new virus delivers next"

Margaret Chan, Director General, World Health Organisation

Winter is drawing to a close in the southern hemisphere and as flu season comes to an end, experts in the northern hemisphere are analyzing the impact of the H1N1 swine flu virus. Government agencies and infectious disease experts in northern countries report primarily good news based on the effects of swine flu in Australia, New Zealand, Chile, Argentina and Uruguay.

At the height of flu season, health care systems in the southern hemisphere were stressed, but managed to handle and recover an increase in patients hospitalized for health problems related to influenza. Experts are calling the H1N1 flu virus pandemic "moderately severe" based on the flu season in the southern hemisphere. The duration of the season was similar in length to average flu seasons, and although swine flu does spread quickly and easily, it's not associated with higher rates of hospitalizations, deaths or health complications than other types of seasonal flu viruses.

Despite high rates of infection, swine flu is a mild disease for the vast majority of the population. Since its outbreak last spring, the virus hasn't changed. It appears to dominate other seasonal flu virus strains, but isn't mixing with any or becoming stronger or more aggressive. While more deaths are being attributed to swine flu than in the past, this reflects a massive increase in infection rates rather than a more deadly virus.

Experts have been able to glean some new information on swine flu based on the recent season in the southern hemisphere. According to the Ministry of Health in Peru, as many as one third of those infected with swine flu have cold-like symptoms without a fever, while others that are infected have no symptoms at all. This indicates that while the virus may spread very easily, many people who acquire it may not even notice. It's also an indication that the infection rate is widely underestimated due to unreported cases.

Although in the past, seniors over the age of 60 weren't believed to be as susceptible to swine flu due to prior exposure to the A(H1N1) virus strains, statistics related to seniors infected in the southern hemisphere are alarming. While fewer seniors may be infected, there is a higher death rate among those who do contract swine flu than was previously realized. Seniors who are infected seem to suffer more complications and be impacted by them more severely.

School age children are most at risk for becoming seriously ill with swine flu, and death rates among infected children are higher than those associated with seasonal flu. Many parents in the northern hemisphere are planning to have their kids vaccinated as soon as possible. Pregnant women, obese people and those with chronic illnesses are all susceptible to higher rates of serious complications from swine flu infection. Experts are recommending those at high risk consider vaccination once it becomes available.

"We cannot say for certain whether the worst is over the worst is yet to come"

Margaret Chan, Director General, World Health Organisation

Despite the relative consistency of the behavior of the H1N1 virus across countries, many flu experts are advising the northern hemisphere to be prepared for surprises. Health care facilities and hospitals should be prepared for the worst, experts warn, so they're truly capable of handling whatever the flu season brings. Based on the experience of hospitals in the Southern Hemisphere, experts warn that ICU (Intensive Care Unit) units in hospitals in particular should be prepared to take on a large number of patients with swine flu complications. The World Health Organisation cites that several countries have reported that nearly 15% of hospitalized cases have required intensive care.

Given that the upcoming flu season in the northern hemisphere represents a second wave of exposure, experts are hopeful that this time around, at least some of the population has already developed immunity. It's also expected that widespread vaccination may curtail the spread of the virus in the north in the coming months. At the very least, it's thought that swine flu isn't likely to have any worse of an impact on the northern hemisphere than it had during the southern hemisphere's flu season.

Tamiflu Update | Pandemic Preparedness

Frontline defense against swine flu... but for how long?

There are now several confirmed cases of swine flu resistant to Tamiflu. Overall, more than ten have been reported, as of August 2009, in various countries, including Canada, China, Japan, Hong Kong, Denmark, Singapore and the US. Further spread could result in the medication becoming ineffective–a worrying scenario, given that Tamiflu is the most widely used medicine for the prevention and treatment of swine flu.

Dangers of stopping treatment

The growing concern over Tamiflu resistance is supported by evidence that, in the past two years, the seasonal flu H1N1 virus has changed into a form almost completely resistant to the drug. Why and how, exactly, this happened is unknown, but it is reasonable to expect that the same thing might occur with the swine flu H1N1 virus.

One suggested reason for resistance is patients not finishing their treatment course; a phenomenon also referred to as medication noncompliance.

The recommended treatment course for swine flu is two 75mg capsules a day for five days. When patients start taking Tamiflu, the first H1N1 strains to die are those highly susceptible to the medication, followed by those less susceptible – that is, the more resistant.

A whole treatment course ensures that both highly and less susceptible strains are killed. But, if patients stop taking Tamiflu, the less susceptible strains survive in the body, where they continue to replicate and may, potentially, originate a strain completely resistant to the drug.

Patients, who don’t finish their treatment course are about 20 percent of all those on Tamiflu, according to researchers at Imperial College London, UK. These patients could be the key agent for transmission of resistant forms of the virus, enabling them to rapidly spread through populations. The good news is there is no evidence, so far, indicating that Tamiflu-resistant strains of H1N1 can be transmitted from person to person.

A single-dose alternative?

A solution to the problem of compliance could be a treatment that is taken only once. A strong candidate, in this regard, is Laninamivir, a swine flu medication administered through inhaler, which, according to recent findings from clinical trials conducted in Asia, is also effective at treating seasonal and avian influenza.

Manufactured by the Australian pharmaceutical company Biota Holdings Limited, Laninamivir – like Tamiflu and the other medication used for swine flu, Relenza – belongs to a class of drugs called neuraminidase inhibitors, which act early in the virus’ replication cycle, “so effectively creating a ‘still birth’ of the new virus,” says the company’s chief executive, Peter Cook.

Laninamivir, which Cook expects to be licensed for marketing in Japan, Europe and the US by next year, could represent a significant improvement in the treatment of swine flu. Not only has it been shown, in studies, to be as effective as Tamiflu, it also has the advantage that, as a single-dose medication, it is easier and less costly to stockpile, and–most importantly–potentially crucial in preventing the virus from becoming resistant due to patients not finishing their treatment.

Widespread use not the best strategy

An important contributing factor to the development to Tamiflu-resistant strains of H1N1 is the mass use of the drug, which is given for prophylaxis (prevention) also to individuals with no symptoms of swine flu.

In the attempt to make it easier for the public to obtain the medication, and avoid placing further strain on already stretched healthcare services, some governments have implemented measures to ensure access to Tamiflu for everyone. For example, in the Netherlands, the drug is distributed for free to anyone with a physician’s prescription and, in the UK, it is sold over the counter in most any store.

But, experts urge caution. Widespread access to Tamiflu may not be the best strategy. Why? Because it speeds up the spread of resistant mutations, increasing the risk of the virus becoming resistant – globally. As a result, Tamiflu would become useless. And if this happens in the fall, when a more powerful strain of H1N1 is likely to circulate, the consequences could be disastrous.

Strategies have been put forward that could, potentially, help prevent the phenomenon of Tamiflu resistance from becoming global. These, according to findings in the journal BioMed Central Infectious Diseases, include not giving Tamiflu to people over 65 – the age group supposedly at least risk of swine flu.

However, mass Tamiflu use is causing another problem. People on the drug develop side effects for which they require medical attention. And this puts additional pressure on healthcare systems worldwide.

A study published this month in the British Medical Journal shows children are a category particularly at risk. The researchers, from Oxford University, say the side effects (mostly vomiting, which may lead to potentially life-threatening complications, like dehydration) are so severe and frequent that physicians should consider giving Tamiflu only to children with underlying health problems. Those with a mild form of the infection should be given paracetamol.

What’s the advice?

In summary, swine flu has been found resistant to Tamiflu in sporadic cases, which may indicate that the threat of a global resistance to the drug is real and that strategies – like improving the drug’s compliance and limiting its use to certain patient groups – to prevent, or delay, H1N1 from becoming completely resistant may be worth considering. However, currently most patients respond well to the drug.

So, what’s the advice? In a briefing note issued on August 21, the World Health Organization (WHO) says: “Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. [Thus] healthy patients with uncomplicated illness need not be treated with antivirals.”

However, “for patients who initially present with severe illness or whose condition begins to deteriorate WHO recommends treatment with oseltamivir [Tamiflu] as soon as possible. Studies show that early treatment, preferably within 48 hours after symptoms onset, is strongly associated with better clinical outcome. For [these patients] treatment should be provided even if started later.”

The same recommendation applies to all children younger than five years, pregnant women and individuals with pre-existing health problems. These, too, should be given Tamiflu as soon as possible.

Since approximately 40 percent of cases of progression to severe illness occur in previously healthy individuals – mostly adults younger than 50 and children – the WHO recommends that clinicians, caregivers, and the patients themselves be particularly alert for signs of deterioration of the infection (e.g., chest pain, confusion, difficult breathing, blue skin, low blood pressure, persistent high temperature, colored sputum) “and take urgent action, which should include treatment with oseltamivir.”

“In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.”


References

Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/h1n1flu [Accessed 08.18.2009].

Merler S., Ajelli M., Rizzo C. “Age-prioritized use of antivirals during an influenza pandemic,” BMC Infectious Diseases, July 28, 2009, 9:117.

Shun-Shin M., Thompson M., Heneghan C., Perera R., Harnden A. “Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomized controlled trials,” British Medical Journal, August 10, 2009, 339:b3172. doi: 10.1136/bmj.b3172

World Health Organization (WHO). http://www.who.int/csr/disease/swineflu/en/. [Accessed 08.18.2009].

World Health Organization (WHO). Recommended use of antivirals. Pandemic (H1N1) 2009 briefing note 8. August 21, 2009. http://www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en/index.html. http://www.who.int/csr/disease/swineflu/en/. [Accessed 08.26.2009].

By Lorena Tonarelli, MSc