Worried about swine Influenza (H1N1)

There has been a lot news stories about the H1N1 influenza virus or as commonly known Swine Influenza and some misinformation. So, Good Healthy Advice has decided to publish the latest information released by the Pharmaceutical Society of Australia.

SWINE INFLUENZA (H1N1) UPDATE 07 MAY 2009

The World Health Organisation has reported that as of 5 May 2009, 21 countries have officially reported 1490 cases of influenza A (H1N1) infection.

The WHO alert status for swine influenza is now Phase 5 on a six-phase scale. Phase 5 is characterised by human-to-human spread of the virus into at least two countries in one WHO region. The declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalise the organisation, communication, and implementation of the planned mitigation measures is short.

The next phase in the process, Phase 6, is the pandemic phase which is characterised by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this
phase will indicate that a global pandemic is under way.

At present in Australia there are 27 suspected cases being investigated by authorities. Since the outbreak swine influenza there have been no confirmed cases reported in Australia. States and Territories have investigated a total of 476 cases, and have so far excluded 449 (94 per cent) of those cases.

PURPOSE
The purpose of this paper is to update the current situation regarding swine influenza and to provide information to help members with public enquiries.

SYMPTOMS
The symptoms of swine influenza are similar to the symptoms of regular human flu and include:

• fever
• cough
• sore throat
• body aches
• headache
• chills
• tiredness/fatigue

POTENTIAL RISKS AND SERIOUS COMPLICATIONS OF FLU

• bacterial pneumonia
• dehydration
• worsening of chronic medical conditions
• ear infections
• sinus problems

PROTECTION AGAINST INFECTION
There is no vaccine available against swine influenza and while antiviral treatments may be helpful, consumers should be advised to consult their medical practitioner who is the prescribing authority. In some cases, medical practitioners may prescribe antiviral treatments as a precautionary measure to people travelling overseas.

The spread of Swine Flu is thought to be happening the way that seasonal flu spreads – mainly person-to-person through coughing, sneezing or coming into contact with an infected person. At present the morality rate at 2 per cent is similar to that of seasonal influenza.

According to the World Health Organisation, swine influenza “has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the
preparation of pork and other meat.”

WHAT TO DO IF SOMEONE IS ILL WITH FLU

• Designate one person as the care giver
• Keep everyone’s personal items separate
• All household members should avoid sharing pens, papers, clothes, towels,sheets, blankets, food or eating utensils unless cleaned between uses
• Disinfect doorknobs, switches, handles, computers, telephones, toys and other surfaces that are commonly touched around the home or workplace
• Wash everyone’s dishes in the dishwasher or by hand using very hot water and soap
• Wash everyone’s clothes in a standard washing machine as you normally would
• Use detergent and very hot water and wash your hands after handling dirty laundry
• Wear disposable gloves when in contact with or cleaning up body fluids.

TAMIFLU AND RELENZA
The run on Tamiflu generated by the swine influenza outbreak has forced the manufacturer to ration its dwindling stocks. The Health Minister, Nicola Roxon, has announced that because of the drain on stocks, Roche, the maker of Tamiflu, will temporarily limit supplies of the drug to doctors and hospitals for confirmed cases of influenza.

TAMIFLU ADVERSE EFFECTS
The surge in use of Tamiflu may increase the likelihood of pharmacists being asked to counsel consumers experiencing some common side effects of antivirals. These may include:

• Nausea and vomiting, which are experienced by 10-20 per cent of people who take Tamiflu (oseltamvir),  specially with the first dose. This may be minimisedby taking the medication with food. It is important that members urge people to persist with their treatment as the nausea often resolves with subsequent doses. However, if symptoms are severe, further consultation with a medical practitioner should be recommended.
• Neuropsychiatric effects (including delirium, convulsions and encephalitis) – have been reported in children and teenagers taking antivirals (in Japan these have allegedly led to a number of suicides). An FDA review of clinical trial and post-marketing data concluded that the neuropsychiatric events were not clearly drug-related but might be related to higher rates of influenza-related encephalitis in Japan. However, parents should be advised to monitor children for these effects
• As for all new medicines, appropriate counseling (including a CMI) should be offered to ensure the patient is informed and aware of adverse effects and any appropriate support information.

HAND HYGIENE
Hand hygiene is especially important in combating the spread of swine influenza and members should impress upon consumers the importance of following good hand hygiene routines.

Some points that can be made include:

• All members of a household should wash their hands -
  • Before eating or handling food
  • After blowing their nose
  • After going to the toilet
  • After handling general waste and garbage

• Wash hands with soap and running water, especially after coughing or sneezing. Alcohol-based gels and hand cleansers are also effective.

• Steps in washing hands are:
  • Wash with soap and running water
  • Wash front and back of hands as well as between fingers, including thumbs and nails
  • Rinse well with running water
  • Dry thoroughly all over

INTERNET AND COUNTERFEIT ANTIVIRALS

• Members should alert consumers to be cautious about buying antivirals over the internet as some international sites have been selling fake Tamiflu and Relenza.

• In the past, samples of counterfeit antivirals have contained no more than trace elements of Tamiflu active ingredient, Oseltamivir, mixed with other ingredients. These other substances can range from harmless ingredients to more dangerous substances that can cause serious risks to health.

• Consumers should also be reminded that it is never a good idea to attempt to obtain a prescription-only medicine without consulting a doctor for a proper medical assessment. The medicine may not be suitable for the individual and could present a serious health risk in some cases. There are a number of steps consumers can take to protect themselves from the threats posed by drug counterfeiters. Roche offers these guidelines

• Look for the Verified Internet Pharmacy Practice Sites, or VIPPS, seal.* VIPPS is a voluntary program that verifies the legitimacy of internet sites dispensing prescription drugs

• Be wary if there is no way to contact the website pharmacy by phone

• Be wary of very low or very high prices

• Beware of advertisements and websites that ask you to waive your legal rights in order to participate in their prescription program

• Check for altered or unsealed containers, or changes in the packaging or label

• Tamiflu comes in a white cardboard box with the wording Tamiflu 30 mg, 45 mg, or 75 mg written clearly on the front.

• The box contains a single blister package containing 10 Tamiflu capsules, which are a distinct yellow and light grey colour

• Each blister contains one capsule which can be seen through the transparent outer layer

• Each blister is printed on the aluminium foil of the reverse side with the words Tamiflu Capsules 30 mg, 45 mg, or 75 mg

• The batch number on the outside packaging should match the batch number on the inner packaging

WHERE TO GET HELP

National Sites

Australian Department of Health and Ageing
Pandemic Influenza website
Department of Foreign Affairs and Trade (SmartTraveller site)
NSW Department of Health
Victorian Government