As winter approaches and we read about a second wave of swine flu we wonder what will be the implications for Ukraine where only 2 cases have so far been reported.
Since the so called “Spanish flu” epidemic of 1918/19 which probably killed between 3-6 percent of the world’s population doctors always treat influenza outbreaks with respect. Each year sees epidemics of influenza many of which are mild, with major epidemics occurring every 10 years or so.
Epidemics, caused by viruses often begin in both pigs and poultry which in many countries and especially in South East Asia live in close proximity to humans, the virus then crossing over to human populations. The current swine flu is complex in that it has genetic origins from 4 sources – 2 from pigs (American and Asian) one from birds and one from humans. Interestingly the current virus contains a markedly different genetic chain from that of the Spanish flu which may explain why it is considerably less dangerous. Most epidemics occur in winter months and epidemiologists are able to best guess the genetic strains and produce vaccines against them. There has been robust research demonstrating that these vaccines have been both effective in preventing hospitalisations and time off work, any many employers have organised cost effective vaccination programmes for their staff.
The current epidemic came without warning from Mexico and spread through America and Europe. The virus is spread by airborne particles and can survive for some hours outside the human body before it dies. It is spread by people sneezing and blowing their noses, and through breathing infected air. Viral particles can also survive on surfaces such as in washrooms, tables and office environments and can be caught through hand contact with these surfaces and later touching your nose or mouth. The risk of exposure to such viruses is increased in crowded public places and on public transport.
Despite an average of 70,000 people entering Ukraine each day there has only been one documented case of swine flu. There may be many reasons, firstly most ill people will not travel, secondly Ukraine does not have high density population and even in cities this does not reach the levels of many American and European cities, and children are often excluded from school at the early stages of respiratory illness. Some patients with influenza may not visit doctors and like western europe specific tests for H1N1 influenza are neither universally available or indeed used and thus the condition is often underdiagnosed. We know that previous influenza epidemics (such as that in 1998) confer protection on populations and that may be the case in Ukraine. Whilst many parents bemoan the Ukrainian system of closing schools in viral epidemics the strategy undoubtedly works as schools are a major source of infection. The sanito-epidemiological services inherited from the soviet healthcare system work well in monitoring disease and instigating public health measures. In Ukraine all doctors make diagnostic returns at rayon level and these are quickly processed to monitor disease activity on a last week basis and at this time of year always show a marked increase in viral illness. The Ministry of Health has integrated a dedicated administrative office for swine flu within this service.
Ukraine has the benefit of the already extensive knowledge about this epidemic. The facts are that H1N1 influenza of the current swine flu type is probably a little more dangerous than seasonal flu for the average healthy person in Ukraine; its genetic makeup suggests that it will not mutate to a highly virulent form of disease. For most fit adults the symptoms of headache, muscle pains, temperature, sore throat will pass in a few days with simple measures of temperature control, fluids and pain relief. We do know that this particular influenza is unusually more serious in young children and young adults and pregnant women than in middle aged and older people. As in any outbreak of influenza patients with respiratory problems, cardiac problems and diabetes as well as those with other chronic illnesses and the very elderly are more at risk of complications. Those who smoke commonly develop a bacterial chest infection after any type of influenza
Recommended treatments for swine flu are the antiviral drugs oseltamivir and zanamivir (usually for children) these drugs are currently recommended for use in the above at risk groups. They are available in Ukraine at a pharmacy cost of $100, however the Ministry of Health has supplies that it can use for high risk cases. They can also be used to prevent influenza but are not routinely recommended for healthy people with influenza. Both drugs can cause unpleasant side effects.
At the time of writing no vaccine is available for swine flu but is hoped to arrive in the Americas and Western Europe next month. It has been produced quickly and tested but doctors will still be vigilant to ascertain any side effects. Its use should probably be initially confined to those of high risk groups.
The spread of all influenzas can be decreased by simple measures. Staying at home when we are unwell and keeping our children from school if they have symptoms of influenza is important. Avoiding crowded public places may be an option for some. The simple measure of sneezing and blowing your nose away from others and safely disposing of tissues in closed containers and then washing your hands in hot (warm for children) soapy water for at least 20 seconds is effective. In the workplace employers can help by providing closed bins for tissues and by maintaining cleanliness in office and washroom areas. People in high risk groups should consider wearing a face mask in crowded places when there is an active epidemic. Individuals can increase their immunity by ensuring they have adequate sleep, a minimum of alcohol, a fresh and varied diet and avoiding being over tired especially after air travel.
In conclusion for most people seasonal influenza or the current outbreak of swine flu should pose no major health risks. Certain groups should excercise special precaution and consider vaccination and avoidance of public places as a priority. The general population should practice increased hygiene and exclude themselves when unwell, and employers should promote such ethics in the workplace.
Dr Richard Styles is a British Family Physician at American Medical Centre, he has 32 years experience of practicing family medicine in the UK, Ukraine and elsewhere, and for 3 years worked for the EEC in co-operation with the Ministry of Health in developing family medicine in Ukraine.