Vigilance vital | Daily News

Vigilance vital

Southern Province influenza under control:

Influenza has a less significant place in the public imagination in our generation to consider it to be life threatening although in the history it has been pandemic in some instances. However the recent outbreak of influenza in Southern Province stirred the country causing devastation to several families.

Top health experts say this recent health scare is dying down but it is wiser to be well-informed about these unpredictable viruses and take precautions.

Seasonal Influenza

Seasonal influenza viruses circulate and cause disease in humans every year. In Sri Lanka, for the last few years, it has been generally observed during April to June and again in November to January.

According to World Health Organisation (WHO) influenza spreads from person-to-person through sneezing, coughing, or touching contaminated surfaces. Seasonal influenza viruses can cause mild to severe illness and even death, particularly in some high-risk individuals. Persons at increased risk for severe disease includes pregnant women, the very young and very old, immune-compromised people, and people with chronic underlying medical conditions such as cancer, diabetes mellitus and heart diseases.

There are three types of seasonal influenza viruses, types A, B, and C. Influenza type A viruses are further classified into sub types according to the combinations of 2 different proteins, the haemagglutinin (H) and the neuraminidase (N), located on the surface of the virus. The sub types of influenza A viruses currently circulating among humans are influenza A(H1N1) and A(H3N2) sub types. The circulating influenza A (H1N1) is also written as A(H1N1) pdm09 as it caused the pandemic in 2009 and subsequently replaced the seasonal influenza A(H1N1) virus which had circulated prior to 2009. Only influenza type A viruses are known to have caused pandemics.

Sri Lanka situation

The Medical Research Institute (MRI) confirmed Influenza A virus was found in most samples tested since May 1 and out of a total of 159 samples (swabs) were received from the Karapitiya Hospital most of them were of children. The institute also said Adino virus and RSV are also found.

However Epidemiology Unit Director, Health Ministry, Dr Anil Dissanayake said the number of `Influenza A’ patients admitted to the hospitals in the Southern Province had significantly reduced recording only 130 to 140 admissions per day. "Yet we are vigilant of the outbreak of influenza. We are collecting statistics and have alerted every hospital in the country providing them guidelines of curative and preventive methods," Dr Dissanayake said.

He added the Health Ministry has catered to the needs of extra medical staff, funds and medicine. "Several pediatric specialists have been assigned to Karapitiya Hospital which has the only Pediatric Intensive Care Unit in the province. The government has allocated more funds to purchase drugs and other requirements to control the viral flu," he explained.

Dr. Dissanayake commended the efforts of the hospital staff in those areas working tirelessly to treat every patient. "This is a seasonal influenza which we have been experiencing in the past years as well. Seasonal influenza outbreaks are experienced all over the world. However this year we experienced an increase in the number of patients infected. Throughout the year Epidemiology Unit conducts surveillance covering the whole island. The appointed Advisory Committee then makes projections and gear up to face any possible outbreak. The slight increase of influenza infected people, the country experienced in the month of April continued through May as well,” he said.

Dr. Dissanayake pointed out the influenza which was all over the country last year was confined to Southern Province this time. “However we cannot confine a viral disease to one geographical area. The nature of the virus is fast spreading. Influenza is a clinically diagnosed and is a simple flu like illness which can be contracted by number of people,” he said.

Epidemiology Unit Director advised people to take precautions to minimize the spreading of influenza. “We urge people not to visit patients who are in hospitals in large numbers and to avoid public gatherings,” he said.

Meanwhile, Southern Province Health Services Director, Dr. G Wijesuriya confirmed that the trend experienced during the past months is declining. “Even though patients infected are still being admitted there is a decline in the trend. There is no need to panic as the situation is under control. We are in continuous dialogue with Health Ministry officials and other concerned parties and have received their fullest co-operation,” he said.

Dr. Wijesuriya assured that all hospitals are equipped with necessary drugs and the Cabinet has granted approval to purchase any other requirement without tender procedure to control the influenza. “Meanwhile more staff who completed their training has been assigned to hospitals. Both the President and Health Minister have looked into requirements to expand the Pediatric Intensive Care Unit of the Karapitiya Hopsital and more pediatric specialists have also been assigned,” Provincial Director explained.

Taking precautions

Director Health Promotion Bureau and former Chief Epidemiologist, Dr. Paba Palihawadana explained the preventive methods that should be followed.

“Seasonal influenza spreads easily, with rapid transmission in crowded areas including schools and nursing homes. When an infected people cough or sneeze where infectious droplets containing viruses are dispersed into the air and will in turn infect persons in close proximity who breathe these droplets in. The virus can also be spread by hands contaminated with influenza viruses. To prevent transmission, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly,” Dr Palihawadana said.

She said apart from vaccination and antiviral treatment, the public health management includes personal protective measures. “Regular hand washing with proper drying of the hands, covering mouth and nose when coughing or sneezing, using tissues and disposing of them correctly and avoiding touching eyes, nose or mouth is important to prevent from contracting the virus,” she said.

“Early self-isolation of those feeling unwell, feverish and having other symptoms of influenza and avoiding close contact with sick people is also vital. Some characteristic of the seasonal influenza are sudden onset of fever, cough, headache, muscle and joint pain, feeling unwell, sore throat and a runny nose. The cough can be severe and can last two or more weeks,” Dr Palihawadana explained.

In industrialized countries most deaths associated with influenza occur among people age 65 or older while the effects of seasonal influenza epidemics in developing countries are not fully known, but research estimates that 99 per cent of deaths in children under five years of age with influenza are related to lower respiratory tract infections.

Dr Palihawadana said patients infected should take adequate rest and be given warm fluids and plenty of nutrition. “Children, if infected, should not attend school or tuition classes but should rest at home. It will prevent the virus spreading to others and will also do well in their recovery. If they have lost appetite children can be given frequent meals in smaller portions than forcing them to have a full meal,” she explained.

Finding the solution

Seasonal influenza viruses evolve continuously, which means that people can get infected multiple times throughout their lives. Therefore the components of seasonal influenza vaccines are generally reviewed biannually and updated periodically to ensure continued effectiveness of the vaccines. Variability of influenza viruses makes it difficult to design universally effective drugs and vaccines. Recently, the National Drug Regulatory Authority of Sri Lanka has given license for the use of seasonal influenza (flu) vaccine.

Although this vaccine is registered a panel of scholars and experts has been appointed to look into the possibility of using the flu vaccine.

The scholarly panel which includes pediatricians, gynecologists, virologists, epidemiologists, and representatives from the Medical Supplies Division etc will decide whether to use the vaccine or not, when, to whom and how.

Health authorities said however a country cannot rely on a flu vaccine but should take preventive methods of maintaining personal hygiene to control infections. Health Minister Dr. Rajitha Senaratne said in Parliament that the government is ready to distribute the influenza vaccine at any given time. Nevertheless the Health Ministry is awaiting the approval of National Technical Committee on Influenza to do so.

Troubled education

As Southern Province was crippled with this health scare Provincial Education Minister Chandima Rasaputra on the advice of specialists took steps to close primary schools in eight education zones and preschools due to the spread of influenza.

Minister said although the schools reopened the attendance is still low. “We reopened the schools last Wednesday (May 30) but have seen attendance in lesser numbers. There was a low percentage in attendance especially of children in primary classes. Secondary was not bad but still not up to satisfactory. Still fears of infection prevail and parents compel to keep their children at home,” Minister Rasaputra said.

He added that the assurance of the declining trend of influenza should come from health experts. “I’m discussing with the Ministry of Health how to tackle this situation. The assurance should come from health experts not from us. Specialists should go to schools or distribute a leaflet and educate and take measures to wipe out the fears of the public especially those who are residing in close proximity to the hospitals,” Minister explained.

The unpredictable nature of influenza presents a challenge for both research and preparedness planning. However a rapid and expansive influenza surveillance and response network will widen the capacity of tackling the ever-shifting landscape of influenza evolution.
 


[High risk groups]

All age groups can be affected by this ever-changing virus but there are groups that are more at risk than others.

People at greater risk of severe disease or complications when infected are: pregnant women, children under 2 years, the elderly, individuals with chronic medical conditions (such as chronic cardiac, pulmonary, renal, metabolic, neurodevelopmental, liver or hematologic diseases) and individuals with immunosuppressive conditions (such as HIV/AIDS, receiving chemotherapy or steroids, or malignancy).

Health care workers are at high risk acquiring influenza virus infection due to increased exposure to the patients and risk further spread particularly to vulnerable individuals.

World Health Organisation recommends patients who are not from a high risk group to get symptomatic treatment and to stay home in order to minimize the risk of infecting others in the community. Treatment focuses on relieving symptoms of influenza such as fever. Patients should monitor themselves to detect if their condition deteriorates and seek medical attention. Patients that are known to be in a group at high risk for developing severe or complicated illness should be treated with antivirals in addition to symptomatic treatment as soon as possible.


 

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