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Swine flu (Influenza A - H1N1): What is it and will it affect you? Your questions answered...

Flu viruses commonly change from year to year. Sometimes, this change is small, but at other times the change can be large. The swine flu that hit the UK earlier this year is significantly different to the standard flu strains that arrive every winter. That is why there is considerable concern about its impact on the health of the population.

That concern has been lessened to some extent because scientists have very speedily developed a vaccine that protects against H1N1 swine flu. This means that it is less likely that the UK will experience a major epidemic. However, it doesn't mean that the government or public should be any less vigilant in guarding against its possible spread.

The virus can affect both humans and animals (pigs and birds), and it is thought that the mixing of a human virus with that of animals is what produces the changes in the virus.

In the past few years, there has been considerable concern over the SARS virus and avian (bird) flu from Asia. Fortunately, the number of people infected was quite small and deaths were few, with none in the UK.

What's different this time is that the flu virus has spread to many parts of the world from its origin in Mexico, and has spread in sufficient numbers to produce flu outside the normal flu season of winter.

Many countries, including the UK, had been preparing for another flu pandemic for several years. This included developing plans for how to respond to a pandemic and stocking up on antiviral drugs that can have some effect on flu viruses.

So far, these plans have worked pretty well. The severity of the disease has been lessened in the thousands of people who had access to Tamiflu® and Relenza®. But the consensus is that we are not yet out of the woods.

It's still not easy to predict how severe the outbreak of swine flu will be. A lot will depend on how quickly the vaccine becomes available to the general population, after the "at risk" groups, and how many choose to have protection.

Nonetheless, the weekly infection rate has been hovering around 50-60,000 - a doubling of the numbers infected in early autumn. And by December 2009, that figure had risen to 78,000 new cases. Although at the start of 2010, a decline in figures has been reported.

As of January 2010, deaths have reached 361 and according to early predictions from the Department of Health, by the end of the winter, more than 1,000 people in the UK will have died from swine flu. That's still a lot less than the numbers who became infected and died during the two big outbreaks of 1957/58 and 1968/70.

Whilst swine flu has posed a threat to certain groups - not normally at risk from flu - children, young adults and pregnant women - the fear that millions would be become sick and thousands die, has not been borne out.

In terms of mortality, more people die from ordinary seasonal flu, than have died from swine flu. However, these deaths - almost exclusively among the elderly - rarely attract attention. But the Department of Health believes it was right to warn of the dangers even though they weren't realised in the end.

Unlike traditional flu, which tends to cause complications and deaths in the elderly and sick, swine flu is showing itself to be a real danger to young adults and children. Deaths and complications in these groups have been noticeably high, much to the surprise of infectious diseases experts. Pregnant women are also being seen as a vulnerable group, with government advice being for pregnant women to contact their GP if they believe they have swine flu. For more information please go to www.direct.gov.uk/swineflu/DG_178075

The decision to include young children in the next phase of the inoculation programme - started in December - is because they are now viewed as a high-risk group for complications and death.

The Department of Health says that around 21 per cent of all H1N1 deaths in the UK have been among the under-14s. And more than 80 per cent of the under-fives who ended up in hospital had no previous health problems.

Flu experts are bracing themselves for a further increase in the overall number of cases early in January, a traditional time for flu to peak in a normal season.

While the disease hasn't yet reached epidemic levels, there is concern about the number of people ending up in hospital with serious complications, and whether both adult and child intensive care units will be able to cope.

While we may well fall short of predictions of the flu affecting 30 per cent of the population (18 million people), this looks to have been the worse flu outbreak in the past 40 years.

In June, the World Health Organization (WHO) declared that there now was a pandemic of this type of flu. This means that the disease had spread to more than one region of the world.

The change to pandemic status does not mean that the nature of the flu virus itself has changed. Indeed, the WHO continues to classify the severity of the pandemic as "moderate" because:

1. The majority of people recover from infection without the need for hospitalisation or medical care.
2. Overall, national levels of severe illness from influenza A (H1N1) appear similar to levels seen during local seasonal influenza periods, although high levels of disease have occurred in some places.
3. Most hospitals and healthcare systems in most countries have been able to cope with the numbers of people seeking care, although the strain has begun to show as winter sets in.

Professor John Oxford, based at Queen Mary College, University of London, and one of the UK's leading virologists, believes the virus will be with us for some time, possibly beyond the winter. His prediction in the autumn that the virus would cause complications and deaths beyond the sick and elderly has been borne out.

However, Prof Oxford is not prepared to predict the final outcome of the outbreak. "This strain has behaved differently to other strains and so one cannot make an accurate forecast," he says.

As with ordinary flu, there are precautions that can be taken to help prevent its spread. The main one is to stay at home if you think you have flu.

Regular hand washing, washing down of surfaces and handles on doors at home, and prompt disposal of paper hankies will also help prevent the spread of the virus.

While you can get flu "out of season", any sign of flu in the current situation should be considered suspect.

There is official advice on what to do on websites such as the Health Protection Agency (see website links, below).

Below we have compiled some questions and answers that we hope will address most of your concerns about swine flu. We have also included a list of website links at the end of this article should you need any more information.

• What is swine flu?
  Swine flu is a respiratory virus caused by influenza type A, which infects pigs. There are many types and the virus is constantly changing. Until now, it has not usually infected humans. This crossing between species is how major changes in flu occur. It is spread by coughing and sneezing.
• What's special about this swine flu?
  This particular form of H1N1 represents a change in the virus which humans will not be immune to it. With smaller changes in flu viruses, the fact that we have had flu previously or been vaccinated means that our immune system recognises the virus and is able to fight it much more rapidly.
• Is this latest version of H1N1 different to any seen before?
  It contains a mix of different strains that affect humans, birds and swine. Animals, such as pigs, are good reservoirs for maturing a new virus.
• Why has this flu got into humans?
  Normally, it would stay in the pig, but the potential is always there for it to "jump" into humans.
• How dangerous is it?
  At the moment, it seems to be no more dangerous than seasonal flu, although there have been deaths. Even seasonal flu can kill the young, the weak and the elderly, and occasionally healthy people. It's worth noting that, according to the WHO, seasonal flu infects 3-5 million people around the world every year and kills 250-500,000 of them without making the headlines.
• What should I look out for?
  Symptoms include fever, cough, sore throat, body aches, chills and fatigue. So far, most cases of swine flu around the world appear to be mild. One thing to watch out for is that there appear to be more reported cases of diarrhoea in patients with swine flu than with seasonal flu.
• How frequent are major pandemics that affect the world?
  The most deadly pandemic in modern times was the 1918 Spanish flu virus that killed both young and old, taking 50 million lives in less than a year. The next big outbreak occurred in 1957, when a flu virus from ducks killed 2 million people worldwide. The death toll was kept down by the swift discovery of a vaccine against the strain. An outbreak in 1968, first detected in Hong Kong, killed over 1 million people worldwide.
• How bad is the situation now?
  The WHO has graded the threat as 6, meaning that there is a flu pandemic (see commentary above). The severity of the flu that H1N1 causes appears to be no worse than a normal seasonal flu, but the lack of immunity to this type of flu virus means that more people are likely to catch it.
• What is the treatment?
  Without any treatment, the vast majority of people with flu get better on their own. However, flu makes people feel awful, with symptoms such as a high temperature, aching muscles, coughing and sneezing. For a proportion of people, flu has serious complications that can be life threatening. People with flu should rest, drink plenty of fluids and take paracetamol for relief of symptoms (unless there are particular reasons why they can't take this drug). In addition, there are two antiviral drugs, Tamiflu® and Relenza®, which are effective against H1N1 influenza. These drugs decrease the time people are ill, alleviate symptoms and reduce the risk of serious complications such as pneumonia.
• What can I do to stay safe?
  Anyone with flu-like symptoms who might have been in contact with the swine flu virus (such as those living or travelling in affected areas of Mexico) should seek medical advice. But patients are being asked not to go into GP surgeries, in order to minimise the risk of spreading the disease to others. Instead, they should stay at home and phone their GP or contact NHS Direct for advice.
• How can I protect myself against infection?
  The best protection would be to get vaccinated when the vaccine becomes generally available. If you choose not to have the vaccine, it is particularly important to avoid close contact with people who appear unwell and who have fever and cough. General infection-control practices and good hygiene can help to reduce transmission of all viruses, including the human swine influenza. This includes covering your nose and mouth when coughing or sneezing and using a tissue when possible and disposing of it promptly. It is also important to wash your hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people. In addition, clean hard surfaces like door handles frequently, using a normal cleaning product.
• I've heard rumours that the swine flu vaccine is not safe. Should I have it?
  You shouldn't worry about safety issues It is extremely safe for the following reason: its non-virus components are the same as those used in the seasonal flu vaccine, which has been tested extensively and monitored for serious reactions for many years; the only difference is that, in the swine flu vaccine, the H1N1 virus replaces the influenza A viruses used in the regular seasonal flu vaccine.
• Can I get swine flu twice?
  The simple answer is no. Once infected, you have built up sufficient immunity, almost as if you have been vaccinated. But you could fall ill again if you were to be infected with a mutated strain of swine flu - ie one that has changed its characteristics as it has spread in the population. You should still have some immunity from your first bout of illness.

• Where can I find further information?

The following official websites provide up-to-date information and advice on swine flu:

Health Protection Agency: http://www.hpa.org.uk

NHS Direct: http://www.nhs24.com

UK Government (Directgov public service)
http://www.direct.gov.uk/en/Swineflu/DG_177831

World Health Organization (WHO):
http://www.who.int/csr/disease/swineflu/en/index.html

The Foreign and Commonwealth Office
http://www.fco.gov.uk/en/

All information in this article was accurate at the time of broadcast on this website.

Source: www.dh.gov.uk/en/Publichealth/Flu/Swineflu

Source : http://www.bmj.com/cgi/content/full/340/jan14_2/c225

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