# Sunday, May 3, 2009
                 
The World Health Organization has announced that the current influenza pandemic alert has been raised from phase 4 to phase 5.  They are suggesting that all countries immediately activate their pandemic preparations to combat this illness. Effective as well as essential measures to combat the swine flu include heightened surveillance, early detection and treatment, and infection control in all health facilities.

As of April 29, 2009, nine countries have officially reported cases of AH1N1 swine influenza infections. The countries with laboratory confirmed cases are:

•    Austria – 1 reported case, no deaths
•    Canada –85 cases, no deaths
•    Germany – 3 cases, no deaths
•    Israel – 2 cases, no deaths
•    New Zealand – 3 cases, no deaths
•    Spain – 4 cases, no deaths
•    United Kingdom – 5 cases, no deaths
•    United States – 91 cases, 1 death
•    Mexico – 26 cases, 7 deaths

These numbers are changing rapidly; so for more information, check the websites of the individual country for the latest confirmed case count.

The World Health Organization is responsible for identifying the phases of outbreaks, as well as defining what those phases are. They are currently defined as:

Phase 1: Influenza viruses circulating in animals, especially birds. Phase 1 does not include humans becoming infected.

Phase 2: Humans becoming infected by an animal influenza virus; potential for pandemic.

Phase 3: Animal and/or animal-human influenza virus causing limited disease in humans; human to human transmission is not widespread, but rather isolated.

Phase 4: Human to human transmission and/or human to animal transmission are confirmed, with widespread or community-level outbreaks. The risk of pandemic infection is much higher, but not yet considered a foregone conclusion.

Phase 5:
Human to human spread of the virus is confirmed in at least 2 countries in one WHO region; it is now likely that a pandemic is imminent.

Phase 6: The Pandemic Phase. Community outbreaks are now occurring in at least one country from a second WHO region; this indicates that a global pandemic is underway.

It is important for people and communities to realize that a pandemic does not indicate the severity of the influenza; but rather that the infection is happening. Cases that have currently been reported in Canada are all considered mild. Pandemic influenza is defined as a new influenza virus that is being spread easily between humans and is affected a wide geographic area. The term pandemic should not be equated with the severity of the infection.

Swine flu is a respiratory disease of pigs that is caused by the influenza A virus. Transmission to humans is rare, but does occasionally happen, resulting in H1N1 flu virus.  The virus in humans is a respiratory illness that has symptoms similar to those of regular human seasonal flu. However, the risk of animal influenza that is transmitted to humans is the potential for the virus to mutate and be directly transmitted human to human. The flu shot that many people receive each year does not protect those people from this virus; it is only effective for the seasonal flu that is expected to affect those people for that given year. The symptoms of swine flu are:

•    fever;
•    lack of appetite;
•    coughing and/or sneezing;
•    sore throat;
•    muscle aches;
•    fatigue;
•    runny nose and/or watery eyes.

Some people have also reported vomiting and/or diarrhea as well. For people with chronic conditions pneumonia may develop from infection of this virus. It is important to note that this is the first time that this strain of the flu virus has been identified in humans. There has been no documentation of this virus having a sustained infection rate in human to human transmission.

Canadian travelers are now being advised to postpone any elective and/or non-essential travel to Mexico. This advisory is in place until further notice; there is no time line yet of when this will be lifted. For those who are going to Mexico, they are advised to:

•    Wash hands frequently. Soap and water should be used often; alcohol-based hand sanitizer is a great way to keep hands sanitary when out in public with little access to public facilities (i.e. beach, pubic transit).
•    Practicing proper sneezing/coughing etiquette; use a tissue, your sleeve, or some other barrier method in order to reduce the spread of germs. After sneezing and/or coughing, make sure that hands are thoroughly washed.
•    Avoid physical contact with anyone who appears to be sick, and/or is displaying any of the symptoms.
•    Pay close and careful attention to local government and public health announcements daily. These announcements can include movement restrictions as well as prevention recommendations. These announcements can and do change frequently, so check often.
•    For those who are at higher risk of severe illness from influenza (i.e. people with diabetes, lung and/or heart disease, the elderly and children under 2 years), consult with your health care provider before travel.

For anyone who is in Mexico and develops symptoms of H1N1 flu virus, seek medial attention immediately. The Canadian Embassy as well as the consulate will be able to provide a list of physicians. The website of the Department of Foreign Affairs and International Trade also has this information available. For those returning from Mexico, it is important to monitor for the symptoms for at least 7 days. Avoid contact with other humans and stay home until you have a confirmed diagnosis of your illness. Contact your health care provider immediately, and advise them that you have recently been to Mexico. If you are displaying symptoms when arriving back into Canada, advise the customs officer as well. You must also advise a customs officer or a quarantine officer if you have been near and/or in contact with someone who either has been confirmed as having this virus, and/or if it is suspected.

It is essential to advise the hospital, clinic, doctor's office, etc. that you have been to Mexico and may have been exposed to the swine flu virus. This will enable the healthcare professionals to promptly isolate you, and/or provide you with a mask in order to prevent any further transmission.

For updates on the swine flu in Canada, visit Health Canada's website. This gives information regarding new transmissions, where the new transmissions are located, as well as any updates on travel advisories. For those who are planning international travel, visit the World Health Organization's website for current information on the country you plan on visiting.

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