Epidemiology Of H1ni Swine Flu In United Kingdom Biology Essay
The 2009 swine flu pandemic was an outbreak which affected everybody globally of a new strain of H1N1 influenza virus often referred to as “swine flu”. The outbreak was first detected in April 2009 in the state of Veracruz, Mexico (WHO, 2009). H1N1 influenza is a pandemic because it has to do with an increase in space and time to the cases of the outbreak in association with a lot of cases and the high abnormality in death. (HPA, 2009). It is also an acute illness resulting from infection and some strains of the influenza can cause severe illness than other strains of the virus.
Influenza A virus is capable of changing its genetic composition either through an antigenic drift or shift. Back in 20th century, there were three outbreaks which was a world record overwhelming pandemics, in 1918, 1957 and 1968 which was caused by H1N1 (Spanish flu), H2N2 (Asian flu) and H3N2 (Hong Kong flu), respectively. Van Reeth K (2007) described Influenza A viruses are been classified into 16 types of hemagglutinin (HA) and nine types of neuraminidase (NA). The avian hosts are the major reservoirs for all subgroups and since December 2003, avian flu has been a major outbreak in affecting poultry which is caused by H5N1 of the influenza A virus. So far, only three types of HA (H1, H2, H3) and two types of NA (N1, N2) have been widely prevalent in humans. Type A influenza are so many reservoirs in humans, pigs, birds, horses, whales but the provision of a clear evidence of direct bird-human transmission is H5N1.
Influenza A which has potentially infected the world’s population within few months and also has been a threat causing 30% of major pandemic threats. Swine flu is a respiratory disease and also can be found in pigs. So far, the scientist have not found any evidence of the disease in pigs but an ongoing research for the origin is been done in UK. Swine flu as a disease is been confirmed in so many countries which is fast spreading from human to human and leads to what is known as pandemic flu outbreak. Ordinary flu is far different from pandemic flu because pandemic flu is a new virus that is only found in humans and the spread is fast and global. Since it’s a new subtype of virus, there is no immunity for the disease until the virus is studied but for now everybody is at risk of been infected. From a healthy person as well as older people to those with an already medical condition.
The influenza A virus came to the United Kingdom in April 2009 in which the first cases were confirmed on the 27th of April, 2009 in passengers returning from Mexico. The first case of person to person transmission within the United Kingdom was announced on the 1st of May 2009. In the first months of its outbreak in the UK, H1N1 mostly affected young people and was most commonly spread through contact. The detailed epidemiology of early cases is unlikely to be representative of latter patterns which means ongoing surveillance will report on these. At the early stage of the spread in England, contacts in school were common and had 60% of cases and infection. Nosocomial infection in healthcare and workplace contact was a little bit or less than 1% most of the cases in the UK were foreign travels which might also have early cases of the outbreak since the disease was first notified in late April 2009 in Mexico, the spread of the disease has been rapid and global.
Source: (HPA, 2009)
Recent data from World Health Organization from different outbreaks in the world indicates that the disease is the most dominant in most part of the countries where it has been found. Since June 2009 when the outbreak was increasing in England till October 2009, 137 deaths have been related to swine flu. In order to avoid any further morbidity and mortality, there is need for effective measures to prevent the disease from spreading and these measures can be done by individuals, the healthcare workers and the communities in conjunction with the Government. The virus spread peak in the UK was at 110,000 but had a drastic reduction in August when the introduction of antiviral drugs, vaccines and other preventive measures. The health practitioners were amazed when they saw that seasonal flu level dropped to a very low level and the continued growth of swine flu. This observation was not only in UK but also in the US and Canada. The question is how serious is the epidemic in UK, and the likely outcomes as autumn arrives? The age group 5-14 year olds is the age group that is most affected and having the West Midlands and London being the region that is worst affected.
Swine Flu (H1N1) Transmission
The pandemic flu seems to have a higher rate in transmission that that of seasonal flu but has a low clinical severity in spite of the early investigation, origin and estimates in Mexico. The route of transmission is normally human-to-human which is the exposure of respiratory droplets in the air or surfaces that has been contaminated. It can also spread by coming in contact with an infected person or surface with the virus and then using that the same hand to touch the face or someone else’s. The virus can be shed for a long period if the person immune system is immunocompromised. The Department of Health (DoH) issued a guideline on how the virus has caused an infection, either in a child or an adult because the swine flu infection could have the same resemblance with other winter viruses. Patients who are infected with swine flu would usually present symptoms within a week of exposure and becomes infectious up to 8 days after the symptoms have started to show up. A patient who is been hospitalized could present sore throat, headache, myalgia, runny nose, cough, breath shortness, fever, severe weakness, aching muscles and most incubation periods are always between 2-3 days. Swine flu could also have complications which could be similar to seasonal flu which includes bacterial co-infections, myocarditis and encephalitis which could cause brain damage.
Public Health Intervention
General health practitioners and World Health Organisation do advice or encourage the use of an antiviral drug to be used as a prophylactic treatment. An alternative to such is an early treatment which is only based on symptoms. In the current swine flu outbreak in the UK, no evidence of the role of neuraminidase inhibitors but a patient who is healthy with a mild illness, such patient does not need a treatment. A patient who is at high risk, oseltamivir or zanamivir is recommended by World Health Organisation and should be given within 48hrs of the illness at onset. Details in prescribing antiviral drugs has recently been produced by Health Protection Agency (HPA) and it includes those at high risk groups such as the children, adults with a severe chronic condition, infants, older patients who are >65 years old whom are less susceptible to the flu but at a higher risk of an illness which is complicated. Vaccination is another major means of intervention in UK because it is the most effective ways to reduce mortality and morbidity. A vaccine becomes more effective after 14 days but it does not expect to protect other strains of the virus. Vaccination can prevent 50-80% of the flu in children and adults but it only depends on the virus match. Health Care Workers (HCWs) have a seasonal flu which is very low but needs to be improved because the vaccine does not only protect against the strain but also has an effect in the reduction of a new HCW being co-infected with a different strain which can cause gene reassortment and also lead to an emergence of a new more virulent strain. The Department of Health (DoH) in England issued some specific guidelines to swine flu vaccination and some certain groups have been given priority for vaccination in UK and these include individuals at the seasonal flu vaccine at risk, all pregnant women (only subject to a licensed condition), contacts within the household of an immunocompromised patients and also the HCWs at the frontline. Pregnant women who are not really at risk of becoming infected with swine flu because of their changes in their immune system, the risk of getting complications is very high when they acquire the illness. In such case, they should be given prophylaxis or an antiviral treatment if the flu is been confirmed. Treatment should be given as soon as possible with an antiviral medication at the onset of the symptoms and World Health Organization recommends oseltamivir as the antiviral drug to be given to a pregnant woman. Post exposure prophylaxis (PEP) in a suspected pregnant woman, zanamivir is advised to be used because an inhaled medication can reduce the systematic absorption and fetal exposure. World Health Organisation (WHO) recommends that pregnant women or any other individual at a high risk of severe illness and their care givers should have an immediate vaccination against swine flu and also take all necessary precautions to prevent the spread including hygiene measures as part of the prevention.
Vaccine Safety and Effectiveness
Before a vaccine is introduced and developed, an assessment of the burden of the disease due to that infection, the main major strains of the organism involved and information on who is affected is required. There has been a big controversy over the safety of vaccine in England for swine flu. Controvery over how safe vaccine could be was done by (Colgrove J, 2005) has achived high visibility over the past decade. According to Center for Disease Control and Prevention (CDC), continued high levels of vaccine coverage are necessary to prevent resurgence of disease which has been nearly eliminated. For an effective immunization programme in England requires strategic planning that integrates the outputs with available health facilities with the least possible disruption. For the public to be safe with the vaccine, there should demand for an effective detection of vaccine realted side effects and then include economic analysis, scientific studies to sipport policy development, collaboration with the international vaccine industry and surveillance (DoH, 2002). In addition to safety and effectiveness, other factors are taken into account in deciding national policy. The attitude which the public will react towards vaccination are monitored through research which is been carried out by Department of Health (DoH) because the safety of the vaccine and effectiveness is critical for the maintenance of successful vaccination programme.
There are a number of approaches that could be adopted to help control swine flu incidence and prevalence in the UK. These approaches might however be difficult to implement. They include the following:
Universal Vaccination of younger children
This has been very well talked about. There are however issues of cost effectiveness given that the disease has a low prevalence and is more common in immigrants than UK-born individuals. It would however be very useful as it would provide protection for the more vulnerable infants and provide herd immunity against swine flu over time.
Immigrants from high endemic countries have contributed significantly to the prevailing levels of swine flu in the UK. It would be a difficult task to control the import of the disease. The inspection of vaccination certificates at the ports of entry might not be an entirely effective means of control. One way of going about this would be to implement a mandatory swine flu screening as a prerequisite for all visa applicants in high endemic countries before their travel is approved. All positive patients would then be offered treatment and their viral loads brought to a minimum before travel is approved. A follow-up program for immigrants that intend to stay for long periods would be put in place to make sure the infection is well managed. This would be a good control measure especially if there would not be a universal vaccination programme. It might however be deemed extreme and probably spark issues with the countries affected.
School entry requirements
Given the data observed over the past years, the incidence of swine flu in infants is at a minimum. The incidence however increases drastically after the age of 6. The incident cases recorded are most likely of those that were symptomatic and presented at the healthcare centres. Infected asymptomatic patients would have been missed. Pre-school vaccination programmes could be implemented along with the ongoing swine flu vaccination programme so that the pre-school children would be protected. This would be easier to implement and more cost effective.
The importance of swine flu is not well appreciated by many especially the immigrants from other countries. Implementation of policy that fully supports the education of parents and pre-school children, especially amongst ethnic minority and socially deprived, about swine flu and its mode of transmission could also be of significant help in reducing the incidence of the disease.
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