Sunday, July 12, 2009

Swine Flu : An Overview with updates.

Swine Flu ( H1N1 ) ... An Overview.


The INCUBATION period : It's the period from the day of the entry of virus into the body to the appearance of the symptoms of the disease of the swine flu. It  is 2 - 7 days here. It would be wise to keep a close watch on the appearance of any symptoms of swine flu viz. fever and cough etc. for about a week, and up to a maximum of 10 days from the day of the exposure.

Preventive measures in Swine Flu.
Basic preventive measures are as outlined above.
Additional measures include ...
 Have good sleep,
Take high protein and balanced diet,
Eat citrus fruits or vitanmin-C rich fruits,
Keep fit by daily morning walk/jogging,
 Do regular Pranayam (respiratory exercises) esp. Anulom-vilom, Kapalbhati, Bhstrika and Udgeet.

Once inflicted by ANY flu : Complete rest is of utmost importance with high protein ( esp.eggs,nuts and milk) and antioxidants rich Vit. C, Vit E and Vit. A rich diets (mentioned below in the blog). 

Latest research also recommends : Sit in light clothes in winters for at least 30-45 minutes daily in the morning in bright  sunlight to have enough Vit. D.

How does the Swnie flu ( a member of Influenza family of viruses) look like ....

Real photograph (E/M) of Swine flu virus particles.

Diagrammatic picture of H1N1 Influenza particle.

Diagrammatic section of Virus particle with its components.

How does Swine flu virus enters and multiply in our body cells ....
Entry of Virus into cell after attachment on cell surface by its haemagglutinin antigen with haemagglutinine receptor on cell membrane and its replication inside cell with subsequent release of replicated virions (new progeny of H1N1) to infect other cells.

How does H1N1 virus changes or mutates itself to become pathogenic to cause infection ....
Ways of mutations in virus : 
DRIFT---Mild change in H-antigen.
SHIFT---Complete change in H-antigen.
( Drifted virus : Less virulentShifted virus : More virulent.)

How does the dangerous strain of human Swine flu virus is produced in the environment by recombination of its different strains, before inflicting human beings ....
Generation of most virulent strain by combination and antigenic shift of different strains e.g. here by a combo of human+birds strains.

Basic difference in human Swine flu (H1N1) and Bird flu (H5N1) ....
H1N1 (Swine flu) : Less virulent involving mainly upper airways ... therefore it Spreads easily by air e.g. during sneezing or coughing.
H5N1 (Bird flu) : More virulent involving mainly lower airways + lungs .... therefore spreads least by air i.e. by coughing or sneezing.

Common complaints in human Swine flu ....
Main symptoms of Swine flu as above plus DIARRHOEA in some cases.

Facts about coughing or sneezing or spread by air/aerosol ...
Aerosol spread : Each cough produces about 40,000 micro droplets and each micro droplet contains millions of viruses.These droplets during coughing/sneezing/talking can spread about 1-2 meters or 3-6 feet away before they fall.)

What tests are done in Swine flu ....
Lab. Tests : 1. Swab culture --nasal, throat, laryngeal swabs.
2. Real Time PCR - (blood in viremia and swabs) ...The only recommended test for h1n1 by CDC(USA) and WHO.
3. Antigen tests ELISA and CLIA : Rapid card tests (only detect "Influenza A" type and is neither specific nor sensitive for H1N1..CDC has warned against use of such rapid card tests).

How long infected people can spread the virus or are contagious ? ....
Usually the "shedding stage "of virus is during the first 4-5 days of illness. However, children can be contagious longer, upto 10 days.

Who spreads the infection most ?  ....
It is the A and B categories ( with milder disease which comprise the dominant 95 % of all the cases and need no hospitalization) who are spreading the swine flu and are directly responsible for making it a pandemic. They are neither bed ridden nor ill enough to restrict their daily activities and freely roam about  in the communities like wild herds. Confirming these cases by test and isolating them in their houses for first 3-5 days of their illness is THE ONLY WAY OUT to control the pandemic spread of this disease.

How long a patient can have symptoms ? ....
Patient can experience prolonged symptoms for 2 weeks or more after being diagnosed with H1N1 flu. It is not unusual to continue feel tired and fatigued or to have a lingering cough.

How long can influenza virus remain viable on objects such as tables,floors handles,books,or doorknobs ? ....
Studies have shown that Swine flu virus can survive on environmental surfaces and can infect any person for 2-8 hours after it gets deposited on any surface.

What kills influenza virus ? ....
Swine flu virus is killed by heat (75-100 C).
Chemical germicides like chlorine, hydrogen peroxide, dettol/savalon soaps, household detergents, Iodine and alcohol easily kill the virus in 15-45 seconds. Therefore, WHO recommends washing of hands with dettol or savalon soaps vigorously for at least 20-30 seconds.

Household cleansing in swine flu  ....
Household surfaces esp. bedside tables, surfaces in kitchen counters, bathroom surfaces and children toys can be disinfected by wiping with good household detergents.

How should linens,eating utensils and dishes of of swine flu patients be handled ? ....
These need not be cleansed separately but importantly these should not be shared without washing thoroughly first with detergents like vim-bar with surf powder. Linens such as bed-sheets, towels etc. should be washed with household soaps and tumbled dry in bright mid day sun light or sunshine till they are completely dried up. Avoid windy areas for drying to have maximum impact of sunlight on linens or cloths. Wash hands with soap after handling dirty or infected items.

How long a flu patient should stay at home ? ....
CDC recommends that you stay home for at least 24 hours after your fever is gone without taking any medicine. You should stay home from work, travel, shopping, social events and public gatherings.

Taking care of a sick person at home  ....
Get plenty of rest, Drink fluids like water, sports drinks etc (weight in kg x 33=ml of fluid daily).
Wear face mask, cover cough/sneezes and wash hands frequently.
Take immunity stimulating foods as outlined under in dietary guidelines.

Be watchful for emergency warning signs like : difficulty in breathing, pain or pressure in chest, purple or blue discoloration of lips, frequent vomiting and unable to keep liquids down, signs of dehydration like dizziness when standing, decrease or absence of urination, or lack of tears in eyes of crying infants, develop seizure or fits and increased irritability, decreased responsiveness and becoming confused.

Steps to lessen the spread of flu in home  ....
Keep sick person away from others in a corner of a room. Remind the sick person to cover cough/sneeze and wash hands with soap after each coughing or sneeze. Everyone in house must clean their hands frequently. Avoid close contact (at least 6 feet) with patient except one healthy adult caregiver in the house.

Placement of sick person and protection of others  ....
Keep sick person in a corner room with attached bathroom or a separate bathroom for him/her which must be cleansed twice daily with household disinfectants. 
No visitors should be allowed to meet the patient other than a caregiver. 
A phone call is safer than a visit. 
Avoid pregnant woman to be a caregiver. 
Keep away infants and children. 
Use separate towels for drying hands for each member of house e.g. have different colored towels for each person.
Maintain good ventilation in shared household areas e.g. keeping windows open in rest rooms,  kitchen, bathrooms etc. 

If you are a caregiver  ....
Avoid being face to face with sick person. 
When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
Clean your hands with soap once you touch a sick person.
Use face mask every time you enter his room.
Wash your face mask at least twice a day.
After you take off your mask, clean your hands with soap.


Comparative symptoms : Swine flu v/s Common flu ....
(1). Stuffy Nose : Stuffy nose or running nose is common in common flu/cold and it is not commonly present in H1N1 flu.
(2). Sneezing : Commonly present in cold but not so common with swine flu.
(3). Fever : Fever is rare with Common flu or is of low grade i.e less than 100*F, while it is usually present (80% cases) in Swine flu ( more than 100*F for 3-4 days is common).
(4). Chills : Uncommon with Common cold while 60% H1N1 patients experience chills.
(5). Coughing : Mucus producing cough is often present in Common cold whereas dry cough is usual in H1N1.
(6). Sore throat : Common in simple cold and not common in H1N1.
(7). Body-aches : Slight body-aches or pain is usual in Common cold. Swine flu is associated with severe aches and pain.
(8). Tiredness : Fairly mild with Common cold, while severe tiredness or fatigue is seen in H1N1 flu.
(9). Headache : Fairly uncommon in Common cold and it is very common (80%) in swine flu.
(10). Chest discomfort : Chest congestion, heaviness, discomfort are mild to moderate in Common flu whereas, they are often severe in H1N1.
(11). Severity of symptoms : Common cold symptoms develop gradually over a few days while Swine flu has a rapid onset within 3-6 hours and it hits hard with sudden development of symptoms of fever, aches etc.

Any virus in our body hijacks our body cells and gives autocratic directions to these cells to function according to its own will. To escape from our immune system it first and foremost suppresses the whole immune system network of our body immediately. Therefore revival of our hijacked and suppressed immune system is of utmost importance.
A good diet and healthy lifestyle help boost your immunity. Immune strengthening dietary and other measures help both flu patients and those at risk. Follow these tips :
(1) Stay hydrated : Hydration (drinking water and fluids) boosts immunity. Drink plenty of water or other non-carbonated, non-alcoholic, non-caffeinated and calory free beverages; as flu viruses prefer dry environments. Water also keeps our body cavity linings wet and moist that prevent sticking of any germ with any cavity lining of our body, which is a key component of our immune system defence. Multiply your weight in Kg by 33 ... that is the minimum mililitre of water/fluid you must drink everyday. Thus, if your weight is 70 Kg then you must drink 70x33=2310 ml (2.31 Litre) of water daily.
(2) Fruits and vegetables : Antioxidants provide protection to our body and immensely benefit our immune system. Best source of antioxidants are plant foods viz. fruits, vegetables, nuts and seeds. Vitamin A, Vitamin C, Vitamin E, Zinc and Selenium are key antioxidants and found in abundance in fruits and vegetables. 
Bioflavanoids, also a good antioxidant is found in skins of brightly colored fruits and vegetables. Cruciferous vegetables like cauliflower, cabbage etc., citrus fruits, dark colored berries, and in nuts and seeds (brazil nuts), pumpkin seeds and sunflower seeds are a rich source of antioxidants.
Garlic, onion and ginger are also the known antiviral foods that help boost the immune system due to their higher sulphur content.
Papermint,  alovera and green tea are also few other good antioxidants.
(3) Essential fats : These play a key role in our cell membrane integrity and immunity. They are found in oils rather than hard fats. Excellent sources are fish, olives, coconut, nuts and seeds.
(4) Proteins Proteins are the backbone of our immune system and all the protective immune system antibodies in our body are made up of proteins. Proteins found in egg, milk, nuts and dry fruits are easily digested and readily absorbed in our intestines and do immediate wonders to boost our immune system. I have a long self experience of eggs and nuts proteins doing immediate wonders in 1-2 days in any viral flu disease.
(5) Get enough Vitamin D : Vitamin D is essential for proper functioning of immune system. There is growing evidence that the reason winter time is "cold and flu season",  because  we do not receive as much of sunlight as needed for the body to synthesize Vit. D. Many doctors and health professionals are now beginning to recommend a daily dose of Vit. D from 2000-10,000 IU of Vitamin D3 in swine flu patients.
(6) Avoid alcohol : Alcohol inhibits our immune system.
(7) Lifestyle :  Exercise ... moderate regular exercise has been shown to support our immune system and reduce risk of flu. Regular moderate exercise has been shown to reduce by half the amount of sick days in cold and flu. If you are not used to exercising or hate the thought of going to a gym ... just go for a walk (3 k.m. in 25-30 minutes). It is easy, healthy and all you need is a good pair of shoes.
Sleep ... Sleep is perhaps the most imp. lifestyle issue in immunity. All repairs, maintenance and growth in our body occur when we are asleep. "Ghode bechkar sona" a proverb in hindi is an ideal way of sleep for a minimum of 6-8 hours daily.
 Destress ... Stress hormones released in stress inhibit our immune system. Reduce stress levels with Relaxation exercises, Yoga, Meditation, Pranayam and Biofeedback.
 Focus on your breathing and take deep refreshing breaths. It is a simple stress buster you can do anywhere anytime.

Seven ways to avoid flu :
(1). Frequently wash your hands with soap and water. Keep your fingers away from your mouth, nose and eyes.
(2). Cover your mouth and nose while you cough or sneeze and wash your hands afterwards. Or still better would be to sneeze in your elbows so as not to transfer the germs to your hands.
(3). Since swine flu is contagious, avoid being near the already sick person.
(4). Get regular seasonal flu vaccination as prevention is always better than cure.
(5). Keep immune system strong, healthy and active by taking immune-boosting diets as outlined above, indulge in regular physical activity and sleep for a minimum of 7-8 hours a day.
(6). If you become ill and have flu ... STAY at home for at least 24-48 hours. This way you will prevent the further spread of the disease.
(7). If you experience severe symptoms, immediately consult your doctor.

WHO guidelines for use of Anti viral drugs (Tamiflu)
(1). CATEGORY III or C : (severe form which need hospitalization and anti viral therapy with Tamiflu) :-
Children : 1. High grade fever ( 104 * F or more) with a rash. 
2. Dehydration.
3. Fast breathing.
4. Bluish discoloration of skin.
5. Slow to wake or sluggish interactions.
6. Severe irritability.
7. Flu like symptoms that improve but then return with fever and cough worsening.

Adults : 1. Difficult breathing.
2. Dizziness or disorientation.
4. Severe or persistent vomiting or diarrhoea.
5. Pain or pressure in chest or stomach.
6. Bluish skin coloration.
7. Not drinking enough fluids.
8. Bloody sputum.
9. Low B.P. 
10. Flu like symptoms improve  and then return back with more severity.

Others which come under severe form or 'C' category ...
* Infants and Children of less than 2 years of age.
* Adults of more than 65 years of age.
* Pregnant women (esp.late pregnancy) upto 2 weeks after delivery.
* Patients with chronic medical diseases esp. asthma, heart patients except hypertension, chronic lung disease, kidney and liver disease, people with a weak immune system like in diabetes, AIDS, post surgery, cancer therapy and patients on steroid therapy.
* People younger than 19 years of age who are receiving long term Aspirin therapy.
* Patients having persistent high grade fever (more than 104 F) that lasts continuously for more than 3 days.
* Patients having persistent, severe, progressive and rapidly worsening symptoms.

(2). CATEGORY II or B : (Need no hospitalisation but require Tamiflu) :-
* Patients having persistent fever between 102* F and 104* F of more than 3 days duration.
* Patients having mild nausea with vomiting or diarrhoea and accepting orally.
* Persons with predominant severe headache or intractable body-aches without vomiting or diarrhoea.
* Patients having predominant persistent severe coughing with running nose.

(3). CATEGORY I or A : (most cases (90%), Need no hopspitalisation and no Tamiflu) :-
* Patints with low grade, irregular and non persistent fever less than 102 F.
* Patients having mild flu symptoms.
* Mild irregular headache and body aches.
* Having good appetite and accepting orally very well.
* No diarrhoea or vomiting.

Additional W.H.O. recommendations for antiviral drugs (Tamiflu) :-
(1). Most healthy persons who develop an illness of uncomplicated swine flu or persons who appear to be recovering well from flu; do not need anti viral drugs.
(2) .WHO does not recommend anti viral drugs for prophylaxis or prevention of swine flu.
(3). Basic supportive therapy (relieving aches, fever and cough) is sufficient for most healthy patients.

Updated guidelines of WHO : WHO has updated guidelines for diagnosis and treatment of patients with swine flu on 24th Nov. Most cases continue to be mild and do not need professional treatment and can be diagnosed without testing based on signs and symptoms presented if influenza is known to be spreading in the community. However, severe symptoms of H1N1 swine flu should be monitored carefully. Signs and severe symptoms progression include : 
(1) High persistent fever (104 F or more) of more than 3 days duration.
(2) Difficulty in breathing or shortness of breath.
(3) Bluish discoloration of skin.
(3) Bloody sputum.
(4) Chest pain/pressure.
(5) Low B.P.
(6) Fast or labored breathing in children.
(7) Dehydration and disorientation.
(8) Pregnant women.
(9) Infants and children of less than 2 years of age . and 
(10) Patients with chronic lung disease.
WHO now  recommends treatment for patients with these warning signs of severe illness, commencing as close to the onset of symptoms as possible and one should not wait for the lab confirmation report in such cases.

When to take Tamiflu :-
Studies have shown that swine flu drug "Tamiflu" work best for treatment if it is started within 2 days of getting sick.Even after 2 days,however, it can be given if patient has shortness of breath,chest pain/pressure,dizziness or confusion.

Side effects of Tamiflu :-
Nausea , vomiting, diarrhoea, stomach pain are common. Headache, severe allergic reactions(rash, hives, itching, difficulty in breathing, tightness in chest, swelling of mouth, face lips or tongue),  delirium, abnormal behavior, confusion, hallucinations, mood or mental changes (all neuro psychiatric symptoms), reddened blistered peeled or swollen skin, seizure or fits and and aggravation of diabetes.

Answers to some of the queries of my esteemed readers ....

Mr. Raman's Query :
What to do in a pregnant wife with + Swine flu report? : Dear Raman, most pregnant women with swine flu will have mild symptoms similar to any other patient but these women have higher risk of complications because of their suppressed immunity. There is only a very small chance that these complications will lead to premature labour or miscarriage. Once a pregnant woman is diagnosed to have swine flu as is in your case, irrespective of the duration of gestation, antiviral medication must be started as soon as possible even if the early 48 hours have gone by. In milder flu symptoms; preferably Zanamivir (Relenza)--an inhaled drug : two 5 mg inhalations(10mg total) twice a day for 5 days should be given after consulting your physician. If severe flu symptoms (high fever (102-104F), severe body aches, severe cough/cold etc.), then oral Osteltamivir(Tamiflu)-75 mg twice a day for 5 days must be given. If Relenza is not available then Tamiflu should replace it. If signs of complications are appearing like high fever (more than 104 F for 3 days), possible pneumonia, dehydration, persistent diarrhoea/vomiting, confusion or difficulty in breathing,  then she must be admitted and given fluids and Tamiflu. 
Risk of these drugs have been studied in pregnant women and proven to be extremely small. It is much smaller than the risk posed by swine flu itself. Non steroidal anti inflammatory drugs like Brufen are contraindicated in such patients and Paracetamol is the safest choice for both fever and body aches. Other measures like diet,etc. are same as outlined in my blog. MOST IMPORTANT IS DON'T PANIC, STAY COOL and must follow your doctor's advice.

Mrs. Abha's query : 
Your site is very useful. I needed to ask something. I have a daughter who is 4.6 years old and has been playing at her friend's house whose father was diagnosed of swine flu after a week's illness. Now I am getting panicky if she has caught the disease ?. I have stopped sending her there after the diagnose was confirmed. But I want to know if I can still get her the dose of Nasovac ?. Will it still be effective ? and how long does it take the symptoms to show after getting infected ??

Abha Ji , ...Welcome and thanks for your visit here.
Your concern for your daughter is genuine but let me first of all reassure you that there is no need to be panicky about it, though children are more vulnerable to contract swine flu in general. 
The incubation period (period from entry of virus into the body to the appearance of symptoms of the disease) of swine flu is 2 - 7 days. It would be wise to keep a close watch on appearance of any symptoms of swine flu in her viz. fever and cough etc. for about a week, and up to a maximum of 10 days from the day you stopped her from visiting her friend's house; to be on more safer side..

Regarding Nasovac vaccine, it is absolutely safe and can be given to anyone except pregnant women and children below 3 years of age.
If your daughter does not develop any flu symptoms in 10 days time, then go for her vaccination. If you can't wait for 10 days due to apprehensions, then go for her swine flu test and if the test is negative then only get her vaccinated soon. But I would suggest to wait for 10 days and there is no reason to be panicky right now.

Swine Flu Vaccine (Nasovac) ....
Once symptoms of any disease or its test is positive then vaccination for that disease is of no use.

Trials of ''Nasovac'' on pregnant rats have been done and it has been proved to be absolutely safe in rats but trials on pregnant women haven't been done so far; hence a word of caution for pregnant ladies. But under the guidance and supervision of a qualified physician vaccination of pregnant ladies has been recommended by the Serum Institute of India. For children below 3 years of age, trials are near completion and in about 2-3 months time the vaccine for them too, will be available.
The pack of Nasovac vaccine officially launched on July 6th, 2010, mentions the manufacturing date as December 2009 and expiry date as August,2010. The people who are purchasing it have raised apprehensions and are inquiring about its efficacy. Let me make it absolutely clear that Serum Institute, NICD (National Institute of Communicable Diseases, New Delhi), IMA and Health ministry officials have made it absolutely clear that this batch of Nasovac is fully effective and can be used up to August 31st, 2010.

The deadly H1N1 virus can be averted by taking 2 puffs of Nasovac in each of the nostrils.

It is further recommended that vaccine be taken once every year.

Swine flu updates :
Aug.,11  : The World Health Organisation Tuesday officially declared the swine flu pandemic over, 14 months after it issued the highest influenza alert level for the disease. 

"The new H1N1 virus has largely run its course," WHO Director-General Margaret Chan said in a teleconference. "We are now moving into the post-pandemic period."

Since June 2009, the WHO has held steady at a Phase 6 alert - the highest in the agency's tracking system - owing to the spread of the influenza virus to most corners of the world and concerns over a mutation to more lethal variation. However, the health agency said Chan was now able to relax the caution level based on expert advice from the Emergency Committee, a panel of 15 international scientists.The committee met for three hours before advising the WHO chief to announce the end of the pandemic, the agency said.Out-of-season outbreaks are no longer being observed, according to the latest data, and the number of influenza cases has dropped to normal seasonal epidemic levels.Two months ago, while still maintaining that the pandemic was ongoing, the WHO said scientific information from laboratories indicated H1N1 was past its peak activity. H1N1 emerged in Mexico and the United States in March 2009, but soon spread and in June last year was declared the first global pandemic in decades.The virus killed at least 18,449 people and affected more than 200 countries and territories, according to WHO figures. It also created widespread panic, with some countries initially banning pork products and restricting travel, despite warnings that these moves were not helpful. However, Chan said the illness could have been much worse."This time around, we have been aided by pure good luck," she said. "The virus did not mutate during the pandemic to a more lethal form."The H1N1 virus was now expected to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come. "Even though we see the ending of the pandemic, the virus is still there," said Keiji Fukuda, the WHO's top official on pandemic influenza."We recommend countries to continue monitoring it," Fukuda noted.The WHO warned that vulnerable groups, such as young children, will continue to remain prone to the illness in the post-pandemic period, and that those with underlying conditions could still fall victim."Groups identified during the pandemic as at higher risk of severe or fatal illness will probably remain at heightened risk, though hopefully the number of such cases will diminish," Chan said in a speech. An external review of the WHO and the swine flu pandemic is currently ongoing.Chan has repeatedly said she wants a "a frank, critical, transparent, credible and independent review", following sharp criticism of the WHO over its handling of the pandemic.Many questions focused on the panic caused by the virus, which turned out to be mild in nature and infected fewer people than had been predicted by the WHO in early  estimates.WHO officials have said they needed to sound alarm bells when the virus started to spread, as no one could know how the pandemic will turn out.

 India update, Oct. 31, 2010 ....
1. Till date, samples from 197622 persons have been tested for Influenza A H1N1 in Government
Laboratories and a few private Laboratories across the country and 45101 (22.8%) of them have been found positive.
2. All 68 cases reported during the week are indigenous cases.
3. Nine Deaths (Rajasthan-8 and Gujarat-1) have been reported during the week.
4. *The cumulative total has been updated as the line list of laboratory confirmed deaths have been received belatedly from health authorities of the state. These deaths have occurred earlier during the months of Aug. 
- Sept. 2010.
The total number of swine flu cases in India now has gone up to 45,101 since the first case was reported in the country in May, 2009.
A total of 9 deaths were reported from swine flu last week ending on 31st Oct. 2010 and with this the total number of swine flu deaths in the country has now gone up to 2,679 since May 2009.
 Out of 9 deaths last week, Rajasthan reported 8, while Gujarat had one death.

“Precaution is needed and the ministry is doing its best to make the people aware about the methods to avoid swine flu,” the health ministry official said.

“We have two indigenous vaccines. In addition to that, ads focusing on target group of the pregnant women and old or ailing persons are also being aired,” he said.
Two vaccines, an injection and a nasal spray, have been launched by Zydus Cadila and Serum Institute of India recently while two more are awaited.

So far, swine flu has claimed 2,679 lives in India since its outbreak in May, 2009.
Meanwhile, the health ministry has recommended the use of swine flu vaccines to avoid the threat.

"The moisture due to monsoon is giving a good breeding ground to the virus. Precautionary measures such as washing of hands, covering the nose and avoiding crowded places must be followed," a health ministry official told IANS

Nasal vaccine (Nasovac) for H1N1 hits the shelves in India : 
In a major boost to treat and prevent the deadly H1N1 flu, the country's 1st intra-nasal vaccine"Nasovac",manufactured by Serum Institute of India, hit the shelves in the country on Tuesday,the 6th July.The vaccine has been tested to be safe for children.It can be given to anyone over the age of 3 years without any side effects.Nasovac is a nasal spray in powder form which has to be reconstituted by adding the supplied distilled water with it.Its one dose is equal to 0.5 ml and it will cost Rs.200/-.The country got its injectable vaccine (Zydus Cadilla) last month for swine flu but there has been poor response amongst the people for this vaccine so far mainly because of low flu activity during past few months in the country and for fear of its side effects.

Geneva,July 2,2010 : The WHO Director General-Margret Chan has said that the swine flu (H1N1) pandemic may not be conquered until 2011.She said it was "prudent and appropriate"to monitor the evolution of the virus for the next 12 months .Cases have peaked in the UK,Canada and the US,she said,but are still increasing in  countries like Egypt and India. The New England Journal of Medicine reported on 31st Dec. that young people are  more likely to catch H1N1 but are not more likely to spread it.People under 18 are twice as likely to catch H1N1 from members of their household than those aged 19-50 years.  US researchers have discovery of a small human protein called IFITM (published in"Cell"on 17th Dec.) might explain why some people shrug off H1N1 while others die.The more the IFITM a person has,the better it is.The virus also replicates 5-10 times more efficiently in absence of IFITM.

10 September 2010 - Influenza activity is currently most intense in the temperate areas of the Southern Hemisphere and southern Asia.India is still experiencing a country-wide outbreak of H1N1 (2009) with active transmission and a substantial number of fatal cases in several states across the country.Chile reported on a sharp increase in respiratory disease activity in the last two weeks. All age groups are affected but the age groups below 65 years appear to be more affected than the older population. The level of activity in Chile in September is very unusual for this time of the year, as the country usually experiences a peak of respiratory disease in June and July. H1N1 (2009) virus has been the most commonly detected influenza virus so far this season but in the recent weeks there has been a shift towards influenza virus type B and influenza A (H3N2), with a decreasing proportion of H1N1 (2009) viruses. Respiratory Syncitial Virus transmission has also been widespread and intense, primarily affecting young children.Australia has reported increasing influenza activity throughout August and September, though recently, the numbers of patients seen in emergency departments for influenza-like illness seem to have levelled off in parts of the country. Overall, influenza activity is well below the activity observed in the winter of 2009. The most commonly identified influenza virus in Australia is H1N1 (2009), though influenza type B is also being detected.In New Zealand, influenza activity has decreased in the last week of August, although activity is still well above baseline levels and with significant regional differences. The majority of influenza detections have been characterized as H1N1 (2009). Levels of influenza transmission in 2010 are below 2009 levels nationally but have exceeded 2009 in some localized areas of the country.In Africa, the Central African Republic reported on their first ever detection of H1N1 (2009). South Africa observed a decrease in detection rate of influenza viruses in outpatients seen for respiratory disease for the second week in a row. Influenza type B has been the most commonly detected influenza virus throughout this winter season in South Africa though in recent weeks the proportion of H1N1 (2009) viruses has increased and a small, decreasing number of influenza A (H3N2) continues to be detected.
The worldwide total for seasonal flu related deaths is between 2,50,000 to 5,00,000 per year.