Our college assignment was to write a thesis style paper for Swine Flu(H1N1) with a special reference to the scenario in India. So I crafted out this. Original and unabridged version as appeared on print on 10.28.2009.
Introduction :
One of the riveting concerns of present healthcare systems around the world is the abrupt outbreak and spread of the H1N1 Strain of the Influenza virus. In todays’ globalized world,the transmission topography is beyond physical barriers and as apprehended,spread quickly enough as H1N1 case reports came flooding from various demographics. This particular strain is colloqually termed as Swine Flu virus,as the zoonotic aspect of this strain is linked with swine; although only few reports concerning potenitial transmission by physical contact with swines has,thus far,been noted.
The Pathogen: What is it:
Swine Flu is the physiological manifestation of infection with the Swine Influenza Virus(SIV),a subtype of the Common Influenza Virus. The SIV has two known subtypes, IfC and IfA. The IfA(Influenza A) subtype has multiple serotypes,namely H1N1,H2N2,H3N2 etc. of which,the H1N1 strain (termed Pandemic H1N1/09 by World Health Organization:WHO) is accredited with the 2009 outbreak. The IfC(Influenza C) strain lacks genetic diveresity,and only few patchy outbreaks had been recorded earlier in US and Japan.
The Zoonotic Scenario:
As previously stated,SIV infection via zoonosis is highly uncommon. The first recorded such case was in September 1988,in Walworth County,Wisconsin,USA,where a pregnant woman died from complicated symptoms of Swine Flu after close contact with the animals in a farm. However,WHO states that the IfA (H1N1) strain is killed by cooking temperatures of 70ºC,thus it is not transmissible by cooked meat. The zoonotic cases might be the result of prolonged physical contact with pigs,as in case of the piggery workers; first batch of people infected with H1N1 in Mexico.
The 2009 Pandemic :
The first publicly released case was at Mexico City,Mexico on 18th March.However it was later ackowledged by US Center for Diesease Control and Prevention(UCDC) that trivial cases were reported on Imperial County,CA,USA as early as January. The skewed case reports from Mexico did not include the mild cases,however. Although EU and other countries(also WHO) advised citizens to postpone non-essential travel to Mexico and the US,the infection rapidly spread from the resident travellers on those countries. WHO announced the Swine Flu (H1N1) disease as a Pandemic on June 11th ,and raised the alert level to Phase Six ,which is characterised by community level outbreaks in at least one country in a different WHO region of the origin[2]. The first reports outside of the Americas was reported in Spain,on July. However,cases in India were non-existant for a long time before 16th May,when a person was quarantined with symptoms of and later confirmed of carrying SIV. On 3rd August,India recorded it’s first death of Swine Flu off a 14 year old girl from Pune.[3] Since then,the death toll has reached 447,after fresh batch of 13 deaths,between the months of September and October.[4] WHO recognises the Indian outbreak as Widespread,although also stating that it is disappearing quickly.[2] Paltry numbers of infections have also been recorded from China,Indonesia and Maldives,among other Asian countries.
Alterations of the Strain :
Although most of the victims recover within a week or two by proper care,isolation and adequate doses of antiviral drugs like Oseltamivir ,the present concern is a small subset of patients who rapidly develop severe progressive pneumonia and often fated to death by consequent complications like Multiple Organ Dysfunction(MOD). These patients have been diagnosed with secondary infections of different bacteria,thus making them more vulnerable to death.
Mutated versions of the Bird Flu(Avian Influenza) Virus H5N1 and seasonal flu(H1N1) virus have had been discovered that are more potent to overcome transmissal barriers,and resistant to Oseltamivir; that escalates the possibilty of discovering an altered (and more competent) variety of H1N1 SIV that might be difficult to treat with,and even render mortality. Such primitive mutated forms were already discovered in a patient in Denmark,with mild Oseltamivir resistance.[5]
Predictions :
The periodic uprising and collapse of casualty figures are typical characteristic of complex systems like viral epidemiology,where chaotic pattern of mortality graphs are frequently seen (for example the sudden outbreak gives a sharp positive, rapid immunization and quarantining retards the growth,and a drug-resistant varity may spike up midway).SIV H1N1 virus may as well develop potent mutant strains like it’s neighbor H5N1 AIV couple of years ago,even change primary hosts previously undealt with and relapse with another pandemic of even a larger scale.[6]
Conclusion :
The acute force of challange that was in form of Swine Influenza is being effectively neutralized by prompt vaccination programs around the world,selective lifestyle choices and antiviral drugs,although the pandemic is far from over. It may only have reached a quasi-pacified state,and can burst out on the epidemiological scene again with more killing power than before,given a favorable condition and enough genetic diversity of the virus.,given that it is an RNA virus capable of constant genetic alteration in vivo. A possibility of a Super Influenza Virus combining the capabilities of all the Influenza virus strains,also,has been mooted; but as of now,resides only in a creative thinkers’ mind.
[1] McNeil,Jr. , Donald G : “In New Theory,Swine Flu Started in Asia,Not Mexico”, New York Times, 06.23.09.
[2]Influenza H1N1,H1N1 Virus, A(H1N1 Outbreak) : WHO :: http://www.searo.who.int/EN/Section10/Section2562.htm
[3] “First Swine Flu Death in India” – The Times Of India, 4th August,2009.
[4] Rediff News : Swine Flu Toll Hits 447, 26th October,2009.
[5] “WHO Says Tamiflu-Resistant H1N1 ‘Isolated Case’ ” : Reuters :: http://us.reuters.com/FullArticle/p.rdt/CHLT/nhealthNews_uUSTRE55T57A20090630
[6] Gabriele Neumann,Takeshi Noda and Yosihiro Kawaoka :“Emergence and Pandemic Potential of Swine-Origin H1N1 Influenza Virus” ,Nature, 14th June,2009.
..
