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SWINE FLU: A pandemic

People wearing masks as a precaution against swine flu, wait at a bus station in Buenos Aires. Argentina's new Health Minister Juan Manzur said Friday that around 100,000 people could have been infected with swine flu along the country, which would be a huge raise comparing to the 1,587 cases officially reported last week. (AP Photo)
The 2009 flu pandemic is an A (H1N1) pandemic and a global outbreak of a new strain of influenza A virus subtype H1N1, identified in April 2009, commonly referred to as "swine flu". It is thought to be a mutation—more specifically, a reassortment—of four known strains of influenza A virus subtype H1N1: one endemic in humans, one endemic in birds, and two endemic in pigs (swine). Experts now assume that the virus "most likely" emerged from pigs in Asia, and the virus was carried to North America by infected people. There is further evidence that the new strain has been circulating among pigs, possibly among multiple continents, for many years prior to its transmission to humans. Influenza A virus strains caused three major global epidemics during the 20th century: the Spanish flu in 1918, Asian flu in 1957 and Hong Kong flu in 1968–69. These pandemics were caused by strains of Influenza A virus that had undergone major genetic changes and for which the population did not possess significant immunity. The influenza virus has also caused several pandemic threats over the past century, including the pseudo-pandemic of 1947, the 1976 swine flu outbreak and the 1977 Russian flu, all caused by the H1N1 subtype.  The H1N1 strain responsible for the current outbreak first evolved around September 2008 and circulated in the human population for several months before the first cases were identified. The virus was first reported in two U.S.children in March, but health officials have said that it apparently infected people as early as last January in Mexico. The outbreak was first detected in Mexico City on March 18, 2009 where surveillance began picking up a surge in cases of influenza-like illness. The new strain has spread widely beyond North America with confirmed cases in eighty-nine countries. Initially, most cases outside North America were following recent travel to Mexico or the U.S. However by May 15 in-country transmission had been reported from Canada, Japan, Panama, the UK, Spain, Germany, Australia, Italy, and Belgium, and as of June 17 most countries within the European Union had documented in-country transmission as had many countries worldwide. Many countries had earlier advised citizens to avoid travelling to infected areas and were monitoring visitors returning from flu-affected areas for flu symptoms. WHO guidance from May 7, recommends no travel restrictions based on this strain of influenza stating that "Scientific research based on mathematical modelling shows that restricting travel would be of limited or no benefit in stopping the spread of disease".
According to researchers, "based on its genetic structure, the new virus is without question a type of swine influenza, derived originally from a strain that lived in pigs". This origin gave rise to the nomenclature "swine flu", largely used by mass media in the first days of the epidemic. Despite this origin, the current strain is a human-to-human transmitted virus, requiring no contact with swine. International health officials from the WHO, FAO, OIE and other food organizations have reaffirmed that pork is safe to eat and hogs are not to blame for the epidemic. Some authorities object to calling the flu outbreak "swine flu". U.S. Agriculture Secretary Tom Vilsack expressed concerns that this would lead to the misconception that pork is unsafe for consumption. The Centers for Disease Control and Prevention (CDC) began referring to it as "Novel influenza A (H1N1)". In the Netherlands, it was originally called "pig flu", then called "Mexican flu" by the national health institute and in the media. South Korea and Israel briefly considered calling it the "Mexican virus". Later, the South Korean press used "SI", short for "swine influenza". Taiwan suggested the names "H1N1 flu" or "new flu", which most local media now use. The World Organization for Animal Health (OIE) proposed the name "North American influenza". The European Commission adopted the term "novel flu virus". After initially opposing changing the name from "swine flu", the WHO announced they would refer to the new influenza virus as Influenza A (H1N1) or "Influenza A (H1N1) virus, human", also to avoid suggestions that eating pork products carried a risk of infection.
According to the World Health Organization, 88 countries had officially reported 44,287 cases of infection, including 180 deaths, as of June 19, 2009. Most early fatalities were in Mexico (72%, as of June 5, 2009). As of June 19, 2009, most deaths have now occurred in the United States, with 115 deaths.
On June 11, 2009, the WHO declared the outbreak had become a pandemic. The WHO declared a Pandemic Alert Level of Phase six (The technical definition of Phase 6 is human-to-human spread of the virus into at least two countries in one World Health Organisation region, with community level outbreaks in at least one other country in a different WHO region), out of a maximum six, describing the degree to which the virus had been able to spread among humans. In the same briefing, WHO stressed that the pandemic level was not linked to severity. On a separate scale for severity, WHO assessed the global severity as "moderate."
Pigs can get swine flu if they inhale respiratory droplets expelled by an infected pig. They can also get infected through direct or indirect contact with an infected pig. Signs of swine influenza in pigs can include dullness, fever, coughing and breathlessness. Some infected pigs (about 1 to 4 %) may die, but most pigs recover rapidly. Swine influenza is present in all pig-producing countries around the world, including India. Outbreaks in pigs occur throughout the year. However, many countries routinely vaccinate pigs against swine influenza. Although there is no indication that the current human infections are linked to cases of swine influenza in pigs in India, the Department for the Environment, Food and Rural Affairs (DEFRA) advises pig keepers to maintain high levels of hygiene. Pig keepers should look out for unusual signs of respiratory disease in their pigs and contact their veterinary surgeon if they are concerned or require any advice on protecting their pigs from swine flu.
This new influenza virus is thought to spread in the same way as seasonal flu, in humans; in tiny droplets, expelled from the mouth and nose of an infected person when they talk, cough or sneeze. People may get infected if they breathe in these droplets or if they touch someone or something that is contaminated with the virus (e.g. a used tissue or door handle), and then touch their nose or eyes. The flu virus can live on a hard surface for up to 24 hours and a soft surface for around 20 minutes. People are most infectious to others soon after they develop symptoms, although they continue to shed the virus (for example, in coughs and sneezes) for up to five days (seven days in children). People become less infectious as their symptoms subside, and once their symptoms are gone, they are no longer considered infectious to others. The incubation period for swine flu (time between infection and appearance of symptoms) can be up to seven days, but is most likely to be between two and five days. It is, however, too early to be able to provide details on virus characteristics, including incubation period, with absolute certainty at this time. The signs of infection with swine flu are similar to other forms of influenza, and include a fever, coughing, headaches, pain in the muscles or joints, sore throat, chills, fatigue and runny nose. Diarrhea and vomiting have also been reported in some cases. People at higher risk of serious complications included people age 65 years and older, children younger than 5 years old, pregnant women, and people of any age with underlying medical conditions, such as asthma, diabetes, obesity, heart disease, or a weakened immune system (e.g., taking immunosuppressive medications or infected with HIV).
According to the CDC, antiviral drugs can be given to treat those who become severely ill. There are two such medications that are recommended for use against the 2009 H1N1 swine flu virus, oseltamivir (Tamiflu) and zanamivir (Relenza). The 2009 H1N1 swine flu virus is resistant to the adamantane antiviral medications, amantadine and rimantadine. The drugs (oseltamivir and zanamivir ) work best if given within 2 days of becoming ill, but might be given later if illness became severe or to those at a high risk for complications.
Good hygiene can help to reduce the spread of a wide range of viruses, including influenza viruses. The Health Protection Agency advises everyone to follow these precautions at all times: Frequently wash your hands with soap and water; When coughing or sneezing, cover your mouth and nose with a tissue if possible; Dispose of used tissues promptly and carefully; Clean hard surfaces (e.g. door handles) frequently; Ensure children follow this advice. If you intend to travel to an affected country, you should check the advice provided by the Foreign and Commonwealth Office.
You cannot get influenza by eating properly handled and prepared pork or other foods derived from pigs (e.g. bacon, sausages). However, good food hygiene helps to prevent a wide range of infections, so it is important that all food is always prepared hygienically- Never eat raw or poorly cooked meat; Keep raw meat away from cooked and ready-to-eat foods; Use a separate chopping board and knife to prepare raw meat; Wash your hands immediately after handling raw meat; Clean and disinfect surfaces and utensils immediately after contact with raw meat.

Crime risk
In early June, the Australian Crime Commission, in a written public report, warned that criminals may exploit a swine flu pandemic. They pointed out that illicit markets, robbery and fraud through false charities were all potential targets for organised crime, and the emergence of a black market for medicine was also a concern. It warns of potential robbery and extortion, counterfeit medicine scams, black markets, charity fraud, welfare fraud and possibly increased community influence. In late May, the U.S. Food and Drug Administration (FDA) uncovered a "surge of phony swine flu treatments" available on the Internet. They have reportedly ordered dozens of Web site operators to stop making fraudulent claims. In the six weeks since FDA's campaign began the number of new sites selling fake swine flu treatments and protective devices has plummeted, whereas at the beginning they were seeing as many as 10 new Web sites a day selling fraudulent products.

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