Europe: H1N1
Overview:
H1N1 (also known as the 2000 Influenza A or swine flu) is a new type of
influenza that has spread rapidly among humans around the world since
its appearance in April 2009. Influenza is a viral infection that spreads from
person to person principally when people cough or sneeze, or by direct or
indirect contact with respiratory secretions from infectious persons that are
on their hands or on surfaces. 1 This new virus was first detected in people
in the United States in April 2009. The Center for Disease Control and
Prevention in 2009 reported that the virus spread from person-to-person
worldwide, almost in much the same way that regular seasonal influenza
viruses spread. On June 11, 2009, The World Health Organization (WHO)
declared that a pandemic of 2009 H1N1 flu was underway. 2
H1N1 has been discovered to contain the genes of pig, birds and human,
in a combination that is rare and has never been observed before. 3
Symptoms of the H1N1 virus include fever, cough, sore throat, runny or
stuffy nose, body aches, headache, chills and fatigue. Some people also
experience vomiting and diarrhea. Others may only have respiratory
symptoms without a fever. People with swine flu may be more likely to feel
nauseous and throw up than people who have seasonal flu. But a lab test
is the only way to know for sure. 4 Severe illnesses and deaths have
occurred as a result of this virus. 5
Soon after the pandemic emerged there was a drug, Pandemrix, made
by a British drug maker, GlaxoSmithKline to prevent the virus. This vaccine
is allegedly the cause of the narcolepsy, an incurable sleepy disorder.
In August 2010 the pandemic was declared over by the World Health
Organization. Europe has now entered a new inter-pandemic phase of
seasonal influenza. 6 Scientists are now conducting massive research to
further understand this pandemic, as well as to know if Pandemrix is a
direct cause of narcolepsy.
Aspects of the Problem
Containing the spread of diseases
For H1N1 there is some hesitancy in using the terms containing or delaying
to describe the prevention of the infection spreading. The term
containment was not recommended by the World Health Organization
(WHO) to explain H1N1 because when it emerged, the rapid spread of
the virus was beyond a delimited area, which is why the term delaying is
preferred. 7 Furthermore, the WHO uses a six-phase approach for easy
incorporation of new recommendations and approaches into existing
1
national preparedness and response plans for pandemics influenzas. 8 The
approach is as follows: phases 1-3 are predominately animal’s infections
and a few human infections; phase 4 is a sustained human-human
transmission, which is where the term containment is preferred; and
phases 5-6 are widespread human infections (a Pandemic). 9 The H1N1
was considered to be between phases 5-6, due to the quickness of which
the virus spread from people to people around the world. 10 If the virus
was considered to be in phase 4 or below then the term containment
would be preferred.
There are two main preventive measures of the spread of the virus under
delaying that the European Centre for Disease Prevention and Control
(ECDC) reports in their June 2009 Influenza A Report (1) case-finding:
detecting imported infections and first generation transmissions; and (2 )
taking actions to prevent their turning into chains of transmission and
outbreaks, notably through vigorous contact tracing, treatment and/or
quarantine of contacts. Within the same ECDC report, there are
additional delaying practices for travellers and the general population in
preparation for the impact of the virus in Europe that consist of: providing
relevant information, isolating symptomatic persons, starting early
treatment of persons under investigation, giving antivirals or alerting them
to watch for symptoms.
The main practical difficulty with the delaying strategy is to practice casefinding vigorously and to extend action to contacts of ill incoming
travellers when transmission starts occurring in the community, which can
be very labor-intensive. 9 The ECDC report, states that vigorous case
finding and contact tracing is hard work and tiring for field staff. As they
prepared with limited time for the pandemic, the potential early
exhaustion and undermining of the public health workforce was a key
concern. 10
Managing the Long-Term Consequences
The WHO currently considers H1N1 to be in the post-pandemic period. This
means that the influenza disease activity has returned to levels normally
seen for seasonal influenza. It is also expected that the pandemic virus will
behave as a seasonal influenza A virus. 11 The WHO suggests that at this
stage, it is important to maintain surveillance and update pandemic
preparedness and response plans accordingly, as well as to be prepared
for the possibility of an intensive phase of recovery and evaluation. While
H1N1 is no longer considered a pandemic, it's still important for people to
protect themselves from getting it. Like seasonal flu, it can cause more
serious health problems for some people. The best protection is to get a flu
vaccine every year. 12
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Even with the availability of the vaccine against 2009 H1N1 virus, the CDC
stills suggests the following measure are important because they can
prevent the spread of other viruses that cause respiratory infections:13

Cover your nose and mouth with a tissue when you cough or sneeze.
Throw the tissue in the trash after you use it.

Wash your hands often with soap and water, especially after you
cough or sneeze. If soap and water are not available, use an
alcohol-based hand rub.

Avoid touching your eyes, nose or mouth. Germs spread that way.

Stay home from work or school and limit contact with others if sick to
keep from infecting them.
Communication Issues
From a report on Risk Communication Research by the Department of
Sociology at the University of Geneva states that among the general
public, H1N1 was often associated with traditional seasonal flu. Therefore,
H1N1 risk was thought to be low. The report also shows that public distrust
in different actors of the pandemic crisis, in particular governments, the
media, pharmaceutical industries, and international and national health
authorities. Nevertheless, a report from the European Commission in
November 2009 shows that health professionals were the most trusted
sources of information among EU citizens.14
There are many myths and rumors in regards to H1N1, such as during the
H1N1 crisis; Mexicans were depicted as unhygienic subjects and
circulators of disease. Mexicans were blamed for the “Mexican flu,” pigs
were blamed for the “swine flu,” and birds for the “avian flu. Mexico was
one of the countries during the early stages where the breakout took
place, however is no shape or form means individuals within Mexico have
a bad hygiene. Furthermore, H1N1 is a multifaceted virus that is a
combination of the human, pig and bird virus interchangeably. 15 A
couple other common myths and facts are as follows:
1. You can catch it from eating pork
a. Swine flu is spread from one person to another like any other flu,
not through the eating of pork, unless an infected human has
sneezed on your ham sandwich. And even if eating an infected
pig could spread it, the influenza doesn't survive contact with
cooking temperatures to at least 160 degrees Fahrenheit.
2. A mask will protect you
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a. Wearing a mask is a good idea if you work in a hospital or
primary care center and make contact with patients who have
flu symptoms. Using a facemask isn't a fail-safe against catching
swine flu. And, after a while, masks get uncomfortable.
Finding and Providing an Inexpensive Cure
The best inexpensive cure for H1N1 is good hygiene, such as hand
washing and cleaning, which is the most effective way of slowing the
spread of flu. Antiviral medication is also offered to people at risk. 16
WebMD, a health information provider, reports that some of the same
antiviral drugs that are used to treat seasonal flu also work against H1N1
swine flu. Antibiotics won't help, because a virus causes the flu, not
bacteria. Oseltamivir (Tamiflu) and zanamivir (Relenza) seem to work best,
although some kinds of swine flu are resistant to Tamiflu.16 These drugs can
help you get over swine flu faster by relieving symptoms and reducing the
risk of serious complications. WebMD also states that they work best when
taken within 48 hours of the first flu symptoms, but they can help when
taken later. 17 In order to lower a high temperature and relieve aches
paracetamol or ibuprofen are acceptable to take. Water is also
important to prevent dehydration. Lastly, there are a few natural remedies
options to prevent H1N1, such as exercising to stay healthy and to boost
one’s immune system to decrease the chance of being infected by the
virus.
If the recommended seasonal influenza vaccine is not available and if
immunization against H1N1 is still needed, is the only time Pandemrix is
used. On 25 September 2009, the European Medicines Agency (EMEA)
approved Pandemrix, the swine flu vaccine produced by GSK.18 Reuters, a
world’s leading source of intelligent information, reports that the
Pandemrix shot was not used in the United States because it is a
adjuvant vaccine and drug regulators are cautious of adjuvant vaccines.
Reuters also reported that more than 30 million people in 47 countries
during the 2009-2010 H1N1 swine flu pandemic received Pandemrix. 19
However, the largest concern of the drug is the side effect that has been
reported to possibly be the cause of narcolepsy, an incurable sleeping
disorder amongst hundreds of people, especially the youth in many areas
in Europe. Narcolepsy is estimated to affect between 200 and 500 people
per million and is a lifelong condition. 20 Much research is still underway
concerning the details of the vaccine injury. 21
4
European 2009 Influenza Pandemic Timeline 22
Date
21-Apr-09
25-Apr-09
25-Apr-09
Event
Two swine influenza cases reported in California
18 confirmed cases in Mexico (including 6 deaths)
WHO declares the novel influenza A (H1N1) outbreak in
Mexico and US
27-Apr-09 First confirmed cases reported in the EU (Spain and UK)
27-Apr-09 Declaration of Phase 4 by WHO and second meeting of the
Emergency Committee
29-Apr-09 Declaration of Phase 5 by WHO
30-Apr-09 EMA prepares for approval of pandemic vaccines
03-May-09 First cases of in country transmission in Germany, Spain and UK
04-May-09 WHO statement on the H1N1 influenza situation
19-May-09 ECDC guidance on personal health measures to reduce risk
of influenza transmission
11-Jun-09 Declaration of Phase 6 by WHO
15-Jun-09 First death in Europe reported from UK
01-Jul-09
UK moves from containment to mitigation of pandemic
influenza
13-Aug-09 Health Security Committee statement on School Closures and
Travel Advice
17-Aug-09 Call to action from WHO, IFRC, UNSIC, OCHA and UNICEF
19-Sep-09 Pandemic vaccine donations for the developing countries
30-Sep-09 Authorization of first two pandemic vaccines (Focetria &
Pandemrix) by European Commission
01-Oct-09 European Medicines Agency recommends updating Tamiflu
product information
26-Oct-09 Death of 13 year child in Toronto area (Canada) leads to
dramatic change in attitude to immunization
04-Dec-09 European Medicines Agency advises of risk of fever among
young children following pandemic vaccination
22-Dec-09 Adoption by the European Council of Recommendation on
Seasonal influenza immunization
22-Jan-10 EMA recommends update of product information for
Pandemrix to include more data from studies in children
08-Mar-10 ECDC's Forward look risk assessment for the 2009 pandemic
influenza A(H1N1) and future influenza season
23-Apr-10 Marketing authorisations for Celvapan, Focetria and
Pandemrix recommended to be switched to 'full'
30-Apr-10 ECDC ceases searching for announced deaths
10-Jul-10
WHO Director General announces that the world is no longer
in a pandemic
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Spread of 2009 Influenza Pandemic in Europe 23
Spread of H1N1 in Europe
Late April
Early May
Mid May
Late May
Early June
Mid June
Late June
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Works Cited
1
http://ecdc.europa.eu/en/healthtopics/Documents/09_07_personal_protective_measures_ECDC2009-0001-00-00-ENEN_final.pdf
2
http://www.cdc.gov/h1n1flu/qa.htm
3
http://ec.europa.eu/health/communicable_diseases/diseases/influenza/h1n1/index_en.htm#fragme
nt0
4
http://www.webmd.com/cold-and-flu/flu-guide/h1n1-flu-virus-swine-flu
5
http://www.wndu.com/mmm/headlines/82824242.html
6
http://ecdc.europa.eu/en/healthtopics/H1N1/basic_facts/Pages/origin_of_virus.aspx
7
http://ecdc.europa.eu/en/publications/Publications/0906_GUI_Influenza_AH1N1_Mitigation_and_Dela
ying_Strategies_for_the_Influenza_in_Europe.pdf
8
http://www.who.int/csr/disease/swineflu/phase/en/
9
http://www.who.int/csr/disease/swineflu/phase/en/
10
http://ecdc.europa.eu/en/publications/Publications/0906_GUI_Influenza_AH1N1_Mitigation_and_Dela
ying_Strategies_for_the_Influenza_in_Europe.pdf
11
http://www.who.int/csr/disease/swineflu/phase/en/
12
http://www.webmd.com/cold-and-flu/flu-guide/h1n1-flu-virus-swine-flu
13
http://onlinelibrary.wiley.com/store/10.1111/irv.12090/asset/irv12090.pdf;jsessionid=A1AA26E7E9A24126
067DB65C86CD0130.f04t02?v=1&t=i80eg3rf&s=3714c6a05688a02c0b16ac27c368638baa51f765
14
http://onlinelibrary.wiley.com/store/10.1111/irv.12090/asset/irv12090.pdf;jsessionid=A1AA26E7E9A24126
067DB65C86CD0130.f04t02?v=1&t=i80eg3rf&s=3714c6a05688a02c0b16ac27c368638baa51f765
15
http://www.discovery.com/tv-shows/mythbusters/about-this-show/h1n1/
16
http://www.nhs.uk/conditions/pandemic-flu/Pages/Introduction.aspx
17
http://www.webmd.com/cold-and-flu/flu-guide/h1n1-flu-virus-swine-flu?page=2
18
http://orthomolecular.org/resources/omns/v08n10.shtml
19
http://www.reuters.com/article/2013/01/22/us-narcolepsy-vaccine-pandemrixidUSBRE90L07H20130122
20
http://www.reuters.com/article/2013/01/22/us-narcolepsy-vaccine-pandemrixidUSBRE90L07H20130122
21
http://orthomolecular.org/resources/omns/v08n10.shtml
22
http://ecdc.europa.eu/en/healthtopics/H1N1/Documents/110810_2009_pandemic_European_Timelin
e.pdf
23
http://commons.wikimedia.org/wiki/File:Spread_of_Swine_Flu_in_Europe.svg
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