No swine flu outbreak in the region, Ministry of Health & WHO belatedly clarify

Islamabad

In what sounded like a belated clarification, the Ministry of Health and the World Health Organisation (WHO) Wednesday rejected all news about a swine flu outbreak in the region, and attributed the 17 deaths between January 1-18, 2016, to seasonal Influenza A (H1N1) pdm09, which has been in circulation in the human population ever since WHO's August 10, 2010 declaration to the effect that the swine-origin H1N1 influenza pandemic was over and that worldwide flu activity had returned to typical seasonal patterns.

Day in and day out for the last over one month, the media has been spreading panic by making repeated references to a swine flu outbreak across various cities of Pakistan. Reports were flashed about Dengue Wards were being converted into Swine Flu wards in preparation for the outbreak at the federal and provincial levels. Ill-informed doctors added fuel to fire by feeding incorrect information to the media, allegedly for the sake of self-promotion. So while the media, the doctors, and the provincial governments are to be blamed for playing an active role in misreporting events and misinforming the public, the federal Ministry of Health too cannot be absolved of not clearing the mist well in time.

Addressing a press conference, Minister of State for Health Saira Afzal informed that a focal person for seasonal influenza has been designated at NIH to prevent further confusion. She said swine flu is a disease of the past and was declared over by WHO in August 2010."Seasonal influenza occurs every year, and influenza viruses change each year. Two types of influenza virus, designated type A and type B are of particular public health concern. Amongst these two, A/H1N1 & A/H3N2 are of concern during the current winter season," she mentioned.

The media was informed that between January 1 and 18, 2016, a total of 350 samples from across Pakistan were tested at the National Institute of Health (NIH) for Influenza A (H1N1) pdm. Of these, 110 tested positive for H1N1pdm09. "Fifteen deaths have been reported from Punjab, and one each from KPK and ICT. Most of the deaths have been reported among persons with co-morbid conditions," the minister of state said. Going slightly back, 28 deaths from Influenza A (H1N1) pdm09 have been reported in Pakistan since November 2015.

Focusing on protection, Saira said, flu vaccine with the latest circulating strain of Influenza A virus is highly recommended on a yearly basis and is considered as the first and most important step in protecting against flu viruses. People at high risk of serious flu complications include young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older. Antiviral drugs (Oseltamivir) can make illness milder and shorten the time of sickness. It works best if started within 72 hours of the start of illness.

Speaking on the occasion, acting WHO Representative Dr. Qamar-ul-Hassan said that the current situation with Influenza A (H1N1) pdm09 is not unique. "The influenza A (H1N1) pdm09 is now circulating as a seasonal influenza virus. Such situation-upsurge of cases from the influenza A (H1N1) pdm09 infections have been observed in many other countries recently, and WHO recommends vaccination against seasonal influenza every year to prevent severe illness. The currently available seasonal influenza vaccine is protective against the circulating flu viruses including the influenza A (H1N1) pdm 2009. Moreover, WHO recommends strengthening of the existed respiratory diseases surveillance system for proper monitoring of the situation," he reinforced.

With reference to transmission, the media was informed that the Influenza virus can be passed on to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.

Influenza virus infections including those caused by A/H1N1 pdm09 typically involve a combination of respiratory (cough, sore throat) and constitutional (fever, headache, muscle aches) symptoms. The majority of people with influenza H1N1 experience mild illness and recover fully without treatment.

In older adults and people with certain pre-existing medical conditions, influenza infections can lead to serious and even life-threatening complications. A notable feature of influenza is that repeated infections can occur throughout life.

People should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever, and especially high fever, continues beyond three days. For parents with a young child who is ill, medical care should be sought if a child has fast or laboured breathing, continuing fever or convulsions (seizures).

To prevent spread, people who are ill should cover their mouth and nose when coughing or sneezing, stay home when they are unwell, wash their hands regularly, and keep some distance from healthy people, as much as possible. For mild illness, only supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches and pains - is adequate for recovery in most cases.

Earlier on, while referring to the role of the federal government, the minister of state said, the federal ministry's role is restricted to issuing advisories, giving recommendations, coordinating with the provinces, and acting as a monitor and facilitator. "We cannot act on our own; if the provinces seek our help, we will be forthcoming," she added, referring to post-devolution compulsions in the context of child deaths in Tharparkar.

The minister of state then referred to some of the measures that are already in place at NIH, such as provision of free diagnostic facilities, and existence of a lab-based Influenza surveillance network with 7 sites functional for surveillance and/or molecular diagnostic facilities. She also referred to sensitisation of healthcare personnel through seminars, physician trainings, rapid response trainings, and laboratory diagnosis of seasonal influenza. However, had the medical fraternity really been sensitized, much of the recent confusion could have been avoided.

Secretary Health Ayub Sheikh wondered why the media does not as emphatically report on the 8,000 tobacco-related deaths occurring in the country every year. His observation would have sounded more logical if he had also explained why the government retracted from its declared commitment to increase the size of pictorial health warnings on cigarette packs!