Swine Flu

Overview of Swine Flu H1N1:

• Generally, Influenza A H1N1 virus is a subtype of influenza A virus and was the most common cause of human influenza (flu) in 2009.
• Furthermore, Some strains of H1N1 are endemic in humans and cause a small fraction of all influenza-like illness and a small fraction of all seasonal influenza.
• Other strains of H1N1 are endemic in pigs (i.e. swine influenza) and in birds (i.e. avian influenza). (1)
• Besides this, H1N1 influenza type A flu which appeared last in 1977-78 as a mild form of pandemic has reappeared in April 2009 as an outbreak in Mexico but is rapidly spreading elsewhere.
• Presently, the disease has already spread to 39 countries including US.
• In view of rising number of cases, with about 10,000 confirmed cases and about 100 deaths by end-May 2009 attributed to swine flu from all over the world, the WHO has alerted that it may become a worldwide flu pandemic. [3]

Epidemiology 

Causes of Swine flu:

• Flu viruses are spread mainly from person to person through either coughing or sneezing by people with influenza.
• Sometimes people may become infected especially by touching something—such as a surface or object—with flu viruses on it also then touching their face. [1]

Types

Risk factor of Swine flue:

• All children from birth to < 5 years, especially < 2 years.
• All persons ≥50 years old
• Pregnant women
• Adults also children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)
• Moreover, Persons who have immunosuppression (including that caused by medications or by HIV infection) Children and adolescents (6 months to 18 years old) who are receiving long term aspirin therapy and who might be at risk for Reye’s syndrome after influenza virus infection
• Lastly, Residents of nursing homes and other long-term care facilities Native Americans/Alaska Natives Persons who are morbidly higher-weight person (body mass index ≥40 kg/m2) [2]

Pathogenesis

Pathophysiology of Swine flu:

• Basically, H1N1 influenza type A virus is primarily an infection in pigs with low mortality in them.
• Human beings acquire infection especially by direct contact with infected pigs.
• However, further transmission of H1N1 flu occurs by person to-person contact such as by coughing, sneezing etc. but it is not known to occur from eating pork. (3)

Clinical Features 

Sign & Symptoms of Swine flu:

• The symptoms of H1N1 flu are similar to other influenzas, also include fever, dry cough, running nose, sore throat, headache, muscle pain, joint pain, chills, and fatigue.
• Diarrhoea, vomiting, also neurological problems have also been reported in some cases.
• People at higher risk of serious complications include older people age group, children less than 5 years of age, children with neurodevelopmental anomalies, pregnant women (especially during the third trimester), and those of any age with underlying medical conditions, such as asthma, diabetes, obesity, heart disease, or those who are immunosuppressed. [1]

Clinical Examination 

Diagnosis of Swine flu

• To confirm the diagnosis, testing of a nasopharyngeal, nasal, or oropharyngeal tissue swab from the patient is required.
• Real-time (in other words, RT) PCR is the recommended test as others are unable to differentiate between pandemic H1N1 and regular seasonal flu.
• However, most people with flu symptoms do not need a test for pandemic H1N1 flu specifically, because the test results usually do not affect the course of treatment.
• CDC recommends testing only for people who are hospitalized with suspected flu, pregnant women, and people with weakened immune systems.

Other diagnostic Factors

• For the mere diagnosis of influenza and not pandemic H1N1 flu specifically, more widely available tests include rapid influenza diagnostic tests (RIDT), which yield results in about 30 minutes, and direct and indirect immunofluorescence assays (DFA and IFA), which take 2 to 4 hours.
• Due to the high rate of RIDT false negatives, CDC advises that patients with illnesses compatible with novel influenza A (H1N1) virus infection but with negative RIDT results should be treated empirically based on the level of clinical suspicion, underlying medical conditions, severity of illness, and risk for complications, and if a more definitive determination of infection with influenza virus is required, testing with RT-PCR or virus isolation should be performed. [1]

Differential Diagnosis

Complications

Investigation of Swine flu

• Laboratory diagnosis depends upon demonstration of the virus also rising antibody titer.
• In detail, Available tests include virus culture, RT-PCR, immunofluorescence using monoclonal antibody to H1N1 and ELISA for detection of antibodies. [1]

Treatment of Swine flu

• Adequate fluid intake and rest have been recommended to help ease symptoms.
• Pain medications, such as acetaminophen and ibuprofen are useful to reduce symptoms.
• Aspirin and other salicylate products should not be used by people under 19 years with any flu-type symptoms because of the risk of developing Reye’s syndrome.
• If the fever is mild and there are no other complications, fever medication is not recommended.
• Most people recover without medical attention, although those with pre-existing or underlying medical conditions are more prone to complications and may benefit from further treatments.
• People in at-risk groups should be treated with antivirals (oseltamivir or zanamivir) as soon as possible when they first experience flu symptoms.
• The dose of oseltamivir is 75 mg twice a day for 5 days.
• The at-risk group includes pregnant and postpartum women, children under two years old, and people with underlying conditions, such as respiratory problems.

Other treatment

• People who are not from the at-risk group who have persistent or rapidly worsening symptoms should also be treated with antivirals.
• These symptoms include difficulty in breathing and a high fever that lasts beyond three days.
• People who have developed pneumonia should be given both anti-viral and antibiotics, as in many severe cases of H1N1-caused illness, bacterial infection develops.
• Antivirals are most useful if given within 48 hours of the start of symptoms and may improve outcomes in hospitalized patients.
• In those beyond 48 hours who are moderately or severely ill, antivirals may still be beneficial.
• If oseltamivir is unavailable or cannot be used, zanamivir is recommended as a substitute.
• Peramivir is an experimental anti-viral drug approved for hospitalized patients in cases where the other available methods of treatment are ineffective or unavailable.
• Both medications have known side effects, including lightheadedness, chills, nausea, vomiting, loss of appetite, and troubled breathing.
• Children were reported to be at increased risk of self-injury and confusion after taking oseltamivir. [1]

Prevention of Swine flu

• Prophylaxis with anti-viral drug recommend for high-risk population in contact with confirmed cases.
• Oseltamivir give in the dose of 75 mg once daily for 10 days.
• Vaccines that have develop to protect against the pandemic H1N1/09 virus either contain inactivated (killed) influenza virus, or live attenuated virus.
• The killed vaccine inject, while the live vaccine is given as a nasal spray.
• In studies, the vaccine appears both effective and safe, providing a strong protective immune response and having similar safety profile to the normal seasonal influenza vaccine.
• Killed vaccine use in pregnant women and immunocompromised persons. [1]

Homeopathic Treatment of Swine Flu:

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Swine Flu:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Eupatorium Perfoliatum:

• The leading characteristic is violent aching, bone breaking pains.
• Aching of bones also soreness of muscles of the lower limbs.
• Thirst or nausea, then violent shaking chill; In detail begins in the small of the back.
• Bitter vomiting after either chill or during heat.
• Burning heat.
• Sweat, relieves all the symptoms except the headache.
• Sweat scanty
• Patient is restless, chilly also nauseated. [4]

Belladona:

• Generally, High fever with comparative absence of toxaemia.
• Internal coldness, with external pungent, burning, steaming heat.
• Hot Head, with cold limbs.
• Skin hot, but moist and dry alternately.
• No thirst with fever
• Fulness, Congestion especially to head and swelling are other characteristic features.
• Pain is throbbing, sharp, cutting, shooting, or clawing, of maddening severity, coming also going in repeated attacks. [4]

Rhus Tox:

• Easily chilled agg. least uncovering; additionally with pain in limbs.
• Chill as if dashed with cold water or cold water in the veins; preceded by cough, alternating with heat.
• Chill in single parts.
• Heat, with busy delirium.
• Sweat, agg. during and pain, with sleepiness.
• Urticaria during fever.
• Wants to yawn also stretch during chill.
• Awakes either tired or nervous.
• Dreams, of great exertion, of blood, or fire [4]

Bryonia Alba:

• Chill with hot head also red face, agg. warm room.
• Dry burning heat, with agg. of all the symptoms.
• Blood seems hot.
• Painful continued fevers.
• Sweat, sour or oily [4]

Aconite:

• Chill passes through him in waves.
• Either Chill or coldness alternating with heat.
• High fever, dry burning heat, in eyelids, nose, mouth, throat, lungs and palms, must uncover.
• Sweat drenching, wants to uncover.
• Sweat on uncovered parts or affected parts
• Complaints caused especially by exposure to cold, dry weather, especially respiratory affections. [4]

Gelsemium:

• Chill with aching and languor, mixed with heat or alternating with heat, chill up also down back.
• Cold hands and feet.
• Heat, with drowsiness.
• Thirst absent, with trembling.
• Cold sweat.
• Bilious remittent, malarial, typhoid, cerebro-spinal fevers. Measles.
• Nervous, shuddering, chill, preceded especially by visual disturbances. [4]

Arsenic Album:

• Externally cold, with internal burning heat.
• Coldness, in spots.
• Sensitive to cold, yet amel. in open air.
• Chills irregular, shaking; craves hot drinks during chill, Dyspnoea during chill.
• Heat as of hot water in veins, or they burn like lines of fire.
• High fever, hectic fever.
• Sweat, with great thirst, Dyspnoea or exhaustion.
• Sweat cold.
• Waves of icy coldness in blood vessels or intense boiling heat.
• Intermittent fever, yellow fever. [4]

Diet and Regiment of Swine flu

• Reasonably effective ways to reduce the transmission of influenza include good personal health and hygiene habits such as: not touching your eyes, nose or mouth, frequent hand washing (with soap and water, or with alcohol-based hand rubs), covering coughs and sneezes, avoiding close contact with sick people, and staying home yourself if you are sick.
• Avoiding spitting also recommend.
• Although face masks might help prevent transmission when caring for the sick, there mix evidence on beneficial effects in the community.

Do’s & Don’t 

Terminology

Reference for Swine Flu 

1. API Textbook of Medicine 2 Volumes 9^th Edition
2. Harrison’s Principles of Internal Medicines 19^th Edition
3. Harsh Mohan Textbook of Pathology
4. Homoeopathic Materia Medica by Dr. S.R. Phatak
5. Sharma, S., et al. (2019). Influenza A (H1N1) in India: Changing epidemiology and its implications. National Medical Journal of India, 32(2), 70-76.
6. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases
   Edition: 9th Edition
   Writer: John E. Bennett, Raphael Dolin, Martin J. Blaser
   (2020), Publication: Elsevier

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