Swine flu in Sri Lanka

Swine flu in Sri Lanka

Did you hear this news?

“COLOMBO, June 16 (Reuters) - Sri Lanka has identified its first case of the H1N1 flu virus in a young patient who arrived from Australia over the weekend, the government said on Tuesday.”We have detected the first swine flu case in Sri Lanka. He is an 8-year-old Sri Lankan living in Australia. He has come to Sri Lanka via Singapore with a family of five. Only he has tested positively for H1N1 and is being treated," Health Minister Nimal Siripala De Silva told reporters.”

The swine flu virus, also known as H1N1 virus now has invaded into Sri Lanka.It was first reported from US and now spreading rapidly all over the world. It is a mixture of swine, bird and human viruses and according to the World Health Organization currently there are approximately 165 people have died due to this H1N1 virus and over 37,000 victims are reported world wide.

What is Swine flu?

Swine flu is a viral disease which infects the respiratory tract of pigs (swine) , and results nasal secretions, barking-like cough, decreased of appetite and inactive behavior which are the most similar symptoms in human flu. Swine flu can last for 1 to 2 weeks in pigs that are able to survive. In 1930 the Swine flu virus was first isolated from pigs in US. The people who are closely associated with pigs like farmers, pork processors infected by swine flu virus in a number of instances and also occasionally the pigs infect by human flu. But these cross species infections between humans and pigs remained in local areas not turning into epidemic level. But these influenza viruses have the potential to be changed into new strain. So scientists think the cause for the epidemic in 2009 is a new swine flu viral strain and it is termed as H1N1 virus because the infected people exhibits two main surface antigens called H1(hemagglutinin type 1) and N1(neuraminidase type1).

Why is swine flu now infecting humans?

Researchers reveal two main series of events can lead swine flu (also bird flu) becoming a major cause for influenza illness in humans.

First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome. Segmented genome means that the viral RNA genetic code exists as eight different RNA segments, not as a single strand of RNA, in the influenza viruses. A human (or bird) influenza virus and swine flu influenza virus can infect a pig respiratory cell simultaneously. In RNA replication, mistakenly some RNA strands of human influenza virus can be getting enclosed inside the enveloped Swine influenza virus. As an example, after above incident one cell could contain eight swine flu and eight human flu RNA segments. Then the total number of RNA types in one cell would be 16. Four of them came from swine influenza virus and other four from human influenza virus. Then those RNA segments could be arranged into one particle by making a viable eight RNA segmented flu virus from the 16 available segment types. In this new subtype of virus, there may be various combinations of RNA segments, thus it is called as antigenic shift and it may has the preferential ability to infect humans but it shows some unique features of swine influenza virus.

Consider this example. If a cell becomes infected with human influenza, swine influenza and bird influenza viruses, it is possible to include RNA strands from birds, swine, and human influenza viruses into one virus. (For example, it is possible to produce a viable eight-segment new type of flu viral genome with three bird flu, three swine flu, and two human flu RNA segments).

Small changes within an individual RNA segment which result minor changes in the virus are called as drift. But this takes a long time (usually years) to produce enough minor changes that cumulatively change the virus' antigenic makeup.

Second reason is the unique role of pigs as an intermediate host to new flu types because respiratory cells of pigs can be infected directly with bird, human, and other mammalian flu viruses. Bird flu viruses usually infect the gastrointestinal cells of many bird species and are spread by bird feces. Pigs can pick these viruses up from the environment and it seems to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.

What are the symptoms of swine flu?

Swine flu symptoms are similar to most influenza infections just like fever (100F or greater), cough, nasal secretions, headache, with fatigue is very common in most infected individuals. Some patients also get nausea, vomiting, and diarrhea. Patients can get pneumonia due to bacterial secondary infection .Death often occurs from secondary bacterial infection of the lungs. Therefore appropriate antibiotics should be used in these patients. The usual mortality rate for typical influenza A is about 0.1%. Swine flu in Mexico (as of April 2009) has a mortality rate of about 6%, but it is far too early to predict the true mortality rate because there are new infections being reported in world wide.

How is swine flu diagnosed?

The presumptive clinical diagnosis of Swine flu is done by considering the patient’s history of association with people shown above symptoms. Generally, a quick test (nasopharyngeal swab sample test) is done to check if the patient is infected with influenza A or B virus. Most of the tests can differentiate A and B types. The test can be negative or positive for type A and B. If the test is positive for type B, the flu is not likely to be swine flu (H1N1). If it is positive for type A, the person could have type A flu strain or swine flu (H1N1). Swine flu (H1N1) is securely diagnosed by forming a particular antibody-antigen reaction. In general, this test is done in a specialized laboratory and it is not done in hospital laboratories.

The following case definitions are developed by the WHO for the purpose of reporting probable and confirmed cases of swine influenza A (H1N1) virus infection.
Note-Without any edition, these facts are available here

Clinical case description

Acute febrile respiratory illness (fever >38°C) with the spectrum of disease from influenza-like illness to pneumonia.

1. Suspected case of Swine Influenza

Individuals presenting with acute febrile respiratory illness (fever >38 °C) with the spectrum of disease from influenza-like illness (cough, sore throat, shortness of breath) to pneumonia

AND

One of the following epidemiological risk factors:

• Close contact* to a suspected case of swine influenza A (H1N1) virus infection while the case was ill


• Recent travel to an area where there are confirmed cases of swine influenza A (H1N1)

*Close contact: having cared for, lived with, or had direct contact with respiratory secretions or body fluids of a probable or confirmed case of swine influenza A (H1N1).

2. A Probable case of swine influenza A (H1N1) virus infection is defined as an individual with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection

OR

An individual with a clinically compatible illness or who died of an explained acute respiratory illness who is considered to be epidemiologically linked to a probable or confirmed case.

3. A Confirmed case of swine influenza A (H1N1) virus infection is defined as an individual with laboratory confirmed swine influenza A (H1N1) virus infection by one or more of the following tests:

• Real-time RT-PCR
• Viral culture
• Four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies.

What treatment is available for swine (H1N1) flu?

In order to prevent influenza infections in humans, vaccination is been used. But still there is no vaccine available for Swine flu (H1N1).ongoing laboratory works in several countries may help to produce a vaccine for Swine flu (H1N1) later this year (2009). It is reported that the swine flu (H1N1) virus that has infected humans is resistant to the antiviral medications amantadine (Symmetrel) and rimantadine (Flumadine).But oseltamivir (Tamiflu) and zanamivir (Relenza) antiviral agents which are also used to prevent influenza A and B viruses can reduce the effect of Swine flu.

These drugs should not be used indiscriminately or they are not recommended if the Swine flu symptoms already have been present for 48 hours or more, because viral resistance can be occurred. Severe infected patients may require additional breathing support and treatment of other infections like pneumonia. In their interim guidelines, the U.S. Centers for Disease Control and Prevention (CDC) has suggested that pregnant females can be treated with those two antiviral agents.

How can swine flu be prevented?

There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

• Cover nose and mouth with a tissue when cough or sneeze. Throw the tissue in the trash after use it or dispose them properly.
• Wash your hands often with soap and water, especially after cough or sneeze. Alcohol-based hand cleaners or disinfectants are also effective.
• Avoid touching eyes, nose or mouth.
• Try to avoid close contact with sick people.
• If get sick with influenza, it is recommended to stay home away from work or school and limit contact with others to avoid infecting them.

Reporting of suspected swine influenza cases

All suspected cases of swine Influenza should immediately report the case to the Epidemiologist, Regional Epidemiologist/MOH by telephone (Epidemiology Unit emergency telephone number for: 011-4740491).

For additional information,

• http://www.cdc.gov/swineflu/
  
• http://www.cdc.gov/swineflu/clinician_pregnant.htm
  
• http://www.cdc.gov/travel/
  
• http://www.medicinenet.com/influenza/article.htm
  
• http://emedicine.medscape.com/article/219557-overview
  

References -

• Swine flu fact sheet published by Epidemiology Unit,Ministry of Healthcare and Nutrition,231, De Saram Place, Colombo 10,Sri Lanka.
• http://www.cdc.gov/socialmedia/h1n1/buttons.html

An article by - Bhagya Kodithuwakku.

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Deadly Dengue Fever-Latest controversy in Sri Lanka

Deadly Dengue Fever Latest controversy in Sri Lanka

After the death of brutal terrorist Prabhakaran, Sri Lankans tend to believe that he has been rebirth as a mosquito in Aedes genus. The latest controversy in Sri Lanka is the epidemic of dengue fever all over the country mostly in Western, Wayamba, Central and Southern provinces. Currently more than 130 people including children have died due to the infection of fatal dengue virus.

What is dengue fever?

Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases, caused by four antigenically different but closely related, virus serotypes* (DEN-1, DEN-2, DEN-3, and DEN-4), found in the tropical and sub tropical areas. These four dengue serotypes are undergoing in a cycle that involves humans and Aedes aegypti mosquitoes or more rarely the Aedes albopictus mosquito. Because of these four different serotypes, it is possible to get dengue fever multiple times. But in each attack of dengue, the immune system produces antibodies against that particular serotype to which the patient was infected.

Dengue fever is also known as "breakbone" and "dandy fever". Victims of dengue often suffer due to the pain in joints and muscles, hence the name breakbone fever. Slaves in the West Indies call dandy fever due to the postures and gait of infected patients.

* Serotypes - closely related set of viruses that can be differentiated by the immune responses that they produced.

Little bit about Dengue virus…..

Group - IV single stranded (+) RNA

Family - Flaviviridae

Genus - Flavivirus

Little bit about Aedes aegypti and Aedes albopictus…..

Aedes aegypti , and Aedes albopictus are the most common Aedes species which include domestic, day-biting mosquitoes that feed on humans.A.albopictus species is also known as Asian Tiger Mosquito. White spots in all over the body are a significant feature of Aedes mosquitoes. They dwell during rainy seasons but can breed in water-filled flower pots, plastic bags, coconut husks, yogurt cups, old tires and cans throughout the year. The Aedes aegypti mosquito is a daytime biter with dominant periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas.

Kingdom - Animalia
Phylum - Arthropoda
Class - Insecta
Order - Diptera
Family - Culicidae
Genus - Aedes
Subgenus - Stegomyia
Species - Aedes aegypti / Aedes albopictus

What are the areas at high risk for contracting dengue fever?

Dengue is found throughout the tropics and subtropics. A wide range of geographical spreading includes Asian countries like Singapore, Malaysia, Taiwan, Thailand, Vietnam, Indonesia, Philippines, Pakistan, India, Sri Lanka, Maldives, Bangladesh and South Pacific, West Indies, South American and African countries like northern Australia ,northern Argentina, Costa Rica, , Mexico, Suriname, Puerto Rico, Jamaica, Bolivia, Brazil, Guyana, Venezuela, Barbados, Trinidad and Samoa.

According to the World Health Organization (WHO), each year they estimate 50 million cases of dengue fever with 500,000 cases of dengue hemorrhagic fever all over the world. Nearly 40% of the world's population lives in an area endemic with dengue. The disease is now epidemic in more than 100 countries.

History of the Dengue fever.

The first reported simultaneous epidemic occurred in 1779-1780 on three continents Asia, Africa and North America. This indicates that more than 200 years ago these viruses and their mosquito vector have had a worldwide distribution in the tropics. During that time, dengue fever was recognized as a mild, nonfatal disease. Normally, between major epidemics, there were long intervals like 10-40 years. This is mainly because the introduction of a new serotype into a population occurred only if mosquito vectors could transport between populations by sailing.

After World War II, an epidemic of dengue reported in Southeast Asia and has spread around the world since then. Epidemics caused by multiple serotypes are more frequent because the geographic distribution of dengue viruses and their mosquito vectors has expanded. And dengue hemorrhagic fever (DHF) has aroused in the Pacific region and America. Epidemic DHF first appeared at 1950s in Southeast Asia, but from 1975 it devastated the lifestyle of people in Southeast region becoming a frequent cause of hospitalization and deaths.

What is typical dengue fever?

The most important thing is that the typical dengue does not cause any death. It is fatal in less than 1% of cases. The severe phase of the typical dengue with fever and myalgias lasts about one to two weeks. At the first stage of recovery, a feeling of weakness (asthenia) is remained, and full recovery often takes several weeks.

What is dengue hemorrhagic fever?

DHF is a specific syndrome that shows its affection in children, aged fewer than 10 and it causes abdominal pain, hemorrhage (bleeding), and circulatory shock. Therefore DHF is also called as dengue shock syndrome. Infants under a year of age are especially at risk of dying from DHF. The mortality (death rate) of DHF is considerable. It is in the range from 6%-30%. Most of the deaths occur in children.

How is dengue infected?

The Flavivirus is infected after biting of an Aedes aegypti or rarely Aedes albopictus mosquito which has previously bitten an infected person. One mosquito bite can infect the disease. The Flavivirus is not contagious and so it cannot be infected directly from person to person. Therefore there must be a person-to-mosquito-to-another-person pathway.

What are the signs and symptoms?

After being bitten by a mosquito carrying the Flavivirus, the incubation period of the virus ranges from 3 to15 (generally 5 to 8) days. Dengue starts with chills, headache, pain upon moving the eyes and low backache. Legs and joints aches occur and the temperature rises quickly as high as 104° F (40° C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are become swollen. Fever continues for two to four days, followed by rapid drop in temperature (defervescence) with utmost sweating. Before this a period with normal temperature and a sense of well-being lasts about a day. Along with the second rapid rise in temperature, a characteristic rash appears and spreads from the extremities to cover the entire body except the face. Bright red and swollen palms and soles may be appeared.

At the initiative level in DHF, it starts with high continuous fever and headache and later it shows respiratory and intestinal symptoms including sore throat, cough, nausea, vomiting and abdominal pain. The circulatory shock occurs two to six days after occurring the symptoms like sudden collapse, weak pulse, cool and clammy extremities (but the trunk is often warm) and blueness around the mouth (circumoral cyanosis).And also in DHF we can see apparent symptoms like bleeding with easy bruising, bleeding gums, nosebleed (epistaxis), blood spots in the skin (petechiae), spitting up blood (hematemesis), and blood in the feces (melena). There is a high opportunity in infecting Pneumonia and inflammation of the heart (myocarditis) can be occured.

What are the treatments?

There is no specific medicine or antibiotic to treat dengue because it is caused by a virus. There is a vaccine undergoing clinical trials, but there are no proofs that it will be safe or effective.

For typical dengue, the treatment is purely concerned to give relief for the symptoms. It is important to rest and intake fluid to adequate hydration. Aspirin and non-steroidal anti-inflammatory drugs should be avoided. Acetaminophen (Tylenol) and codeine may be given for severe headache and for the joint and muscle pain (myalgia).

Patients with DHF must be monitored tightly for first few days because unobservant shock may occur or recur. Cyanotic (bluish) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Bleed controlling can be done by transfusion of blood.

How can dengue fever be prevented?

The Aedes aegypti mosquito is dominant in daytime with peak periods of biting around sunrise and sunset. It can bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas. The transmission of the virus to mosquitoes must be restricted to prevent the illness. For that patients are kept under mosquito netting until the second active term of fever is over and then they are no longer contagious.

The prevention of dengue needs control or eradication of the mosquito vectors that carry the Flavivirus. People in the nations, pandemic by dengue fever are urged to empty stagnant water from the places where water can be collected like old tires, trash cans, plastic bags, coconut husks, yogurt cups and flower pots. Governments of epidemic countries also initiate for the eradication of mosquitoes.

For personal protection, wear long pants and long sleeves, use mosquito repellent sprays when visiting places where dengue is endemic. Limiting exposure to mosquitoes and clean regularly the places where standing water can be collected will help for the dengue prevention.

The future Outlook of Dengue.

At this moment no dengue vaccine is available. But recently, attenuated candidate vaccine viruses have been developed. Efficacy trials using human volunteers have yet to be started. There is a research being conducted to create second-generation recombinant vaccine* viruses. So an effective dengue vaccine will not be available for 5 to 10 years for public use.

Recombinant vaccine* -creating an attenuated virus using the technique of recombination which exposes an immune response against the particular viral strain and then can be used as a vaccine for humans.

References-

http://www.phac-aspc.gc.ca/tmp-pmv/2007/dengue070823_e.html
http://www.who.int/tdr/publications/publications/pdf/planning_dengue.pdf
http://www.cdc.gov/ncidod/dvbid/dengue/ http://www.medicinenet.com/dengue_fever/page3.htm
http://en.wikipedia.org/wiki/Dengue_fever#Diagnosis
http://www.cdc.gov/NCIDOD/DVBID/DENGUE/

An article by-Bhagya Kodithuwakku.

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CHINA POISONED MILK

CHINA POISONED MILK

Milk poisoning incidents in all over the world mainly in china make everyone afraid for food.Always the reports are changing. No one can clearly inform us what to eat and not.

Poisened milk is the milk powder mixed with “MELAMINE”.Melamine is an organic chemical with the C3H6N6 formula. There are 3 amine (-NH2) groups in Melamine.Melamine is an industrial chemical use in the production of “melawares”.It is also used in home decorations.So, Melamine is used in industrial productions.

The most important nutrient in milk is protein.That is the reason traders add melamine to milk.The amino acids (the building blocks of proteins) found in protein contains an amine (-NH2) group. All amino acids have the amine group(–NH2) as part of its chemical structure. As an example, in Glycine, an amino acid (NH2CH2COOH) and in Alanine, another amino acid (HO2CCHNH2CH3), the -NH2 amine group is apparent. According to the chemical structure of Melamine, it contains 3 amine (-NH2) groups. When milk protein and Melamine are together, it cannot be detected using “Kjeldah method “; the old method used to measure the protein amount in milk by looking for the amine (-NH2) group. Kjeldah method can only detect Crude proteins which contain “Nitrogen” in proteins and “Nitrogen” in non proteins.

So adding Melamine in milk reduces milk content and it is cheaper than milk. Then, it lowers capitalization. It can give more profit to the businessman. Considering all facts we can conclude that the introduction of Melamine into milk powder is intentional but surely not accidental.
Below is a picture of Melamine powder. Doesn’t it look like milk? It doesn’t have any smell, so cannot be detected.

It was discovered in year 2007 US cats and dogs died without any apparent reason, and they found that pet food from China contains Melamine.

Starting 2008, In China, an abnormal increase in infant cases of kidney stones.

In August 2008-China Sanlu Milk Powder tested with Melamine.
In September 2008-New Zealand government asks China to check this problem.
In September 21, 2008-Lots of food products in Taiwan tested with Melamine.

When Melamine enters into the body, a portion of it is eliminated and a portion of it participates in chemical reactions and converts into other chemical compounds such as cyanuric acid, ammeline and ammelide which are not supposed to be found in human body.

These chemicals can enter human body in 2 ways. The first way is they can be ingested along with the Melamine. The second way is that Melamine can be converted to these compounds after it is ingested.

Cyanuric acid, ammeline, ammelide are found in laboratory synthesis of Melamine. The first step in Melamine synthesis is ammeline synthesis from urea. Further hydrolysis of ammeline yields ammelide and the thermal decomposition of Melamine produces cyanuric acid.

The biochemical pathways in human metabolism to facilitate the conversion of Melamine into cyanuric acid, ammeline and ammelide cannot be easily identified. Because the large variety of microbial organisms inhabiting in the intestinal tract including beneficial and non-beneficial bacteria and yeast have a metabolism of their own. They are capable to synthesize and break down chemical compounds that humans cannot. And there are some bacteria that have specialized enzymes such as Melamine Deaminase, Atrazine Chlorohydrolase which can break down Melamine into various compounds like cyanuric acid, ammeline and ammelide.

Cyanuric acid is most commonly used as a chlorine stabilizer in swimming pools. It is toxic to the kidneys. The combination of cyanuric acid and Melamine crystallizes in the kidneys and causes kidney stones to be formed. The crystals block the tubules in the kidneys and lead to kidney failure. Pain will be eminent and person cannot urinate. Kidney will then swell.

Although surgery can remove the stones, but it will cause irreversible kidney damage. It can lead to loss of kidney function and will require kidney dialysis or lead to death because of uremia.

Generally, dialysis is called as “blood washing”. It is filtering all of the body’s blood into a machine and then goes back to the body. A small hole is cut in the arm to insert the sub-dialysis catheter.

The whole process takes 4 hours and it is necessary to dialysis once for every 3 days for the rest of the life for survival.

This condition is most serious to babies because their kidneys are very small and they drink a lot of milk powder.

Also in Sri Lanka, some companies are forbidden to sell their products base on the allegation of their foods contain Melamine. Here in Sri Lanka we haven’t sufficient laboratory facilities to do Melamine tests. But some companies did Melamine tests with the help of foreign laboratories and issued their laboratory reports to the public.

But deception is not an uncommon practice for traders. So,NO ONE IS SAFE.

Reference:

• Based on a survey done by

http://groups.yahoo.com/group/fun_and_fun_only/s=rveys?id=2139003

http://www.osha.gov/dts/chemicalsampling/data/CH_250440.html

http://monographs.iarc.fr/ENG/Monographs/vol73/volume73.pdf

http://www.fda.gov/cvm/menufoodrecallfaq.htm

http://en.wikipedia.org/wiki/2008_baby_milk_scandal

A special gratitude to:Professor Priyani Paranagama, Department of Chemistry, University of Kelaniya, Sri Lanka.

• An article by - Bhagya Kodithuwakku.

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