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Pandemic flu outbreak, school closures and other public health restrictions Print E-mail
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อังคาร, 03 พฤศจิกายน 2009

Medical Alerts  

Authors:
Dr. Doug Quarry
Dr. Irene Lai
Viki Hansen-Landis, MPH
David DoQuang, MPH

Created: October 31, 2009 07:39 GMT
Updated: October 31, 2009 09:05 GMT

An outbreak of pandemic (H1N1) 2009 influenza in the western region of the country has prompted the government to implement a number of measures to reduce spread of the disease.

In mid-October a rise in influenza-like illness was noted in the Ternopil, Lviv and Ivano-Frankivsk, Chernivtsi regions, with a number of severe cases of pneumonia and several deaths. The outbreak has been confirmed to be at least in part due to pandemic flu. Estimates are that across the country, more than 80,000 people have had a flu-like illness. Over 2,000 are hospitalized, about half of them children. There have been 33 deaths associated with the illness. Two deaths are in children, the remainder in adults between the ages of 20 to 50 years. Pregnant women have been affected.

 

The Ministry of Health (in Ukrainian) describes a very rapid spread of the disease, with features of the illness which are consistent with the features of pandemic flu seen globally (severe disease in people with underlying health problems, pneumonia which is very difficult to treat and follows a "fulminant" course). Due to testing limitations, confirmation of H1N1 virus is delayed.

Amongst measures introduced to try and limit spread of flu are closures of schools, and restrictions on large public gatherings for three weeks. Cinemas and other entertainment establishments have been closed, and preventative measures have been strengthened at transport hubs, including airports and train (subway) stations, as well as market places and commercial establishments.

The Disease
Influenza H1N1 is a new strain of influenza virus, causing a respiratory illness in humans. It was first discovered in April 2009, and for a time was referred to as "swine" or "pig" flu because it is similar to influenza viruses that infect pigs. The virus has spread to many countries, and caused outbreaks in the general community.

The majority of people infected develop a mild illness. Symptoms are similar to seasonal influenza - fever, sore throat, cough, headache, muscle pains, runny nose. It also causes vomiting and diarrhea. In some people, a severe illness with a rapidly progressive pneumonia develops, and can be fatal Pregnant women and people with health issues (obesity, asthma, other lung conditions, heart disease, diabetes, weakened immune system) appear to be at higher risk for severe illness, although people without any underling health problems may aslo develop severe disease.

The disease is thought to be spreading in the same way as seasonal flu - through the droplets an infected person generates when they cough, sneeze or talk. People who are in close contact (within 1 to 2 meters) can be infected when they inhale the droplets directly, or touch them with their hands and then transfer them to their eyes, nose or mouth.

Most people recover on their own, however the illness can be treated with antiviral medications (Tamiflu or Relenza). Severe cases may require hospitalization and intensive care management. Prevention is through attention to hygiene, and specific pandemic influenza H1N1 2009 vaccination. Vaccine is mostly in limited supply, and may be restricted to national priority groups.

 

International SOS Comment


International SOS is monitoring the situation closely. For the latest information see the Pandemic Preparedness Website www.internationalsos.com/pandemicpreparedness. In particular the Flu News, Public Health Restrictions and Ukraine country page.

The outbreak is likely to be largely due to pandemic influenza. The nature of the illness is likely to be similar to that seen globally - that is a mild illness in the majority of people although severe illness and death can occur.

The outbreak is likely to spread rapidly through the country, and the Ukrainian health system may be strained or overwhelmed. Authorities may impose restrictions on public gatherings and may initiate limited travel bans with little warning.

To reduce your risk of infection, as well as the risk that your personal movements will be restricted (due to potential quarantine implications), International SOS recommends all travelers should monitor developments closely.

Monitor the latest information on the virus and quarantine and isolation procedures being implemented at both your origin and your destination. Some countries may impose mandatory isolation and quarantine of individual suspected of having, or having been in contact with someone with, pandemic flu.
Talk to your travel health professional about whether flu may be a more serious disease for you. Pregnant women and people with underlying health conditions (such as diabetes, asthma, other lung diseases, heart disease, obesity) are at higher risk of severe infection.
Consider pandemic H1N1 vaccination prior to departure, especially if you are in a higher risk group for severe infection. The vaccine is not available in all countries and may be restricted to certain national priority groups. Your doctor can advise you.
Consider your general health prior to travel. Your doctor may recommend you carry a course of antiviral medication, to be used in the event that you develop flu symptoms and are unable to get prompt medical attention.
Maintain good personal hygiene. Wash your hands frequently. Carry a hand sanitizer for use when soap and water aren't readily available.
Avoid touching your face.
Avoid people who are obviously sick.
 Ensure all routine vaccinations are up-to-date. This includes pneumocococcal vaccination for some groups of people. Your doctor will advise.
People who have not had an annual flu vaccination should consider having one to prevent regular seasonal flu.
Other measures to consider, particularly when you are in an area where flu is circulating in the community:

Avoid crowds as much as possible . If you cannot avoid crowds, consider wearing a face mask or respirator (if you are trained in how to use a respirator). See CDC guidance
Monitor your health, and seek medical attention if you become unwell .
To reduce the spread of flu:

Cover coughs and sneezes with a mask or a tissue.
Stay at home if you are unwell. Limit your contact with others as much as possible.
Contact your health care provider if you or your children develop flu-like symptoms. If practical, before you arrive at the healthcare facility, advise them that you may have flu.

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