FAQ on Influenza A(H1N1)

Although the signs and symptoms of Influenza A(H1N1) have been widely publicised, many are still unclear about the way it could affect them personally. Here are a few frequently asked questions :

I. How do we get infected with Influenza A(H1N1)?

The A(H1N1) virus is mainly transmitted person to person by droplets that comes out the noses or mouths of infected people when they cough or sneeze. We can get infected if we inhale the droplets or touch something – such as a surface or object – with flu viruses on it and then touch our mouth, nose or eyes.

A person can remain infectious as long as symptoms of influenza-like illness persist, or one day before and up to seven days after symptoms (especially fever) appear. Children and those whose immune systems are compromised can spread the virus longer.

That is why you should ...


a. practise good cough etiquette and personal hygiene


b. clean commonly touched surfaces in the house/workplace


c. practise social distancing (stay 1m away from a person who is sneezing/coughing)

II. How does the Influenza A(H1N1) virus make us sick?

The Influenza A(H1N1) virus is a virus that mainly affects our respiratory system. It penetrates cells lining our airways and replicates inside them. When they are released from infected cells, the infected cell is damaged.

As our immune system fights the infection with an inflammatory response, it may cause swelling in our airways and we may have fever, cough, sore throat, and difficulty in breathing.

III. How is Influenza A(H1N1) different from the common cold?

High fever (>38°C) that lasts for 3 to 4 days, sore throat, headaches, severe body aches, extreme fatigue and severe cough are common in Influenza A(H1N1) but rare in common colds. Running or stuffy nose and sneezing, however, is sometimes present in Influenza A(H1N1) but prominent in common colds.

While Influenza A(H1N1) can lead to other complications, colds generally do not result in serious health problems such as pneumonia, bacterial infections, or hospitalisations.

IV. How does the Influenza A(H1N1) virus cause complications and death, and how can we prevent them?

Pneumonia (an inflammatory illness of the lungs) is the major serious complication of influenza virus infections, including the Influenza A(H1N1) virus. The inflammation in the lungs may cause difficulty in breathing or cause the lungs to be filled with fluid, making it difficult for the body to get enough oxygen.

It can develop about 3 to 5 days after symptoms start. But it is uncommon, and usually occurs in susceptible individuals from the high-risk groups.

Pneumonia can be caused by the spread of the influenza virus into the lungs, or by unrelated bacteria, which infects the lungs after a person's immune system is weakened by the virus infection.

Other complications include cardiovascular, muscular, neurological and systemic ones. Cardiac events following influenza are not uncommon.

So far, about 70% of those who died due to Influenza A(H1N1) related complications had underlying medical conditions or were from other high-risk groups. However, 40% of deaths in the country are linked to delays in seeking treatment, while 13% of them have sought medical help but were treated with a low index of suspicion.

If you have influenza-like illnesses, follow medical advice, and be watchful for emergency warning signs. SEEK IMMEDIATE MEDICAL ATTENTION if you have any of the warning signs.

V. How does anti-viral medication work, and does it have any side effects?

Oseltamivir and zanamivir are drugs called neuraminidase inhibitors. They help prevent influenza viruses from multiplying in the body by interfering with the production and release of virus from cells that line the airways. This may slow the spread of the infection within the airways and lungs.

Oseltamivir is taken orally while zanamivir is taken by inhalation.

Although generally well tolerated, the most common side-effects associated with oseltamivir are nausea and vomiting. People with the flu, particularly children and adolescents, may be at an increased risk of self-injury and confusion shortly after taking oseltamivir and should be closely monitored for signs of unusual behaviour. A healthcare professional should be contacted immediately if the patient taking oseltamivir shows any signs of unusual behaviour.

As many patients with asthma or chronic obstructive pulmonary disease (COPD) have had bronchospasm (wheezing) or serious breathing problems when they used zanamivir, it is not recommended for people with chronic respiratory disease such as asthma or COPD. If you develop worsening respiratory symptoms such as wheezing or shortness of breath, stop using zanamivir and contact your healthcare provider right away.


More info on INFLUENZA A HERE.

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FAQ on Flu Pandemics

by Dr. Y.L.M

I am curious about how many influenza pandemics there have been in history, because this is the first time I have ever been in a WHO Pandemic Level 6 situation. Then again, I am only 15 years old! What is a pandemic anyway?

A pandemic (pan = all; demos = people or population) is defined as an epidemic (or sudden outbreak of a certain disease) that becomes very widespread and goes on to affect a whole region, or continent, or even the world.

A WHO definition of Pandemic Level 6, the highest level, is when a disease is widespread and sustaining rapid human-to-human transmission in 2 or more regions around the world. The H1N1 flu pandemic is the first global flu pandemic in over 41 years since the 1968 Hong Kong flu!

Note that the term 'Pandemic Level 6', which is scary-sounding in itself, denotes the spread of the disease, but not its severity. Being in a Pandemic Level 6 does not necessarily mean that a lot of people will die from the disease that is spreading.

Seasonal influenza, the type you get in certain months like winter, is not considered a pandemic.

Have all the flu pandemics been recorded only from the 20th century?

The first major influenza epidemic (not pandemic) was recorded by Hippocrates, the father of medicine, in 412 BC, though it was not called 'influenza' then. Only in 1357 AD was the term 'influenza' coined, from the Italian word 'influence'. At that time, it was thought that flu was 'influenced' by the stars in the sky!

The first ever pandemic was recorded in 1580 – and you guessed it, it involved influenza. It originated in Asia Minor (the Middle East) and Northern Africa and swept into Europe within 6 weeks. It entered Europe by way of Malta into Italy, then propagated rapidly north through the Italian peninsula. It also entered Spain because at that time, Spain ruled several North African ports.

At least 10% of all Rome's population (then numbering 81,000 people) died within the first week of contracting it. Some Spanish cities were almost completely depopulated.

Then for a long, long time, there was no further pandemics until the 18th century.

How do you explain that?

This historical fact has also baffled many scientists. This is called a period of pandemic stability. Many questions arise as to whether a pandemic comes by chance. Because during the period between 1580 and 1729, there were plenty of epidemics. And the question remains to be answered whether epidemic situations prevent pandemics, or at least help delay them.

So when was the next pandemic and what happened?

There were 3 pandemics in succession then, the first from 1729 to 1730, the second from 1732 to 1733 and the third from 1781 to 1782. You must remember that in the 18th century, doctors did not know influenza was caused by a virus. They blamed it an unknown poison in the air and wind/temperature and meteorological phenomena. So their documents on pandemics are filled with these theories!

The 1729-1730 pandemic was a flu, and it is believed to have originated from Russia. There were two outbreaks in Moscow and Astrakhan on the Caspian Sea in April. Surprisingly, the summer of 1729 was a quiet one, Then suddenly there were influenza reports in Sweden in Sept 1729, and in Vienna come October. By November 1729, the flu had swept through Hungary, Poland, Germany and England.

But this particular pandemic, although virulent, caused relatively few deaths. Flu was unknown in North America until 1732 (yes, the American Indians never had flu before that!), because of the settlers in New England.

The 1781-82 pandemic on the other hand was not only virulent but deadly. This one started in China, involved then British-occupied India and then spread to the Western hemisphere. There were tens of millions of cases, spreading through all transport modes available then.

1918 Spanish flu pandemic.
I heard that the worst flu pandemic occurred in the 20th century.

Yes. There were major pandemics from 1830 to 1834. Then in 1918, the Spanish flu began. (Though researchers think it actually started in the US.) It was also caused by a H1N1 flu virus, and is the worst flu pandemic to date. It was very dangerous to young adults, especially those from age 20 to 40.

The Spanish flu was memorable because it killed millions of people and it killed those in the prime of their lives. At first, it attracted little attention as people thought it was the 'normal' flu. Then when a second killer wave descended and young adults began to be affected, people panicked.

This pandemic was extremely deadly as well as virulent. From North America, it spread to Europe and the rest of the world. In Switzerland in July 1918, 53,000 people alone died in that one month.

By August 1918, the flu had morphed into a 3rd deadly strain. World War 1 occured, and the spread of troops and disruption of the world's population then helped transmit the virus. What is worse, this particular pandemic came before treatment was available, so people succumbed easily.

At the end of it, it was estimated that 20 million to 100 million people worldwide had died. In the US alone, half a million people died. It is difficult to say today whether this 1918 flu would have the same impact on us with the advent of antibiotics to treat secondary pneumonia.


More info on SWINE FLU HERE.

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