CDAlert

Monthly Newsletter of National Institute of Communicable Di

seases,
Directorate General of Health Services, Government of In
dia
March- April 2009
Vol.12 : No.8
Special Issue: Human Swine Influenza: a pandemic threat
pigs, the viruses ca
n re-assort (i.e. swap genes)
INTRODUCTION
and new viruses , a
mix of swine, human and/or
avian influenza viru
ses - can emerge leading to
Influenza (Flu) pandemics are caused by new
development of new n
ovel strain for which
influenza viruses that have recently adapted to
human beings do not
have no immunity. There
humans and resemble major natural disasters
are four main influe
nza type A virus subtypes
both in terms of recurrence and magnitude.
that have been isola
ted in pigs: H1N1, H1N2,
The influenza virus, known to be circulating as
H3N1 and H3N2. Howev
er, most of the recently
a pathogen in the human population since at
least the 16th century is notable for its unique isolated influenza v
iruses from pigs have been
H1N1 viruses.
ability to cause recurrent epidemics and global
pandemics. Genetic re-assortments in the
influenza virus cause fast and unpredictable Swine flu virus spre
ads mostly through close
antigenic changes in important immune targets contact among pigs a
nd possibly from
leading to recurrent epidemics of febrile contaminated objects
moving between infected
respiratory disease every 1 to 3 years, and uninfected pigs.
Symptoms of swine flu in
consistently necessitated the development of pigs can include sud
den onset of fever,
new vaccines. Each century has seen some depression, coughing
(barking), discharge
pandemics rapidly progressing to all parts of from the nose or eye
s, sneezing, breathing
the world due to emergence of a novel virus to difficulties, eye re
dness or inflammation, and
which the overall population holds no going off feed.
immunity.
SWINE FLU IN HUMANS
SWINE FLU IN PIGS
Swine flu viruses do
not normally infect humans.
Swine Influenza (swine flu) is a respiratory However, sporadic hu
man infections with swine
disease of pigs caused by type A influenza flu have occurred. M
ost commonly, these cases
virus that regularly causes outbreaks of occur in persons hav
ing direct exposure to pigs.
influenza in pigs. Swine flu viruses cause high In addition, there h
ave been sporadic cases of
levels of illness and low death rates in pigs. one person spreading
swine flu to others.
Swine influenza viruses usually circulate Occasional human swi
ne influenza virus
among swine throughout the year, but most infection occurs eve
ry one to two years in the
outbreaks occur during the late fall and winter U.S., but from Decem
ber 2005 through February
months similar to outbreaks in humans. The 2009, 12 cases of hu
man infection with swine
classical swine flu virus (an influenza type A influenza have been
reported.
H1N1 virus) was first isolated from a pig in
1930. H3N2 influenza viruses began SWINE FLU OUTBREAK
circulating among pigs from 1998. The H3N2
viruses initially were introduced into the pig Recently, human case
s of swine influenza A
population from humans. (H1N1) virus infecti
on have been recently
reported in several
countries. This is a novel
Like all influenza viruses, swine flu viruses influenza A virus th
at has not been identified in
change constantly. Pigs can be infected by people before,
and human-to-human
avian influenza, human influenza viruses as transmission of the
virus appears to be
well as swine influenza viruses and hence the ongoing and thus rep
resents a real pandemic
pigs are known to be a mixing vessel. When threat. WHO has upgr
aded the phasing of
influenza viruses from different species infect pandemic influenza f
rom Phase -3 to Phase - 5
1
WHO PHASES OF PANDEMIC ALERT
Influenza A HA and NA Subtypes
(Source: WHO)
N1
H1
N2
H2
N3
H3
N4
H4
N5
H5
N6
H6
H7 N7
H8 N8
H9 N9
H10
 H11
H12
H13
H14
H15, H16
The above diagram shows various subtypes of Phase 1 No animal influe
nza virus circulating
Influenza, A virus which infects humans, swine,
among animals ha
s been reported to
birds, poultry and horses and other animals, but
cause infections
in humans.
wild birds are the natural hosts for these viruses.
Phase 2 An animal influe
nza virus circulating
Influenza type A viruses are divided into subtypes
among domesticat
ed or wild animals
and named on the basis of two proteins on the
is known to have
caused infection in
surface of the virus: hemagglutinin (HA) and
humans, and is t
herefore considered
neuraminidase (NA. There are 16 known HA
a specific poten
tial pandemic threat.
subtypes and 9 known NA subtypes. Many different
Phase 3 An animal or hum
an-animal influenza
combinations of HA and NA proteins are possible. .
reassortant viru
s has caused sporadic
For example, an “H1N1” virus has an HA 1 protein
cases or small c
lusters of disease in
and an NA 1 protein Only some influenza A
people, but has
not resulted in human-
subtypes (i.e., H1N1, H1N2, and H3N2) are
to-human transmi
ssion sufficient to
currently in general circulation among people.
sustain communit
y-level outbreaks.
Other subtypes are found most commonly in other
Phase 4 Human-to-human t
ransmission(H2H)
animal species.
of an animal or
human-animal
influenza reasso
rtant virus able to
Current Situation: The current situation sustain “communi
ty-level outbreaks
regarding the outbreak of swine influenza has been verifie
d.
A(H1N1) is evolving rapidly. As on 29 April Phase 5 The same identif
ied virus has caused
2009, nine countries have officially reported sustained commun
ity level outbreaks
in two or more c
ountries in one WHO
148 confirmed cases of swine influenza
region
A/H1N1 infection. Of these, United States has
Phase 6 The pande
mic phase, is
reported 91 laboratory confirmed human
characterized by
community level
cases, including one death. Mexico has
outbreaks in at
least one other country
reported 26 confirmed human cases including
in a different W
HO region in addition to
seven deaths. the criteria def
ined in Phase 5.
Post Peak Levels of pandem
ic influenza in most
The following countries have reported Period countries with a
dequate surveillance
laboratory confirmed cases with no deaths - have dropped bel
ow peak levels
Austria (1), Canada (13), Germany (3), Israel Possible Level of pandemi
c influenza activity in
new wave most countr
ies with adequate
(2), New Zealand (3), Spain (4) and the United
surveillance ris
ing again
Kingdom (5). All these cases have history of
Post Levels of Influe
nza activity have
travel to Mexico.
Pandemic returned to leve
ls seen for seasonal
Period influenza in mos
t countries with
Unlike the experience in Mexico, the United adequate surveil
lance.
States is currently reporting infection by the
identical virus strain or less severe clinical
The current WHO phase of pan
demic alert is 5.
spectrum of disease. Mexican health officials WHO has declared the outbrea
k as PUBLIC
have reported several hundred suspect cases, HEALTH EMERGENCY OF INTERNAT
IONAL
including several deaths associated with swine CONCERN (PHEIC)
influenza A (H1N1) virus infection. In Mexico,
many patients have experienced rapidly
progressive pneumonia, respiratory failure and (Source: WHO: Pa
ndemic influenza
acute respiratory distress syndrome (ARDS) preparedness and response)
requiring mechanical ventilation.
2
 A probable case of swine
influenza A (H1N1) virus
INFLUENZA SURVEILLANCE
infection is defined as
a person with an acute
febrile respiratory illn
ess who:
Surveillance is the foundation of all efforts to
understand and control influenza. The monitoring of
is positive for influe
nza A, but unsubtypable for
influenza disease patterns is essential for
H1 and H3 by influenz
a RT-PCR or reagents
identification of high risk groups, planning of
used to detect season
al influenza virus infection,
prevention and response activities for complications
or
and for estimating the burden of disease in terms of
is positive for influe
nza A by an influenza rapid
health and economic impact.
test or an influenza
immunofluorescence assay
(IFA) plus meets crit
eria for a suspected case, or
It is important to use standardized case definitions
individual with a clin
ically compatible illness who
that enable comparisons between different areas
died of an unexplaine
d acute respiratory illness
within a country and also between countries. There
who is considered to
be epidemiologically linked
are two case definitions used by the influenza
to a probable or conf
irmed case.
surveillance system:
A confirmed case of swin
e influenza A (H1N1) virus
1. Influenza-like illness (ILI) is defined (according
infection is defined as
a person with an acute febrile
to WHO criteria) as:
respiratory illness with
laboratory confirmed swine
• Sudden onset of a fever over 38°C, AND
influenza A (H1N1) virus
infection at WHO approved
• Cough or sore throat, AND
laboratories by one or m
ore of the following tests:
• An absence of other diagnoses.
2. Severe Acute Respiratory Infections (SARI):. Real Time PCR
Viral culture
For persons ≥ 5 years the definition for SARI is Four-fold rise in swin
e influenza A (H1N1) virus
adapted from the WHO protocol on rapid specific neutralizing
 antibodies.
response:
• Sudden onset of fever over 38°C, AND
OTHER DEFINITIONS
• Cough or sore throat, AND
• Shortness of breath or difficulty in breathing, AND
Close contact is defined
within 6 feet of an ill
• Requiring hospital admission
person who is a confirme
d, probable or suspected
case of swine influenza
A (H1N1) virus infection
For children <5 years old: definition is adapted
during the infectious pe
riod.
from the program for Integrated Management of
Childhood Illness (IMCI):
Any child <5 years old clinically suspected of Acute respiratory illnes
s is defined as illness of
having Pneumonia or Severe/very Severe recent onset with least
two of the following:
Pneumonia and requiring hospital admission. rhinorrhea or nasal cong
estion, sore throat, cough
(with or without fever).
3. Confirmed case of influenza is defined as any
case with laboratory test results positive for High-risk group for comp
lications of influenza is
influenza virus. defined as a person such
as:
resident of institu
tions for elderly people and
CASE DEFINITION OF SWINE FLU IN the disabled;
HUMANS people with certain
chronic health conditions
(chronic heart or l
ung disease, metabolic or
renal disease or im
munodeficiencies);
A suspected case of swine influenza A (H1N1)
elderly people and
very young children.
virus infection is defined as a person with acute
febrile respiratory illness (fever ≥ 380 C) with onset.
Infectious period: The i
nfectious period for a
confirmed case of swine
influenza A (H1N1) virus
within 7 days of close contact with a person who
infection is defined as
1 day prior to the onset of
is a confirmed case of swine influenza A (H1N1)
illness to 7 days after
onset.
virus infection, or
within 7 days of travel to areas where there are
TRANSMISSION
one or more confirmed swine influenza A(H1N1)
cases, or
resides in a community where there are one or Influenza viruses can
be directly transmitted from
more confirmed swine influenza cases. pigs to people and fr
om people to pigs.
Human infection with f
lu viruses from pigs are
most likely to occur
when people are in close
3
proximity to infected pigs, such as in pig barns labeled clearly and in
clude patient’s
and livestock exhibits housing pigs at fairs. complete information a
nd should be sent to
Human-to-human transmission of swine flu can
NIV, Pune or NICD, Del
hi within 24 hours
also occur. This is thought to occur in the same for further investigat
ions.
way as seasonal flu which is mainly person-to-
Laboratory biosafety m
easures should
person transmission through coughing or
be followed for collec
tion, storage,
sneezing by people infected with the influenza
packaging and shipping
of influenza
virus.
samples.
Disease spreads very quickly among the
Available Laboratory t
ests:
population especially in crowded places.
Rapid Antigen Tests:
not as sensitive as
Cold and dry weather enables the virus to survive
longer outside the body than in other conditions other available tes
ts.
and, as a consequence, seasonal epidemics in RT-PCR
temperate areas appear in winter.
Virus isolation
People may become infected by
Virus Genome Sequenc
ing
touching/handling something contaminated with
Four-fold rise in sw
ine influenza A
flu viruses on it and then touching their mouth or
(H1N1) virus
specific neutralizing
nose.
antibodies.
Swine influenza viruses are not transmitted by
food.
Eating properly handled and cooked pork (at an
It is important to note
that samples from
internal temperature of ≥160°F) and pork all cases, once the Pand
emic starts, are
products is safe. not required to be teste
d.
SYMPTOMS Important Contact Number
s:
Outbreak Monitoring Cell
(Control Room,
The symptoms of swine flu in people are NICD): 011-23921401
expected to be similar to the symptoms of EMR Control room (Minist
ry of Health and
regular human seasonal influenza like fever, family Welfare: 011- 230
61469
lethargy, lack of appetite and cough. Some Important Websites:
people have also reported runny nose, sore www.mohfw.nic.in; www.ni
cd.nic.in
throat, nausea, vomiting and diarrhoea.
PREVENTIVE MEASURES
DIAGNOSIS OF SWINE FLU
There is currently no vacc
ine available
For diagnosis of swine influenza A infection, against human swine influe
nza. One has
respiratory specimen would generally need to to follow proper hand hygi
ene and
be collected within the first 4 to 5 days of respiratory etiquettes.
illness (when an infected person is most likely
to be shedding virus). However, some Do’s and Don’ts:
persons, especially children, may shed virus
for 10 days or longer. Avoid close contact wi
th people who are
having respiratory il
lness.
Sample Collection & Laboratory Diagnosis Sick persons should ke
ep distance from
others.
If possible, stay at h
ome, away from work,
Sample Collection and handling is same
school, and public pl
aces when you are
as for human avian flu or seasonal
sick.
influenza like illness (Refer CD Alert on AI).
Cover your mouth and n
ose with a tissue or
Sample Collection: should be done by the handkerchief when cou
ghing or sneezing.
treating doctor who is managing the case. If you have no tissue
or handkerchief you
Preferred respiratory samples : should not clean the
nose with the hands
nasopharyngeal swab and throat swab but with the cuff of
your shirt or clothes.
 Storage of Samples: all samples should Washing your hands oft
en with soap or
be kept at 2-80C until they can be placed at alcohol based hand wa
sh will help protect
-700C. from germs.
Get plenty of sleep, b
e physically active,
Transportation of Samples: Clinical
manage your stress, d
rink plenty of fluids,
samples should be transported on dry ice
and eat nutritious fo
od.
in triple packaging. All samples should be
4
Schools and childcare
facilities in
Persons who develop influenza-like-illness o
unaffected areas shou
ld begin to prepare
(ILI) (fever with either cough or sore throat)
for the possibility o
f school or childcare
should be strongly encouraged to self-
facility closure.
isolate in their home for 7 days after the
onset of illness or at least 24 hours after Social Distancing Interven
tions:
symptoms have resolved, whichever is o Large gatherings linked
to settings or
longer. institutions with
laboratory-confirmed
cases should be cance
lled, for example a
Persons who experience ILI and wish to
school event linked t
o a school with cases;
seek medical care should contact their
other large gathering
s in the community
health care providers to report illness (by
may not need to be ca
ncelled at this time.
telephone or other remote means) before
o Additional social distan
cing measures are
seeking care at a clinic, physician’s office,
currently not recomme
nded.
or hospital.
o Persons with
underlying medical
Persons who have difficulty breathing or
conditions who are at
 high risk for
shortness of breath should seek immediate
complications of infl
uenza may wish to
medical attention and report to the nearby
consider avoiding lar
ge gatherings.
hospital.
If ill persons must go into the community
SWINE INFLUENZA A (H1N1) VIR
US:
(e.g., to seek medical care) they should
wear a face mask to reduce the risk of BIOSAFETY GUI
DELINES FOR
spreading the virus in the community.
LABORATORY WORKERS
If a face mask is unavailable, ill persons
needing to go into the community should
Laboratory workers who may b
e processing or
use a handkerchief or tissues to cover any
performing diagnostic testin
g on clinical specimens
coughing and sneezing.
from patients with suspected
swine influenza A
Persons in home isolation and their
(H1N1) virus infection, or p
erforming viral isolation.
household members should be given
infection control instructions like frequent
Diagnostic laboratory work o
n clinical samples from
hand washing with soap and water; use of
patients who are suspected c
ases of swine
alcohol-based hand gels (containing at least
influenza A (H1N1) virus inf
ection should be
60%alcohol).
conducted in a BSL2 laborato
ry. All sample
When the ill person is within 6 feet of others
manipulations should be done
inside a biosafety
at home, the ill person should wear a face
cabinet.
mask, if available or handkerchief or
tissues.
Viral isolation on clinical
specimens from patients
Household contacts who are well should:
who are suspected cases of s
wine influenza A
remain home at the earliest sign of illness;
 o
(H1N1) virus infection shoul
d be performed in a
minimize contact in the community to the
o
BSL2 laboratory with BSL3 pr
actices (enhanced
extent possible;
BSL2 conditions).
designate a single household family
o
member as the ill person’s caregiver to
minimize interactions with asymptomatic Additional precautions inclu
de:
persons.
Precautions for School children:
Recommended Personal Pr
otective Equipment
Schools with a confirmed or a suspected
o (based on site specific
risk assessment )
case should be considered for closure.
Respiratory protection
– fit-tested N95
All school or childcare related gatherings
o
respirator or higher le
vel of protection.
should be cancelled and encourage
Shoe covers
parents and students to avoid
Closed-front gown
congregating outside of the school.
Double gloves
Schools and childcare facilities should bar
o
Eye protection (goggles
or face shields)
students for a time period to be evaluated
Appropriate disinfectan
ts
on an ongoing basis depending upon
o 70% Ethanol
epidemiological findings.
o 5% Lysol
Schools and childcare facilities should
o
o 10% Bleach
consult with their local or state health
departments for guidance on reopening. If
All personnel should self mo
nitor for fever and other
no additional confirmed or suspected
symptoms of Swine influenza.
Any illness should be
cases are identified among students (or
reported to the supervisor i
mmediately.
school-based personnel) for a period of 7
days, schools may consider reopening.
 5
Oseltamivir is the dru
g of choice.
For personnel who had unprotected exposure or a
Prophylaxis should be
provided till 10 days after
known breach in personal protective equipment to
clinical material or live virus from a confirmed case last exposure (maximu
m period of 6 weeks)
By Weight:
of swine influenza A (H1N1), antiviral
chemoprophylaxis with oseltamivir for 7 days after For weight <1
5kg: 30 mg OD
15-23kg:
45 mg OD
exposure can be considered.
24-<40kg:
60 mg OD
≥40kg:
75 mg OD
Waste disposal
For infants:
< 3 months:
not recommended unless
All waste disposal procedures should be followed
situation jud
ged critical due to limited data
as outlined in the respective facility standard
on use in thi
s age group
laboratory operating procedures.
3-5 months:
20 mg OD
6-11 months
: 25 mg OD
ANTIVIRAL TREATMENT
Close Contacts of susp
ected, probable and
Oseltamivir is the recommended drug both for confirmed cases shoul
d be advised to remain at
prophylaxis and treatment. home (voluntary home
quarantine) for at least 7
days after the last c
ontact with the case.
Supportive therapy includes: Monitoring of fever s
hould be done for at least 7
- IV Fluids. days. Prompt testing
and hospitalization must be
- Parentral nutrition. done when symptoms ar
e reported.
- Oxygen therapy/ ventilatory support.
- Antibiotics for secondary infection. All suspected cases, clu
sters of ILI/SARI cases need to be
- Vasopressors for shock. notified to the State He
alth Authorities and the Ministry of Health
- Paracetamol or ibuprofen is prescribed for fever, & Family Welfare, Govt.
of India (Director, EMR and Director,
NICD)
myalgia and headache. Patient is advised to
 drink plenty of fluids. Smokers should avoid
FREQUENTLY ASKED QUESTIO
NS
smoking. For sore throat, short course of topical
decongestants, saline nasal drops, throat
What is swine flu?
lozenges and steam inhalation may be
beneficial. Swine Influenza (swine f
lu) is a respiratory disease
- Salicylate / aspirin is strictly contra-indicated in of pigs caused by type A
influenza viruses that
any influenza patient due to its potential to causes regular outbreaks
in pigs. People do not
cause Reye’s syndrome. normally get swine flu,
but human infections can
and do happen. Swine flu
viruses have been
The suspected cases would be constantly reported to spread from
person-to-person, but in
monitored for clinical / radiological evidence of the past, this transmiss
ion was limited and not
lower respiratory tract infection and for hypoxia sustained beyond three p
eople.
(respiratory rate, oxygen saturation, level of Are there human infectio
ns with swine flu in
consciousness). India.?
In late March and early
April 2009, cases of human
Adult patients should be discharged 7 days after infection with swine inf
luenza A (H1N1) viruses were
symptoms have subsided. first reported in Southe
rn California and near San
Children should be discharged 14 days after Antonio, Texas. Other U.
S. states have reported
symptoms have subsided. cases of swine flu infec
tion in humans and cases
have been reported inter
nationally as well. Central &
The family of patients discharged earlier should be State Health Authorities
are monitoring the situation
educated on personal hygiene and infection control in India. So far, no cas
e has been reported.
measures at home; children should not attend
Is this swine
flu virus contagious?
school during this period.
CDC has determined that
this swine influenza A
(H1N1) virus is contagio
us and is spreading from
ANTIVIRAL CHEMOPROPHYLAXIS human to human. However,
at this time, it is not
known how easily the vir
us spreads between people
Prophylaxis is given to: and between countries.
What are the signs and s
ymptoms of swine flu in
All close contacts of suspected, probable and people?
confirmed cases. Close contacts include The symptoms of swine fl
u in people are similar to
 household /social contacts, workplace or school the symptoms of regular
human flu and include
contacts, fellow travelers etc. fever, cough, sore throa
t, body aches, headache,
All health care personnel coming in contact with chills and fatigue. Some
people have reported
suspected, probable or confirmed cases
6
diarrhea and vomiting associated with swine flu. In What can I do to protec
t myself from getting
the past, severe illness (pneumonia and respiratory sick?
failure) and deaths have been reported with swine flu Currently available sea
sonal influenza vaccine does
infection in people. Like seasonal flu, swine flu may not protect against swi
ne flu. There are everyday
cause a worsening of underlying chronic medical actions that can help p
revent the spread of germs
conditions. that cause respiratory
illnesses like influenza. Take
these everyday steps to
protect your health:
How does swine flu spread?
Spread of swine influenza A (H1N1) virus is thought Cover your nose and m
outh with a tissue when
to be happening in the same way as that of seasonal you cough or sneeze.
Throw the tissue in the trash
flu. Flu viruses are spread mainly from person to after you use it.
person through coughing or sneezing of people with Wash your hands often
with soap and water,
influenza. Sometimes people may become infected especially after you
cough or sneeze. Alcohol-
by touching something with flu viruses on it and then based hand cleaners
are also effective.
touching their mouth or nose. Avoid touching your e
yes, nose or mouth. Germs
spread this way.
How can someone with the flu infect someone
Try to avoid close co
ntact with people having
else?
respiratory illness.
Infected people may be able to infect others
If one gets sick with
influenza, one must stay at
beginning 1 day before symptoms develop and up to
home, away from work
or school and limit contact
7 or more days after becoming sick.
with others to keep
from infecting them. However,
What should I do to keep from getting the flu?
if one is having any
respiratory distress, one
First and most important: wash your hands
should report to a n
earby hospital.
frequently. Try to stay in good general health. Get
What should I do if I g
et sick?
plenty of sleep, be physically active, manage your
stress, drink plenty of fluids, and eat nutritious food. If you live in areas wh
ere swine influenza cases
Avoid touching surfaces that may be contaminated have been identified an
d become ill with influenza-
with the flu virus. Avoid close contact with people like symptoms e.g. feve
r, body aches, runny nose,
having respiratory illness. sore throat, nausea, or
vomiting or diarrhea, you
may contact their healt
h care provider, particularly if
Are there medicines to treat swine flu?
you are worried about y
our symptoms. Your health
Yes. The use of oseltamivir for the treatment and/or
care provider will dete
rmine whether influenza
prevention of infection with these swine influenza
testing or treatment is
needed.
viruses is recommended. Antiviral drugs fight against
the flu by keeping flu viruses from reproducing in If you are sick, you sh
ould stay home and avoid
your body. If you get sick, antiviral drugs can make contact with other peop
le as much as possible to
your illness milder and make you feel better faster. keep from spreading you
r illness to others. If you
They may also prevent serious flu complications. For become ill and experien
ce any of the following
treatment, antiviral drugs work best if started soon warning signs, seek eme
rgency medical care.
after getting sick (within 2 days of symptoms). They
In children emergency w
arning signs that need
are currently available with hospitals and are to be
urgent medical attentio
n include:
administered under supervision of clinicians.
Fast breathing or
trouble breathing
How long can an infected person spread swine
Bluish skin color
flu to others?
Not drinking enou
gh fluids/eating food
People with swine influenza virus infection should be
Not waking up or
not interacting
considered potentially contagious as long as they are
Being so irritabl
e that the child does not
symptomatic and possibly for up to 7 days following
want to be held
onset of illness. Children, especially younger children,
might potentially be contagious for longer periods. Flu-like symptoms
improve but then return
with fever and wo
rse cough
What surfaces are most likely to be sources of
Fever with a rash
contamination?
In adults, emergency wa
rning signs that need
Germs can be spread when a person touches
urgent medical attentio
n include:
something that is contaminated with germs and
then touches his or her eyes, nose, or mouth. Difficulty breathi
ng or shortness of breath
Droplets from a cough or sneeze of an infected Pain or pressure i
n the chest or abdomen
person move through the air. Sudden dizziness
Confusion
How long can viruses live outside the body?
We know that some viruses and bacteria can live 2 Severe or persiste
nt vomiting
hours or longer on surfaces like cafeteria tables, Can I get swine influen
za from eating or
doorknobs, and desks. Frequent hand washing will preparing pork?
help you reduce the chance of getting contamination No. swine influenza vir
uses are not spread by food.
from these common surfaces. Eating properly handled
and cooked pork products
is safe.
7
...about CD Alert
CDAlert is a monthly newsletter of the National Institute of Communicable Diseas
es (NICD) , Directorate General of Health
Services, to disseminate information on various aspects of communicable diseases
to medical fraternity and health
administrators. The newsletter may be reproduced, in part or whole, for educatio
nal purposes.
Chief Editor: Dr. R. K. Srivastava
Editorial Board: Dr. Shiv Lal, Dr. R. L. Ichhpujani, Dr. Shashi Khare,
Dr. A. K. Harit
Guest Editor (Authors): Dr Archana Aravindan, Dr. Avdhesh Kumar, Dr Arti Bahl,
Dr Shashi Khare
Publisher: Director, National Institute of Communicable Diseases,
22 Shamnath Marg, Delhi 110 054
Tel: 011-23971272, 23971060 Fax : 011-23922677
E-mail: dirnicd@bol.net.in and dirnicd@gmail.com Websi
te: www.nicd.nic.in
Acknowledgement: Financial assistance by WHO/USAID is duly acknowledged
.
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