The viral flu currently sweeping across the country, especially, in the Southern Province though said to be under control due to inputs by the Health Ministry and swift treatment, has already claimed ten lives of mostly very young children. In the Matara General Hospital the number of suspected cases admitted is said to have leaped from 164 to 175 within a week.
While health officials allayed fears of the public and urged them not to panic as it was only a seasonal flu which commonly occurs during the rainy season, the World Health Organization in its latest report has warned that it can cause mild to severe illness leading to death, with those at risk being mostly very young children, the very old, those with compromised immune systems and people with chronic underlying medical conditions like cancer, diabetes and heart diseases. WHO has urged the public to take personal hygienic measures to protect themselves and others by covering their nose, mouth, when sneezing or coughing, with a tissue or hanky if they had flu like symptoms, to wash their hands with soap and water frequently, and avoid touching their faces . They have also been asked to stay away from crowded areas to avoid infecting others.
The flu this year has coincided with a dengue outbreak which despite the drastic reduction in cases compared to last year, are nevertheless mounting and causing concern to health officials.
The Sunday Observer spoke to Consultant Respiratory Physician, Dr Upul Pathirana, who has freshly returned from the UK after specializing in this field to share his views and give us more insight into this fast spreading health issue.
Excerpts...
Q. Respiratory infections have lately become the focus of attention following the deaths of several children at the Karapitiya Teaching Hospital and several patients still suffering from the disease in the Southern Province. There has been some confusion over the actual cause and even the definition of the term Respiratory Infection, with conflicting views over the actual cause by the attending doctors. Your comments?
A. Respiratory infections can appear from time to time as outbreaks in any part of the world. Therefore, this can happen locally too. During such epidemics, many individuals are affected within a short period of time resulting in the death of severely affected patients.
One hundred years ago, in 1918, an influenza outbreak killed millions of people worldwide. This situation is called influenza pandemic.
Q.. For the sake of our readers, tell us what Respiratory Infection is in laymen language.
A. Respiratory passages expose to microorganisms (bugs like bacteria and viruses) during the process of normal breathing. All of these organisms are not capable of causing illnesses in human, and on the other hand, the defence mechanisms within the air passages act to protect us from these bugs. However, when the microorganism is powerful enough to overcome the protective mechanisms, it can invade the tissues within the respiratory system causing respiratory infection.
Q. Is Respiratory Disease caused by one or several infections?
A. Respiratory infections can be categorized into several groups according to the types of infectious agents causing illnesses such as, viruses, bacteria, fungi and parasites. There are a number of identified microorganisms within these groups and additionally, new forms of them appear from time to time. Furthermore, some viruses such as, influenza increase the susceptibility to bacterial infection.
Q. What are the organs or sites of the body it affects most? Lungs? Chest? Nose?
A. The respiratory infections can involve one or more sites within the respiratory system such as, nose, sinuses, throat, airways (windpipe) and lungs. However, patients can experience symptoms related to other body systems like the gut and heart due to the involvement of these sites in addition to the respiratory system.
Q. Acute Upper Respiratory Infections (URI) and Upper Respiratory Tract Infections (URTI) – are the same thing? Is Influenza the same thing?
A. Yes, acute upper respiratory infections and upper respiratory tract infections are similar. This includes respiratory infections affecting nose, sinuses, throat and upper part of the airways. Influenza is an acute respiratory infection caused by influenza A or B viruses which affect both, the upper and lower respiratory tract.
Q. What are the typical symptoms? Are they the same for all?
A. The symptoms might vary among patients. Also, the symptoms you experience are different, depending on the site of involvement within the respiratory system. The typical symptoms are a cough – you may bring up mucus (phlegm), sneezing, a stuffy or runny nose, a sore throat, headaches, muscle aches, breathlessness, tight chest or wheezing, high temperature (fever), and feeling generally unwell. Some experience symptoms such as, vomiting and diarrhoea due to the involvement of other systems.
Q. Who are most at risk of getting such infections? Children? Adults? Or everyone?
A. It’s almost impossible to avoid viruses and bacteria; therefore, all of us can catch respiratory infections. But, certain risk factors increase your chances of developing acute respiratory infection. Children are especially at risk because of their constant contact with other kids who are infected with a virus. Therefore, children are important vectors for the spread of disease. Children often don’t wash their hands regularly. They are also more likely to rub their eyes and put their fingers in their nose, resulting in the spread of viruses.
Q. Who are likely to be adversely affected by respiratory infections?
A. There are vulnerable groups who are badly affected by respiratory infections. For example, acute respiratory illness caused by influenza virus can complicate in children (less than 5 years, and especially less than 2 years), older people (above 65 years), those under medical conditions (chronic lung diseases, heart diseases, nervous system diseases, kidney diseases, liver diseases and diabetes etc), weak immune system, women who are pregnant or delivered a baby recently, the extreme obese, and residents of nursing homes and other long term care facilities.
Q. What are the common Dengue types now spreading in the island? Is this usual at this time around?
A. In contrast to respiratory infections, Dengue fever is a mosquito borne disease caused by one of four closely related dengue viruses. According to the Dengue notification data from the Epidemiology Unit, Ministry of Health, there is some reduction of Dengue during April and May compared to January 2018. However, the incidence of Dengue may go up in the near future due to the present rainy weather.
Q. Do you see anything different in the kind of virus you see at present? Why?
A. Any virus can change their viral components with time. The difference is the extent of expected changes. The influenza virus can change its genetic and viral structure rapidly resulting in new form of influenza viruses. These new forms have the capability to cause influenza epidemics or sometimes pandemics. Dengue virus has also changed its genetic and viral structure. There had been an abrupt increase in Dengue incidence in the past due to such changes.
Q. How is 1) dengue 2) Influenza diagnosed?
A. Doctors can recognize the pattern of symptoms caused by dengue infection. They examine you to detect complications of dengue infection and order investigations to support or confirm the diagnosis. The NS-1 antigen detection test is a simple blood test to make the diagnosis of dengue during the first 4-5 days of fever. However, negative test cannot rule out the possibility of dengue. Therefore, the clinical judgement of a qualified doctor is mandatory to take decisions regarding hospital admissions and also for the treatment, once you are hospitalized. Similarly, doctors can suspect influenza with your presenting symptoms.
They focus their examination on your breathing pattern and listen to your lungs. Doctors might request chest x-ray depending on your illness status. Samples of respiratory secretions are processed in laboratories to confirm the diagnosis of influenza when it is indicated. The decision to test for influenza infection should be taken by a qualified doctor.
Q. When should a patient with flu like symptoms or symptoms that indicate DHF come to hospital?
A. You should consult a qualified doctor when you develop an acute febrile illness. Those at high risk of complications as listed above should seek medical advise early. Your doctor will decide whether you need hospital admission or not.
Q. Is the treatment and diagnosis available free in our state hospitals? Where?
A. Treatment facilities are available in state hospitals all over the country and is free of charge. Experienced doctors on clinical suspicion make the provisional diagnosis. Doctors request samples for laboratory diagnosis depending on your clinical situation and will provide appropriate advice regarding sample handling and transport to laboratories.
Q. Is Influenza a notifiable disease? Why not?
A. The disease surveillance system for communicable diseases in Sri Lanka comprised a number of aspects. One is routine notification of the diseases, which are approved by the advisory committee on communicable diseases, Epidemiology Unit, Sri Lanka. These are the listed diseases as locally and internationally notifiable diseases. The second is the special surveillance of selected communicable diseases. Another way of disease surveillance is the sentinel site surveillance. There is a national program of sentinel site virological surveillance of influenza. This helps to identify the current circulating viral pattern.
Q. The last guidelines for treating human influenza were issued in 2015 under two components 1) Influenza like illnesses ( ILI) and 2) Severe Acute Respiratory Infections ( SARI). Are they the same today?
A. Influenza is an uncomplicated respiratory infection in many affected individuals. On the other hand, it can be a complicated disease with severe illness causing respiratory failure or involvement of other organs such as heart or brain. Therefore, the treatment principles at present are similar to the 2015 revised summary guidelines for the management of influenza infection.
Q. I understand that the Epidemiological data collected are analyzed at the Medical Research Institute. Is that correct?
A. National Influenza Centre at Medical Research Institute (MRI) receives respiratory specimen samples from all over the country. These samples are processed within the virology department at MRI to type and subtype the influenza virus. The data of these tests are analyzed and published by the National Influenza Centre at MRI.
Q. Is there a link between dengue and Influenza manifestations?
A. . Yes, we can acquire both dengue and influenza during the period when virus outbreaks are coinciding. Those co-infected with dengue and influenza can have enhanced clinical disease.
Q. Can one confuse symptoms of dengue with respiratory infections?
A. Of course, there is a spectrum of presentation of Dengue. Many patients infected with dengue virus remain asymptomatic. Those who develop symptoms have an acute febrile illness with severe headache, muscle pain, joint pain, and bone pain. Some patients may have sore throat, vomiting and diarrhoea.
Influenza also causes symptoms of acute febrile illness with the above symptoms similar to dengue fever. Both, Dengue and Influenza are associated with complications. Therefore, you should consult a qualified doctor to avoid late diagnosis if you develop these symptoms.
Q. Is there a preventive vaccine for influenza?
A. Yes, there are vaccines developed to prevent influenza infection. Influenza continues to be a major threat to humans worldwide because of its ability to spread rapidly through populations. Vaccination is the principal measure to prevent the disease reducing the impact of epidemics.
The vaccines developed for influenza are being used worldwide for many years and they have proven that vaccines are safe and effective.
This virus changes its viral characteristics constantly. Therefore, influenza surveillance system identifies the most recently circulating influenza type and changes the vaccine periodically. This makes influenza vaccine an annual vaccine.
Based on the data from industrialized countries, the influenza vaccine may be targeted following high-risk groups, such as the following in order to reduce the incidence of severe illness and premature death
1. Residents of institutions for elderly people and disabled
2. All individuals above 6 months of age with chronic heart or lung diseases, metabolic or kidney diseases, and immuno deficiencies
3. Elderly people above a nationally defined age limit irrespective of other risk factors
4. Other groups defined on the basis of national epidemiological data and capacities such as pregnant women, health care workers, and children 6-23 months old (Source: Immunization hand book, Third edition, Epidemiology Unit, Ministry of Health, Sri Lanka). . Good hygienic practices are of utmost importance to protect you and others. You should cover your nose and mouth with a disposable tissue when coughing and sneezing, and dispose the used tissue immediately and properly. We should wash our hands with soap and water regularly, and avoid touching your face with unwashed hands to prevent introducing germs into your system. If you have flu-like symptoms: 1. Stay home from work, school and crowded places 2. Avoid hugging, kissing and shaking hands when greeting 3. Seek medical advice.
For more information on the subject contact, if you have any queries, please do not hesitate to contact 0716858158