A/H1N1: With upcoming poll, health officials warn of public gatherings

By Nadia Fazlulhaq

The upcoming Presidential poll campaign has set a serious poser for health authorities. In order to prevent the spread of A/HINI flu, they want to prevent large crowds congregating.

Ministry of Health Chief Epidemiologist Dr. Paba Palihawadane said yesterday, “Avoiding crowds is one of the best methods to control this epidemic. Participating in public rallies, conventions and public gatherings should be avoided as much as possible. Schools should take measures to avoid holding assemblies and concerts.”

This concern arose after health authorities discovered that some participants had been infected after they attended the SLFP convention at the Khettarama Stadium on November 15..

Dr. Palihawadane said that travelling in over crowded buses and trains are also a major cause for the spreading of the flu.

Eight laboratory confirmed deaths and 260 confirmed cases have been reported up-to-date, while many deaths and cases are left as “suspected cases” due to procedures and cost.

The Medical Research Institute, recognized as the national Influenza laboratory by the World Health Organization (WHO ) has reduced its tests to only 20 samples a day as instructed by the Ministry of Health.

“The Ministry bears a cost of Rs. 12,000 a test. Around 850 laboratory tests have been conducted and only 260 were confirmed as A/H1N1 flu. As it is costly the Ministry was compelled to cut down the number of sample tests,” a Health Ministry spokesman said.

Amidst desperate measures to control the spreading of the disease, the Health Ministry last week placed an immediate order to import 380,000 WHO approved, Novel Influenza (A)H1N1 2009 vaccine to Sri Lanka. The vaccine is due to arrive in December.

Global health authorities are recommending the use of oseltamivir or zanamivir drugs to treat and prevent the disease. Presently the anti viral agent oseltamivir to treat severe A/H1N1 cases is available only in 20 hospitals here.

Expecting a peak of the outbreak in the coming weeks, the Ministry also has decided not to grant foreign trips to public sector consultant specialists and doctors with exception for those attending important matters and post graduate studies.

“As there is an outbreak of A/ H1N1 influenza, the Health Ministry officially decided not to grant leave for long workshops and holidays for doctors. Only those who need to travel for postgraduate studies and urgent personal matters are given permission to leave the country,” he said.

The WHO’s latest update mentions that with the exception of Sri Lanka, overall transmission continued to decline in most parts of tropical South and Southeast Asia. Worldwide more than 206 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6770 deaths.

The winter influenza season continues to intensify across North America and much of Europe. In Canada, influenza transmission continues to intensify without a clear peak in activity; In Europe, widespread and increasing transmission of pandemic influenza virus was observed across much of the continent.

“A large number of tourists are expected this holiday season especially after the end of the war. A clear increase in the flu will be seen as most of the tourists are from western countries,” Dr.
Risintha Premaratne, consultant epidemiologist attached to the Epidemiology Unit said. He said, students presently studying overseas and who would come here for the vacation could be possible-carriers of the virus.

“The first confirmed case of pandemic influenza A/H1N1 in the country was reported in June 2009--a boy who arrived from Australia,” he said. Initially a surveillance programme was initiated at the Bandaranaike International Airport, Katunayake where all arriving passengers were screened by the 2 thermal scanners installed at the immigration desk and those detected with high fever directed to the healthdesk.

At the immigration desk all passengers are handed a leaflet containing necessary information on the disease symptoms and the contact points. If any suspected cases are detected they are sent to the Infectious Diseases Hospital (IDH) Colombo through a separate exit and a special ambulance is available for this purpose.

However according to Airport health officials the two thermal scanners have been removed now and there is no health desk at the airport to detect possible A/H1N1 patients. The Sunday Times learns that following the community outbreak the Health Ministry had informed the airport health officials to remove the thermal scanners.

Dr. Premaratne said that with A/H1N1 declared as a global pandemic, it is feared that it could affect the more risked groups in the country.

Children younger than 2 years old, adults 65 years and older, pregnant women and those with certain chronic medical or immuno suppressive conditions such as chronic lung (including asthma), cardiovascular, (excluding hypertension), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), immuno suppression, including that caused by medications or by HIV, those with disorders that can compromise respiratory function e.g. spinal cord injuries, seizure disorders and people younger than 19 years who are receiving long-term aspirin therapy fall under the risk group.

“This is a new strain of Influenza virus that has minimal or no population immunity and spreads easily from human to human like seasonal flu. It also has the potential to cause serious illness with high mortality,” Dr. Premaratne said.

He said that increased global transport , urbanization & overcrowded conditions, ability to reach all corners of globe in a short time , adverse outcome among high risk groups and the economic cost – 800 billion US $ ( 20 times > SARS) are some of the major concerns related to A/H1N1 influenza.
The symptoms of pandemic flu are similar to the symptoms of regular human flu that include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with pandemic flu.

Difficulty in breathing or shortness of breath, severe or persistent vomiting, pain or pressure in the chest or abdomen, sudden dizziness, confusion, symptoms improving to return with fever and worse cough prevailing among adults are considered as danger signs that need immediate medical treatment.
In Children, fast breathing or trouble breathing, cyanosis, reduced fluid intake, reduced urine output, severe or persistent vomiting, lack of interactions, irritability, symptoms improving only to return with fever and worse cough are considered as danger signs.

The initial community outbreak in the country was reported with a few students of an International School in Nugegoda reportedly infected with the Influenza. But the virus was fast spreading especially in the Central Province.

Central Province Health Director Dr. Shanthi Samarasinghe said that 15 suspected deaths were reported while five of them were confirmed.

“At present 52 suspected cases have been admitted to hospitals of the three districts, although hundreds are treated daily. Most of them are pregnant women, children and those suffering from various medical conditions,” she said.

She said that the school vacation which is scheduled for December 9 will be given early as health authorities were concerned about the students in the province.

“We are of the view that the schools should be closed to prevent further deaths occurring. The weather condition in the province is making the situation worse .We have also informed to close private classes as well as international schools. Some of the schools had their term tests but the others will be conducted at the beginning of the next term,” Dr.Samarasinghe said.

She said that hospitals were instructed to advise the public to reduce the number of visitors coming to the hospitals. Meanwhile, several schools and classrooms were closed temporarily in Wennappuwa, Homagama, Nuwara Eliya, Kurunegala and Ratnapura. Suspected cases were reported from Kegalle, Matara, Galle, Ratnapura, Chilaw, Anuradhapura and Batticoloa.

Two deaths of pregnant women were reported from Anuradhapura and Matara while the death of a school principal was reported from Kurunegala. The 58-year-old principal, K.W Gunathilaka from Kurunegala died after he was admitted to the Kurunegala Hospital due with suspected A/H1N1.
Kurunegala Deputy Provincial Director of Health Services Dr. Palitha D. Yapa said 50-60 persons were admitted to the Kurunegala Teaching hospital. Around 16-17 were clinically confirmed cases but they were awaiting the laboratory tests.

National Hospital Director Dr. Hector Weerasinghe said patients from Colombo are directed to the Infectious Diseases Hospital (IDH). “There are 115 beds in the Fever Hospital and if the beds are occupied we have identified a separate a ward at the National Hospital,” he said.

“A pregnant woman who was suffering from Influenza, died while giving birth to her fourth child due to complications Dr. B. Wijekoon, the Director of Anuradhapura Teaching Hospital said. He said that the baby was in good health and was not infected with the virus.

He said that around 12 confirmed cases were receiving treatment at the hospital. The case of forty-year-old Muthulechchumi from an estate in Thalawakelle being infected with the virus has causd concern that it could spread in the estates.

According to regional health sources from Nuwara Eliya, presently there are several flu cases being reported from the estates and Estate Medical Superintendents have been advised to carry out awareness programmes on A/H1N1 sysmptoms.

People at high risk of developing flu-related complications

  • Children younger than 5, especially those younger than 2 years old
  • Adults 65 years of age and older
  • Pregnant women People who have medical conditions including:
  • Asthma
  • Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].
  • Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
  • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
  • Blood disorders (such as sickle cell disease)
  • Endocrine disorders (such as diabetes mellitus)
  • Kidney disorders
  • Liver disorders
  • Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
  • Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids)
  • People younger than 19 years of age who are receiving long-term aspirin therapy

Source: Centre for Disease Control and Prevention

Signs and symptoms

  • Difficult to differentiate from seasonal flu
  • Fever
  • Cough
  • Sore throat
  • Body ache
  • Head ache
  • Fatigue
  • +/- Nausea, vomiting and diarrhea (especially in children)
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