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Swine Flu Update and guidance for parents

Humanitarian Resource Institute
Stephen M. Apatow
President, Director of Research and Development, Humanitarian University Consortium Graduate Studies Center for Medicine, Veterinary Medicine and Law

Tel: (203) 668-0282
Internet: www.humanitarian.net

 4 May 2009

IDIN: Pathobiologics International: Biodefense Threat Analysis & Communication Center
Subject: Pandemic Influenza: Contingency Planning Discussion

Update regarding Novel A/H1N1 (Swine Flu):

1. The name Swine Flu (Novel A/H1N1) has been a controversial topic but it is important to know that the reason why it was called "Swine Flu" is because influenza viruses rarely jumps from swine to human with efficient transmission, the last time this happened was 1918.  See: Novel A/H1N1: WHO Fact Sheet.

2. This strain has now demonstrated the capacity to be transmitted from Human to Swine.  (1) suspect farm worker returns from Mexico begins working April 14, (2) 10 days later pigs exhibiting symptoms and (3) currently herd of 2,200 pigs infected.  See: Alberta pig farm under flu quarantine: Calgary Herald, 3 May 2009; WHO urges close watch on farms for new swine flu: AFP, 3 May 2009.

Note: Swine are considered the mixing vessel, where reassortment and new strains can evolve... this is a natural process that has always occurred.  The concern is not swine food production facilities with high biosecurity, but farms in the global regions with severe poverty (over 3 billion of the earths population) and no public health infrastructure.  We are still awaiting the test results from pigs on the small back yard farms in the region associated with ground zero in Mexico.

In the context of surveillance, containment and control, our objective to realize access to molecular diagnostics capability to within 4 hours of any global population demographic with satellite links to reference labs and bioinformatics capability.  

3.  As this new strain (Novel A/H1N1) spreads and is transmitted to swine in regions across the globe with endemic high consequence strains in the ecosystem, the capacity for reassortment rises as does the evolution of a more pathogenic strain.  Recombination analytics, concerns regarding geographic surveillance encompass:

4.  If new highly pathogenic recombinant strain(s) evolve (Swine to Human with efficient Human to Human transmission), then the entire global emerging infectious disease picture will exponentially become more complicated.  Ex. If a new strain picked up the characteristics of Pandemic H5N1 or West Nile virus, we could watch migratory birds contribute to global spread.  Following the initial outbreak of West Nile Virus in New York City, the virus spread throughout North America by migratory birds within two years.

Collaborative efforts between veterinary and human medicine for surveillance, containment and control of this WHO Level 5 Pandemic Strain of Novel A/H1N1 (Swine Flu), is a priority.


Stephen M. Apatow
Founder, Director of Research and Development
Pathobiologics International

In its continuing coverage of the H1N1 Flu (Swine Flu), the Consumer Reports medical team today takes a look at flu guidance for parents.


Stay tuned for CR’s up-to-the minute coverage or log on for previous reports on symptoms to watch for; travel tips for avoiding the flu; a report on which antivirals work; when to use a mask; how to tell the difference between seasonal allergies, colds and the flu; and helpful tips for the uninsured.


Log on to http://blogs.consumerreports.org/health/swine-flu/ for CR’s coverage.



Flu guidance for parents

Schools have been one of the main avenues of transmission of the H1N1 (swine) flu in the U.S. Some individual schools have closed, and in Fort Worth, Texas today all public schools were closed through May 11, according to the New York Times. More closings will likely follow.

All parents should stay informed about flu incidence in their local communities and teach their children about the simple measures that can help prevent infection. If you live in a community where the H1N1 flu has been diagnosed or suspected, stay in contact with your school or daycare, and local public health authorities to get the latest information and guidance.

Here are the key prevention, planning, and treatment recommendations from the federal government and Consumer Reports’ medical experts.


  • If swine flu is in your community, stay away from malls, theaters and other crowded places.

  • Teach your children to wash their hands vigorously with soap and water for 20 seconds, especially after going to the bathroom, before and after eating, and after coughing or sneezing.

  • Show them how to cough or sneeze into their elbow to avoid infecting their hand, or cover their mouth with a tissue when they cough or sneeze, and to throw it away.

  • Tell them to try their best to keep a distance of about six feet from others who are sick.

  • Keep sick children at home from school or daycare until they are better. Children can remain infectious longer than adults, up to 10 days, compared to about 7 for adults.


If the flu does come, expect school closings and have a plan in place for taking care of your child. If you don’t have any friends or relatives who can take care of your kids in an emergency, you might ask your employer what options you might have. Can you take time off, sick leave or telecommute? It’s best to get these questions answered now, so you’re prepared in the event of a school closing, or a sick child. You might also get in touch with your daycare to see if a pandemic flu plan is in place. If not you can help them make one.


If your child does get symptoms of the flu call your health provider to see about testing and treatment. Typical symptoms include fever, cough, sore throat, body aches and headache, chills and fatigue and sometimes gastrointestinal symptoms, such as diarrhea and vomiting. Very young children appear less likely to have typical flu symptoms, like fever and cough. In young children also watch for difficulty breathing and low activity. If infants have fever and lethargy, call the doctor, even if they don’t have respiratory symptoms, like coughing.

Pregnant women and young children, especially those under 5 years of age and those with underlying medical conditions are at increased risk of complications of flu.

Your doctor may prescribe one of the antiviral drugs—either Tamiflu (oseltamivir) or Relenza (zanamivir)--for children one year of age or older. Also, the FDA recently issued an emergency authorization allowing Tamiflu to be prescribed for children under one.

In addition to an antiviral medication, ask about fever reducing medications appropriate for their age. Stay away from aspirin, and aspirin-containing products such as Pepto-Bismol, which can cause Reye’s syndrome, and for children under six, cough and cold medicines. Make sure children have plenty of liquids, such as water, juice or Pedialyte, and keep them comfortable so they get enough rest. To limit transmission, try to keep sick children separated from uninfected ones, and give them a box of tissues and a garbage bag to throw them away in.

Seek emergency help if you notice any of the following symptoms in children:

  • Rapid breathing or trouble breathing

  • Bluish or gray skin color

  • Dehydration or refusing fluids

  • Child won’t wake up or interact with you

  • Extreme irritability making the child not want to be held

  • Symptoms improve then return with fever and worse cough

Kevin McCarthy, associate editor

Keep up to date with our swine-flu coverage and recommendations.



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