Tag Archives: pandemic

Pandemic

(Survival Manual/1. Disaster/Pandemic)

 Humans often tend to forget that they are not the only living species which adapts to and exploits the populations of other living beings.
A virus, such as one of the influenza variety, would have  a field day in our global, highly inter-connected society, especially in the midst of an economic depression (remember, H1N1 killed 50 million people in the early 20th century).

 1.  Overview: Surviving a deadly  pandemic
•  The duration of  a medical crisis  is usually 14-21 days depending on the disease and its method of movement through the country. There may be another 2-3 months before things swing back  to normal, but the worst will be over in 3 weeks.
•  Today we understand that a 30-40 day break in a human borne diseases cycle will stop most from spreading, except in the case where there are vectors such as rates, mice, pigeons that continue to harbor, carry and spread the disease.
•  Successful medical survivors will need to be news junkies, learning all there is to know about any threatening disease. What is it, how is it spread, why is  it here, what hosts are involved, and how long lived outside of human/ animal hosts?
•  Things to watch for: Look for signs that diseases are spreading than the experts normally expect, that the strain if disease is especially difficult to treat, that it is being spread by means not previously observed by those in the medical profession, that there are observed multiple /simultaneous outbreaks, that the disease is strangely affecting plants and /or livestock.

Diseases characterized as being ‘a far more virulent strain’ and/or that ‘are attacking our agricultural production’ are especially cautionary.
•  The basics of survival need not include anything more than provision for food, water, shelter, energy, medical and sanitary and self actualization.
•  Own a full face respirator (HEPA=high efficiency particulate air) with HEPA filters capable of sorting out particle down to about 0.3 microns. That size includes TB and smallpox organisms. Smallpox is one of the largest viruses known. You will need to store 4-6 extra sets of filters for each apparatus per
person. (see Disaster/Biological warfare document)
•  When an outbreak reaches the 30-50% rate victims will be whisked away to a central location if for no other reason to get them out of sight to die.
•  If  the epidemic is raging in your community or the neighbor have contracted it, you may be faced with wearing your mask continuously indoors.  (safety people who currently use masks claim,  “You get use to them”). In any event, city survivors might wish to wear at least a model N95 HEPA disposable filter during any infrequent time they leave the retreat to replenish supplies.
•  Remember that irregardless of the promises and issued statements, government never has done well at medical or any other enterprise. There is no penalty for government workers who fail to produce or who make wrong decisions.
•  The best survival defense is total obscurity. Another iron rule of survival is that you should never, never become a refugee. Worldwide, throughout history, refugees have always been as good as dead.  Refugees are characterized as being hopeless people with absolutely no control over  their lives. All of lives necessities are provided by others—always at their whim. Crime is rampant. In refugee camps, private property ownership is always nonexistent. Any necessity of life comes from the will of an often-disinterested, corrupt, arrogant, bureaucrat. Food, shelter, warmth, family stability, sanitation and personal safety are all in the hands of another person—who usually doesn’t give a damn.
•  Another rule of survival is that as much energy as possible should come from renewable or scrounged sources, ie firewood, burnable scrap, , peat dug out of a nearby bog, etc.
•  Effective shelter absolutely must provide for a place to safely store food supplies, prepare food, provide access to water, answer to one’s need for cleanliness and sanitation, and provide protection and security.
•  The deployment of tents means more than one tent, as there should be one tent for kitchen and food supplies, and another for personal shelter and maybe a 3rd for sanitation and porta-pottie.

How a pandemic might look (synopsis)
Some effects that a pandemic might have:
First off, people might not go to work, either because they’ve got the disease, they’re  too scared to show up, their workplace has been closed, or they’ve got to stay home because their kids are out of school.

The results of this might include:
•  Utility plants (power, gas, water, sewage) left untended, and maintenance and routine chores neglected until they cease tofunction.
•  Nobody available to fix things that break: powerlines, water mains, etc.
•  Public transit closed, either because there’s no employees around to run said transit (or for quarantine reasons)
•  Farmers who can’t farm, because they’re sick or they can’t get gas, diesel, propane, or supplies.
•  Items stored in warehouses can’t be distributed,including, potentially, food and medication and parts to fix things
•  Gasoline and diesel shortages
•  Retail and grocery stores closed
•  Additionally, local authorities may institute quarantines and closures. Either you may be unable to
travel to get your groceries, or the groceries themselves may be stuck inside or outside of a quarantined area. (One would assume that the authorities will figure out how to safely get supplies delivered; one would also assume that there would be some chaos and bureaucracy involved. I’d rather not go hungry
for a few days while they wrangle out the details.) It’s the rare grocery store that stocks more than enough food for a day or two for a given area. And areas where large groups gather, including schools, retail stores, movie theaters, and nonessential businesses of any kind, may simply be closed to limit spread.
•  Quarantine is a real possibility. Some of the families of the infected patients in the US have already been told to stay home until the authorities are sure they’re not sick. (See above: contagious before symptoms.) I’ll assume that, since there are only a few of them, having food and supplies delivered to the sick and quarantined won’t be a problem. However, if there are tens of thousands of families sick,
and all their friends, family, and the local pizza delivery drivers in the city are sick? Yeah. That could be logistically a little bit more of a challenge.
•  Finally, a pandemic will put a huge stress on the economy. Businesses will go under. It’s kinda hard to keep a cash flow going if you can’t sell anything because both your customers and your employees are unable to buy anything because of illness, quarantine, or unwillingness to leave the house. And if people can’t work because of quarantines and closures, they won’t have money to buy things.  Our economy is already a fragile house of cards. A pandemic would yank a few supporting aces out of the base, in unpredictable and potentially disastrous ways.

So. You need to prep in a hurry. What do you do?
First off, consider the basics. (See topic, Preparing for a Pandemic, below
1)  Water
2)  Food
3)  Shelter
4)  Health care
5)  Personal protection

First, cover your “water supplies” first. This is fairly easy, but also rather important. You  could see either shortages or contaminated water if water treatment plants break down, and if you’re on a well, you’ll need a power source to pump the well.
Get some jugs, fill them up, set them aside somewhere in your house. Figure a couple gallons per person per day. (You’ll need water for cleaning, drinking, and cooking.) How many days worth of water you feel you need to store is very situation dependent, of course. I’m probably going to need have a lot more water stored in Arizona than a guy living on a lake somewhere in the Pacific Northwest where it rains every day.
Also, if you don’t have some in your laundry room, get a couple jugs of chlorine bleach,and set it aside for water purification. For unscented chlorine bleach at 4-6% strength add 8 drops per gallon of water. If water is contaminated (see: water treatment plant breakdown) or you need to resort to natural sources of water such as rainwater or rivers and creeks you’ll have something to purify it with.
If you don’t need to purify water, you can use it for sanitation or for your laundry, and an extra jug of bleach is cheap enough that it shouldn’t be a budget breaker.

Second, figure out what you’re going to do for food. A few weeks, or even a month or two, of supplies is a good idea.
If you buy basic staples, you probably won’t break the bank. Buy food that you’ll actually eat and know how to cook, or can easily learn. Also, buy food with an idea of how you’ll cook it if the power goes out. If you’ve got a large home propane tank that’s been recently topped off or a wood burning stove you may chose to stock different types of food than someone who’s living in an apartment with just an electric range. If the power goes out, cooking a big pot of dry beans is not easy … but you can still eat a cold can of soup.
Go for the most calories for your buck if you’re short on money. Also, do not overstock on items that need to be frozen or refrigerated.  If the power goes out, or your freezer simply breaks down (See:  Murphy’s Law), you’re going to be eating a lot of meat in a hurry if your preps included half a cow.

Severity?
The severity of the next pandemic cannot be predicted, but modeling studies suggest that its effect
in the United States could be severe. In the United States, a pandemic influenza outbreak similar to the 1918 strain, could result in:
•  2.25 million deaths
•  90 million falling ill
•  60% absenteeism in the workplace
•  An economic impact of $310 billion reduction in GDP

Bird flu poses no great threat to humanity. This disease is simply too lethal to its victims and  too fast in killing them to ever pose any significant threat to mankind. With a 50% or so mortality rate  occurring in about 5 to 7 days after infection this disease cannot live long enough to spread. It also assures prompt detection.
Quick effective countermeasures can be applied. It may be a problem, but H5N1, as this virus is known, is not going to be a mass killer.

A pandemic disease of great danger has a unique pattern for its transmission and lethality. A dangerous pandemic disease will only have a moderate mortality rate in the order of 1% or 2%. This
will allow the disease to survive and infect. It will spread slowly and incubate for fairly long periods of time. This provides effective transmission to large numbers of victims. H5N1 simply doesn’t fit the bill. Even in a fairly mutated form this disease has little or no prospect of ever being a serious threat. The high rates of morality for bird flu and its fast transmission will make great headlines. It will not make a great epidemic. This bird flu will die out too fast to amount to anything. This is why the disease after 7 years has only produced a few deaths.

The flu is truly a dangerous disease.
In any given year the USA will lose between 10,000 and 50,000 people to the flu. It will make ill in varied degrees of seriousness between a million and 5 million persons. A truly serious flu epidemic could kill millions and make sick large parts of the population. We definitely need much more effective measures to deal with the flu in whatever form that arrives each year.

Pandemic Self Quarantine (Influenza)
•  10 days for personal infection = 1 incubation period
•  21 days minimum, more likely 8 to 10 with 12 weeks maximum for the community = 3 to 5 incubation periods
•  The disease may have run its course after the initial wave, if not may return in 3,6 or 12 months with a second wave. While the initial wave will most likely occur during the normal flu season, November through March, subsequent waves may arrive for a few individuals in June, but no new community outbreaks occur until August. with a wave peak in October (see below–to get chronology right).

2.  Preparing for a Pandemic
An expert discusses the ‘Must-Haves’ if Bird Flu (or ‘fill in the blank’) cripples the country.

The Red Cross says that if there’s a pandemic, we need to prepare for 10 days of being stuck in our homes, and that we may be without power and water during that time. In the event of a bird flu pandemic, Americans should plan for interruptions or delays in other services: Banks might close, hospitals could be overwhelmed, and postal service could be spotty. Experts also say that people need to begin stocking up on extra food and supplies like protective masks, flashlights, portable radios, batteries and matches.

“When you go to the store and buy three cans of tuna fish, buy a fourth and put it under the bed.
When you go to the store to buy some milk, pick up a box of powdered milk, put it under the bed,” said Health and Human Services Secretary Mike Leavitt. “When you do that for a period of four to six months, you are going to have a couple of weeks of food. And that’s what we’re talking about.”

Previous pandemics occurred in 1918, 1957 and 1968, and the worst waves of illness seem to pass
through communities in a matter of six weeks to eight weeks. Computer models suggest about 30 percent of people could be infected, but not all at the same time.

In the event of a pandemic, people must practice what the health officials call “social distancing,” or keeping away from other people’s germs. Schools and day-care centers could be closed, sporting events and other large gatherings could be canceled, and shaking hands could become socially unacceptable, at least for a while.

Darlene Washington, the director of disease prevention education at the American Red Cross, points
out some of the must-haves in the event of a bird flu pandemic.

Have 3 sources for each of the following necessities
•  Water–(utility, potable water storage, rainwater catchment, local fresh water supply/ treatment).
•  Food–(store, stocked cupboard, food storage program)
•  Shelter–(Home, camper, tent, 2nd home, relative or friend living away from the area)
•  Energy–(Utilities, Propane and propane appliances, firewood, solar appliances, battery backup/ photovoltaic

Water
“We recommend that each member of your family has a gallon of water for each day, so a family of
four needs to have 40 gallons of water available for a 10 day emergency period, that water needs to be stored because there’s a chance that your water will get cut off if there’s a pandemic,” Washington said. “Workers may not be able to make it, and plants may stop operating. Your family will need to drink water and for hygiene, for brushing their teeth and washing their hands.”

Food
In previous centuries, people had no means of  accumulating and preserving enough food and water to see them through a 3-10 week crisis. Fortunately, this is no longer true today. Modern technology
allows us to store food and water and to separate ourselves from disease  organisms.
You need foods that will not spoil, so you need canned foods like tuna. You also need to get foods that you don’t have to heat, because just like your water, your powers may go out, too. In addition, to things like canned tuna, you should start storing peanut butter, protein, bars, crackers. Again, foods that have a long shelf life and that don’t need to be heated. Make sure you have enough formula and baby food to get through that 10 days. You have to plan for every member of your family and that includes your pets. So get extra dog food or cat food, and make sure you have extra water for your pets. You need a 10-day supply for everyone.”

In spite of the apparent violation of the Rules of Three: Food storage alone is the best single recommendation for epidemic  survivors.

Some common sense:
•  If there is a avian type disease around, don’t  eat pigeons.
•  If yellow fever, malaria or any other mosquito borne disease is pandemic you may not want to wade into the swamp or hang around the lake collecting cattails.
•  If some mutant form of bubonic plague, spread by natural causes or bio-warfare is around, don’t consider rats as an emergency food.

Power Outages
It’s reasonable to believe that the grid will mostly  stay up during an epidemic and that emergency may be short lived.
“Stores are going to run out of what you need, too,” Washington said. “So that’s why you need to stock up now. And we encourage families to have supplies on hand like flashlights and batteries, matches. Hand-cranked or battery-operated radios, and a manual can opener, because you are going to need to open all those cans of food. And this may not seem important, but you must get activities for your children and yourself, games, coloring books, cards.”

Cleaning Supplies
“You have to have all those on hand to keep your home clean and to have receptacles for all your
trash,” she said. “You probably won’t have trash service and you need to account for that. You need to make sure to have paper towels, toilet paper and soap. Everything you need to keep your home clean and practice good hygiene.”

Medication
“You need to get an additional 10 days of all your prescription medications,” Washington said. “You
should also have over-the-counter, fever-reducing medications; medications for upset stomach; and cold and flu medication. You’ll also want to have fluids like Gatorade and Pedialite, which have electrolytes and will help a family member rehydrate if they get sick. Also, keep a few thermometers around in case someone gets sick.”
Taking refuge in a travel trailer or tent is OK for medical survivors, as long as you  don’t become refugees.

 If a Family Member Gets Sick …
“The first thing is  to strengthen your hand washing and to have the infected family member cover
his mouth when he coughs,” she said. “You should also keep that person isolated in a certain part of the house and identify a family member who will help him. You may have to take turns.”

Concepts to consider when preparing for a pandemic & self quarantine
•  Flu spreads in waves of 3-5 months with 3 months in-between.
•  Self-quarantine for 90-120 days per wave.
•  Government efforts to supply food and water are 10% effective at best.
•  Outside dirty, inside clean; Boy in the Bubble concept
•  Maintain household shelter with a good seal.
•  Clear brush and undergrowth 100 feet parameter around the house.
•  Preferable: Heat pump with forced air cooling/heat to filter out virus/microbes.
• Have a water reservoir, i.e., covered, pool, tubs and barrels, then disinfected.
•  Any source of standing water or body of water is a contaminate. Remove birdbaths,  old tires and/or fill puddles. Virus lives in water for days, influenza lives on hands 5 minutes.
•  Don’t have  bird feeders or chicken in your yard
•  Food supply; Have 1year supply per person.
•  Vacuum with bags that filter for allergens.
•  No eating from outside gardens, only preserved food.
•  Indoor sprouts, fluorescent lights for indoor growing plants vegetables.
•  Bleach for water disinfectant (10 drops/gallon) and medicinal wound care (½ sterile water ½ bleach).
•  Hand cleaners- soap and alcohol based.
•  Running water for washing hands, not standing water.
•  Face masks N-95 and goggles for outside.
•  No individual contact less than 8 feet (NO handshakes etc) social distancing.
•  Animals inside space and same social considerations.
•  Dogs and cats immunizations kept up (any stray dog will be shot).
•  Water repellent clothing w/ hood when outside (large garbage bags)
•  Toilet bowl cleaner tablets for inside standing water (tidy-bowl etc).
•  No contact with people within 8 feet, viruses jump 5+ feet.
•  If an exchange is required drop item in spot i.e. porch and leave then the receiver can pick up the item i.e. soup, firewood etc. (This was the practice during the 1918 influenza)
•  Keep dust to minimum, dusters, wet wipes. Sneeze into your elbow.
•  Keep surfaces clean with disinfectant.
•  Bake items coming into house for 20 min at 325F+ degrees (Microwave is best)
•  Good hygiene; Wash hands thoroughly and frequently after contact from outside world.
•  Once one individual leaves and breaks quarantine, they cannot return to re-infect rest of household.
•   No group meetings parties’ weddings, funerals, church, etc.
•  Only burn wood that is stored under protective covering and dry, if wet consider it contaminated.
•  Wallpaper the ceiling, walls and windows with foil in one safe room to insulate and retain heat.
•  UV lighting on surfaces (can cause skin cancer).
•  No washing cars by hand.
•  Flies and mosquitoes out must be kept out, don’t leave windows, doors open, screens are not an option. Bug Zappers are either a really good idea because they kill bugs or a real bad idea because they attract bugs.
•  Handling mail, wear gloves and bake mail before opening it (e-mail best).
•  Analog phone for when power goes out.
•  OTC medicine supply for diarrhea and cold remedies.
•  Homemade ‘Gatorade’: 1 tsp Lite Salt (source of potassium) + 1/3 tsp Baking Soda + 10 tsp sugar + 1 qt water OR 1 tsp salt + 3 tsp sugar + 1 qt water.
•  Turnips, clover and potatoes are good crops for cold weather.
•  0.4 rads / min acceptable after nuclear fall out.
•  Mice- use copper wool stuffed into holes around plumbing to keep them out.
•  Garbage bags to wear punch holes in sides and put arm through, good for warmth and as a disposable barrier from the outdoors.
•  Have a supply of Vitamins.
•  Wash down entryways w/ bleach or cleaner.
•  Keep shoes outside of living quarters (on enclosed pourch).
•  Use a pressure cooker and/or microwave to disinfect food.
•  Food from the outside- root veggies only (microwave and wash).
•  Cage animal, not range free (rabbits)
•  Dishwasher sterilizes
•  Remember your dishcloth is the dirtiest item in household
•  Shopping cart handles are the dirtiest item in public
•  Magazines  are the dirtiest item in doctor’s office
•  Your purse is exposed to everything, same with the morning coffee mug that follows you around at work
•  Do not share pens, combs, etc.
•  Tarp and duct tape corpses, bury deep at home if possible
•  Remove moss from roof as it harbors bacteria and virus.
•  Streams, lakes, ponds, marshes, rivers are sources of contamination.
•  Keep the outside yard dry, no watering lawn.
•  Rain, Snow, Mist, and fog are also carriers for the virus…
•  The Plague never returned to London after London’s Great Fire

3.  Flu Pandemic Mitigation – Social Distancing
 “It’s not like a ‘snow day!”
The so-called social distancing measures they studied would dramatically alter the life of the city for a period of months — long enough, Eubank said, for vaccine makers to develop a vaccine.

Schools and day-care centers would close. Theaters, bars, restaurants and ball parks would be shuttered.
Offices and factories would be open but hobbled as workers stay home to care for children. Infected people and their friends and  families would be confined to their homes.
“We are not talking about simply shutting things down for a day or two like a ‘snow day’. It’s a sustained period for weeks or months,” he said. “You wouldn’t go out to the movies. You wouldn’t
congregate with people. You’d pretty much be staying home with the doors and windows battened down,” he said.

While those measures seem draconian, Eubank said they are steps many people would take on their own in the face of a deadly flu outbreak. “In the context of a very infectious disease that is killing a
large number of the people, I think large fractions of the population won’t have a problem with these recommendations,” Eubank said.

 Two ways of increasing social distance activity restrictions are to 1) cancel events and 2) close buildings or to restrict access to certain sites or buildings. These measures are sometimes called “focused  measures to increase social distance.” Depending on the situation, examples of cancellations and building closures might include: cancellation of public events (concerts, sports events, movies, plays) and closure of recreational facilities (community swimming pools, youth clubs, gymnasiums).

Closure of office buildings, stores, schools, and public transportation systems may be feasible community containment measures during a pandemic. All of these have significant impact on the community and workforce, however, and careful consideration should be focused on their potential
effectiveness, how they can most effectively be implemented, and how to maintain critical supplies and infrastructure while limiting community interaction. For example, when public transportation is cancelled, other modes of transportation must be provided for emergency medical services and medical
evaluation.

In general, providing information to domestic and international travelers (risks to avoid, symptoms to look for, when to seek care) is a better use of health resources than formal screening. Entry  screening of travelers at international borders will incur considerable expense with a disproportionately small impact on international spread, although exit screening would be considered in some situations.

Although data is limited, school closures may be effective in decreasing spread of influenza and reducing the overall magnitude of disease in a community. In addition, the risk of infection and illness among children is likely to be decreased, which would be particularly important if the pandemic strain causes significant morbidity and mortality among children. Children are known to be efficient transmitters of seasonal influenza and other respiratory illnesses. Anecdotal reports suggest that community influenza outbreaks may be limited by closing schools. Results of mathematical modeling also suggest a reduction of overall disease, especially when schools are closed early in the outbreak.
During a Pandemic Period, parents would be encouraged to consider child care arrangements that do not result in large gatherings of children outside the school setting.

There is some evidence that big gatherings of people encourage spread of flu, and measures to flatten the epidemic curve can helpful in easing the most intense pressure on health services. Limiting public gatherings can be an effective preventive measure for diseases that are transmitted through the air [unlike flu] – especially for diseases that are transmitted by individuals with no symptoms [such as flu]. Often, public health experts recommend limiting exposures to others-such as frequently occurs during influenza season. There is a big difference between recommending limited public gatherings and enforcing a more specific and uniform requirement. In making a decision to close gathering places, the impact on economy, education, and access to food / water / other necessities needs to be balanced with the ability to effectively protect the public through such means.

During the 1957-1958 pandemic, a WHO expert panel found that spread within some countries
followed public gatherings, such as conferences and festivals. This panel also observed that in many countries the pandemic broke out first in camps, army units and schools; suggesting that the avoidance of crowding may be important in reducing the peak incidence of an epidemic.

During the first wave of the Asian influenza pandemic of 1957-1958, the highest attack rates were seen in school aged children. This has been attributed to their close contact in crowded settings. A published study found that during an influenza outbreak, school closures were associated with significant decreases in the incidence of viral respiratory diseases and health care utilization among children aged 6-12 years.

Given a pandemic strain causing significant morbidity and mortality in all age groups and the absence of a vaccine, the WHO consultation on priority public health interventions before and during an influenza pandemic concluded that authorities should seriously consider introducing population-wide measures to reduce the number of cases and deaths. These would include population-wide measures to
reduce mixing of adults (furlough non-essential workers, close workplaces, discourage mass gatherings). Decisions can be guided by mathematical and economic modeling.

The Center for Biosecurity of University of Pittsburgh Medical Center [UPMC] argued that idea that the cancellation of public gatherings or the imposition of travel restrictions might limit the spread of disease are scientifically unfounded, and that presenting them has the potential to create false expectations about what can be accomplished by government officials and their proposed containment measures. The UK Government, for instance, has concluded that closing schools and other
educational facilities would have a limited effect on the epidemic. There would be a major reduction in the numbers of students affected. On the other hand, there would be little reduction in the number of cases in the rest of the population. The UK Government concluded that there was little evidence that
cancelling large public events would have any significant impact on the course of the epidemic.

Flu Pandemic Home Care
Home care will be the predominant mode of care for most people infected with influenza. Most patients with pandemic influenza will be able to remain at home during the course of their illness and can be cared for by other family members or others who live in the household.  Anyone residing in a household with an influenza patient during the incubation period and illness is at risk for developing influenza. A key objective in this setting is to limit transmission of pandemic influenza within and outside the home. When care is provided by a household member, basic infection control precautions should be emphasized (e.g., segregating the ill patient, hand hygiene). Infection within the household may be minimized if a primary caregiver is designated, ideally someone who does not have an underlying condition that places them at increased risk of severe influenza disease. Although no studies have assessed the use of masks at home to decrease the spread of infection, use of surgical or procedure masks by the patient and/or caregiver during interactions may be of benefit.

The term “flu” is much used and abused.
Some people use the term “stomach flu” as an informal way of saying “gastroenteritis of unknown etiology.” Sometimes people confuse cold and flu, which share some of the same symptoms and occur at the same time of the year (cold and flu season). However, the two diseases are very different. Most
people get a cold several times each year, and the flu only once every several years. Others think that “flu” is any kind of illness with aches and fever with or without respiratory symptoms. In reality, influenza is none of these things. Influenza is a specific, often severe, respiratory viral infection caused by influenza viruses. The whole body suffers from it.

Typical symptoms include:
• 
The flu usually begins abruptly, with a fever between 102 to 106°F (with adults on the lower end of the spectrum). Other common symptoms include a flushed face. Some people have dizziness or vomiting. The fever usually lasts for two or three days, but can last 5 days.
•  Somewhere between day 2 and day 4 of the illness, the “whole body” symptoms — chills, weakness, lack of energy, loss of appetite, and aching of the head, back, arms, legs — begin to subside, and respiratory symptoms begin to increase.
•  The virus can settle anywhere in the respiratory tract, producing symptoms of a cold, croup, sore throat, bronchiolitis, ear infection, or pneumonia. The most prominent of the respiratory symptoms is usually a dry, hacking cough. Most people also develop a sore (red) throat and a headache.
Nasal discharge and sneezing are common. These symptoms (except the cough)
usually disappear within 4-7 days
•  Sometimes there’s a second wave of fever at this time.
•  Often the person continues to feel sick for several days. Cough and tiredness usually last for weeks after the rest of the illness is over.
•  Sometimes the person can have complications, such as dehydration or pneumonia.The disease is characterized by abrupt onset of constitutional and respiratory symptoms, including fever, chills, muscle aches, headache, malaise, nonproductive cough, sore throat, and runny nose. Upper respiratory and constitutional symptoms tend to predominate in the first several days of
illness, but lower respiratory symptoms, particularly cough, are common after the first week. In children, nausea and vomiting and, occasionally, ear infection are also symptoms.
•  Since several other respiratory pathogens (including adenovirus, respiratory syncytial virus, para influenza virus, rhinovirus, corona virus, human metapneumo virus, Mycoplasma pneumoniae and Legionella) can also cause a similar clinical picture, definitive diagnosis of influenza requires laboratory confirmation. However, laboratory testing is not necessary for all patients. In the presence of a community outbreak of respiratory illness, a presumptive diagnosis can be made based on knowledge of the predominant agent causing the outbreak. Uncomplicated influenza gets better with or without treatment, but may cause substantial discomfort and limitation of activity before getting better.
Complications of influenza can include bacterial infections, viral pneumonia, and cardiac and other organ system abnormalities. People with chronic medical conditions may have increased risk of complications when they get influenza.
Many other diseases, including serious infections such as rapidly progressive bacteremias, may start with symptoms that resemble influenza and may need to be considered in treatment decisions. Many people with uncomplicated influenza use over-the-counter medicines to help lessen their symptoms.Here are some tips to keep from spreading your germs to others, and to keep from catching someone else’s germs.

Keep your germs to yourself
•   Cover your nose and mouth with a tissue when sneezing, coughing or blowing your nose.
•   Throw out used tissues in the trash as soon as you can.
•   Always wash your hands after sneezing, blowing your nose, or coughing, or after touching used
tissues or handkerchiefs. Wash hands often if you are sick.
•   Use warm water and soap or alcohol-based hand sanitizers to wash your hands.
•   Try to stay home if you have a cough and fever.
•   See your doctor as soon as you can if you have a cough and fever, and follow their instructions,
including taking medicine as prescribed and getting lots of rest.
•   If asked to, use face masks provided in your doctor’s office or clinic’s waiting room; follow their instructions to help stop the spread of germs.

Keep the germs away
•  Wash your hands before eating, or touching your eyes, nose or mouth.
•  Wash your hands after touching anyone else who is sneezing, coughing, blowing their nose, or whose nose is running.
•  Don’t share things like cigarettes, towels, lipstick, toys, or anything else that might be contaminated with respiratory germs.
•  Don’t share food, utensils or beverage containers with others.
•  Especially during a pandemic or disaster situation you are best served by not visiting the hospital if you can help it, where you are more likely to sit or stand next to a person carrying incurable TB, flu, smallpox, or whatever epidemic disease is ‘going around’. Remember, the doctor’s office and hospital’s
waiting room is where the sick congregate, it’s this infected group that you are trying to avoid! You are much more likely to encounter contagious people in hospitals than anywhere else, even though the facilities are generally much more sanitary. Survivors will try to avoid contact with anyone while outside.

4.   Plan  Ahead
People should plan ahead and think about what they need to have in their house in case someone in their household were to become infected with influenza and need to receive care at home. If you live alone, are a single parent of young children, or are sole caregiver for a frail or disabled adult, it would be a good idea to have some items stored in your home in case of illness:
•  Have enough fluids (e.g. water, juice, soup) available to last for 2 weeks.
•  Have enough basic household items (e.g. tissues) to last for 2 weeks.
•  Have acetaminophen and a thermometer in the medicine cabinet. Do you know how to use/read a thermometer correctly? If not, ask someone to show you how.
•  Think of someone you could call upon for help if you became very ill with the flu and discuss this possibility with him or her.
•  Think of someone you could call upon to care for your children if you were required to work and their school or day care was closed because of the influenza pandemic; discuss the possibility with them.

A.  Infection Control Measures in the Home
•  All persons in the household should carefully follow recommendations for hand hygiene (i.e., hand washing with soap and water or use of an alcohol-based hand rub) after contact with an influenza patient or the environment in which care is provided.
•  Although no studies have assessed the use of masks at home to decrease the spread of infection, use of surgical or procedure masks by the patient and/or caregiver during interactions may be of benefit. The wearing of gloves and gowns is not recommended for household members providing care in the
home.
•  Soiled dishes and eating utensils should be washed either in a dishwasher or by hand with warm water and soap. Separation of eating utensils for use by a patient with influenza is not necessary.
•  Laundry can be washed in a standard washing machine with warm or cold water and detergent. It is not necessary to separate soiled linen and laundry used by a patient with influenza from other household laundry. Care should be used when handling soiled laundry (i.e., avoid “hugging” the laundry) to avoid contamination. Hand hygiene should be performed after handling soiled laundry.
•  Tissues used by the ill patient should be placed in a bag and disposed with other household waste. Consider placing a bag for this purpose at the bedside.
•  Normal cleaning of environmental surfaces in the home should be followed.

B.  Management of Well Persons in the  Home
•  Persons who have not been exposed to pandemic influenza and who are not essential for patient care or support should not enter the home while persons are actively ill with pandemic influenza.
•  If unexposed persons must enter the home, they should avoid close contact with the patient.
•  Persons living in the home with the pandemic influenza patient should limit contact with the patient to the extent possible; consider designating one person as the primary care provider.
•  Household members should monitor closely for the development of influenza symptoms and contact a telephone hotline or medical care provider if symptoms occur.

C.  Management of Influenza Patients
Persons who have a sudden onset of influenza-like symptoms (e.g. headache, fever, chills, cough, chest pain, sore throat, muscle aches, weakness, exhaustion) should do the following:
•  Remain at home at least until all symptoms have resolved (approximately 4-5 days)
•  Take medication as needed to relieve the symptoms of the flu.
•  Decongestants, such as phenylephrine, and pseudoephedrine, produce a narrowing of blood vessels. This leads to clearing of nasal congestion, but it may also cause an increase in blood pressure in patients who have high blood pressure. OTC drugs to relieve stuffy noses often contain more than one ingredient. Some of these products are marketed for allergy relief and others for colds. They usually contain both an antihistamine and a nasal decongestant. The decongestant ingredient unstuffs nasal passages; antihistamines dry up a runny nose. But some of these products may also contain aspirin or acetaminophen, and some contain a decongestant alone. Closely related products with similar names may have different ingredients. There are other medications in the form of nasal drops and sprays sold OTC for this purpose. As with pills, some of these are long acting (up to 12 hours) and some  are shorter acting. And, as with pills, most have some side effects. Many of the products contain a nasal decongestant such as oxymetazoline or phenylephrine. When used for more than three days or more often than directed by the label, these drops or sprays can sometimes cause a “rebound” effect, in which the nose gets more stuffy. Other nose drops and sprays are formulated with a saline (salt) solution and can be used for dry nose or to relieve clogged nasal passages.
• Dextromethorphan, an antitussive, is used to relieve a nonproductive cough caused by a cold, the flu, or other conditions.
Dextromethorphan comes as a liquid or as a lozenge to take by mouth. It is usually taken every 4-8 hours as needed. Do not take more than 120 mg of dextromethorphan in a 24-hour period. Refer to the package or prescription label to determine the amount contained in each dose. The lozenge should
dissolve slowly in your mouth. Drink plenty of water after taking a dose. Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
•  Antipyretics are fever-reducing medications; the term comes from the Greek word pyresis, which means fire. Ibuprofen (Motrin) and acetaminophen (Tylenol) are generally recognized as safe and effective single analgesic-antipyretic active ingredients. These two antipyretics can be taken
together or on an alternating 4 hour schedule. Ibuprofen provides greater temperature decrement and longer duration of antipyresis than acetaminophen when the two drugs are administered in approximately equal doses.
•  Never give aspirin to children or teenagers who have flu-like symptoms (and particularly fever) without first speaking to your doctor. Giving aspirin to children and teenagers who have influenza can cause a rare but serious illness called Reye syndrome. Reading the label becomes especially important when it comes to products containing aspirin (acetylsalicylic acid) or their chemical cousins, other salicylates, which are used to reduce fever or treat headaches and other pain.
•  A person’s fluid needs are greater when that person has fever. Drink lots of fluids (water and other non-alcoholic, non-caffeinated beverages) to avoid becoming dehydrated. Start with sips of any fluid other than caffeinated beverages. Drinking too much fluid at once can bring on more vomiting. Electrolyte solutions available in drugstores are usually best. Sport  drinks contain a lot of sugar and can cause or worsen diarrhea.
•  If you have diarrhea, it’s a good idea to rest, eat only small amounts of food at a time, and drink plenty of fluids to prevent dehydration. Avoid over-the-counter diarrheal medications unless specifically instructed to use one by your doctor. Certain infections can be made worse by these drugs. When you have diarrhea, your body is trying to get rid of whatever food, virus, or other bug is causing it. OTC products marketed to stop diarrhea may contain loperamide (Imodium A-D), or attapulgite (Diasorb, Kaopectate and others), or bismuth subsalicylate (Pepto-Bismol and others).
•  Use either a traditional glass thermometer for each person [don’t cross-contaminate patients], or a digital thermometer with lots of  disposable sleeves. The thermometers are a few dollars. The sleeves are a dollar or so per hundred.

  • Get plenty of bed rest
  • Do not smoke
  • Restrict visitors to their home
  • Cover mouth and nose with a tissue when coughing or
    sneezing.
  • Keep at least 3 feet away from others.
  • Patients should not leave the home during the period when
    they are most likely to be infectious to others (i.e., 5 days after onset of
    symptoms). When movement outside the home is necessary (e.g., for medical
    care), the patient should follow cough etiquette (i.e., cover the mouth and
    nose when coughing and sneezing) and wear procedure or surgical masks if
    available.

To protect the patients infected with influenza, individuals having contact with the patient, and the community in general, certain infection control measures should be practiced:

  • Wash hands often with warm soap and water, scrubbing for 15-20 seconds
  • Family members should wash hands or use waterless hand sanitizer after contact with the patient
  • Do not share eating utensils or drinks
  • Do not rub eyes, touch nose or mouth
  • Patients should cover their mouths and noses with tissue when coughing or sneezing, dispose of used tissues immediately after use and wash hands after using tissues
  • In general, wearing goggles or a face shield for routine contact with patients with pandemic influenza is not necessary. If sprays or splatter of infectious material is likely, goggles or a face shield should be worn as recommended for standard precautions.
  • In the absence of visible soiling of hands, approved alcohol-based products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbiocidal activity, reduced drying of the skin, and convenience.
  • Physically separate the patient with influenza from non-ill persons living in the home as much as possible.

In a pandemic influenza event, some individuals who are cared for at home may develop complications. Should complications develop, these individuals should seek medical care immediately, either by calling the doctor or going to an emergency room. Upon arrival, the receptionist or nurse should be told about the symptoms so that precautions can be taken (providing a mask and or separate
area for triage and evaluation).

D. Warning Signs to seek urgent medical care
In children, these include:
1.  High or prolonged fever for more than 4-5 days
2. Fast breathing or trouble breathing
3. Bluish skin color
4. Not drinking enough fluids
5. Changes in mental status, somnolence, irritability
6. Seizures, confusion or seizures
7. Influenza-like symptoms improve but then return with fever and worse cough
8. Worsening of underlying chronic medical conditions (for example, heart or lung disease, diabetes)
9. Cough becomes productive of yellow sputum

In adults,  these include:
1. High or prolonged fever for more than 4-5 days
2. Difficulty breathing or shortness of breath
3. Cough becomes productive of yellow sputum
4. Pain or pressure in the chest
5. Near-fainting or fainting
6. Confusion or seizures
7. Severe or persistent vomiting [2 to 3 times in 24 hours] (vomiting is usually present in young children and elderly persons with influenza infection)
8. Skin color changes (lip and hands)
9.  Persons should seek medical attention at their physician’s office, urgent care facility or hospital emergency department if they are at high risk for the development of complications:
•   People age 65 and older, people of any age with chronic medical conditions and very young children are more likely to get complications from influenza.
•  Pregnant women also have an increased risk for pneumonia, lung insufficiency, and death after an influenza infection.

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Viral Hemorrhagic Fevers

(Survival Manual/6. Medical/b) Disease/Viral hemorrhagic fevers)

  http://www.mayoclinic.com/health/viral-hemorrhagic-fevers/DS00539

Definition
Viral hemorrhagic (hem-uh-RAJ-ik) fevers are infectious diseases that interfere with the blood’s natural ability to clot. These diseases can also damage the walls of tiny blood vessels, making them leaky. The internal bleeding that results can range from relatively minor to life-threatening.

Some viral hemorrhagic fevers include:
•  Dengue – (see Survival Manual/6. Medical/b) Disease/ Dengue)
•  Ebola – (see Survival Manual/6. Medical/b) Disease/ Ebola)
•  Lassa – (see Survival Manual/6. Medical/b) Diseas/Lassa fever)
•  Marburg
•  Yellow fever – (see Survival Manual/6. Medical/b) Disease/Yellow Fever)

These diseases most commonly occur in tropical areas of the world. When viral hemorrhagic fevers occur in the United States, they’re usually found in people who’ve recently traveled internationally.
Viral hemorrhagic fevers are spread by contact with infected animals, people or insects. No current treatment can cure viral hemorrhagic fevers, and immunizations exist for only a few types. Until additional vaccines are developed, the best approach is prevention.

Symptoms
Signs and symptoms of viral hemorrhagic fevers vary by disease. In general, initial symptoms may include:
•  High fever
•  Fatigue
•  Dizziness
•  Muscle aches
•  Weakness
[Photograph at right: The face of this patient appeared flushed due to dilation of the capillaries. Severe     vomiting could also cause rupture of the blood vessels in the eyes.]

Symptoms can become life-threatening
Severe cases of some types of viral hemorrhagic fevers may cause bleeding:
Under the skin
•  In internal organs
•  From the mouth, eyes or ears
Other signs and symptoms of severe infections can include:
•  Shock
•  Nervous system malfunctions
•  Coma
•  Delirium
•  Seizures
•  Kidney failure

 When to see a doctor
The best time to see a doctor is before you travel to a developing country to ensure you’ve received any available vaccinations and pre-travel advice for staying healthy. If you develop signs and symptoms once you return home, consider consulting a doctor who focuses on international medicine or infectious diseases. A specialist may be able to recognize and treat your illness faster. Be sure to let your doctor know what areas you’ve visited.

Causes
The viruses that cause viral hemorrhagic fevers live naturally in a variety of animal and insect hosts — most commonly mosquitoes, ticks, rodents or bats.
Each of these hosts typically lives in a specific geographic area, so each particular disease usually occurs only where that virus’s host normally lives. Some viral hemorrhagic fevers also can be transmitted from person to person.

 How is it transmitted?
The route of transmission varies by specific virus. Some viral hemorrhagic fevers are spread by mosquito or tick bites. Others are transmitted by contact with infected blood or semen. A few varieties are breathed in if you’re around infected rat feces or urine.
If you travel to an area where a particular hemorrhagic fever is common, you may become infected there and then develop symptoms after you return home.

Risk factors
Simply living in or traveling to an area where a particular viral hemorrhagic fever is common will increase your risk of becoming infected with that particular virus. Several other factors can increase your risk even more, including:
Working with the sick
•  Slaughtering infected animals
• Sharing needles to use intravenous drugs
•  Having unprotected sex
•  Working outdoors or in rat-infested buildings

Complications
Viral hemorrhagic fevers can damage your: Brain, Eyes, Heart, Kidneys, Liver, Lungs and/ or Spleen; in some cases, the damage is severe enough to cause death.

Tests and diagnosis
Diagnosing specific viral hemorrhagic fevers in the first few days of illness can be difficult because the initial signs and symptoms — high fever, muscle aches, headaches and extreme fatigue — are common to many other diseases.
To reach an accurate diagnosis, your doctor is likely to ask about your medical and travel history and any exposure to rodents or mosquitoes. Be sure to describe international trips in detail, including the countries you visited and the dates, as well as any contact you may have had with possible sources of infection.
Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis. Because viral hemorrhagic fevers are particularly virulent and contagious, these tests are usually performed in specially designated laboratories using strict precautions.

Treatments and drugs
While no specific treatment exists for most viral hemorrhagic fevers, the antiviral drug ribavirin (Virazole, Rebetol) may help shorten the course of infection and prevent complications in some cases.

 Therapy
Supportive care is essential. To prevent dehydration, you may need fluids to help maintain your balance of electrolytes — minerals that are critical to nerve and muscle function.

Surgical and other procedures
Some people may benefit from kidney dialysis, an artificial way of cleaning wastes from your blood when your kidneys fail.
Patients receive supportive therapy, but generally speaking, there is no other treatment or established cure for VHFs. Ribavirin, an anti-viral drug, has been effective in treating some individuals with Lassa fever or HFRS.

Prevention
 Preventing viral hemorrhagic fevers, especially in developing nations, presents enormous challenges. Many of the social, economic and ecological factors that contribute to the sudden appearance and spread of infectious diseases — war, displacement, destruction of habitat, lack of sanitation and proper medical care — are problems that have no easy or quick solutions.
If you live in or travel to areas where viral hemorrhagic fevers are common, you should take precautions to protect yourself from infection.

 Get vaccinated
The yellow fever vaccine is generally considered safe and effective, although in rare cases, serious side effects can occur. Check with the Centers for Disease Control and Prevention about the status of the countries you’re visiting — some require certificates of vaccination for entry. The yellow fever vaccine isn’t recommended for children under 9 months of age or for pregnant women, especially during the first trimester. Vaccines for several less common types of viral hemorrhagic fevers are currently in development.

 Avoid mosquitoes and ticks
Wear light-colored long pants and long-sleeved shirts or, better yet, permethrin-coated clothing. Don’t apply permethrin directly to the skin. Avoid unnecessary activities at dusk and dawn when mosquitoes are most active and apply mosquito repellent with a 20 to 25 percent concentration of DEET to your skin and clothing. If you’re staying in tented camps or local hotels, use bed nets and mosquito coils.

 Guard against rodents
To prevent rodent infestations in your home:
•  Keep pet food covered and stored in rodent-proof containers.
•  Store trash in rodent-proof containers, and clean the containers often.
•  Dispose of garbage on a regular basis.
•  Make sure doors and windows have tightfitting screens.
•  Place woodpiles and stacks of bricks and other materials at least 100 feet from your house.
•  Mow your grass closely and keep brush trimmed to within 100 feet from your house.

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Dengue fever

(Survival manual/6. Medical/b) Disease/Dengue fever)

Dengue Fever Overview
Dengue fever is a disease caused by viruses that are  transmitted to people by mosquitoes. Dengue fever usually causes fever (high, about 104 F-105 F), skin rash (see Figure 1), and pain (headaches and often severe muscle and joint pains). The disease has also been termed “breakbone” or “dandy fever” because the unusually severe muscle and joint pains can make people assume distorted body positions or exaggerated walking movements in an effort to reduce their pain.

Dengue fever is endemic in tropical and subtropical areas. Dengue fever is estimated by the WHO (World Health Organization) to cause about 50-100 million infections per year worldwide. The CDC considers dengue fever to cause the majority of acute febrile illnesses in travelers returning to the U.S. In 2009, dengue fever was noted to occur in Key West, Florida, in residents who did not travel
outside the U.S. More cases were identified in 2010, which suggests that dengue fever may become endemic in Florida, and possibly south Texas, due to new infections also diagnosed in this area. The first clinical report of dengue fever was in 1789 by B. Rush, although the Chinese may have described the disease associated with “flying insects” as early as 420 AD. Africans described “ka dinga pepo” as cramp-like seizure caused by an evil spirit. The Spanish may have changed “dinga” to dengue since it means fastidious or careful in Spanish, which describes the gait of people trying to reduce the pain of walking.
[Photo above right: Rash on legs due to dengue fever; image reprinted from eMedicine.com, photo courtesy of Duane Gubler, PhD.]

(See also CDC Health Travel Advisory, updated to 8 September 2011: http://wwwnc.cdc.gov/travel/notices/outbreak-notice/dengue-tropical-sub-tropical.htm
Unfortunately, the disease incidence seems to be increasing in Thailand, India, Singapore, Philippines,
Puerto Rico, Mexico, and Cape Verde with new outbreaks in 2009-10. Researchers suggest the surge in dengue fever may be due to several factors:
• Increased urban crowding  with more sites for mosquitoes to develop
• International commerce that contains infected mosquitoes, thus introducing the disease to areas previously free of the disease
• Local and world environmental changes that allow mosquitoes to survive the winter months
• International travelers who carry the disease to areas where mosquitoes have not been previously infected.

“…Currently, dengue fever and its complications cause an estimated 50 to 100 million infections, a half-million hospitalizations, and 22,000 deaths annually in more than 100 countries, including parts of South America, Central America, the Caribbean, India, Southeast Asia, and Africa. By 2085, an estimated 5.2 billion people—3 billion additional people worldwide—are projected to be at risk for dengue because of climate change–induced increases in humidity that contribute to increased mosquito presence. Already, the specific types of mosquitoes that can transmit dengue fever have become established in a swath of at least 28 states and the District of Columbia, and across the south and mid-Atlantic regions of the United States and there were 4000 cases of the disease reported to the Centers for Disease Control between 1995 and 2005…”
http://maryanncp.wordpress.com/2009/10/29/coming-to-your-area-soon-breakbone-fever-and-jericho-buttons/

Dengue Fever Symptoms and Signs
The symptoms and signs for dengue begin about three to 15 days after a mosquito bite transfers a virus (dengue virus serotype 1-4) to a person previously unexposed to the viruses. Fever and painful muscle and joint aches can occur during the first few hours of symptoms when headache, chills, rash, and swollen lymph nodes first appear. Pain behind the eyes is also a common symptom. These symptoms usually last about two to four days and then diminish, only to reappear again with a rash that covers the body and spares the face. The rash also may occur on the palms of the hands and the bottom of the feet, areas frequently spared in many viral and bacterial infections. The symptoms may last about one to two weeks with complete recovery, in most cases, in a few weeks. However, some people can develop more severe symptoms and complications, such as hemorrhagic areas in the skin, gums, and the gastrointestinal tract. This clinical problem is termed dengue hemorrhagic fever (DHF). The majority of DHF is seen in children under 15 years of age, but it can occur in adults. Another clinical variation of dengue fever is termed dengue shock syndrome (DSS); DHF usually precedes DSS. The patients eventually develop severe abdominal pain, heavy bleeding, and blood pressure drops; this syndrome, if not treated quickly, may cause death.

Causes of Dengue Fever
Four closely related viruses cause dengue fever. The viruses are transmitted from Aedes aegypti and Aedes albopictus mosquitoes to humans in a viral cycle that requires both humans and these mosquitoes. There is no human-to-human dengue fever transmission. Once a mosquito is infected, it remains infected for its life span. A human can infect mosquitoes when the human has a high number
of viruses in the blood (right before symptoms develop). The viruses belong to the Flaviviridae family and have an RNA strand as its genetic makeup.
Virologists term them dengue virus types 1-4 (DENV 1-4). All four serotypes are closely related. However, there are enough antigenic differences between them that if a person becomes immune to one serotype, the person can still be infected by the other three serotypes.

Diagnosis of Dengue Fever
Dengue fever is presumptively diagnosed by a medical caregiver by the relatively characteristic sequence of high fever, rash appearance, and other symptoms in a person who has a history of recent travel to dengue endemic areas and recalls mosquito bites while in the endemic area. However, if not all of the symptoms or history is complete, the caregiver is likely to run a number of tests to obtain a
definitive diagnosis. Other diseases may yield similar symptoms (for example, leptospirosis, typhoid fever, yellow fever, scarlet fever, Rocky Mountain spotted fever, meningococcemia, and several others) if the patient has severe symptoms; or if the medical caregiver does not have enough information to make a presumptive diagnosis, the patient is likely to undergo a number of other tests to definitively distinguish dengue fever from other diseases. In general, the more serious the symptoms such as easy bruising, fevers at or above 104 F, hemorrhages or shock syndrome, the more tests are likely to be done.
In general, most clinicians will order a complete blood test (CBC), with a metabolic panel, along with coagulation studies in most patients with high fever and any bleeding problems.

Dengue Fever Treatment
Fortunately, this viral disease is usually self-limited and usually adequate hydration and pain control will help the person through the infection. However, for dengue fever, a caution is given by most clinicians in home treatment. Nonsteroidal anti-inflammatory agents (for example, aspirin (Bayer, Ecotrin), ibuprofen (Motrin), and other NSAIDs) should be avoided because of the tendency of the dengue viruses to cause hemorrhages. The NSAIDs may add to the hemorrhage symptoms. Other medications such as acetaminophen (Tylenol), codeine, or other agents that are not NSAIDs may be used.

Self-Care at Home
Home care for dengue fever is simply supportive care. Good oral hydration, pain control with Tylenol (or other non-NSAIDs) is usually adequate treatment for most people. However, there is no role for home care in patients with dengue hemorrhagic fever or for dengue shock syndrome; depending on the patient’s condition, many clinicians consider these conditions to be medical emergencies.

Dengue Fever Risk Factors
The risk factors for dengue fever are as follows:
•  traveling to or living in endemic or outbreak areas, especially if no mosquito control is attempted by
the people or government;
•  mosquito bites;
•  a repeated infection with another serovar of dengue virus with antibodies in the serum active against the first infecting serovar;
•  and not taking precautions to avoid mosquito bites.

Dengue Fever Complications
The complications of dengue fever are usually associated with the more severe forms of dengue fever, hemorrhagic and shock syndrome. The most serious complications, although infrequent, are as follows:
•  dehydration;
•  bleeding (hemorrhage);
•  low platelets;
•  low blood pressure (hypotension);
•  bradycardia;
•  liver damage;
•  neurological damage (seizures, encephalitis);
•  and death.

Dengue Fever Prognosis
For the large majority of people infected with dengue fever viruses, the prognosis is excellent, although they are likely to feel very ill during the first one or two weeks of the acute illness and weak for about one month. Patients with underlying illness or immune depression have a fair to good prognosis because they are more likely to get complications. Also, people who have been infected by one dengue viral serovar are still able to be infected by the remaining three serovars; a second infection increases the possibility that complications will develop so patients with second-time dengue fever have a less optimal prognosis. Patients who develop DHF or DSS have a range of outcomes from good to poor, depending on their underlying medical problems and how quickly supportive measures are given. For example, DHF and DSS have about 50% fatality rate if untreated but about a 3% rate if treated with supportive measures.
Overall, the fatality rate is about 1% of all dengue fever infections. While this rate may seem low, worldwide it means that about 500,000 to 1 million people die each year from dengue fever. This is a concern since the worldwide case numbers and outbreaks are increasing.

Dengue Fever Prevention
Dengue fever can be prevented by stopping mosquitoes from biting because they are the vectors the dengue viruses require for transfer to humans. The CDC (2010) has supplied these general rules to prevent transfer of viruses and other pathogens by mosquitoes and other biting vectors:
•  Avoid outbreaks: To the extent possible, travelers should avoid known foci of epidemic disease transmission. The CDC Travelers’ Health web page provides alerts and information on regional disease transmission patterns and outbreak alerts (http://www.cdc.gov/travel).
•  Be aware of peak exposure  times and places: Exposure to arthropod bites may be reduced if travelers
modify their patterns of activity or behavior. Although mosquitoes may bite at  any time of day, peak biting activity for vectors of some diseases (for example, dengue, chikungunya) is during daylight hours. Vectors of other diseases (for example, malaria) are most active in twilight periods (for example, dawn and dusk) or in the evening after dark. Avoiding the outdoors or focusing preventive actions during peak hours may reduce risk. Place also matters; ticks are often found in grasses and other vegetated areas.
Local health officials or guides may be able to point out areas with greater arthropod activity.
•  Wear appropriate clothing: Travelers can minimize areas of exposed skin by wearing long-sleeved shirts, long pants, boots, and hats. Tucking in shirts and wearing socks and closed shoes instead of sandals may reduce risk. Repellents or insecticides such as permethrin (Elimite) can be applied to clothing and gear for added protection; this measure is discussed in detail below.
•  Check for ticks: Travelers should be advised to inspect themselves and their clothing for ticks during outdoor activity and at the end of the day. Prompt removal of attached ticks can prevent some infections.
•  Bed nets: When accommodations are not adequately screened or air conditioned, bed nets are essential to provide protection and to reduce discomfort caused by biting insects. If bed nets do not reach the floor, they should be tucked under mattresses. Bed nets are most effective when they are treated with an insecticide or repellent such as permethrin. Pretreated, long-lasting bed nets can be purchased prior to traveling, or nets can be treated after purchase. The permethrin will be effective for several months if the bed net is not washed. (Long-lasting pretreated nets may be effective for much longer.)
•  Insecticides: Aerosol insecticides, vaporizing mats, and mosquito coils can help to clear rooms or areas of mosquitoes; however, some products available internationally may contain pesticides that are not registered in the United States. Insecticides should always be used with caution, avoiding direct inhalation of spray or smoke.
•  Optimum protection can be provided by applying repellents.

The CDC recommends insect repellent should contain up to 50% DEET (N,N-diethyl-m-toluamide) which is the most effective mosquito repellent for adults and children over 2 months of age.
There are no vaccines currently available commercially for dengue virus serovars.
Sources: http://www.emedicinehealth.com/script/main/hp.asp

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Pandemic timelines

(Survival Manual/6. Medical/b) Disease/Pandemic timelines)

PANDEMIC TIMELINES

1.  Historic pandemics
http://en.wikipedia.org/wiki/Infectious_disease
•  430 BC, The Peloponnesian War Pestilence: The very first pandemic in recorded history was described by Thucydides. In 430 BC, during the Peloponnesian war between Athens and Sparta, the Greek historian told of a great pestilence (thought to be either Typhus or Bubonic plague) that wiped out over 30,000 of the citizens of Athens (roughly 33%-66% of all Athenians died).
•  165AD, The Antonine Plague: In 165 AD, Greek physician Galen described an ancient pandemic, now thought to be smallpox, that was brought to Rome by soldiers returning from Mesopotamia. The disease was named after Marcus Aurelius Antoninus, one of two Roman emperors who died from it. At its height, the disease killed some 5,000 people a day in Rome. By the time the disease ran its course some 15 years later, a total of 5 million people were dead.
•  541-542 The Plague of Justinian: In 541-542 AD, there was an outbreak of a deadly disease in the Byzantine Empire. At the height of the infection, the disease, named the Plague of Justinian after the reigning emperor Justinian I, killed 10,000 people in Constantinople every day. With no room nor time to bury them, bodies were left stacked in the open. By the end of the outbreak, nearly half of the inhabitants of the city were dead. Historians believe that this outbreak decimated up to a quarter of human population in the eastern Mediterranean.
•  In 1200 AD, China’s population was reliably reported to be about 123 million; 200 years later it had plummeted to some 65 million (47% reduction, 1 of 2). Reportedly, vast country sided was empty. No crops were being raised. Now 800 years later it’s difficult to be sure, but this dramatic  dieback was probably due to the effects of plagues and famines that followed.
• 1340s, The Black Death (Plague): After the Plague of Justinian, there were many sporadic outbreaks of the plague, but none as severe as the Black Death of the 14th century. The Black Death took a heavy toll on Europe. The fatality was recorded at over 25 million people or 25% of the entire population. The Black Death came in three forms: the bubonic, pneumonic, and septicemic plague. The first, the bubonic plague, was the most common: people with this disease have buboes or enlarged lymphatic glands that turn black (caused by decaying of the skin while the person is still alive). Without treatment, bubonic plague kills about half of those infected within 3 to 7 days.
•  Ca 1500, During the 3 decade prior to 1520, when Hernan Cortez landed in Mexico, Smallpox wiped out an estimated 15 million Aztecs.
•  Between 1500 until about 1520, some 10 million Europeans died from a more virulent form of Syphilis than exists today.
•  1700s: Influenza pandemics in 1729-1730, 1732-1733, 1781-1782.
•  1781: Major epidemic causing high mortality among the elderly spreads across Russia  from Asia.
•  1817-2011 (and continuing) Cholera: 8 pandemics; hundreds of thousands killed worldwide. In  the 19th century, Cholera became the world’s first truly global disease in a series of epidemics that proved to be a watershed for the history of plumbing.  The major cholera pandemics are generally listed as: First: 1817-1823, Second: 1829-1851, Third: 1852-1859, Fourth: 1863-1879, Fifth: 1881-1896, Sixth: 1899-1923: Seventh: 1961- 1970, and some would argue that we are in the Eighth: 1991 to the present. Each pandemic, save the last, was accompanied by many thousands of deaths. As recently as 1947, 20,500 of 30,000 people infected in Egypt died.
•  1830: A 2nd major epidemic (previous similar pandemic 39 years earlier, in 1781) causing high mortality among the elderly spread across Russia from Asia.
•  1793, Yellow Fever killed 15% of Philadelphia’s population in 1793.
•  1918, The Spanish Flu: In March 1918, during the last months of World War I, an unusually virulent and deadly flu virus was identified in a US military camp in Kansas. Just 6 months later, the flu had become a worldwide pandemic in all continents. When the Spanish Flu pandemic was over, about 1 billion people or half the world’s population had contracted it. It was perhaps, the most lethal
pandemic in the history of humankind: between 20 and 100 million people were killed, more the number killed in the war itself.
•  Between 1917-1921, rural Russia lost an estimated 10 million people out of a population of 85 million (12% reduction, 1 in 8), not as battlefield casualties, but as a direct result of famine and disease.
Minimally, 3 million are thought to have died from Typhus.
•  In 1947, during the chaos of their struggle for independence, an estimated 1 million Indians died in the world’s worst Malaria epidemic.
•  As late as 1940, immediately before the wise spread introduction of antibiotics, some 13,000 Americans still died annually from Syphilis. AIDS by contrast killed about 16,000 people in the US in 1999.
•  1981 – 2011 (and continuing) AIDS: Has killed 25 million people worldwide. Acquired Immune Deficiency Syndrome (AIDS) has led to the deaths of more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history.
http://en.wikipedia.org/wiki/Infectious_disease
Note: The highest historical death rates in an community from plagues and disease is 60%.

Note: While the following articles were written about the H1N1 Swine Flu, they should be understood as a metaphor for communicable human diseases in general.

__A. History of swine flu,  H1N1
In 2009 the swine flu emerged as a massive threat to global health. It seemed to come out of nowhere, but our timeline explains how the origins of the H1N1 pandemic go back more than a century to 1889.

Prior to 1889
The main flu virus circulating in humans has been from the H1 family. But in 1889, a new strain of H2 flu emerged in Russia and spread around the world, killing about 1 million people. Thereafter, H2 replaced H1 in humans. Such replacements seem to be a regular feature of flu pandemics. People born before 1889, who had been exposed to H1 flu, had some immunity to it. This afforded them some protection in the deadly H1N1 epidemic of 1918. Those born after 1889 did not have any immunity to H1.

1918
The “Spanish flu” epidemic of 1918 kills at least 50 million people worldwide. It is caused by an H1N1 virus which evolves directly from a bird flu into a human flu.
After a mild wave of infections in the summer, the epidemic goes global: one-third of the population eventually get sick. Although most cases are mild, any sufferers develop a rapidly fatal infection deep in their lungs. People born before 1889 are less susceptible, thanks to their previous exposure to H1N1.
Most deaths are caused by bacterial lung infections that move in after the virus.
Modern antibiotics might mean that a re-run of the 1918 pandemic would be less dangerous.
After 1919, the descendants of the H1N1 virus continue to circulate and cause seasonal flu outbreaks in humans – and pigs.

1931
Swine flu is first isolated from a pig in Iowa.

1933
The first human flu virus is isolated at Mill Hill in London. When given to  ferrets, it produces a disease whose symptoms are all but identical to the Iowan pig virus. But ferrets that have had the human virus are not fully immune to the pig virus, showing that the two viruses have already started to evolve apart.

 1957
An H2N2 virus causes the “Asian” flu pandemic, completely displacing the H1N1 viruses that have been circulating in humans since 1918. The pandemic is fairly mild, killing 1 to 1.5 million people worldwide.
The virus is produced by a reassortment, in which human-adapted H1N1 swaps genes with an H2N2 bird flu. The new H and N surface proteins mean most people do not have antibodies to the virus, allowing it to go pandemic. However, its human-adapted genes mean it is not as lethal to humans as the 1918 virus, which came, with few changes, from birds.

People tend to mount the best immune response to the first kind of flu virus they experience. Because of this, people born before 1957, whose first experience of flu would have been the H1N1 viruses then in circulation, have some immunity to the 2009 H1N1 strain causing the current pandemic. People born after the 1957 pandemic do not have this immunity.

1968
An H3N2 virus causes the “Hong Kong” flu pandemic, which is even milder than the Asian flu, killing an estimated 0.75 million to 1 million people worldwide. (I contracted the Hong Kong flu and am fortunately still here to tell you, that in no way, did I consider it ‘milder’ than any other instance of the ‘flu’ I’ve had in the following 43 years. -Mr Larry).
The virus only differs from H2N2 in one of its surface proteins, the H; since many people still have antibodies to the unchanged N2 protein, its effects are less severe. But because H3N2 completely replaces H2N2 in people, no one born since 1968 has any immunity to H2.

1972
Researchers Graham Laver and Robert Webster discover that waterfowl are the natural hosts  of influenza viruses. The birds harbour strains unknown in humans that could reassort with human strains and give rise to new human pandemics.

1976
An H1N1 virus jumps from pigs to humans and kills a US army recruit. However the virus does not spread beyond the army base and fizzles out without triggering a pandemic.
Nevertheless, fears of a replay of the 1918 pandemic lead to 48 million people being hastily vaccinated against the swine flu virus. The vaccine is associated with an unusual number of cases of Guillain-Barré syndrome: 532 people get it, and 25 die.

1977
An H1N1 virus appears in north-east China and starts circulating in humans. It causes seasonal flu in every subsequent year. No one knows where it came from, though it looks like an H1N1 that circulated in the Soviet Union in 1950 and some suspect it escaped in a laboratory accident.
The virus causes a mild flu pandemic, which mainly affects people born after H1N1 flu disappeared in 1957. However, the real surprise is that it does not displace the previous, and more virulent, seasonal flu, H3N2. Instead, it continues circulating alongside it.
The antibodies people produce after being infected by this new seasonal H1N1 do not protect against 2009 H1N1. However, infections also trigger another reaction called cell-mediated immunity, in which certain white blood cells target and destroy infected cells. Tests of the 2009 H1N1 pandemic vaccine show that, unlike antibodies, cell-mediated immunity to seasonal H1N1 may help protect against the pandemic virus. This does not prevent disease altogether, but can reduce its severity

1998
The predecessor of the 2009 H1N1 swine flu virus emerges in the US . It is a hybrid of human, bird and swine flu viruses, and by 1999 it is the dominant flu strain  in US pigs.
US pig farms try to control it with vaccines, but these attempts are largely ineffective because the virus evolves too rapidly, changing the surface proteins targeted by the vaccine while keeping its internal genes unchanged. The 2009 pandemic virus is a variant on this 1998 flu, and behaves the same way.

 2004-2006
H5N1 flu, first identified as a threat to humans in Hong Kong in 1997, spreads from Asia around the world, apparently carried by wild birds. While this “bird  flu” proves deadly to humans, killing more than half of its victims, it is kept in check by its inability to spread readily from human to human. H5N1 is also found in pigs in Indonesia, raising fears that it might reassort with other human flu viruses that pigs can harbor.
The threat posed by bird flu leads to the first real efforts to be made at pandemic planning: governments start to stockpile antiviral drugs, and the world’s drug companies start doing serious research on pandemic vaccines. These plans are  made with the highly lethal H5N1 in mind, meaning that they are not always appropriate for the 2009 pandemic.

__B.  Flu pandemics come in three waves… (and so did the Black Plague, but in waves separated by years instead of months)

The graph (see top of page) comes from a CDC analysis of the 1918 Spanish flu pandemic. As you can see from the graph, there were three waves: June 1918, Oct-Dec 1918, and Feb-Mar 1919. The worst was the Fall 1918 wave.

If we look back at the four previous major flu pandemics: 1) 1889, 2) Spanish flu pandemic of 1918, 3) Asian flu pandemic of 1957, and 4) Hong Kong flu pandemic of 1968 — they all followed the same pattern. A spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease. However, in all but the 1918 case, the Fall wave was still  fairly mild.
Thus, based on history, we can expect the modern pandemics to fizzle around July (except in the Southern Hemisphere), but then return in a more virulent form in the fall. The fear is that we’ll follow the 1918 pattern, and the Fall wave will be extremely virulent (easily spread and highly lethal).
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2.   Timeline of Human Flu Pandemics
http://www.niaid.nih.gov/topics/flu/research/pandemic/pages/timelinehumanpandemics.aspx
(Including human cases of avian and swine  influenza viruses.)

Recent major pandemics
The appearance of new influenza strains in the human population:

1918 Pandemic
“Spanish flu” H1N1 The most devastating flu pandemic in recent history, killing more than 500,000 people in the United States, and 20 million to 50 million people worldwide.

1957-58 Pandemic
“Asian flu” H2N2 First identified in China, this virus caused roughly 70,000 deaths in the United States during the 1957-58 season. Because this strain has not circulated in humans since 1968, no one under 30 years old has immunity to this strain.

1968-69 Pandemic
“Hong Kong flu” H3N2 First detected in Hong Kong, this virus caused roughly 34,000 deaths in the United States during the 1968-69 season. H3N2 viruses still circulate today.

1976
Four soldiers in a US army base in New Jersey are infected with swine influenza, resulting in one death.

1977 Appearance of a new influenza strain in humans,
“Russian flu” H1N1. Isolated in northern China, this virus was similar to the virus that spread before 1957. For this reason, individuals born before 1957 were generally protected; however children and young adults born after that year were not because they had no prior immunity.

1997 Appearance of a new influenza strain in humans
H5N1 The first time an influenza virus was found to be transmitted directly from birds to people, with infections linked to exposure to poultry markets. Eighteen people in Hong Kong were hospitalized, six of whom died.

1999  Appearance of a new influenza strain in humans
H9N2 Appeared for the first time in humans. It caused illness in two children in Hong Kong, with poultry being the probable source.

2002 Appearance of a new influenza strain in humans
H7N2 vidence of infection is found in one person in Virginia following a poultry outbreak.

2003 Appearance of a new influenza strain in  humans
H5N1 Caused two Hong Kong family members to be hospitalized after a visit to China, killing one of them, a 33-year-old man. (A third family member died while in China of an undiagnosed respiratory illness.)
•  H7N7 In  the first reported cases of this strain in humans, 89 people in the Netherlands, most of whom were poultry workers, became ill  with eye infections or flu-like symptoms. A veterinarian who visited one of the affected poultry farms died.
•  H7N2 Caused a person to be hospitalized in New York.
•  H9N2 Caused illness in one child in Hong Kong.

2004  Appearance of a new influenza strain in humans
•  H5N1 Caused illness in 47 people in Thailand and Vietnam, 34 of whom died. Researchers are especially concerned because this flu strain, which is quite deadly, is becoming endemic in Asia.
•  H7N3  Is reported for the first time in humans. The strain caused illness in two poultry workers in Canada.
•  H10N7 Is reported for the first time in humans. It caused illness in two infants in Egypt. One child’s father is a poultry merchant.

2005
H5N1 The first case of human infection with H5N1 arises in Cambodia in February. By May, WHO reports 4 Cambodian cases, all fatal. Indonesia reports its first case, which is fatal, in July. Over the next three months, 7 cases of laboratory-confirmed H5N1 infection in Indonesia, and 4 deaths, occur.
On December 30, WHO reports a cumulative total of 142 laboratory-confirmed cases of H5N1 infection worldwide, all in Asia, with 74 deaths. Asian countries in which human infection with H5N1 has been detected: Thailand, Vietnam, Cambodia, Indonesia and China.

2006
H5N1 In early January, two human cases of H5N1 infection, both fatal, are reported in rural areas of Eastern Turkey, while  cases in China continues to spread. As of January 25, China reports a total of
10 cases, with 7 deaths. On January 30, Iraq reports its first case of human H5N1 infection, which was fatal, to the WHO.
•  In March, the WHO confirmed seven cases of human H5N1 infection, and five deaths, in Azerbaijan. In April, WHO confirmed four cases of human H5N1 infection, and two fatalities, in Egypt.
•  In May, the WHO confirmed a case of human H5N1 infection in the African nation of Djibouti. This was the first confirmed case in sub-Saharan Africa. Throughout 2006, 115 human cases of H5N1 infection occur, with 79 deaths.

2007
•  H5N1  In early January, two human cases of H5N1 are confirmed in Indonesia. By the end of 2007, 88 confirmed cases occur in Indonesia, Cambodia, China, Lao People’s Democratic Republic, Myanmar, Nigeria, Pakistan and Vietnam, with 59 deaths.
•  H7N7  In May, four cases of H7N7 avian influenza were confirmed in the United Kingdom among individuals exposed to infected poultry.

2008
H5N1  On May 28, Bangladesh reports its first case of human H5N1 infection to the WHO. By the end of the year, 40 cases are confirmed in Bangladesh, Cambodia, China, Egypt, Indonesia and Vietnam.

2009
•  H5N1 On January 7, Indonesia confirmed a new case of human infection with H5N1 influenza. Since that time, new cases have been identified in Egypt, China, Indonesia and Vietnam.
•  Appearance  of a new influenza strain in humans:  H1N1  In April, human infection with a new strain of H1N1 influenza is confirmed in Mexico. Within weeks, human infections spread to the United States and cases begin occurring in other regions around the world.
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3.   One Flu Season: The Timeline of a mild H1N1 Influenza outbreak
GENEVA, Aug 10, 2010 – The following is a timeline of the spread of swine flu, officially known as influenza A(H1N1), after the World Health Organization announced the end of the pandemic, more than a year after it was declared.

2009: April 24: The WHO announces that around 800 suspected cases of so-called swine flu have been recorded in Mexico, along with seven cases in the United States.

April 25: The WHO warns that the virus, identified as a member of the H1N1 family, has “pandemic potential.”

April 26: Health authorities step up vigilance measures around the world.

April 27: First three cases are confirmed in Europe. The WHO raises its level of alert to four from three on a scale of six.

April 28: The first cases in the Middle East.

April 29: A 23-month-old Mexican child is the first confirmed fatality in the United States. The WHO raises its alert level to five and calls for preparations for an “imminent” pandemic.

April 30: WHO adopts the term “influenza A(H1N1)” after veterinary experts point out that the virus is not occurring among pigs.

May 2: The virus makes its appearance in Asia.

May 20: The WHO says that A(H1N1) has officially contaminated 10,243 people in 41 countries and killed 80 people.

June 11: The WHO raises its alert to the maximum level six and declares A(H1N1) the first flu pandemic of the 21st century. The UN body calls on pharmaceutical laboratories to produce vaccines against the virus.

June 14: One death in Scotland, the first death outside the American continent.

June 29: Denmark reports the first case of resistance to Tamiflu, considered to be the most effective treatment for the flu by the WHO. The virus continues to spread throughout the world with 11,000
new cases in three days.

July 17: The WHO says that the swine flu pandemic is moving around the globe at an “unprecedented” speed.

August 28: The WHO says that the swine flu virus has supplanted other viruses to establish itself as the most prevalent strain of flu.

September 21: China becomes the first country in the world to launch a mass vaccination campaign.

September 24: The WHO drops its forecast of needed vaccines to three billion doses from five billion a year.

October 30: The flu has killed at least 5,700 people around the world, hitting in particular the northern hemisphere where vaccination campaigns are being put into place with the approach of winter.

December 18: The number of dead passes 10,000, according to the WHO.

2010
January 22: The WHO says the pandemic is in decline. It has killed at least 14,000 people around the world since emerging.

April 21: A year after the outbreak, the epidemic has spread to 213 countries and territories. The WHO and national health authorities come under criticism for dramatizing the threat of the flu and for the billions of dollars (euros) spent on buying medicines and vaccines.

June 8: WHO chief Margaret Chan denies that  she has been influenced by pharmaceutical firms in managing the flu crisis and denies allegations of a conflict of interest.

August 10: The WHO declares the pandemic over.
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4.  The Seasonal Flu Vaccine
A seasonal vaccine is distributed routinely every year.
•  Unlike during the 2009 flu season, when you needed to get two vaccines, the 2009 H1N1 and the seasonal vaccine, during the 2010 and 2011 flu season you only need the seasonal vaccine.
•  The 2010-2011 flu vaccine protects against an influenza A H3N2 virus, an influenza B virus and the 2009 H1N1 virus that caused so much illness last season.
•  Everyone 6 months of age and older should get vaccinated against the flu.
•  Vaccination of high risk persons is especially important to decrease their risk of severe flu illness.
•  Vaccination is important for health care workers, and other people who live with or care for high risk people to keep from spreading flu to high risk people.
•  Children younger than 6 months are at high risk of serious flu illness, but are too young to be vaccinated. People who care for them should be vaccinated.
•  As the flu season approaches, many people are wondering if they are in jeopardy of catching H1N1. At this stage in the game, the Centers for Disease Control (CDC) predict that the H1N1 virus will continue to spread along with the regular seasonal viruses. Because viruses can and do mutate, it also is possible for new flu strains to appear during the 2010-2011 season.
•  The CDC said that H1N1, also known as swine flu, was responsible the first influenza pandemic in 40 years. According to the World Health Organization (WHO), an influenza pandemic occurs when a new influenza virus emerges and spreads across the world at a time when most people don’t have immunity to that strain.
•  On a more positive note, scientists at the NationalInstitute of Allergy and Infectious Diseases (NIAID) estimate that 183 millionAmericans have developed some immunity to the 2009 H1N1 virus, either throughexposure, infection or immunization during the previous flu season.

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