Behavioural change, the best vaccine

Behavioural change, the best vaccine


Our H1N1 screening efforts in India are stuck just at the international airports, and the related quarantines, laboratory tests for confirmation and Tamiflu for those who test positive. Nearly 600 confirmed cases so far are largely from the airports and few self-reported. However, those passengers who were ‘yet-to-develop’ symptoms have quietly escaped the airport screening net and brought the virus into communities already since May 2009. The few reported cases on one hand do not reflect the real situation in the country, but on the other hand have portrayed a false picture in public minds that H1N1 is a problem mostly of international travel and of passengers arriving from abroad.

Public is not fully aware that once H1N1 is in local community, an H1N1 infected person - be it a student, teacher in a classroom, passenger in a train or bus, filmgoer etc - can inadvertently spread the virus to healthy people through unprotected coughs and sneezes. As the secondary attack rate of this virus is high, it is known to spread faster than the common flu virus.

The recent unfortunate death of a 14-year-old girl in Pune has not only provoked public panic and shock, but has also invoked a spurt of Government actions that otherwise should have started two months ago. Unfortunately, the central focus still is confined to Tamiflu ‘stockpile’, it’s distribution and accessibility and laboratory testing.

A vaccine is projected to be available in India by the end of 2009 or early next year. But, when available this seems to be not for all as the quantities would be inadequate. It is high time, therefore, that we must integrate preventive strategies that can minimise the local spread of the virus in communities.

Why Panic?
Many recover even without Tamiflu. The intention of the H1N1 virus when it infects a person, is to multiply in human respiratory epithelial cells within a week, get released through the cough and sneeze and infect others. Later the virus gets excreted in faeces and urine. In most cases, if symptoms are managed during the illness along with good rest and sufficient fluid intake, the recovery in a week is the rule. Killing an infected person is the least in it’s (H1N1 virus) agenda. One needs to be concerned if the infected person also has other threatening infections or a disease condition. When cases become too many and Tamiflu is in short supply, doctors may resort to selectively prescribing Tamiflu to only those with a warranting underlying medical condition such as asthma, immune compromised, HIV-infected, cancer affected and in pregnancy. The case fatality rate of H1N1, however, is only 0.5% or lesser in comparison with the bird flu virus H5N1 where the case fatality has been over 60%.

Adolescents, young adults
Very young children, adolescents and young adults seem to get more post-infection complications, often fatal. Considering that most from these groups attend schools and colleges, there is need to specially monitor these institutions and provide necessary support. It is not enough if the school returns a student with suspected symptoms on ‘home quarantine’ for a week. Awareness and support is needed at this home for ‘home-based care’.

Only prevention can contain the further spread of H1N1. Our first intervention should be to engage the community, schools and colleges through mass media and public education to let everyone recognise the disease in comparison with the common flu, how it spreads and what is to be done when a member of family is affected. We need an effective combination of education and communication that could result in a behaviour change in the community, specifically in personal and family attitudes and hygiene practices. NGO and Government partnerships are critical. Planning needs to consider interactive spaces, monitoring and support for NGOs, health care staff, village panchayats and schools. The expected outcome: an empowered community with improved hygienic practices that do not favour the spread of not only Swine Flu but also other epidemic such as cholera and typhoid. An integrated intervention should, therefore, integrate other current epidemics such as Chikungunya, Dengue and Malaria also, as we do not need  individual vertical projects  for each of these.
(The writer is a former UNICEF Programme Officer.)

What to do?
Maintain at least 1 metre distance from people with influenza-like symptoms; reduce time spent in crowded settings; open windows to improve airflow; adopt healthy habits - sleep well, eat nutritious food & be physically active.

When to seek help?
If possible, contact a health professional before going to a health facility to discuss whether medical examination is needed; if you have shortness of breath or difficulty breathing; if fever continues for more than three days.

What to do if ill?
Stay at home; rest, plenty of fluids and pain reliever for aches is adequate for recovery in most cases; maintain hygiene; when you cough or sneeze, cover mouth with tissue or crook of your elbow.

Went to take antiviral?
Only when advised by health care providers; exercise caution in buying antivirals on internet.

Should breastfeeding be stopped if ill?
No, not unless your health care provider advises it;  breastfeeding lowers the risk of respiratory disease & improves immunity.

Safety of pork?
Influenza viruses are not known to be transmitted to people through eating processed pork or other food products derived from pigs. But, meat from sick pigs or ones found dead should never be processed or used for human consumption.

Source: WHO

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