QUESTIONS & ANSWERS

Swine Influenza and YouWhat is swine flu?Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses. Outbreaks of swine flu happen regularly in pigs. People do not normally get swine flu, but human infections can and do happen. Most commonly, human cases of swine flu happen in people who are around pigs but it’s possible for swine flu viruses to spread from person to person also.

Are there human infections with swine flu in the U.S.?In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas. CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?CDC has determined that this virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How serious is swine flu infection?Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

How do you catch swine flu?Spread of swine flu can occur in two ways:

Through contact with infected pigs or environments contaminated with swine flu viruses.

Through contact with a person with swine flu. Human-to-human spread of swine flu has been documented also and is thought to occur in the same way as seasonal

flu. Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.

Are there medicines to treat swine flu?Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What can I do to protect myself from getting sick?There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

Try to avoid close contact with sick people. If you get sick with influenza, CDC recommends that you stay home from work

or school and limit contact with others to keep from infecting them. Avoid touching your eyes, nose or mouth. Germs spread this way.

What should I do if I get sick?If you live in San Diego County or Imperial County California or Guadalupe County, Texas and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

Fast breathing or trouble breathing Bluish skin color Not drinking enough fluids Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms improve but then return with fever and worse cough Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting

Can I get swine influenza from eating or preparing pork?No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

Swine fluA new strain of swine flu that has killed as many as 81 and

sickened more than 1,324 in Mexico has spread to the United States and is raising fears of a possible pandemic. Learn more about the disease and why it is causing concern among health officialsA new strain of swine flu that has killed as many as 81 and sickened more than 1,324 in Mexico has spread to the United States and is raising fears of a possible pandemic. Learn more about the disease and why it is causing concern among health officialsA new strain of swine flu that has killed as many as 81 and sickened more than 1,324 in Mexico has spread to the United States and is raising fears of a possible pandemic. Learn more about the disease and why it is causing concern among health officialsHow do people get infected? Human infection happens intermittently, with most cases occurring when patients have direct contact with pigs. But cases of an infected person transmitting the swine flu to others have also been documented, says the CDC. (A 1988 outbreak in pigs in Wisconsin led to multiple human infections, and there was evidence that a patient transmitted the virus to health care workers.) About one case of swine flu in humans is reported to the CDC every one to two years, but from December 2005 through February 2009, 12 cases were reported to the agency. According to WebMD.com, 11 of those people had direct or indirect contact with infected pigs. Human-to-human infections do occur similar to the way the human seasonal flu virus is transmitted — through coughing, sneezing and coming in contact with a person or object with the virus. People cannot become infected by eating pork or pork products. Cooking pork to

an internal temperature of 160 degrees Fahrenheit kills the virus as well as other bacteria, notes the CDC.What are the symptoms? Symptoms are similar to those of the regular human influenza virus: fever, lethargy, lack of appetite and coughing. Some who have been infected with the swine flu also reported having a runny nose, sore throat, nausea, vomiting and diarrhea.How is it diagnosed? A respiratory specimen must be collected within the first four to five days of illness, when the infected person is most likely to be shedding the virus. However, some patients (such as children), may shed the virus for 10 days or longer, according to the CDC. Specimens must be sent to the CDC for laboratory testing in order to identify swine flu.Four antiviral drugs are licensed to treat the disease in the U.S.: amantadine, rimantadine, oseltamivir and zanamivir. Most of the viruses are susceptible to all four, but the CDC currently recommends oseltamivir or zanamivir to treat and prevent swine flu infections. The antivirals should be taken as soon as possible symptoms appear. Tamiflu, the generic name for oseltamivir, appears to be effective against the new strain when taken early, says the CDC. There is currently no human vaccine for swine flu, but the flu vaccine may provide some protection against the H3N2 strain, though not the H1N1 strainDepartemen Kesehatan : Awas Flu BabiMinggu, 26 April 2009 | 17:09 WIBTEMPO Interaktif, Jakarta: Penetapan status darurat kasus swine flu (flu babi) oleh Badan Kesehatan Dunia (WHO), membuat Departemen Kesehatan mengedarkan surat kewaspasdaan dini, ke seluruh kantor kesehatan.

"Ini langkah antisipasi, kami belum tahu situasinya seperti apa," ujar Direktur Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan Departemen Kesehatan Tjandra Yoga Aditama ketika dihubungi Ahad (26/4).

Sabtu (25/4) sore telah dikumpulkan aparat kesehatan di pelabuhan di seluruh Indonesia untuk mengaktifkan dan memastikan thermal scanner bekerja dengan baik. Saat ini seluruh perwakilan kantor kesehatan tengah berkumpul mengikuti simulasi Pandemi Flu Burung di Makasar. "Sekalian membahas situasi terakhir dan pengetatan lalu lintas pintu masuk lewat bandara dan pelabuhan" imbuh Yoga.

Departemen Kesehatan juga membentuk kerjasama dengan Departemen Pertanian untuk membentuk tim terpadu penanggulangan kasus zoonosis (penyakit yang dapat menular dari hewan kepada manusia).

Upaya pencegahan masuknya flu babi ke Indonesia, kata Tjandra, tergantung situasi yang terjadi. Langkah yang sudah dilakukan hingga Ahad ini adalah mengumpulkan data dan kajian ilmiah serta berkoordinasi dengan WHO. Departemen kata Tjandra juga mempersiapkan  pemeriksaan laboratorium untuk Flu Babi.

Flu babi, jelasnya adalah penyakit influenza yang  disebabkan oleh virus influenza

A subtipe H1N1 yang dapat ditularkan melalui binatang, terutama babi, dan ada kemungkinan penularan antar manusia. "Secara umum penyakit ini mirip dengan influenza, gejala klinisnya sama," tambahnya

Cara penularannya, Ia menambahkan bisa melalui udara dan dapat juga melalui kontak langsung dengan penderita. Masa inkubasinya 3 sampai 5 hari. (Inkubasi: Waktu antara masuknya bibit penyakit sampai munculnya gejala-gekala awal: Agus Ramdani, he.. hee..) Tjandra mengingatkan antisipasi penyebarannya dengan menjaga pola hidup bersih.Tercatat hingga saat ini 8 kasus positif (confirm) di Amerika Serikat dan di Meksiko sebanyak 878 kasus dan 60 diantaranya meninggal dunia (20 kasus positif flu babi).

DIANING SARI MAKASSAR - Delapan kasus Flu Babi yang ditemukan di Amerika Serikat diduga ditularkan antar manusia.

Dirjen Pengendalian Penyakit dan Penyehatan Lingkungan (P2PL) Departemen Kesehatan Tjandra Yoga Aditama mengungkapkan dugaan tersebut saat konferensi pers di Hotel Imperial Aryaduta Makassar. Dia menjelaskan, Flu Babi yang muncul saat ini adalah virus tipe A H1N1.

"Ada H1N1, H1N2, H3N1, H3N2. Dan yang ditemukan adalah H1N1," ujarnya, Sabtu (25/4/2009).

Tjandra menambahkan, virus tersebut berbeda dengan virus Flu Burung. Pada Flu Burung, virus H5N1 tidak ada penularan antar manusia. Dugaaan sementara, virus H1N1 penyebab Flu Babi dapat menular antar manusia.

"H5N1 tidak sama dengan H1N1, sangat berbeda. Virus ini berdekatan dengan virus flu biasa tipe A," terangnya.

Sebelumnya, virus Flu Babi mewabah di Meksiko. Dari 878 orang yang mengalami gejala Flu Babi, 60 orang telah meninggal dunia. 20 di antaranya telah conform terkena virus H1N1 penyebab Flu Babi.Minggu, 26/04/2009 20:02 WIB

Flu Babi Meksiko Diduga Telah Merambah Selandia Baru

Shohib Masykur - detikNews VIDEO

TERKAIT Flu Babi Merebak di Meksiko dan AS FOTO TERKAIT Flu Babi Menyerang Meksiko Wellington - Kekhawatiran merebaknya flu babi Meksiko ke

seluruh dunia tampaknya mulai menjadi kenyataan. Diduga flu jenis baru ini telah merambah ke Selandia Baru.

Reuters, Minggu (26/4/2009), menyebutkan, sekelompok guru dan murid di kota Auckland yang baru pulang dari Meksiko terindikasi terserang flu sehari setelah tiba di tanah air. Setelah menjalani uji laboratorium, 10 dari 25 guru dan murid itu dipastikan terinfeksi virus flu tipe A.

Hasil dari pengujian laboratorium itu telah dikirim ke laboratorium WHO di Australia untuk dipastikan apakah virus tersebut H1N1 atau bukan.

"Kementerian Kesehatan tidak bisa memastikan itu adalah flu babi, tapi kemungkinan ada saja," ujar Menteri Kesehatan Selandia Baru Tony Ryall.

"Meski begitu, semua pasien itu tidak mengalami sakit serius dan kebanyakan mulai sembuh," imbuhnya.

Virus babi jenis baru yang merupakan kombinasi antara flu babi, flu burung, dan flu manusia ini telah menewaskan 81 orang dan menginfeksi sekitar 1.300 orang di Meksiko. Virus ini juga telah merambah ke Amerika Serikat dan menginfeksi 11 orang di California, Texas, dan Kansas.

WHO belum menyatakan penyakit tersebut sebagai pandemi global. Namun WHO memperingatkan kemungkinan itu bisa saja terjadi dan menyerukan agar seluruh dunia waspada

terhadap virus ini.Swine influenzaFrom Wikipedia, the free encyclopedia  (Redirected from Swine Flu)Jump to: navigation, search

This pathology is related to a current event: 2009 H1N1 flu outbreak. Information may change rapidly as the event progresses.

This article may require cleanup to meet Wikipedia's quality standards. Please improve this article if you can. (April 2009)

Flu

Influenza Virus Avian influenza Swine

influenza Flu season Research Vaccine Treatment Genome project H5N1 strain H1N1 strain

Pandemic

Pigs can harbor influenza viruses adapted to humans and others that are adapted to birds, allowing the viruses to exchange genes and create a pandemic strain.Swine influenza virus (referred to as Swine influenza viruses or SIV) refers to influenza cases that are caused by Orthomyxoviruses endemic to pig populations. SIV strains isolated to date have been classified either as Influenzavirus C or one of the various subtypes of the genus Influenzavirus A.[1]Swine flu infects people every year and is found typically in people who have been in contact with pigs, although there have been cases of person-to-person transmission.[2] Symptoms include fever, disorientation, stiffness of the joints, vomiting, and loss of consciousness ending in death.[3] Swine influenza is known to be caused by influenza A subtypes H1N1,[4] H1N2,[4] H3N1,[5] H3N2,[4] and H2N3.[6]In swine, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are circulating throughout the world.[citation needed] In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. Most H3N2 virus isolates are triple reassortants, meaning that it contains genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.[citation needed]

Contents[hide]

1 H5N1 2 History

o 2.1 1918 epidemic o 2.2 1976 U.S. outbreak o 2.3 2007 Philippine outbreak o 2.4 2009 H1N1 flu outbreak

3 Veterinary swine flu vaccine 4 See also 5 Further reading

6 References

H5N1Avian influenza virus H3N2 is endemic in pigs in China and has been detected in pigs in Vietnam, increasing fears of the emergence of new variant strains.[7] Health experts[who?] say pigs can carry human influenza viruses, which can combine (i.e. exchange homologous genome sub-units by genetic reassortment) with H5N1, passing genes and mutating into a form which can pass easily among humans.[8] H3N2 evolved from H2N2 by antigenic shift.[9] A combination of these two subtypes of the species known as the avian influenza virus in a country like China is a worst case scenario.[10] In August 2004, researchers in China found H5N1 in pigs.[11] Measured resistance to the standard antiviral drugs amantadine and rimantadine in H3N2 in humans has increased to 91% in 2005.[citation needed]In 2005 it was discovered that H5N1 could be infecting up to half of the pig population in some areas of Indonesia, but without causing symptoms. Chairul Nidom, a virologist at Airlangga University's tropical disease center in Surabaya, East Java, conducted an independent research; he tested the blood of 10 apparently healthy pigs housed near poultry farms in West Java where avian flu had broken out, Nature reported. Five of the pig samples contained the H5N1 virus. The Indonesian government has since found similar results in the same region. Additional tests of 150 pigs outside the area were negative.[12][13]History1918 epidemicMain article: Spanish FluIn the spring of 1918, bird influenza mutated into a severe human form in just a few months. It was originally thought the strain evolved from a mix of swine flu which humans are more susceptible to and bird flu, with the two strains combining in a pig infected with both strains at the same time. But recovery of the actual 1918 strain from preserved tissue samples revealed it to be a mutated bird flu virus and not a swine flu virus combination.In the U.S., approximately 675,000 people died.[14] Worldwide, the number of casualties was between 50 and 100 million.[15]1976 U.S. outbreakOn February 5, 1976, an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that swine flu was the cause of death and that this strain of flu appeared to be closely related to the strain involved in the 1918 flu pandemic. Alarmed public-health officials decided that action must be taken to head off another

major pandemic, and they urged President Gerald Ford that every person in the U.S. be vaccinated for the disease. The vaccination program was plagued by delays and public relations problems, but about 24% of the population had been vaccinated by the time the program was canceled.[16]About 500 cases of Guillain-Barré syndrome, resulting in death from severe pulmonary complications for 25 people, were probably caused by an immunopathological reaction to the vaccine.[16] Other influenza vaccines have not been linked to Guillain-Barré syndrome.[17]2007 Philippine outbreakOn August 20, 2007 Department of Agriculture officers investigated the outbreak of swine flu in Nueva Ecija and Central Luzon, Philippines. The mortality rate is less than 10% for swine flu, if there are no complications like hog cholera. On July 27, 2007, the Philippine National Meat Inspection Service (NMIS) raised a hog cholera "red alert" warning over Metro Manila and 5 regions of Luzon after the disease spread to backyard pig farms in Bulacan and Pampanga, even if these tested negative for the swine flu virus.

[18][19]2009 H1N1 flu outbreakTrain commuters in Mexico City wearing surgical masks.Main article: 2009 H1N1 flu outbreakIn March and April 2009, more than 1,000 cases of swine flu in humans were detected in Mexico, and more than 80 deaths are suspected to have a connection with the virus. As of April 25, 2009 19:30 EDT there are 11 laboratory confirmed cases in the southwestern United States and in Kansas,[20] and several suspected cases in the New York City metropolitan area. Following a series of reports of isolated cases of swine flu,[21][22] the first announcement of the outbreak in Mexico was documented on April 23, 2009. Some of the cases have been confirmed by the World Health Organization to be due to a new genetic strain of H1N1.[23][24] The

new strain has been confirmed in 16 of the deaths and 44 others are being tested as of April 24, 2009.[25] The Mexican fatalities are said to be mainly young adults, a hallmark of pandemic flu.[26]At 8 p.m. on Sunday, April 26, the New Zealand Minister of Health confirmed that 22 students returning from a school trip from Mexico had flu like symptoms (most likely swine flu). 13 of the students with flu like symptoms were tested and 10 tested positive for Influenza A, their cases strongly suspected to be the swine flu strain. However there is a possibility that the infected are not infected with the swine flu but other forms of the flu. The government has suggested that citizens of New Zealand with flu-like symptoms should see their G.P. immediately.There have been five cases of possible swine flu in Canada, according to the Canadian Press. Two in British Columbia, and three in Nova Scotia. According to the Government of Nova Scotia, four students in Windsor, Nova Scotia have confirmed cases of swine flu.[27]The new strain appears to be a recombinant between two older strains. Preliminary genetic characterization found that the hemagglutinin (HA) gene was similar to that of swine flu viruses present in U.S. pigs since 1999, but the neuraminidase (NA) and matrix protein (M) genes resembled versions present in European swine flu isolates. Viruses with this genetic makeup had not previously been found to be circulating in humans or pigs, but there is no formal national surveillance system to determine what viruses are circulating in pigs in the U.S.[28]According to University of Virginia virologist Frederick Hayden, the most recent flu season was dominated by H1N1 viruses, and people who had received flu shots in the U.S. may have some protection against swine flu.[29]Veterinary swine flu vaccineSwine influenza has become a greater problem in recent decades as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases.[30][31]Present vaccination strategies for SIV control and prevention in swine farms, typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates

examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses.[32]

[33]The current vaccine against the seasonal influenza strain H1N1 is thought unlikely to provide protection.[34] The director of CDC's National Center for Immunization and Respiratory Diseases said that the United States' cases were found to be made up of genetic elements from four different flu viruses—North American swine influenza, North American avian influenza, human influenza A virus subtype H1N1, and swine influenza virus typically found in Asia and Europe. On two cases, a complete genome sequence had been obtained. She said that the virus is resistant to amantadine and rimantadine, but susceptible to oseltamivir (Tamiflu) and zanamivir (Relenza).[35][36][37]See also

Bird flu Dog flu Horse flu

Human flu

Zoonosis Pandemic List of epidemics

Infectious disease

Further reading"Swine Flu Cases Without Swine Exposure" Center for Biosecurity of UPMC

The Swine Flu Affair: Decision-Making on a Slippery Disease Original 1978 U.S.A. Department of Health Education and Welfare review by Richard E. Neustadt and Harvey V Fineberg available from Louisiana State University Law Center Medical and Public Health Law Site.

Surface sanitation and interruption of influenza using NAV-CO2 The Swine Flu Episode and the Fog of Epidemics by Richard Krause in CDC's

Emerging Infectious Diseases Journal Vol. 12, No. 1 January 2006 published December 20, 2005

SWINE INFLUENZA by Carol G. Woodlief of College of Veterinary Medicine at North Carolina State University Overview, symptoms in pigs, treatment for pigs

In California and Texas, 5 New Swine Flu Cases Washington Post, By Rob Stein (Staff Writer)

Swine Flu In Mexico And U.S. May Lead To Pandemic, WHO Says AHN, Mayur Pahilajani (Staff Writer)

News and information on the 2009 human swine flu outbreak

References1. ̂ Heinen P. (15 September 2003). "Swine influenza: a zoonosis". Veterinary Sciences

Tomorrow. http://www.vetscite.org/publish/articles/000041/print.html. "Influenza B and C viruses are almost exclusively isolated from man, although influenza C virus has also been isolated from pigs and influenza B has recently been isolated from seals.".

2. ̂ Cuevas Mayra, Curley Ann, Hellerman Caleb, Quijano Elaine, Candiotti Susan (25 April 2009). "More cases of swine flu reported; WHO warns of health emergency". http://www.cnn.com/2009/HEALTH/04/25/swine.flu/index.html.

3. ̂ "World Health Organization: Swine flu could spread globally". CNN.com. http://www.cnn.com/2009/HEALTH/04/25/swine.flu/index.html. Retrieved on 2009-04-25.

4. ^ a b c "Swine Influenza". Swine Diseases (Chest). Iowa State University College of Veterinary Medicine. http://www.vetmed.iastate.edu/departments/vdpam/swine/diseases/chest/swineinfluenza/.

5. ̂ eurekalert Tips from the Journals of the American Society for Microbiology - Novel H3N1 Swine Influenza Virus Identified in Pigs in Korea

6. ̂ PNAS Published online before print December 18, 2007, doi: 10.1073/pnas.0710286104 PNAS December 26, 2007 vol. 104 no. 52 20949-20954

7. ̂ Yu, H. (March 2008). "Genetic evolution of swine influenza A (H3N2) viruses in China from 1970 to 2006". Journal of Clinical Microbiology 46 (3): 1067. doi:10.1128/JCM.01257-07. PMID 18199784. http://jcm.asm.org/cgi/content/full/46/3/1067?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=phylogenetic&searchid=1&FIRSTINDEX=230&resourcetype=HWFIG.

8. ̂ "Bird flu and pandemic influenza: what are the risks?". UK Department of Health. http://www.dh.gov.uk/en/Aboutus/MinistersandDepartmentLeaders/ChiefMedicalOfficer/Features/DH_4102997.

9. ̂ "Genetic analysis of human H2N2 and early H3N2 influenza viruses, 1957–1972: evidence for genetic divergence and multiple reassortment events". ScienceDirect. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WXR-4D67B89-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=9fd281ee498caee256bc5bf8e3f52970.

10. ̂ "Economic impact of avian flu". The World Bank. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/EASTASIAPACIFICEXT/EXTEAPREGTOPHEANUT/0,,contentMDK:20713527~pagePK:34004173~piPK:34003707~theSitePK:503048,00.html.

11. ̂ WHO (October 28, 2005). "H5N1 avian influenza: timeline" (PDF). http://www.who.int/csr/disease/avian_influenza/Timeline_28_10a.pdf.

12. ̂ "Indonesian pigs have avian flu virus; bird cases double in China". CIDRAP. 27 May 2005. http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/may2705avflu.html.

13. ̂ . 31 March 2009. http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/mar3109swine-jw.html. report on Pigs as carriers

14. ̂ Pandemics and Pandemic Threats since 1900. U.S. Department of Health & Human Services

15. ̂ Taubenberger JK, Morens DM (January 2006). "1918 Influenza: the mother of all pandemics". Emerg Infect Dis (Centers for Disease Control and Prevention (CDC)) 12 (1). http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm.

16. ^ a b "The sky is falling: an analysis of the swine flu affair of 1976". Haverford.edu. http://www.haverford.edu/biology/edwards/disease/viral_essays/warnervirus.htm. Retrieved on 2009-04-25.[dubious – discuss]

17. ̂ "Influenza / Flu Vaccine". University of Illinois at Springfield. http://www.uis.edu/healthservices/immunizations/influenzavaccine.html. Retrieved on 26 April 2009.

18. ̂ "DA probes reported swine flu 'outbreak' in N. Ecija". Gmanews.tv. http://www.gmanews.tv/story/56805/DA-probes-reported-swine-flu-outbreak-in-N-Ecija. Retrieved on 2009-04-25.

19. ̂ "Gov't declares hog cholera alert in Luzon". Gmanews.tv. http://www.gmanews.tv/story/53014/Govt-declares-hog-cholera-alert-in-Luzon. Retrieved on 2009-04-25.

20. ̂ "Human swine influenza investigation". Center for Disease Control and Prevention. 24 April 2009. http://www.cdc.gov/swineflu/investigation.htm. Retrieved on 2009-04-25.

21. ̂ Stobbe Mike (April 21, 2009). "Officials alert doctors after 2 California children infected with unusual swine flu". Associated Press. http://www.startribune.com/lifestyle/health/43357097.html?elr=KArks7PYDiaK7DUvDE7aL_V_BD77:DiiUiacyKUUr. Retrieved on April 24, 2009.

22. ̂ Brown David (22 April 2009). "New Strain of Swine Flu Investigated: Two Children in San Diego Area Had No Contact With Pigs". Washington Post. http://www.washingtonpost.com/wp-dyn/content/article/2009/04/21/AR2009042103694.html. Retrieved on April 24, 2009.

23. ̂ "Q&A: Swine flu". BBC News. http://news.bbc.co.uk/2/hi/health/8017585.stm. 24. ̂ "Influenza-like illness in the United States and Mexico". World Health Organization.

24 April 2009. http://www.who.int/csr/don/2009_04_24/en/index.html. 25. ̂ "Experts probe deadly Mexico flu". 24 April 2009.

http://news.bbc.co.uk/1/hi/world/americas/8016909.stm. 26. ̂ "Deadly new flu virus in US and Mexico may go pandemic". New Scientist. 24 April

2009. http://www.newscientist.com/article/dn17025-deadly-new-flu-virus-in-us-and-mexico-may-go-pandemic.html.

27. ̂ "Swine Influenza Live Webcast". Government of Nova Scotia. 2009-04-26. http://gov.ns.ca/stayinformed/respiratoryillness.asp.

28. ̂ "Swine Influenza A (H1N1) Infection in Two Children --- Southern California, March--April 2009". MMWR. Centers for Disease Control. 22 April 2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5815a5.htm.

29. ̂ "Swine flu emergency caused by new variant of old bug". Bloomberg. 2009-04-26. http://www.bloomberg.com/apps/news?pid=20601087&sid=aD0VK0_oNmw4.

30. ̂ "Swine flu virus turns endemic". National Hog Farmer. 15 September 2007. http://nationalhogfarmer.com/mag/swine_flu_virus_endemic/.

31. ̂ "Swine". Custom Vaccines. Novartis. http://www.livestock.novartis.com/cv_swine.html.

32. ̂ Gramer Marie René, Lee Jee Hoon, Choi Young Ki, Goyal Sagar M, Joo Han Soo (July 2007). "Serologic and genetic characterization of North American H3N2 swine influenza A viruses". Canadian Journal of Veterinary Research 71 (3): 201–206. PMID 1899866. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1899866.

33. ̂ Myers KP, Olsen CW, Gray GC (April 2007). "Cases of swine influenza in humans: a review of the literature". Clin Infect Dis 44 (8): 1084–8. doi:10.1086/512813. PMID 17366454.

34. ̂ "Update: Swine Influenza A (H1N1) Infections --- California and Texas, April 2009". MMWR. Centrers for Disease Control. 24 April 2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm.

35. ̂ Steven Reinberg (24 April 2009). "Swine Flu Cases Now Total 7: CDC". ABC News. http://www.abcnews.go.com/Health/Healthday/story?id=7415611&page=1.

36. ̂ Rob Stein (23 April 2009). "In California and Texas, 5 New Swine Flu Cases". Washington Post. http://www.washingtonpost.com/wp-dyn/content/article/2009/04/23/AR2009042304116.html.

37. ̂ "CDC Briefing on Public Health Investigation of Human Cases of Swine Influenza". CDC online newsroom. 23 April 2009. http://www.cdc.gov/media/transcripts/2009/t090423.htm.

Egyptian health officials have just reported two deaths from bird flu within days of each other. The dangerous virus variant H5N1 struck down a six-year-old boy and a young woman, bringing the total death toll in Egypt to 25. While bird flu experts note that Egypt has seen a surge in human cases in recent months, with 16 confirmed since the start of the year, compared to seven cases between January 1 and April 17 last year [Reuters], they also say that the Egyptian people’s level of alarm is out of proportion to the threat.

Rumors have appeared in the Egyptian media that the virus is circulating widely, and that some people get “silent infections” which show no symptoms, but still allow them to pass on the virus. The rumors have been fueled by the pattern of recent infections: Many of the infected patients have been toddlers, leading to the belief that stronger adults are also infected but simply show no symptoms. Although thousands of Egyptians have rushed their children to hospitals this flu season, there is no evidence yet of asymptomatic avian flu cases or any significant mutation in the H5N1 virus. “Right now, it’s all hot air,” said Dr. Robert G. Webster, a flu expert…. “I hope to hell it’s not happening, because it would mean the virus is adapting to humans. But there’s not a shred of data” [The New York Times].

While the H5N1 virus rarely infects people, the looming fear is that the virus may mutate into a form that can be transmitted easily from person to person, which could spark a deadly pandemic. However, an outbreak of swine flu across the world from Egypt, in Southern California, has reminded people of the hazards of overreacting before all the information is in.

Swine flu is found in pigs and very rarely in humans who have direct contact with pigs; the United States reports one human case every one or two years. However, two California children were diagnosed with the disease this spring, sparking an investigation by the Centers for Disease Control. Since neither of the two children, a 10-year-old boy and a 9-year-old girl, had contact with pigs, it “increases the possibility that human-to-human transmission of this new influenza virus has occurred,” according to a CDC

report. The girl did attend an agricultural fair four weeks before becoming sick, she said, but did not have any contact with pigs or other livestock [CNN].

The incident has brought back memories of another swine flu outbreak in 1976 among army recruits at Fort Dix, New Jersey, which taught public health officials a tough lesson. That winter, 13 men got sick and one died of what proved to be swine influenza viruses–viruses that were thought to be similar to the one responsible for the 1918 Spanish flu pandemic. U.S. officials ordered the manufacture of swine flu virus vaccine and the country proceeded to launch a mass immunization program that saw upwards of 40 million people injected with the vaccine. The feared pandemic never occurred. But the vaccine appeared to trigger a high level of cases of Guillain-Barre syndrome, a type of paralysis [The Canadian Press], and thousands of vaccine recipients filed injury claims.

Govt ups efforts to increase Swine Flu awareness

The Jakarta Post ,  Jakarta   |  Sun, 04/26/2009 12:43 PM  |  National

The government is working on efforts to increase awareness within the health sector, particularly at ports, in response to the spread of human cases of swine flu that has struck parts of Mexico and North America since March.

"The Ports' Health Office (KPP) was asked to be on alert and a second batch of warning letters was circulated among the KPPs across the country," director general for Disease Control at the Health Ministry Tjandra Yoga Aditama said on the sidelines of a flu simulation exercise in Makassar on Sunday.

According to Antara state news agency, Aditama said the government's recent move was in response to a statement issued by the World Health Organization stating that swine flu constituted a public health emergency of international concern.

He added, however, that despite increasing concern over a possible swine flu pandemic, the government has yet to issue a travel warning for its citizens.

"The WHO has yet to recommend specific measures to be taken in response to the flu, including travel warnings or bans. We can wait for such to be issued, but could also move on our own, we need to see how things progress," Aditama argued.

Among the measures the government has taken is the allocation of thermoscanners across major Indonesian harbors to identify possible infection among travelers.

The president of Mexico recently assumed emergency powers to deal with the health crisis, which has killed at least 81 people and infected about 1,300 others.

All public gatherings have been banned, including more than 500 concerts and sporting events and the popular bicycle rides on closed boulevards.

Dr. Margaret Chan, the director general of the World Health Organization, said the events in Mexico “constitute a public health emergency of international concern.”

The WHO convened an emergency meeting of experts on Saturday, but the panel adjourned without raising the global pandemic alert level, saying it wanted more information. Some experts expressed surprise that no action was taken since the Mexico outbreak seems to meet the definition of a Level 4 alert – sustained human-to-human transmission of a new virus. The alert has been at Level 3 for years because of the small clusters of human cases of avian flu. (amr)  

DEFINISI KASUS

1. Kasus Suspek Seseorang yang menderita ISPA dengan gejala demam (suhu ≥ 38

oC), batuk dan atau sakit tenggorokan dan atau ber-ingus serta dengan salah satu keadaan:

Seminggu terakhir mengunjungi peternakan yang sedang berjangkit flu burung.

Kontak dengan kasus konfirmasi flu burung dalam masa penularan.

Bekerja pada suatu laboratorium yang sedang memproses spesimen manusia atau binatang yang dicurigai menderita flu burung.

2. Kasus “Probable” Kasus suspek disertai salah satu keadaan:

Bukti laboratorium terbatas yang mengarah kepada virus influenza A (H5N1), misal test HI yang menggunakan antigen H5N1.

Dalam waktu singkat berlanjut menjadi pneumonia, gagal pernafasan, meninggal.

Terbukti tidak terdapat penyebab lain.3. Kasus Konfirmasi

Kasus suspek atau “probable” didukung oleh salah satu hasil pemeriksaan laboratorium:

Kultur virus influenza H5N1 positip. PCR influenza (H5) positip. Peningkatan titer antibody H5 sebesar 4 kali.