To date, the following observations are made by World Health Organization (WHO), specifically about the H1N1 virus, and more generally about the vulnerability of the world population. Observations specific to H1N1 are preliminary, as they are based on limited data in only a few countries. We have looked at the observations and came up with our interpretation of what they mean to us in Singapore.

Observation 1

WHO: The H1N1 virus strain causing the current outbreaks is a new virus that has not been seen previously in either humans or animals. Although firm conclusions cannot be reached at present, scientists anticipate that pre-existing immunity to the virus will be low or non-existent, or largely confined to older population groups.

With the capability of human-to-human transmission, the H1N1 virus definitely has the required characteristics of a pandemic influenza virus. It must therefore be monitored closely by the health authorities. The measures as taken by the Ministry of Health in alerting the public and stepping up surveillance in healthcare settings are therefore timely and necessary.

Observation 2

WHO: H1N1 appears to be more contagious than seasonal influenza. The secondary attack rate of seasonal influenza ranges from 5% to 15% but the current estimates of the secondary attack rate of H1N1 range from 22% to 33%.

The mortality rate of H1N1 is estimated at about 5-6% while the past pandemic flu mortality rates were estimated at between 0.1 to 2.5%. With a higher attack rate and mortality rate, it is important that we as individuals should take measures to protect ourselves, such as

1. Maintaining good personal hygiene

2. Keeping oneself healthy though proper diet, exercise and rest

3. Be a socially responsible person with good coughing etiquette and taking medical leave when we are sick

Observation 3

WHO: With the exception of the outbreak in Mexico, which is still not fully understood, the H1N1 virus tends to cause very mild illness in otherwise healthy people. Outside Mexico, nearly all cases of illness, and all deaths, have been detected in people with underlying chronic conditions.

1. Maintaining physical health is therefore of utmost important in the face of this possible pandemic threat.

2. For patients with chronic diseases and their care-givers, it is important that they take extra precautions to maintain a clean environment at home and work places to reduce the potential for infection.

3. Keeping good personal hygiene cannot be over-emphasised.

4. Aside from the current H1N1, prevention against the seasonal flu is also important as complications are more common among patients who are elderly and patients with chronic diseases. In 2008 alone there were about 600 deaths in Singapore as attributed to influenza or complications that arose from influenza infection. Therefore the annual influenza vaccination is necessary for the elderly as well as patients with chronic disease

Observation 4

WHO: In the two largest and best documented outbreaks to date, in Mexico and the United States of America, a younger age group has been affected than seen during seasonal epidemics of influenza. Though cases have been confirmed in all age groups, from infants to the elderly, the youth of patients with severe or lethal infections is a striking feature of these early outbreaks.

As with the Spanish Flu Pandemic in 1918-1919, the affected are mainly the younger aged adults who are the main bread winners for the families. High mortality among this group resulted in social and economic disruption. As we prepare for any pandemic, it is imperative that the young adults should not take things for granted, assuming that only the weak and the elderly will be affected more seriously. Without sounding paranoiac, one should seriously consider financial planning and insurance for oneself and the family members in the face of ever present threat of a pandemic flu event.

Observation 5

WHO:

1. In these early days of the outbreaks, some scientists speculate that the full clinical spectrum of disease caused by H1N1 will not become apparent until the virus is more widespread. This, too, could alter the current disease picture, which is overwhelmingly mild outside Mexico.

2. Apart from the intrinsic mutability of influenza viruses, other factors could alter the severity of current disease patterns, though in completely unknowable ways, if the virus continues to spread.

3. Scientists are concerned about possible changes that could take place as the virus spreads to the southern hemisphere and encounters currently circulating human viruses as the normal influenza season in that hemisphere begins.

4. The fact that the H5N1 avian influenza virus is firmly established in poultry in some parts of the world is another cause for concern. No one can predict how the H5N1 virus will behave under the pressure of a pandemic. At present, H5N1 is an animal virus that does not spread easily to humans and only very rarely transmits directly from one person to another.

1. The more chance that we give the H1N1 virus to intermingle with the seasonal flu virus, the higher the chance that the H1N1 may acquire other characteristics to make it a more virulent virus.

2. People travelling to the Southern Hemisphere regions for holidays in the coming June and July are exposed to higher risk of being infected with seasonal flu or the H1N1 virus as it will be the flu season then.

3. There is currently no travel restriction to any Southern Hemisphere countries e.g. Australia or New Zealand. However we would advise that travellers to these countries in the coming months should receive an Influenza vaccination and have a travelling kit containing items such as masks and hand sanitizers in case of an influenza outbreak.

We hope that the above information will be useful to you.

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