“It’s just the flu”

Let’s face it, the flu doesn’t seem very scary. If you tell your friends that you’ve been infected with dengue, you’ll receive some very concerned letters and emails. If you tell your friends that you’ve gotten the flu, the worst you’re likely to experience is that they won’t want to shake hands with you or share your drink.

Why aren’t we scared of the flu? Historically, influenza has been the world’s largest enemy of humanity. We’ve all heard of the black plague that ravaged the world during the middle ages, or smallpox’s continuing ravage of life in less developed countries. We’re all concerned about AIDS and the millions of deaths it’s caused, but all of these actually pale in comparison to the death toll of the flu. Influenza has killed more people in one year than smallpox or the black plague during their respective 50 year reigns. Influenza has killed more people in 24 weeks than AIDS has killed in 24 years. In 1918, the Spanish Flu infected 500 million people and killed 50-100 million of them. To put these extraordinary numbers in context, think of the incredible density of life in Singapore. Now imagine a virus so contagious and deadly that it infects 100x the amount of people in Singapore, and kills 1/10th to 1/5th of them. At the time, the Spanish flu killed an unbelievable 3-5% of the entire human population on earth.

Perhaps many of us aren’t scared of the flu because we’ve all experienced it ourselves. Sure, the headaches, shivering and body aches weren’t fun at all, but we’re all still alive, aren’t we? What we’re scared of is those “special” cases of influenza, like swine flu (H1N1) or avian flu (H5N8). What many don’t realize is that there is nothing “special” about these flu strains – the influenza virus is incredibly resilient and mutates every year. Many of these strains cause the same mild symptoms that we are used to experiencing, but any mutation may result in a new strain that is especially contagious, deadly, or in the worst of scenarios, both.

Worse yet, the emergence of these dangerous strains can be measured with some certainty. Over the last 300 years, the world has reliably produced 3 pandemics (wide infections by new virus strains) each century.

Every single year, influenza spreads around the world in an outbreak, infecting 3-5 million people and causing 250,000-500,000 deaths. This is considered “normal”, and not within pandemic proportions. Which, if you think about it, is quite worrisome.

My goal with this article isn’t to create paranoia in you, but to educate, and to impart a healthy fear of influenza. It’s important to be aware of how dangerous influenza can be, and with the other resources in this blog, limit its spread.

Influenza or human? Who is more intelligent?

As mentioned in the previous post, humans have a sophisticated defense mechanism to effectively counter viruses infecting our body.

But even then, influenza viruses are highly successful in causing disease in humans. The viruses are so effective to the point that the human population is continuously spending millions on researching these viruses and creating effective vaccines to combat it.

research

Huge amount of money is also spent on conducting campaigns, advisories, and educational workshops. This aims to create awareness and educate public about the dangers of this virus and how to protect ourselves.

advisory workshop

Why are we so bothered about these tiny viruses which we can’t even see?

To think about it, influenza virus has about 13,000 base pairs in its genome. Then we might wonder how big human genome is? We have a staggering 3.2 billion base pairs in our genome!!!!!

Yet the viruses are so successful in infecting us???

This shows that viruses have in turn evolved ingenious complex methods to overcome our immune system. In other words, viruses are able to fool our immune system and successfully breed inside human body.

Here are some ways how the virus fools our body:

  1. Our body has an efficient system of detecting foreign bodies and sounding an alarm to trigger immune response. However influenza virus has incorporated a protein in its structure to prevent the alarm being triggered. Hence the immune system will not be informed and remain oblivious of the foreign uninvited guest.
  1. Another way our body combats virus is by clearing up the infected cells (by engulfing them). Influenza virus however has found a mechanism to stop the signal to be sent to the immune cells which clears away the infected cells. Hence the infected cells would still be present in the body and the virus will keep on reproducing from it.
  1. Another ingenious way how viruses adapt to successfully infect humans is by having random mutations in the viral genes. These are just slight 1 or 2 base pair change in the genome. However since viruses are replicated in astronomical quantities, these slight changes causes the viruses to occur naturally in quiet huge amounts. These mutations create variety of Hemaglutinin and Neuraminidase combinations (for eg. H1N1, H5N1, H5N2 and etc) some of which the human population have not encountered . The immune system then could not recognize these and we do not have resistance to it.

These are just some ways how influenza viruses fool our immune system. Research is ongoing to discover more of these methods.

So who is more intelligent?

Sources:

http://news.usc.edu/13613/How-influenza-evades-the-body-s-defenses/

http://www.bunniestudios.com/blog/?p=353

http://www.sciencedirect.com/science/article/pii/S0092867406001322

http://jvi.asm.org/content/80/13/6295.full.pdf+html

Antibiotics do not treat flu

ANTIBIOTICS are prescribed to treat BACTERIA infection. If you have been following our posts, you would have known by now that flu VIRUSES cause flu, and therefore, antibiotic will not be effective against flu.

To treat VIRUS infections, you need ANTIVIRAL DRUGS.

Tamiflu (oseltamivir phosphate) and Relenza (zanamivir) are two FDA-approved anti-influenza antiviral drugs which are commonly used.

However, some common side effects were reported while using these drugs. They include:

Tamiflu

1.       Nausea and vomiting

2.       Diarrhea

3.       Stomach pain

Relenza

1.       Nausea and vomiting

2.       Diarrhea

3.       Headaches

4.       Cough

5.       Dizziness

Adverse side effects include:

Tamiflu

1.       Liver inflammation

2.       Rashes

3.       Fever

4.       Seizure

5.       Sudden confusion

6.       Hallucinations

7.       Aggravation of diabetes

8.       Irregular heartbeats

9.       Breathing difficulties

Relenza

1.       Bronchospasm that causes breathing difficulties

2.       Fever

3.       Ear; nose; and throat infections

DO NOT take these drugs if you have the following health complications:

  1. Kidney disease;
  2. Heart disease;
  3. Chronic lung disease, including asthma;
  4. Condition causing swelling or disorder of the brain;
  5. Weak immune system; or
  6. Diabetes

Sounds terrifying isn’t it?

flu-ss-cartoon

Fortunately, flu can be treated with or without these antiviral drugs. Below are some tips to make you feel better (not cure) other than taking these antiviral drugs:

  1. Take medicines which can help relieve the symptoms

Paracetamol to relieve backaches and fever

Antihistamine to relieve nasal congestion and running nose

Lozenges to relieve sore throat

  1. Stay hydrated, drink plenty of water

Fluids may include fruit juices, soda, electrolyte drinks, soups, and etc.

Avoid coffee, tea and alcohol because they are diuretic, meaning they contain substances that promote the production of urine, causing you to lose more body fluids.

  1. Get plenty of sleep

Your body is already protesting that you should get some rest, so rest and stop all work and chores!

  1. Take hot showers

Breathing in moist air can help to relieve nasal congestion.

  1. Gargle with salt water (1:1 ratio) to soothe sore throat

Immune-system-cartoon

Sources:

http://www.drugs.com/tamiflu.html

http://www.drugs.com/relenza.html

http://www.flu.gov/symptoms-treatment/treatment/

Flu can cause HOT FEVER for SEVERAL DAYS?

There are many differences and some similarities between flu (influenza) and common cold. According to a HPB online article (Singapore-based) the KEY DIFFERENCE is that FLU can cause HIGH FEVER and SEVERE ACHES for SEVERAL DAYS and  common cold generally do not. We are lucky because in Singapore it is still easy to visit a doctor and get your medication a few streets away from home. Imagine what may happen if the flu virus spread on to a young child in a developing country? Higher chances for child death?

Flu and Fever

animated photo made by https://imgflip.com/images-to-gif

Don’t worry, just be RESPONSIBLE, SEE A DOCTOR, REST and AVOID vulnerable ELDERLY and CHILDREN, unless your house unavoidably houses vulnerable elderly and children!

If you are still curious about the differences and similarities between flu and cold, you may want to refer to the screenshot below (US-based). Probably the doctor may make you do further lab test or diagnostic test to confirm that flu is in your body.

Nevertheless, according to MOH statistics, report on 2015 week 12, page 3,
there are three strains of flu virus found in 29.2% of 119 Singapore polyclinic patients, who have flu like symptoms.

The three strains of flu virus are:
1) Influenza A (H3N2)
2) Influenza B
3) Influenza A (H1N1)pdm09

References

http://www.hpb.gov.sg/HOPPortal/breathe-article/HPB-047366

http://www.cdc.gov/flu/about/qa/testing.htm

https://www.moh.gov.sg/content/moh_web/home/statistics/infectiousDiseasesStatistics/weekly_infectiousdiseasesbulletin.html

http://www.who.int/mediacentre/factsheets/fs211/en/

Images

http://www.goodreads.com/book/show/12398946-spongebob-pergi-ke-dokter

http://www.thedailyfetch.com/tag/maple-street-correctional-center/

http://spongebob.wikia.com/wiki/Pineapple_Fever

https://drawception.com/viewgame/EGGYHayLhb/batman-has-the-flu/

Diabetes and Influenza

Continuing from my previous post “Are you considered HIGH RISK for influenza complication?“, I am going to highlight the risk for people with diabetes. I am a person living with diabetes.

Actually, I know nothing about the risk for influenza complication for people with diabetes. I am going to take this as an opportunity to educate myself, as well as my readers.

Diabetes (from Diabetes Australia)
Diabetes is a chronic condition. In people with diabetes, insulin is no longer produced or not produced in sufficient amounts by the body. Insulin is a hormone, essential for the conversion of glucose (sugar) from food into energy. Hence, when people with diabetes eat glucose, from food such as breads, cereals, fruits, rice, noodles, starchy vegetables, milk, yoghurt and sweets, it cannot be converted into energy (due to the lack of insulin). Instead of being converted into energy, the glucose stays in the blood.

Influenza and Diabetes
From the Centers of Disease Control and Prevention (CDC), people with diabetes are three times more likely to be hospitalised from the flu and three times more likely to die from the flu and its complications than other people. Falling ill with flu may also affect blood glucose levels.

At the same time, people with diabetes need to know that diabetes can weaken our immune system, according to Flu.gov. This means that our body will have to fight much harder against the flu virus. At the same time, being down with influenza can raise our blood glucose and prevent use from eating properly.

Prevention
The best way for people with diabetes to protection themselves from influenza is through YEARLY vaccination.

According to a clinical report published on American Diabetes Association, ‘Influenza Vaccination: An Unmet Need in Patients With Diabetes‘ (open access), it is reported that “influenza vaccinations remain low in people with diabetes” despite the high complication risk and rising number of people diagnosed with diabetes.

Remember, the vaccine used in flu shot is made from killed virus. We cannot get the flu from the flu shot.

Of course, practicing proper personal hygiene is one big step in preventing yourself from the flu virus.

(Note: It is mentioned in flu.gov and in CDC that the nasal spray vaccine is not safe for people with diabetes. It is recommended to get a flu shot instead of nasal spray. As far as I know, Singapore does not have nasal spray for influenza vaccine.)

Influenza complications
Some examples of flu-related complications:

  • may worsen diabetes condition
  • pneumonia (due to chest infections)
  • bronchitis
  • sinus infections
  • ear infections
  • tonsillitis
  • meningitis
  • encephalitis, etc.

What to do if you have diabetes and is ill with influenza?

  1. Contact your health care provider immediately.
  2. Follow sick day rules as discussed with your health care provider.
  3. Continue with your diabetes medications.
  4. Increase the frequency of blood glucose test and keep track of the results.
  5. Increase fluids (calorie-free) and try to eat as you normally would.

Hence, it is important that people with diabetes should start discussing with their health care provider, as soon as possible, on preventing and treating influenza.

Speaking of which, I should make an appointment to get my influenza vaccination soon.

Vaccinate my children? But what about Autism!

I’d like to begin this article with 3 simple truths:

  • Vaccines do not cause Autism
  • Vaccines do not cause Autism, and
  • Vaccines do not cause Autism.

If you take a survey of the population though, it would seem that a fairly large amount of people don’t believe this truth, despite the wealth of scientific data that proves otherwise. This leads to a few interesting questions: how did these anti-vaccine beliefs start, what do vaccine disbelievers (anti-vaxxers) believe, and why are they still believing it today?

The How

Although talk of anti-vaxxers is prevalent in the news today, it may come as a surprise that the anti-vaccination movement has existed as long as vaccines have— dating all the way back to the mid 1800s and the invention of the deadly smallpox vaccine. Doctor and scientist Edward Jenner found that by infecting a child with cowpox (a mild disease), they would gain immunity to the much more deadly smallpox virus. Unfortunately, the early methods for vaccination were far from, well, pretty.

Vaccinating a child involved scouring their arm, and when the skin barrier was broken, to insert the liquid that came from the open blister of an earlier vaccinated individual. As you can imagine, many parents saw the practice as barbaric, and put forth a large amount of criticism, ranging from sanitary objections to religious and political ones.

As the vaccine evolved, so have the arguments. Because of the amazing effectiveness of vaccines inpreventing sickness, governments saw fit to make vaccinations mandatory in children. This forced adoption of a medical practice saw the rise of many objectors who claimored for the right to look after their own bodies, and make medical decisions for themselves and their children as they saw fit. At its peak in 1885, this movement gathered 80,000-100,000 anti-vaxxers in a march that took place in Leicester, England.

Because of this large movement, and others like it, commissions were set up to study vaccines and assess their safety. The result? No ill effects, effective prevention of smallpox.

Today, that vaccinations are effective is no longer in doubt. So what do modern-day anti-vaxxers believe?

The What and the Why

Modern day anti-vaxxers believe that vaccines may cause autism in children. Two primary arguments exist that seem to support this: 1) a medical journal, The Lancet publishes a paper by researcher Andrew Wakefield in 1998 that hints at a link between bowel disease, autism, and the Measles, Mumps, and Rubella (MMR) vaccine; 2) Thimerosal, a mercury-containing compound was used as a preservative in certain vaccines. Mercury poisoning is a definite possibility that may lead to neurological damage in infants and fetuses. We will debunk both of these arguments in the following paragraphs.

1) Andrew Wakefield’s published findings seem damning for the MMR vaccine. His statements that the vaccine was not properly tested before deployment were seized by the media and blasted through media outlets – after all, the story that you might be damaging your children is an incredibly juicy story to tell (and sell). Unfortunately for the truth, these stories incited a lot of public confusion and fear of vaccines. To get to the bottom of the matter, the General Medical Council (a regulatory organisation for doctors in the UK) investigated Andrew Wakefield and his claims, only to find that Wakefield had a “fatal conflict of interest”. He had been paid by a law organisation who was actively seeking a favorable link between autism and vaccines. Other independent bodies looked into Wakefield’s research, and found that he had falsified data in his research findings. The resulting chaos saw the retraction of Wakefield’s paper from the medical journal, and his loss of a practice license. In other words, Wakefield was deemed unfit to practice medicine in Great Britain.

Since then, a large number of further studies investigated the relationship between the MMR vaccine and autism. The result? Not a single link between the two was found.

2) Less black and white is the question of Thimerosal in vaccines. Research into the matter has found that there was not enough evidence to prove or disprove the dangers of thimerosal. While scientific certainty is not established, The Institute of Medicine’s Immunization Safety Review Committee issued a statement that “favors rejection” of a link between thimerosal and autism. In part due to these findings, US drug manufacturers have agreed to eliminate thimerosal from vaccines as a preventive measure. The argument today then, is mostly moot, since modern vaccines no longer contain Thimerosal anyway.

To conclude, fear of vaccination has been around as long as vaccination itself. Although times have changed and science has progressed, so has fear evolved to fit the modern context. I will leave you then with the facts, and the facts only: no reputable link between vaccines and autism have ever been found. When you decide to go for your annual influenza vaccination, there is only one thing you need to worry about– where to go for lunch after your shot.

FSS (Flu Season Singapore) and GSS (Great Singapore Sales)

FSSNote: the above picture is purely fiction….

Influenza virus is in Singapore all year long, every single day.

Regardless Singapore’s wet/rainy season (Sep till Feb) or dry season (March till August), there are TWO Flu Seasons in Singapore according to HPB.

So people, take note and take care.

Upcoming Event…
Flu Season SG number 2: May 2015- July 2015
coincides with Labour Day, Singapore June School Holidays, Vesak Day, Hari Raya Puasa, and Great Singapore Sales

Past Event
Flu Season SG number 1: December 2014- Feb 2015
coincides with Singapore December School Holidays, Christmas Day, New Year Celebrations, and Chinese New Year Celebrations

upcoming fluj9eqc

References:

http://www.tripadvisor.com.sg/Travel-g294262-s208/Singapore:Weather.And.When.To.Go.html

http://en.wikipedia.org/wiki/Great_Singapore_Sale

http://www.channelnewsasia.com/news/singapore/h3n2-most-prevalent/1572640.html

http://www.hpb.gov.sg/HOPPortal/article?id=552

http://www.mom.gov.sg/newsroom/Pages/PressReleasesDetail.aspx?listid=493

http://www.mom.gov.sg/employment-practices/leave-and-holidays/pages/public-holidays-2015.aspx

Images from

http://en.wikipedia.org/wiki/Influenza_prevention

http://pixabay.com/en/photos/ill/

No273 13 Oct 2009 Sneeze

mcfarlandmo some rights reserved photo

Singapore Influenza Publications

I was rather interested to find out more about the various publications and advisories regarding influenza which the various Ministries in Singapore have produced over the past years of tackling varying degree of influenza situations.

h1n1-are-you-a-contact-499x250

What first caught my interest in searching for these publications was the comic strip Chew On It!, created by Lee Chee Chew. If you find the above characters or drawing style familiar, you would understand what I mean. Lee’s depicts the lives of Singaporeans through comics drawings and his comics strip are published in comics section of The Sunday Times and maybe also in the Opinion section of The Straits Times.

In my quest of online and library search of advisories and publications regarding influenza from various agencies in Singapore, here is a list of what I have found.
(Do note that some of the hyperlinks leads you to the individual posts about the material, some leads you to the actual online copy.)

Resources websites:

Advisories, Guides and Publications (not exhaustive):

The list will get updated along the way. Do come back and have a look.

H1N1 Advisory for Patients

This advisory booklet was created by the Ministry of Health and Singapore Health Promotion Board. You will find the drawings familiar as these is done by the creator of Chew On It!, Lee Chee Chew.

The advisory informs people who are unwell with influenza-like illness to practice the following:

  • Be Socially Responsible
  • Observe Good Personal Hygiene
  • Emergency Warning Signs in Adults and in Children

The online copy of the advisory booklet can be found here.

h1n1-advisory-for-patients-brochure

h1n1-be-socially-responsible-stay-at-home-rest

h1n1-wear-mask-at-home

h1n1-avoid-influenza-related-complications h1n1-observe-good-personal-hygiene h1n1-wash-hands  h1n1virus-do-not-return-to-work-before-the-end-of-medical-leave

h1n1-emergency-warning-signs-in-adults-children

Page images of the advisory was obtained from Money4Invest.com.