Wikinews discusses H1N1 with the WHO

Wednesday, March 31, 2010

Flag of the World Health Organization.

The World Health Organization (WHO) is a program of the United Nations and a global authority on human health. In an interview with Wikinews, the WHO tells about the current H1N1 pandemic.

The organization's 93rd update as of March 26, 2010 states 213 countries, territories, and other communities have laboratory-confirmed cases and there have been at least 16,931 confirmed deaths, including 4,653 deaths in Europe and 7,673 in the Americas.

Wikinews reporter Mike Morales talks with Karen Mah, a media relations representative for the WHO, and asks her several questions.


 ((Mike Morales )) Can you tell us what exactly H1N1 is and how it affects us today?

 ((Karen Mah )) As of 21 March 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 16,931 deaths. This number is a large underestimation of total deaths with total figures unavailable until a year or two after the pandemic is declared over.

 ((MM )) How does the WHO feel the media coverage has been and does the WHO suggest any changes to coverage and if so, what kind?

 ((Karen Mah )) WHO does not have any comment with regards to media coverage nor is it in our purview to suggest changes to coverage. The pandemic is a global event and media coverage can't be characterized with any generalities.

 ((MM )) Which areas around the world are most affected by the pandemic and why?

 ((Karen Mah )) Current disease activity and epidemiological activity indicates we are seeing the highest levels of activities occurring in Southeast Asia, West Africa, and in the tropical zone of the Americas. After a period of sustained pandemic influenza transmission in Thailand over the past two months, overall activity now appears to be decreasing. In West Africa, limited data suggests that active transmission of pandemic influenza virus persists without clear evidence of a peak in activity. In Central America and in the tropical zone of South America, an increasing trend of respiratory disease activity associated with circulation of pandemic influenza virus has been reported since early March 2010 in an increasing number of countries.

The H1N1 virus.
Image: Cybercobra.

 ((MM )) What advice does the WHO recommend to any areas affected by H1N1? What does the WHO recommend to governments' health authorities of countries affected?

 ((Karen Mah )) This is a very far-reaching question and answer and paraphrasing the pandemic preparedness guidelines is too simplistic. I will refer you to this page [URL below] to see the whole spectrum of guidance for countries ranging from response, surveillance, reduction of spread, travel, hygiene etc. From a WHO perspective, we have to offer the broadest range of guidance to cover developing, mid-level and developed countries.

 ((MM )) What does the WHO recommend for those individuals affected by H1N1? How does H1N1 affect someone who is infected?

 ((Karen Mah )) Since the H1N1 pandemic virus is now the dominant influenza virus circulating worldwide, most cases of influenza-like illness are likely pandemic influenza.

Typical symptoms to watch for include fever, cough, headache, body aches, sore throat and runny nose.

WHO advises health care providers to treat people with influenza-like illness based on their symptoms and the progress of their illness, and not to wait for laboratory confirmation of pandemic influenza. The pandemic H1N1 virus has already spread worldwide.

Regarding laboratory testing of cases, public health authorities and WHO partners continue to do selective testing of samples from patients with influenza-like illness to characterize outbreaks, monitor the virus and identify disease trends.

Anti-viral drugs (which are medicines that act directly on viruses to stop them from multiplying) should not be taken to prevent H1N1. There are two antiviral drugs are being used to treat pandemic influenza infections. These are oseltamivir and zanamivir, which both block the action of an influenza virus protein called neuraminidase.

For patients with symptoms of severe illness that are probably due to pandemic influenza, WHO recommends that treatment with oseltamivir should start immediately, no matter when the illness started and without waiting for laboratory results to confirm infection.

For patients at higher risk for serious disease from pandemic influenza, including pregnant women, children under age 5 and those with certain underlying medical conditions, WHO recommends treatment with either oseltamivir or zanamivir as soon as possible after the onset of symptoms, and without waiting for the results of laboratory tests.

Otherwise healthy people who are not from a higher risk group but who have persistent or rapidly worsening symptoms should be treated with antivirals. These symptoms include difficulty breathing or a high fever that lasts beyond three days.

 ((MM )) How does H1N1 affect someone who is infected?

 ((Karen Mah )) Pandemic H1N1 virus is spread from person to person in the same way that seasonal influenza viruses are spread. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.

Signs of the pandemic influenza are flu-like, including malaise, fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea.

The majority of people with pandemic influenza experience mild illness and recover fully without treatment. However, people should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever, and especially high fever, continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).

Supportive care at home with plenty of rest, drinking plenty of fluids and using a pain reliever for aches and pains is adequate for recovery in most cases. A non-aspirin pain reliever should be used for children or adolescents under age 18.

The public should be made aware that there are specific groups of people who appear to be at higher risk of more complicated or severe illness which include:

  • pregnant women;
  • infants, and young children particularly under age 2;
  • people of any age with certain chronic health conditions (including asthma or lung disease, heart disease, diabetes, kidney disease or some neurological conditions);
  • people with severely compromised immune systems.

Currently, people age 65 or older are the least likely to be infected with the pandemic influenza, but those who do get sick are also at high risk of developing serious complications, just as they are from seasonal flu.

 ((MM )) Is it known when the virus will become less virulent and cease becoming a major threat to health and of so when?

 ((Karen Mah )) It is impossible to predict when the pandemic H1N1 virus will become less virulent.

Diagram showing antigenic shift.

 ((MM )) Is there a significant risk of H1N1 mutating and becoming more deadly?

 ((Karen Mah )) Influenza viruses constantly change through a process called antigenic drift. All influenza viruses undergo this process but there is no way to predict if, when and how the pandemic H1N1 virus will shift.

 ((MM )) Are the current anti-flu vaccines effective and how sufficient is the current supply? Can you explain how these anti-virus vaccine work and any possible side effects?

 ((Karen Mah )) The current H1N1 vaccines are effective and supply is sufficient. The safety profile of H1N1 vaccines is very good. Outcomes of studies completed to date indicate that pandemic vaccines have a similar safety record as seasonal influenza vaccines. Pandemic influenza vaccines underwent the same production and testing methods as seasonal vaccines.

The safety tracking of the vaccine for adverse events after its distribution and use worldwide has likely been the most thorough and sensitive in history.

Influenza vaccines cause antibodies to develop in the body. These antibodies provide protection against infection with the viruses that are in the vaccine.

Possible side effects can depend on the type of vaccine, how it is administered and the age of the recipient. There are two main types of vaccines: one is manufactured with inactivated viruses, the other uses live viruses. Inactivated vaccines, administered by injection, commonly cause local reactions such as soreness, swelling and redness at the injection site, and less often can cause fever, muscle- or joint- aches or headache. These symptoms are generally mild, do not need medical attention, and last 1 to 2 days. Fever, aches and headaches can occur more frequently in children compared to elderly people.

Rarely, such influenza vaccines can cause allergic reactions such as hives, rapid swelling of deeper skin layers and tissues, asthma or a severe multisystem allergic reaction due to hypersensitivity to certain vaccine components.

Live vaccines are given via a nasal spray, and can commonly cause runny nose, nasal congestion, cough, and can less frequently cause sore throat, low grade fever, irritability and head- and muscle- aches. Wheezing and vomiting episodes have been described in children receiving live influenza vaccines.

 ((MM )) What action has the WHO taken, if any, to insure vaccines are available?

 ((Karen Mah )) During the first stages of the pandemic in 2009, the Director-General highlighted the need to make vaccine and medicines available to countries who would be unable to access them on their own. As the WHO pandemic vaccine donation programme was first established, all countries were surveyed by WHO, and 95 identified as having no access to pandemic vaccines, and therefore eligible for donations.

Based on the pledges of donated vaccine, a plan was prepared for a two phase approach to supply sufficient vaccines for 10% of the population in these countries; an initial supply to cover health workers and other essential workers, equivalent to 2% of the population, and a second supply of 8% for other priority groups. The sequencing of supply was based on assessments of vulnerability to the pandemic, and readiness to utilize vaccines.

To date, 25 countries have received donated H1N1 vaccine totaling more than 10 million doses, along with ancillary supplies. Another 15 to 20 countries will be receiving their vaccine shipments in the upcoming few weeks.

The 25 countries who have received shipments are: Azerbaijan, Afghanistan, Cambodia, Fiji, Kiribati, Kosovo, Laos PDR, Maldives, Mongolia, Nauru, Nicaragua, Papua New Guinea, Solomon Islands, Togo, Tonga, Vanuatu, Cuba, Honduras, El Salvador, Kenya, Samoa, Tokelau, Cook Islands, Pakistan, [and] Philippines

 ((MM )) Last November, the WHO stated the H1N1 virus is world's most dominant virus. Is this still true?

 ((Karen Mah )) On February 18th, WHO concluded a four-day meeting to look at vaccine strains for seasonal influenza vaccine for the 2010 and 2011 season. This is part of the routine work that WHO does twice yearly to determine vaccine strains to be included in upcoming northern and southern hemisphere seasonal influenza vaccines.

During the scientific discussions which ended on the 18th of February, it was confirmed that the overwhelming number of influenza viruses that were isolated around the world were the pandemic H1N1 virus. The experts believe that based on this information that this virus will continue to be one of the dominant viruses in wide circulation in the coming fall and winter season.

 ((MM )) Is there anything that the WHO believes to be very important for the public to know about the H1N1?

 ((Karen Mah ))

  • The overall impact of the pandemic has been moderate and most people experienced mild symptoms or illness. However, some groups are more vulnerable and have a higher risk of complications or severe illness, for example pregnant women, infants, young children and people with chronic diseases.
  • Many of the severe cases have been due to viral pneumonia, which is harder to treat than the bacterial pneumonia normally associated with seasonal influenza. Many of these patients have required intensive care, which has led to intensive care units being frequently overwhelmed at the peak of the outbreak.
  • Most of the deaths caused by the pandemic influenza disease occurred among younger people than is the case during seasonal influenza outbreaks, including among those who were previously healthy.
  • To protect people from infection and avoid related severe outcomes, the H1N1 vaccine is an important public health tool as long as the pandemic H1N1 virus is circulating and causing illness.
  • Since September 2009, more than 75 Member States and territories have implemented immunization programmes, and 290 million doses of the pandemic (H1N1) 2009 vaccine have been administered.

 ((MM )) Thank you for your time.


This exclusive interview features first-hand journalism by a Wikinews reporter. See the collaboration page for more details.
This article is a featured article. It is considered one of the best works of the Wikinews community. See Wikinews:Featured articles for more information.