Good Global Health Issue- H1n1 Swine Flu In Mexico In 2009 Research Paper Example
Influenza viruses have the potential to cause annual epidemics and occasional pandemics that can claim millions of lives. Point mutations and genetic rearrangements in the DNA cause the genomic content of Influenza viruses to change constantly. These changes in genomic content result in the development of new influenza strains with epidemic or pandemic potential (Neumann G, 2009). Pandemics are global disease outbreaks. Influenza virus pandemics are typically caused by the introduction of this HA subtype that is new to the human population. The pandemic potential of an influenza virus strain requires efficient human to human transmission. Prior to the 2009, human to human transmission of swine-origin H1N1 viruses was limited and since it was not sustained it did not lead to an influenza pandemic (Besler J, 2010).
Demographics of area affected
In April 2009, novel influenza A H1N1 virus (pandemic H1N1) had been identified from two Mexican samples (one from Veracruz and another from Oaxaca). The Centers for Disease Control and Prevention (CDC) based in Atlanta also confirmed cases of human infection with swine-origin influenza A H1N1 virus around the same time in April 2009. This influenza A H1N1 virus contained a unique combination of gene segments and was colloquially referred to as “swine-flu”. By the end of September 2009, the influenza pandemic caused more than 4000 deaths worldwide with approximately 3000 of these deaths occurring in countries such as USA, Argentina, Mexico, Brazil and Canada based in the Americas (Echeverria-Zuno S, 2009).
The patients who contacted novel Influenza A H1N1 ranged in age from the very young newborn babies (0-3 months of age) to the elderly above 80 years. Thus, the very young, the elderly and those with chronic health conditions were found to be more at risk for developing serious symptoms, needing hospitalization or mortality due to Influenza A H1N1 infections. Several American patients had also reported travelling to Mexico in the days prior to getting H1N1 infection (H1N1 virus Investigation Team, 2009). School- aged children were also highly affected by the influenza virus transmission.
Volume and prevalence over time, before and after the intervention
IMSS is a Mexican public institution that provides healthcare to Mexicans and manages several primary health care units and hospitals across Mexico. The Mexican surveillance system for influenza was active but incomplete prior to the 2009 H1N1 influenza outbreak. Epidemiological evidence gathered by IMSS indicates that the outbreak of respiratory type influenza infection initially started in the Mexican town of La Gloria, Veracruz in mid-February 2009 (Neumann G, 2009). The first large Mexican metropolitan area to be affected by the influenza outbreak was Mexico City from April to June, 2009 (Echeverria-Zuno S, 2009).
Initially, the Mexican surveillance system was able to detect the first few early cases of the novel influenza virus but was not effective in determining the extent of the influenza epidemic. However, active surveillance for influenza-like illness was started in all Mexican health-care units and hospitals after the first alert in April 2009. Epidemiologists in Mexico updated the database daily. In addition, IMSS obtained detailed medical records for all the deaths in order to obtain more information to describe severe cases (Echeverria-Zuno S, 2009). This novel swine-flu H1N1 influenza virus outbreak quickly spread from Mexico to several other countries in a few weeks and to most other countries in the world by December 2009.
Significance of effect on the community
Certain vulnerable populations such as the elderly, the very young, pregnant women, those with chronic conditions are usually disproportionately affected during pandemics. Other disease conditions such as asthma, other lung conditions, diabetes, obesity, autoimmune disorders, those on immunosuppressive therapies, cardiovascular disorders and neurological disorders caused people to be more at risk for hospitalization from H1N1 influenza infection (Echeverria-Zuno S, 2009).
Community factors such as quality and access to health care, physical environment, the density of the population, mixing rates all affect the variation in mortality between different communities. Certain immunizations such as the seasonal influenza vaccines appeared to have a protective effect on some members of the community. If schools are closed for long intervals of time then contact between children in other settings could also occur. Hospital preparedness and risk communication were found to be key factors in reducing mortality due to H1N1 infection in Mexico during the 2009 outbreak (Echeverria-Zuno S, 2009).
Causes, contributing behavioral and environmental factors
In cases of pandemic outbreaks, infection and death rates are different in different countries depending on their medical infrastructure, emergency preparedness and several other factors that influence transmission of the influenza infection. Exposure to individuals infected with H1N1 influenza virus results in spreading the influenza infection. Crowded places, public transportation, school and work environments all promote spreading the influenza H1N1 infection (Jones JH, 2009). In addition to all these factors, weather conditions can also affect influenza virus transmission efficacy especially since efficient human to human transmission is a necessary feature for the generation of a pandemic influenza virus (Besler J, 2009).
Government role and level of effect: national, state, and local
IMSS is the Mexican public institution that provides healthcare and manages several primary health care units and hospitals across Mexico. IMSS is responsible for the co-ordination of Mexican government efforts at the local, state and national levels in order to keep outbreaks of infectious diseases such as swine-flu under control (Echeverria-Zuno S, 2009).
Pandemics are classified according to various alert levels designated by the WHO (World Health Organization) from Phase 1 to Phase 6. Phase 6 is the highest level of a Pandemic alert designated by the WHO that a Pandemic is imminent and that time is short to finalize the organization, communication, and implementation of planned mitigation measures to deal with the pandemic. Phase 5 is designated when the virus has spread to at least 2 countries in one WHO region however most countries will not be affected at this stage (Missouri DHS, 2011). WHO raised the pandemic alert level from Phase 4 to Phase 5 in April 2009 for the swine-flu H1N1 influenza outbreak (Neumann G, 2009). Later the pandemic level alert for H1N1 virus was raised from Phase 5 to Phase 6 by the WHO in June 2009.
Does this disease expand to a global setting?
Yes H1N1 infections spread to various countries across the world. There were several hundred thousand (approximately 200,000) confirmed cases of “swine-flu” caused due to the H1N1 virus reported globally from different parts of the world in 2009. The H1N1 virus had a higher reproduction number and somewhat higher fatality ratio than seasonal influenza viruses (Jones JH, 2009).
During the first few weeks of the outbreak in 2009, H1N1 influenza virus spread to over 30 countries in different parts of the world (Smith G, 2009). The H1N1 influenza virus outbreak had spread to 168 countries and territories worldwide by the end of 2009 (Echeverria-Zuno S, 2009). Thus, H1N1 influenza virus was highly contagious since it is spread through airborne mechanisms such as coughing and sneezing from one human to another. H1N1 viral infections easily spread across the world aided by frequent international land and air travel from Mexico and the US to other countries.
Identify the government structure
Mexican Institute for Social Security is the Mexican government’s social institution responsible for public health and collective wellbeing of Mexicans. It is responsible for the co-ordination of primary health care units and larger hospitals in Mexico to help detect outbreaks of infectious diseases before they threaten lives. In the US, the CDC (Centers for Disease Control) based in Atlanta performs the role of protecting public lives from disease outbreaks. In addition, there are also surveillance programs to help prevent US-Mexico border transmission of infectious diseases. In 1997, Border Infectious Disease Surveillance (BIDS) project was set up between the CDC and the Mexican Secretariat of Health (Weinberg M, 2003).
Discuss the function and role for this issue
It is critically important to correctly identify a possible influenza outbreak before it becomes dangerous and spreads efficiently from human to human thereby threatening the lives of the public. Mexican labs at the time of the initial outbreak in 2009 did not have the required sophisticated biotechnology methods required for identifying a virus’ genetic makeup and pinpointing the unusual strain of the H1N1 Influenza A virus (Padgett T, 2009).
Identify and discuss the interaction or overlap between levels of government
This 2009 swine-flu H1N1 pandemic highlighted the need for closing the gaps in the global surveillance network to detect novel human pathogens. Government agencies need to effectively communicate to the public in a timely and transparent manner in order to be effective in containing the disease outbreak. International co-ordination of government surveillance efforts is vital in the case of pandemics.
Describe the health objectives at each level
The influenza infection rates are higher during pandemics among susceptible populations when there is little to no pre-existing immunity to influenza virus (Belser J, 2009). Therefore it is very important to correctly identify the influenza strain through surveillance efforts of the influenza virus’ genomics and develop effective vaccines for mass production in a timely manner. Co-ordination between government authorities of various countries is important for providing appropriate screening at international borders and airports in order to control the spread of infection between countries.
Intervention and treatment
Vaccinations are used to help prevent and reduce disease burden due to influenza infection. The use of antiviral drugs is considered to be the first line of defense to contain the spread of influenza. Adamantanes and NA inhibitors are two classes of antiviral drugs that are licensed for treatment of influenza (Belser J, 2009). Fever, coughs, muscle ache and rhinorrhoea are the main symptoms of H1N1 infection. Additional flu symptoms such as dypsonea were more strongly associated with increased hospitalization risk and resulting death if these symptoms occurred at the first visit (Echeverria-Zuno S, 2009).
Identify and discuss the primary, secondary, and tertiary interventions
Prevention and control of swine-flu H1N1 Influenza A virus from spreading is based on the understanding of seasonal flu. A simple task of hand washing frequently is believed to help prevent the spread of the virus. Avoiding crowded places and wearing face masks in public probably helped deter the spread of H1N1 Influenza infection in Mexico. Schools in Mexico were also closed during the start of the pandemic (Figure 1) in order to reduce transmission of the swine-flu H1N1Influenza A virus (Echeverria-Zuno S, 2009).
Healthcare workers who were exposed to patients suspected of having H1N1 infections were advised to observe contact and droplet protection in order to prevent the spread of infection. These Healthcare workers were advised to personal protective equipment such as gowns, gloves, face masks, eye protection and fit-tested disposable N95 respirators to minimize the risk of getting H1N1 influenza infection (H1N1 virus Investigation Team, 2009).
Discuss the effect or effectiveness of the intervention
Mexico closed all schools from nurseries for very young children to university level at the start of the pandemic in 2009. School closings might have helped reduce within-school transmission and within the community in general because transmission of the virus was more common among school-aged children. Other methods used in Mexico in 2009 such as isolating of people suspected of being sick with possible respiratory-tract infections, frequent hand-washing, barrier methods (face masks) probably helped reduce the spread of H1N1 infection (Echeverria-Zuno S, 2009).
Discuss the opportunity for change and continued improvement
The major influenza pandemics of the twentieth century were likely to be caused due to a series of multiple genetic reassortment events that occurred over many years in swine or humans before pandemic recognition (Smith G, 2009). There were indications that gaps in genetic surveillance of influenza viral strains for several years before the swine-flu outbreak in 2009. The lack of systematic swine surveillance unlike widespread human influenza surveillance allowed the evolution of this particular pandemic strain of influenza for many years (Smith G, 2009).
Identify the social and behavioral effect of this issue: Discuss the strategies for successful effects on these variables
In general, people with anxiety about swine-flu H1N1 infection were more likely to respond with protective behavior to avoid getting infected. The spread of the infection is influenced by social distancing and it can greatly help to prevent human to human transmission of the infection. According to a survey conducted in April 2009 at Stanford University in California, protective measures (epidemiologically relevant behavior) such as avoiding travel to Mexico, hand-washing and wearing masks in response to swine-flu outbreak in Mexico were measured and represented in Figure 2 (Jones JH, 2009).
Identify resources in the community and their support or effect on the issue and the interventions
The outbreak of swine-flu in April 2009 initially occurred in Mexico City which has several teaching hospitals. Many deaths occurred here from swine-flu and thus the mortality rate was high initially especially due to delayed hospital admission. However, health service agencies were unprepared and they did not take effective measures to warn the public about cardinal symptoms of swine-flu caused by H1N1 virus (Echeverria-Zuno S, 2009). Later on from May 2009 onwards better screening methods and school closures helped reduce mortality rates and decrease the spread of infection. The public campaign (Figure 3) aimed at educating the community about the infection, its spread and what protective measures to take also likely helped reduce mortality rates due to swine-flu in Mexico (Echeverria-Zuno S, 2009).
Identify gaps in the community plan, actions, and resources, and recommend strategies to address the gaps
Mexican media questioned why the Mexican authorities did not sent samples from the first infected person in Mexico and the first patient to die from the infection in 2009 to labs in US and Canada sooner than they did. The first patient to die from swine-flu was mis-diagnosed as having severe pneumonia instead of swine-flu (Padgett T, 2009). This was a major gap in recognizing the start of the swine-flu pandemic in Mexico and taking appropriate action to limit its spread.
Effective global human surveillance and swine surveillance for influenza viral strains at the genomic level and better international co-ordination are necessary in taking appropriate steps in a timely manner to prevent the next major outbreak of disease caused due to influenza viruses. All countries need to have appropriate emergency preparedness measures and protocols in place in case their need arises in a real emergency.
Figure 1: Mexican Institute of Social Security data about the number of influenza-like cases and confirmed swine-flu cases in Mexico in 2009 (Echeverria-Zuno S, 2009).
Figure 2: Protective measures (epidemiologically relevant behavior) taken by survey respondents in response to swine-flu outbreak in Mexico in 2009 (Jones JH, 2009).
Figure 3: Delay between symptom onset to hospital admission in Mexico between April and July 2009 (Echeverria-Zuno S, 2009).
Neumann G, Noda T, Kawaoka Y (2009). Emergence and pandemic potential of swine origin H1N1 influenza virus, Nature, 459, 931-939
Belser J, Maines TR, Tumpey TM, Katz JM (2010). Influenza A virus transmission: contributing factors and clinical implications, Expert Reviews in Molecular Medicine, 12, e39
Echeverria-Zuno S, Mergia- Arangure JM, Mar-Obeso AJ, Grajales-Muniz C, Robles-Perez E, Gonzalez-Leon M, Ortega-Alvares MC, Gonzalez-Bonilla C, Rascon-Pacheco RA, Borja-Aburto VH (2009). Infection and death from Influenza A H1N1 virus in Mexico: a retrospective analysis, Lancet, 374, 2072-2079
H1N1 Novel Swine Origin Virus Investigation Team (2009). Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans, New England Journal of Medicine, 360 (25), 2605-2615
Missouri (DHS) Department of Health and Human Services (2011) Pandemic Phases and Stages
Padgett T, Mascarenas D, May (2009). As Swine-Flu Eases Mexicans Ask: Was the Government Lucky or Good? Time Magazine, May Issue retrieved from the website http://content.time.com/time/world/article/0,8599,1895559,00.html on March 29, 2015
Jones JH, Salathe M (2009). Early Assessment of Anxiety and Behavioral Response to Novel Swine-Origin Influenza A (H1N1), PLos One, 4 (12), e8032
Smith G, Vijaykrishna D, Bahl J, Lycett SJ, Worobey M, Pybus O, Ma S, Cheung C, Raghwani J, Bhatt S, Peiris J, Guan Y, Rambaut A (2009). Origins and Evolutionary Genomics of the 2009 swine-origin H1N1 influenza A epidemic, Nature Letters, 459, 1122-1125
Weinberg M, Waterman S, Lucas CA, et.al, Border Infectious Disease Surveillance Project Working Group (2003). The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Bi-national Border Surveillance, Emerging Infectious Diseases, 9(1), 97-102
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