Pandemic and avian influenza
A poster on how to deal with H1N1 pandemic, funded by UNICEF Pacific
These are challenging times in world health with the food, fuel and finance crises and now with pandemic influenza spreading. The potential for other new viruses (such as SARS) to emerge and spread rapidly around the globe also needs to be kept in mind in the response to the current pandemic. When a new outbreak occurs, each country needs to be in a position to contain and limit the spread of the virus and its impact, especially on vulnerable populations.
The current pandemic situation is not as severe as the 1918 pandemic but is similar to the 1957 and 1968 pandemics. A key part of the response is increased attention to hygiene and prevention, improving communication to the different target audiences on how to protect themselves and developing national and subnational capacities to respond to a variety of emergencies. How countries respond to this virus will certainly help them better prepare for the next new virus threat.
The 2009 pandemic influenza A(H1N1) virus (misleadingly called ‘swine flu’) is now the dominant circulating strain of influenza in both the northern and southern hemispheres. The H1N1 virus so far does not appear to be similar in severity to a severe seasonal influenza outbreak – with the difference that there is greater impact on adults younger than 65 years, including pregnant women. The World Health Organization (WHO), the lead health agency in tackling pandemics, is warning countries to remain vigilant and prepare for an increase in cases as the virus continues to spread in its second wave. The WHO is monitoring the viruses from all outbreaks; so far it has found that they remain similar and have not changed into a more virulent or lethal form, or developed resistance to anti-virals, except in isolated cases.
Nearly all people infected with the 2009 pandemic H1N1 virus recover without needing any medical treatment, although as with seasonal influenza, the illness can lead to severe symptoms for a few days. However, the virus can cause very severe and even fatal illness in a small number of people, as with seasonal influenza. The only difference is that many more people younger than 65 years, including pregnant women, are experiencing severe illness and dying. With seasonal influenza, more than 90 percent of fatal cases occur in people aged 65 or older, whereas most deaths from pandemic influenza are among people younger than 65.
Risk factors are the same as for seasonal flu but the risk of infection differs; older people, for instance, are less susceptible. More infections from H1N1 are likely because most people lack any or sufficient immunity to the new virus. Certain conditions increase the risk of severe and fatal illness from both seasonal and 2009 pandemic influenza. These include pregnancy, respiratory disease, asthma, cardiovascular disease, renal disease, diabetes and immunosuppression. Morbid obesity is a newly recognized risk factor for severe illness from the 2009 pandemic influenza.
The H1N1 virus spreads from person to person as easily and in the same ways as seasonal flu; it can be passed to other people by exposure to infected droplets expelled through talking, coughing or sneezing, which can be inhaled or can contaminate hands or surfaces.
There are no known instances of people getting infected by exposure to pigs or other animals. However, pigs and birds have been infected by people, but they have very mild symptoms.
Prevention People who are ill should cover their mouth and nose when coughing or sneezing – with a tissue or their inside elbow, stay home when they are unwell, clean their hands regularly and as best as possible keep some distance from others (more than 1 m), especially sick people.
Signs of influenza A (H1N1) are the same as with seasonal influenza and vary widely between people; they include fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea.
Avian influenza, or 'bird flu', is essentially an animal disease. H5N1, the highly pathogenic virus that has caused outbreaks of bird flu in East Asia and the Pacific and in some parts of Europe and Africa, continues to circulate in this region. In some countries of East Asia, it is commonly found throughout the bird population. Over the past several years, H5N1 has caused mortality among pockets of wild fowl and domestic poultry, provoking culling of domestic flocks and generating serious concern among animal health and human health experts.
While H5N1 is different from the virus that causes influenza in humans – generally known as ‘seasonal influenza’ – it can infect humans who are in close contact with sick or dead birds or their droppings. Although only a tiny fraction of the huge number of people who are in close contact with infected birds have become ill, the disease in humans has been severe in terms of morbidity and mortality. Globally, the WHO has recorded 440 confirmed cases of H5N1 in humans and of them, 262 deaths – with most of the fatalities in Asia. Avoiding infection is critical.
Scientists fear that H5N1 could change, or mutate, into a form that could pass easily between people, leading to a global human influenza pandemic that could affect millions of people. Although some scientists believe that a human pandemic is inevitable, no one can predict with any certainty when it might occur or how serious it would be. Governments have been responding to the possibility of a pandemic through awareness building and planning at many different levels.
A poster on flu prevention funded by UNICEF
UNICEF in Action
UNICEF is one of many partners in the comprehensive efforts to contain and control the spread of both the H1N1 and the avian influenza virus that draws on the expertise of people in all sectors of society: government, civil society, international donors and development organizations, UN agencies and the private sector. As part of the overall UN response, UNICEF and its partners support governments in East Asia and the Pacific to promote:
• Pandemic preparedness
• Behaviour change communication strategies that use inter-personal communication, radio, television, plays, posters, leaflets, booklets and lesson plans for teachers to spread key messages.
Within the UN family, UNICEF is mandated to conduct communication to help communities adopt and sustain behaviours that prevent the transmission, reduce risks or mitigate the consequence of an influenza pandemic.
UNICEF formed an informal working group on communication for pandemic influenza with the WHO (South-East Asia and Western Pacific Regions) and the Food and Agriculture Organization in May 2009 to coordinate communication activities and to leverage technical assistance. Current and future activities include:
• provide guidance and technical assistance to planning of strategic communication to country offices and government counterparts
• conduct a joint exercise to map risk-communication capacity in selective countries to better inform capacity-building activities
• conduct joint training to build capacity of country offices and government counterparts regarding risk communication
• revise and adapt current CREATE! pandemic package of communication materials for influenza A/H1N1.
Across the region, UNICEF country offices provide communication support to governments on both avian and human influenza prevention and management. Activities entail:
• revise and update the communication component of pandemic preparedness and response plans
• develop communication strategies, materials and launch national campaign to promote behaviours that improve surveillance and prevent transmission of the viruses
• help coordinate communication activities via the communication working group.
An online resource centre is available at www.influenzaresources.org to provide communication strategies, products, information and tools developed around the globe in response to the current pandemic of Influenza A(H1N1) virus, the highly pathogenic avian influenza (H5N1) virus and to prepare for future influenza pandemics.
The resource centre has been developed through the UN System Influenza Coordinator (UNSIC) as a joint initiative of the Food and Agriculture Organization, the United Nations Development Programme, the World Food Programme, the World Health Organization and UNICEF.