3 Davao patients tested for 'swine flu'

by Froilan Gallardo/MindaNews

DAVAO CITY (MindaNews/26 May) -- Three persons were placed under quarantine at the Davao Medical Center and tested for suspected influenza A (H1N1) infection, health officials said.

Dr. Leopoldo Vega, chief of the Davao Medical Center, said a series of two tests needs to be conducted on the patients before they can be declared negative of the virus.

Swab throat specimens, he said, were taken from the three patients on Monday and sent to the Research Institute for Tropical Medicine (RITM) in Manila.He said that results are expected within 48 hours (either on Wednesday or Thursday) from the taking of the specimen because of the delay involved in transporting the samples to Manila.

De Vega said a patient needs to have two negative results before he can be discharged. If they test negative on the first swab, another would be taken and if the result is still negative, then the patient can be discharged.

If positive, de Vega said, they will have to do contact-tracing. “We have to trace people they were with and if the person traveled from abroad, we’d have to contact trace three seats in front of him and one seat at the back.”

De Vega said one of the patients is a 27-year-old male, a hairdresser, who arrived from Macau and Hong Kong. The other is a 41-year-old female who came from Indiana in the United States.

Vega said the last patient is a 19-year-old male painter from Panabo City who manifested flu-like symptoms after working aboard a Japanese freighter.

"All of them manifested fever, sore throat, cough. But these are also symptoms of ordinary influenza," he told reporters.

He said the three are now confined at a special isolation ward, a building separate from the main hospital complex. But they can be visited by family members, he said.

“The virus spreads by droplets, respiratory droplets. It is not airborne,” he said, as he urged the public to ensure personal hygiene.

But Vega said the public should not be unduly alarmed because the H1N1 virus that has so far struck two Filipinos "appeared to be benign."

"We think this is a benign virus. The two confirmed patients in the country are already on the road to recovery," he said.

But De Vega also noted that there is a need to “balance it with the unpredictability of the mutation of the virus.”

For now, he said, the three patients at the DMC are “doing well.”

Without dismissing the threat of influenza A (H1N1), de Vega urged the public to also focus on the anti-dengue campaign. With the onset of the rainy season, “we must really watch out for dengue and take the necessary precautions,” he said. (Froilan Gallardo/MindaNews)

DA steps up monitor vs ‘swine flu’ virus in Davao

http://www.sunstar.com.ph/davao/da-steps-monitor-vs-swine-flu-virus-davao

By Carlo P. Mallo

THE Department of Agriculture (DA) in Davao Region has now stepped up its campaign against the dreaded Influenza A or H1N1 virus, although there has been no confirmed transmission from swines to humans.

In an interview with Sun.Star Davao, DA Southern Mindanao Executive Director Roger Chio said they have created monitoring teams down to the barangay level.

"There has been no reported swine flu affecting our hog farms here in the region," Chio said. "But we are monitoring them."

"The monitoring team that we created during the height of the avian flu scare, we will be using the same team to monitor the swine flu," Chio said. "We are monitoring the seaports and airports for the possible smuggling of live hogs here in the city."

Meanwhile, the Davao City Police Office (DCPO) is mapping all backyard piggeries in the city as part of their role in the task force created by the city government to prevent the entry of the dreaded Influenza A or H1N1 virus. The mapping on commercial piggeries was already completed.

DCPO director Senior Superintendent Ramon Apolinario said they have started their mapping immediately after Davao City Mayor Rodrigo Duterte created Task Force Swine Influenza.

Duterte signed Executive Order 11-2009 creating and constituting the Swine Influenza Task Force early this month. Initial moves, however, have already been made to facilitate actions spurred by the EO.

The Surveillance Team and Rapid Action Team have been activated along with the action plans in case of an outbreak. The Information and Education Team has also started to translate flyers on swine flu in local dialect.

Duterte met with officials of the Department of Agriculture, City Veterinary's Office, City Health Office, Bureau of Immigration, and the police last April 30 to discuss precautionary measures in the wake of reports that the virus had killed people in Mexico, United States, and Canada.

Swine Flu alert in the Philippines

Health officials in the Philippines are stepping up monitoring efforts against swine flu.

Swine Flu

Dr. Joe Bresee with the CDC Influenza Division describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it and the steps people can take to protect themselves.

Philippines alert against Swine Flu

China view


MANILA, April 29 (Xinhua) -- There is no incidence yet of swine flu in the Philippines, but government agencies are on high alert against the disease that has spread from North America to Asia and other continents, officials said on Wednesday. 

    "The Philippines is on high alert and is moving quickly to defend our borders against threats of emerging infectious diseases," Health Secretary Francisco Duque said at the 4th Asia-Pacific BioSafety Association Conference held in Manila. 

    Following the World Health Organization's (WHO) alert that the outbreak of swine flu has escalated to a public-health emergency of international concern, the Philippine Department of Health immediately has taken a series bio-security measures in all airports to prevent the entry of the virus. 

    A total of 11 thermal scanners have been deployed in six international airports in the country to screen possible signs and symptoms of the disease. Fifteen doctors and 27 medical assistants specifically assigned to handle such cases are on round-the-clock duty in all the terminals of Manila's Ninoy Aquino International Airport. Any passengers confirmed to have fever will be immediately quarantined and brought to a Research Institute of Tropical Medicine. 

    Duque told reporters that the health department is planning to place more thermal scanners not only in airports but also in seaports to prevent the H1N1 swine flu strain from entering the Southeast Asian country.
    Swine flu is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses. Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones. Swine flu viruses are most commonly of the H1N1 subtype, but other subtypes (e.g., H1N2, H3N1, H3N2) are also circulating in pigs. 

    H1N1 is the subtype that has killed 159 people out of over 2,000 suspected cases in Mexico. Besides, more than 100 cases -- suspected or confirmed -- of human infection have been found in 14 other countries, including one suspected case in the South Korean. 

    Officials said that there has been no case of swine flu reported in the Philippines, but media reports say hundreds of hogs died recently in the northern province of Pangasinan. Doctors say the pigs died of a deadly disease called "poor reproductive and respiratory syndrome" not swine flu as suspected by some local media. Some samples of organ specimen from swine casualties have been sent for laboratory confirmation to the Philippine Animal Health Center under the Bureau of Animal Industry in Manila and the result is expected to come out later this week. 

    Officials pledged to make the situation transparent to the public and advised the people not to panic over the swine flu epidemic, boasting that the government had succeeded in keeping the country free from avian flu, and managed to keep cases of Severe Acute Respiratory Syndrome (SARS) to a minimum. 

    "Our record in preventing SARS and avian flu from coming to the country...have been successful and based on that experience, the government is pulling no stops to ensure that our people will be protected," Press Secretary Cerge Remonde said in a news briefing. 

    Meanwhile, the health authorities issued an advisory suggesting that people should cover their mouths and noses when coughing or sneezing, wash their hands regularly with soap and refrain from kissing, hugging and shaking hands. 

    The health chief, as well as the country's Department of Foreign Affairs, discouraged Filipinos to travel to swine flu-hit countries like Mexico and the United States although there is no ban on traveling to those countries. 

    For its part, the country's Department of Agriculture ordered to temporarily suspend pork imports from affected areas in Mexico, the United States and Canada, adding that it is also closely monitoring reports of swine flu incidences in France, New Zealand, South Korea, and Spain to find out if there is a need to expand the temporary suspension of pork imports from these areas. Agriculture Secretary Arthur Yap said that the temporary ban covers only specific areas of the three countries, not the whole. 

    The Philippines does not import pork from Mexico but imports about 20,000 metric tons annually from the United States and about the same amount from Canada. Yap said the Philippines will maintain the import ban as a precautionary measure despite the latest pronouncement by the World Organization for Animal Health that "there is no evidence that this virus is transmitted by food." 

    In spite of all efforts government agencies have made, Duque said that the authorities "can't give 100-percent assurance that it (the virus) won't get to the Philippines." 

    "We should be alarmed and take precautions because we are now at alert level 4 as announced by the WHO," he said. Level 4 means there is already human-to-human transmission of the virus, while alert levels 5 and 6 mean there is widespread human-to-human transmission, according to the health chief. 

    "We made sure the stockpile of anti-flu medicine is adequate," he said, adding the government has about 600,000 capsules for 60,000 possible swine flu cases. The government is also ensuring adequate supply of masks for frontline health workers, who would also be provided with other forms of protection.

Human Cases of Swine Influenza (Flu)

From CDC website

U.S. Human Cases of Swine Flu Infection (As of April 29, 2009, 11:00 AM ET)

States	# of laboratory confirmed cases	Deaths
Arizona	1
California	14
Indiana	1
Kansas	2
Massachusetts	2
Michigan	2
Nevada	1
New York	51
Ohio	1
Texas	16	1
TOTAL COUNTS	91 cases	1 death
International Human Cases of Swine Flu Infection See: World Health Organization

The outbreak of disease in people caused by a new influenza virus of swine origin continues to grow in the United States and internationally. Today, CDC reports additional confirmed human infections, hospitalizations and the nation’s first fatality from this outbreak. The more recent illnesses and the reported death suggest that a pattern of more severe illness associated with this virus may be emerging in the U.S. Most people will not have immunity to this new virus and, as it continues to spread, more cases, more hospitalizations and more deaths are expected in the coming days and weeks.

CDC has implemented its emergency response. The agency’s goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials and the public address the challenges posed by the new virus. Yesterday, CDC issued new interim guidance for clinicians on how to care for children and pregnant women who may be infected with this virus. Young children and pregnant women are two groups of people who are at high risk of serious complications from seasonal influenza. In addition, CDC’s Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond to the outbreak. The swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir.

This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.

Facts about Swine Influenza (Swine Flu)

From CDC website


What is Swine Influenza?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

How many swine flu viruses are there?
Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Swine Flu in Humans

Can humans catch swine flu?
Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

How common is swine flu infection in humans?
In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported. What are the symptoms of swine flu in humans?
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can people catch swine flu from eating pork?
No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.
How does swine flu spread?
Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What do we know about human-to-human spread of swine flu?
In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.
In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.

How can human infections with swine influenza be diagnosed?
To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.

What medications are available to treat swine flu infections in humans?
There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

What other examples of swine flu outbreaks are there?
Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).

Is the H1N1 swine flu virus the same as human H1N1 viruses?
No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

Swine Flu in Pigs

How does swine flu spread among pigs?
Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.

What are signs of swine flu in pigs?
Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.

How common is swine flu among pigs?
H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.
While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.

Is there a vaccine for swine flu?
Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.

How to spot Swine Dysentery

Swine dysentery (SD), is caused by a spirochaetal bacterium called Brachyspira hyodysenteriae. This organism causes a severe inflammation of the large intestine with a bloody mucous diarrhoea (i.e. dysentery). 

Disease is common in pigs from 12 to 75kg but severe cases occur occasionally in sows and their sucking piglets. 

SD will survive outside the pig for up to seven weeks in cold moist conditions but it dies out in two days in dry warm environments. 

Spread through the herd is slow, building up in numbers as the dose rate of the causal agent builds up in the environment. Pigs that recover develop a low immunity and rarely suffer from the disease again. 

The high cost of disease is associated with mortality (low), morbidity (high), depression of growth and feed conversion efficiency, and costs of continual in-feed medication.

The incubation period in field cases is normally 7 to 14 days but can be as long as 60 days. Pigs may develop a sub-clinical carrier state initially and then break down with clinical disease when put under stress or when there is a change of feed.

Symptoms

Sows

• Clinical disease in sows is uncommon unless new disease appears in the herd.

Piglets

• Severe acute dysentery may occur.
• Sloppy light brown faeces with or without mucous or blood.
• Loss of condition.
• Sows become symptom less carriers. 

Weaners and Growers

The first signs are:-

• Sloppy diarrhea, which stains the skin under the anus.
• Initially the diarrhea is light brown and contains jelly-like mucus and becomes watery.
• Twitching of the tail.
• Hollowing of the flanks with poor growth.
• Partial loss of appetite.
• Slight reddening of the skin.

As the disease progresses:

• Blood may appear in increasing amounts turning the faeces dark and tarry.
• The pig rapidly loses condition.
• Becomes dehydrated.
• A gaunt appearance with sunken eyes.
• Sudden death sometimes occurs mainly in heavy finishers.

Causes / Contributing factors

• Pigs become infected through the ingestion of infected faeces.
• Spread is by carrier pigs that shed the organism in faeces for long periods.
• It may enter the farm through the introduction of carrier pigs.
• Mechanically in infected faeces via equipment, contaminated delivery pipe of feed vehicles, boots or birds.
• It can be spread by flies, mice, birds and dogs.
• Stress resulting from change of feed may precipitate.
• Poor sanitation and wet pens enhance the disease.
• Overcrowding.
• It is a major disease in the growing pig but the breeding female can become a carrier for a long period of time and therefore acts as a potential source of infection to other pigs.

Diagnosis

This is based on the history, the clinical picture, post-mortem examinations, laboratory tests on faecal smears and the isolation and identification of S. hyodysenteriae by serological and biochemical tests and DNA analysis. Identification requires specialised procedures which are not available in every laboratory. 

Post-mortem examinations show that the lesions are confined to the large bowel and sometimes the greater curvature of the stomach. 

The disease has to be distinguished from colitis caused by other spirochetes, non-specific colitis, PIA and bloody gut (PHE), acute salmonella infections and heavy infections of the whip worm, trichuris.

How to spot Swine Dysentery

The disease usually affects olders pigs
especially those in the starter-grower stages

 

Brownish Diarrhea

Diarrhea progresses to brownish red

with a much more liquid consistency
 

 Lesions are found in the large intestine

 

Typical shape of the swine dysentery infected pigs

How to spot Hog Cholera

Pigs affected with hog cholera appear weak, staggering and tend to sit like a dog.

Pigs showing erythema in different areas of the skin

Purplish discoloration of the skin, ears, abdominal part, legs

'Goose-stepping' in hog cholera

Running movement, a nervous sign in hog cholera

Button ulcers in the ceco-colic

Normal-sized spleen with infarcts at the margin (black spots)

Petechial hemorrhages in the mucusa of the urinary bladder

Petechial hemorrhages in the kidney (turkey-egg kidney)

Enlarged and hemorrhagic lymph nodes

Piglets born from a hog cholera-infected sow

Hog Cholera

(From this useful site )

Definition
Hog cholera (HC) is a highly contagious viral disease of swine that occurs in an acute, a subacute, a chronic, or a persistent form. In the acute form, the disease is characterized by high fever, severe depression, multiple superficial and internal hemorrhages, and high morbidity and mortality. In the chronic form, the signs of depression, anorexia, and fever are less severe than in the acute form, and recovery is occasionally seen in mature animals. Transplacental infection with viral strains of low virulence often results in persistently infected piglets, which constitute a major cause of virus dissemination to noninfected farms.

Transmission

The pig is the only natural reservoir of HCV. Blood, tissues, secretions and excretions from an infected animal contain HCV. Transmission occurs mostly by the oral route, though infection can occur through the conjunctiva, mucous membrane, skin abrasion, insemination, and percutaneous blood transfer (e.g., common needle, contaminated instruments). Airborne transmission is not thought to be important in the epizootiology of HC, but such transmission could occur between mechanically ventilated units within close proximity to each other.

Introduction of infected pigs is the principal source of infection in HC-free herds. Farming activities such as auction sales, livestock shows, visits by feed dealers, and rendering trucks are also potential sources of contagion. Feeding of raw or insufficiently cooked garbage is a potent source of HCV. During the warm season, HCV may be carried mechanically by insect vectors that are common to the farm environment. There is no evidence, however, that HCV replicates in invertebrate vectors. Husbandry methods also play an important role in HC transmission. Large breeding units (100 sows) have a higher risk of recycling infection than small herds. In large breeding units where continuous farrowing is practiced, strains of low virulence may be perpetuated indefinitely until the cycle is interrupted by stamping-out procedures and a thorough cleaning and disinfection are carried out.

Incubation Period

The incubation period is usually 3 to 4 days but can range from 2 to 14 days.

Clinical Signs

The clinical signs of HC are determined by the virulence of the strain and the susceptibility of the host pigs. Virulent strains cause the acute form of the disease, whereas strains of low virulence induce a relatively high proportion of chronic infections that may be inapparent or atypical. These strains are also responsible for the "carrier-sow" syndrome from which persistently infected piglets are produced.

UN mission investigates Ebola-Reston outbreak in Philippines

From Yahoo News

MANILA (AFP) – Experts from three UN agencies have arrived in the Philippines to investigate an outbreak of the Ebola-Reston virus at two pig farms north of Manila, the World Health Organisation said Wednesday.
Ebola-Reston, which is only found in the Philippines, had been confined to monkeys and the latest outbreak is the first time it has jumped species.

According to the WHO, the strain is not dangerous to humans, unlike the four deadly Ebola subtypes found in Africa.The Food and Agriculture Organisation and the World Organisation for Animal Health are also represented in the mission."The fact that this is the first time that the virus has been found outside monkeys, and the first time ever, worldwide, that it has been found in swine, a food-producing animal, makes this mission particularly important," a WHO statement said.

It added the case had "potential implications for animal and human health and welfare.

"The Philippine government quarantined the affected farms in Santo Nino and Pinagpanaan villages and halted pork exports when the virus was first detected in October.

The UN team was set to work with its Filipino counterparts over 10 days to establish "the source of the virus, its transmission, its virulence and its natural habitat, in order to provide appropriate guidance for animal and human health protection.

"Preliminary results are expected in a few weeks at the earliest," said the statement.

Local authorities have been unable to find any sign of the virus among farmhands or slaughterhouse workers who handled the pigs.

Ebola-Reston was first detected in 1989 in laboratory monkeys sent from the Philippines to Reston in the United States.