Influenza virus a h1n1. Symptoms of H1N1 influenza in humans. Preventing the spread of influenza, preventing swine flu

H1N1 influenza or “swine flu” is an acute viral disease that affects both adults and children equally. The name “swine flu” comes from its first manifestation in domestic animals. In particular, pigs. Initially, the H1N1 flu was typical only for the USA, Africa, and Japan. Recently, swine flu in Russia has also become a fairly common disease. The greatest danger of the disease is that the virus can mutate. Death is no exception.

Etiology

The virus was first discovered in 1931 in America. Despite the fact that the virus is called a swine virus, almost all domestic animals, including birds, can become ill with it.

First, the most common myth should be dispelled. Transmission of the virus from animals to humans is unlikely. Moreover, thermally processed meat from an infected animal does not pose a danger to human life. The main route of transmission of the H1N1 virus is through airborne droplets or through close contact with a sick person.

The main risk group includes people belonging to the following categories:

• people with weakened immune systems;
• have suffered from or are suffering from chronic illnesses;
• children of primary preschool age (up to 5 years);
• people with metabolic disorders.

However, it should be noted that the virus can infect even a healthy person with a strong immune system if there are contributing factors. H1N1 infection can only be detected through a laboratory blood test.

A person is considered contagious one day before the onset of symptoms and a week after recovery. Therefore, during this period, you should continue to take prophylactic medications. Tamiflu is considered the most effective for this form of the virus.

The incubation period for H1N1 can last from a few hours to 3 days. In some cases, the incubation period from infection to the onset of symptoms can last up to a week. In this case, the period of development of the disease is individual.

Causative agents of the disease

There are several forms of this virus. Form A (H1N1) is considered the most dangerous and highly pathogenic. A form of swine influenza A (H1N1) is the result of a cross between a human and a swine virus. This subform can mutate, which significantly complicates not only diagnosis, but also treatment. The main pathogen remains the infected animal and man.

Clinicians note that forms of the virus may mutate in the future. Thus, even more complex combinations can be created, which will lead to dire consequences.

General symptoms

The initial symptoms of the H1N1 virus are very similar to the common cold. Therefore, patients often do not even suspect it and do not seek medical help during this period of development of the disease. In some clinical cases, the disease occurs without any symptoms, which increases the risk of complications.

Initially, the virus manifests itself in the form of the following symptoms:

• elevated temperature (up to 40 degrees);
• fever, chills;
• coughing;
• a sore throat;
• runny nose, nasal congestion;
• fast fatiguability;
• gastrointestinal disorders;
• bluish skin or unhealthy blush.

Due to the fact that such signs also indicate normal symptoms, the patient does not seek medical help in a timely manner. As a result, complications may develop. The general clinical picture is complemented by the following signs in adults:

• chest pain;
• attacks of sudden dizziness;
• severe vomiting for no apparent reason;
• loss of consciousness;
• heavy, shallow breathing.

Swine flu in children, in addition to general symptoms, can be accompanied by the following symptoms:

• the child becomes lethargic, does not want to eat or play;
• breathing becomes difficult and shallow;
• high fever;
• attacks of aggression are possible;
• severe vomiting.

During this period, the child’s clinical picture only worsens, and intoxication of the body begins. You should immediately consult a doctor or seek emergency medical help. The H1N1 virus is most dangerous for children of primary preschool age (from 2 to 5 years).

It is worth noting that in more severe clinical cases, high fever may persist for up to 3 days. This patient's condition is very dangerous. Death is no exception.

Since swine flu has ambiguous symptoms, similar at first to regular flu, many patients do not receive timely and correct treatment. This leads not only to serious complications, but also to infection of other people with the virus.

Diagnostics

Diagnosis of H1N1 does not always require any instrumental studies. After a personal examination by a therapist or pediatrician, an infectious disease specialist can begin to clarify the medical history. Laboratory tests may be needed to clarify the diagnosis. The virus can be determined through the following tests:

• blood test for antibodies.

If the patient’s condition is critical, or there are suspicions of serious complications, then additional instrumental tests may be prescribed in the form of a chest x-ray. In general, the diagnostic program is drawn up based on the patient’s condition. It is impossible to determine the virus without laboratory tests.

Treatment

Treatment of the disease is prescribed only after the diagnosis is confirmed. If the virus does not cause dangerous complications in the body, then it is quite possible to completely cure swine flu.

Treatment involves hospitalization of the patient, and only bed rest. A comprehensive treatment is carried out, within which the doctor can prescribe drugs with the following spectrum of action:

• antiviral (Tamiflu);
• for general strengthening of the immune system;
• antibiotics.

The mandatory treatment program includes the drug Tamiflu. Today this is the most effective medicine against this type of virus.

Tamiflu powder is used to treat viral infections type A and B. Tamiflu is contraindicated in children under one year of age. But for children of primary school age and adults, Tamiflu is an effective drug not only for the treatment, but also for the prevention of influenza.

Tamiflu is available in powder or suspension form. The dosage of Tamiflu should only be prescribed by a doctor. Self-medication or treatment with folk remedies is inappropriate in this case.

Prevention

The best way to prevent swine flu is to get vaccinated. For this, you should consult a general practitioner or pediatrician. Vaccination almost completely eliminates infection with the swine virus. But it should be taken into account that the vaccination is not a panacea for the flu. If you don’t take care of your health, no medications or vaccinations will protect you from contracting a viral disease.

Prevention includes the following activities:

• taking preventive medications (Tamiflu is also included here);
• proper, balanced nutrition;
• maintaining personal hygiene.

During the period of exacerbation of the disease, stay in public places should be minimized. As for vaccinations and taking Tamiflu, such precautions are mandatory for children. Avoiding infection with a virus is much easier than curing it.

The so-called swine flu is a type of influenza caused by a reassortant virus (in English literature the pathogen is referred to as Swine-Origin Influenza A(H1N1) Viruses).

Swine flu type A was described in 1931. Its local outbreaks have occurred repeatedly. The latest epidemic began in Mexico in March 2009, spread to the United States, South America, and then to other continents and countries, including Russia, and assumed pandemic proportions. In 2010, WHO announced the end of the pandemic.

As of 2016, the H1N1 virus continues to circulate as one of the seasonal influenza strains. On the one hand, it is expected that the H1N1 virus will continue to circulate as a seasonal influenza strain for the foreseeable future and, as a result, more people will develop immunity to the virus. On the other hand, it is also expected that the virus will change over time as a result of antigenic drift, and such changes may mean that the protective power of immunity developed to that variant of the virus may be weakened against future variants of that virus. In addition, many people were not infected with the H1N1 virus during the pandemic and, therefore, in some countries there may be areas where the impact of the pandemic was less severe and where it may be more severe later.

Based on current evidence, H1N1 virus currently continues to pose an increased risk of severe illness to these same groups, including young children, pregnant women, and people with respiratory and chronic health conditions. It is likely that we will still see cases of severe disease among both high-risk people and otherwise healthy people.

Causes of swine flu

The swine influenza virus is a triple reassortant of the human, poultry and swine influenza virus. All influenza viruses belong to the group of pneumotropic RNA viruses and belong to the Orthomyxoviridae family. Their virions are round or oval in shape with a particle diameter of 80–100 nm. The core of the virion (nucleocapsid) consists of a helical strand of ribonucleoprotein covered on top with a lipoglycoprotein shell. The outer layer of the virion shell includes glycoproteins with hemagglutinating and neuraminidase activity. The virus contains the enzyme RNA polymerase. According to the antigenic characteristics of the internal nucleoprotein (S-antigen), influenza viruses are divided into types A, B and C. Influenza viruses of type A, depending on the antigenic properties of the outer shell glycoproteins - hemagglutinin (H) and neuroamindase (N) - are divided into subtypes (H1- 3, N1–2). The standard designation of influenza A virus strains includes: virus type, host species (other than humans), location of isolation, strain number, year of isolation, and hemagglutinin and neuroamidase formula, for example A/California/07/2009(H1N1).

Unlike viruses B and C, which are characterized by a more stable antigenic structure, influenza A viruses have significant variability in surface antigens. It manifests itself either in the form of antigenic “drift” (partial renewal of antigenic determinants) of hemagglutinin or neuraminidase within one subtype, or in the form of antigenic “shift” (complete replacement of a genome fragment encoding hemagglutinin or hemagglutinin and neuraminidase), which leads to the emergence of new subtypes among type A viruses.

The 2009 influenza pandemic, known as “swine flu,” was caused by the A/H1N1/09 ​​virus, which has the greatest genetic similarity to the swine flu virus.

“Swine flu” is a combination of genetic material from already known strains - swine, bird and human influenza. The exact origin of the strain is unknown, and the epidemic spread of this virus among pigs could not be established. Viruses of this strain are transmitted from person to person and cause illness with symptoms common to the flu.

The disease is transmitted by airborne droplets.

Susceptibility has an age-related nature. Mostly people under 30 years of age are affected. The overall incidence rate is lower than with “seasonal” influenza, however, since only severely inpatients are examined, registration is incomplete.

Pathogenesis of swine flu

A pathogenetic feature of swine flu is the ability of the new virus to cause a sharp activation of inflammatory mediators, which in severe cases leads to damage to the alveolar epithelium, the development of ARDS and pneumonia.

Like any disease of an infectious nature, influenza is the result of a two-way interaction between micro- and macroorganisms. The high ability to change the genome of viruses has led to the emergence of their new subtypes, which have a significantly greater ability than classical respiratory viruses to generate an uncoordinated inflammatory response of the macroorganism. As in the case of complicated bacterial infections, with influenza A/H1N1/09 ​​the main driving force behind the systemic disorders that occur in the body is the systemic inflammatory response syndrome. It has been shown that in this case, in addition to IL-6, IL-8, IFN-γ, TNF, a number of others act as key mediators of inflammation - IL-9, IL-15, IL-17, IL-12p70, secreted by activated leukocytes.

Important features of the course of the pandemic variant of influenza are more frequent and severe damage to the lower respiratory tract, the ability to develop and rapidly progress acute respiratory failure due to viral pneumonia with the development of acute respiratory distress syndrome (ARDS), and in some cases, shock, renal dysfunction and coagulopathy consumption. This requires treatment for some patients in the intensive care unit (ICU). According to WHO, from 10 to 30% of hospitalized patients with influenza A/H1N1/09 ​​required treatment in an ICU.

Based on the results of an analysis of the influenza epidemic caused by the A/H1N1/09 ​​virus in 2009, five types of respiratory complications can be distinguished: viral “pneumonitis”, exacerbation of bronchial asthma or chronic obstructive pulmonary disease, exacerbation of other chronic diseases, secondary bacterial pneumonia, and bronchiolitis in the pediatric population.

Overall, secondary bacterial infection was diagnosed in 14–29% of cases.

It should be noted that the majority of patients who passed through the ICU had viral “pneumonitis”, and the clinical picture was characterized by progressive hypoxemia and bilateral infiltrates on chest x-ray (manifestations of ARDS). Therefore, a transfer to artificial pulmonary ventilation (ALV) and the use of fairly “strict” ventilation parameters were required.

Due to the presence of morphological features in lung damage induced by a viral infection, such lung damage is defined as “viral pneumonitis,” although in most publications the authors use the term “viral pneumonia.”

Against the background of viral pneumonia and ARDS, hospital pneumonia can develop, the etiological structure of which is dominated by non-fermenting gram-negative bacteria (P. aeruginosa, Acinetobacter spp.), enterobacteria - producers of extended spectrum betalactamase (ESBL) and methicillin-resistant staphylococcus.

During autopsy, three main types of pathological changes were determined:
1) diffuse alveolar damage with alveolar and fibrinous exudate, with the formation of “hyaline membrane” syndrome and activated pneumocytes;
2) necrotizing bronchiolitis with the formation of areas of pulmonary emphysema;
3) diffuse alveolar damage with a pronounced hemorrhagic component, microvascular thrombosis, hemorrhages in the intraalveolar space and submucosa and interstitial edema.

Clinical picture (symptoms) of swine flu

The incubation period for this disease ranges from two to seven days.

Clinical symptoms are similar to “seasonal” flu; in most cases the disease is benign, but some patients experience gastrointestinal syndrome (nausea, vomiting, diarrhea).

According to WHO data (January 2010), the mortality rate is about 0.9% (among registered severe patients). Among intensive care patients it reaches 14-40%.

In a number of patients, the onset of the disease is rapid: 2-3 days pass from the first symptoms to a severe condition.

In the second option, in the first 5-7 days, a clinic of a moderate form of ARVI is formed. By the end of the first week of illness, patients’ well-being may improve somewhat, which creates the impression of imaginary well-being. On the 5th–7th day, the patient’s condition worsens again, fever and weakness increase, a dry cough and shortness of breath appear. It is this variant of the course of the disease that predominates.

An important feature of the pandemic variant of influenza is more frequent and severe damage to the lower respiratory tract, the ability to develop and rapidly progress acute respiratory failure due to acute respiratory distress syndrome (ARDS) and pneumonia.

First, an increase in the pulmonary pattern appears, mainly in the lower sections, then a picture of lower lobe pneumonia. Infiltration occurs on one or both sides simultaneously. Further, the clinical and radiological picture worsens rapidly, and after 3-5 hours a total darkening of the lungs is determined.

The disease rapidly deteriorates within several hours: intoxication increases, oxygen saturation decreases, and the phenomena of hypoxic encephalopathy and hemorrhagic pulmonary edema increase.

Blood tests more often record normocytosis or hyperleukocytosis with a shift of the leukocyte formula to the left, changes in blood gases in the form of an increase in decompensated respiratory and metabolic acidosis.

Diagnosis of swine flu

The main diagnostic method is PCR. Timely diagnosis of the disease and the stage of respiratory failure using portable pulse oximeters in emergency rooms and therapeutic departments with timely transfer to the intensive care unit due to the rapid progression of acute respiratory failure is of decisive importance in preventing fatal cases of pneumonia.

Treatment of swine flu

In most cases, patients are subject to outpatient treatment using pathogenetic and symptomatic therapy. Treatment is carried out with oseltamivir and antibiotics.

Antiviral therapy is primarily indicated for patients with risk factors for adverse development of the disease:
a) pregnancy,
b) overweight (BMI > 30 kg/m2),
c) persons with chronic lung diseases (bronchial asthma, COPD, etc.),
d) concomitant severe somatic diseases (diabetes mellitus, chronic cardiac, renal, liver failure, taking aspirin, immunosuppressants, chronic alcohol intoxication).

Antiviral therapy for swine flu

The antiviral drugs of choice are the viral neuraminidase inhibitors oseltamivir and zanamivir.

Oseltamivir is administered orally in 75 mg capsules or as a suspension prepared from 12 mg/ml powder ex tempore.

For adults and adolescents 12–17 years old with uncomplicated forms, the drug is prescribed 75 mg twice a day for 5 days. Zanamivir in adults and children over 5 years of age is used in the following regimen: 2 inhalations of 5 mg twice a day for 5 days.

There are no data regarding the use of oseltamivir in children under 1 month of age.

Zanamivir can be used in cases of resistance of the A/H1N1/2009 virus to oseltamivir. According to WHO information (2009), the effectiveness of intravenous use of zanamivir and alternative antiviral drugs (peramivir, ribavirin) in cases of resistance of the A/H1N1/2009 virus to oseltamivir is being studied.

It should be noted that the maximum therapeutic effect from the use of these drugs was noted only when treatment was started in the first two days of the disease.

There is evidence that in patients with severe forms of pandemic influenza A/H1N1/2009 with the development of viral pneumonia against the background of standard therapy, a higher intensity of viral replication (viral load) and a long-term (7-10 days) presence of the virus in the bronchial contents are detected. This makes it justified to increase the dose of antiviral drugs (adults oseltamivir 150 mg twice a day) and lengthen the course of treatment to 7–10 days.

Due to the resistance of the A/H1N1/2009 virus to M2 protein blockers, the use of amantadine and rimantadine is inappropriate.

Outpatient management of patients requires regular monitoring of the dynamics of disease manifestations. Signs of disease progression are:
– increase in body temperature or persistence of high fever for more than three days,
– the appearance of shortness of breath at rest or during physical activity,
– cyanosis,
– bloody or blood-stained sputum,
– chest pain when breathing and coughing,
– arterial hypotension,
– change in mental status.

When the above symptoms appear, specific antiviral therapy and referral of the sick person to a specialized hospital are necessary.

Emergency hospitalization is indicated if the following criteria are met:
– tachypnea more than 24 breaths per minute,
– hypoxemia (SрO2< 95%),
– presence of focal changes on the chest x-ray.

Critical conditions in such patients primarily include rapidly progressive damage to the lower parts of the tracheobronchial tree with the development of viral pneumonia and ARDS with persistent hypoxemia. Features of a severe course of a respiratory viral infection are: rapid development (in the first 72 hours) of acute respiratory failure, severe hypoxemia (PaO2< 60 мм рт. ст.), рефрактерность к проводимой комплексной терапии, высокий риск баротравмы (пневмоторакса) при проведении ИВЛ.

Other complications of the disease are secondary infectious processes (pneumonia, septic shock), renal and multiple organ failure, myocarditis, meningoencephalitis, as well as decompensation of concomitant chronic diseases (bronchial asthma, COPD, chronic heart failure). In patients with severe disease, as a rule, there was an increase in the levels of LDH, ALT, AST and creatinine, leukopenia and lymphopenia.

When a patient is hospitalized during his initial examination in a hospital emergency department, a comprehensive assessment of the clinical manifestations of influenza is necessary, primarily the nature of damage to the respiratory system, the degree of compensation for concomitant diseases, the main physiological constants: respiratory rate and pulse, blood pressure, blood oxygen saturation (SpO2) , diuresis. X-ray (or wide-format fluorography) of the lungs and ECG are required. A standard laboratory examination is carried out, material is taken for specific diagnostics - RT-PCR, serological tests (an increase in antibody titer by 4 times or more is of diagnostic significance).

During treatment, regular monitoring of basic clinical and laboratory parameters is necessary, since in patients who initially exhibit symptoms of uncomplicated influenza, the disease can progress within 24 hours to a more severe form. There are known cases of fulminant development of ARF/ARDS (within 1 to 8 hours) in patients with no predictors of severe influenza.

Indications for transfer to the intensive care unit

Clinical picture of rapidly progressive acute respiratory failure (RR > 30 per minute, SpO2< 90%, АДсист. < 90 мм рт. ст.), а также другая органная недостаточность (ОПН, энцефалопатия, коагулопатия и др.).

It is necessary to timely transfer patients to mechanical ventilation before hypoxemia progresses, while using high-quality breathing equipment. The ventilation mode should be forced mechanical ventilation by pressure (CMV-PC) with mandatory drug synchronization for the first three days and monitoring of blood gases. Transfer to independent breathing should be carried out only using assisted ventilation modes (SIMV with PSV) with clear positive clinical dynamics of the disease.

One of the key points in the treatment of viral pneumonia is antiviral therapy, and the basis of empirical antibacterial therapy in intensive care units should be modern antimicrobial drugs that affect the main respiratory pathogens that cause pneumonia, with further correction based on the results of bacterial cultures of sputum. The selection of the volume of infusion therapy should be individual, regulated only by the administration of antibiotics, hormones and dopamine, with early initiation of enteral nutrition.

Treatment of acute respiratory failure in swine flu

In the ICU, all patients should immediately receive oxygen through nasal catheters or regular face masks. Start with an average flow rate (5–7 l/min), if necessary increasing to 10 l/min in order to ensure an acceptable level of blood oxygenation (PaO2 more than 60 mm Hg, SpO2 above 90%). The lack of improvement in the condition of patients with persistent “borderline” gas exchange rates may serve as a basis for the use of non-invasive mechanical ventilation through a nasal mask according to generally accepted rules with careful monitoring of the PaO2 level or SpO2 value.

If there are indications, transfer to mechanical ventilation must be carried out immediately (respiratory rate more than 35 per 1 min, decrease in PaO2 less than 60 mm Hg, decrease in SpO2< 90% и нарушение сознания на фоне инсуфляции кислорода). При этом следует иметь в виду, что прогрессирование дыхательной недостаточности может происходить чрезвычайно быстро.

As a rule, parenchymal damage to the lungs during influenza A/H1N1/2009 is accompanied by a decrease in the compliance of the respiratory system due to a decrease in lung volume, loss of surfactant, and interstitial edema. Parenchymal damage may also affect the airways, especially the bronchioles and alveolar ducts. Their narrowing and collapse contribute to the deterioration of ventilation of the damaged parts of the lungs. The main pathophysiological mechanism of impaired oxygenation during parenchymal damage is associated with a violation of ventilation-perfusion relationships and the development of a shunt.

The strategic goal of respiratory support for this type of parenchymal lung injury is to ensure adequate gas exchange and minimize potential iatrogenic lung injury.

When choosing a ventilation mode, the clinical decision is made mainly taking into account four important factors: possible hyperextension of the lungs by volume or pressure, the degree of arterial oxygen saturation of hemoglobin, arterial pH, and fractional oxygen concentration (oxygen toxicity).

Regional overdistension of the lung tissue can be carried out in two ways: 1) with repeated closing and opening of damaged alveoli that collapse during exhalation (atelectasis injury); 2) with excessive overextension of the lungs at the end of inspiration due to a large tidal volume or high PEEP.

Parameters and modes of mechanical ventilation that cause excessive stretching of the alveoli cause or aggravate tissue edema and damage to these structures. In accordance with this, it is required: a) to restore gas exchange in the “recruited alveoli” using PEEP; b) avoid overdistension of healthy alveoli during the inspiratory phase, focusing on plateau pressure or inspiratory pressure when performing pressure-controlled ventilation (no more than 30–35 cm H2O).

In ARDS secondary to viral pneumonia, the use of pressure-controlled mandatory ventilation is probably the preferred option because, compared with volumetric ventilation, it is more effective in limiting the maximum distension in all ventilated units to a set level, regardless of regional changes in the lungs. Other possible benefits of pressure-controlled ventilation are higher mean pressure (due to higher initial inspiratory flow rate and faster achievement of target pressure) and better matching of inspiratory flow to patient demand (if spontaneous breathing attempts are maintained).

Due to the risk of overstretching of the lung tissue in case of severe lung damage and the need to limit the supplied volume (pressure), it can be considered acceptable to reduce the level of hemoglobin oxygen saturation (SpO2) to 88%. The oxygen tension in arterial blood should be maintained within 55–60 mmHg. Art. to minimize the effect of pulmonary vasoconstriction, and pH values ​​should not be lower than 7.2 (against the background of possible hypercapnia). This pH level correlates with an increase in PaCO2 to 70–80 mmHg. Art. (“acceptable hypercapnia”). Meanwhile, this tactic should be carried out with extreme caution, especially in patients with central nervous system pathology and unstable hemodynamics (with inotropic support or cardiac arrhythmias).

The exact concentration of oxygen in the supplied air mixture at which it becomes toxic is unknown. A FiO2 level of 0.5–0.6 is considered acceptable.

In case of severe lung damage, forced and forced-assisted ventilation are mainly used, for example, CMV-PC, CMV-VC, AssistCMV, IMV, SIMV modes. This approach ensures that most of the work of providing ventilation is done by the ventilator. The use of triggered ventilation (eg, AssistCMV) and mechanical ventilation modes (SIMV + PS, BIPAP) allows the patient to initiate additional breaths, which can help achieve the required CO2 level and improve patient comfort. In cases where there are critical values ​​of gas exchange and respiratory mechanics, and desynchronization of the device with the patient’s breathing is observed, preference in respiratory support should be given to forced mechanical ventilation with adequate sedation and/or the use of muscle relaxants.

Sedation or myoplegia is also necessary when using an unnatural breathing pattern (long inhalation) or when the peak pressure is high. If the lung damage is not very severe or there is a positive trend in the patient’s condition, assisted ventilation is used with a gradual decrease in ventilation support so that the patient takes on part of the work of providing ventilation. With partial support, there is generally a lower peak pressure and less sedation is required.

Tidal volume and PEEP should be selected so that the plateau pressure does not exceed 30–35 cm of water. Art. (or inspiratory pressure if using pressure-controlled ventilation). To maintain this pressure, it may be necessary to reduce the tidal volume to 5–6 ml/kg instead of the traditionally used 8–10 ml/kg. Breathing frequency is usually selected based on the PaCO2 level. The initial respiratory rate is usually 12–18 per minute.

An increase in the frequency and, accordingly, minute ventilation leads to an increase in CO2 excretion. At a certain point, however, there is a delay in gas elimination (“air trapping”) due to inadequate expiratory time. In this situation, pressure-controlled ventilation decreases minute ventilation, while volume-controlled ventilation increases airway pressure. As a rule, the occurrence of auto-PEEP is noted when the respiratory rate is more than 20 per minute.

The choice of the optimal PEEP value, based on the possibility of undesirable effects of this regime, is based on gas exchange indicators (PaO2, PaCO2, SpO2), achievement of the highest value of static compliance of the lungs or the level of oxygen delivery to tissues. You can use the so-called “decreasing” option for selecting PEEP. It is necessary to first perform an alveolar recruitment maneuver and establish inspiratory pressure (pressure above PEEP) so that the tidal volume is approximately 6-8 ml/kg.

The alveolar recruitment maneuver is carried out by setting PEEP at 20 cm of water. Art. and inspiratory pressure – 20 cm water. Art. (from the PEEP level) in the pressure-controlled forced ventilation mode for 2–3 minutes (it is preferable to use pressure-controlled ventilation modes). If there is no effect, higher pressure levels can be used (Ppic up to 60 cm water column, PEEP 20–25 cm water column). Then a certain level of inspiratory pressure is established (tidal volume 6–8 ml/kg) and, gradually changing PEEP (steps of 1–2 cm H2O), the PEEP level is determined when pulmonary-thoracic compliance or oxygenation indicators are the highest. PEEP values ​​that are optimal from the point of view of respiratory mechanics and oxygenation may not coincide. If it is necessary to use a high level of PEEP in order to avoid overdistension of the lungs, it is necessary to maintain SpO2 at the level of 88–90% (PaO2 60–65 mm Hg). The effect of PEEP on gas exchange manifests itself slowly, sometimes over several hours. At the same time, even a short-term decrease in pressure in the airways can lead to a critical deterioration in oxygenation. Unnecessarily prolonged depressurization of the circuit and a decrease in pressure in the respiratory tract should be avoided, even when performing the necessary medical procedures (bronchoscopy, sanitation of the tracheobronchial tree).

Indications for performing the maneuver of “opening” the alveoli are:
critical hypoxemia,
lack of sufficient effect from optimizing the respiratory pattern and/or using non-respiratory methods for treating ARF;
the period after episodes of “respiratory distress” and/or invasive manipulations (transportation, fibrobronchoscopy, tracheostomy, reintubation, aspiration of secretions, etc.);
use as a method for optimizing PEEP.

The optimal effect of the alveolar “opening” maneuver in most cases is observed only in the early stages of ARDS.

It should also be emphasized that during prolonged mechanical ventilation the risk of developing pneumothorax increases significantly.

Absolute contraindications for performing the lung “opening” maneuver are:
pneumo-/hydrothorax,
bullous changes in the lungs,
high risk of development and/or recurrence of pneumothorax,
lack of modern ventilators,
insufficient monitoring,
severe hypovolemia.

Techniques that improve oxygenation include inverting the ratio of inhalation and exhalation times. Prolonged inspiratory time (without the development of auto-PEEP) can increase mean alveolar pressure without changing maximum alveolar pressure. It is believed that prolongation of inspiratory time leads to an increase in the time of gas mixing in the alveoli, improved ventilation of poorly filled alveolar units, and recruitment of part of the alveoli.

The effect of this technique and its impact on the outcome of acute lung injury are not fully understood.

It is known that if expiratory time becomes inadequate (short), autoPEEP develops and venous return sharply decreases.

Intrinsic (auto-)PEEP, however, is difficult to assess. If the inspiratory duration is set incorrectly, it can affect the ventilation parameters.

With volume ventilation, auto-PEEP increases peak pressure, and with pressure-controlled ventilation, it decreases tidal volume.

In addition, an increase in the inspiratory to expiratory ratio of more than 1:1 (or inspiratory time of more than 1.5 s) is extremely uncomfortable for the patient. Typically, in these cases, additional sedation and myoplegia of the patients are required if they have not been used previously. In this regard, increasing the inhalation to exhalation ratio by more than 1: 1 is inappropriate.

A certain improvement in gas exchange can be achieved by periodically changing the position of the ventilated body (prone position) by turning him onto his stomach (for 4–12 hours) and back onto his back.

There is positive experience in the use of extracorporeal oxygenation, HFIV and nitric oxide for critical gas exchange disorders due to viral pneumonia. Improved oxygenation rates (4–6 hours) can also be achieved through the use of surfactant, although the effectiveness of this treatment method for ARDS of other etiologies has not been proven. However, if refractory hypoxemia persists, it appears that the use of this additional method of maintaining oxygenation should still be considered.

Thus, in patients with ARDS against the background of viral pneumonia with influenza A/H1N1/2009, it is initially most advisable to perform mechanical ventilation in the mode of forced ventilation with pressure control (PCV, SIMV (PC), BIPAP) with setting an adequate level of PEEP (if necessary up to 15–20 cm of water column and above) under the control of gas exchange parameters and respiratory mechanics. You should be prepared for long-term ventilation (2–4 weeks).

Simplification of the ventilation mode must be carried out gradually, first by reducing FiO2, then by a progradient decrease in PEEP.

Taking into account the duration of ventilation, patients may undergo tracheostomy.

It is better to make the decision about surgery on the 7th–10th day, when, on the one hand, the further course of the process becomes clear, and on the other hand, some stabilization of gas exchange occurs.

Prerequisites for connecting auxiliary ventilation modes. Before starting the process of weaning from the ventilator, the general condition of the patient should be assessed. Any identified deviations in homeostatic parameters should, if possible, be reduced to acceptable values.

When making a decision to stop mechanical ventilation, attention is paid to the mechanical and neuromuscular capabilities of the respiratory system, as well as the ability of the lungs to adequately oxygenate arterial blood without the support of the device (PaO2 more than 60 mm Hg at FiO2< 0,3, SрО2 не ниже 95%, частота дыхания менее 25 в минуту при величине поддержки давлением не более 8–10 см вод. ст.).

Transfer to spontaneous breathing.

Transfer to spontaneous breathing refers to the process of gradually reducing the level of respiratory support using assisted ventilation modes. Transfer to spontaneous breathing can take up more than 40% of the total time patients are on mechanical ventilation, so the role of correct tactics during this stage is extremely important.

Initiation of transfer to spontaneous breathing (use of assisted ventilation and spontaneous breathing modes with a gradual decrease in the share of hardware support) can only be started when PaO2 is more than 60 mm Hg. Art., and SpO2 is above 95% against the background of ventilation with an air-oxygen mixture with FiO2 0.3–0.4 and a decrease in PEEP to 10–12 cm of water. Art.

Another criterion for the success of transferring to spontaneous breathing is the value of the inspiratory index. This index is calculated by dividing the respiratory rate by the tidal volume in liters. A rapid increase in the index value > 100 after switching to spontaneous breathing indicates questionable success. If the index value is less than 100, the probability of successful transfer to spontaneous breathing is quite high.

Before extubation, it is useful to perform another sanitation of the tracheobronchial tree. After disconnecting from the respirator, it is imperative to continue supplying humidified oxygen through the face mask at a flow rate of 4–6 l/min.

After transferring the patient to fully independent breathing, he needs careful observation and monitoring for at least the next 24 hours. In this case, the spontaneous tidal volume should be at least 5 ml/kg with a respiratory rate of less than 25 times per minute. Patients who require ventilation of more than 10 l/min, as a rule, cannot provide such ventilation without fatigue of the respiratory muscles.

Glucocorticosteroids

In case of refractory shock, especially in combination with ARDS, it is advisable to use low doses of steroids: hydrocortisone - 300 mg/day or methylprednisolone - bolus 1 mg/kg followed by daily infusion of the same dose.

Antibacterial therapy for swine flu

Taking into account the nature of the pathological process in the lungs and the severity of the condition, antibacterial drugs are not indicated for patients with a good premorbid status in the first days of the disease.

In individuals with acute lung injury syndrome, it is not possible to exclude association with a bacterial infection at the time of admission. In addition, in some cases, the diagnosis of influenza may be misdiagnosed and pneumonia is associated solely with a bacterial infection. In this regard, along with antiviral therapy, the prescription of antibiotics is indicated according to the protocol for the treatment of severe community-acquired pneumonia, according to which a combination of 3rd generation cephalosporins with antipneumococcal activity should be used (ceftriaxone - 2.0 g / day or cefotaxime 6.0 g / day ) with macrolides (azithromycin 0.5 g/day or clarithromycin 0.5 g twice a day). As an alternative regimen, the use of respiratory fluoroquinolones—moxifloxacin 0.4 g/day or levofloxacin 0.5 g twice daily, with or without ceftriaxone—can be considered.

If it is possible to exclude the presence of a bacterial infection based on clinical and laboratory signs and microbiological examination data, antibiotics should be discontinued. Performing mechanical ventilation should not serve as a basis for prescribing antibiotics for prophylactic purposes.

In cases of development of hospital-acquired (nosocomial) pneumonia, including ventilator-associated pneumonia, the choice of empirical ABT regimen is carried out in accordance with the microbial landscape of a particular hospital/department and the pathogen resistance phenotype. Possible regimens can be selected: carbapenems (meropenem, imipenem, doripenem), piperacillin/tazobactam, cefaperazone/sulbactam. If the prevalence of MRSA in the ICU is high (> 20% in the etiological structure), it is advisable to add vancomycin or linezolid to the indicated drugs. When receiving the results of a bacteriological study, the need to correct the selected starting scheme is considered.

Summary of clinical management of patients with pandemic influenza A/H1N1/09 ​​virus infection

Prevention of swine flu

Prevention measures are the same as for “seasonal” flu. In case of contact with a patient, oseltamivir is indicated. Vaccines exist, but they are ineffective.

Specific prevention

Because no one can predict which and how many circulating influenza viruses will infect them, the trivalent seasonal influenza vaccine will provide the broadest protection. However, in some areas the trivalent vaccine is not available and it may be appropriate to be vaccinated against the H1N1 virus to prevent severe disease.

Swine flu (California, Swine influenza)– a conditional disease of animals and humans caused by subtypes of the influenza A virus. First discovered in 1931. It gained its greatest notoriety in 2009, when its most famous subtype, H1N1, caused mass panic around the world and led to a declaration by the World Health Organization. The first cases of infection with the new flu occurred in North America.

It should be noted that the reason for the panic and declaration of a flu pandemic by the WHO was the fact that a new hitherto unknown strain of the H1N1 influenza virus appeared, which was formed as a result of mixing (reassortment) of the swine flu virus, and. This caused panic, which turned out to be unfounded, since the mortality rate from the new pandemic flu was statistically the same as from the regular seasonal flu, which was eventually recognized by the WHO.

Source of infection

Now let's look at what the swine flu pathogen itself is. This is an influenza virus that initially infected pigs, but then, under the influence of mutations in their body, acquired the ability to be transmitted to humans, that is, it is a mutated swine flu and such a definition would be more correct, since pure swine flu can hardly be transmitted to humans from -due to the heterogeneity of the antigenic structure of human and pig cells, that is, it can enter the human body, but this will be a dead-end path for its evolution. According to WHO data for the entire last century!!! Swine flu infection was reported in 50 people.

In the human body, this modified virus also mutated and gained the ability to be transmitted from person to person, which accelerated its spread and caused panic, since at that time there were simply no vaccines for the new virus (when did they exist? Every year the same gimmick with the vaccination of vaccines that were ineffective in a given year, since a mutated virus comes to which vaccines developed on the basis of last year’s viruses do not work) and there was no layer of people who had recovered from the new virus, which further accelerated its spread in the population. The 2009 outbreak was caused by the H1N1 influenza virus. It is worth noting that the influenza strains associated with the so-called swine flu are subtypes A/H1N1, A/H1N2, A/H3N1, A/H3N2 and A/H2N3.

Features of the H1N1 swine flu virus

It is worth noting several features that were characteristic of the H1N1 swine flu virus that was widespread in 2009 (at the time the pandemic was declared). I collected a complete collection of them all in a separate article, here are only the most typical ones:

1. Pandemic swine flu resulted in a significant number of deaths among the young population (under 50 years of age). Of course, older people, as well as weakened people, died from this infection in significant numbers, but the statistically significant death of the young population also gave rise to the notorious panic
2. It was also a fact that people died quickly from primary viral pneumonia, and not as with ordinary seasonal influenza, when pneumonia is mostly of a secondary bacterial nature and as a complication of influenza
3. the number of deaths was no higher than the number of deaths from regular seasonal influenza. This was the most popular rumor at that time, that people were dying in the thousands from the new disease, that there was no escape from swine flu. In fact, people die in the thousands even during the regular flu epidemic season, so it was not worth exaggerating the significance of this type of virus, just as it is not worth it now

Other antiviral drugs showed their complete ineffectiveness during the swine flu epidemic, or they helped in cases where they were prescribed to patients who would have recovered anyway without resorting to chemotherapy.

Prevention

Measures as for seasonal flu:

• regular hand washing
• life guidelines aimed at limiting contact of hands with the face and mucous membranes (do not touch the face with hands)
• rinsing the nose with plain water or saline
• regular cleaning of rooms and surfaces where the virus, which is unstable in the external environment, may be located
• avoiding crowded places
• healthy lifestyle - balanced nutrition, healthy and long sleep, general strengthening procedures (hardening, playing sports)

Complications

The most dangerous complication of swine flu, which killed a significant number of the population in 2009, and many had one foot in the next world. Until our healthcare system threw ineffective drugs into the trash and began to use expensive drugs with proven effects and reverse the negative trend in the treatment of this type of complication and the disease itself.

Otherwise, it is typical for regular seasonal flu and is no different from it.

Two years have passed since the first epidemic of the new strain of the 2009 H1N1 swine flu virus. During this time, the virus has been included in vaccination plans for the new season and will remain so for a long time. But that epidemic should teach us the most important thing: new viruses and diseases can appear at regular intervals. Our environment is aggressive both towards humans and towards our smaller brothers; new agents (viruses and bacteria) as a result of mixing (or as they say scientifically, reassortment) in the body of humans, animals or birds and their mutations acquire new properties and become more aggressive, angrier. But the progress of the human body follows the same paths, so that for every new infection, be it swine, bird, or some other new type of flu, we respond with new facets of our immunity. Therefore, we must take care of our own health and remember that it is easier to prevent a disease than to treat it later.

Material edited doc- 3-10-2012, 16:00. Cause: current data for 2012

Many people know that in the 20s of the last century, death walked around Europe under the name “Spanish flu”. She took about 100 million earthlings to their graves. Just recently, scientists studied in detail material taken from the corpse of a Spanish flu victim buried in permafrost, and discovered the H1N1 virus in it. Yes, yes, exactly the virus that made so much noise in 2009. Over the years, it has been modified many times, becoming either H2N2, then H3N2, then H1N2, each time causing new epidemics. At some point, the virus spread from humans to pigs, adapted (mutated) in new hosts and became swine flu, capable of living only in animals. After a while, the virus again entered a person and, demonstrating its unique abilities, mutated again, adapting to a new host. During this adaptation period, the new H1N1 strain caused only up to 50 cases of swine flu, and in people who, due to their occupation, had contact with animals. Modifying further, the virus has developed a form that can not only be transmitted from pigs to humans, but also in the future infect new people. Thus began an epidemic of a disease called swine flu.

What is AN1N1

Differences in the disease

The H1N1 flu is not very different from the classic seasonal flu and for most people it occurs without any complications. But it also has one unpleasant feature - in some victims it can cause primary viral pneumonia, which cannot be cured with antibiotics (this is how it differs from bacterial pneumonia). If patients in whom the H1N1 virus has caused a complication in the form of do not begin to be treated correctly at the first symptoms, they die within 24 hours. It was this circumstance that was the main cause of death for almost 2 thousand people during the 2009 epidemic. Other differences between swine flu and regular flu include nausea, vomiting and diarrhea.

At-risk groups

Anyone can catch the H1N1 virus, but not everyone develops life-threatening complications. According to statistical data, the following categories of the population are most susceptible to severe swine flu:

Young children (ages 0 to 2 years);

Pregnant;

Having any pulmonary diseases, such as asthma;

People over 65 years of age;

Suffering from chronic diseases of internal organs;

HIV-infected.

As you can see, swine flu poses the greatest danger to those whose bodies are weakened.

Routes of infection

As noted above, the H1N1 virus is mainly transmitted aerogenously. Important: when sneezing or coughing, microorganisms released from the mouth or nose of a sick person can “fly” through the air for a distance of up to 2 meters. If a healthy person inhales them, he will certainly become infected.

But even those viruses that did not reach the victim, but settled on some surfaces, continue to live for 8 hours. That is, you can become infected with swine flu through personal contact, for example, if you hold a handrail with viruses and then eat without washing your hands.

The third route of infection is the most passive - pork from a sick animal. You can catch the flu this way only if you eat the meat raw or half-cooked, because standard cooking kills the H1N1 virus in a few minutes.

Classic symptoms of the disease

From the moment of infection until the first signs of the disease appear, it can take from one to three to four days, which depends on the characteristics of the body. The H1N1 virus can cause symptoms similar to the classic flu:

General malaise;

Aches throughout the body (myalgia);

Runny nose;

Headache;

Sore and/or sore throat;

Increase in temperature to high levels (sometimes no temperature is observed);

Chills, fever.

Some patients have complaints of nausea, sometimes to the point of vomiting, and diarrhea.

H1N1 virus, symptoms and complications

To avoid an irreparable disaster, you should immediately consult a doctor for help if, against the background of an apparent cold, the following are observed:

Very high temperature, not brought down by tablets;

Persistent causeless nausea;

Heavy and/or rapid breathing;

Pale and/or cyanotic skin, blue lips (more common in children);

Hypersomnia;

Long absence of the urge to urinate;

Pain in the chest and abdomen;

Dizziness;

Disorientation in space;

Children cry without tears;

Increased excitability for no reason;

After some improvement in the course of the “cold,” a sudden deterioration suddenly occurred.

H1N1 virus, treatment of mild disease

Diagnosis of swine flu, which passes without complications, is difficult due to the similarity of symptoms with regular flu. The type of virus can only be determined by culture of sputum secreted during coughing and mucus from the nose and mouth.

For mild forms of influenza, therapy can be carried out at home. It consists of mandatory bed rest, taking antipyretic drugs if the temperature is above 38 degrees, non-steroidal anti-inflammatory drugs, vitamins, cough and runny nose remedies. Small children should not be given medications that contain aspirin, since complications are possible. Among antipyretics, you can take Nurofen, Paracetamol, and adults can also take Ibuprofen.

For mild cases of H1N1 antiviral drugs, the following can be used:

- "Arbidol".

- “Viferon”.

- "Grippferon".

- "Reaferon".

- “Ingaron”.

- “Lipind.”

- “Ingavirin”.

- “Cycloferon”.

- “Kagotsel”.

It is also advisable to take antihistamines, drink plenty of liquids - teas, fruit drinks, water with honey, decoctions of currants, raspberries, viburnum and medicinal herbs.

The flu goes away in about 6-7 days.

Treatment of severe forms

Complicated H1N1 influenza is noticeably different from seasonal influenza and can be recognized without waiting for culture results. If symptoms characteristic of severe swine flu are listed above, the patient should be hospitalized, and if there are breathing problems, resuscitation therapy should be started immediately. For treatment, Oseltamivir or Tamiflu, Zanamivir or Relenza are used, which suppress the activity of neuraminidase. At the same time, antibacterial therapy is prescribed so that bacterial pneumonia does not develop against the background of viral pneumonia, the body is cleansed of toxins released by the H1 N1 virus, and the prognosis for patients with complicated swine flu is favorable only if proper treatment is started in a timely manner.

With moderate severity of the disease, when high fever, nausea, vomiting, diarrhea are observed, but there are no breathing problems, fainting, impaired consciousness and pneumonia, treatment is possible at home.

Precautionary measures

Prevention of H1N1 mainly involves limiting visits to public places and contact with people who have the slightest signs of a cold (cough, runny nose). Doctors also recommend:

Wearing a mask in all public places;

Before going outside, use oxolinic ointment;

After returning home, thoroughly wash your hands, rinse your nose and mouth;

Avoid snacking on the street and in public places without first thoroughly washing your hands.

It has been established that the swine flu virus quickly dies when exposed not only to high temperatures, but also to antiseptics, such as soap, alcohol solutions, and bactericidal agents. Therefore, in public places (schools, hospitals, catering outlets and others) during the epidemic, it is necessary to carry out wet cleaning, wipe tables, and door handles more often.

At the first symptoms of illness, especially if there is a cough, runny nose, or fever, you need to call a doctor at home to avoid infecting other people.

At the moment, a new vaccine has been developed against H1N1, which simultaneously helps against classical influenza B and H3N2 strains. You cannot get sick from vaccination, since the vaccine does not use whole viruses, but only their fragments. However, after vaccination you can still become infected with the flu, but it will be very mild. Also, vaccination does not protect against all other possible modifications of the H1N1 virus.

It should be done annually, preferably a month before the expected epidemic (in the fall before the start of dank, damp, cold weather).

A dangerous and insidious swine flu virus... The mere mention of this disease makes many people shiver. Those who have had close encounters with pathology before are especially worried. There is no need to cause panic and terrify people. It is enough to know how the h1n1 flu manifests itself and is treated. Then you will be able to react in time without missing out on precious days or even hours.

Treatment of swine flu should be started in a timely manner to avoid complications.

Since the thirties of the last century, humanity first started talking about a new “plague”. It was none other than the h1n1 flu. This disease originally affected pigs. Animals fell ill one after another, which led to massive deaths of livestock on farms. Over time, the virus mutated, combined with human seasonal flu, after which it received a new name. Now not only animals, but also people could get sick. It is worth noting that swine flu from sick livestock is rarely transmitted to humans. The reason for this is the different antigenic structure.

The disease gained mass popularity in 2009. Then the pathology acquired pandemic proportions. Now they say about that period that the h1n1 pdm09 influenza virus was raging. Treatment did not help all those infected, so the disease claimed a large number of lives. Among the affected people there were a lot of people under 50 years of age, which caused incredible fear. People said that the disease had become like a plague; there was no cure for it.

What to do to prevent infection?

Influenza H1n1, as it turns out, cannot be prevented by administering a vaccine. To this day, great scientists and bright minds are trying to develop a vaccine. By your own actions you can minimize the risk of infection. It is enough to follow the following rules:

1. do not contact someone who is sick;
2. Wash your hands regularly and use antiseptics;
3. avoid crowded places;
4. carry a protective sterile mask with you;
5. Rinse your nose with saline solutions several times a day;
6. strengthen your immune system.

Avoid contact with someone who is sick

If you are afraid of catching the h1n1 influenza virus, be sure to discuss protection with your doctor. Your doctor may prescribe certain antiviral medications for you to take preventatively.

If you are sick...

Contact with a sick person during an epidemic leads to inevitable infection in 90% of cases. If you are sick or think you are sick, stay calm. At the first symptoms, be sure to consult a doctor. Don't try to treat yourself. And, even more so, you cannot continue to go to work and visit crowded places. It is important to know what the h1n1 flu symptoms are. Read about them in more detail.

Incubation period: timing

When the virus has just entered the body, a person does not feel any changes. Unlike the usual ARVI, which causes a dry nose, sneezing and a feeling of a lump in the throat, with the flu there are no such symptoms. According to various sources, the incubation period of influenza ah1n1 lasts from 1 to 5 days.

Signs that appear in humans

What symptoms of H1n1 influenza a person develops largely depends on his immunity. If the body is weakened, then the first signs may appear quite quickly and have a pronounced manifestation. With more stable protection, the disease manifests itself more often within 2-3 days. It is not necessary to have all the symptoms mentioned below.

Bad feeling

The first signs of the h1n1 flu that appear are headache and general malaise.. Unpleasant sensations are present in the forehead and temples. They are accompanied by pain in the eyes and increased lacrimation. Any bright light irritates the sick person, so the patient should be placed in a dark room, ensuring complete rest. Weakness, lack of appetite, drowsiness - this is what characterizes the onset of the disease.

High temperatures

The h1n1 influenza clinic is manifested by fever. The thermometer readings can rise to critical numbers. Most often this is what happens. More severe fever is observed in children. In exceptional cases, the temperature remains within normal limits. This often confuses patients into inaction. Often, the temperature due to the swine flu virus does not decrease after using the usual Paracetamol or Nurofen. The patient needs stronger antipyretics.

Digestive disorders

Influenza H1N1 symptoms necessarily have the following: diarrhea or increased frequency of stools, nausea and vomiting. They arise because the virus spreads mainly in the intestines. The disease suppresses the natural microflora and acquired immunity, disrupts digestive function. A large amount of carbohydrates and fats, not processed by the necessary enzymes, attracts water from all parts of the body. This provokes loose stools and frequent urge to defecate. Vomiting and nausea are provoked by intoxication, which inevitably appears due to the toxic effect of the pathogen on the body.

Digestive disorders are one of the signs of swine flu

Catarrhal phenomena

The symptoms of the H1n1 flu are not similar to the standard ARVI.

Catarrhal phenomena in the form of a runny nose, nasal congestion and sore throat are often absent. But other symptoms take their place. The swine flu virus is accompanied by difficulty breathing and a severe dry cough. It causes pain in the sternum and shortness of breath. Symptoms of h1n1 influenza in a young child may be accompanied by seizures and confusion. This is how high temperature affects the functioning of the nervous system.

Is the disease curable?

If you have h1n1 flu, symptoms and treatment should be determined and prescribed accordingly by a doctor. As practice shows, the uncomplicated course of the disease usually does not require the use of specific medications. In most cases, the disease lasts 5-7 days, after which it subsides. With the correct organization of the regime, the sick person begins to recover from the fifth day. Final recovery occurs within another 2-3 weeks.

Treatment for h1n1 influenza is necessary when it becomes severe. The patient is prescribed certain medications that prevent the proliferation of microorganisms, promoting a speedy recovery. Find out which drugs are effective for the reported viral infection.

Symptomatic remedies

Depending on the symptoms of the H1n1 flu, appropriate treatment is prescribed. Symptomatic therapy is carried out in almost all patients. Such medications are intended to improve well-being rather than eliminate a viral infection.

• Antipyretics and painkillers. Often drugs have these two effects simultaneously. More preferable medications are those based on ibuprofen (Nurofen, Advil) and paracetamol (Teraflu, Ferfex, Coldact). Ibuklin, which combines both active ingredients, is widely used. Less often, patients resort to Analgin, Nimesulide and other, stronger medications.
• Against cough. All drugs for the treatment of this symptom are divided into: expectorants, sputum thinners and antitussives. You should not take the latter on your own, as you will stop the removal of thick sputum from the lungs, which will provoke a complication. In this situation, the following medications are recommended: ACC, Lazolvan, Erespal, Askoril, and so on.
• For diarrhea and vomiting. To prevent fluid loss, it is necessary to eliminate this symptom. Loperamide and Imodium tablets will help you stop diarrhea. Intestinal antiseptics (Stopdiar, Ecofuril) will cleanse the digestive tract of pathogenic flora. Vomiting will be stopped by Motilium and Cerucal. To replenish the lack of fluid, use saline solutions, for example, Regidron.

Loperamide helps relieve diarrhea

Neuraminidase inhibitors

If symptoms of influenza h1n1 in a person are so severe that the use of antiviral drugs is required, then neuraminidase inhibitors are always preferred. As the practice of past years has shown, popular and accessible antiviral drugs are powerless against such a disease. The famous Rimantadine, Arbidol, Kagocel help those whose body could cope with the disease on its own.

There are currently two well-known drugs that act as neuraminidase inhibitors: Tamiflu and Relenza. The first medicine is available in tablets, and the second is administered by inhalation due to its high toxicity. Medicines effectively eliminate the neuraminidase enzyme. It is part of the envelope of the h1n1 influenza virus; treatment with these drugs prevents further spread of the infection. As a result of therapy, the virus loses its ability to contact healthy cells.

What to do on your own?

Almost every person at risk of infection asks the question: how to treat h1n1 flu at home? It’s worth saying right away that you shouldn’t take any medications without a doctor’s prescription. You can, of course, take an antipyretic if you have a high fever or a painkiller if you feel unwell. More serious medications should always be prescribed by a specialist.

You can independently ease the course of the disease by creating comfortable conditions. If you have the flu, you should not go to work or have contact with healthy people. Your body needs strength to fight infection, do not waste it. Maintain bed rest and drink plenty of fluids.

It is better to refuse food for now, but if you really want to, then give preference to food that is quickly and easily digested and does not irritate the intestines. It is permissible to gargle with all kinds of decoctions, take vitamin C in the form of drinks, consume honey and raspberry jam. Set sufficient humidity in the room and ventilate regularly. Coordinate all other actions with your doctor.

Gargling helps relieve coughs and sore throats.

Possible complications

In some cases, the h1n1 flu acquires more serious symptoms. Then doctors talk about a complication. Most often, the disease causes damage to the lower respiratory tract, transforming into bronchitis or pneumonia. If the nature of the complication is bacterial, then treating it is not so difficult. When the question of viral pneumonia is raised, it is already more dangerous. It was this complication that claimed more than one thousand lives during the 2009 pandemic.

Pathology can result in problems with the urinary, cardiovascular and nervous systems. It often provokes myocarditis. If during your illness you notice that you are feeling worse and worse, then do not hesitate: urgently call an ambulance. Complications of influenza develop very quickly. Death may occur within a few hours.

Let's sum it up

The h1n1 swine flu virus initially seemed not as dangerous as it later became. During a massive epidemic, it claimed lives one after another. At the same time, people died not from the virus itself, but from the complications that the disease causes. Many have paid dearly because they chose self-medication.

Perhaps timely medical assistance could have saved her. Therefore, doctors recommend that pathologists seek help at the first manifestation. The nature of the disease can only be determined reliably through laboratory diagnostics.

Do not try to diagnose yourself based on all the symptoms you have.

Don't self-diagnose. Entrust this matter to medical specialists!

The next outbreak of swine flu was predicted by doctors for the beginning of 2016. During that period, many people actually got sick. There are officially registered deaths. Despite this, the viral infection has not become as widespread as it was 7 years ago. Probably, people have already been taught by the bitter experience of inaction. Many patients sought medical help at the first symptoms of the disease. Having received the correct treatment regimen, they recovered within a few days. The h1n1 virus does not form lasting immunity, so it cannot be guaranteed that a person who has recovered from the disease will not become infected again.

Many people know that in the 20s of the last century, death walked around Europe under the name “Spanish flu”. She took about 100 million earthlings to their graves. Just recently, scientists studied in detail material taken from the corpse of a Spanish flu victim buried in permafrost, and discovered the H1N1 virus in it. Yes, yes, exactly the virus that made so much noise in 2009. Over the years, it has been modified many times, becoming either H2N2, then H3N2, then H1N2, each time causing new epidemics. At some point, the virus spread from humans to pigs, adapted (mutated) in new hosts and became swine flu, capable of living only in animals. After a while, the virus again entered a person and, demonstrating its unique abilities, mutated again, adapting to a new host. During this adaptation period, the new H1N1 strain caused only up to 50 cases of swine flu, and in people who, due to their occupation, had contact with animals. Modifying further, the virus has developed a form that can not only be transmitted from pigs to humans, but also in the future infect new people. Thus began an epidemic of a disease called swine flu.

What is AN1N1

Differences in the disease

The H1N1 flu is not very different from the classic seasonal flu and for most people it occurs without any complications. But it also has one unpleasant feature - in some victims it can cause primary viral pneumonia, which cannot be cured with antibiotics (this is how it differs from bacterial pneumonia). If patients in whom the H1N1 virus has caused a complication in the form of viral pneumonia are not treated correctly at the first symptoms, they die within 24 hours. It was this circumstance that was the main cause of death for almost 2 thousand people during the 2009 epidemic. Other differences between swine flu and regular flu include nausea, vomiting and diarrhea.

At-risk groups

Anyone can catch the H1N1 virus, but not everyone develops life-threatening complications. According to statistical data, the following categories of the population are most susceptible to severe swine flu:

Young children (ages 0 to 2 years);

Pregnant;

Having any pulmonary diseases, such as asthma;

People over 65 years of age;

Suffering from chronic diseases of internal organs;

HIV-infected.

As you can see, swine flu poses the greatest danger to those whose bodies are weakened.

Routes of infection

As noted above, the H1N1 virus is mainly transmitted aerogenously. Important: when sneezing or coughing, microorganisms released from the mouth or nose of a sick person can “fly” through the air for a distance of up to 2 meters. If a healthy person inhales them, he will certainly become infected.

But even those viruses that did not reach the victim, but settled on some surfaces, continue to live for 8 hours. That is, you can become infected with swine flu through personal contact, for example, if you hold a handrail with viruses and then eat without washing your hands.

The third route of infection is the most passive - pork from a sick animal. You can catch the flu this way only if you eat the meat raw or half-cooked, because standard cooking kills the H1N1 virus in a few minutes.

Classic symptoms of the disease

From the moment of infection until the first signs of the disease appear, it can take from one to three to four days, which depends on the characteristics of the body. The H1N1 virus can cause symptoms similar to the classic flu:

General malaise;

Aches throughout the body (myalgia);

Runny nose;

Headache;

Sore and/or sore throat;

Increase in temperature to high levels (sometimes no temperature is observed);

Chills, fever.

Some patients have complaints of nausea, sometimes to the point of vomiting, and diarrhea.

H1N1 virus, symptoms and complications

To avoid an irreparable disaster, you should immediately consult a doctor for help if, against the background of an apparent cold, the following are observed:

Very high temperature, not brought down by tablets;

Persistent causeless nausea;

Heavy and/or rapid breathing;

Pale and/or cyanotic skin, blue lips (more common in children);

Fainting, hypersomnolence;

Long absence of the urge to urinate;

Pain in the chest and abdomen;

Dizziness;

Disorientation in space;

Children cry without tears;

Increased excitability for no reason;

After some improvement in the course of the “cold,” a sudden deterioration suddenly occurred.

H1N1 virus, treatment of mild disease

Diagnosis of swine flu, which passes without complications, is difficult due to the similarity of symptoms with regular flu. The type of virus can only be determined by culture of sputum secreted during coughing and mucus from the nose and mouth.

For mild forms of influenza, therapy can be carried out at home. It consists of mandatory bed rest, taking antipyretic drugs if the temperature is above 38 degrees, non-steroidal anti-inflammatory drugs, vitamins, cough and runny nose remedies. Small children should not be given medications that contain aspirin, as complications (Reye's syndrome) are possible. Antipyretics you can take are Nurofen, Paracetamol, and for adults also Ibuprofen.

For mild cases of H1N1 antiviral drugs, the following can be used:

- "Arbidol".

- “Viferon”.

- "Grippferon".

- "Reaferon".

- “Ingaron”.

- “Lipind.”

- “Ingavirin”.

- “Cycloferon”.

- “Kagotsel”.

It is also advisable to take antihistamines, drink plenty of liquids - teas, fruit drinks, water with honey, decoctions of currants, raspberries, viburnum and medicinal herbs.

The flu goes away in about 6-7 days.

Treatment of severe forms

Complicated H1N1 influenza is noticeably different from seasonal influenza and can be recognized without waiting for culture results. If symptoms characteristic of severe swine flu are listed above, the patient should be hospitalized, and if there are breathing problems, resuscitation therapy should be started immediately. For treatment, Oseltamivir or Tamiflu, Zanamivir or Relenza are used, which suppress the activity of neuraminidase. At the same time, antibacterial therapy is prescribed so that bacterial pneumonia does not develop against the background of viral pneumonia, the body is cleansed of toxins released by the H1 N1 virus, and symptomatic treatment is prescribed. The prognosis for patients with complicated swine flu is favorable only if proper treatment is started in a timely manner.

With moderate severity of the disease, when high fever, nausea, vomiting, diarrhea are observed, but there are no breathing problems, fainting, impaired consciousness and pneumonia, treatment is possible at home.

Precautionary measures

Prevention of H1N1 mainly involves limiting visits to public places and contact with people who have the slightest signs of a cold (cough, runny nose). Doctors also recommend:

Wearing a mask in all public places;

Before going outside, use oxolinic ointment;

After returning home, thoroughly wash your hands, rinse your nose and mouth;

Avoid snacking on the street and in public places without first thoroughly washing your hands.

It has been established that the swine flu virus quickly dies when exposed not only to high temperatures, but also to antiseptics, such as soap, alcohol solutions, and bactericidal agents. Therefore, in public places (schools, hospitals, catering outlets and others) during the epidemic, it is necessary to carry out wet cleaning, wipe tables, and door handles more often.

At the first symptoms of illness, especially if there is a cough, runny nose, or fever, you need to call a doctor at home to avoid infecting other people.

At the moment, a new vaccine has been developed against H1N1, which simultaneously helps against classical influenza B and H3N2 strains. You cannot get sick from vaccination, since the vaccine does not use whole viruses, but only their fragments. However, after vaccination you can still become infected with the flu, but it will be very mild. Also, vaccination does not protect against all other possible modifications of the H1N1 virus.

It should be done annually, preferably a month before the expected epidemic (in the fall before the start of dank, damp, cold weather).

Swine flu. This diagnosis plunges the entire population into panic and horror - it is believed that this disease is very difficult and, at best, leads to complications, and at worst ends in death. What does science know about swine flu and how to prevent its occurrence?

Overview of Influenza A (H1N1)

It is believed that the outbreak of swine flu occurs during the New Year holidays - people stay at home for a long time, their immunity is reduced due to the consumption of large amounts of fatty foods and alcoholic beverages. By the way, it is precisely because people are in their homes that cases of influenza with severe complications are recorded very often - patients turn to doctors in critical condition.

Note: from year to year the same picture is repeated: first the influenza B virus rages, then the H1N1 influenza begins to appear, but it quickly “burns out” and the influenza B virus comes again, which can sluggishly infect people. And even the period of such a wave-like infection occurs at the same time every year - from January to March.

A large percentage of swine flu cases were observed in 2009 – then deaths were recorded, and the severe course of the infection was clearly visible. Doctors predicted an outbreak of influenza A (H1N1) in 2016 in advance; this strain was included in the vaccine with which a large number of people were vaccinated - this made it possible to create a good immune layer among the population. And yet, from the beginning of 2016, dangerous swine flu began to actively spread throughout the countries of the Northern Hemisphere - Russia, Ukraine, Turkey, Israel.

Swine flu symptoms

The danger of the disease in question lies in its rapid development, so everyone needs to know the symptoms of swine flu clearly. These include:

1. Severe intoxication of the body, which always manifests itself suddenly - the patient can literally name the hour when he felt unwell.
2. Hyperthermia is a high body temperature that can reach critical levels.
3. Headache of a sharp nature, intense - the patient is irritated by bright light, noise and any movement.
4. Problems in the functioning of the respiratory system - patients complain of a dry cough.
5. General weakness, accompanied by aches throughout the body.
6. A feeling of compression of the lungs - patients complain of severe pain in the chest, the inability to take a deep breath and exhale.

Very rarely, symptoms of influenza A (H1N1) include a runny nose and conjunctivitis.

There is a designated group of people who are at risk for infection with the influenza A virus. It includes:

• children under 5 years of age;
• pregnant women;
• people over 65 years of age;
• patients with previously diagnosed chronic pathologies - for example, pulmonary diseases, kidney problems, and so on;
• people with diabetes and heart disease;
• patients with severe obesity.

Why is swine flu dangerous?

It is influenza A (H1N1) that poses a particular danger to human health and life - this disease is characterized by the development of severe complications. These include:

1. Changes in the structure of the blood - it becomes thicker, coagulability increases, and the risk of blood clots reaches the highest level.
2. Within 1-2 days, swine flu develops into viral pneumonia, which is often accompanied by pulmonary edema.
3. The influenza virus has a detrimental effect on the kidneys - this can trigger the development of nephritis.
4. The myocardium of the heart is negatively affected by the virus.

Note: It is viral pneumonia, which develops rapidly against the background of swine flu, literally within a few hours/days, that most often leads to the death of the patient.

Head of Rospotrebnadzor Anna Popova:

“That is why, literally on the very first day, constant monitoring by a doctor is necessary: ​​call him at home, because only a specialist can prescribe adequate treatment. Many regions where the active spread of influenza has already begun are introducing this practice - a patient with a confirmed diagnosis of influenza does not go to the hospital every five days to extend his sick leave, but every day he describes his condition to the attending physician in a text message. In no case should the condition be allowed to worsen; if a person feels that he is having difficulty breathing, urgent hospitalization is necessary.”

How to recognize swine flu

Sometimes it is very difficult to immediately determine the development of swine flu - many patients mistake its symptoms for signs of a common cold or acute respiratory viral infection. This entails inadequate treatment, missing the first hours of the disease and the development of severe complications.

The following table will help you distinguish between the symptoms of swine flu and a common cold:

Features of influenza A (H1N1)

It is worth knowing that swine flu is transmitted by airborne droplets - you can become infected by being near a sick person who is sneezing and coughing. For example, in a movie theater, flu viruses, when sneezed by an already sick person, spread 10 meters around.

Virologists identify several distinctive features of the course of swine flu:

1. Headaches are localized in the forehead area - patients complain of heaviness of the brow ridges. Even a simple attempt to open the eyes and lift the eyelids completely leads to intense, boring pain in the eyeballs.

Note: If a child of preschool age with cold symptoms begins to complain of a headache, then immediately call a doctor - headaches are not typical for preschool children .

1. If a person with a cold has a history of heart disease or hypertension, then if you complain of profuse cold sweat against a background of high body temperature and difficulty breathing, you should call an ambulance. This is a sign of the development of swine flu, and especially for heart patients and hypertensive patients, it quickly turns into viral pneumonia with pulmonary edema.
2. Influenza A (H1N1) is characterized by respiratory failure - the patient cannot take a deep breath, he is tormented by a constant feeling of lack of air, the breathing rhythm becomes very fast.

Complications from swine flu can affect almost every organ:

Important nuances

There is a lot of debate about how to behave when the first symptoms of swine flu appear. But the main recommendations of doctors are as follows:

1. There is no need to reduce the temperature too zealously. An increase in temperature is a signal that the body's immune forces have begun to fight the infection. But too sharp a jump has a bad effect on the functioning of the heart. The threshold is 38 degrees Celsius. If during flu the temperature reaches 38.5 degrees (for small children - up to 38 degrees), it is better not to take anything antipyretic. If it is higher, use products with paracetamol, ibuprofen, if there are no contraindications. If the temperature does not decrease, immediately call an ambulance, be sure to report the measures taken and that the fever does not subside.
2. There is no antiviral food and drink, no matter how pseudo-helpful notes on social networks present it to us. But the following will help activate the immune system:

• natural fermented milk products (low-fat yogurt, ayran, tan),
• citrus fruits (this is a classic: for patients - a bunch of oranges to lift their spirits, or better yet, lime in tea and grapefruit a day - they also help the heart survive flu stress). Vitamin C, which they are rich in, and pectins help remove phlegm from the lungs and reduce the risk of congestion.
• Fruit drinks of all types (from lingonberries, cranberries, currants), except sweet ones (excess sugar interferes with the removal of viruses from the body).
• natural proteins that are easily digestible and strengthen the heart - eggs, turkey, chicken breast, rabbit, fish.

1. You should not self-medicate - the result will be disastrous. Yes, it is possible and necessary to provide the patient with plenty of fluids, but no medications should be taken! Usually, in case of severe swine flu, doctors prescribe antiviral drugs, but they are selected on an individual basis. If the situation requires resuscitation, the presence of medical workers next to the patient will save his life.

What to do as part of prevention

When the season of mass infection with the influenza A (H1N1) virus begins, it is worth taking certain preventive measures - they will help reduce the risk of infection significantly. Virologists give the following recommendations:

1. You should not visit places with large crowds of people - it is better to exclude theaters, discos, cinema centers, shopping centers and the like from your routine.
2. After visiting various institutions, being on the street and on public transport, wash your hands with soap and be sure to have special disinfectant wipes with you - you can wipe your hands and face with them.
3. Rinse your nose with saline solution as often as possible throughout the day. An alternative could be seawater sprays - they are sold in pharmacy chains and have a very reasonable price.
4. Before leaving home and going to work or any other place, lubricate your nostrils (the direct entrance to the nose) with oxolinic ointment - a barrier will be provided to viruses.
5. A medical mask is not a panacea for the flu. Viruses are so small that they penetrate through the smallest pores. But it is quite suitable as an additional security measure, especially if you need to move and communicate a lot. A caveat: wear a mask only in transport or in closed spaces where there are a lot of people. Outdoors, the chance of infection is minimal, so don’t torture yourself.
6. The house or office must be ventilated daily, and each procedure must take at least 15 minutes. Remember - swine flu spreads only in a warm and dry room, it is afraid of cold and dampness.

Swine flu is a dangerous disease that can lead not only to serious consequences, but also to the death of the patient. Only immediate seeking help from doctors and strict implementation of all recommendations and prescriptions of specialists can prevent such developments. By the way, if swine flu is mild, the disease goes away within 1-3 weeks without any consequences in the future.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.

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experienced participants and may differ significantly from

H1N1- a subtype of influenza A virus (the most common type of influenza that causes the most widespread epidemics) can cause illness in both humans and many animals. It was first discovered in 1931 by the American scientist Richard Shoup.

This subtype was a common cause of influenza in the 1918 (Spanish Flu) and 2009 (Swine Flu) pandemics.

The pandemic H1N1 2009 strain (“Pandemic (H1N1) 09 Virus”) in 2009 became known in the media under the name "swine flu".

On June 11, 2009, the World Health Organization (WHO) officially announced the outbreak of the influenza A(H1N1/09) epidemic - the 2009 H1N1 influenza pandemic.

About the dangers of the virus

For the vast majority of people around the world, the disease occurs as a flu-like illness without complications, with full recovery within a week even without drug treatment. There is currently no data to indicate that the overall case fatality rate of H1N1, without taking into account age categories, is greater than that of a typical seasonal influenza epidemic.

However, the severe form of the disease is characterized by rapidly progressing primary viral pneumonia, which, unlike bacterial pneumonia, is not sensitive to antibiotics and, if not properly treated, can lead to death within 24 hours after the first signs of complications appear.

At-risk groups

Three groups are at highest risk of developing severe disease: pregnant women (especially during the third trimester of pregnancy), children under two years of age, and people with chronic lung disease, including asthma. Neurological disorders can increase the risk of severe illness in children.

Although the exact role of obesity is poorly understood to date, it is strongly implicated in severe and fatal cases of the disease. This is especially true for morbid obesity. Obesity was not considered a risk factor during either past epidemics or during seasonal influenza.

Symptoms of the usual course of the disease

Symptoms of influenza A(H1N1) are in most cases similar to those of seasonal influenza and include fever (high temperature), cough, sore throat, runny nose, myalgia (muscle pain), tachycardia, headache, chills and weakness. In some cases, symptoms also include nausea, vomiting or diarrhea.

The temperature is most often higher than with ARVI and other colds not caused by the influenza virus. In rare cases, people with influenza A (H1N1) have respiratory symptoms without fever.

Dangerous symptoms

The patient should immediately seek medical help if, against the background of influenza or acute respiratory viral infection, he develops shortness of breath or difficulty breathing, blue lips, persistent nausea or vomiting, signs of dehydration, convulsions, confusion, and also if the temperature is very high and does not decrease when taking antipyretics, or remains elevated for longer than 4-5 days.

Parents of children with the flu should also immediately seek medical help if their child develops the following symptoms during illness:

• rapid or difficult breathing
• blue or pale skin
• refusal to drink
• difficulty urinating (or lack of urge for a long time)
• lack of tears when crying
• persistent, persistent nausea or vomiting
• extreme lethargy and drowsiness, similar to fainting
• extreme degree of excitement, the child cannot be calmed down
• pain or pressure in the chest, abdomen
• sudden dizziness, fainting
• confusion, disorientation
• after the improvement, deterioration occurs again with an increase in temperature and increased cough

Treatment for normal course

In the normal course of the disease, hospitalization is not required. Full recovery occurs within a week. Children are not recommended to be given drugs containing acetylsalicylic acid as an antipyretic due to the risk of developing Reye's syndrome. Preferable drugs containing paracetamol and ibuprofen, as well as non-steroidal anti-inflammatory drugs.

Otherwise, prevention and treatment measures do not differ from those during a seasonal influenza epidemic.

Clinical presentation and treatment of severe cases of A (H1N1)

The clinical picture of the complicated course of influenza A (H1N1) disease differs significantly from cases of seasonal influenza. While patients with chronic diseases, children and pregnant women (as with seasonal influenza) are at increased risk for developing complications, there are now many cases of severe disease in healthy young people. The mechanism causing serious complications in such initially healthy patients has not yet been determined.

In severe cases of the disease, patients' condition usually worsens 3-5 days after the onset of symptoms. The condition deteriorates rapidly, with many patients developing respiratory failure within 24 hours, requiring immediate admission to the intensive care unit. Most hospitalized patients require immediate respiratory support with mechanical ventilation. However, some patients do not respond well to standard ventilatory support techniques, making further treatment difficult.

Studies show that timely treatment with antiviral drugs (neuraminidase inhibitors - oseltamivir and zanamivir) reduces the risk of complications and increases the chances of survival in case of severe disease.

In addition to the addition of viral pneumonia caused directly by the H1N1 virus, the course of the disease can also be complicated by the addition of bacterial pneumonia, which causes a rapidly progressive deterioration of the patient's condition. Bacterial pneumonia is most often caused by Streptococcus pneumoniae and Staphylococcus aureus, including methicillin-resistant strains. In this regard, to prevent additional bacterial complications, it is recommended to promptly begin antibacterial therapy prescribed by a doctor.

Mexican swine flu, origin and spread

The outbreak was first reported in the Federal District of Mexico City, which began monitoring a large surge in cases of influenza-like illnesses that began on March 18. Mexican authorities attributed the surge to "late season flu" until April 21, when the US Centers for Disease Control and Prevention became alarmed by two independent cases of new swine flu illnesses reported in the media.

In March and April 2009, more than 1,000 cases of suspected swine flu were reported in Mexico and the southwestern United States. The strain was unusually contagious in Mexico, causing 81 confirmed deaths, mostly in Mexico City, but there were also reports of such cases in the states of San Luis Potosi, Hidalgo, Queretaro, Mexico City, all in central Mexico. Some cases in Mexico and the United States have been confirmed by the World Health Organization as previously unknown strains of H1N1.

On April 27, 2009, the World Health Organization raised the danger level to level 4, and on April 30, at an emergency meeting, the level was raised to level 5 due to the fact that for the first time a human death from swine flu was recorded outside of Mexico, namely in USA.

On June 11, WHO announced the introduction of the sixth, maximum pandemic threat level due to the rapid spread of the disease throughout the world.

On May 22, swine flu came to Russia. On May 24, a second case of A(H1N1) was detected in a resident of the Kaluga region. On May 29, the third case of A(H1N1) was detected in a native of Belarus, who flew to Moscow for business purposes from Prague, and had previously been in New York. The Russian authorities created a government commission to prevent the entry of the virus into the country and banned the supply of pork from Mexico and a number of US states, but in September 2009, unconfirmed information appeared about 29 cases of the virus in the Russian Federation.

By August 2009, cases of swine flu had been confirmed in 168 countries. At this point, the WHO reported that individual case counting had stopped due to the inability to track all cases of infection. As of July 31, 2009, 162,380 cases of swine flu were laboratory confirmed worldwide, of which 1,154 were fatal.

According to WHO data from October 17, 2009, more than 414,000 laboratory-confirmed cases have been registered worldwide, of which about 5,000 are fatal. But, since in many countries the counting of cases has been stopped due to the inability to fully monitor all cases of infection, the number of confirmed cases of the disease is significantly lower than the real one.

In the northern hemisphere, the incidence continues to increase markedly (due to seasonal cooling), while in the southern hemisphere the incidence rate is falling, with the exception of certain regions (Cuba, Colombia, El Salvador).

In Russia, as of November 2, 2009, there were 3,122 laboratory-confirmed cases of influenza (H1N1) 2009. 19 fatal cases were registered, including 14 laboratory-confirmed.

Additional Information

• Precautions recommended:
  • wear a mask or respirator, or at least cover your mouth and nose with a tissue when coughing and sneezing (for those already infected)
  • do not approach a person with cold symptoms closer than 1-2 m.
  • wash your hands frequently with soap or wipe with alcohol-soaked tissues
  • do not touch mucous membranes: nose, eyes, mouth - especially in public places
  • stay home and avoid contact with people when the first flu symptoms appear.
• The sick person is contagious to others not only from the moment flu symptoms appear, but also during the incubation period, which is usually 1-2 days, up to 7 days from the onset of the disease. According to some data, sick children remain infectious longer than adults.
• Studies have shown that the influenza virus survives on hard surfaces for 2-8 hours and dies when:
  • temperature rises to 75-100 °F
  • exposure to chemical bactericides
  • exposure to antiseptics
  • exposure to surfactants (such as soap)
  • exposure to alcohol solution

Notes

see also

• Spanish flu
• Bird flu
• Hong Kong bird flu (1968-1969), estimated to have killed 1 million people worldwide.
• Severe acute respiratory syndrome (SARS)
• 2009 H1N1 influenza pandemic
• 2009 swine flu pandemic by country
• US Centers for Disease Control and Prevention

Links

• Percentage of cases and deaths from influenza A(H1N1) in the United States for the period August 30 - October 10, 2009: on the US Centers for Disease Control and Prevention website (English)
• Swine flu (English) on the World Health Organization website
• Clinical signs of severe cases of pandemic influenza (WHO) (Russian)

Cards

• Live map of swineflu,
• H1N1 live map
• H1N1 online incidence map in Russia
• 2009 H1N1 Flu Outbreak Map