Some chilling truths about flu and other viruses

When scores of school-children from seven Catholic schools in Metro Manila complained of flu-like symptoms last week, some people were worried sick and thought that we were being attacked by deliberate biological or chemical infection. Of course, the authorities have assured us that this is far-fetched and efforts are at fever pitch to arrest the situation. And so we can all sleep in peace and not have to worry waking up the next day with smallpox, anthrax, botulism or some such potential agents used in biological warfare.

But FYI, here’s everything you’ve always wanted to know about flu and other viruses, which are certainly not to be sneezed at.

INFLUENZA

What is influenza?

Commonly called flu (or trangkaso), it is a viral infection caused by Influenza A and B viruses that typically infect the upper and lower respiratory tracts. It is most common in fall and winter in winter-occurring countries. In the Philippines, according to Dr. Veronica Chan of the WHO National Influenza Center, flu occurs during the rainy months of July to September and the cold months of November to February.

What are its symptoms?

Watch out for the sudden onset of the following symptoms: fever, body aches and pains, tiredness and weakness, extreme exhaustion, headache, cough, chills, sore throat.

The onset of flu symptoms are often abrupt that people infected with the flu can’t exactly recall the time they first felt sick.

Is flu contagious?

Flu is highly contagious. In most communities, school-age children are the first to get infected with the flu virus. Then they carry it home and subsequently, family members carry it to the offices and to other group activities. In a mild flu season, about 10-15 percent of the population becomes infected. In children, infection rate is even higher, 1 out of 3 children becomes infected.

Flu is usually passed on when the person infected with the virus coughs and sneezes. The virus becomes airborne and can be inhaled by anyone nearby. It usually enters the body through the mucous membranes in the mouth, nose or eyes. Flu continues to be contagious for 3-4 days after symptoms appear.

Is flu dangerous?

A bad case of the flu will probably send a healthy individual or child to bed for 3-5 days. Afterwards, the person will recover fully, but cough and tiredness may persist for days or weeks.

While it may be an infection that is self-limiting, flu can sometimes be variable. Flu can also be one of the deadliest. According to Dr. Chan, when left untreated, flu can lead to serious complications such as bronchitis and pneumonia, which may require hospitalization and sometimes lead to death. It can also further complicate chronic ailments such as asthma, cardiac diseases, renal and kidney insufficiency, as well as metabolic diseases such as diabetes.

Can the flu be cured with antibiotics?

No, because the flu is a viral infection. Antibiotics kill bacteria and are, therefore, only useful for treating bacterial infections. Inappropriate use of antibiotics that are not prescribed by your doctor contributes to the development of antibiotic-resistant strains of bacteria, which is a major public health concern.

What should I do if I get the flu?

Rest is important to help you get better. And if you stay home, there’s less risk that you will pass on the virus to other people.

Drink plenty of fluids. Hot liquids may relieve the feeling of congestion. A pain reliever such as paracetamol can be taken for aches and fever. Never give aspirin to a child under 12 who has the flu due to the risk of serious adverse effect known as Reye’s syndrome.

Doctors may prescribe an antiviral medication (like the new anti-influenza drug Oseltamivir, Tamiflu), which may be taken within 24 hours after symptoms first appear to reduce the duration and severity of flu-related symptoms. Consult your doctor for the prescription drug once you recognize the flu symptoms.

Is there anything I can do to avoid getting the flu?

To prevent the flu, or to lessen the severity once infected, you should get a flu shot at least three weeks before the start of the flu season, particularly if you are over the age of 50 or have a chronic health problem.

If you are pregnant or if you are allergic to eggs, you should ask your doctor whether or not you should get a flu shot.

Here are some simple commonssensical things you can do to protect yourself from the flu:

• Keep your distance, if possible, from people who have the flu since the virus is spread when a person with the flu coughs or sneezes.

• Wash your hands frequently to reduce your risk of catching a cold or the flu.

• Avoid second-hand cigarette smoke and if you smoke, try to quit.

• Try to maintain a healthy lifestyle: Follow a good diet, get enough sleep, keep stress levels low and drink lots of water.

SMALLPOX

Here’s a little note about smallpox: Under a massive program by the WHO, smallpox has been eradicated. It now exists only as stored virus at two research disease centers. Currently, there is a debate as to whether to store the last remaining virus or destroy it.

ANTHRAX

What is anthrax?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. It most commonly occurs in wild and domestic lower vertebrates (such as cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in humans when they are exposed to infected animals or tissue from infected animals.

Why has anthrax become a current issue?

Because anthrax is considered to be a potential agent for use in biological warfare, the Department of Defense (in the US) has begun mandatory vaccination of all active duty military personnel who might be involved in conflict.

How common is anthrax and who can get it?

Anthrax is most common in agricultural regions where it occurs in animals. These include South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. When anthrax affects humans, it is usually due to an occupational exposure to infected animals or their products. Workers who are exposed to dead animals and animal products from other countries where anthrax is more common may become infected with B. anthracis (industrial anthrax). Anthrax in wild livestock has occurred in the US.

How is anthrax transmitted?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. B. anthracis spores can live in the soil for many years, and humans can become infected with anthrax by handling products from infected animals or by inhaling anthrax spores from contaminated animal products. Anthrax can also be spread by eating undercooked meat from infected animals.

What are the symptoms of anthrax?

The symptoms vary, depending on how the disease was contracted, but symptoms usually occur within 7 days.

Cutaneous: 95 percent of anthrax infections occur when the bacterium enters a cut or abrasion on the skin, such as when handling contaminated wool, hides, leather or hair products (especially goat hair) of infected animals. Skin infection begins as a raised itchy bump that resembles an insect bite but within 1-2 days develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20 percent of untreated cases result in death.

Inhalation: Initial symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is usually fatal.

Intestinal: This may follow the consumption of contaminated meat and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25 to 60 percent of cases.

Where is anthrax usually found?

Anthrax can be found globally, but it is more common in developing countries or countries without veterinary public health programs. Certain regions of the world (South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East) report more anthrax in animals than others.

Can anthrax be spread from person to person?

Direct person-to-person spread of anthrax is extremely unlikely to occur. Communicability is not a concern in managing or visiting with patients with inhalational anthrax.

How can we prevent infection?

In countries where anthrax is common and vaccination levels of animal herds are low, humans should avoid contact with livestock and animal products, and avoid eating meat that has not been properly slaughtered and cooked.

Is there a treatment for anthrax?

Doctors can prescribe effective antibiotics. To be effective, treatment should be initiated early. If left untreated, the disease can be fatal.

BOTULISM

What is botulism?

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum.

There are three kinds of botulism. Foodborne botulism is caused by eating foods that contain the botulism toxin. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism can be especially dangerous because many people can be poisoned by eating contaminated food.

What are the symptoms of botulism?

The classic symptoms of botulism are double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating contaminated food, but they can occur as early as 6 hours or as late as 10 days.

How can botulism be treated?

The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. Currently, antitoxin is not routinely given for treatment of infant botulism.

Are there complications from botulism?

Botulism can result in death due to respiratory failure. However, in the past 50 years, the proportion of patients with botulism who die has dropped from about 50 to 8 percent. Patients who survive an episode of botulism poisoning may have fatigue and shortness of breath for years and long-term therapy may be needed to aid recovery.

How can botulism be prevented?

Foodborne botulism has often been from home-canned foods with low acid content, such as asparagus, green beans, beets and corn. The more unusual sources are from chopped garlic in oil, chile peppers, tomatoes, improperly handled baked potatoes wrapped in aluminum foil, and home-canned or fermented fish. Persons who do home canning should follow strict hygienic procedures to reduce contamination of foods. Oils infused with garlic or herbs should be refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety.

Another sweet reminder: Because honey can contain spores of Clostridium botulinum, which has been a source of infection for infants, children less than 12 months old should not be fed honey. Honey is safe for persons 1 year of age and older. Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs.

A final word of advice: Don’t take the threat of these viruses sitting or lying down.