With the world in high alarm over a new strain of the dreaded A(H1N1) virus, which is said to be twice as deadly and affects even the young and relatively healthy, the time has come to take a closer look at H1N1.

How many of us remember the SARS Song by Phua Chu Kang, Singapore's most successful export to Malaysia since, well, ever? Remember how he sung, 'use your brain, use your brain', in an effort to help combat the Severe Acute Respiratory Syndrome (SARS) pandemic of 2002? He had something going on there, yellow boots and all.

Because the time has come to 'use our brains' again. With a death toll of 72 Malaysians (as of August 31), the H1N1 virus is one that should not be left unchecked and 'unmasked'. With a startling level of complacency among Malaysians about the disease, it has become ever more important to know what we're dealing with, and what we can do to prevent it.

 

Epidemics VS Pandemics

First of all, what is a pandemic, and how does it differ from an epidemic? Basically, the word pandemic comes from the Greek word 'pandemos', which means "pertaining to all people". According to the Medilexicon´s medical dictionary, a pandemic is 'a disease affecting or attacking the population of an extensive region, country, continent, global.'

In good ol' English, that means that pandemics are an outbreak of a new virus, affecting many regions in the world and is infectious, to boot. An epidemic, on the other hand, is usually specific to one city or country - only when it starts to transmit between borders is it termed - or evolves into becoming - a pandemic.

Pandemics are also characterised by a much higher fatality and infection rate; the effects of a pandemic are global and widespread. 

 

So, what is the Influenza A(H1N1)?

Influenza is a term used for the flu. While the common cold is characterised by a runny nose, clogged sinuses and maybe a headache/chill or two, the flu is often marked by a fever, sore throat, chills, severe headaches and coughing.

The A(H1N1) differs from the common seasonal flu: the seasonal flu is endemic only in certain communities and rarely causes death except among the elderly and very young children, or those whose immune systems are weakened. That is why the elderly, children and pregnant women are considered 'high risk' groups.

Now, the World Health Organisation (WHO) has identified the six stages of influenza - and the H1N1 is in stage six already.  The six stages are:

• Stage 1: No animal influenza virus circulating among animals have been reported to cause infection in humans.
• Stage 2: An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is therefore considered a specific potential pandemic threat.
• Stage 3: An animal or human-animal influenza has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks.
• Stage 4: Human-to-human transmission of an animal or human-animal influenza able to sustain community-level outbreaks has been verified.
• Stage 5: The same identified virus has caused sustained community level outbreaks in two or more countries in one WHO region.
• Stage 6: In addition to the criteria defined in Phase 5, the same virus has caused sustained community level outbreaks in at least one other country in another WHO region.

This simply means that as the disease progresses, it crosses boundaries and affects more and more people, with a chance of change in the genetic sequence of the virus strain. 

 

Can the H1N1 mutate into a much worse strain?

According to Dr Harpal Singh, Technical Officer with the WHO Representative Office for Brunei Darussalam, Malaysia and Singapore, as of now, Malaysia has shown no signs of a new strain.

"From an epidemiological (the study of factors affecting the health and illness of populations) view; the virus causing the present pandemic (the Influenza A H1N1) has not shown a change in Malaysia," said Harpal. "This is supported by the fact that all severe cases and death cases that have occurred in Malaysia, are not clustered or linked. All the death cases in Malaysia have been sporadic."

As for the characteristics of the virus, they remain largely unknown, thus, trying to predict whether the outbreak could worsen, may not be possible for now.

"From the very beginning of H1N1 cases being reported out of Mexico around April 27, the WHO has been indicating that the virus is a novel (new) one and certain characteristics of the virus remains unknown. As such it is best that countries activate their Influenza Contingency Plans, just like what Malaysia did," said Harpal.

According to the WHO, the H1N1 is a strain of influenza that has a ribonucleic acid (RNA) genome. Very much similar to DNA (the building blocks of our genes), RNA is however less complex and essentially, every virus produced is a mutant (new RNA sequence), which is why it is hard to tell if it would mutate into a more severe strain.

In addition, the WHO has found that large outbreaks of disease have not yet been reported in many countries and the full clinical characteristics of the disease is still unknown. The pandemic is early in its evolution and many countries have not yet been substantially affected for any conclusive indications. 

 

How does H1N1 compare to other serious outbreaks of the past in our country?

"To directly compare H1N1 with other diseases in the past without taking into consideration other factors can skew the comparison," said Harpal. "In addition, the word serious is highly subjective: any disease outbreak can have significant impact on a country's health care system, social system and economic system, if not necessarily in terms of death." 

Harpal also noted that when it comes to 'serious' diseases, the death toll of the dengue outbreak far exceeds the cases of H1N1, or even the 2006 avian flu.

"Take for instance, in 2007, 48 846 cases of dengue were reported, of which 94.4 per cent were dengue fever and 5.6 per cent was dengue hemorrhagic fever," explained Harpal. "The dengue incidence rate was 179.2 per 100,000 people."

"Also," he added, "there was an increase in the number of episodes of food poisoning reported from various states with the majority of outbreaks occurring in schools, and a special committee within the Ministry of Education was even set up to tackle this problem."

 

Okay, but what can we do?

Harpal highlighted that the Ministry of Health has been very active in responding to the present H1N1 pandemic with the appropriate response and timely strategies to protect the vulnerable population in Malaysia against the present pandemic.

He, however, also highlighted the need for the public to do their parts.

"The public must also play their role. They should also be aware of their responsibilities, and must cooperate with the Ministry of Health as it involves everyone," he cautioned.

"At this stage of the pandemic in Malaysia; we must all be proactive and be responsible to prevent further spread," he said. "If someone develops flu-like symptoms and belongs to the high-risk group, then he/she needs to seek immediate medical attention. Going to a medical doctor when it is too late will not do anyone good."

Harpal also cautioned against the complacent attitude towards the H1N1 among Malaysians, as was recently highlighted in a local daily. Even though the H1N1 has reached a nationwide red-alert, many still walk around into public places without masks on, and without taking heed of the proposed home quarantines for those who exhibit ILI (Influenza-like illness).

The WHO also strongly encourages everyone to stay informed, through reliable sources of information to learn what the individual can do to protect her or himself and to stay updated as the pandemic evolves.

"There is a daily press release by the Ministry of Health; keeping oneself updated to the present situation and taking precautionary steps is prudent in preventing the spread of the virus. There are 2 websites that one can refer to http://h1n1.moh.gov.my and http://www.h1n1.net.my/," said Harpal.

So, although PCK's English may have had its problems, his message did not. So, use your brains and arm yourself with knowledge and information to work towards curbing this entirely new, entirely scary but not entirely unpreventable disease.