What is swine flu?

Swine flu is a highly contagious acute respiratory disease found in pigs. It is caused by one of the swine influenza A viruses. Swine flu results in high morbidity and low mortality of about 1-4%. Amongst the pigs themselves, the virus spreads through aerosols, direct and indirect contact, and through asymptomatic carrier pigs. Although the pigs are prone to regular infections, incidences increase in the fall and winter months in the temperate zones. Therefore, pigs are routinely vaccinated against swine influenza in many countries.

How is swine flu diagnosed?

When a person is under the weather, many symptoms may be present. However, symptoms of swine flu are very similar to normal cold and flu symptoms, and may include:

• Headache
• Fever
• Cough
• Appetite loss
• Fatigue
• Sore throat
• Runny nose
• Chills
• Nausea
• Vomiting
• Diarrhea

Fatigue, appetite loss and diarrhea can be dangerous. If the symptoms are persistent, it becomes imperative that you see a doctor. In order to diagnose your illness, the doctor may order:

• Chest x-rays
• Respiratory specimen
• Blood work

To diagnose swine influenza A infection, a respiratory specimen must be collected within the first 4 to 5 days of the onset of the illness as this is the time when the infected person is most likely to be shedding virus; however, children especially, may be shedding the virus for 7 days or longer. In order to identify the swine influenza A virus, the specimen must be sent to the CDC for laboratory testing.

Only RT-PCR or viral culture has the potential to confirm infection with swine-origin influenza A (H1N1) virus. The test performance of rapid antigen tests and immunofluorescence tests for detection of swine-origin influenza A (H1N1) virus is unknown. Persons who are suspected of having swine-origin influenza A (H1N1) virus and who test positive for the same using one of these tests should then have confirmatory RT-PCR or viral culture testing to confirm the presence of swine-origin influenza A (H1N1) virus. A negative rapid antigen or immunofluorescence test cannot be used to rule out swine-origin influenza A (H1N1) virus infection.

The results of this test from nasopharyngeal or nasal swab, along with other information, will in all probability help your doctor take better care of you. Knowing the test results will help prevent the spread of the virus to others.

The Swine Influenza Test Kit is a sensitive test to detect the swine flu virus; however, the FDA has not cleared or approved this test. But it has been agreed by the FDA has agreed that this test can be used under an Emergency Use Authorization.

How is swine flu different from bird flu?

The swine flu and the bird flu viruses do not have a twin-like similarity but are however quite similar. The virus that causes bird flu in humans first mutated from a virus that birds had so that it could then be passed on to humans; once established, it now passes from human to human contact. Same is the case with swine flu. It started among pigs as a virus but then soon mutated to spread to humans. Viruses have the ability to replicate rapidly; these viruses are able to mutate very quickly thereby creating new strains that then move on to multiply in other areas and susceptible hosts.

Avian flu so far has found it difficult to infect humans unless they were exposed to birds intensely. This is because the virus has not mutated in a way that makes it transmissible by one human to another. However, the swine flu virus has genetic origins from both pigs and birds. The biggest difference here is that the swine flu virus has mutated to an extent where it can readily be transmitted on human to human contact.

What drugs are available to treat swine flu and bird flu?

Antiviral treatment is normally the first line of treatment for the confirmed, probable or suspected cases of swine-origin influenza A (H1N1) virus infection, prioritizing treatment of hospitalized patients and patients with high risk for complications.

Antiviral drugs are prescription medicines (pills, liquid or an inhaler) with actively works against influenza viruses, including the swine influenza virus. Antiviral drugs are generally used to treat swine flu or to prevent infection with swine flu viruses. These medications are prescribed by a health care professional.

As of today, four influenza antiviral drugs are approved for use in the United States. They are:

• Oseltamivir (Tamiflu)
• Zanamivir (Relenza)
• Amantadine
• Rimantadine (Flumadine)

Laboratory testing conducted on the swine influenza A (H1N1) viruses so far has indicated that the viruses are susceptible (sensitive) to oseltamivir and zanamivir. Antiviral drugs can make the illness milder as well prevent serious influenza complications. However, these antiviral drugs work best when they are started within two days of the onset of the illness.

Antiviral drugs can also be used as a preventive measure to protect a person who has been or may be near a person with swine flu. Antiviral drugs are about 70% to 90% effective in preventing the flu.

Antiviral doses recommended for treatment of swine-origin influenza A (H1N1) virus infection in adults or children 1 year of age or older are the same as those recommended for seasonal influenza. Oseltamivir use in children less than 1 year of age was recently approved by the U.S. FDA under an Emergency Use Authorization (EUA).

Moreover, there are vaccines available that can be given to pigs to prevent swine influenza from spreading. Nonetheless, there is no vaccine to protect humans from swine flu yet. It is believed that the seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.

The extraordinary development came after Australian scientists found skin cancer cells died when injected with coxsackie A21 - a common air-borne virus associated with the common cold. The virus was found to kill known melanoma cells in immunocomprimised mice within five hours of injection before then spreading throughout the body and attaching itself to other, previously undiagnosed tumours, and attacking them. The Cutting Edge has also learned that the innovate discovery has already been tested successfully on human cells in laboratory conditions although it has not been tested on human subjects.

Cutaneous malignant melanoma (CMM), is considered the most serious type of skin cancer because of its rapid ability to spread to other parts of the body, including the eye. It starts when melanocytes become abnormal and invade and destroy the normal cells around them. On average each year, about 375 new cases of malignant melanoma of the skin are diagnosed in Ireland each year, 235 in females, and 140 in males. Every year about 60 people in Ireland die of CMM, of these about 32 are female and 28 are male. This makes CMM the 6th most frequent category of malignant cancer in females, but only the 12th most frequent in males. On average, an Irish female is estimated to have a 1-in-100 chance of developing this cancer by age 74, while males a 1-in-150 chance. CMM is now the most common cancer amongst Irish women aged 20-29 years. Irish females also have the third highest number of cases of this form of skin cancer in the EU, while Irish males have the sixth highest out of 15 other European nations. (EUCAN study Ferlay et al 1999). Within the EU, a north-south gradient is evident with melanoma rates higher in the more northerly countries, especially Sweden. This is consistent with the hypothesis that intermittent sunlight exposure in sun-sensitive individuals may be a critical factor in melanoma development.

I spoke to Dr. Shafren soon after the discovery and he told the Irish Medical Times “this appears to be a significant break-through in the treatment of cutaneous melanoma and the results we have had to date using human cells and animal studies have been very exciting.” Dr Shafren continued, “we succeeded in giving an injection of coxsackie A21 virus into a melanomatous tumour of an immunocomprimised mouse and within a few days it had not only killed the lesion but also one on another part of the body.” “If we can replicate that success in human trials, the treatment of this often fatal disease could be available within the next few years.” “Obviously, the patients would have to screen antibody negative to the virus for it to be effective”

Coxsackie A is a cytolytic virus of the Picornaviridae family, a enterovirus (a group containing the polioviruses, coxsackieviruses, and echoviruses). The virus was first documented in 1948, during an investigation into polio, and was named after the settlement in which it was found, Coxsackie, New York. There are 61 non-polio enteroviruses that can cause disease in humans, of them 23 are Coxsackie A viruses (6 are Coxsackie B viruses). Enterovirus are the second most common viral infectious agents in humans (after the rhinoviruses). The most well known Coxsackie A disease is Hand-Foot-and-Mouth Disease, a common childhood illness, often produced by Coxsackie A16. In most cases infection is asymptomatic or causes only mild symptoms. In others, infection produces short-lived (7-10 days) fever and painful blisters in the mouth, on the palms and fingers of the hand, or on the soles of the feet. Other diseases include acute haemorrhagic conjunctivitis (A24 specifically), herpangina, and aseptic meningitis (both Coxsackie A and B viruses). Coxsackie B viruses also cause infectious myocarditis, infectious pericarditis, and pleurodynia. Viruses have waged war against man throughout the centuries and recently in these columns we have detailed the recent link that has been discovered between Epstein-Barr virus and human cancer IMT June 6, 2003 and more recently the battle we are fighting against the raging HIV pandemic on the African continent.

Now, this team may have identified a potential way that viruses can be used by the body to fight and destroy disease. The discovery means that viruses could be used in the future either as a stand-alone therapy or possibly incorporated into more conventional radiation and chemotherapeutic strategies as an effective “three-pronged attack” on melanoma. It is too early to say whether the discovery could also mean surgery on melanomas could become obsolete, because the coxsackie A21 virus would effectively dissolve tumours from within. It is also possible that the treatment could be used to combat other forms of cancer, including prostate and breast cancer, within a decade. Professor Shafren admits that an immunocomprimised mouse model is not ideal and the results may not translate into the human model. “As many as 10% of people may have immunity to the cocksackie virus and there have been many other great medical techniques that have fallen down whenever they were moved from the mouse to the human cell environment. Dr Shafren said he was hopeful approval for research on human subjects would be obtained by the end of next year.

Professor Shafren said the coxsackie virus had much more in common with the receptors found on malignant melanoma cells than healthy cells. “It is like a lock and key thing and if the virus does not have the combination it does not get into the cell,” he continued. “This particular virus has the combination and therefore the probability of this virus killing the cancer cells than the healthy cells is much higher”. “Theoretically you get a new virus approximately five hours after infection starts and what we have found with the melanoma cells in the lab we get complete destruction of these cells within eight to 10 hours after they are exposed to the virus.”

Dr Shafren said the breakthrough was significant “but it is very hard to say we have the cure”.

To help the consumers afford the brand name drugs, the drug manufacturers offer drug coupons. Some of these may be in the form of discounts, free trials, etc. The drug manufacturers also employ many representatives to market their drugs to the physicians. These representatives may provide the physicians the drug coupons. Therefore, always ask your physicians if they have any coupons that can be used with your prescriptions.

Another source for getting the coupons is the Internet. For each prescription drug, you may have to perform several searches to find the coupons. If you take multiple prescription drugs, you may have to perform multiple searches. Because this search process can be time consuming, many consumers simply find the experience frustrated.

The best way to find your coupons is to visit a site that collects all the coupons and make them available to the consumers. One example of such a site is Drugzoo.com. This site provides hundreds of coupons for prescription drugs as well as non-prescription drugs. Since these drug coupons are offered from a single web site, the consumers can save significant time finding the right coupons. The coupons are organized in alphabetical orders, making it very easy to review the drug information and to access them. Most of the times, these drug coupons can be printed at home using own personal computer printer. Some of these drug coupons can save the consumers hundreds of dollars per year.

In this economy, being able to save several hundreds per year is a good enough motivation for many of us. Be sure to print the coupons before heading to the pharmacies.