Swine flu
 

We leave for a trip to Vietnam, Cambodia, Thailand, and Hong Kong in just under two weeks. Should we be concerned about travelling abroad with this flu threat? I know there are few, if any, reported cases in those countries, but would we receive adequate medical care, particularly in Vietnam and Cambodia, if, heaven forbid, we got sick? Thanks for your input.

Well, you are at higher risk for contracting swine flu in the US or Mexico.

Hong Kong is doing careful screening of arriving visitors, and I expect (from my experience during SARS) that VN will be screening arriving air passengers as well.

Hong Kong has excellent medical care available. If I was ill in VN or Cambodia, I'd get myself to Bangkok which has excellent medical care.

Do you carry med evac insurance? It's the only travel insurance I carry.

On the local news tonight in Thailand they are showing strict screening of incoming passengers from the Americas. As Kathie has said, the current cases are mostly being discovered in North America. If it does become a pandemic then I don't think many people will be travelling.

I know that Thailand has enough medicine for around 250,000 doses in case of an outbreak of bird flu. I'm not sure if the medicine will be effective with swine flu. One thing that is relatively comforting is that the flu viruses don't do too well in hot climate and IT'S HOT HERE!

Actually, the Tamiflu Thailand (and many other countries) have stockpiled isn't even known to be effective against bird flu, since a human-to-human version of that virus has yet to evolve. It's a possibly useful stopgap treatment, not a vaccine.

The thermal screening technology is an ineffective leftover from the SARS days when it picked up only a few cases. Not everyone who has swine flu will have a fever or other symptoms as they come through the airport. I believe the incubation period is 3-5 days and the airplane itself is, as someone commented this morning, a very effective transmission vehicle (maybe better at that than at transportation!).

Michael,

Who said that Tamiflu is a vaccine? Since you've bought it up here's an interesting article from Reuters - India.

http://in.reuters.com/article/domest...45664420090428

Will, of course, the thermal screening won't pick up all cases, but will pick up those who are actively ill.

The airplane is an environment that creates risk with the dry, recirculated air and close quarters. No one can cut their risk to zero, even they stay home, but you can do things to reduce risk including handwashing.

It seems that Thailand has over 320,000 doses + a share of the ASEAN stockpile of Tamiflu and the abilities to produce 1,000,000 more doses.

Here's a cut and paste from the article:

Following are some details of how Asian countries are responding to the crisis:

JAPAN -- Central government has Tamiflu stockpile for about 22.5 million, and Relenza stockpile for about 2.68 million people, for combined stock which would cover nearly 20 percent of population. Local governments have own stockpiles but figures not available. Checking passengers from Mexico, Canada and the United States at international airports.

SOUTH KOREA -- Tamiflu stockpile for 2.5 million people and is working to increase that to 10 percent of population of about 49 million.

AUSTRALIA -- Enough anti-viral drugs stockpiled to cover around 41 percent of 21 million population. Australia has stockpiled 8.7 million doses of Tamiflu and Relenza drugs. Large stores of surgical masks.

NEW ZEALAND -- Public health officials say "ample stocks" of anti-flu drugs. NZ built up stockpile after bird flu scare sufficient to cover between 25-30 percent of the 4.3 million population. New Zealand has raised the level of its national pandemic plan and is screening all flights from North America.

HONG KONG -- Media reports that Hong Kong authorities have 20 million doses of Tamiflu and other anti-flu medication. Steps up port health protection measures, and sets up temperature screening machines at all checkpoints.

TAIWAN -- Current supplies of swine flu treatment to cover 10 percent of Taiwan's 23 million population. More than one million facemasks for emergency use.

MALAYSIA - Tamiflu stockpile covering more than 2 million of the 27-million strong population. Does not have stockpile of personnel protection equipment such as face masks for general population yet, but has a supply for health staff who will be dealing with crisis.

THAILAND - Government has 320,000 sets of Tamiflu stockpiled. GPO, state-owned drug maker, can produce one million capsules of generic Tamiflu if needed. Temperature screening checkpoints at international airports in Bangkok, Chiang Mai, Phuket.

PHILIPPINES -- Govt says sufficient face masks and Tamiflu. Surveillance and other measures stepped up at entry points. Thermal scanning of all arriving passengers from countries with reported swine flu cases.

CHINA -- A Chinese health official said a reported outbreak of flu in a school in northwest China was not swine flu and had been identified as Type-B influenza. Chinese authorities tell hospitals to swiftly report any suspected cases of swine flu, and the official press is vowing fast public disclosure of any cases.

VIETNAM -- Ho Chi Minh City, Vietnam's largest city of more than 8 million people, has stocks of Tamiflu enough for 1 million people.

SINGAPORE -- Thermal scanners at airport and isolation units at hospitals, where staff at some emergency departments are wearing full protective clothing.

BANGLADESH - Travellers, particularly those coming from countries already hit by recent outbreak, to be screened.

INDONESIA -- Temperature scanners installed at 10 airports and ports with immediate effect. At least 3 million Tamiflu capsules in stock.

INDIA -- Has stockpiled one million Tamiflu doses which cover more than 142,000 people. Government has requested another one million doses which it expects to receive within 7-10 days. Government to step up surveillance at international airports and ports.

ASEAN -- Has 500,000 courses of antivirals stockpiled in Singapore and another 500,000 distributed among ASEAN member states. ASEAN also has stockpile of personal protective equipment but it did not give details.

Kathie, thermal screening doesn't even pick up all those who are actively ill.
Here's an American doctor specializing in aviation medicine quoted in Newsweek:
"There was a meta-analysis of thermoscanner use that shows it didn't work well during the SARS outbreak because it had a lot of false negatives. It wasn't getting people who were symptomatic. Airport screening is going to get done, I guarantee it, but it typically doesn't work particularly well with flu. With flu, there's a time frame between when you get infected and become contagious. In that area, you don't know you're sick even though you're contagious. Thermoscanning in airports is not effective in picking up the people you want to."

I suppose you could lump scanners in with the antiviral stockpiles and bans on the import of pork products from the US or Mexico. The actual usefulness of such policies might be questionable (the pork products ban is downright silly, IMO), but governments have to be seen to be "doing something" to protect their people. Note that WHO is being a lot more cautious this time around about travel bans and the like, since it turned out such things done during SARS did much more economic harm than medical good.

BTW, was reading today that most Asian flu strains are already resistant to Tamiflu. So much for all those stockpiles!

Michael,

I don't understand your criticism of Tamiflu and what the countries are doing in order to try and cope with this disease or the possible outbreak of it. I'm not a doctor but from what I've read on the net it clearly shows that if Tamiflu is prescribed early enough it can reduce the severity of the flu and help limit its spread. If you caught the swine flu in the early stages will you refuse Tamiflu because you think it will not help you?

Here are some information from my own research:

As news of the A/1H1N Swine Flu pandemic spreads so do the rumours and fear. One persistently reoccurring statement is that existing flu treatments Tamiflu and Ralenza (generic names: Oseltamivir and Zanamivir) are not effective against the newest strain of Swine Flu. These rumours are not true; Tamiflu and Ralenza (Oseltamivir and Zanamivir) are considered to be effective and viable Swine Flue treatments.

According to the CDC and WHO websites both Tamiflu and Ralenza (Oseltamivir and Zanamivir) can treat the A/1H1N Swine Flu strain. Both drugs are currently recommended as effective treatment options. What does not currently exist is a vaccine for the A/1H1N Swine Flu strain.

Swine Flu virus A/1H1N is a never before super flu that consists of 3 known swine flu strains, 3 known bird flu strains and a human flu virus. The combination of these strains makes the A/1H1N Swine Flu an unusual, but as of yet still treatable, strain of the flu.

While there is no vaccine that combats these strains, alone or in combination the anti-viral medications Tamiflu and Ralenza (Oseltamivir and Zanamivir) are expected to be fully effective when administered quickly and properly.

If you suspect you or somebody you know may be suffering from this new hybrid strain of Swine Flu seek treatment immediately. The sooner you are given Tamiflu or Ralenza, the better your chances of making a full recovery.

All of theknown US and Canadian cases of the A/1H1N Swine Flu are being treated with either Tamiflu or Ralenza (Oseltamivir or Zanamivir) and it is too soon to declare them ineffective. More will be known as the people currently suffering from the illness in Canada and the US start to recover.

Source:

http://www.nowpublic.com/health/swin...enza-zanamivir
http://www.cdc.gov/swineflu/antiviral_swine.htm
http://www.cdc.gov/swineflu/key_facts.htm
http://www.thisislondon.co.uk/standa...rks/article.do
http://www.who.int/csr/disease/swine...index.html#how

It's true that the use of Tamiflu has been controversial. Because of its extensive use when people were worried about Avian flu, most of the "usual" flu strains are resistant to tamiflu. BUT - this strain of swine flu is not resistant and is so far being treated efectively with tamiflu. Of course, since flu viruses frequently exchange genetic material with other flu viruses, there is concern that thsi particular strain of swine flu will soon be resistant to tamiflu.

There is no magic solution to preventing the spread on swine flu. It will take much vigilance and the cobbling together of many differnt approaches to keep this flu contained. I support all reasonable efforts to do so, even ones that may have relatively low yield like the thermal screening. Some believe that it was somewhat helpful with SARS in part because people knew they would be screend so didn't fly if they felt ill.

Don't forget that some of the simplelst things - like handwashing - can be most effective in preventing the spread.

Fortunately, this flu is occuring at the end of the usual flu season, so there will be time to create an effective vaccine in time for the fall flu season.

I've heard on the news that someone is trying to change the name from "swine flu" to "North American" flu. The reasoning is the falling sales of pork around the world.
I think they should keep the name swine flu so that people will avoid areas where there are pigs around.

During the bird flu crisis, while playing golf, a bird just drop from the sky and landed very near my golf ball. It got up and stumble around but it looked so sick that I forgo my shot and drop a new ball(far away) instead!

Why not ask your doctor to give you a prescription for Tamiflu or Relenza (although amantidine is much cheaper) to take with you in case of need? To be effective, any of these meds must be taken within the first 72 hours after the onset of symptoms or you're wasting your time. If you think you have the flu, don't wait.

Hanuman, my criticism is not of Tamiflu per se, but the seemingly widely held belief that it is some kind of magic bullet. Like Kathie, my caution stem from the bird flu scare, when people were buying up the drug - and using it - even though there was almost no basis for believing it would be effective against the disease once it mutated into a form that can be transmitted from person to person. Remember, such a form of H5N1 doesn't exist. How can you claim a drug is effective against a disease that doesn't exist? I'm not against Tamiflu, I'm FOR common sense, which seems to go out the window in times like these.

By the way, you may wish to read a report from the New York Times back in January, before all this started:
http://www.nytimes.com/2009/01/09/he...ef=health?_r=1

To answer your question directly, if a doctor prescribed me Tamiflu for a current illness, of course I would take it. But I wouldn't self medicate myself as some have suggested.

OK that make sense Michael. Tamiflu in Thailand is strictly controlled and you can only get it once you've been hospitalized. You can not buy it at drug stores so there are no abusing of the anti-viral here. If you remember during the bird flu crisis the Thanksin government refuse to admit that bird flu was spreading rampantly through the poultry farms and a few people as well. It was only after months that they admitted it to the public just so that they can protect one of their financial supporter's business.

I saw on CNN that even the US Senates are asking why there are not scanners at US airports even though the helpfulness is only marginal but it's still helpful. A few of my political friends are talking privately about halting or redirecting flights from North America if the situation becomes a level 6 alert by WHO. Silly thinking!

I think this is a more interesting article on patient zero and the pig business.

http://www.guardian.co.uk/world/2009...utbreak-source

Just like in China during the outbreak of the the bird flu and Thailand after that, businesses and financial interest were put into consideration first and only afterward did they they put human health as the main priority. Let's hope the world learn something then and will not repeat the mistake again.

I would rather "self medicate" myself in a country where I might not have access to quick or efficient medical care. Taking the medication will cause one no harm, but may prevent something much worse. Unless one is allergic to Tamiflu or any other drug, it can be taken with impunity, but in all cases, one's own family physician is the best resource. My doctor always gives me antibiotics before I travel overseas.

indianapearl, indeed, taking the medication can cause considerable harm. Flu viruses exchange genetic material often. If flu viruses have been exposed to tamiflu without being killed (such as when someone takes the medication unnecessarily) they may develop resistance which can then be passed on to more virulent forms of influenza. If you would feel more secure having tamiflu with you, make sure you know how and when to take it.

Antibiotics taken incorrectly can also cause antibiotic resistance. This is, of course, a major problem world-wide. Did you know that Cipro, which was formerly the antibiotic of choice for treating travelers diarrhea is no longer effective in Thailand and Nepal? I assume your doctor has given you complete instructions on when to take the antibiotics and when not to.

I see there are a handful of people in Bangkok wearing face masks out in public. (they look a bit silly, but it is their decision to do so)

I am wondering about the screening process going OUT of the country. I leave Monday. I would think there would be no long wait for screening if one is leaving Thailand. We shall see.

I thought the name here was being changed to Mexican flu.... ?

Carol

No, the political correct way is to call it H1N1. But I just heard that the letters "H" and "N" are not happy about this. They tolerated it during the H5N1 avian flu a few years back, but they are now saying "Enough is enough. We letters have feelings too", according to some news reports.

The number "1" cannot be reached for comment at this time.

Sorry I didn't read all of this thread but noted Kathie's suggestion that if you got sick in VN to go to Thailand for treatment. Made me wonder.

Suppose you did have the flu and showed up at immigration at BKK coming off of a plane from SGN. You look sick, perspiring heavily, coughing stuff up, maybe throw up. What are they going to do with you?

They'll most likely send you to a quarantine ward at a Bangkok hospital.

Mr, W,. if you were that ill, I expect they wouldn't let you on the plane. Nor should you fly and expose all of those passengers to your illness. If you have med evac insurance, they would likely get you to Bangkok from VN (in such a way that you didn't expose a hundred people to your illness). If you have a minor illness or accident in VN, use one of the SOS clinics. I know there is one in Hanoi and one in HCMC. I don't know if there are others.

Kathie, I took you literally when you wrote "get myself to Bangkok".

rkkwan- very witty. I think the number 1 is beside himself on this issue.

Who else here thinks that the swine flu situation has been hyped into the stratosphere? The media would have us believe this is the Great Flood. Meanwhile, 36,000 Americans will die from the seasonal flu that strikes each winter. Where's the proportionality? For more ranting, check out http://travelvaccineforum.wordpress....om-a-doorknob/

Take a lok at this artice for a more balanced view:

www.nytimes.com/2009/05/05/health/05well.html

Agree that New York Times article is a good piece. You may have also noticed their front page article today on the extent that Mexico and its citizens are being stigmatized.

http://www.nytimes.com/2009/05/05/wo...0stigma&st=cse

Then, read the 'doorknob' link 2 comments above.

I did read your "doorknob" link. I was disappointed in the lack of content on your site, as I was expecting a good review of what we know about the influenza and influenza transmission as well as info about how this virus differs and why there is concern about it. The NYT article offers this info.

And of course, people can get influenza from a doorknob or other surface previously touched by someone with the virus. As I'm sure you remember, there was a significant cluster of people who contracted SARS this way in a Hong Kong hotel. While you do eventually say that, given the title of this blog entry, I would have thought you'd want to answer the question upfront, rather than meandering though myths not relevant to the question. Hand washing is one of the best ways to prevent the spread of upper respiratory viruses.

The 'doorknob' piece primarily dealt with how irrational myths arise and can become considered as fact. For example, many countries have banned the importation of pork, despite that scientists explain that influenza A(H1N1), formerly known as swine flu,cannot be transmitted in this manner. China is now rounding up visiting Mexicans, some of whom haven't been in Mexico for months. Many folks in our country wanted our border to be sealed, which would not have had any meaninful medical benefit to Americans. Incidentally, while it is theoretically possible to contract influenza from a contaminated surface, the majority of infections are contracted by inhalation. Certainly agree with the value of handwashing with as well as isolating yourself if you have flu symptoms.