Pandemic Influenza A (H1N1)

Finally, WHO has declared an Influenza A (H1N1) pandemic. It is obvious that it is difficult to contain a virus that spread through droplet infection and close contact. Now that it has affected more than 30,000 people in more than 75 countries, it is inevitable that the WHO has to announce a pandemic. Now the whole world is on the alert.

It is obvious that the Influenza A H1N1 has been very mild. We hope that it will not mutate into a more virulent virus. We should not panic and overreact since the common influenza affects millions of people every year with more death than the H1N1. Having said that, it does not mean that we should let our guards down. The necessary precaution still needs to be taken. H1N1 causes more morbidity and fear rather than mortality.

In Malaysia, all cases are now imported. There is yet any confirmed case of human-to-human transmission within the local community. Hence, stringent measures should be undertaken at all entry points. Students returning from overseas, especially from Australia, USA and UK should be advised to postpone their trip home if they have flu-like symptoms. At the entry point, these countries, which are regarded as the epicentre of the H1N1 virus should be targeted for more stringent screening before entering the country. There is no fullproof screening since there is often an incubation period where at the early stages, there is no symptoms at all. If they develop H1N1 at a later stage and if they are not isolated early, then the likelihood of a local transmission is increased. Hence, people should be exercising more self-responsibility by seeking treatment early for any flu-like symptoms. Healthcare providers should be on high alert. Doctors should always keep in mind that any patient with flu-like symptoms and coming into contact with people who have travelled to any of the 75 affected countries could be an H1N1 patient.

In a disease where close contact is the mode of transmission, personal cleanliness and avoiding crowded and congested place will be the best form of precaution. Hence, it is wise to avoid the cinema, crowded restaurants and shopping centres. Travelling should be on the need basis. It is not a good time to go oversea for family holiday.

When I was in Beijing, I discovered that all big international gatherings have been postponed. This action can be regarded as quite drastic. Probably China has the SARS phobia and has been extremely stringent at its point of entry. When we arrived in Beijing, we were not allowed to disembark and health personnel came on board to do a quick temperature screening. If there are people with fever on board, then all the passengers may be quarantined until a diagnosis is made of the suspect. This is to prevent the problem of contact tracing after the disembarkation in the event that one of the passengers with fever is diagnosed with H1N1.

Since the disease is mild, doctors should be more conservative in the usage of Tamiflu. If Tamiflu is used routinely to treat all H1N1 cases, the danger is that they may develop resistant to Tamiflu. If a patient is down with H1N1 and also has underlying disease, at the same time, the patient’s H1N1 is resistant to Tamiflu, then it is likely that the patient will succumb to the illness.

Meanwhile, Malaysians should relax and do not panic. It is personal hygiene and common sense that will prevent us from being infected.

世界卫生组织最终宣布全球A（H1N1）型流感大流行。这是一种通过飞沫传播及接触传染而难以遏制的病毒。现在，全球已有75个国家受影响，3万人被感染，世卫组织宣布全球流感大流行乃无可避免的举措。全球各国也已提高警惕。

A型H1N1流感的疫性爆发以来还属温和。我们希望不会有异变而成为新的致命病毒。我们不应该过度惊慌。每年有数百万人感染普通流感，其死亡病例比H1N1型还要高。尽管如此，这不意味我们可松懈防疫。目前，由于H1N1发病率高，人们因此惊惶失措。

目前出现在马来西亚的都是外传病例。迄今国内还没出现人传人的确诊病例。因此，所有入境处都要进行严格防范措施。那些计划从外国返马，尤其是从澳洲、美国及英国回国的学生，若已经出现流感症状，应该展延回程。那些被鉴定为A型流感严重扩散疫区国的入境处，要进行更严格的扫描检查。其实扫描检查也非百分百安全，因为病毒有潜伏期，患者在早期阶段不会有任何症状。若感染者在初期阶段没有被隔离，那他会与其他人接触，这将提升本地传染的可能性。因此，人们一旦发现本身出现流感症状，有责任尽早求医。医疗单位也要高度警惕。医生务必要紧记，任何出现流感症状，且之前曾有接触来自75个被感染国家人民的病患，极可能是H1N1流感患者。

对于任何能通过接触传染的疾病，注意个人卫生以及避免到人潮拥挤地方是最好的防范措施。因此，最好避免到戏院、人多的餐厅及购物中心。此外，若非有必要，人们应该避免出远门。这时不是和家人出外度假的好时机。

我在北京时，发现当地的所有国际会议已经展延，这可谓是高度防范的举措。可能中国有非典型肺炎（SARS）恐惧症，它在每一个入境处进行严密检查。我们抵达北京时，机上乘客一律不获准下机，直至当医务人员登入机舱内完成体温测试。若机上有一人发高烧，那么所有乘客都可能被隔离，直到当局有诊断结果。这么做是减少当局在追踪行动面对的问题。

由于此疾病性质温和，医生在使用达菲（Tamiflu）务必要更小心。若经常使用达菲治疗H1N1流感病患，人体恐会对达菲产生抗体。若H1N1患者同时患有其他潜在疾病，会因体内对达菲产生抗体而病倒。

目前，大马人民应该放松。注意个人卫生及了解医药常识，就能预防自己被传染。