Hemagglutinin One Neuraminidases One (H1N1, Swine flu)
Sandra Adrianne Pena
Concordia University
Applied Epidemiology
MPH 510
Dr. Boye
June 01, 2013
H1N1 7
H1N1
Hemagglutinin one Neuraminidases one is more commonly referred to as H1N1 or the ‘swine flu’ Hemagglutinin refers to the, “protein the virus uses to attach to the host cells” (Morgridge Institute for Research [Morgridge], n.d). Neuraminidases is what, enables the virus to be” (Morgridge, n.d). The knowledge of these terms is essential because they are also known as the host characteristics of this particular version of the flu. Many individuals commonly and blindly refer to all versions of the influenza virus as simply having the flu without knowing that there are many different variation of the influenza virus. At the broadest of categories there are types of influenza A, B, and C. H1N1 falls into the category of A, which is the most common of the three types sometime H1N1 is referred to as A(H1N1). Every [known] version of the influenza virus has, “different hemagglutinin and neuraminidase proteins. There are 16 (1 to H16) known types of hemagglutinin and 9 (N1 to N9) known types of neuraminidase, which gives 144 different possible combinations of these proteins” (Morgridge, n.d). When H1N1 is observed under an electron microscope is has a circular presentation, similar to a cluster of grapes as seen below.
“Hemagglutinin helps the virus attach to its target cells, the ciliated epithelial cells lining the respiratory tract. Once attached, the neuraminidase helps break down the protective mucous coating on these cells, and helps the influenza virus fuse with and enter the cell” (World Health Organization [WHO], 2009).
H1N1 has an origin that is not unlike the origin of many other diseases and viruses that have come to light in recent decades. Mutations in genetic code is not a new occurrence and it is believed that H1N1 was a result of “reassortment, a process through which two or more influenza viruses swapped genetic information by infecting a single human or animal host”(Centers for Disease Control and Prevention [CDC], 2009). This genetic swapping is why H1N1 is considered a ‘subtype’ and why there is currently 144 variations of the influenza virus. Genetic mutations continue to be a problem for scientists and healthcare providers because it requires continued and ongoing research to find drugs that are effective against these ever changing diseases and viruses.
This virus is not sex, marital status, or ethnic group specific. When referring to H1N1 the individuals that are at an increased risk are those that are young, the old, and immune system compromised. Immune compromised can cover a lot of ground, so more specifically those that have asthma, chronic lung disease, blood and/or endocrine disorders, and those with metabolic disorders (CDC, 2013) are some of those that should take special precautions during the times of year when this virus is at high virulence, virulence refers to the times when this virus has the ability to wreak the most havoc (Friis & Sellers, 2014). For the influenza virus, flu season is usually referred to as a six- to 12-week period in winter when influenza activity rises above the baseline threshold. Even though there is a typical flu season, flu may still be present in low levels during summer months (Wollenberg, 2013).
H1N1 was first detected in 2009, ("flu.gov," 2013) more specifically, it was first documented in humans in the United States in April of 2009 (Centers for Disease Control and Prevention [CDC], 2013). So, in comparison to something like the HIV/AIDS virus which has been around for decades, H1N1 is a relatively new and young virus. Early on it was referred to as the ‘swine flu’ because initially there were many gaps in knowledge regarding this virus but, it was found that, “many of the genes in the virus were very similar to influenza viruses that normally occurred in pigs which are also known as, swine” (CDC, 2013). This virus was first referred to as a, pandemic on “June 11, 2009” (CDC, 2013). A Pandemic is an, “epidemic that spans a wide geographic area” (Friis & Sellers, 2014) this virus has been documented in Venezuela, Peru, South Africa, and Mexico among many, many other countries as well as almost all of the United States as pictured below.
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The symptoms for the H1N1 virus are very similar to the symptoms of the influenza virus. Those symptoms can include any or all of the following symptoms listed below:
· 100 degrees or higher fever, or feeling feverish
· A cough and/or sore throat
· A runny or stuffy nose
· Headaches and/or body aches
· Chills
· Fatigue
· Nausea, vomiting, and/or diarrhea (flu.gov," 2013)
These symptoms can vary in severity, up to and including death. The high risk categories and those that display extreme symptoms should seek prompt medical attention.
Respiratory droplets are defined as, “droplet transmission occurs when relatively large particles (>5 microns) containing a biological agent are propelled from an infected person over relatively short distances (3-6 feet) and deposited onto the mucous membranes, usually mouth or nose of another person or onto an environmental surface ("UPMC," n.d.). Since everyone sick or well has the potential to spread respiratory droplets it is another reason to utilize the equipment available which is also known as Personal Protective Equipment (PPE).
The steps essential to preventing the H1N1 virus are similar to many other viruses that you may have heard of in the past. Reducing the spread and severity is dependent on, hand washing or alcohol/non-alcohol based hand sanitizers, avoiding touching face, nose, or mouth, and most importantly is if you have flu-like symptoms that you say home to prevent the spread. It is recommended that individuals stay home, also known as social distancing for at least 24-hours after the individual has been fever free, a fever is defined as a temperature over 100 degrees Fahrenheit (37.8 degrees Celsius). Additionally, surfaces that the ill come into contact with need to be appropriately disinfected. As previously mentioned the Swine flu is potentially problematic for the young, the old, and the immunocompromised but, what about the healthcare workers that comes into contact with this virus daily? Yes, hand washing and/or alcohol based hand sanitizers are still critical to preventing the spread but, since H1N1 is transmitted through respiratory droplets front-line healthcare providers need to do more that more includes wearing the appropriate PPE which dependent on what you are dealing with a gown and mask are advised to assist in protecting healthcare providers from falling victim to the viruses like that of H1N1 that does not discriminate against those it effects.
By healthcare workers, parents, and teachers showing a good example about hand hygiene and covering your cough it is one of the first steps in the education process for this particular pandemic, initially there was lots of fear which is understandable since this disease blindsided communities around the world. One of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) among many others was to rein in that fear H1N1 and explain it at a level that was understandable by the public at large because few people would understand if scientists explained H1N1 as Hemagglutinin one Neuraminidases One, a subtype of influenza A.
With this virus quickly progressing from outbreak to pandemic it was critical that every attempt be made to rapidly develop and effective vaccine that could aid in slowing the spread of this virus. As the World was affected the world came together to create a vaccine, “Vietnam started the phase 1 clinical trials for the first H1N1 pandemic influenza vaccine in partnership with the U.S. Department of Health and Human Services ("flu.gov," 2013). After successful completion of the phase 1 clinical trial, the WHO recommended global vaccination and campaigns for continued education and awareness (Stephen, 2010). The vaccines was first available November of 2009, 7 very long months after the virus was detected in the United States. The first vaccine was referred to as TIV, an injection of trivalent that addressed three strains A(H1N1), A(H3N2) and B(H3N2) or the LAIV, Live Attenuated Influenza Vaccine which was a nasal spray (WHO, 2009).
Now that H1N1 is officially in the post-pandemic stage it is still recommended that everyone including individuals from high-risk categories routinely obtain a flu vaccination, even though the flu vaccine is ever changing (mutating) and cannot always guarantee an individual protection it is still helpful in combating the flu. As with all vaccines the flu vaccine does more good than harm, as there are some reports that the H1N1 vaccine was linked to Guillain-Barre syndrome (GBS) – a rare nerve disorder (Wanjek, 2012).
The seasonal flu will always be something that is studied and researched for the simple fact that it is ever changing and every year a new vaccine must be developed to meet the needs of the global population to prevent needless deaths caused by the flu. In the 2009/2010 H1N1 pandemic it was estimated that approximately 19,000 people lost their lives alone (Fox News [Fox], 2013). In summary, the influenza virus type A subtype H1N1 quickly changed from something that individuals thought they could get from undercooked pork or contaminated water to a virus that simply had some of the characteristics of the viruses that swine sometimes carry, leaving the title ‘swine flu’ behind and being referred to as its formal name H1N1.
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