Keep our family safe
These questions are provided by the general public and the responses are provided by designated clinicians (doctors) or health care personals involved in the management of the H1N1 outbreak. These clinicians are part of the RIPAS H1N1 Committee, Ministry of Health.
Q: I noticed that there has not been less media coverage on H1N1 in Brunei. Does that mean that the outbreak is settling?
A: When a new type of germ emerges there will be a lot of interest particularly to the scientific and medical community as it important to gain a good understanding. Of course this interest is picked up by the media in order to inform the public as in the earlier stages of the pandemic there was a lot of media interest. At the moment we are still seeing cases of H1N1 in our hospitals and health centres here in Brunei. It is still a little early to say whether the outbreak is settling but we believe the cases that we see are about the expected number. Hopefully, by continuing to educate the public about good hygiene measures (hand washing, proper soiled tissue disposal, etc) and by keeping up good infection control measures in the hospital (using masks, limiting visitors) we can help to settle the outbreak.
Q: I am concerned with the increasing number of deaths reported in Malaysia reported in the newspaper. Is the virus strain different?
A: Deaths are of course always of concern for those looking after patients, and it is understandable that members of the public will also be concerned. The strain known as Pandemic Influenza A H1N1 has caused deaths around the world, including within the Southeast Asian region but we must remember that any infection can be fatal including seasonal flu or "selesma biasa". This usually happens amongst people whose body protection (immune) system is weakened such as those with chronic illnesses like heart disease, lung disease and kidney disease. It is also possible that fit, healthy people can die from H1N1 if the infection overpowers the body.
All countries are keeping a close watch on deaths in people with H1N1. Malaysia has reported an increasing number of deaths but in a country of that size, this would be expected. The majority of deaths have occurred in people who are in high-risk groups although there have been deaths in healthy people too. This fits in with what we understand about the way that viral infections work. It is the same strain in Malaysia but we cannot be certain whether the strain takes on different forms.
Q: My neighbour was recently treated for H1N1 and she has a few young children. I am concerned as I have a young baby. I heard that the best way to prevent other family members from getting infected, self-quarantine away for a period of seven days is the best way. In my situation, it would be impossible as there is no one to look after my baby. What can I do? Will wearing a mask help?
A: "Prevention is better than cure" as the saying goes. We would definitely agree with that statement and this is why anyone infected with H1N1 should be isolated until they get better so that they will reduce the risk of spreading the infection to others, especially children and other vulnerable groups like pregnant women and those with chronic illnesses. It may not be possible or practical to isolate yourself from your family members but we would strongly encourage you to try so that you do not spread it.
In your situation, if it would be absolutely impossible then you could reduce the risk of spreading it to your baby by practising really strict hygiene such as washing your hands before touching your baby, not sleeping in the same room, keeping surfaces clean and wearing a mask. Your baby would still be at risk though and you should try to enlist the help of friends and family during this time e.g. your husband could ask for emergency leave from work to help you. Remember also that if you had flu that for a few days you may feel too ill to look after yourself and you would probably not be fit enough to look after the baby.
Q: My neighbour's child had just completed treatment for H1N1. However, he still has a bit of runny nose although much better than before. Is it safe for me to allow my children to play with him?
A: Ideally anyone with a runny nose should still consider themselves possibly infective. It would be wiser to wait for at least 24 hours until all symptoms have cleared up. The five-day course of Tamiflu will have lessen the severity of the illness for the individual taking it, but we also know that sometimes children continue to shed the virus for longer periods than adults. Symptoms are therefore an important sign of whether someone can be considered recovered from the flu. This is why the advice for both school children and adults is to only go back to school or to work when they have been free of symptoms for 24 hours.
Q: Why is there a shortage of vaccines?
A: There will be an expected shortage of vaccine for H1N1 because the usual production capacity of all the pharmaceutical companies combined worldwide is only 300 millions doses per year. This is assuming that the capacity for production is shifted completely from production of seasonal flu vaccines to the production of H1N1 vaccine. Due to the limited production capacity, it is obvious that there is not enough vaccine available for everyone.
Q: If there is a shortage of vaccine, will it mean that I may not get the vaccination when it is available?
A: Yes. People needing vaccinations have been categorised into those with risk (high or medium) to those low or no risk. People considered and categorised as high risks are pregnant ladies, patients with chronic disorders (chronic lung diseases, chronic heart diseases, kidney failure patients on dialysis or needing dialysis soon, patients requiring immune suppression medications (i.e. some cancers, rheumatological disorders, autoimmune disorders etc...), chronic liver diseases with evidence of compromise, haematological, neurological and neuro-muscular disorders. Lower risk includes diabetes especially if controls are satisfactory, high cholesterol and high blood pressure. Children under the age of five and elderly over the age of 65 are also considered high risk.
Q: Can one be a carrier but show no symptoms and pass it on?
A: Usually most people with flu, including H1N1 do show symptoms, however it is possible that they may show very mild symptoms if the infection is mild or if they are in the early stages.
Q: Now that we are in the Protect and Treat Phase where patients are not checked for H1N1 anymore, how do we know what is happening with the current outbreak?
A: As rightly pointed out, in the Protect and Treat Phase, we are now not routinely screening all patients attending with flu likenesses for H1N1 before starting treatment. Patients who have symptoms suggestive of H1N1 infection, especially with added risk factors (i.e. contacts with positive or treated cases or return from other affected countries) or considered high risk (pregnant ladies, person with chronic disorders listed in the high risk categories) will be given immediate treatment for H1N1. For those who are reasonable well and not considered high risk, patients maybe provided other symptomatic treatment and advised to self-monitor.
Q: How do we know what is going on is we are not screening anymore?
A: Currently, screenings are still being carried out, scaled down compared to previously. In the hospital settings, all patients with fever and chest symptoms suggestive of flu like illness or chest infections will be screened. Those with fever and less common symptoms consistent with a viral illness will also be screened. Currently, all adult suspected patients are being admitted to designated wards.
In the non-hospital settings, the Public Health division in the Ministry of Health has several sites known as the 'Sentinel sites' where random screening are being carried on patients with flu like illness patients attending for treatment. Apart from screening for H1N1, the total numbers of cases of flu like illness attendees are also being monitored.
All these measures ensure that the current situation and trend are being closely monitored. Therefore, any sudden increase can be detected early.
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