Malta was the last EU country to register its first cases of the new H1N1 swine flu virus, when four men who returned from a holiday in Spain developed the symptoms and were diagnosed with the virus yesterday and the day before, but the health authorities are on top of the situation and said there is no cause for alarm.
The four men who are being treated for the flu virus are in a group of 24 who returned from Salou, Spain on Tuesday.
The first two cases were confirmed on Wednesday evening. Seeing that they had developed flu symptoms, the two men visited their general practitioner, who in turn informed the health authorities.
Another 13 people from the same group were also tested for the virus yesterday, after they too had developed flu-like symptoms, but only two of the swab tests resulted positive.
Meanwhile, another three people who may have had some kind of association with the group that travelled to Spain, will be tested for the flu virus this morning.
The parliamentary secretary for community care Mario Galea, who addressed a press conference yesterday morning, said those diagnosed with the flu virus and the suspected cases are under voluntary quarantine in their homes.
Ray Busuttil, the director of health, said during the press conference that those who were diagnosed with the virus are not terribly ill.
They have each been given a course of antiviral medicine Tamiflu, and because they were the first people in Malta known to have contracted the virus, members of their families have also been given a course of the antiviral.
The government has a total supply of antiviral medicines Tamiflu to cover 25 per cent of the population, and another batch of medicines is currently on order.
As for the availability of the antiviral medicines for children, the syrup that the government had in stock has expired.
The government decided not to buy the medicine again, and instead, should it be needed, the health division has the necessary expertise to make the medicine by mixing Tamiflu powder with a syrup that has a palatable taste.
“We are monitoring the situation closely. We are in touch with the patients twice a day to see what their situation is. There is no cause for alarm. People just need to be more vigilant to protect themselves from the virus. Basic hygiene practices can make a difference.”
The health authorities’ suggestion to avoid crowded places and gatherings may prove to be somewhat problematic, considering the large number of events organised throughout the summer.
Although no H1N1 flu vaccine is currently available, a number of pharmaceutical companies have produced a vaccine and the first batches are currently in the pre-clinical evaluation and testing stage.
Dr Busuttil said that because the virus is still relatively mild, pharmaceutical companies are going through the whole process to ensure vaccine safety. Should the virus mutate and become more dangerous, the vaccine may be made available before all the tests are completed.
In addition to about e4.5 million invested in recent years to combat a potential pandemic, the government is investing e3.5 million on measures aimed at ensuring that the country is well prepared for a potential outbreak of the disease.
The money is being invested in purpose-made face masks, aprons, and gloves for doctors and nurses, as well as a supply of the anti-viral medicine Relenza, and an extra supply of antibiotics that would be necessary if patients develop complications.
The government has balanced its antiviral stockpiles by buying 10,000 courses of Relenza, in addition to the available stocks of Tamiflu.
People are urged not to abuse antiviral medicines. The H1N1 virus is responding very well to Tamiflu and Relenza so far, but the situation could take a turn for the worse if the virus becomes resistant to the medicines.
Should it be suspected that a patient has been infected with the virus, the situation is first dealt with at community level. A throat swab is taken and sent to a laboratory in Malta to be tested for the H1N1 strain. Complications that may arise would then be dealt with in a special section that will be set up at Mater Dei Hospital should the need arise.
Swine flu virus still mild, but widespread
The swine flu virus is still relatively mild. Although a total of 77,201 cases have been reported globally since the emergence of the virus in late April, only 332 deaths are known to have been caused by the virus.
Only four deaths have so far been recorded in member states of the European Union and the European Free Trade Association.
When the World Health Organisation (WHO) raised the influenza pandemic alert to the highest possible level on 11 June, making it the first global flu pandemic in 41 years, the number of reported cases was more than half the number of today’s cases.
WHO director general Margaret Chan had said that the organisation did not expect a sudden and dramatic jump in the number of severe or fatal infections.
The overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment.
“We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years.
“In some of these countries, around two per cent of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia. Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.”
This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail, elderly people.
How did the virus develop in humans?
A recent analysis of the possible origins of the H1N1 flu virus highlights the need for systematic surveillance of influenza in swine, and provides evidence that new genetic elements in swine can result in the emergence of viruses with pandemic potential in humans.
The analysis was published in the international weekly science journal Nature, and the author of the paper, Oliver Pybus, from Oxford University’s Department of Zoology, said the results show that this strain has been circulating among pigs for many years prior to its transmission to humans.
Dr Pybus and Andrew Rambaut from the University of Edinburgh, along with other researchers, used evolutionary analysis to estimate the timescale of the origins and the early development of the epidemic.
They believe that it was derived from several viruses circulating in swine, and that the initial transmission to humans occurred several months before recognition of the outbreak.
The team of researchers concluded that “despite widespread influenza surveillance in humans, the lack of systematic swine surveillance allowed for the undetected persistence and evolution of this potentially pandemic strain for many years”.
Even if the virus originated from pigs, it has not shown to be transmissible to people through properly handled and prepared pork or other products derived from pigs. The virus is killed by cooking temperatures of 70 degrees Celsius, corresponding to the general guidance for the preparation of meat.
Information for travellers
Anyone developing a fever and flu-like symptoms (cough, sore throat, runny nose, aches and pains and tiredness) within seven days of returning from countries where there has been human to human transmission should contact the 24-hour hotline 2132-4086, and seek medical assistance.
The countries where there is sustained human to human transmission are: the US, Mexico, Canada, Australia, Japan, UK, Spain, Philippines, Honduras, Guatemala, Dominican Republic, Chile, Argentina, Panama and Costa Rica.