Editorial

It is abundantly clear that the incidence of H1N1 "swine flu" cases has increased significantly over the past few weeks and it seems that the country is approaching a second peak or wave, typical of in-fluenza in general.

It was therefore appropriate for the Health Division to shift its strategy from the "mitigation phase" to the next phase which is the "treatment phase", a decision based upon recommendations by the World Health Organisation (WHO). This effectively means that there will be no need to swab high-risk groups in suspected cases of H1N1. Patients who manifest clear symptoms of influenza will simply be treated with an antiviral. These patients include all pregnant women irrespective of their stage of pregnancy, all children under five years and all neonates (under one month of age) with severe or progressive clinical illness. Other high-risk groups include patients with chronic lung disease, such as asthma and chronic obstructive pulmonary disease, patients with chronic heart disease, diabetes, chronic kidney or liver disease, persons with neurological or chronic muscular disorders and individuals who have a suppressed immune system. Breast feeding mothers should continue to breast feed even while ill with suspected H1N1 and receiving treatment.

It needs to be emphasised that people who do not fall within the above high-risk groups and have a mild and uncomplicated form of disease should not be treated with antivirals as these may have side effects (as all drugs may). Also, inappropriate usage encourages the development of resistance to these drugs and unwarranted and excessive usage may deplete the country's stock of antivirals.

It is also worth spelling out once more the symptoms of influenza of all types: fever, cough, sore throat, runny or blocked nose, headache, muscle pains, general malaise, diarrhoea and vomiting.

High-risk patients with suspected influenza will be able to fill their prescriptions, after being seen by their doctor, at health centres and health centre pharmacies. This is important as while the majority of patients suffer from only relatively mild disease, it is vital to re-member that influenza may also kill.

Prevention remains crucial in order to limit the spread of H1N1 until all can be vaccinated. Prevention is mostly common sense and includes strict hand washing, avoidance of crowds and, if one is ill, staying in and not mingling as this will spread disease. This is particularly crucial in the childhood age group as sick children who are sent to school are cooped up in classes and the rest of the class will be readily infected, transmitting the disease to siblings and to the rest of the family and so on. Sick children should not be sent to school if at all ill, once the holidays finish.

The vaccination process will commence in the New Year, starting with health workers, pregnant women and the high-risk groups outlined above. The vaccine is safe, and over 37 million people worldwide have already been vaccinated with the same type of vaccine that Malta will be introducing. Children between six months and nine years of age, and those over 60 years of age, will need two doses of the vaccine, at least three weeks apart. Malta will initially have 100,000 doses, clearly an insufficient amount for the entire population, and the Health Division must be racking its brains working out the logistics of distributing and giving the vaccine! The second batch of vaccines is expected toward February/March and the rest of the population will be vaccinated, perhaps a little late, but better late than never.