Human H1N1 pandemic developed from the originally localized Mexican source early in the spring 2009. For the emergency created by the epidemic of influence of the pigs in Mexico it was correct not to create alarmism being victims of bad information. Cytokine storm should be mentioned as one of the key pathogenic events contributing to the overall mortality in substantial portion of patients. If active immunization is assumed to be preventive measure of proven efficacy, clinicians are still in doubt how to treat a complicated course of infection. The possibility that the virus arrives in other parts of the world is real as for all the types of influence virus. In order that a strain has a wide distribution, its antigenic characteristics must ensure that it escapes the neutralization of antibodies of the host and of the surrounding population. So the outbreaks will happen with those strains that have dominant antigens that fit the deficiency, or better, the absences of antibody in the population.
It seems, in conclusion that the flu virus shows ability and an aptitude for survival built on the possibility of emergence of new models that allow the virus being confused easily through populations still partly immune to previous antigenic forms. According to this view, the changes in the influenza A can be designed in single meaning, in the context of a principle and of an evolutionary progress, from Burnet said immunological drift or steering immunology. The antiviral drugs (inhibitors of the neuraminidases, receptor of the virus surface) should be assumed within 48 hours by the appearance of the influence symptoms and for the subjects that have had a close contact with people infected by the flu virus. The vaccination against the influence is the most effective method to prevent the illness.
1. Neuraminidases inhibitors intake, which prevent adhering of viral capsid to the eukaryotic (e.g. mammal or human) cell membrane and “decoating” of RNA into cytosol. Different pharmaceutical markets, with different rate of success, had experiences with oseltamivir, zanamivir and peramivir, applied through several dosing regimens and routes of administration and consequently choice of drug forms used,
2. Bacterial super infections antibiotics treatment, most commonly situated in lower respiratory tract, according to available evidence-based guidelines on hospital acquired pneumonia management,
3. Low dose cortisol analogues are proper only with developed respiratory distress syndrome and together with neuraminidases inhibitor. High doses are not recommended even as adjuvant therapy and have neither proven efficacy nor safety in this indication.
4. From the moment that we find the isolation of a new flu virus, we must wait for the preparation of a new specific vaccine that will be ready for the next influence season in autumn.
The history of flu viruses teaches that the influence has origin from animal’s birds, generically aquatic, and then transferred to man through the leap into pigs. The promiscuity of the herds, as it is in use in Asia, determines this transition and then the spread. The Spanish influence (1918, H1N1), the one from Asia (1957, H2N2), that of Hong Kong (1968, H3N2) and soon have had this origin .
The strains common in some years may have also relations with those of other years. The person’s mostly old people have antibodies directed towards the antigens more important of the strains with which they were in contact. With the progress
of the age it is a broader spectrum immunity that is reflected in antibodies polyvalent made through the contact with many antigens primary and secondary present in strains those they meet during the following years. But each contact following with a flu virus of type A involves not only specific antibodies, but also an increase in those directed towards the strain responsible for the first flu infection of the subject (phenomenon of Davenport or doctrine of original sin). In this way, the immunization to a particular strain, spread in a certain period, involves progressively increasing difficulty in its further distribution and creates the selective advantage, for some variant of the virus, to multiply and spread.
We can easily notice that there are developed and from WHO
and CDC recommended procedures in handling the diseased. In
that sense from historical military sanitary doctrine it is well
known that epidemiological surveillance and proper organisation
on the field are much more important for raising survival
rates than experienced physicians or quality of equipment
available. Therefore, in accordance with this we present an
algorithm on handling infected persons in primary care setting.
Recommended procedure differs significantly at secondary and
tertiary levels of care and assumes selection and follows up of
patients in line with natural course of disease and response to
treatment. In order to more easily find the assistance on clinical
decision making we gave the next algorithm No 2. The new
strains will be in conditions of an increase in visitors, regardless
of whether they have or not an immunologic experience with the
previous strains. As a result of that, shortly after the appearance
of a new type, the old forms will disappear and the new family
will become dominant for a period which in general covers 10-
20 years, in which there is, for the emergence of minor antigenic
variation, the subdivision in various subtypes. The outcrops of
a new epidemic strain may, therefore, be regarded as a process
of development interesting the characteristics of the strain and
the susceptibility of the population. In order that a strain has
a wide distribution, its antigenic characteristics must ensure
that it escapes the neutralization of antibodies of the host and of
the surrounding population. So the outbreaks will happen with
those strains that have dominant antigens that fit the deficiency,
or better, the absences of antibody in the population. It seems, in
conclusion, that the flu virus shows an ability and an aptitude for
survival built on the possibility of emergence of new models that
allow the virus being confused easily through populations still
partly immune to previous antigenic forms (Figure 1 & Table 1).
According to this view, the changes in the influenza A can
be designed in single meaning, in the context of a principle and
of an evolutionary progress, from Burnet said immunological
drift or steering immunology. Very important to remember that
it was demonstrated the presence of antibodies to the more
recent strains of 1957 Asian flu (A2) in older segment of that
population: in Asian influence there were obviously strains with
dominant characters, other than those that had characterized
the previous years, more or less, but similar to those of the
strains widespread much before (1889-90pandemic).
For the emergency created by epidemic of avian flu in Asia
it was right not to create panic as victims of bad information
. The possibility that the avian virus entries in other parts
of the world it was like the rest for all types of flu viruses. It is
clear that the dead animal is harmless, and therefore there are
other veterinary and agricultural interests there is a potential
risk of genetic recombination with human flu viruses that might
hesitate to a viral variant capable of a transmission from human
Some important medicinal natural herbs or plants used for
the treatment of swine flu Basil: Ocimum sanctum and Ocimum
basilicum also known as Tulsi (Hindi) and Holy Basil (English) is
an aromatic plant of the family Lamiaceae. The plant, as a whole,
is a treasure house of potent compounds with its leaves, seeds,
and roots, as well as flower being medicinally important and is
considered divine by the Hindus. Ocimum sanctum and Ocimum
basilicum are great Ayurvedic treatment option for swine flu.
Ayurvedic practitioners claim that basil not only keeps the nasty
swine flu virus at bay, but it also assists in the fast recovery of
an affected person. They claim that basil improves the body’s
overall defense mechanism, thereby increasing its ability to
fight viral diseases. It is also believed to strengthen the immune
system of the afflicted person. For the control and prevention of
many diseases, Ocimum extracts are used in ayurvedic remedies
for common colds, headaches, stomach disorders, inflammation,
heart disease, various forms of poisoning, and malaria. For the
control and prevention of swine flu, basil must be consumed
in the fresh form. The paste or juice of a minimum of 25 leaves
(medium size) should be consumed twice a day. Moreover,
it should be had on an empty stomach. Ocimum sanctum is
considered to be an adaptogen par excellence [3,4]. It harmonizes
different processes in the body and is helpful in acclimatizing to
stress. The main chemical constituents of Ocimum sanctum are
oleanolic acid, ursolic acid, rosmarinic acid, eugenol, carvacrol,
linalool, and β-caryophyllene . Ocimim sanctum is reported
to be an effective treatment for diabetes and high cholesterol
 O.sanctum also shows promise for protection against
radiation damage [7,8]. Ocimum sanctum leaves contain highest
percentage of essential oils, infusion of which is given in malaria.
Juice of the leaves is taken internally and is very effective in skin
diseases such as itches fungal infections. Fresh leaves also cure
chronic fever and when mixed with honey and ginger juice, it is
useful in cough and bronchitis . The antimicrobial properties
of O. sanctum make it useful for the prevention of novel H1N1
flu. Basil is safe, with no side effects and is great to prevent swine
flu from spreading like wildfire.
In the course of epidemic of avian influenza that struck in
2005 10 Asian countries (China, Pakistan, Thailand, Cambodia,
Indonesia, North Korea, South Korea, Taiwan, Laos, Vietnam)
with 80 million chickens died or sacrificed and 42 fatal human
cases it was identified H5N1 as an etiologic agent, the same as
the one that in 1997 had caused an epidemic outbreak in Hong
Kong with 18 human subjects infected and 6 dead and with the
sacrifice of 1.5 million chickens .
The Avian Influenza recent outbreaks with involvement of
viral strains as H9N2 in 1999, infected two children and other
individuals, and in 2003, infected a boy in Hong Kong, while
H5N1 hit three subjects of a family killing two in 2003. At the
same time in the Netherlands an epidemic from avian influenza
viruses H7N7 hit 83 people and led to death a veterinarian.
In 2005 in the USA outbreaks of avian influenza have been
identified in Texas and in Delaware (virus H7N2), and in the last
State together with territories of Maryland and of Virginia there
are working 14,000 people and 1,900 families that produce the
8% of the meat of American poultry, with a budget of one and a
half billion dollars. In 2003 the American export in Europe has
reached the share of eight million and eight hundred thousand
eggs and 452 thousand chicks, respectively for 20 million and 3
million of Euro.
For the emergency created by the epidemic of “influence
of the pigs” in Mexico it is correct not to create alarmism being
victims of bad information . The possibility that the virus
arrives in other parts of the world is real as for all the types of
influence virus . For the SARS a direct contact was necessary,
in practical terms the so-called droplets of Pflugge, for this swine
influence it is different, in fact, it also spreads through the air to
distance. And a potential risk exists of a panic syndrome that it
often happens through bad information or a scarce knowledge of
the phenomenon. Then no alarmism because the number of the
victims is decidedly inferior to other pandemics .
Few years ago there were announced in Naples of an
outbreak of disease of Newcastle in a group of parrots coming
from Pakistan. The disease of Newcastle represents a useful
paradigm of the influence infection in man. Fortunately there
is not a reported human pathology to this virus, for which the
discovery of the outbreak of disease of Newcastle in Naples did
not give worries of any sort for the health of the Neapolitans.
Finally the risks of the disease of Newcastle are more tied to the
breeding of home volatile that, not immune to this virus, can be
exposed to the epidemic .
The vaccination against the influence is the most effective
method to prevent the illness. From the moment that we find the
isolation of a new flu virus, we must wait for the preparation of
a new specific vaccine that will be ready for the next influence
season in autumn .
The antiviral drugs (inhibitors of the neuraminidases,
receptor of the virus surface) should be assumed within 48
hours by the appearance of the influence symptoms and the
subjects that have had a close contact with people infected by
the flu virus [16,17].
The history of flu viruses teaches that influence originates
from birds, usually aquatic, and then it is transferred to man
through the leap into pigs. The promiscuity of the herds facilitates
this transition and then the spread. Three pandemics caused by influenza A viruses, which occurred in the 20th century, have
all had this origin: the ‘Spanish flu’ (1918, H1N1), the ‘Asian
flu’ (1957, H2N2) and the ‘Hong Kong flu’ (1968, H3N2). The
2009 H1N1 influenza virus acted during the winter in Australia
and New Zealand yielding a pattern effect for the treatment of
patients during the winter in the Northern Hemisphere. The
performance of rapid diagnostic test for the detection of novel
influenza A (H1N1) virus was evaluated by the Centres for
Disease Control and Prevention.
The findings of severe respiratory disease concurrent with the
circulation of H1N1 influenza was proved by the aforementioned
test. Even the potential impact of pandemic influenza during the
Hajj pilgrimage was taken in account to reduce the substantial
effect on the crowd to spread the infection.