Due to the different types of viruses circulating, the MRI has a pivotal role to identify them accurately.
Coughing? Sneezing? Difficulty in breathing?
If you are experiencing any of these symptoms you may be a victim of the viral flu or Influenza, currently sweeping the country affecting many thousands in its wake. If neglected, it could have deadly outcomes, doctors warn. Recent global studies have endorsed their concerns. So has our Epidemiology Unit,(EU) whose experts have sent out circulars to all Regional Directors of Health in state hospitals to carry out awareness raising programs to educate their staff and the public to halt the current runaway disease that has gripped the country.
Describing it as a ‘Seasonal flu’ the Epidemiology Unit has also listed a number of precautionary measures to the public and attending staff of all hospitals which should be adhere a to. They have also advised medical staff on admission criteria requesting that priority be given to pregnant women presenting with symptoms to avoid negative outcomes on the mother and unborn child..
Influenza or viral flu, call it by any name you wish, is no respecter of persons.
Tragically, it strikes its hardest blow on children under two years, pregnant women, elderly persons over 65 years, those with compromised immune systems and those with chronic lung, heart, metabolic, liver, renal or neurological disease.
“Apparently, healthy people in these high risk groups should also watch out for clinical manifestations of Influenza and avoid close contact with anyone showing symptoms of the flu. Its mode of transmission is direct close contact with infected persons, and by droplets when one sneezes or coughs.”, says the EU. Although it is said to be a self limiting disease in the majority , they warn that severe disease in high risk groups could cause serious complications and even death, following pneumonia, etc. Allaying fears of an imminent epidemic, health officials have said, there was nothing unusual in the current outbreak “ The influenza currently circulating is caused by three viruses, Influenza A H1N1, H3N2 and B, and occurs throughout the year in two peaks – May , June and July and again in November, December and January. It is not something new we are experiencing”, says , Head of the National Influenza Centre, Medical Research Institute ( MRI), the country’s largest investigative unit for Viral Flu, Dr Jude Jayamaha. Speaking to the Sunday Observer, he fields questions on the disease and the kind of lab tests required to confirm positive cases.
Excerpts…
Q. Viral flu is still circulating in the country. In a previous interview you mentioned it was nothing to worry about. However, almost everyone you meet seems to have symptoms of the flu. As Head of the National Influenza Unit at the Medical Research Institute does this reflect a surge or change in the disease pattern?
A. Sri Lanka, usually has more influenza cases during December to February, compared to other months of the year.
Q. There is still a lot of confusion between viral flu and influenza . What is the difference?
A. The term Influenza can be used to name the disease and also the virus. Influenza virus is viral flu.
Q. There are four types of influenza viruses. What are they? Which of them cause human influenza seasonal outbreaks?
A. Influenza A, B, C and D. Influenza A and B are the types that commonly cause disease in humans while Influenza C rarely causes disease. Influenza type D causes disease only in animals.
Q. Which of these viruses is currently trending in Sri Lanka?
A. Influenza (A) H3N2 and HINI.
Q. What organs can be affected by these viruses ?
A. Mainly lungs, but complications to other organs can also arise if the illness progresses.
Q. Is it a highly contagious disease?
A. It is contagious through respiratory droplets and by direct contact
Q. Who are most at risk?
A. Children below 2 years, elderly people over 65 years of age,
pregnant mothers, chronic lung and heart disease patients, diabetics.
Q. How is influenza different from a cold and fever? What are the symptoms to look for?
A. Influenza cannot be differentiated from a cold and fever by symptoms. However, the typical symptoms to look out for are: fever, cough, cold (runny nose) sore throat, body aches and in some instances, difficulty in breathing.
Q. Can any non specialist medical officer manning an OPD be able to accurately identify the symptoms?
A. They can identify common features and alarming features, such as, difficulty in breathing, and direct patients appropriately for treatment.
Q. If a hospital needs to confirm a serious case of viral flu in an in ward patient, what is the usual procedure?
A. Firstly, it is not necessary to confirm all suspected patients. But if a needed, the hospital can send a respiratory secretion (phlegm sample) to the National influenza laboratory at the Medical Research Institute ( MRI) for confirmation.
Q. Do most hospitals have well equipped laboratories to do the necessary tests for confirmation of viral flu? Where do these samples come from?
A. The MRI receives samples from all over the country.
Q. As head of the National Influenza lab tell us about the role of the MRI in confirming positive cases of influenza?
A. It plays a pivotal role in identifying influenza types (A or B) and subtyping of influenza A as H1N1 or H3N2 and by culturing viruses for further characterization as per WHO recommendations. MRI also disseminates influenza data to the Health Ministry and other stakeholders for action and policy decisions.
Q. Does treatment of individual patients depend on identifying the specific virus?
A. No, it does not depend on whether it is influenza A or B as treatment would be the same.
Q. As many are not familiar with the way a viral flu virus is identified, tell us in detail how your lab technicians identify the viral flu virus and what instruments are used for this purpose.
A. First, we process samples to reduce the stickiness of phlegm and extract
the (RNA) of the virus in a special laboratory, adhering to special precautions. Then, we subject it to the state of modern molecular diagnostic test- real time PCR (Polymerase Chain Reaction).
Q. Does getting a viral flu stop you from getting it again? If not why? Because the virus has mutated? Or lowered immunity following an attack?
A. Influenza virus changes its genetic material and causes new strains with time, and not due to lowered immunity following an attack.
Q. What about anti viral therapy?
A. Anti viral therapy is only used for hospital admitted patients . It is given to in-ward patients when needed.
Q. What are the Do’s and Don’ts in prevention?
A. To prevent it , they should follow simple personal hygiene rules such as, washing hands with soap and water frequently, covering mouth and nose while sneezing and coughing with a tissue or a handkerchief , disposing tissue and masks in no touch receptacles , cleaning and disinfecting the immediate environment and equipment used. Avoiding large crowds is also advisable.
Q. Apart from humans is it correct to say that dogs too can be infected? A study by the Center for Disease Control and Prevention ( CDC) has referred to this relatively new canine influenza in its latest journal. Your comments?
A. Influenza D can cause infections in dogs and this type was discovered a few years ago.
Q. What are the current gaps in the delivery of a satisfactory service to patients with influenza ? Are there adequately trained doctors? Training courses for Nurses? Midwives and grassroots workers?
A. Yes, training and awareness programs are carried out by the Ministry of Health regularly, to all categories of staff, including public health staff at Medical Officer Health level.
Q. Your message to the public?
A. There is no need to panic. Adhere to personal hygiene such as cough etiquette, etc. If you feel unwell stay at home and rest.Drink plenty of fluids to keep hydrated.
Q. If readers want more information who should they contact?
A. They should contact the Chief Epidemiologist on 0112695112 or
Epidemiology Unit 0112681598.