S.S.C/ Dakhil/ Vocational- 2009 Result Publication

To see the full result online, visit

http://result.educationboard.gov.bd

Number of GPA-5 achievers goes up

This year's Secondary School Certificate (SSC) examination results show an over three-percent drop in the pass rate from last year but a jump in the number of students obtaining GPA-5.

This year 67.41 percent students passed while last year the figure was 70.81 percent.

A total of 45,934 students of eight education boards received the highest score of GPA-5 (Grade Point Average) this year. Last year 41,917 students got the highest score.

The number of schools with cent percent pupils passed has also increased to 2,726 from last year's 2,272.

The results were published yesterday, within two months of the exams.

Viqarunnisa Noon School and College of Dhaka once again became the top school in the country.

The average pass percentage of SSC, SSC (vocational) and Dakhil examinations, held under 10 education boards, including the Technical Education Board and Madrasa Board, also decreased by 1.29 percent as the total pass rate dropped to 70.89 percent from last year's 72.18 percent.

Some 3,08,136 examinees failed this year.

The results show a significant, 15.73 percent, rise of GPA-5 scorers with 62,307 students achieving the distinction--an increase of 9,807 from last year's 52,500.

This grading system was introduced in 2001 when only 76 examinees secured GPA-5.

The number of schools with zero pupils passed came down to 72 from last year's 91. This year the number of examinees expelled also continued to drop. Only 541 students were expelled against last year's 707.

As many as 10,58,674 students--5,56,839 boys and 5,01,835 girls--sat for this year's SSC and equivalent examinations and 7,50,538 of them passed. Pass percentage of boys and girls is 73.13 and 68.41 respectively.

For the first time, SSC examinations were held under the Dinajpur Education Board. At least 1,02,101 students sat for the examinations under this board and 64,913 of them passed.

Education Minister Nurul Islam Nahid handed over the results to Prime Minister Sheikh Hasina formally around 12:30pm yesterday. Chairmen of all the education boards were present on the occasion.

Announcing the official results at a press conference at the education ministry, he said, "A positive change in the standard of education has been made even though it fell short of our expectations."

The results were also made available on the education board website and in all schools and exam centres. The results could also be received via SMS on mobile phones.

THE 10 EDUCATION BOARDS Students of Madrasa Board did exceptionally well compared to those of the other nine education boards' with a pass rate of 85.85. About 1,59,444 students came out successful and of them 16,309 obtained GPA-5.

Students of Sylhet Education Board did better than those of the seven other general education boards. Sylhet Education Board had 78.71 percent of their examinees passed while Rajshahi Board had the lowest, 58.41 percent, of students passed.

In Sylhet Board 29,443 students came out successful and 1,896 of them obtained GPA-5. Last year, Sylhet Board had the lowest percentage of pupils passed.

In Dhaka Board, 69.11 percent, about 1,65,570 students, passed the SSC exams with 19,086 students securing GPA-5.

About 66,457 students or 58.41 percent passed the exam in Rajshahi Board with 4,474 achieving GPA-5.

In Comilla Education Board, 64,266 students, 72.77 percent, came out successful and 4,202 got GPA-5.

In Jessore Board, 72,271 students or 68.01 percent passed and 4,767 achieved GPA-5.

In Chittagong Board, 43,132 examinees passed with a success rate of 69.61 and 4,529 of them scored GPA-5.

In Barisal Board, 31,826 students were successful with a pass percentage of 65.63, while number of GPA-5 achievers is 1,688.

In Dinajpur Education Board, the pass rate is 63.58 percent. The number of GPA-5 securers is 5,292.

Students of the SSC (vocational) also did well this year with 70.90 percent passed. Some 53,216 students passed the exam, while 64 of them got GPA-5.

The success of science group students marked a slight drop to 83.75 percent compared to last year's figures. In humanities group 55.10 percent students passed and 72.06 percent passed in the business studies and commerce group.

Like the previous years, schools in urban areas, especially in the metropolitan cities, dominated with high number of the GPA-5 achievers and cent percent pass records.

TOP GPA-5 SECURING SCHOOLS The top GPA-5 securing schools of the eight general education boards are: Viqarunnisa Noon School and College (887) of Dhaka Board; Collegiate School (346) of Chittagong Board; Comilla Zilla School (264) of Comilla Board; Khulna Zilla School (199) of Jessore Board; Cantonment Public School and Collage, Rangpur, (197) of Dinajpur Board; Cantonment Public School and College, Bogra, (174) of Rajshahi Board; Blue Bird High School of Sylhet (138) of Sylhet Board and Barisal Zilla School (122) of Barisal Board.

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A Funny Post | Punch Line Fun

See what happens to the punch line when all the famous big companies produce CONDOMS::

MIRINDA CONDOM - ZOR KA JHATKA DHERE SE LAGE MRF CONDOM - EXTRA RUBBER EXTRA MILEAGE MOOV CONDOM - AH SE AHAA TAK AIRINDIA - MAHARAJA CONDOM PANAMA CONDOMS = NOTHING BETWEEN YOU AND ME.. DUNLOP CONDOMS = EXTRA WIDE EXTRA GRIP DURACELL CONDOMS = LONGER LASTING.. GADGIL CONDOMS = ENVIRONMENTAL FRIENDLY, REUSABLE.. HERO HONDA CONDOM = FILL IT SHUT IT FORGET IT.. MRF ZIGMA CONDOMS = SPACE AGE.. LUX CONDOMS=== FILMI SITARON KI PASAND KELVINATOR CONDOMS=== ITS THE COOLEST ONE BAJAJ CONDOMS=== BULAND BHARAT KI BULAND TASVEER FOUR SQUARE CONDOMS=== LIVE LIFE KING SIZE VIDEOCON CONDOMS=== BRING HOME THE LEADER PHILPS CONDOMS=== LETS MAKE THINGS BETTER ONIDA CONDOMS=== NEIGHBOURS ENVY, OWNERS PRIDE

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My Prayers...

I asked for Strength ......... And God gave me difficulties to make me strong. I asked for Wisdom ......... And God gave me Problems to solve. I asked for Prosperity...... And God gave me Brain and Brawn to work. I asked for Courage......... And God gave me Danger to overcome. I asked for Love......... And God gave me Troubled people to help. I asked for Favors......... And God gave me Opportunities. I received nothing I wanted. ..........................I received everything I needed. "War doesn't determine who's right. War determines who's left."

10 POINTS TO MAINTAIN A GOOD FRIENDSHIP

10 POINTS TO MAINTAIN A FRIENDSHIP *********************** 1. FOCUS ON WHAT YOU CAN GIVE TO A FRIEND, NOT WHAT YOU CAN GET OUT OF AFRIENDSHIP If being happy is your only motive for wanting someone to be your friend, then you is not being a real friend. Don't get caught up in keeping tabs on who has given most in the friendship. Give to your friends regardless of how much they give to you. 2. ENCOURAGE YOUR FRIEND. Real friends inspire and push each other to be the best that they can be, rather than drag each other down. They are happy when other people achieve their goals. 3. BE WILLING TO FORGIVE. Don't let hurt turn to grudge. This is one sure way to destroy a friendship. Forgive your friend and move on. 4. TACTFULLY POINT OUT THEIR MISTAKES. This is one way to show concern for others. If you really care, you will tactfully point out a specific example for his own good. But once you've brought the problem to your friend's attention, don't harp on it all the time. Don't walk away from a friendship when you see some of your friend's faults. Be patient with a friend as he or she tries to change. Realize that nobody is perfect. 5. BE RELIABLE. When you say you are going to be there, be there. 6. DON'T TRY TO CONTROL YOUR FRIENDS. Real friendship does not mean you always have to be together. It may be tempting to have a fun person all to yourself, and feel threatened when your friend spends time with others. If you are afraid to let your friends out of your sight, you are probably afraid of losing them. Good friendship will endure time spent apart. You and your friends may learn to appreciate each other even more. 7. BE THERE FOR THE GOOD AND THE BAD TIMES. Celebrate with them if your friends are excited about something. But don't be there just for the good times. When your friend is upset about something, give them your full attention. Most of the time, what friends really need is a sympathetic ear, someone who understand their feelings. 8. LEARN TO ACCEPT PERSONALITY DIFFERENCES IN YOUR FRIENDS. Be careful not to evaluate other people by how you react in a particular situation. Do not automatically take your friends' behavior personally. 9. DON'T BE A BLABBERMOUTH. Learn and be willing to keep each other's secrets. 10. DON'T LET ARGUMENTS DESTROY YOUR FRIENDSHIP. Suppose you're having a discussion with a friend and after you've said what you think is true, they still disagree. Don't keep arguing until you get mad with each other. Just drop it. Your desire to win the argument may ruin your friends. Follow these rules and hope you'll find a good & lasting friendship.

Bangla Internet Radio | Listen Free Bangla Internet Radio

1ST BANGLA INTERNET RADIOs
Now we Bangladeshi have 2 Bangla Internet Radios. They are as like FM Radios ( Radio Aamar 101 FM, Radio Foorti 88.00 FM, Radio Today 89.6 FM etc). These Radios have entire week programs. Have slow internet??? Don't Wory, These Internet Radios can be played in slow internet connections. So, let's joy...
About Radio Goongoon
To listen radio Goongoon click the link above. The link leads you to Radio Goongoon homepage. There select your player according to your Internet Sprred. There are two types of player. One for High Speed Internet Connection and another for Slow Connection. Select Any of them. Now opens the Radio Player Window. It usually takes 10 second to start palaying. If not started, Then you have to select the player option. Click the Arrow Button after "Auto Detect". Select "WMP". Now the player will must start to play. Enjoy... 


  Radio GoonGoon Program Schedeule
  • Both Channel 1 & 2 broadcasting/netcasting nonstop bangla Songs 24/7
  • Tuesday-Sunday BDT 2-3PM Live Program " Rodela Dupure " with RJ Sami.
  • Everyday BDT 5pm "GoonGoon Khobor"
  • "Tarunno" Live With RJ Shuvo - Sunday,Tuesday & Thusday (BDT 6-7PM)
  • more programgs are coming up ...
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  About Radio2Fun




What is the views of radio 2fun ?
Radio 2fun is a Bangladeshi online radio. Our only one destination to spread the Bangladeshi culture worldwide.


What type of technical support radio 2fun have ? 
Radio 2fun uses two powerful servers by which it can give coverage about 30 millions listeners worldwide. More than 5 Engineers are working to upgrade this radio station in every moment. Two well known radio technical companies are giving support for transmission regular. Radio 2fun has some talented web partners who are helping to bring new features in our net service. Our transmission system is so much efficient that users will not get any buffering while they are listening. 


What are the special features for slow net users ?

We Provide several options for slow, medium & high speed net users. Users can listens at their own net speed. there are 18 KBPS (2KB download speed), 32 KBPS (4KB download speed), 48 KBPS (6KB download speed), 64 KBPS (8KB download speed) features for the users. Users can use any features. 2KB feature will run always in homepage so that all users can get access easily. after that users can click on the options to hear the radio 2fun at their speed. we provide the highest quality in every speed features. 




How they solve the problems to hear radio 2fun in various Internet Connection ?


If your net speed is so poor (Below the 2 KB) then we suggest you to wait some moment and look at the player which is at the center bottom. There you will see a percentage of buffering. We suggest you to wait until it reaches the 100%. We've used a windows player in home page. If you use other operating system then you can get problems to hear but we also provided this soloutions also. There are a option by which you can get so many players. You can use one of them by your choice.


RADIO2FUN PROGRAM SCHEDULE 


 .:: Saturday ::. TIME:: 9:00 AM. 12:00 PM. :|: PROGRAM NAME :: City Of Sunshine BD TIME:: 12:00 P.M. 3:00 P.M. :|: PROGRAM NAME :: Dhun @ Noon BD TIME:: 3:00 P.M. 6:00 P.M. :|: PROGRAM NAME :: Alshe Dupur BD TIME:: 6:00 P.M. 9:00 P.M. :|: PROGRAM NAME :: Icche Ghuri BD TIME:: 9:00 P.M. 12:00 P.M. :|: PROGRAM NAME :: 2Fun Exclusive BD TIME:: 12:00 A.M. 3:00 A.M. :|: PROGRAM NAME :: 2Fun Rockers BD TIME:: 3:00 A.M. 6:00 A.M. :|: PROGRAM NAME :: Raat Jaga Pakhira BD TIME:: 6:00 A.M. 9:00 A.M. :|: PROGRAM NAME :: Khola Janala .:: Sunday ::. TIME:: 9:00 AM. 12:00 PM. :|: PROGRAM NAME :: City Of Sunshine BD TIME:: 12:00 P.M. 3:00 P.M. :|: PROGRAM NAME :: Dhun @ Noon BD TIME:: 3:00 P.M. 6:00 P.M. :|: PROGRAM NAME :: Alshe Dupur BD TIME:: 6:00 P.M. 9:00 P.M. :|: PROGRAM NAME :: Icche Ghuri BD TIME:: 9:00 P.M. 12:00 P.M. :|: PROGRAM NAME :: 2Fun Exclusive BD TIME:: 12:00 A.M. 3:00 A.M. :|: PROGRAM NAME :: 2Fun Rockers BD TIME:: 3:00 A.M. 6:00 A.M. :|: PROGRAM NAME :: Raat Jaga Pakhira BD TIME:: 6:00 A.M. 9:00 A.M. :|: PROGRAM NAME :: Khola Janala .:: Monday ::. TIME:: 9:00 AM. 12:00 PM. :|: PROGRAM NAME :: City Of Sunshine BD TIME:: 12:00 P.M. 3:00 P.M. :|: PROGRAM NAME :: Dhun @ Noon BD TIME:: 3:00 P.M. 6:00 P.M. :|: PROGRAM NAME :: Alshe Dupur BD TIME:: 6:00 P.M. 9:00 P.M. :|: PROGRAM NAME :: Icche Ghuri BD TIME:: 9:00 P.M. 12:00 P.M. :|: PROGRAM NAME :: 2Fun Exclusive BD TIME:: 12:00 A.M. 3:00 A.M. :|: PROGRAM NAME :: 2Fun Rockers BD TIME:: 3:00 A.M. 6:00 A.M. :|: PROGRAM NAME :: Raat Jaga Pakhira BD TIME:: 6:00 A.M. 9:00 A.M. :|: PROGRAM NAME :: Khola Janala .:: Tuesday ::. TIME:: 9:00 AM. 12:00 PM. :|: PROGRAM NAME :: City Of Sunshine BD TIME:: 12:00 P.M. 3:00 P.M. :|: PROGRAM NAME :: Dhun @ Noon BD TIME:: 3:00 P.M. 6:00 P.M. :|: PROGRAM NAME :: Alshe Dupur BD TIME:: 6:00 P.M. 9:00 P.M. :|: PROGRAM NAME :: Icche Ghuri BD TIME:: 9:00 P.M. 12:00 P.M. :|: PROGRAM NAME :: 2Fun Exclusive BD TIME:: 12:00 A.M. 3:00 A.M. :|: PROGRAM NAME :: 2Fun Rockers BD TIME:: 3:00 A.M. 6:00 A.M. :|: PROGRAM NAME :: Raat Jaga Pakhira BD TIME:: 6:00 A.M. 9:00 A.M. :|: PROGRAM NAME :: Khola Janala .:: Wednesday ::. TIME:: 9:00 AM. 12:00 PM. :|: PROGRAM NAME :: City Of Sunshine BD TIME:: 12:00 P.M. 3:00 P.M. :|: PROGRAM NAME :: Dhun @ Noon BD TIME:: 3:00 P.M. 6:00 P.M. :|: PROGRAM NAME :: Alshe Dupur BD TIME:: 6:00 P.M. 9:00 P.M. :|: PROGRAM NAME :: Icche Ghuri BD TIME:: 9:00 P.M. 12:00 P.M. :|: PROGRAM NAME :: 2Fun Exclusive BD TIME:: 12:00 A.M. 3:00 A.M. :|: PROGRAM NAME :: 2Fun Rockers BD TIME:: 3:00 A.M. 6:00 A.M. :|: PROGRAM NAME :: Raat Jaga Pakhira BD TIME:: 6:00 A.M. 9:00 A.M. :|: PROGRAM NAME :: Khola Janala .:: Thursday ::. TIME:: 9:00 AM. 12:00 PM. :|: PROGRAM NAME :: City Of Sunshine BD TIME:: 12:00 P.M. 3:00 P.M. :|: PROGRAM NAME :: Dhun @ Noon BD TIME:: 3:00 P.M. 6:00 P.M. :|: PROGRAM NAME :: Alshe Dupur BD TIME:: 6:00 P.M. 9:00 P.M. :|: PROGRAM NAME :: Icche Ghuri BD TIME:: 9:00 P.M. 12:00 P.M. :|: PROGRAM NAME :: 2Fun Exclusive BD TIME:: 12:00 A.M. 3:00 A.M. :|: PROGRAM NAME :: 2Fun Rockers BD TIME:: 3:00 A.M. 6:00 A.M. :|: PROGRAM NAME :: Raat Jaga Pakhira BD TIME:: 6:00 A.M. 9:00 A.M. :|: PROGRAM NAME :: Khola Janala .:: Friday ::. TIME:: 9:00 AM. 12:00 PM. :|: PROGRAM NAME :: City Of Sunshine BD TIME:: 12:00 P.M. 3:00 P.M. :|: PROGRAM NAME :: Dhun @ Noon BD TIME:: 3:00 P.M. 6:00 P.M. :|: PROGRAM NAME :: Alshe Dupur BD TIME:: 6:00 P.M. 9:00 P.M. :|: PROGRAM NAME :: Icche Ghuri BD TIME:: 9:00 P.M. 12:00 P.M. :|: PROGRAM NAME :: 2Fun Exclusive BD TIME:: 12:00 A.M. 3:00 A.M. :|: PROGRAM NAME :: 2Fun Rockers BD TIME:: 3:00 A.M. 6:00 A.M. :|: PROGRAM NAME :: Raat Jaga Pakhira BD TIME:: 6:00 A.M. 9:00 A.M. :|: PROGRAM NAME :: Khola Janala Others Regular Exclusives Events NEWS........... LATEST SONGS EVENT........... DRAMA........... TALK SHOWS 


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Slack swine flu screening at ZIA

Shahabul, a migrant worker returning from M alaysia, was coughing yesterday as his relatives helped him away from Zia International Airport (ZIA) after his arrival.

The 25-year-old man said he was forced to give up his job and return home after suffering from continuous fever and coughs for over three months, but on arrival at ZIA he did not report his health condition at the Airport Health Support Desk.

Shahabul wasn't even aware of the health desk set up to screen inbound passengers to prevent the entry of influenza A(H1N1), commonly known as swine flu, into the country.

Like Shahabul, many other passengers travelling back from Abu Dhabi, Saudi Arabia and Malaysia also are not aware of the necessity to report.

The government has listed 19 countries -- including Mexico, USA, Canada, United Kingdom, and India -- passengers from which have to report for screening at the airport. The list keeps getting longer every day as new suspected cases are found in different countries.

However, there is no provision for screening of patients coming in from other countries who might be carrying the virus.

"We are handing yellow forms to inbound passengers from only these 19 countries to report to the desk. Countries like Malaysia, Abu Dhabi and Saudi Arabia are however not on this list," an on-duty health officer explained.

The banner on display inside the airport, however, says that all travellers suffering from fever or with runny noses, sneezes or coughs are to report to the Health Support Desk before immigration.

Experts warn that unless strict vigilance is kept at the entry points of the country, carriers of the virus could easily slip into the country without detection.

Prof Nazrul Islam of the department of virology at BSMMU said, "There is no guarantee that swine flu cases will never be detected in countries which don't have any reported cases today. They might discover a case tomorrow for example. Therefore it is vital that there is strict monitoring of all entering the country, especially those with flu-like symptoms."

On enquiry, the Assistant Airport Health Officer Nasrin Sultana said that the health support desk has been open since April 29 and is providing passengers with necessary information.

Immigration officers on duty at the airport, trained accordingly, are also helping out, she said, so that no passenger can leave the airport with any flu-like symptom without reporting it.

Immigration officers said they have not received any training yet. A special training session, however, has been scheduled for Saturday.

The Director of Institute of Epidemiology, Disease Control and Research (IEDCR) Prof Mahmudur Rahman told the Daily Star yesterday that a strong role of all on duty at the airport is required to monitor the situation.

He said adequate training of immigration officers, in addition to health officials, is vital for management of the situation and also self-protection.

At a seminar at the Institute of Public Health (IPH) yesterday morning, Prof Mahmudur said epidemiological trends show that every 10 to 40 years a pandemic takes place.

He too emphasised vigilance at the entry points of the country.

"We need not panic about swine flu but take adequate precautions and preventive measures. Trained teams already keep vigil at airports, land ports and seaports -- at nine different entry points -- of the country to prevent the entry of the virus," he said.

Meanwhile, the government said that it has enough stock of Oseltamivir to treat swine flu patients, if required, and the World Health Organisation (WHO) is going to provide an additonal two lakh units of Oseltamivir to tackle emergencies if such a situation arises.

WHO has already provided 5,000 masks for use in airports, land ports and seaports.

From : The Daily Star, Bangladesh

Swine Influenza, Swine Flu, SIV

Flu
H1N1 influenza virus photographed at the CDC Influenza Laboratory.

Swine influenza (also called swine flu, hog flu, and pig flu) refers to influenza caused by those strains of influenza virus, called swine influenza virus (SIV), that usually infect pigs. Swine influenza is common in pigs in the midwestern United States (and occasionally in other states), Mexico, Canada, South America, Europe (including the United Kingdom, Sweden, and Italy), Kenya, Mainland China, Taiwan, Japan and other parts of eastern Asia.

Transmission of swine influenza virus from pigs to humans is not common and properly cooked pork poses no risk of infection. When transmitted, the virus does not always cause human influenza and often the only sign of infection is the presence of antibodies in the blood, detectable only by laboratory tests. When transmission results in influenza in a human, it is called zoonotic swine flu. People who work with pigs, especially people with intense exposures, are at risk of catching swine flu. However, only about fifty such transmissions have been recorded since the mid-20th Century, when identification of influenza subtypes became possible. Rarely, these strains of swine flu can pass from human to human. In humans, the symptoms of swine flu are similar to those of influenza and of influenza-like illness in general, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.

The 2009 flu outbreak in humans, known as "swine flu", is due to a new strain of influenza A virus subtype H1N1 that contained genes most closely related to swine influenza. The origin of this new strain is unknown, however, the World Organization for Animal Health (OIE) reports that this strain has not been isolated in pigs. This strain can be transmitted from human to human, and causes the normal symptoms of influenza.

Classification

Of the three genera of influenza viruses that cause human flu, two also cause influenza in pigs, with Influenzavirus A being common in pigs and Influenzavirus C being rare. Influenzavirus B has not been reported in pigs. Within Influenzavirus A and Influenzavirus C, the strains found in pigs and humans are largely distinct, although due to reassortment there have been transfers of genes among strains crossing swine, avian, and human species boundaries.

Influenza C

Influenza C viruses infect both humans and pigs, but do not infect birds. Transmission between pigs and humans have occurred in the past. For example, influenza C caused a small outbreaks of a mild form of influenza amongst children in Japan, and California. Due to its limited host range and the lack of genetic diversity in influenza C, this form of influenza does not cause pandemics in humans.

Influenza A

Swine influenza is known to be caused by influenza A subtypes H1N1, H1N2, H3N1, H3N2, and H2N3. In pigs, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are the most common strains worldwide. In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.

Surveillance

Although there is no formal national surveillance system in the United States to determine what viruses are circulating in pigs, there is an informal surveillance network in the United States that is part of a world surveillance network.

History

Swine influenza was first proposed to be a disease related to human influenza during the 1918 flu pandemic, when pigs became sick at the same time as humans. The first identification of an influenza virus as a cause of disease in pigs occurred about ten years later, in 1930. For the following 60 years, swine influenza strains were almost exclusively H1N1. Then, between 1997 and 2002, new strains of three different subtypes and five different genotypes emerged as causes of influenza among pigs in North America. In 1997-1998, H3N2 strains emerged. These strains, which include genes derived by reassortment from human, swine and avian viruses, have become a major cause of swine influenza in North America. Reassortment between H1N1 and H3N2 produced H1N2. In 1999 in Canada, a strain of H4N6 crossed the species barrier from birds to pigs, but was contained on a single farm.

The H1N1 form of swine flu is one of the descendants of the strain that caused the 1918 flu pandemic. As well as persisting in pigs, the descendants of the 1918 virus have also circulated in humans through the 20th century, contributing to the normal seasonal epidemics of influenza. However, direct transmission from pigs to humans is rare, with only 12 cases in the U.S. since 2005. Nevertheless, the retention of influenza strains in pigs after these strains have disappeared from the human population might make pigs a reservoir where influenza viruses could persist, later emerging to reinfect humans once human immunity to these strains has waned.

Swine flu has been reported numerous times as a zoonosis in humans, usually with limited distribution, rarely with a widespread distribution. Outbreaks in swine are common and cause significant economic losses in industry, primarily by causing stunting and extended time to market. For example, this disease costs the British meat industry about £65 million pounds every year.

1918 pandemic in humans

The 1918 flu pandemic in humans was associated with H1N1 and influenza appearing in pigs, thus may reflect a zoonosis either from swine to humans, or from humans to swine. Although it is not certain in which direction the virus was transferred, some evidence suggests that, in this case, pigs caught the disease from humans. For instance, swine influenza was only noted as a new disease of pigs in 1918, after the first large outbreaks of influenza amongst people. Although a recent phylogenetic analysis of more recent strains of influenza in humans, birds, and swine suggests that the 1918 outbreak in humans followed a reassortment event within a mammal, the exact origin of the 1918 strain remains elusive.

1976 U.S. outbreak

On February 5, 1976, in the United States an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that the cause of death was a new strain of swine flu. The strain, a variant of H1N1, is known as A/New Jersey/1976 (H1N1). It was detected only from January 19 to February 9 and did not spread beyond Fort Dix.

President Ford receives swine flu vaccination

This new strain appeared to be closely related to the strain involved in the 1918 flu pandemic. Moreover, the ensuing increased surveillance uncovered another strain in circulation in the U.S.: A/Victoria/75 (H3N2) spread simultaneously, also caused illness, and persisted until March. Alarmed public-health officials decided action must be taken to head off another major pandemic, and urged President Gerald Ford that every person in the U.S. be vaccinated for the disease.

The vaccination program was plagued by delays and public relations problems. On October 1, 1976, the immunization program began and by October 11, approximately 40 million people, or about 24% of the population, had received swine flu immunizations. That same day, three senior citizens died soon after receiving their swine flu shots and there was a media outcry linking the deaths to the immunizations, despite the lack of positive proof. According to science writer Patrick Di Justo, however, by the time the truth was known — that the deaths were not proven to be related to the vaccine — it was too late. "The government had long feared mass panic about swine flu — now they feared mass panic about the swine flu vaccinations." This became a strong setback to the program.

There were reports of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, affecting some people who had received swine flu immunizations. This syndrome is a rare side-effect of modern influenza vaccines, with an incidence of about one case per million vaccinations. As a result, Di Justo writes that "the public refused to trust a government-operated health program that killed old people and crippled young people." In total, less than 33 percent of the population had been immunized by the end of 1976. The National Influenza Immunization Program was effectively halted on Dec. 16.

Overall, about 500 cases of Guillain-Barré syndrome (GBS), resulting in death from severe pulmonary complications for 25 people, which, according to Dr. P. Haber, were probably caused by an immunopathological reaction to the 1976 vaccine. Other influenza vaccines have not been linked to GBS, though caution is advised for certain individuals, particularly those with a history of GBS. Still, as observed by a participant in the immunization program, the vaccine killed more Americans than the disease did.

1988 zoonosis

In September 1988, a swine flu virus killed one woman in Wisconsin, and infected at least hundreds of others. 32-year old Barbara Ann Wieners was eight months pregnant when she and her husband, Ed, became ill after visiting the hog barn at the Walworth County Fair. Barbara died eight days later, though doctors were able to induce labor and deliver a healthy daughter before she passed away. Her husband recovered from his symptoms.

Influenza-like illnesses were reportedly widespread among the pigs at the farm they had visited, and 76% of the swine exhibitors there tested positive for antibody to SIV, but no serious illnesses were detected among this group. Additional studies suggested between one and three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection. However, there was no community outbreak.

1998 US outbreak in swine

In 1998, swine flu was found in pigs in four U.S. states. Within a year, it had spread through pig populations across the United States. Scientists found that this virus had originated in pigs as a recombinant form of flu strains from birds and humans. This outbreak confirmed that pigs can serve as a crucible where novel influenza viruses emerge as a result of the reassortment of genes from different strains.

2007 Philippine outbreak in swine

On August 20, 2007 Department of Agriculture officers investigated the outbreak (epizootic) of swine flu in Nueva Ecija and Central Luzon, Philippines. The mortality rate is less than 10% for swine flu, unless there are complications like hog cholera. On July 27, 2007, the Philippine National Meat Inspection Service (NMIS) raised a hog cholera "red alert" warning over Metro Manila and 5 regions of Luzon after the disease spread to backyard pig farms in Bulacan and Pampanga, even if these tested negative for the swine flu virus.

2009 outbreak in humans

The 2009 flu outbreak is due to a new strain of subtype H1N1 not previously reported in pigs.[41] Following the outbreak, on May 2, 2009, it was reported in pigs at a farm in Alberta, Canada, with a link to the outbreak in Mexico. The pigs are suspected to have caught this new strain of virus from a farm worker who recently returned from Mexico, then showed symptoms of an influenza-like illness. These are probable cases, pending confirmation by laboratory testing.

The new strain was initially described as apparent reassortment of at least four strains of influenza A virus subtype H1N1, including one strain endemic in humans, one endemic in birds, and two endemic in swine. Subsequent analysis suggested it was a reassortment of just two strains, both found in swine. Although initial reports identified the new strain as swine influenza (ie, a zoonosis originating in swine), its origin is unknown. Several countries took precautionary measures to reduce the chances for a global pandemic of the disease.

Transmission

Electron microscope image of the reassorted H1N1 virus. The viruses are 80–120 nanometres in diameter

Transmission between pigs

Influenza is quite common in pigs, with about half of breeding pigs having been exposed to the virus in the US. Antibodies to the virus are also common in pigs in other countries.

The main route of transmission is through direct contact between infected and uninfected animals. These close contacts are particularly common during animal transport. Intensive farming may also increase the risk of transmission, as the pigs are raised in very close proximity to each other. The direct transfer of the virus probably occurs either by pigs touching noses, or through dried mucus. Airborne transmission through the aerosols produced by pigs coughing or sneezing are also an important means of infection. The virus usually spreads quickly through a herd, infecting all the pigs within just a few days. Transmission may also occur through wild animals, such as wild boar, which can spread the disease between farms.

Transmission to humans

People who work with poultry and swine, especially people with intense exposures, are at increased risk of zoonotic infection with influenza virus endemic in these animals, and constitute a population of human hosts in which zoonosis and reassortment can co-occur. Vaccination of these workers against influenza and surveillance for new influenza strains among this population may therefore be a important public health measure. Transmission of influenza from swine to humans who work with swine was documented in a small surveillance study performed in 2004 at the University of Iowa. This study among others forms the basis of a recommendation that people whose jobs involve handling poultry and swine be the focus of increased public health surveillance. Other professions at particular risk of infection are veterinarians and meat processing workers, although the risk of infection for both of these groups is lower than that of farm workers.

Interaction with avian H5N1 in pigs

Pigs are unusual as they can be infected with influenza strains that usually infect three different species: pigs, birds and humans. This makes pigs a host where influenza viruses might exchange genes, producing new and dangerous strains. Avian influenza virus H3N2 is endemic in pigs in China and has been detected in pigs in Vietnam, increasing fears of the emergence of new variant strains. H3N2 evolved from H2N2 by antigenic shift. In August 2004, researchers in China found H5N1 in pigs.

Main symptoms of swine flu in swines. These H5N1 infections may be quite common, in a survey of 10 apparently healthy pigs housed near poultry farms in West Java, where avian flu had broken out, five of the pig samples contained the H5N1 virus. The Indonesian government has since found similar results in the same region. Additional tests of 150 pigs outside the area were negative.[58][59]

Signs and symptoms

In swine

In pigs influenza infection produces fever, lethargy, sneezing, coughing, difficulty breathing and decreased appetite. In some cases the infection can cause abortion. Although mortality is usually low (around 1-4%), the virus can produce weight loss and poor growth, causing economic loss to farmers. Infected pigs can lose up to 12 pounds of body weight over a 3 to 4 week period.

In humans

Main symptoms of swine flu in humans

Direct transmission of a swine flu virus from pigs to humans is occasionally possible (called zoonotic swine flu). In all, 50 cases are known to have occurred since the first report in medical literature in 1958, which have resulted in a total of six deaths. Of these six people, one was pregnant, one had leukemia, one had Hodgkin disease and two were known to be previously healthy. Despite these apparently low numbers of infections, the true rate of infection may be higher, since most cases only cause a very mild disease, and will probably never be reported or diagnosed.

Video xo.ogv
In this video, Dr. Joe Bresee, with CDC's Influenza Division, describes the symptoms of swine flu and warning signs to look for that indicate the need for urgent medical attention. See also: See this video with subtitles in YouTube

According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. The 2009 outbreak has shown an increased percentage of patients reporting diarrhea and vomiting. The 2009 H1N1 virus is not zoonotic swine flu, as it is not transmitted from pigs to humans, but from person to person.

Because these symptoms are not specific to swine flu, a differential diagnosis of probable swine flu requires not only symptoms but also a high likelihood of swine flu due to the person's recent history. For example, during the 2009 swine flu outbreak in the United States, CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset." A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).

Prevention

Prevention of swine influenza has three components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans.

Prevention in swine

Methods of preventing the spread of influenza among swine include facility management, herd management, and vaccination. Because much of the illness and death associated with swine flu involves secondary infection by other pathogens, control strategies that rely on vaccination may be insufficient.

Control of swine influenza by vaccination has become more difficult in recent decades, as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases. Present vaccination strategies for SIV control and prevention in swine farms typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses. The United States Department of Agriculture researchers say that while pig vaccination keeps pigs from getting sick, it does not block infection or shedding of the virus.

Facility management includes using disinfectants and ambient temperature to control virus in the environment. The virus is unlikely to survive outside living cells for more than two weeks, except in cold (but above freezing) conditions, and it is readily inactivated by disinfectants. Herd management includes not adding pigs carrying influenza to herds that have not been exposed to the virus. The virus survives in healthy carrier pigs for up to 3 months and can be recovered from them between outbreaks. Carrier pigs are usually responsible for the introduction of SIV into previously uninfected herds and countries, so new animals should be quarantined. After an outbreak, as immunity in exposed pigs wanes, new outbreaks of the same strain can occur.

Prevention in humans

Prevention of pig to human transmission
Swine can be infected by both avian and human influenza strains of influenza, and therefore are hosts where the antigenic shifts can occur that create new influenza strains.

The transmission from swine to human is believed to occur mainly in swine farms where farmers are in close contact with live pigs. Although strains of swine influenza are usually not able to infect humans this may occasionally happen, so farmers and veterinarians are encouraged to use a face mask when dealing with infected animals. The use of vaccines on swine to prevent their infection is a major method of limiting swine to human transmission. Risk factors that may contribute to swine-to-human transmission include smoking and not wearing gloves when working with sick animals.

Prevention of human to human transmission

Influenza spreads between humans through coughing or sneezing and people touching something with the virus on it and then touching their own nose or mouth. Swine flu cannot be spread by pork products, since the virus is not transmitted through food. The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. Diagnosis can be made by sending a specimen, collected during the first five days for analysis.

Recommendations to prevent spread of the virus among humans include using standard infection control against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public. Although the current trivalent influenza vaccine is unlikely to provide protection against the new 2009 H1N1 strain, vaccines against the new strain are being developed and could be ready as early as June 2009.

Experts agree that hand-washing can help prevent viral infections, including ordinary influenza and the swine flu virus. Influenza can spread in coughs or sneezes, but an increasing body of evidence shows small droplets containing the virus can linger on tabletops, telephones and other surfaces and be transferred via the fingers to the mouth, nose or eyes. Alcohol-based gel or foam hand sanitizers work well to destroy viruses and bacteria. Anyone with flu-like symptoms such as a sudden fever, cough or muscle aches should stay away from work or public transportation and should contact a doctor to be tested.

Social distancing is another tactic. It means staying away from other people who might be infected and can include avoiding large gatherings, spreading out a little at work, or perhaps staying home and lying low if an infection is spreading in a community. Public health and other responsible authorities have action plans which may request or require social distancing actions depending on the severity of the outbreak.

Treatment

In swine

As swine influenza is rarely fatal to pigs, little treatment beyond rest and supportive care is required. Instead veterinary efforts are focused on preventing the spread of the virus throughout the farm, or to other farms. Vaccination and animal management techniques are most important in these efforts. Antibiotics are also used to treat this disease, which although they have no effect against the influenza virus, do help prevent bacterial pneumonia and other secondary infections in influenza-weakened herds.

In humans

If a person becomes sick with swine flu, antiviral drugs can make the illness milder and make the patient feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms). Beside antivirals, palliative care, at home or in hospital, focuses on controlling fevers and maintaining fluid balance. The U.S. Centers for Disease Control and Prevention recommends the use of Tamiflu (oseltamivir) or Relenza (zanamivir) for the treatment and/or prevention of infection with swine influenza viruses, however, the majority of people infected with the virus make a full recovery without requiring medical attention or antiviral drugs. The virus isolates in the 2009 outbreak have been found resistant to amantadine and rimantadine.

In the U.S., on April 27, 2009, the FDA issued Emergency Use Authorizations to make available Relenza and Tamiflu antiviral drugs to treat the swine influenza virus in cases for which they are currently unapproved. The agency issued these EUAs to allow treatment of patients younger than the current approval allows and to allow the widespread distribution of the drugs, including by non-licensed volunteers.

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Swine influenza

Flu
H1N1 influenza virus photographed at the CDC Influenza Laboratory.

Swine influenza (also called swine flu, hog flu, and pig flu) refers to influenza caused by those strains of influenza virus, called swine influenza virus (SIV), that usually infect pigs. Swine influenza is common in pigs in the midwestern United States (and occasionally in other states), Mexico, Canada, South America, Europe (including the United Kingdom, Sweden, and Italy), Kenya, Mainland China, Taiwan, Japan and other parts of eastern Asia.

Transmission of swine influenza virus from pigs to humans is not common and properly cooked pork poses no risk of infection. When transmitted, the virus does not always cause human influenza and often the only sign of infection is the presence of antibodies in the blood, detectable only by laboratory tests. When transmission results in influenza in a human, it is called zoonotic swine flu. People who work with pigs, especially people with intense exposures, are at risk of catching swine flu. However, only about fifty such transmissions have been recorded since the mid-20th Century, when identification of influenza subtypes became possible. Rarely, these strains of swine flu can pass from human to human. In humans, the symptoms of swine flu are similar to those of influenza and of influenza-like illness in general, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.

The 2009 flu outbreak in humans, known as "swine flu", is due to a new strain of influenza A virus subtype H1N1 that contained genes most closely related to swine influenza. The origin of this new strain is unknown, however, the World Organization for Animal Health (OIE) reports that this strain has not been isolated in pigs. This strain can be transmitted from human to human, and causes the normal symptoms of influenza.

Classification

Of the three genera of influenza viruses that cause human flu, two also cause influenza in pigs, with Influenzavirus A being common in pigs and Influenzavirus C being rare. Influenzavirus B has not been reported in pigs. Within Influenzavirus A and Influenzavirus C, the strains found in pigs and humans are largely distinct, although due to reassortment there have been transfers of genes among strains crossing swine, avian, and human species boundaries.

Influenza C

Influenza C viruses infect both humans and pigs, but do not infect birds. Transmission between pigs and humans have occurred in the past. For example, influenza C caused a small outbreaks of a mild form of influenza amongst children in Japan, and California. Due to its limited host range and the lack of genetic diversity in influenza C, this form of influenza does not cause pandemics in humans.

Influenza A

Swine influenza is known to be caused by influenza A subtypes H1N1, H1N2, H3N1, H3N2, and H2N3. In pigs, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are the most common strains worldwide. In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.

Surveillance

Although there is no formal national surveillance system in the United States to determine what viruses are circulating in pigs, there is an informal surveillance network in the United States that is part of a world surveillance network.

History

Swine influenza was first proposed to be a disease related to human influenza during the 1918 flu pandemic, when pigs became sick at the same time as humans. The first identification of an influenza virus as a cause of disease in pigs occurred about ten years later, in 1930. For the following 60 years, swine influenza strains were almost exclusively H1N1. Then, between 1997 and 2002, new strains of three different subtypes and five different genotypes emerged as causes of influenza among pigs in North America. In 1997-1998, H3N2 strains emerged. These strains, which include genes derived by reassortment from human, swine and avian viruses, have become a major cause of swine influenza in North America. Reassortment between H1N1 and H3N2 produced H1N2. In 1999 in Canada, a strain of H4N6 crossed the species barrier from birds to pigs, but was contained on a single farm.

The H1N1 form of swine flu is one of the descendants of the strain that caused the 1918 flu pandemic. As well as persisting in pigs, the descendants of the 1918 virus have also circulated in humans through the 20th century, contributing to the normal seasonal epidemics of influenza. However, direct transmission from pigs to humans is rare, with only 12 cases in the U.S. since 2005. Nevertheless, the retention of influenza strains in pigs after these strains have disappeared from the human population might make pigs a reservoir where influenza viruses could persist, later emerging to reinfect humans once human immunity to these strains has waned.

Swine flu has been reported numerous times as a zoonosis in humans, usually with limited distribution, rarely with a widespread distribution. Outbreaks in swine are common and cause significant economic losses in industry, primarily by causing stunting and extended time to market. For example, this disease costs the British meat industry about £65 million pounds every year.

1918 pandemic in humans

The 1918 flu pandemic in humans was associated with H1N1 and influenza appearing in pigs, thus may reflect a zoonosis either from swine to humans, or from humans to swine. Although it is not certain in which direction the virus was transferred, some evidence suggests that, in this case, pigs caught the disease from humans. For instance, swine influenza was only noted as a new disease of pigs in 1918, after the first large outbreaks of influenza amongst people. Although a recent phylogenetic analysis of more recent strains of influenza in humans, birds, and swine suggests that the 1918 outbreak in humans followed a reassortment event within a mammal, the exact origin of the 1918 strain remains elusive.

1976 U.S. outbreak

On February 5, 1976, in the United States an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that the cause of death was a new strain of swine flu. The strain, a variant of H1N1, is known as A/New Jersey/1976 (H1N1). It was detected only from January 19 to February 9 and did not spread beyond Fort Dix.

President Ford receives swine flu vaccination

This new strain appeared to be closely related to the strain involved in the 1918 flu pandemic. Moreover, the ensuing increased surveillance uncovered another strain in circulation in the U.S.: A/Victoria/75 (H3N2) spread simultaneously, also caused illness, and persisted until March. Alarmed public-health officials decided action must be taken to head off another major pandemic, and urged President Gerald Ford that every person in the U.S. be vaccinated for the disease.

The vaccination program was plagued by delays and public relations problems. On October 1, 1976, the immunization program began and by October 11, approximately 40 million people, or about 24% of the population, had received swine flu immunizations. That same day, three senior citizens died soon after receiving their swine flu shots and there was a media outcry linking the deaths to the immunizations, despite the lack of positive proof. According to science writer Patrick Di Justo, however, by the time the truth was known — that the deaths were not proven to be related to the vaccine — it was too late. "The government had long feared mass panic about swine flu — now they feared mass panic about the swine flu vaccinations." This became a strong setback to the program.

There were reports of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, affecting some people who had received swine flu immunizations. This syndrome is a rare side-effect of modern influenza vaccines, with an incidence of about one case per million vaccinations. As a result, Di Justo writes that "the public refused to trust a government-operated health program that killed old people and crippled young people." In total, less than 33 percent of the population had been immunized by the end of 1976. The National Influenza Immunization Program was effectively halted on Dec. 16.

Overall, about 500 cases of Guillain-Barré syndrome (GBS), resulting in death from severe pulmonary complications for 25 people, which, according to Dr. P. Haber, were probably caused by an immunopathological reaction to the 1976 vaccine. Other influenza vaccines have not been linked to GBS, though caution is advised for certain individuals, particularly those with a history of GBS. Still, as observed by a participant in the immunization program, the vaccine killed more Americans than the disease did.

1988 zoonosis

In September 1988, a swine flu virus killed one woman in Wisconsin, and infected at least hundreds of others. 32-year old Barbara Ann Wieners was eight months pregnant when she and her husband, Ed, became ill after visiting the hog barn at the Walworth County Fair. Barbara died eight days later, though doctors were able to induce labor and deliver a healthy daughter before she passed away. Her husband recovered from his symptoms.

Influenza-like illnesses were reportedly widespread among the pigs at the farm they had visited, and 76% of the swine exhibitors there tested positive for antibody to SIV, but no serious illnesses were detected among this group. Additional studies suggested between one and three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection. However, there was no community outbreak.

1998 US outbreak in swine

In 1998, swine flu was found in pigs in four U.S. states. Within a year, it had spread through pig populations across the United States. Scientists found that this virus had originated in pigs as a recombinant form of flu strains from birds and humans. This outbreak confirmed that pigs can serve as a crucible where novel influenza viruses emerge as a result of the reassortment of genes from different strains.

2007 Philippine outbreak in swine

On August 20, 2007 Department of Agriculture officers investigated the outbreak (epizootic) of swine flu in Nueva Ecija and Central Luzon, Philippines. The mortality rate is less than 10% for swine flu, unless there are complications like hog cholera. On July 27, 2007, the Philippine National Meat Inspection Service (NMIS) raised a hog cholera "red alert" warning over Metro Manila and 5 regions of Luzon after the disease spread to backyard pig farms in Bulacan and Pampanga, even if these tested negative for the swine flu virus.

2009 outbreak in humans

The 2009 flu outbreak is due to a new strain of subtype H1N1 not previously reported in pigs.[41] Following the outbreak, on May 2, 2009, it was reported in pigs at a farm in Alberta, Canada, with a link to the outbreak in Mexico. The pigs are suspected to have caught this new strain of virus from a farm worker who recently returned from Mexico, then showed symptoms of an influenza-like illness. These are probable cases, pending confirmation by laboratory testing.

The new strain was initially described as apparent reassortment of at least four strains of influenza A virus subtype H1N1, including one strain endemic in humans, one endemic in birds, and two endemic in swine. Subsequent analysis suggested it was a reassortment of just two strains, both found in swine. Although initial reports identified the new strain as swine influenza (ie, a zoonosis originating in swine), its origin is unknown. Several countries took precautionary measures to reduce the chances for a global pandemic of the disease.

Transmission

Electron microscope image of the reassorted H1N1 virus. The viruses are 80–120 nanometres in diameter

Transmission between pigs

Influenza is quite common in pigs, with about half of breeding pigs having been exposed to the virus in the US. Antibodies to the virus are also common in pigs in other countries.

The main route of transmission is through direct contact between infected and uninfected animals. These close contacts are particularly common during animal transport. Intensive farming may also increase the risk of transmission, as the pigs are raised in very close proximity to each other. The direct transfer of the virus probably occurs either by pigs touching noses, or through dried mucus. Airborne transmission through the aerosols produced by pigs coughing or sneezing are also an important means of infection. The virus usually spreads quickly through a herd, infecting all the pigs within just a few days. Transmission may also occur through wild animals, such as wild boar, which can spread the disease between farms.

Transmission to humans

People who work with poultry and swine, especially people with intense exposures, are at increased risk of zoonotic infection with influenza virus endemic in these animals, and constitute a population of human hosts in which zoonosis and reassortment can co-occur. Vaccination of these workers against influenza and surveillance for new influenza strains among this population may therefore be a important public health measure. Transmission of influenza from swine to humans who work with swine was documented in a small surveillance study performed in 2004 at the University of Iowa. This study among others forms the basis of a recommendation that people whose jobs involve handling poultry and swine be the focus of increased public health surveillance. Other professions at particular risk of infection are veterinarians and meat processing workers, although the risk of infection for both of these groups is lower than that of farm workers.

Interaction with avian H5N1 in pigs

Pigs are unusual as they can be infected with influenza strains that usually infect three different species: pigs, birds and humans. This makes pigs a host where influenza viruses might exchange genes, producing new and dangerous strains. Avian influenza virus H3N2 is endemic in pigs in China and has been detected in pigs in Vietnam, increasing fears of the emergence of new variant strains. H3N2 evolved from H2N2 by antigenic shift. In August 2004, researchers in China found H5N1 in pigs.

Main symptoms of swine flu in swines. These H5N1 infections may be quite common, in a survey of 10 apparently healthy pigs housed near poultry farms in West Java, where avian flu had broken out, five of the pig samples contained the H5N1 virus. The Indonesian government has since found similar results in the same region. Additional tests of 150 pigs outside the area were negative.[58][59]

Signs and symptoms

In swine

In pigs influenza infection produces fever, lethargy, sneezing, coughing, difficulty breathing and decreased appetite. In some cases the infection can cause abortion. Although mortality is usually low (around 1-4%), the virus can produce weight loss and poor growth, causing economic loss to farmers. Infected pigs can lose up to 12 pounds of body weight over a 3 to 4 week period.

In humans

Main symptoms of swine flu in humans

Direct transmission of a swine flu virus from pigs to humans is occasionally possible (called zoonotic swine flu). In all, 50 cases are known to have occurred since the first report in medical literature in 1958, which have resulted in a total of six deaths. Of these six people, one was pregnant, one had leukemia, one had Hodgkin disease and two were known to be previously healthy. Despite these apparently low numbers of infections, the true rate of infection may be higher, since most cases only cause a very mild disease, and will probably never be reported or diagnosed.

Video xo.ogv
In this video, Dr. Joe Bresee, with CDC's Influenza Division, describes the symptoms of swine flu and warning signs to look for that indicate the need for urgent medical attention. See also: See this video with subtitles in YouTube

According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. The 2009 outbreak has shown an increased percentage of patients reporting diarrhea and vomiting. The 2009 H1N1 virus is not zoonotic swine flu, as it is not transmitted from pigs to humans, but from person to person.

Because these symptoms are not specific to swine flu, a differential diagnosis of probable swine flu requires not only symptoms but also a high likelihood of swine flu due to the person's recent history. For example, during the 2009 swine flu outbreak in the United States, CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset." A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).

Prevention

Prevention of swine influenza has three components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans.

Prevention in swine

Methods of preventing the spread of influenza among swine include facility management, herd management, and vaccination. Because much of the illness and death associated with swine flu involves secondary infection by other pathogens, control strategies that rely on vaccination may be insufficient.

Control of swine influenza by vaccination has become more difficult in recent decades, as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases. Present vaccination strategies for SIV control and prevention in swine farms typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses. The United States Department of Agriculture researchers say that while pig vaccination keeps pigs from getting sick, it does not block infection or shedding of the virus.

Facility management includes using disinfectants and ambient temperature to control virus in the environment. The virus is unlikely to survive outside living cells for more than two weeks, except in cold (but above freezing) conditions, and it is readily inactivated by disinfectants. Herd management includes not adding pigs carrying influenza to herds that have not been exposed to the virus. The virus survives in healthy carrier pigs for up to 3 months and can be recovered from them between outbreaks. Carrier pigs are usually responsible for the introduction of SIV into previously uninfected herds and countries, so new animals should be quarantined. After an outbreak, as immunity in exposed pigs wanes, new outbreaks of the same strain can occur.

Prevention in humans

Prevention of pig to human transmission
Swine can be infected by both avian and human influenza strains of influenza, and therefore are hosts where the antigenic shifts can occur that create new influenza strains.

The transmission from swine to human is believed to occur mainly in swine farms where farmers are in close contact with live pigs. Although strains of swine influenza are usually not able to infect humans this may occasionally happen, so farmers and veterinarians are encouraged to use a face mask when dealing with infected animals. The use of vaccines on swine to prevent their infection is a major method of limiting swine to human transmission. Risk factors that may contribute to swine-to-human transmission include smoking and not wearing gloves when working with sick animals.

Prevention of human to human transmission

Influenza spreads between humans through coughing or sneezing and people touching something with the virus on it and then touching their own nose or mouth. Swine flu cannot be spread by pork products, since the virus is not transmitted through food. The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. Diagnosis can be made by sending a specimen, collected during the first five days for analysis.

Recommendations to prevent spread of the virus among humans include using standard infection control against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public. Although the current trivalent influenza vaccine is unlikely to provide protection against the new 2009 H1N1 strain, vaccines against the new strain are being developed and could be ready as early as June 2009.

Experts agree that hand-washing can help prevent viral infections, including ordinary influenza and the swine flu virus. Influenza can spread in coughs or sneezes, but an increasing body of evidence shows small droplets containing the virus can linger on tabletops, telephones and other surfaces and be transferred via the fingers to the mouth, nose or eyes. Alcohol-based gel or foam hand sanitizers work well to destroy viruses and bacteria. Anyone with flu-like symptoms such as a sudden fever, cough or muscle aches should stay away from work or public transportation and should contact a doctor to be tested.

Social distancing is another tactic. It means staying away from other people who might be infected and can include avoiding large gatherings, spreading out a little at work, or perhaps staying home and lying low if an infection is spreading in a community. Public health and other responsible authorities have action plans which may request or require social distancing actions depending on the severity of the outbreak.

Treatment

In swine

As swine influenza is rarely fatal to pigs, little treatment beyond rest and supportive care is required. Instead veterinary efforts are focused on preventing the spread of the virus throughout the farm, or to other farms. Vaccination and animal management techniques are most important in these efforts. Antibiotics are also used to treat this disease, which although they have no effect against the influenza virus, do help prevent bacterial pneumonia and other secondary infections in influenza-weakened herds.

In humans

If a person becomes sick with swine flu, antiviral drugs can make the illness milder and make the patient feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms). Beside antivirals, palliative care, at home or in hospital, focuses on controlling fevers and maintaining fluid balance. The U.S. Centers for Disease Control and Prevention recommends the use of Tamiflu (oseltamivir) or Relenza (zanamivir) for the treatment and/or prevention of infection with swine influenza viruses, however, the majority of people infected with the virus make a full recovery without requiring medical attention or antiviral drugs. The virus isolates in the 2009 outbreak have been found resistant to amantadine and rimantadine.

In the U.S., on April 27, 2009, the FDA issued Emergency Use Authorizations to make available Relenza and Tamiflu antiviral drugs to treat the swine influenza virus in cases for which they are currently unapproved. The agency issued these EUAs to allow treatment of patients younger than the current approval allows and to allow the widespread distribution of the drugs, including by non-licensed volunteers.

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