As Published on Borneo Bulletin

THE Ministry of Health, in consideration of outstanding concerns by the general public about the current Influenza A(H1N1) pandemic, has addressed such concerns with an extensive set of answers that were provided by designated clinicians involved in the management of the H1N1 outbreak. The clinicians are part of the RIPAS H1N1 Committee, Ministry of Health. The questions were made by the public.

Q: My mother is on dialysis. Is she at risk of contracting H1N1 ?
A: All patients with kidney failure are at increased risk for H1N1 infection. The more severe the kidney failure, the greater will be the risk. Obviously people on dialysis will have the greatest risk amongst all patients with kidney disease. The reason for the increased risk is that patients with kidney disease like most other patients with chronic illness have a weaker immune system. This makes them more likely to contract illnesses. Furthermore, with the chronic illness, they are less likely to handle the effects of the infections as well as a person without any chronic illness.

Q: How can we reduce the risks of getting H1N1 in patients with kidney disease?
A: The usual advice for all patients also applies for patients with kidney disease. It is very important for us to re-emphasise the importance of hand hygiene, avoidance of crowded areas, avoidance of people with symptoms, use of face mask and avoidance of foreign travel.

Q: As patients with kidney disease are more susceptible to H1N1, shouldn’t they be on prophylaxis / preventative medicine eg Tamiflu?
A: For prophylactic treatment to be effective, it needs to be taken for the duration of time that the patient is at risk. Therefore patients will need to take Tamiflu regularly for the duration of the H 1N1 outbreak. This is impractical because we do not know how long the pandemic is going to last and furthermore, this practice is likely to encourage the emergence of Tamiflu- resistant H1N1 virus in the future. Another reason for not using Tamiflu for a long term is that renal patients may have unpredictable clearance of Tamiflu from the body (ie because of the poor kidney function, removal of the drug is less efficient) and hence may suffer from undesirable side-effects of the medication.

Q: I am a dialysis patient. What do I do if I become unwell? Can I attend my regular dialysis session?
A: If you are very unwell, you must go and see a doctor (any clinic or the Accident and Emergency department) to
be assessed. You may need to be checked for H1N1. The doctor seeing you may need to contact the kidney doctor. If you attend the Accident and Emergency department, our kidney doctors will see you there and decide on the appropriate treatment and where to place you for dialysis.
If you are unwell but still able to go to your usual dialysis centre for dialysis, then you must inform the nurse in charge upon arrival (or at the flu desk) who will then decide on whether to dialyse you in the main dialysis area or in the designated isolation area.

Q: In view of the quarantining rules, can a dialysis H1N1 patient (who has to attend dialysis treatment at least three times a week) still be on home treatment?
A: If the dialysis H1N1 patient is well enough to go home, we will let him / her go home provided strict home criteria are met (eg separate toilet facilities, no high risk patients at home, small household members etc). We will arrange for transport if necessary to pick them up for their usual dialysis.
If the dialysis H1N1 patient cannot meet our home criteria or are unwell, then they will have to be quarantined in our hospital until they are stable enough to go home.

Q: How long can the virus survive outside of the body, i.e. on contaminated surfaces?
A: Viruses, unlike other organisms such as fungus or bacteria do survive outside of the host for too long. For the Influenza virus, studies have shown that the concentration of virus fall off rapidly outside of the body. However, the virus can still be recovered up to two days depending on the level of humidity, level of sunlight and type of surface the contamination occurred. On hard non porous surfaces such as metal and plastic (ie plastic banknotes, doorknobs and light switches), the virus can survive longer up to two days compared to surfaces like tissue paper (fifteen minutes). Again, therefore, it is important to remember to maintain personal and hygiene of the environment.

Q: Can a person catch H1N1 by eating food prepared by an infected person?
A: Spread of H1N1 just like the other flu virus occurs when there is contact with infected secretions produced through sneezing, coughing, spitting or transfer after toughing infected area. When the next person inhales contaminated droplets or touched contaminated surfaces, they may develop the infection. If a person is suspected or confirmed to be infected, all precautionary measures should be taken that include hygiene, regular hand-washing, in addition to the treatment and self-quarantine. If food for consumptions are properly prepared, cleansed and cook, the risk of transmissions are minimal. However, the general advice would be that an affected person should avoid preparing food for others during that period despite the minimal risk of transmissions.

Q: How is influenza A H1N1 different to the normal selesma we get every year or during travel to other countries?
A: The “common cold” or “selesma biasa” is caused by a number of different viruses that include the Influenza viruses. In most cases, the effects are mild with runny nose, cough and a slight temperature. Influenza flu is caused by a variety of different Influenza viruses that include Influenza A, B and the H1N1 and can be more severe than the common cold. The sufferer does feel ill enough that they need to stay in bed. In the majority of cases people are much better after a few days but may feel tired for a week or two. It is well recognised however that in a small minority of people it may be fatal especially if there is any underlying illness such as lung disease, kidney disease, heart disease or if the sufferer is pregnant, very young or very old when the body is less able to fight off disease. Based on current knowledge, H1N1 is behaving like the normal influenza or selesma. However, whether this may change remains to be seen.

Q: Is H1N1 virus airborne?
A: Spread of H IN I can be considered airborne. However, this is only limited to a short distance. When an affected person sneezes or coughs, they produce a mist of secretions. In a single sneeze, incredibly up to 40,000 droplets can be produced. Most of these droplets are quite large and will quickly settle down out of the air. Generally, these droplets are not propelled to beyond six feet. This also explains why six feet distance is considered a minimal safe distance and anyone within six feet of an affected person is considered as a close contact.

Q: Can I catch the infections by sharing the utensils used by a person infected with the virus?
A: Yes. This is because the virus can survive on utensils outside the body for many hours. Sharing of utensils such as spoon and cups during meal time, there is risk of transfer of saliva. Touching contaminated utensils can also spread the infection. It is also important that if you are in close contact with an affected person (close contact being defined as within six feet), then you are already at risk of catching the infection even without sharing any utensils. Again, it is important to maintain personal and environmental hygiene.

• Live displays at Brunei Art Forum Exhibition
• Lost
• Visiting hours at hospital need to be respected
• 'Capitalise on Tutong's tourism'
• Blue Flag bid begins with ubiquitous recycling bins