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Even though the village doctor has been talking about the flu on many occasions. This issue again presents the issue of influenza in this column. For readers to understand this disease in detail in every aspect. Especially during this period, the spread of morbidity and mortality in Thai people from the 2009 swine flu has caused people to panic. flocked to check at hospitals and nursing homes firmly Most of them are just common colds and minor fevers from other causes.


* Thai name :
influenza

* English name : Influenza, Flu

* cause
caused by influenza infection which is a virus named influenza virus orthomyxovirus

There are three types of influenza viruses: influenza A (A), B (B) and C (C) viruses, the latter two being severe and epidemic. less than type A

influenza A virus often causing severe symptoms may be widespread and can mutate into new species continuously This virus can be found in both humans and animals (Types B and C, found only in humans), divided into subspecies. Named after the type of protein found on the surface of the virus, there are two types of proteins: hemagglutinin. (hemagglutinin, abbreviated H), which has 16 subspecies, and neuraminidase (neuraminidase, abbreviated N), which has nine subspecies in the designation of the influenza A virus. Therefore, the letter H with N is used with a number at the end of each letter according to the type of protein, for example:

♦ The H1N1 influenza virus is the cause of the global pandemic in 1918-1919 There were 500-1 billion cases, between 20-40 million deaths due to its origin in Spain. So it’s called the Spanish flu (Spanish flu). Epidemic again in 1977 because it originated from Russia. Hence it is called the Russian flu.

♦ 2009 swine flu virus, a mutated H1N1 strain. It contains the genetic material of the influenza virus found in pigs, poultry and humans. The first outbreak was found in Mexico. At first it was called Mexican flu (Mexican flu) and Swine flu (Swine flu due to the presence of a large part of the viral genetic material in pigs), later called the new influenza. 2009 To avoid confusion, this type of influenza has now spread all over the world. It is expected to continue for the next 1-3 years.

♦ The H2N2 influenza virus caused the Asian Flu epidemic of 1957-1958, killing about 2 million people.

♦ The H3N2 influenza virus caused the 1968-1969 Hong Kong Flu pandemic, which killed about 1 million people.

♦ The H5N1 influenza virus is the cause of Avian flu, also known in Thailand as avian influenza. The epidemic began in 2003, a new strain that is highly virulent. But fortunately, it is transmitted from birds to humans. but still very little infecting from person to person therefore spreading less


how to spread
Influenza is found in the mucus, saliva, and sputum of patients and infected people. Can infect others from 1 day before getting sick, most contagious in the first 3 days of being sick. (Most often infect within 7 days) is transmitted by inhalation of sputum droplets that the patient coughs or sneezes within a distance of not more than 1 meter or by touching hands. appliances or contaminated environment (i.e., the virus may infect the patient’s hands. appliances or environment that the patient coughs or sneezes at When normal people touch their hands or things that are contaminated with germs. The germ will stick to that person’s hand. and when using your fingers to rub your eyes or pick up your nose the germs will enter the person’s body)

Influenza can also be spread through airborne transmission, that is, when a person coughs or sneezes. The bacteria trapped in the sputum droplets can spread over a long distance and stay in the air for a long time. When others inhale this misty air can be infected Therefore, this disease can spread faster than the common flu.

the incubation period of the disease Mostly 1-3 days, fewer than 7 days.

* symptom
Flu-like symptoms (common) are fever, sore throat, stuffy nose, clear runny nose, dry cough, but are more severe than the common cold. (So ​​called influenza) is high fever, headache, fatigue, muscle aches, and loss of appetite, often requiring bed rest.

Some people may have abdominal distension, nausea, vomiting, and diarrhea.
The fever lasts for 1-7 days (mostly 3-5 days).
Cough and fatigue may persist for 1-4 weeks, although other symptoms will be relieved
in severe cases May show symptoms of complications such as mucus or thick yellow or green sputum, ear pain, tinnitus, shortness of breath, etc.

* Disease isolation
Fever, fatigue, sore throat, cold can be caused by other causes such as

♦ Flu the patient will have a fever Slight sore throat, clear runny nose, cough, but no pain. can still eat and able to work or study sufficiently

bronchitis Patients will have a fever, cough with mucus, but are usually not short of breath or have difficulty breathing.

♦ Pneumonia The patient will have high fever, chills, cough with thick yellow or green sputum. Severe chest pain, rapid breathing, or trouble breathing

♦ Dengue fever Patients will have high fever all the time, red face, red eyes, loss of appetite, sleep poorly, may have abdominal pain, vomiting, often no runny nose, sore throat or cough, later may find red and green spots on the body. or shock (cold, sweating, restlessness) followed, often with outbreaks

♦ Chikungunya fever The patient will have high fever for 3 days, joint pain, red rash all over the body. Often there is no runny nose, sore throat or cough, often in outbreaks.

♦ Malaria Patients will have high fever, chills, once a day or every other day. There is a history in the forest area. or travel back from the forest area There is usually no runny nose, sore throat, or cough if left untreated. Often has a fever for weeks or a month

other infectious diseases Such as typhoid, scrub typhus, leptospirosis (leptospirosis), patients have high fever, headache, loss of appetite, no runny nose, often having a fever for more than 1 week.

* Diagnosis
Doctors often diagnose the symptoms as high fever, colds, loss of appetite, and severe muscle aches. There may be a history of close contact with someone who has the flu (e.g. at home, school, factory, work).
in cases that require a clear diagnosis Your doctor will perform a blood test for your antibodies to the influenza virus. or testing for influenza virus from the nose and pharynx

If suspected of having pneumonia or other serious causes They will perform additional special tests such as blood tests, urine tests, X-rays, etc.


* self care

When you have a fever, runny nose (cold), cough, you should take the following precautions:
1. Take a break Don’t wash your body, don’t take a cold shower, drink plenty of water, eat easily digestible food (such as sweetened water, milk, soy milk, fruit juice, porridge, porridge).

2. Take medication to relieve symptoms. such as
– Paracetamol relieves fever, headache every 4-6 hours, should avoid aspirin. (Especially in those under the age of 19) because it may increase the risk of a complication Known as Reye’s syndrome, there are symptoms of the brain and liver. can be dangerous
– If there is a lot of mucus, give a nasal decongestant such as chlorpheniramine.
– If coughing a lot, give cough medicine or take a sip of honey and lemon.

3. Reduce the spread of infection to others. by regularly washing hands (with soap and water), especially after wiping your nose or covering your mouth with your hands when coughing. When coughing, use your upper arm or tissue instead of your bare hands. If someone else is near or entering a crowded place, wear a mask. Do not cough and sneeze in the face of others. and should rest at home and not go out in the community

4. You should see a doctor immediately. If there are any of the following characteristics:
♦ Loss of consciousness, unconsciousness, or spasms

♦ Severe headache, severe vomiting, or severe abdominal pain.

♦ Shock (sweating, cold, restless)

♦ Shortness of breath, difficulty breathing, or cyanosis of the mouth.

5. You should see a doctor asap. (within 1-2 days) if any of the following

♦ Fever every day for more than 1 week

♦ Has severe chills. (must be covered in thick blankets) or suspected to have malaria or bird flu

♦ Yellow eyes, jaundice, pale, blotchy red spots on the body or bleeding.

♦ Vomiting, unable to eat

♦ Take care of yourself for 2-3 days and still have no relief.

♦ Anxiety or insecurity in taking care of yourself.

♦ People who are at risk of developing complications (see section ” Complications”).

* treatment
in the case of influenza (either from old or new strains) (Paracetamol for fever, cough medicine, nasal decongestants) is the main
For those at risk for complications (see section “Complications”), your doctor may consider antiviral medications such as amantadine or rimantadine. (rimantadine) for seasonal influenza (Old strains). If suspected to be avian influenza or new flu strains 2009, oseltamivir will be given. (oseltamivir)

The doctor will also treat complications such as giving antibiotics. In those who have mucus or thick yellow or green sputum People with otitis media, bronchitis and sinusitis.

in the case of pneumonia The doctor will accept the patient for treatment in the hospital and closely monitor the condition.


* Complications

The most common include sinusitis (pain in the sinus cavity. at the cheekbones or the head of the eyebrows thick, purulent mucus) tracheobronchitis (Cough with yellow or green mucus) Otitis media (ear pain, tinnitus)

serious complications which may cause death of the patient, including pneumonia (with rapid breathing, difficulty breathing, severe chest pain), recurrent heart disease (in patients with a history of heart disease) Encephalitis (rare consciousness, unconsciousness, spasms)
Those at risk for serious complications include:

♦ Children under 5 years old

♦ Elderly (over 65 years old)

♦ Pregnant women

♦ Heavy smokers

♦ People with chronic diseases such as diabetes, HIV infection, asthma, emphysema, heart disease, chronic renal failure. have low immunity, etc.

* Disease progression
most patients especially young people and those without underlying diseases Usually resolves on its own within 1-2 weeks, with fever lasting 1-7 days, while coughing and fatigue It may last 1-4 weeks.
In the case of symptoms of bronchitis after treatment Some people may cough for 7-8 weeks due to the destruction of the bronchial mucosa. This makes them more sensitive to irritants (such as dust, smoke) and will eventually subside on their own.

In cases where there are non-serious complications such as sinusitis, otitis media, bronchitis, when treated properly, it can often be cured.

For those who are at risk and serious complications (eg pneumonia, encephalitis, heart attack) if treated promptly. It may help to be safe, but if the patient’s physical condition is weak. received delayed treatment Or have a severe disease, it may die.

The average mortality rate of influenza is about 0.05-0.01% (that is, out of 10,000 patients with this disease, death is .5-10 percent).

* protection
1. During the flu epidemic Avoid entering crowded places (e.g. entertainment venues, theaters, shopping malls) if unavoidable. should wear a mask Regularly wash your hands with soap and water. or wipe your hands with alcohol gel And don’t rub your eyes with your fingers or pick up your nose.

2. If someone close to you is sick with influenza Should be at least 1 meter away from the patient if close supervision is necessary. should wear a mask and wash your hands regularly Avoid touching the patient’s hands and sharing items with the patient (e.g. towels, glasses, phones, toys, TV remotes).

3. Preventive vaccination that are currently in use can Prevents only seasonal influenza Three types of (old strains) are influenza A (H1N1 and H3N2) and type B, but they do not protect against avian influenza (A H5N1) and 2009 new influenza.

In general, if there is no outbreak Usually, such vaccinations are not recommended for the general public. except those who are at risk of serious complications Healthcare workers, people traveling to endemic areas, people with non-stop activities (e.g. police, actors, athletes, travelers), people under the age of 19 who need to take aspirin as regular and pregnant women who expect their pregnancy to enter the 4th month (second trimester) or more during the time when the disease may be outbreak In this group, doctors may consider vaccination against

each vaccination Can protect for 1 year. If necessary, should be sprayed once a year before the rainy season.

* Prevalence
Influenza is a common disease among people of all ages. It can be found throughout the year, but is more common during the rainy season. (June to October) and winter (January to March). Some years there may be a pandemic.

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