document_title: US Airways Flight 1549

question_text: what happened to the plane in the hudson

text: US Airways Flight 1549

text: Background[edit]

text: On January 15, 2009, US Airways Flight 1549[b] with call sign 'CACTUS 1549' was scheduled to fly from New York City's LaGuardia Airport (LGA) to Charlotte Douglas (CLT), with direct onward service to Seattle–Tacoma International Airport. The aircraft was an Airbus A320-214 powered by two GE Aviation/Snecma-designed CFM56-5B4/P turbofan engines.[9][c]

text: The pilot in command was 57-year-old Chesley B. "Sully" Sullenberger, a former fighter pilot who had been an airline pilot since leaving the United States Air Force in 1980. At the time, he had logged 19,663 total flight hours, including 4,765 in an A320; he was also a glider pilot and expert on aviation safety.[12][13][14] First officer Jeffrey B. Skiles, 49,[13][15][16] had accrued 15,643 career flight hours, but this was his first Airbus A320 assignment since qualifying to fly it.[17] There were 150 passengers and three flight attendants aboard.[1][18]

text: Accident[edit]

text: Takeoff and bird strike[edit]

text:
New York TRACON audio

Air traffic control audio from about time of bird strike until ditching (3:10 long)

Problems playing this file? See media help.

text: The flight was cleared for takeoff to the northeast from LaGuardia's Runway 4 at 3:24:56 pm Eastern Standard Time (20:24:56 UTC). With Skiles in control, the crew made its first report after becoming airborne at 3:25:51 as being at 700 feet (210 m) and climbing.[19]

text: The weather at 2:51 p.m. was 10 miles (16 km) visibility with broken clouds at 3,700 feet (1,100 m), wind 8 knots (15 km/h; 9.2 mph) from 290°; an hour later it was few clouds at 4,200 feet (1,300 m), wind 9 knots (17 km/h; 10 mph) from 310°.[20] At 3:26:37 Sullenberger remarked to Skiles: "What a view of the Hudson today."[21]

text: At 3:27:11 the plane struck a flock of Canada geese at an altitude of 2,818 feet (859 m) about 4.5 miles (7.2 km) north-northwest of LaGuardia. The pilots' view was filled with the large birds;[22][23] passengers and crew heard very loud bangs and saw flames from the engines, followed by silence and an odor of fuel.[24][25][26]

text: Realizing that both engines had shut down, Sullenberger took control while Skiles worked the checklist for engine restart.[d][2] The aircraft slowed but continued to climb for a further 19 seconds, reaching about 3,060 feet (930 m) at an airspeed of about 185 knots (343 km/h; 213 mph), then began a glide descent, accelerating to 210 knots (390 km/h; 240 mph) at 3:28:10 as it descended through 1,650 feet (500 m).

text: At 3:27:33, Sullenberger radioed a mayday call to New York Terminal Radar Approach Control (TRACON):[28][29] "... this is Cactus 1539 [sic – correct call sign was Cactus 1549], hit birds. We've lost thrust on both engines. We're turning back towards LaGuardia".[21] Air traffic controller Patrick Harten[30] told LaGuardia's tower to hold all departures, and directed Sullenberger back to Runway 13.[29] Sullenberger responded, "Unable".[29]

text: Sullenberger asked controllers for landing options in New Jersey, mentioning Teterboro Airport.[29][31][32] Permission was given for Teterboro's Runway 1,[32] but Sullenberger responded: "We can't do it ... We're gonna be in the Hudson".[31] The aircraft passed less than 900 feet (270 m) above the George Washington Bridge.[33] Sullenberger commanded over the cabin address system, "Brace for impact",[33] and the flight attendants relayed the command to passengers.[34] Meanwhile, air traffic controllers asked the Coast Guard to caution vessels in the Hudson and ask them to prepare to assist with rescue.[citation needed]

text: Ditching and evacuation[edit]

text: About ninety seconds later, at 3:31 pm, the plane made an unpowered ditching, descending southwards at about 125 knots (140 mph; 230 km/h) into the middle of the North River section of the Hudson tidal estuary, at 40°46′10″N 74°00′17″W / 40.7695°N 74.0046°W / 40.7695; -74.0046[35] on the New York side of the state line, roughly opposite West 50th Street (near the Intrepid Sea, Air & Space Museum) in Manhattan and Port Imperial in Weehawken, New Jersey. Flight attendants compared the ditching to a "hard landing" with "one impact, no bounce, then a gradual deceleration."[31] The ebb tide then began to take the plane southward.[36]

text: Sullenberger opened the cockpit door and ordered evacuation. The crew began evacuating the passengers through the four overwing window exits and into an inflatable slide/raft deployed from the front right passenger door (the front left slide failed to operate, so the manual inflation handle was pulled). A panicked passenger opened a rear door, which a flight attendant was unable to reseal.[37] Water was also entering a hole in the fuselage and through cargo doors that had come open,[38] so as the water rose the attendant urged passengers to move forward by climbing over seats.[e] One passenger was in a wheelchair.[40][41] Finally, Sullenberger walked the cabin twice to confirm it was empty.[42][43][44]

text: The air and water temperatures were about 19 °F (−7 °C) and 41 °F (5 °C) respectively.[20] Some evacuees waited for rescue knee-deep in water on the partially submerged slides, some wearing life-vests. Others stood on the wings or, fearing an explosion, swam away from the plane.[37] One passenger, after helping with the evacuation, found the wing so crowded that he jumped into the river and swam to a boat.[45][31][46]

text: Rescue[edit]

text: Sullenberger had ditched near boats which facilitated rescue.[19][42] NY Waterway ferries Thomas Jefferson and then Governor Thomas H. Kean both arrived within minutes[47][48] and began taking people aboard using a Jason's cradle. Sullenberger advised the ferry crews to rescue those on the wings first, as they were in more jeopardy than those on the slides, which detached to become life rafts.[33] As the plane drifted, passengers on one slide, fearing that the boat would crush them, shouted for it to steer away.[49] The last person was taken from the plane at 3:55 pm.[50]

text: About 140 New York City firefighters responded to nearby docks,[51][52][53] as did police, helicopters, and various vessels and divers.[51] Other agencies provided medical help on the Weehawken side of the river, where most passengers were taken.[54]

text: Aftermath[edit]

text: There were five serious injuries,[2] including a deep laceration in flight attendant Doreen Welsh's leg.[31][55] Seventy-eight people were treated, mostly for minor injuries[56] and hypothermia,[57] twenty-four passengers and two rescuers treated at hospitals,[58] with two passengers kept overnight. One passenger now wears glasses because of jet fuel damaging his eyes.[45] No pets were being carried on the flight.[59]

text: Each passenger later received a letter of apology, $5,000 in compensation for lost baggage (and $5,000 more if they could demonstrate larger losses) and refund of the ticket price.[60][61] In May 2009 they received any belongings that had been recovered. In addition, they reported offers of $10,000 each in return for agreeing not to sue US Airways.[62]

text: Many passengers and rescuers later experienced post-traumatic stress symptoms such as sleeplessness, flashbacks, and panic attacks; some began an email support group.[63] Patrick Harten, the controller who had worked the flight, said that "the hardest, most traumatic part of the entire event was when it was over", and that he was "gripped by raw moments of shock and grief".[64]

text: In an effort to prevent similar accidents, officials captured and gassed 1,235 Canada geese at 17 locations across New York City in mid-2009 and coated 1,739 goose eggs with oil to smother the developing goslings.[65]

text: Investigation[edit]

text: The partially submerged plane was moored to a pier near the World Financial Center in Lower Manhattan, roughly 4 miles (6 km) downstream from the ditching location.[34] The left engine, detached by the ditching, was recovered from the riverbed.[66] On January 17 the aircraft was barged[67][68] to New Jersey.[69]

text: The initial National Transportation Safety Board (NTSB) evaluation that the plane had lost thrust after a bird strike[70][71][72] was confirmed by analysis of the cockpit voice and flight data recorders.[73]

text: Two days earlier the plane had experienced a less severe compressor stall,[74][75] but the affected engine was restarted. A faulty temperature sensor was replaced, and inspection verified the engine had not been damaged in that incident.[76]

text: On January 21, the NTSB found evidence of soft-body damage in the right engine along with organic debris including a feather.[77][78] The left engine also evidenced soft body impact, with: "dents on both the spinner and inlet lip of the engine cowling. Five booster inlet guide vanes are fractured and eight outlet guide vanes are missing." Both engines, missing large portions of their housings,[79] were sent to the manufacturer for examination.[80] On January 31, the plane was moved to Kearny, New Jersey. The bird remains[76][81] were later identified by DNA testing to be Canada geese, which typically weigh more than engines are designed to withstand ingesting.[76]

text: Because the plane was assembled in France[82] the European Aviation Safety Agency (the European counterpart of the FAA) and the Bureau d'Enquêtes et d'Analyses pour la Sécurité de l'Aviation Civile (the French counterpart of the NTSB) joined the investigation, with technical assistance from Airbus Industrie and GE Aviation/Snecma, respectively the manufacturers of the airframe and the engines.[83][84]

text: The NTSB used flight simulators to test the possibility that the flight could have returned safely to LaGuardia or diverted to Teterboro; only seven of the thirteen simulated returns to La Guardia succeeded, and only one of the two to Teterboro.[85] Furthermore, the NTSB report called these simulations unrealistic: "The immediate turn made by the pilots during the simulations did not reflect or account for real-world considerations." A further simulation, conducted with the pilot delayed by 35 seconds, crashed.[86] In testimony before the NTSB, Sullenberger maintained that there had been no time to bring the plane to any airport, and that attempting to do so would likely have killed those onboard and more on the ground.[87]

text: The Board ultimately ruled that Sullenberger had made the correct decision,[87] reasoning that the checklist for dual-engine failure is designed for higher altitudes, when pilots have more time to deal with the situation, and that while simulations showed that the plane might have just barely made it back to LaGuardia, those scenarios assumed an instant decision to do so, with no time allowed for assessing the situation.[88][89]

text: The NTSB concluded its investigation on May 4, 2010, identifying the probable cause as "the ingestion of large birds into each engine, which resulted in an almost total loss of thrust in both engines."[86] The final report credited the outcome to four factors: good decision-making and teamwork by the cockpit crew (including decisions to immediately turn on the APU and to ditch in the Hudson); the fact that the A320 is certified for extended overwater operation (and hence carried life vests and additional raft/slides) even though not required for that route; the performance of the flight crew during the evacuation; and the proximity of working vessels to the ditching site. Contributing factors were good visibility and a fast response from the ferry operators and emergency responders. The report also makes a range of recommendations to improve safety in such situations.[2]

text: Author and pilot William Langewiesche asserted that insufficient credit was given to the A320's fly-by-wire design, by which the pilot uses a side-stick to make control inputs to the flight control computers. The computers then impose adjustments and limits of their own to keep the plane stable, which the pilot cannot override even in an emergency. This design allowed the pilots of Flight 1549 to concentrate on engine restart and deciding the course, without the burden of manually adjusting the glidepath to reduce the plane's rate of descent.[50] Sullenberger said that these computer-imposed limits also prevented him from achieving the optimum landing flare for the ditching, which would have softened the impact.[90]

text: In 2010, the damaged plane (excluding its engines)[91] was acquired for the Carolinas Aviation Museum in Charlotte, North Carolina,[92] which held a reception on June 11 to commemorate the arrival in Charlotte of the plane's body, with Sullenberger as keynote speaker and the passengers invited.[93][94][95][96]

text: Crew awards and honors[edit]

text:
The reactions of all members of the crew, the split second decision making and the handling of this emergency and evacuation was "text book" and an example to us all. To have safely executed this emergency ditching and evacuation, with the loss of no lives, is a heroic and unique aviation achievement.

—Guild of Air Pilots and Air Navigators citation

tag: div

text: An NTSB board member called the ditching "the most successful ... in aviation history. These people knew what they were supposed to do and they did it and as a result, no lives were lost."[97]

text: The crew, especially Sullenberger, was praised, notably by New York City Mayor Michael Bloomberg and New York State Governor David Paterson, who said: "We had a Miracle on 34th Street. I believe now we have had a Miracle on the Hudson."[56][98][99] U.S. President George W. Bush said he was "inspired by the skill and heroism of the flight crew," and praised the emergency responders and volunteers.[100] President-elect Barack Obama said that everyone was proud of Sullenberger's "heroic and graceful job in landing the damaged aircraft." He thanked the crew, whom he invited to his inauguration five days later.[101][102]

text: The Guild of Air Pilots and Air Navigators awarded the crew a Master's Medal on January 22, 2009; this is awarded only rarely, for outstanding aviation achievements at the discretion of the Master of the Guild.[8] New York City Mayor Michael Bloomberg presented the crew with the Keys to the City, and Sullenberger with a replacement copy of a library book lost on the flight, Sidney Dekker's Just Culture: Balancing Safety and Accountability.[103] Rescuers received Certificates of Honor.[104]

text: The crew received a standing ovation at the Super Bowl XLIII on February 1, 2009,[105] and Sullenberger threw out the first pitch at the 2009 Major League Baseball season for the San Francisco Giants. His Giants' jersey was inscribed with the name "Sully" and the number 155 – the count of people aboard the plane.[106]

text: On July 28, passengers Dave Sanderson and Barry Leonard organized a thank you luncheon for emergency responders from Hudson County, New Jersey, on the shores of Palisades Medical Center in North Bergen, New Jersey, where 57 passengers had been brought following their rescue. Present were members of the U.S. Coast Guard, North Hudson Regional Fire and Rescue, NY Waterway Ferries, the American Red Cross, Weehawken Volunteer First Aid, the Weehawken Police Department, West New York E.M.S., North Bergen E.M.S., the Hudson County Office of Emergency Management, the New Jersey E.M.S. Task Force, the Guttenberg Police Department, McCabe Ambulance, the Harrison Police Department, and doctors and nurses who treated survivors.[107][108]

text: Sullenberger was named Grand Marshal for the 2010 Tournament of Roses Parade in Pasadena, California.

text: In August 2010, Jeppesen issued an approach plate titled "Hudson Miracle APCH," dedicated to the five crew of Flight 1549 and annotated "Presented with Pride and Gratitude from your friends at Jeppesen."[109]

text: Sullenberger retired on March 3, 2010, after thirty years with US Airways and its predecessor, Pacific Southwest Airlines. At the end of his final flight he was reunited with Skiles and a number of the passengers from Flight 1549.[110]

text: Media and popular culture[edit]

text: The accident was recorded by several closed-circuit television cameras. Various television reports and documentaries produced soon afterwards contained extensive video of the ditching and rescue, and recorded interviews with the aircrew, passengers, rescuers, and other key participants. These included:

text:
On February 8, 2009, the CBS program 60 Minutes broadcast three segments that included interviews with the aircrew as well as their reunion with passengers. The program aired again on July 5, 2009.

"Flight 1549: A Routine Takeoff Turns Ugly"[111]
"Flight 1549: Saving 155 Souls In Minutes"[112]
"Flight 1549: An Emotional Reunion"[113]

On February 19, 2009, Channel 4 in the United Kingdom aired a documentary entitled The Miracle of the Hudson Plane Crash included personal accounts from passengers, rescuers, and witnesses.[49]
On February 21, 2009, KGO-TV in San Francisco broadcast an interview in the "Face to Face" series. Dan Ashley talked to Captain and Mrs. Sullenberger about their experiences during and since the accident.[114]
On March 4, 2009, the Discovery Channel broadcast a one-hour documentary entitled Hudson Plane Crash – What Really Happened, with computer-generated imagery (CGI) animations of the flight, and interviews with passengers, crew, witnesses, rescuers, and aviation safety experts.[115]
On January 10, 2010, TLC aired a documentary entitled Brace For Impact, aired again on April 14 in Australia as Brace For Impact: Inside The Hudson Plane Crash.[116]
In March 2011, Ric Elias, a front-row passenger shared his experience during a TED conference.[117]
Beginning in June 2011, the University of North Carolina School of Filmmaking and Process Pictures, LLC worked with the Carolinas Aviation Museum to produce a documentary, which also looked at the impact of the incident on society.[118][119]

text: The crash was featured in the Discovery Channel (Canada) / National Geographic TV series Mayday on the episode Hudson Splash Down.[120] It was also recreated in a National Geographic Channel TV special titled "Miracle Landing on the Hudson,"[121] and in the United Kingdom for a Channel 5 special in 2011.[122]

text: Garrison Keillor honored the entire flight crew by writing a song and performing it on his show, A Prairie Home Companion.[123]

text: The ditching is referenced in the song "A Real Hero" by College and Electric Youth, best known from the 2011 movie Drive. The lyrics of the second verse describe the water landing and the survival of the passengers and crew, as well as alluding to the freezing river.[124]

text: Sullenberger's memoir, Highest Duty: My Search for What Really Matters was adapted into a feature film Sully: Miracle on the Hudson, directed by Clint Eastwood,[125] with Tom Hanks as Sullenberger and Aaron Eckhart as co-pilot Jeff Skiles.[126] It was released by Warner Bros. on September 9, 2016.[127]


document_title: Swine influenza

question_text: which of the animal is a carrier of h1n1

root

text: Swine influenza

text: Signs and symptoms[edit]

text: Swine[edit]

text: In swine, an influenza infection produces fever, lethargy, sneezing, coughing, difficulty breathing and decreased appetite.[7] In some cases the infection can cause abortion. Although mortality is usually low (around 1–4%),[2] the virus can produce weight loss and poor growth, causing economic loss to farmers.[7] Infected pigs can lose up to 12 pounds of body weight over a three- to four-week period.[7] Swine have receptors to which both avian and mammalian influenza viruses are able to bind to, which leads to the virus being able to evolve and mutate into different forms.[8] Influenza A is responsible for infecting swine, and was first identified in the summer of 1918.[8] Pigs have often been seen as "mixing vessels", which help to change and evolve strains of disease that are then passed on to other mammals, such as humans.[8]

tag: p

text: Humans[edit]

text: Direct transmission of a swine flu virus from pigs to humans is occasionally possible (zoonotic swine flu).[citation needed] 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.[10] Of these six people, one was pregnant, one had leukemia, one had Hodgkin's lymphoma and two were known to be previously healthy.[10] 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.[10]

text: 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, watery eyes, body aches, shortness of breath, headache, weight loss, chills, sneezing, runny nose, coughing, dizziness, abdominal pain, lack of appetite and fatigue. The 2009 outbreak has shown an increased percentage of patients reporting diarrhea and vomiting as well. The 2009 H1N1 virus is not zoonotic swine flu, as it is not transmitted from pigs to humans, but from person to person through airborne droplets.[citation needed]

text: 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 and past medical history. For example, during the 2009 swine flu outbreak in the United States, the 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 seven days preceding their illness onset."[12] A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).[12]

text: The most common cause of death is respiratory failure. Other causes of death are pneumonia (leading to sepsis),[13] high fever (leading to neurological problems), dehydration (from excessive vomiting and diarrhea), electrolyte imbalance and kidney failure.[14] Fatalities are more likely in young children and the elderly.

text: Virology[edit]

text: Transmission[edit]

text: Between pigs[edit]

text: Influenza is quite common in pigs, with about half of breeding pigs having been exposed to the virus in the US.[15] Antibodies to the virus are also common in pigs in other countries.[15]

text: The main route of transmission is through direct contact between infected and uninfected animals.[7] 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.[16][17] 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.[7] The virus usually spreads quickly through a herd, infecting all the pigs within just a few days.[2] Transmission may also occur through wild animals, such as wild boar, which can spread the disease between farms.[18]

text: To humans[edit]

text: People who work with poultry and swine, especially those 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.[19] Vaccination of these workers against influenza and surveillance for new influenza strains among this population may therefore be an important public health measure.[20] 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.[21] 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.[19] 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.[22]

text: Interaction with avian H5N1 in pigs[edit]

text: Pigs are unusual as they can be infected with influenza strains that usually infect three different species: pigs, birds and humans.[23] This makes pigs a host where influenza viruses might exchange genes, producing new and dangerous strains.[23] 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.[24] H3N2 evolved from H2N2 by antigenic shift.[25] In August 2004, researchers in China found H5N1 in pigs.[26]

text: 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.[27][28]

text: Structure[edit]

text: The influenza virion is roughly spherical. It is an enveloped virus; the outer layer is a lipid membrane which is taken from the host cell in which the virus multiplies. Inserted into the lipid membrane are "spikes", which are proteins—actually glycoproteins, because they consist of protein linked to sugars—known as HA (hemagglutinin) and NA (neuraminidase). These are the proteins that determine the subtype of influenza virus (A/H1N1, for example). The HA and NA are important in the immune response against the virus; antibodies (proteins made to combat infection) against these spikes may protect against infection. The NA protein is the target of the antiviral drugs Relenza and Tamiflu. Also embedded in the lipid membrane is the M2 protein, which is the target of the antiviral adamantanes amantadine and rimantadine.

text: Classification[edit]

text: Of the three genera of influenza viruses that cause human flu, two also cause influenza in pigs, with influenza A being common in pigs and influenza C being rare.[29] Influenza B has not been reported in pigs. Within influenza A and influenza C, the strains found in pigs and humans are largely distinct, although because of reassortment there have been transfers of genes among strains crossing swine, avian, and human species boundaries.

text: Influenza C[edit]

text: Influenza viruses infect both humans and pigs, but do not infect birds.[30] Transmission between pigs and humans have occurred in the past.[31] For example, influenza C caused small outbreaks of a mild form of influenza amongst children in Japan[32] and California.[32] Because of its limited host range and the lack of genetic diversity in influenza C, this form of influenza does not cause pandemics in humans.[33]

text: Influenza A[edit]

text: Swine influenza is caused by influenza A subtypes H1N1,[34] H1N2,[34] H2N3,[35] H3N1,[36] and H3N2.[34] In pigs, four influenza A virus subtypes (H1N1, H1N2, H3N2 and H7N9) are the most common strains worldwide.[7] 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.[37] In August 2012, the Center for Disease Control and Prevention confirmed 145 human cases (113 in Indiana, 30 in Ohio, one in Hawaii and one in Illinois) of H3N2v since July 2012.[38] The death of a 61-year-old Madison County, Ohio woman is the first in the nation associated with a new swine flu strain. She contracted the illness after having contact with hogs at the Ross County Fair.[39]

text: Diagnosis[edit]

text: The CDC recommends real-time PCR as the method of choice for diagnosing H1N1.[40] The oral or nasal fluid collection and RNA virus preserving filter paper card is commercially available.[41] This method allows a specific diagnosis of novel influenza (H1N1) as opposed to seasonal influenza. Near-patient point-of-care tests are in development.[42]

text: Prevention[edit]

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

text: Swine[edit]

text: Methods of preventing the spread of influenza among swine include facility management, herd management, and vaccination (ATCvet code: QI09AA03 (WHO)). 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.

text: 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.[43][44] 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 current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses.[10][45] The United States Department of Agriculture researchers say while pig vaccination keeps pigs from getting sick, it does not block infection or shedding of the virus.[46]

text: Facility management includes using disinfectants and ambient temperature to control viruses in the environment. They are unlikely to survive outside living cells for more than two weeks, except in cold (but above freezing) conditions, and are readily inactivated by disinfectants.[2] 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 three 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.[15] After an outbreak, as immunity in exposed pigs wanes, new outbreaks of the same strain can occur.[2]

text: Humans[edit]

text: Swine can be infected by both avian and human flu strains of influenza, and therefore are hosts where the antigenic shifts can occur that create new influenza strains.

text: The transmission from swine to humans 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 face masks 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, especially, not wearing gloves when working with sick animals, thereby increasing the likelihood of subsequent hand-to-eye, hand-to-nose or hand-to-mouth transmission.[47]

text: Influenza spreads between humans when infected people cough or sneeze, then other people breathe in the virus or touch something with the virus on it and then touch their own face.[48] "Avoid touching your eyes, nose or mouth. Germs spread this way."[49] Swine flu cannot be spread by pork products, since the virus is not transmitted through food.[48] 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.[50]

text: Recommendations to prevent spread of the virus among humans include using standard infection control, which includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public.[51] Chance of transmission is also reduced by disinfecting household surfaces, which can be done effectively with a diluted chlorine bleach solution.[52]

text: Experts agree hand-washing can help prevent viral infections, including ordinary and the swine flu infections. Also, avoiding touching one's eyes, nose or mouth with one's hands helps to prevent the flu.[49] 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 eyes, nose or mouth. 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 for advice.[53]

text: Social distancing, another tactic, is 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.

text: Vaccination[edit]

text: Vaccines are available for different kinds of swine flu. The U.S. Food and Drug Administration (FDA) approved the new swine flu vaccine for use in the United States on September 15, 2009.[54] Studies by the National Institutes of Health show a single dose creates enough antibodies to protect against the virus within about 10 days.[55]

text: In the aftermath of the 2009 pandemic, several studies were conducted to see who received influenza vaccines. These studies show that whites are much more likely to be vaccinated for seasonal influenza and for the H1N1 strain than African Americans [56] This could be due to several factors. Historically, there has been mistrust of vaccines and of the medical community from African Americans. Many African Americans do not believe vaccines or doctors to be effective. This mistrust stems from the exploitation of the African American communities during studies like the Tuskegee study. Additionally, vaccines are typically administered in clinics, hospitals, or doctor’s offices. Many people of lower socioeconomic status are less likely to receive vaccinations because they do not have health insurance.

text: Surveillance[edit]

text: Although there is no formal national surveillance system in the United States to determine what viruses are circulating in pigs,[57] an informal surveillance network in the United States is part of a world surveillance network.[58]

text: Treatment[edit]

text: Swine[edit]

text: As swine influenza is rarely fatal to pigs, little treatment beyond rest and supportive care is required.[15] Instead, veterinary efforts are focused on preventing the spread of the virus throughout the farm, or to other farms.[7] 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.[15]

text: Humans[edit]

text: 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 two days of symptoms). Beside antivirals, supportive care at home or in a hospital focuses on controlling fevers, relieving pain and maintaining fluid balance, as well as identifying and treating any secondary infections or other medical problems. The U.S. Centers for Disease Control and Prevention recommends the use of oseltamivir (Tamiflu) or zanamivir (Relenza) 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.[59] The virus isolated in the 2009 outbreak have been found resistant to amantadine and rimantadine.[60]

text: 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 volunteers.[61]

text: History[edit]

text: Swine influenza was first proposed to be a disease related to human flu during the 1918 flu pandemic, when pigs became ill at the same time as humans.[62] The first identification of an influenza virus as a cause of disease in pigs occurred about ten years later, in 1930.[63] 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.[63]

text: The H1N1 form of swine flu is one of the descendants of the strain that caused the 1918 flu pandemic.[64][65] 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.[65] However, direct transmission from pigs to humans is rare, with only 12 recorded cases in the U.S. since 2005.[66] 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.[67]

text: 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 every year.[68]

text: 1918 pandemic[edit]

text: The 1918 flu pandemic in humans was associated with H1N1 and influenza appearing in pigs;[65] this 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, in this case, pigs caught the disease from humans.[62] For instance, swine influenza was only noted as a new disease of pigs in 1918, after the first large outbreaks of influenza amongst people.[62] Although a recent phylogenetic analysis of more recent strains of influenza in humans, birds, animals, and many others and swine suggests the 1918 outbreak in humans followed a reassortment event within a mammal,[69] the exact origin of the 1918 strain remains elusive.[70] It is estimated that anywhere from 50 to 100 million people were killed worldwide.[65][71]

text: 1976 U.S. outbreak[edit]

text: On February 5, 1976, a United States 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 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.[72]

text: 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), which spread simultaneously, also caused illness, and persisted until March.[72] 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.[73]

text: The vaccination program was plagued by delays and public relations problems.[74] On October 1, 1976, immunizations began, and three senior citizens died soon after receiving their injections. This resulted in a media outcry that linked these deaths to the immunizations, despite the lack of any proof the vaccine was the cause. 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.[75]

text: There were reports of Guillain–Barré syndrome (GBS), a paralyzing neuromuscular disorder, affecting some people who had received swine flu immunizations. Although whether a link exists is still not clear, this syndrome may be a side effect of influenza vaccines. As a result, Di Justo writes, "the public refused to trust a government-operated health program that killed old people and crippled young people." In total, 48,161,019 Americans, or just over 22% of the population, had been immunized by the time the National Influenza Immunization Program was effectively halted on December 16, 1976.[76] [77]

text: Overall, there were 1098 cases of GBS recorded nationwide by CDC surveillance, 532 of which occurred after vaccination and 543 before vaccination.[78] About one to two cases per 100,000 people of GBS occur every year, whether or not people have been vaccinated.[79] The vaccination program seems to have increased this normal risk of developing GBS by about to one extra case per 100,000 vaccinations.[79]

text: Recompensation charges were filed for over 4,000 cases of severe vaccination damage, including 25 deaths, totalling US$3.5 billion, by 1979.[80] The CDC stated most studies on modern influenza vaccines have seen no link with GBS,[79][81][82] Although one review gives an incidence of about one case per million vaccinations,[83] a large study in China, reported in the New England Journal of Medicine, covering close to 100 million doses of H1N1 flu vaccine, found only 11 cases of GBS, which is lower than the normal rate of the disease in China: "The risk-benefit ratio, which is what vaccines and everything in medicine is about, is overwhelmingly in favor of vaccination."[84]

text: 1988 U.S. outbreak[edit]

text: In September 1988, a swine flu virus killed one woman and infected others. A 32-year-old woman, Barbara Ann Wieners, was eight months pregnant when she and her husband, Ed, became ill after visiting the hog barn at a county fair in Walworth County, Wisconsin. Barbara died eight days later, after developing pneumonia.[85] The only pathogen identified was an H1N1 strain of swine influenza virus.[86] Doctors were able to induce labor and deliver a healthy daughter before she died. Her husband recovered from his symptoms.

text: Influenza-like illness (ILI) was reportedly widespread among the pigs exhibited at the fair. Of the 25 swine exhibitors aged 9 to 19 at the fair, 19 tested positive for antibodies to SIV, but no serious illnesses were seen. The virus was able to spread between people, since one to three health care personnel who had cared for the pregnant woman developed mild, influenza-like illnesses, and antibody tests suggested they had been infected with swine flu, but there was no community outbreak.[87][88]

text: 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 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.[89][90][2] Genetic components of these 1998 triple-hybrid stains would later form six out of the eight viral gene segments in the 2009 flu outbreak.[91][92][93][94][95]

text: 2007 Philippine outbreak[edit]

text: On August 20, 2007, Department of Agriculture officers investigated the outbreak 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 five 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.[96][97]

text: 2009 Northern Ireland outbreak[edit]

text: Since November 2009, 14 deaths as a result of swine flu in Northern Ireland have been reported. The majority of the victims were reported to have pre-existing health conditions which had lowered their immunity. This closely corresponds to the 19 patients who had died in the year prior due to swine flu, where 18 of the 19 were determined to have lowered immune systems. Because of this, many mothers who have just given birth are strongly encouraged to get a flu shot because their immune systems are vulnerable. Also, studies have shown that people between the ages of 15 and 44 have the highest rate of infection. Although most people now recover, having any conditions that lower one's immune system increases the risk of having the flu become potentially lethal. In Northern Ireland now, approximately 56% of all people under 65 who are entitled to the vaccine have gotten the shot, and the outbreak is said to be under control.[98]

text: 2015 and 2017 India outbreaks[edit]

text: Swine flu outbreaks were reported in India in late 2014 and early 2015. As of March 19, 2015 the disease has affected 31,151 people and claimed over 1,841 lives.[6][99] The largest number of reported cases and deaths due to the disease occurred in the western part of India including states like Delhi, Madhya Pradesh, Rajasthan, and Gujarat. Researchers of MIT have claimed that the swine flu has mutated in India to a more virulent version with changes in Hemagglutinin protein. This has however been disputed by Indian researchers.[100]

text: There was another outbreak in India in 2017. The states of Maharashtra and Gujarat were the most affected states.[101] Gujarat high court has given Gujarat government instructions to control deaths by Swine Flu.[102] Actor Aamir Khan and wife Kiran Rao were among the latest to be afflicted by swine flu.[103] The couple spoke about their battle with the H1N1 virus via video conference at the Satyamev Jayate Water Cup event in Pune, which they had to skip due to ill-health. More than 1094 people died of Swine flu in India in year 2017 till 26 August 2017.[104]

text: 2015 Nepal outbreak[edit]

text: Swine flu outbreaks were reported in Nepal in the spring of 2015. As of April 21, 2015 the disease has claimed 26 lives in the most severely affected district, Jajarkot in Northwest Nepal.[105] Cases were also detected in the districts of Kathmandu, Morang, Kaski, and Chitwan.[106] As of 22 April 2015 the Nepal Ministry of Health reported that 2,498 people had been treated in Jajarkot, of whom 552 were believed to have swine flu, and acknowledged that the government's response had been inadequate.[107] The Jajarkot outbreak had just been declared an emergency when the April 2015 Nepal earthquake struck on 25 April 2015, diverting all medical and emergency resources to quake-related rescue and recovery.

text: 2016 Pakistan outbreak[edit]

text: There were seven cases of Swine flu reported in Punjab province of Pakistan mainly in the city of Multan in January 2016.Cases of Swine Flu have also been reported in Lahore.[108]

text: 2017 Maldives outbreak[edit]

text: As of 16 March 2017, over a hundred confirmed cases of Swine flu and at least six deaths were reported in the Maldivian capital of Male' and some other islands. Makeshift flu clinics were opened in Male'.[109] Schools, universities and colleges in the capital were closed, prison visitations suspended, several events cancelled, and all non-essential travel to other islands outside the capital was advised against by the HPA. An influenza vaccination program focussed on pregnant women was initiated soon after.[110] An official visit by the Saudi King Salman bin Abdulaziz Al Saud to the Maldives during his Asian tour was also cancelled last minute amidst fears over the outbreak of swine flu.

text: H1N1 virus pandemic history[edit]

text: A study conducted in 2008, and published in the journal Nature, has managed to establish the evolutionary origin of the flu strain of swine origin (S-OIV).[111]

text: The phylogenetic origin of the flu virus that caused the 2009 pandemics can be traced before 1918. Around 1918, the ancestral virus, of avian origin, crossed the species boundaries and infected humans as human H1N1. The same phenomenon took place soon after in America, where the human virus was infecting pigs; it led to the emergence of the H1N1 swine strain, which later became the classic[clarification needed] swine flu.

text: New events of reassortment were not reported until 1968, when the avian strain H1N1 infected humans again; this time the virus met the strain H2N2, and the reassortment originated the strain H3N2. This strain has remained as a stable flu strain until now.

text: The mid-1970s were important for the evolution of flu strains. First, the re-emergence of the human H1N1 strain became a seasonal strain. Then, a small outbreak of swine H1N1 occurred in humans, and finally, the human H2N2 strain apparently became extinct. Around 1979, the avian H1N1 strain infected pigs and gave rise to Euroasiatic swine flu and H1N1 Euroasiatic swine virus, which is still being transmitted in swine populations.

text: The critical moment for the 2009 outbreak was between 1990 and 1993. A triple reassortment event in a pig host of North American H1N1 swine virus, the human H3N2 virus and avian H1N1 virus generated the swine H1N2 strain. Finally, the last step in S-OIV history was in 2009, when the virus H1N2 co-infected a human host at the same time as the Euroasiatic H1N1 swine strain. This led to the emergence of a new human H1N1 strain, which caused the 2009 pandemic.

text: On June 11, 2009, the World Health Organization raised the worldwide pandemic alert level to Phase 6 for swine flu, which is the highest alert level.[112] This alert level means that the swine flu had spread worldwide and there were cases of people with the virus in most countries. The pandemic level identifies the spread of the disease or virus and not necessarily the severity of the disease.

text: Swine flu spread very rapidly worldwide due to its high human-to-human transmission rate and due to the frequency of air travel.[112]

text: In 2015 the instances of swine flu substantially increased to five year highs with over 10,000 cases reported and 660 deaths in India.[113] The states reporting the highest number of cases and deaths are Rajasthan, Gujarat, Madhya Pradesh, Maharashtra, Delhi, and Telangana.[114] The circulating strain of influenza being the same, unmutant strain that caused global pandemic in 2009 (A H1N1 pdm 09), the sudden spurt of the cases in the beginning of 2015 left the Indian government unexplained but concerned. Government instructed the affected states to investigate into the epidemiological reasons of such spurt in the states, and had detailed the advisory guidelines to all states. The guidelines are mainly for (a) description of A H1N1 for prompt identification, detection, and distinction from the symptoms of other similar infection such as common flu(cold) (b) categorization of screening of influenza A H1N1 cases, (c) clinical management protocol of Pandemic influenza A H1N1, (d) providing home care, (e) collection of human sample.[115] Besides, through the National Centre for Diseases Control (NCDC), Directorate General of Health Services (DGHS), Government of India (GoI) had placed a tender to procure 8 kits of Assay sets, 37 kits of one step RT-PCR kit, and 36 kits of viral RNA extraction kits.[116]

text: Notes[edit]

text:
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Jump up ^ Patterson KD, Pyle GF (1991). "The geography and mortality of the 1918 influenza pandemic". Bulletin of the History of Medicine. 65 (1): 4–21. PMID 2021692.
^ Jump up to: a b Gaydos JC, Top FH, Hodder RA, Russell PK (January 2006). "Swine influenza a outbreak, Fort Dix, New Jersey, 1976". Emerging Infectious Diseases. 12 (1): 23–8. doi:10.3201/eid1201.050965. PMID 16494712.
Jump up ^ Schmeck, Harold M. (March 25, 1976). "Ford Urges Flu Campaign To Inoculate Entire U.S". The New York Times.
Jump up ^ Richard E. Neustadt and Harvey V. Fineberg. (1978). The Swine Flu Affair: Decision-Making on a Slippery Disease. National Academies Press.
Jump up ^ "The Last Great Swine Flu Epidemic", Salon.com, April 28, 2009.
Jump up ^ Retailliau HF, Curtis AC, Storr G, Caesar G, Eddins DL, Hattwick MA (March 1980). "Illness after influenza vaccination reported through a nationwide surveillance system, 1976–1977". American Journal of Epidemiology. 111 (3): 270–8. PMID 7361749.
Jump up ^ "Historical National Population Estimates: July 1, 1900 to July 1, 1999". Washington D.C.: Population Division, U.S. Bureau of the Census. 2000-06-28. Retrieved 2009-08-21.
Jump up ^ Schonberger LB, Bregman DJ, Sullivan-Bolyai JZ, et al. (August 1979). "Guillain–Barre syndrome following vaccination in the National Influenza Immunization Program, United States, 1976–1977". American Journal of Epidemiology. 110 (2): 105–23. doi:10.1093/oxfordjournals.aje.a112795. PMID 463869.
^ Jump up to: a b c "General Questions and Answers on Guillain–Barré syndrome". Centers for Disease Control and Prevention. September 14, 2009.
Jump up ^ "Swine Flu 1976 | Swine flu 'debacle' of 1976 is recalled – Los Angeles Times". Articles.latimes.com. 2009-04-27. Retrieved 2011-08-17.
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Jump up ^ Kaplan JE, Katona P, Hurwitz ES, Schonberger LB (August 1982). "Guillain–Barré syndrome in the United States, 1979–1980 and 1980–1981. Lack of an association with influenza vaccination". JAMA. 248 (6): 698–700. doi:10.1001/jama.248.6.698. PMID 7097920.
Jump up ^ Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P (March 2009). "Safety of trivalent inactivated influenza vaccines in adults: Background for pandemic influenza vaccine safety monitoring". Vaccine. 27 (15): 2114–2120. doi:10.1016/j.vaccine.2009.01.125. PMID 19356614.
Jump up ^ "Last Year's (2009) H1N1 Flu Vaccine Was Safe, Study Finds". Wunderground.com. 2011-02-02. Retrieved 2011-05-22.
Jump up ^ McKinney WP, Volkert P, Kaufman J (January 1990). "Fatal swine influenza pneumonia during late pregnancy". Archives of Internal Medicine. 150 (1): 213–5. doi:10.1001/archinte.150.1.213. PMID 2153372.
Jump up ^ Kimura K, Adlakha A, Simon PM (March 1998). "Fatal case of swine influenza virus in an immunocompetent host". Mayo Clinic Proceedings. 73 (3): 243–5. doi:10.4065/73.3.243. PMID 9511782.
Jump up ^ "Key Facts About Swine Flu (CDC)". Cdc.gov. Retrieved 2009-05-07.
Jump up ^ Wells DL, Hopfensperger DJ, Arden NH, et al. (1991). "Swine influenza virus infections. Transmission from ill pigs to humans at a Wisconsin agricultural fair and subsequent probable person-to-person transmission". JAMA. 265 (4): 478–81. doi:10.1001/jama.265.4.478. PMID 1845913.
Jump up ^ Stephanie Desmon (April 28, 2009). "Expert: Swine flu virus more complex than typically seen". Baltimore Sun. [dead link]
Jump up ^ "Dayquil is used to cure the Cold and flu". https://www.drugs.com.  External link in |website= (help)
Jump up ^ CDC Confirms Ties to Virus First Discovered in U.S. Pig Factories Archived August 23, 2009, at the Wayback Machine.
Jump up ^ Video Segments 3,4,5 in Flu Factories: Tracing the Origins of the Swine Flu Pandemic Archived October 13, 2009, at the Wayback Machine.
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Jump up ^ "Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic : Article". Nature. 459: 1122–1125. doi:10.1038/nature08182. Retrieved 2011-08-17.
^ Jump up to: a b Choffnes, Eileen R., Alison Mack, and David A. Relman. The Domestic and International Impacts of the 2009-H1N1 Influenza a Pandemic: Global Challenges, Global Solutions : Workshop Summary. Washington, D.C.: National Academies, 2010. Print.
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tag: ol

text: Further reading[edit]

text:
Alexander DJ (October 1982). "Ecological aspects of influenza A viruses in animals and their relationship to human influenza: a review". Journal of the Royal Society of Medicine. 75 (10): 799–811. PMC 1438138 . PMID 6752410.
Hampson AW, Mackenzie JS (November 2006). "The influenza viruses". The Medical Journal of Australia. 185 (10 Suppl): S39–43. PMID 17115950.
Lipatov AS, Govorkova EA, Webby RJ, et al. (September 2004). "Influenza: Emergence and Control". Journal of Virology. 78 (17): 8951–9. doi:10.1128/JVI.78.17.8951-8959.2004. PMC 506949 . PMID 15308692.
Van Reeth K (2007). "Avian and swine influenza viruses: our current understanding of the zoonotic risk". Veterinary Research. 38 (2): 243–60. doi:10.1051/vetres:2006062. PMID 17257572.
Webster RG, Bean WJ, Gorman OT, Chambers TM, Kawaoka Y (March 1992). "Evolution and ecology of influenza A viruses". Microbiological Reviews. 56 (1): 152–79. PMC 372859 . PMID 1579108.
Winkler WG (October 1970). "Influenza in animals: its possible public health significance". Journal of Wildlife Diseases. 6 (4): 239–42; discussion 247–8. doi:10.7589/0090-3558-6.4.239. PMID 16512120.

tag: ul


document_title: Nursing in Australia

question_text: when did nursing become a degree in australia

text: Nursing in Australia

text: History[edit]

text: Prior to the transfer of nursing education to the university sector, nurses were trained on the job in a three-year course of theory and practice instruction in hospital nursing schools and on the wards commencing with a 6-week preliminary training school (PTS) with the earliest accepted entry age being 17 years. First, second and third year student nurses were often distinguished by the number of stripes on their uniform caps and or belts. Hospital-based examinations were held each year and a successful pass meant progression to the next year and a fail meant a student nurse was cut, no second chances. Three years of student nursing culminated in final year exams. Student Nurses were paid employees of the parent hospital and there was no sick leave. If a student nurse missed time off through sick leave over the three years of training this time was added on to be worked at the end of the three years and if not worked a nurse was not allowed to graduate. Hospitals awarded distinctive badges and veils (think the flying nun) upon graduation. In addition, state registering authorities awarded a badge of registration. These were generally worn with pride on the uniform collars.

text: As early as the 1930s, attempts were made to establish university credentialed nursing courses in Australia, most notably by then director of nursing at the Royal Melbourne Hospital and the University of Melbourne. As recently as the 1970s, Sandra Stacy, one of the first Australian nurses to attain a PhD enrolled in a school of anthropology to submit her thesis.

text: In the late 1970s, the Royal College of Nursing Australia pioneered a course that became the Diploma of Applied Science (Nursing), awarded by the Lincoln Institute in Melbourne and Cumberland College in Sydney. The transfer of nursing education to the university sector continued throughout the 1980s, and gradually hospital schools ceased operating. In the early 1990s, universities finally granted nursing education the same status as allied health, and granted bachelor degrees in nursing rather than diplomas for entry-level courses.

text: The first move towards baccalaureate recognition was the development of the Bachelor of Applied Science (Advanced Nursing), a post graduate degree that required registration as a registered nurse as a prerequisite to admission and completion of 16 units. This course is no longer offered, and has been superseded by the transition of "post basic courses" conducted by various hospitals as a form of in-service training to the tertiary sector. The College of Nursing still runs post graduate certificate courses for nurses in many specialities.

text: The transfer of nursing education to the university sector from the hospital setting was the result of long-time efforts by leaders in Australian nursing. It was opposed by the medical hierarchy who viewed the development of highly trained professional nurses as a threat to their monopoly on the delivery of high-level health care.[citation needed] Many nurses themselves opposed the transfer on the grounds that "hands on experience in hospitals" would be lost.[citation needed] One underlying cause of the opposition was that of societal views toward appropriate gender roles: nursing as a "female" profession and medicine as a "male" profession.

text: Historically, a "double" or "triple certificated sister" would have been a registered nurse who held general, midwifery, psychiatric, or other range of certificates. The post nominal "RN (DC)" or "RN (TC)" was used by some nurses to signify this attainment.

text: Nurse practitioners are being introduced into the Australian healthcare community. It was only in December 2000, that the first Nurse Practitioner was authorised to work in Australia. Since then there are approximately 700 practicing throughout Australia. To become a Nurse Practitioner you must firstly apply to the Nursing and Midwifery Board of Australia, NMBA. After applying to the NMBA you are then required to provide affirmation of the following to be considered:[3]

text: · General registration as a nurse

text: · The required hours of experience in a leading practice, which is 3 years full-time within the space of the last 6 years

text: · A Masters degree which is from an approved provided

text: Legal regulation[edit]

text: As of 1 July 2010, nurses are regulated by the Nursing and Midwifery Board of Australia, an agency under the Australian Health Practitioner Regulation Agency (AHPRA) under the National Registration and Accreditation Scheme. The practice of nursing was previously governed by state and territorial nursing regulation authorities. The Australian Nursing and Midwifery Accreditation Council (ANMAC) was established in 1992 and works with these authorities to facilitate a national approach to nursing and midwifery regulation. Which has now been superseded by the Nursing and Midwifery Board of Australia (NMBA).

text: Types of nurses[edit]

text: Nurses fall into the following major categories:

text:
Nurse practitioner (NP)
Registered nurse (RN)
Enrolled nurse (EN)
Assistant In nursing (AIN)

text: Mandatory Registration Requirements for Nurses in Australia[edit]

text: Before being able to work as a nurse you must become registered in Australia. There are specific registration requirements that all new applicants and applicants renewing their registration[5] must meet:

text: · Criminal history check – international as of the 4th of February 2015

text: · Professional indemnity insurance arrangements

text: · English skills

text: · Continuation of professional development

text: · Recency of practice

text: Education[edit]

text: Registration as a registered nurse now requires a Bachelor of Nursing, considered the foundation for any future specialisation within nursing. Postgraduate diplomas provide further vocational training for specialist areas. Masters level courses are available in both research and course work streams; a specialist course has been developed to provide preparation for registration as a nurse practitioner. Professional doctorates are also available.

text: Australia has a long tradition of post-basic courses, usually of a six-month (minor) or twelve-month (major) duration, which included midwifery, maternal and child welfare, psychiatric, perioperative (theatre nursing), intensive care, and coronary care in later years, as well as a myriad of other courses. They are now provided by the university sector as postgraduate diplomas or post graduate certificates, depending on the length and complexity.

text: There are options available for hospital trained nurses to upgrade their qualifications to a Bachelor of Nursing (post registration). However, most opt instead to undertake specialist courses such as a postgraduate diploma or certification in the area of their clinical interest.

text: Enrolled nurses (Endorsed) complete a Diploma of Nursing and are trained in the "technical and further education" (TAFE) sector and also Universities, although still obtaining the same degree. Course length has been increased to 18 months to include a module that permits enrolled nurses to dispense oral medications, as well as perform intramuscular injections, subcutaneous injections, and intradermal injections when. Additional post-graduate certificates are offered. Diploma (Endorsed) and Certificate nurses can attend University to gain a Bachelor of Nursing in just 2 years, as their previous qualification allows most to enter at 2nd year.

text: Professional titles[edit]

text: The professional courtesy title "sister" has fallen into disuse and disapproval, even though it was formerly used by both male and female registered general nurses. The title "nurse" was used when addressing enrolled nurses.

text: Salary[edit]

text: The salary of a nurse depends on two factors: the type of nurse and the years of experience in the position.

text:
Nurse Practitioner: $118,419 to $123,629
Registered Nurse: $62,724 to $86,316
Endorsed Enrolled Nurse: $56,515 to $59,982
Assistant in Nursing: $52,228 to $57,182

text: The initial figure would be the commencing salary, then after years of experience the nurse could potentially receive the larger figure. The salary rates[6] above are the most current rates in Australia, which are from the 1st of April 2016.


document_title: List of Billboard Hot 100 number-one singles of 1984

question_text: what was the number one song on april 17 1984

text: Chart history[edit]

text:
Key

The yellow background indicates the #1 song on Billboard's 1984 Year-End Chart of Pop Singles.

tag: table

text:
Issue Date
Song
Artist(s)
Reference

January 7
"Say Say Say"
Paul McCartney and Michael Jackson
[1]

January 14
[2]

January 21
"Owner of a Lonely Heart"
Yes
[3]

January 28
[4]

February 4
"Karma Chameleon"
Culture Club
[5]

February 11
[6]

February 18
[7]

February 25
"Jump"
Van Halen
[8]

March 3
[9]

March 10
[10]

March 17
[11]

March 24
[12]

March 31
"Footloose"
Kenny Loggins
[13]

April 7
[14]

April 14
[15]

April 21
"Against All Odds (Take a Look at Me Now)"
Phil Collins
[16]

April 28
[17]

May 5
[18]

May 12
"Hello"
Lionel Richie
[19]

May 19
[20]

May 26
"Let's Hear It for the Boy"
Deniece Williams
[21]

June 2
[22]

June 9
"Time After Time"
Cyndi Lauper
[23]

June 16
[24]

June 23
"The Reflex"
Duran Duran
[25]

June 30
[26]

July 7
"When Doves Cry"
Prince
[27]

July 14
[28]

July 21
[29]

July 28
[30]

August 4
[31]

August 11
"Ghostbusters"
Ray Parker, Jr.
[32]

August 18
[33]

August 25
[34]

September 1
"What's Love Got to Do with It"
Tina Turner
[35]

September 8
[36]

September 15
[37][38]

September 22
"Missing You"
John Waite
[39][40]

September 29
"Let's Go Crazy"
Prince and the Revolution
[41]

October 6
[42][43]

October 13
"I Just Called to Say I Love You"
Stevie Wonder
[44][45]

October 20
[46][47]

October 27
[48][49]

November 3
"Caribbean Queen (No More Love on the Run)"
Billy Ocean
[50][51]

November 10
[52][53]

November 17
"Wake Me Up Before You Go-Go"
Wham!
[54][55]

November 24
[56][57]

December 1
[58][59]

December 8
"Out of Touch"
Daryl Hall and John Oates
[60][61]

December 15
[62][63]

December 22
"Like a Virgin"
Madonna
[64][65]

December 29
[66]