School principals have been given responsibility for overseeing precautionary measures and distributing information about the virus that causes swine flu, the Ministry of Education announced yesterday. Principals will lead teams of staff members tasked with educating students and teachers on ways to counter the disease and deal with H1N1 cases, including hygiene and protection. A newsletter detailing the measures must be read at morning meetings or assemblies in all schools.
The Minister of Education, Humaid al Qattami, declared the directives yesterday "without sparking fears among students or affecting classes", according to the state news agency, WAM. The announcement comes after widespread concern among students and parents about the likelihood of catching swine flu at schools. Attendance at private schools that have already opened has been reduced by as much as 40 per cent. One school in Sharjah was closed for more than two weeks after a large number of students fell ill with the flu, though no students tested positive for the H1N1 virus.
Experts have warned that when all students return to school after Eid, there is likely to be a spike in the number of flu cases. Last week the Minister of Health said the approach to combat the disease would be three-pronged: to educate the students, parents and teachers; to train teachers about how to respond to suspected cases; and to inform parents about what happens if their children are infected. Yesterday was the first formal announcement from the Ministry of Education.
It was also announced yesterday that Sharjah municipality has adopted measures to prevent H1N1 from spreading in youth centres, public swimming pools, picnics and other social points. A senior official from the Ministry of Health also said yesterday that its H1N1 flu portal had been linked with the website of the Ministry of Education. Dr Ali bin Shukar, Director of the Ministry of Health, said the move would ensure employees in schools and other educational establishments could get easy access to the ministry's website for up-to-date information about the disease.
Pregnant women, meanwhile, have been urged by doctors and international health experts to take the antiviral drug Tamiflu if they develop flu-like symptoms, but not all of them comply. Six people have died in the UAE from swine flu-related complications, including two women who were in the later stages of pregnancy. One of the women, in her 30s, refused to take medicine for fears it would harm her unborn baby. She was then admitted to hospital in the later stages of the disease and died. Her baby was delivered by caesarean section and is doing well, a source from Dubai Hospital said.
The World Health Organisation released comprehensive guidance notes last month on the recommended use of oseltamivir, the active ingredient in the antiviral. It referred to studies showing that early treatment, within 48 hours of symptoms appearing, was "strongly associated with better clinical outcome". "This applies to all patient groups, including pregnant women, and all age groups, including young children and infants."
Because pregnant women are included among groups at increased risk, the WHO advised that they take the treatment as soon as possible after the onset of symptoms. Roche, the manufacturer of Tamiflu, has said there are insufficient data on whether the drug may have an adverse effect on unborn children. The US Food and Drug Administration categorises drugs according to the potential risk to unborn babies. Tamiflu falls into category C, which means tests in animals have shown adverse effects on the foetus but that there is not enough data from human studies. Overall, the potential benefits may warrant use of the drug despite the potential risks. Category A implies no risk, and category X means the risks outweigh the benefits. There are five categories in total.
Dr Sabina Aidarous, a family medicine specialist with a strong interest in women's health, said the categorisation demonstrated why pregnant women should visit their doctors as soon as they develop flu-like symptoms. "As doctors, we can only advise," she said. "Doctors can present the facts, and it is up to the patient. They need to know the background, medical history and details of the pregnancy before advising."
Dr Aidarous, who works at the Imperial Healthcare Institute in Dubai, said that in light of the pandemic and the way the H1N1 virus had developed, there would be times when women had to choose between risks. Pregnant women, experts say, have a weakened immune system and are more susceptible to infections and need more time to recover. Ideally, pregnant women would make a decision based on results of clinical trials, Dr Aidarous said, but not enough data are available for that.
"Because we can't be sure what will happen until further studies are done, we just have to go with the 'take it and save yourself, and hopefully your baby, too' approach." Roche performed a number of studies on rats to evaluate the risk of the drug to pregnant women or the developing foetus. It said, however, that there were insufficient "human data upon which to base an evaluation" of the risk. "The possible effects of Tamiflu on unborn children are unknown," Roche said. "You must tell your doctor if you are pregnant, if you think you are pregnant or if you are trying to get pregnant so that your doctor can decide if Tamiflu is right for you."
Shaimaa Dweek is 22 weeks pregnant with her second child, a boy, due in January. "If I am diagnosed with swine flu, I have no idea if I would take Tamiflu medication, even if it is prescribed by my doctor," said Mrs Dweek, who is a pharmacist, like her father and husband. "There is no way I would take Tamiflu in my first and second trimester; I would rather take the risk and not take any medication that has not been proven to be 100 per cent safe for my baby.
"But even in the final months of the pregnancy, I really cannot say if I can make myself take it, even if I am severely ill." Mrs Dweek said that although she was aware that Tamiflu could save her life, she would not be able to live with herself if she caused damage to her unborn baby by taking it. munderwood@thenational.ae hkhalaf@thenational.ae