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Tuesday, October 06, 2009

What You Should Know About the Swine Flu

 SwineFlu

Being that this is the flu season and swine flu is on everybody's mind, I thought it was a good idea to highlight this recent story from WebMD and pass it on to my readers.  For those of you who do not receive the WebMD newsletter, I highly recommend it.  This article is long, but it answers your questions about the swine flu and what we can all do to prevent this virus from infecting us and our families.  I've added images throughout to make it more interesting and to help you get through it. 

Most importantly, stay safe, keep your hands washed regularly, and see your doctor if you think you may have the flu, any flu (but wear a face mask when you go to his office and out in public please) - Susan

Swine Flu FAQ

Answers to your questions about swine flu.

By Daniel J. DeNoon
WebMD Feature

Reviewed by Louise Chang, MD

The swine flu virus in the U.S. is the same one causing a deadly epidemic in Mexico. What is swine flu? What can we do about it? WebMD answers your questions.

Swine Flu Outbreak: Get the Facts

Get the latest swine flu facts and information from WebMD, the CDC and other public health agencies.

Swine Flu Slideshow

Like people, pigs can get influenza (flu), but swine flu viruses aren't the same as human flu viruses. View the slideshow.

 Swinefluvirus

What is swine flu?

Like people, pigs can get influenza (flu), but swine flu viruses aren't the same as human flu viruses. Swine flu doesn't often infect people, and the rare human cases that have occurred in the past have mainly affected people who had direct contact with pigs. But the current "swine flu" outbreak is different. It's caused by a new swine flu virus that has changed in ways that allow it to spread from person to person -- and it's happening among people who haven't had any contact with pigs.

That makes it a human flu virus. To distinguish it both from flu viruses that infect mainly pigs and from the seasonal influenza A H1N1 viruses that have been in circulation for many years, the CDC calls the virus "novel influenza A (H1N1) virus" and the World Health Organization calls it "pandemic (H1N1) 2009." The CDC calls swine flu illness "H1N1 flu" and the World Health Organization calls it "pandemic influenza A (H1N1)."

 Severeswineflu

What are swine flu symptoms?

Symptoms of swine flu are like regular flu symptoms and include fever, cough, sore throat, runny nose, body aches, headache, chills, and fatigue. Many people with swine flu have had diarrhea and vomiting.  Nearly everyone with flu has at least two of these symptoms. But these symptoms can also be caused by many other conditions. That means that you and your doctor can't know, just based on your symptoms, if you've got swine flu. Health care professionals may offer a rapid flu test, although a negative result doesn't necessarily mean you don't have the flu.

Like seasonal flu, pandemic swine flu can cause neurologic symptoms in children. These events are rare, but, as cases associated with seasonal flu have shown, they can be very severe and often fatal. Symptoms include seizures or changes in mental status (confusion or sudden cognitive or behavioral changes). It's not clear why these symptoms occur, although they may be caused by Reye's syndrome. Reye's syndrome usually occurs in children with a viral illness who have taken aspirin -- something that should always be avoided.

Only lab tests can definitively show whether you've got swine flu. State health departments can do these tests. But given the large volume of samples coming in to state labs, these tests are being reserved for patients with severe flu symptoms. Currently, doctors are reserving antiviral drugs for people with or at risk of severe influenza.

 Personwithflu

Who is at highest risk from H1N1 swine flu?

Most U.S. cases of H1N1 swine flu have been in older children and young adults. It's not clear why, and it's not clear whether this will change.

But certain groups are at particularly high risk of severe disease or bad outcomes if they get the flu:

  • Young children, especially those under 12 months of age
  • Elderly people are at high risk of severe flu disease. But relatively few swine flu cases have been seen in people over age 65.
  • People with cardiovascular conditions (except high blood pressure)
  • People with liver problems
  • People with kidney problems
  • People with blood disorders, including sickle cell disease
  • People with neurologic disorders
  • People with neuromuscular disorders
  • People with metabolic disorders, including diabetes
  • People with immune suppression, including HIV infection and medications that suppress the immune system, such as cancer chemotherapy or anti-rejection drugs for transplants
  • Residents of a nursing home or other chronic-care facility

People in these groups should seek medical care as soon as they get flu symptoms.

A striking number of adults who developed severe swine flu complications have been morbidly obese. However, obesity itself does not seem to be the issue. The vast majority of extremely obese people suffer respiratory problems and/or diabetes, which seem to be the underlying reason for their severe flu complications.

 Sickwoman

If I think I have swine flu, what should I do? When should I see my doctor?

If you have flu symptoms, stay home, and when you cough or sneeze, cover your mouth and nose with a tissue. Afterward, throw the tissue in the trash and wash your hands. That will help prevent your flu from spreading

If you have only mild flu symptoms, you do not need medical attention unless your illness gets worse. But if you are in one of the groups at high risk of severe disease, contact your doctor at the first sign of flu-like illness. In such cases, the CDC recommends that people call or email their doctor before rushing to an emergency room.

But there are emergency warning signs.

Children should be given urgent medical attention if they:

  • Have fast breathing or trouble breathing
  • Have bluish or gray skin color
  • Are not drinking enough fluid
  • Are not waking up or not interacting
  • Have severe or persistent vomiting
  • Are so irritable that the child does not want to be held
  • Have flu-like symptoms that improve but then return with fever and a worse cough
  • Have fever with a rash
  • Have a fever and then have a seizure or sudden mental or behavioral change.

Adults should seek urgent medical attention if they have:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms that improve, but then come back with worsening fever or cough

Keep in mind that your doctor will not be able to determine whether you have swine flu, but he or she may take a sample from you and send it to a state health department lab for testing to see if it's swine flu. If your doctor suspects swine flu, he or she would be able to write you a prescription for Tamiflu or Relenza.

These antiviral medications aren't a question of life or death for the vast majority of people. Most U.S. swine flu patients have made a full recovery without antiviral drugs.

 SwineFluSpread

How does swine flu spread? Is it airborne?

The new swine flu virus apparently spreads just like regular flu. You could pick up germs directly from droplets from the cough or sneeze of an infected person, or by touching an object they recently touched, and then touching your eyes, mouth, or nose, delivering their germs for your own infection. That's why you should make washing your hands a habit, even when you're not ill. Infected people can start spreading flu germs up to a day before symptoms start, and for up to seven days after getting sick, according to the CDC.

The swine flu virus can become airborne if you cough or sneeze without covering your nose and mouth, sending germs into the air. Ferret studies suggest that swine flu spreads less easily by small, airborne droplets than does seasonal flu. But it does spread by this route, and it may begin to spread even more readily as the new virus fully adapts to humans.

The new swine flu virus is a human virus spread by people and not by pigs. The only way to get the new swine flu is from another person.

 Appleaday

How is swine flu treated?

Pandemic H1N1 swine flu virus is sensitive to the antiviral drugs Tamiflu and Relenza. These antiviral drugs are most effective when taken within 48 hours of the start of flu symptoms.

Not everyone needs those drugs. Most people who come down with swine flu recover fully -- without antiviral treatment.

But the CDC strongly recommends antiviral treatment for people at risk of severe flu complications who come down with flu-like symptoms. Since it's very important to start these drugs soon after symptoms appear, doctors should offer treatment to at-risk patients if they suspect they have the flu. Doctors should not rely on rapid flu tests (they are too unreliable for definitive diagnosis) or wait for results of lab-based tests (because they take too long).

Early treatment is so important that the CDC suggests doctors offer a Tamiflu or Relenza prescription to at-risk patients. If these patients develop flu-like symptoms, they would call their doctor, and based on the doctor's clinical judgment, the patient could then simply fill the prescription.

Is there enough Tamiflu and Relenza to go around? Federal and state stockpiles are large enough to treat at-risk patients with flu symptoms. But there isn't enough to offer treatment to otherwise healthy people who may have the flu. And health officials have asked people not to hoard Tamiflu or Relenza.

Tamiflu and Relenza can prevent swine flu, but the CDC urges even at-risk people to try to avoid using the drugs in this way. Not only is supply insufficient for preventive use, but preventive use appears to be a major factor in the few cases of drug-resistant H1N1 swine flu that have appeared.

There are situations in which preventive use of Tamiflu or Relenza may be appropriate for an at-risk person who must come into close contact with someone who has the flu. But the CDC suggests that doctors consider a "watchful waiting" approach. In this case, the at-risk person would wait to fill the prescription only if she or he actually developed flu symptoms.

 Swine_flu_trouble

Is there a vaccine against the new swine flu virus?

It's in the works.  Vaccines are being made in large quantities. Clinical tests began in August 2009. Depending on how long federal officials wait for the results of these tests, millions of doses of swine flu vaccine could be ready as soon as September 2009, with more vaccine becoming available each month thereafter.

Although the decision to begin mass vaccinations has not yet been made, federal and state governments are looking at a mid-October launch. By then, 45 million vaccine doses should be available -- fewer than originally predicted, but enough to cover the highest risk groups. Each week after that, another 20 million doses a week will be delivered to states. The U.S. has purchased  a total of 195 million doses.

If swine flu vaccine is in short supply -- nationally or in local areas -- pregnant women and people caring for or living with infants will go to the front of the line. So would health care workers and first responders who have direct contact with patients, children 6 months to 4 years old, and kids 4 to 19 years old with medical conditions that put them at risk of severe flu disease. There are about 42 million Americans in these groups.

If the vaccine supply seems sufficient to meet initial demand, priority will extend to all young people aged six months to 24 years, to people 25 to 64 with underlying medical conditions that put them at risk of severe flu disease, and a larger group of health care workers and emergency medical technicians.

Once there's enough vaccine for these urgent groups, swine flu vaccine will be offered to healthy people 24 and older.

Many questions remain. It's not yet clear whether people will need one or two shots, given three weeks apart, or whether an immune-boosting substance called adjuvant will have to be used.

Spurred by the safety concerns that sank vaccination efforts during the 1976 swine flu scare, federal officials are increasing efforts to track the safety of a pandemic flu vaccine. In addition to beefing up the CDC's vaccine adverse-event surveillance system, health care organizations and the U.S. military will be helping track vaccine safety.

 Swine-flu-patient-zero

I had a flu vaccine this season. Am I protected against swine flu?

No. This season's flu vaccine does not protect against the new swine flu virus.

Whether or not there's a swine flu vaccine this winter, there will be a new seasonal flu vaccine in the fall. This year, it will be more important than ever to get a flu shot. It may not protect against swine flu -- but it will keep you and others from getting the seasonal flu viruses that kill some 36,000 Americans each year.

 Hand_washing

How can I prevent swine flu infection?

The CDC recommends taking these steps:

  • Wash your hands regularly with soap and water, especially after coughing or sneezing. Or use an alcohol-based hand cleaner if soap and water are not available.
  • Avoid close contact -- that is, being within 6 feet -- with people who have flu-like symptoms.
  • Avoid touching your mouth, nose, or eyes. That's not easy to do, so keep those hands clean.
  • If you have flu-like symptoms -- fever plus at least cough or sore throat or other flu symptoms -- stay home for seven days after symptoms begin or until you've been symptom-free for 24 hours -- whichever is longer.
  • Wear a face mask (consider using an N95 respirator) if you must come into close contact with a sick person. "Close contact" means within 6 feet. Note: There is no definitive proof that a face mask prevents flu transmission. Do not rely solely on a face mask to prevent infection.
  • Wear an N95 respirator if helping a sick person with a nebulizer, inhaler, or other respiratory treatment. Note: There is no definitive proof that a respirator prevents flu transmission. Do not rely solely on a respirator to prevent infection.
  • People who have or are suspected of having swine flu should wear a face mask, if available and tolerable, when sharing common spaces with other household members, when outside the home, or when near children or infants.
  • Breastfeeding mothers with swine flu symptoms should express their breast milk, and the child should be fed by someone else.

  WearaMask

Should I wear a face mask or respirator?

Short answer: Maybe.  Face masks and respirators may very well offer extra protection, but should not be your first line of defense against either pandemic or seasonal flu. 

Every day, newspapers carry pictures of people wearing face masks to prevent swine flu transmission. But very little is known about whether face masks actually protect against the flu.

There's a difference between a face mask and a respirator. A face mask does not seal tightly to the face. Face masks include masks labeled as surgical, dental, medical procedure, isolation, or laser masks. Respirators are N95- or higher-rated filtering face pieces that fit snugly to the face. Respirators filter out virus particles when correctly adjusted -- which is not as simple as it sounds. But it's hard to breathe through them for extended periods, and they cannot be worn by children or by people with facial hair.

People who have flu-like symptoms should carry disposable tissues to cover their coughs and sneezes. When going out in public, or when sharing common spaces around the home with family members, they should put on a face mask -- if one is available and tolerable.

People not at risk of severe flu illness can best protect themselves from swine flu with frequent hand washing and by staying at least 6 feet away from people with flu symptoms. But if swine flu is circulating in the community, a face mask or respirator may be protective in crowded public places.

People at increased risk of severe flu illness -- pregnant women, for example -- should add a face mask to these tried-and-true precautions when providing assistance to a person with flu-like illness. And anyone else who cannot avoid close contact with someone who has swine flu (if you must hold a sick infant, for example) may try using a face mask or respirator.

 Fluvirusonsurfaces

How long does the flu virus survive on surfaces?

Flu bugs can survive for hours on surfaces. One study showed that flu viruses can live for up to 48 hours on hard, nonporous surfaces such as stainless steel and for up to 12 hours on cloth and tissues. The virus seems to survive for only minutes on your hands -- but that's plenty of time for you to transfer it to your mouth, nose, or eyes.

 Swine-flupig

Can I still eat pork?

Yes. You can't get swine flu by eating pork, bacon, or other foods that come from pigs.

 Swineflutracker

What else should I be doing during the swine flu pandemic?

Keep informed of what's going on in your community. Your state and local health departments may have important information if swine flu develops in your area. For instance, parents might want to consider what they would do if their child's school temporarily closed because of flu. Don't panic,  but a little planning wouldn't hurt.

Here's the advice from the U.S. government's pandemicflu.gov web site:

To plan for a pandemic:

  • Store a two-week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.
  • Periodically check your regular prescription drugs to ensure a continuous supply in your home.
  • Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
  • Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
  • Volunteer with local groups to prepare and assist with emergency response.
  • Get involved in your community as it works to prepare for an influenza pandemic.

Items to have on hand for an extended stay at home:

Examples of food and non-perishables

Examples of medical, health, and emergency supplies

•         Ready-to-eat canned meats, fish, fruits, vegetables, beans, and soups

•         Prescribed medical supplies such as glucose and blood-pressure monitoring equipment

•         Protein or fruit bars

•         Soap and water, or alcohol-based (60-95%) hand wash

•         Dry cereal or granola

•         Medicines for fever, such as acetaminophen or ibuprofen

•         Peanut butter or nuts

•         Thermometer

•         Dried fruit

•         Anti-diarrheal medication

•         Crackers

•         Vitamins

•         Canned juices

•         Fluids with electrolytes

•         Bottled water

•         Cleansing agent/soap

•         Canned or jarred baby food and formula

•         Flashlight

•         Pet food

•         Batteries

•         Other non-perishable items

•         Portable radio


•         Manual can opener


•         Garbage bags


•         Tissues, toilet paper, disposable diapers


 Swinefluresearch

How severe is swine flu?

The severity of cases in the current swine flu outbreak has varied widely, from mild cases to fatalities. Most U.S. cases have been mild, but there have been a number of deaths and hundreds of hospitalizations -- mostly in young people aged 5 to 24.

Like seasonal flu, children who get swine flu can have serious neurological complications such as seizures and Reye's syndrome. But as with seasonal flu, these complications fortunately are rare.

Studies of the swine flu virus show that it is more infectious to lung cells than are seasonal flu viruses. But studies also suggest that the swine flu virus is less well adapted to humans and may be harder to inhale deep into the lungs.

Flu viruses change all the time, and the way the pandemic swine flu virus evolved suggests that it is particularly liable to swap gene segments with other flu viruses. But so far the swine flu virus hasn't changed much. That's good news, as the vast majority of swine flu cases have been mild. And it's also good news for the swine flu vaccine, which is based on swine flu strains isolated early in the pandemic.

It's impossible to know whether the virus will become more deadly. Scientists are watching closely to see which way the new swine flu virus is heading -- but health experts warn that flu viruses are notoriously hard to predict.

But there's a lot of planning you can do. CDC officials predict that just about every U.S. community will have H1N1 swine flu cases. It's possible some schools in your community may temporarily close, or even that major gatherings may be canceled. So make contingency plans just in case you are affected. For more information on preparedness planning, see the U.S. government's pandemicflu.gov web site.

 Swine-flu-outbreak-in-Mex-001

Why has the swine flu infection been more severe in Mexico than in other countries?

That's not clear yet. Researchers around the world are investigating the differences between the cases in Mexico and those elsewhere. The data so far suggests that many more people in Mexico had mild swine flu infections than had originally been appreciated. So the disease now seems to have been no more severe in Mexico than elsewhere.

 Oldswineflu

Have there been previous swine flu oubtreaks?

I was vaccinated against the 1976 swine flu virus. Am I still protected?

Probably not. The new swine flu virus is different from the 1976 virus. And it's not clear whether a vaccine given more than 30 years ago would still be effective.

 Swineflumap

How many people have swine flu?

That's no longer possible to answer, because so many people have become infected that most nations can no longer test everyone suspected of having H1N1 swine flu. The CDC counts hospitalizations and deaths. But instead of misleading case counts, the CDC offers a map showing where flu is widespread and charts showing whether unusual numbers of people are showing up in doctors' offices with flu-like symptoms and whether there are unusually high numbers of deaths from pneumonia and influenza.

 Fluepidemic

How serious is the public health threat of a swine flu epidemic?

The U.S. government has declared swine flu to be a public health emergency. The World Health Organization considers it a global emergency.

It remains to be seen how severe swine flu will be in the U.S. and elsewhere, but countries worldwide are monitoring the situation closely and preparing for worst-case scenarios.

The World Health Organization has declared swine flu to be a pandemic. That means that all nations can expect to see swine flu infections -- and should prepare for them -- but does not mean the virus has become more severe.

The H1N1 swine flu outbreak came at the end of the U.S. flu season. The virus spread across the nation and around the globe in the spring and summer, seasons when flu usually ebbs to nearly undetectable levels in the Northern Hemisphere.

In the Southern Hemisphere, most nations have seen large numbers of H1N1 swine flu cases. Fortunately, there's no sign that the pandemic flu bug has become more deadly, more resistant to new flu drugs, or less likely to be stopped by the H1N1 swine flu vaccine now in production.

Nobody knows how bad the swine flu will be during the Northern Hemisphere flu season. But the CDC is warning Americans to prepare for a bad flu season this fall. It's better to over-prepare and look a little silly if nothing happens than to be unprepared for an emergency.

WebMD senior writer Miranda Hitti contributed to this report.


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