Prevent Swine Flu

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Like seasonal flu, 2009 H1N1 flu in humans can fluctuate in seriousness from mild to severe. Formerly known as swine flu, the 2009 H1N1 flu virus infection can cause a wide range of symptoms, including fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people with the flu may also experience symptoms of vomiting and diarrhea. It has been noted that certain groups might be more likely to develop a severe illness from 2009 H1N1 flu infection, such as pregnant women and persons with chronic medical conditions.

Influenza viruses are thought to spread from person to person by respiratory droplets coming from coughs and sneezes of an infected person. This can happen when droplets from a cough or sneeze of an infected person are spread through the air and settles on the mouth or nose of someone close by.  Influenza viruses may also be spread when a person touches respiratory droplets that may be on another person or an object and then touches their own mouth or nose before washing their hands.

The preferred course of action, of course, would be to avoid close contact with persons infected with the flu as much as humanly possible.  Close contact would be considered less than about 6 feet away from the infected person.  If you must come into contact with a sick person spend the least amount of time possible near them and try to wear a facemask or surgical mask or N95 disposable respirator if at all possible. An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask. It may harder to breathe through an N95 mask for long periods of time compared to a facemask. Facemasks and respirators can be found for purchase at a pharmacy, building supply or hardware store.

Some helpful hints to keep in mind if you find yourself in need of wearing a facemask or N95 respirator are the following:

• Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor. Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
• Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they don’t touch anything else.
• Avoid re-using disposable facemasks and N95 respirators, if possible. If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
• After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.

Things to look for – protect yourself from H1N1

How do you Prevent Flu?
Experts are recommending that if you are showing signs of flu-like symptoms this flu season, staying home and avoiding contact with other people except to get medical care is the best option. The thought is to keep the spread of flu-like symptoms to a minimum.  Most people who have come down with the 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs.  This is also true of seasonal flu.

In the event that you are one of the people who are more likely to get flu complications then you should talk to a health care provider about whether you need to be examined if you get flu symptoms this season. People who fall into a higher risk category are children younger than 5, but especially children younger than 2 years old, people 65 and older and pregnant women.  Others at risk are people who have the following:

o    Cancer

o    Blood disorders (including sickle cell disease)

o    Chronic lung disease [including asthma or chronic obstructive pulmonary disease (COPD)]

o    Diabetes

o    Heart disease

o    Kidney disorders

o    Liver disorders

o    Neurological disorders (including nervous system, brain or spinal cord)

o    Neuromuscular disorders (including muscular dystrophy and multiple sclerosis)

o    Weakened immune systems (including people with AIDS)

There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called antiviral drugs. These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications like those mentioned above. Your health care provider will decide whether antiviral drugs are needed to treat your illness. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, talk to your doctor. It is not advised to go to the emergency room because if you do not have the flu, you may catch it from sick people who are there.

Symptoms of the flu could be one or a combination of fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue and sometimes diarrhea and vomiting.  An important side note to keep in mind is that not everyone suffering from the flu will show signs of a fever.  Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.  Also, it’s possible for healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care provider.

Swine flu or swine influenza or influenza A h1n1 is defined as a respiratory disease caused by influenza viruses that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide.

In a number of instances, people have developed the swine flu infection when they are closely associated with pigs and likewise, pig populations have occasionally been infected with the human flu infection. Farmers and pork processors are at the highest risk. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans.

Regrettably, this cross-species infection with influenza viruses has had the capability to transform. Researchers think the 2009 swine flu strain, first seen in Mexico, should be called novel H1N1 flu since it is predominately found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type1). Current research shows the eight RNA strands from novel H1N1 flu have one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains.

In areas with confirmed human cases of swine influenza A (H1N1) virus infection, the possibility of infection can be lessened through a combination of actions. No single action will provide complete protection, but an approach combining the following steps can help decrease the likelihood of transmission. These steps include frequent washing hands frequently, covering coughs, and having ill persons remain at home, except to seek medical care, and minimize contact with others in the household. Additional measures that can limit transmission of a new influenza strain include voluntary home quarantine of members of households with confirmed or probable swine influenza cases, reduction of unnecessary social contacts, and avoidance whenever possible of crowded settings.

A confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by either a real-time RT-PCR or viral culture test.

For antiviral treatment of a confirmed case of swine influenza A (H1N1) virus infection, either oseltamivir or zanamivir may be administered. The recommended length of treatment is five days. These same antivirals should be considered for treatment of cases that test positive for influenza A but test negative for seasonal influenza viruses H3 and H1.

The CDC says that a good way to prevent any flu disease is to avoid exposure to the virus. This is done by frequent hand washing, not touching your hands to your face.  Be especially careful to avoid the nose and mouth and avoiding any close proximity to or touching any person who may have flu symptoms. Since the virus can remain live and infectious for about 48 hours on many surfaces it is essential to practice good hygiene like cleaning with soap and water or alcohol-based hand disinfectants. Some physicians say face masks may help prevent getting airborne flu viruses from a cough or sneeze but others think it would be better for the people who actually have symptoms and sneeze or cough to wear the masks.

The use of Tamiflu or Relenza may help prevent the flu if taken before symptoms develop or reduce symptoms if taken within about 48 hours after symptoms develop. The vaccine recommendations as of October 2009 from the CDC say the following groups should get the vaccine as soon as it is available:

* people who live with or provide care for children younger than 6 months of age,
* pregnant women,
* health-care and emergency medical services personnel,
* people between 6 months and 24 years of age, and
* people from the ages of 25 through 64 who are at higher risk because of chronic health disorders such as asthma, diabetes, or a weakened immune system.

Generally speaking, about 90%-95% of people who get the disease feel dreadful but eventually bounce back with no problems.  This has been seen in patients in both Mexico and the U.S. Caution is still crucial as the swine flu (H1N1) is still spreading and has become a pandemic. So far, young adults been hit hardest, and in Mexico, this group currently has the highest mortality rate. This data however is constantly changing.

At this time the CDC is stating that people ages 10 and above are likely to need only one vaccine shot to provide protection against novel H1N1 swine flu and further suggest that these shots will be effective in about 76% of people who obtain the vaccine. One type of vaccine (currently named Influenza A [H1N1] 2009 Monovalent Vaccine Live, Intranasal) has been made available during the first week in October 2009. It is a live attenuated novel H1N1 flu vaccine that contains no thimerosal.  This vaccine is produced by MedImmune, LLC, and is administered by spraying it into the nostrils. This vaccine is only for healthy people 2-49 years of age. Children 2-9 years of age should receive two doses (0.1 ml in each nostril; total equals 0.2 ml per dose) and the second dose should be given the same way about one month after the first dose.  Children, adolescents and adults, 10-49 years of age should receive one dose (0.1 ml in each nostril; total equals 0.2 ml per dose).

The CDC is recommending all healthcare providers receive both the seasonal influenza vaccine every year and the 2009 H1N1 vaccine. Healthy persons including healthcare providers, who are infected with influenza virus, can transmit the virus to persons at higher risk for complications from influenza, like patients with inflammatory rheumatic disease.

Early treatment with oseltamivir or zanamivir should be contemplated for persons with flu-like symptoms, suspected or confirmed, who have an elevated risk for complications including patients with inflammatory rheumatic disease. Patients with inflammatory rheumatic disease within any of the following prioritized groups are recommended to receive the 2009 H1N1 vaccine:

• Pregnant women
• People who live with or care for children younger than 6 months of age
• Healthcare and emergency medical services personnel
• Persons between the ages of 6 months and 24 years old
• Persons between the ages of 25 and 64 years old who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems (including with inflammatory rheumatic disease)

Persons age 65 or older are not included in these specific groups because recent research indicates that the chance of infection among persons age 65 or older is less than the chance for younger age groups. While not expecting a shortage of 2009 H1N1 vaccine, the CDC states that availability and demand can be unpredictable. Once the need for the vaccine among the younger groups has been taken care of, the vaccine should be offered to people age 65 or older, including people with inflammatory arthritis.  Persons with inflammatory rheumatic disease who develop flu-like symptoms need to know the following:

• If you develop flu-like symptoms contact your healthcare provider.
• Avoid contact with others. Seek medical care early. You should stay home and avoid travel, including not going to work or school, until at least 24 hours after your fever is gone except to get medical care or necessities. Your fever should be gone without using fever-reducing medications.
• If you leave the house to seek medical care, wear a facemask, if available and tolerable, and cover your coughs and sneezes with a tissue.
• Do not stop taking any medicine you take for your arthritis unless told to do so by your physician.
• Seek medical attention early. Treatment is available for persons with severe disease and those at high risk for complications. Persons with inflammatory rheumatic disease are considered high risk for complications from the flu; therefore, your health care provider may choose to prescribe antiviral medications for you if you get the flu.
• If you are exposed to someone who has flu, consult your health care provider.  They may prescribe medication to help prevent you from getting the flu or watch you closely to see if you develop flu symptoms.

Flu activity in the U.S. is reported to now be widespread in 41 states. Across the nation visits to doctors for influenza-like-illness continued to be on the rise and are now about equal to or higher than what is seen at the height of most normal flu seasons. Flu-related hospitalizations and deaths are also continuing to mount and are above expectations for this time of year.

The CDC continues to remind health providers and the public of the need to continue hand and cough hygiene measures for the period of any influenza symptoms, even while taking antiviral medications in order to combat the spread of antiviral resistant virus strains. The influenza activity reported by both state and territorial epidemiologists shows geographic spread of both seasonal influenza and 2009 influenza A (H1N1) viruses.

Each week CDC evaluates information collected about influenza disease activity in the United States and issues findings of key flu indicators in a report called FluView. A review of the key indictors found that during the week of October 4-10, 2009 influenza activity continued to increase in the United States from the previous week. Below is a summary of the latest significant indicators:

· Visits to doctors for influenza-like illness (ILI) continued to increase in the United States, and overall, are higher than what is expected for this time of the year. ILI activity now is equal to or higher than what is seen at the peak of many regular flu seasons.

· Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year.

· The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and exceeds what is normally expected at this time of year. In addition, 11 flu-related pediatric deaths were reported this week; 10 of these deaths were confirmed 2009 H1N1, and one was influenza A virus, but unsubtyped. Since April 2009, there have been 86 confirmed pediatric 2009 H1N1 deaths; 39 of these have been reported to CDC since August 30, 2009.

· Forty-one states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Texas, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity are unprecedented during seasonal flu.

· Almost all of the influenza viruses identified so far is 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

Joe Raedle / Getty

Since this global swine flu issue is taking off in the media and by word of mouth nearly everywhere you turn, there’s no wondering why so many people may easily panic and overact to even the smallest sign that they feel ill right now. Because of this terror instilled in people, some are going so far as to pour into emergency rooms in many states across our country; they fear they have this horrifying disease. It is strongly urged that people DO NOT rush to the emergency room if they start feeling the tiniest inkling that they have contracted swine flu. Like, “oh, my throat hurts…”, or “I feel more tired than i usually do”, or “what’s with my coughing and sniffling?, that can’t be good!”

It also burdens hospitals, the more that “just paranoid” people that start rushing to ER.  Having to examine people who aren’t really sick puts a toll on the already strained/stressed hospitals that are trying to prepare for a pandemic. Additionally, going to an emergency room without just cause may even put you further in harms way and risk your health. In past outbreaks, including SARS in 2003, hospitals were actually breeding grounds of infections — all those sick people in close proximity — and the same could be true of swine flu.

“If you actually have flu-like symptoms — a fever above 100° F, headache, sore throat, body aches, chills or fatigue — and you live in an area where there have been confirmed swine flu cases, by all means report to your doctor. Otherwise, leave the hospital to the sick people.”

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