SWINE FLU What is swine flu? There are 2 types of influenza (flu) viruses- those that affect humans and those that affect animals. Swine flu (virus affecting the pigs) 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 allows 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 Centre for Disease Control (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)." 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. So you need to consult your doctor for a proper diagnosis and management. 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 of throat/ nasal swabs 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. Who is at highest risk from H1N1 swine flu? 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. • 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 • 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. People in these groups should seek medical care as soon as they get flu symptoms. 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. 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 swine flu patients have made a full recovery without antiviral drugs. 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. The swine flu virus can become airborne if you cough or sneeze without covering your nose and mouth, sending germs into the air. 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. How is swine flu treated? Pandemic swine flu virus is sensitive to the antiviral drugs Tamiflu and Relenza. The CDC recommends those drugs to prevent or treat swine flu; the drugs are most effective when taken within 48 hours of the start of flu symptoms. But not everyone needs those drugs. Most people who have come down with swine flu have recovered without treatment. Health officials have asked people not to hoard Tamiflu or Relenza. Tamiflu or Relenza may also be used to prevent swine flu. The CDC recommends this "can be considered" for people at high risk of severe flu illness who come into close contact with someone who has the flu. 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 govt. 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. 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. 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, officials are increasing efforts to track the safety of a pandemic flu vaccine 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 also kill many each year. 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 flulike 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. Should I wear a face mask or respirator? 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. 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. Can I still eat pork? Yes. You can't get swine flu by eating pork, bacon, or other foods that come from pigs. 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. 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. How severe is swine flu? The severity of cases in the current swine flu outbreak has varied widely, from mild cases to fatalities. Most 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. 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. Have there been previous swine flu oubtreaks? Yes. There was a swine flu outbreak at Fort Dix, N.J., in 1976 among military recruits. It lasted about a month and then went away as mysteriously as it appeared. As many as 240 people were infected; one died. The swine flu that spread at Fort Dix was the H1N1 strain. That's the same flu strain that caused the disastrous flu pandemic of 1918-1919, resulting in tens of millions of deaths worldwide. Concern that a new H1N1 pandemic might return in winter 1976 led to a crash program to create a vaccine and vaccinate all Americans against swine flu. That vaccine program ran into all kinds of problems -- not the least of which was public perception that the vaccine caused excessive rates of dangerous reactions. That may not have been the case. But after more than 40 million people were vaccinated, the effort was abandoned. As it turned out, there was no swine flu epidemic. Even though it's an H1N1 type A flu bug, the new swine flu is a different virus than the ones that emerged in 1918 and in 1976 -- and from the seasonal type A H1N1 virus that has been circulating for many years. There have been two flu pandemics since 1918 -- one that began in 1957, and another that began in 1968. 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. 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. How serious is the public health threat of a swine flu epidemic? The World Health Organization considers it a global emergency. It remains to be seen how severe swine flu will be 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 virus spread 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.