BREATHE LA New Public Health Tips for Avoiding the 2009 H1N1 Flu (Swine Flu)

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What are symptoms of swine flu?

Symptoms associated with swine flu are the same as with any influenza (flu-like) illness.  The incubation period is 1-2 days,  but may be as long as 7 days and the most common symptoms include fever, headache, cough, sore throat and myalgias (muscle aching).  Other symptoms include a runny nose, nausea, vomiting, and diarrhea.

What happens to people with swine flu infections?

For most, the illness is mild and people recover without any special treatment. The illness lasts about 4-6 days and resolves with supportive care (fluids, rest, anti-pyretics such as acetaminophen or ibuprofen).  Note that aspirin or aspirin containing products (e.g. bismuth subsalicylate – Pepto Bismol®) SHOULD NOT be given to children with suspected influenzae or swine influenza who are under the age of 18 years because of the risk of Reye syndrome).

However, the illness can be more severe in some patients. Those who develop worsening symptoms such as breathing difficulties, severe dehydration, dizziness, confusion, persistent lethargy, or fever with a rash should seek immediate medical attention as these symptoms may warrant additional treatment including hospitalization.

What about vaccination against influenza?

A vaccine against the swine influenza (H1N1) is now available in two forms, the monovalent inactivated vaccine and the live attenuated influenza vaccine. Both are acceptable, but in limited supply, with more doses available in the next few months. This is a separate vaccine from the vaccine that will be administered to protect against seasonal influenza.  Therefore vaccination against influenza this upcoming winter season will require two vaccinations.  One will be for the seasonal influenza with another vaccine for swine influenza.  Simultaneous administration of the vaccine against seasonal influenza and swine influenza will be acceptable as long as administration is in two separate anatomic sites. The initial target groups for swine influenza vaccination are as outlined.

The CDC Advisory Committee on Immunization Practices (ACIP) recommends that programs and providers provide vaccine to all persons in the following five initial target groups as soon as vaccine is available (order of target groups does not indicate priority):

• pregnant women,
• persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
• health-care and emergency medical services personnel,†
• children and young adults aged 6 months--24 years, and
• persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications.§

Subset of initial target groups

ACIP recommends that all persons in the following subset of the five initial target groups receive priority for vaccination if vaccine availability is not sufficient to meet demand (order of target groups does not indicate priority):

• pregnant women,
• persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
• health-care and emergency medical services personnel who have direct contact with patients or infectious material,
• children aged 6 months--4 years, and
• children and adolescents aged 5--18 years who have medical conditions that put them at higher risk for influenza-related complications.§

* Priority should be given to persons in the subset of the five target groups only if initial vaccine availability is not sufficient to meet demand for all persons in the five target groups. As vaccine availability increases, vaccination programs should be expanded to include all members of the initial target groups. Vaccination of other adult populations is recommended as vaccine availability increases.

† Health-care personnel (HCP) include all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza, infectious materials, including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP. The recommendations in this report apply to HCP in acute-care hospitals, nursing homes, skilled nursing facilities, physicians' offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. Emergency medical services personnel might include persons in an occupation (e.g., emergency medical technicians and fire fighters) who provide emergency medical care as part of their normal job duties.

§ Medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) and immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).

Is there a treatment for swine flu?

Vaccination is the best preventive measure to take against swine influenza.  However, if one does become infected, there are available antiviral agents.

This H1N1 virus is susceptible to both oseltamivir and zanamivir, two antiviral drugs which can by prescribed by your physician.  Oseltamivir and zanamivir can be given both as chemoprophylaxis and treatment for H1N1 influenza.

Healthcare providers and pharmacists should be aware that the oral dosing dispenser for oseltamivir is marked in milligrams as opposed to the recommended dosing which is in milliliters or teaspoons. Cautions is advised in administration since there is potential for an error in dosing.  Contact your physician or pharmacists if there are any questions regarding the use of any medication.

Doses and scheduled for treatment of H1N1 virus infections have been recent updated (10/09) and can be found on the CDC website:

http://www.cdc.gov/h1n1flu/recommendations.htm

 What else can one do to reduce the risk of getting swine flu?

There are common sense measures that can help prevent respiratory illnesses like influenza.

1)  Cover the nose and mouth whenever one coughs or sneezes.  Use a tissue and then throw the tissue in the trash.

2)  Good hand washing with soap and water, especially after coughing or sneezing. Alcohol-based hand cleaners are also effective.  Wash or use hand cleaners frequently.

3)  Avoid close contact with sick people, especially if they are coughing or sneezing.

4)  If you get sick with influenza, stay home from work or school to limit contact with others to keep from spreading the infection.

Can I get swine influenza from eating or preparing pork?
No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

For the most current US information see www.cdc.gov/h1n1flu  or www.pandemicflu.gov

Please note that this information is changing rapidly, should be considered interim  and is being updated as new information becomes available.