Q. What is swine flu?
Swine flu, also known as 2009 H1N1 type A influenza, is a human disease. People get the disease from other people, not from pigs.
The disease originally was nicknamed swine flu because the virus that causes the disease originally jumped to humans from the live pigs in which it evolved. The virus is a “reassortant” — a mix of genes from swine, bird, and human flu viruses. Scientists are still arguing about what the virus should be called, but most people know it as the H1N1 swine flu virus.
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 — among people who haven’t had any contact with pigs.
What are swine flu symptoms?
Symptoms of H1N1 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. 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 mean you don’t have the flu. The accuracy of the test depends on the quality of the manufacturer’s test, the sample collection method, and how much virus a person is shedding at the time of testing.
Only PCR lab tests can definitively show whether you’ve got swine flu.
Q. Who is at highest risk from H1N1 swine flu?
Most U.S. cases of H1N1 swine flu have been in children and young adults. It’s not clear whether this will change as the 2009 H1N1 pandemic wanes and the virus becomes a seasonal flu bug.
But certain groups are at particularly high risk of severe disease or bad outcomes if they get the flu:
- Pregnant women are six times more likely to have severe flu disease than non pregnant women
- Young children, especially those under 2 years of age
- People with asthma.
- People with COPD or other chronic lung conditions
- 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 cancerchemotherapy or anti-rejection drugs for transplants
- Residents of a nursing home or other chronic-care facility
- Elderly people are at high risk of severe flu disease — if they get it. Relatively few swine flu cases have been seen in people over age 65.
People in above mentioned groups should seek medical care as soon as they get flu symptoms.
Q. Help! I’ve been exposed to H1N1 swine flu. What should I do?
If you come into close contact with a person who has the flu — especially if that person did not cover a cough or sneeze when you were within 6 feet — you’ve been exposed. Exposure does not guarantee infection or illness, so there’s still a good chance you won’t get the flu.
What you should do next depends on your risk for getting severe disease and on the risk of severe disease in others with whom you cannot avoid contact.
If you have any of the conditions that put you at increased risk of severe H1N1 swine flu — pregnancy, asthma, lung disease, diabetes, heart disease, neurologic disease, immune suppression, or other chronic conditions — it may be riskier for you to get the flu than for other people. That also goes for children under age 2 years, young people under age 19 taking daily aspirin therapy, and people over age 65. And if you are a caretaker for an infant under age 6 months, that child is at risk of severe disease if he or she catches the flu from you.
The CDC advises against the use of the anti-flu drugs Tamiflu and Relenza to keep exposed people from getting the flu. That’s because most of the few cases of drug-resistant H1N1 swine flu have popped up in people taking Tamiflu to prevent flu.
Instead, the CDC advises at-risk individuals to call their health care providers if they are exposed to flu. The provider may choose to write a prescription for Tamiflu or Relenza, to be filled only if flu symptoms appear. Or the provider may ask the patient to call again at the first sign of flu, at which time a prescription will be written.
Don’t wait for a rapid flu test. The tests often give negative results even in people who really have H1N1 swine flu. If you’ve got flu symptoms and you’re at risk of severe disease, start taking flu drugs right away.The drugs work best when taken within 48 hours of the first symptom, although even when taken much later they can prevent severe illness.
Q. 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 can do it comfortably, wear a surgical mask if you must be around others.
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.
- Difficulty breathing or shortness of breath
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Severe or persistent vomiting
Keep in mind that your doctor will not be able to determine whether you have H1N1 swine flu, but he or she may take a sample from you and send it to a lab where PCR test for swine flu is done or 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.
Q. How does swine flu spread? Is it airborne?
The new H1N1 swine flu virus apparently spreads just like regular flu. You could pick up germs directly from airborne droplets from the cough or sneeze of an infected person. You could also pick up the virus by touching an object contaminated by the cough or touch of an infected person and then touching your eyes, mouth, or nose. 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 H1N1 swine flu virus, like the seasonal 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 H1N1 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.
Q. 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. It’s resistant to older flu drugs.
A third antiviral drug, Peramivir, can be used only in hospitalized patients with severe flu. Peramivir is an intravenous drug approved for use under the FDA’s Emergency Use Authorization.
Not everyone needs treatment with these anti-flu drugs. Most people who come down with H1N1 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.
Many people who have died of H1N1 swine flu had bacterial co-infections, particularly pneumococcal infections. There’s a vaccine against pneumococcal infections. It’s routine for children and recommended for adults with underlying health conditions, smokers, or people over age 65. If your flu symptoms get worse after getting better, call your doctor. You may need treatment with antibiotic medications.
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.
Q. 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. Scrub for at least 20 seconds and rinse thoroughly.
- If soap and water are not available, wash your hands with an alcohol-based hand gel. Rub your hands together until the alcohol dries completely.
- 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.
- 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.
Q. How long does the flu virus survive on surfaces?
- Flubugs 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.
Q. Can I still eat pork?
- You can’t get swine flu by eating pork, bacon, ham, or other foods that come from pigs. You can only get the 2009 H1N1 swine flu from another person.
Q. 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.