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H1N1 Flu (Swine Flu)

H1N1 (Swine) Influenza

Definition
Swine influenza is flu virus usually found in pigs. The virus occasionally changes (mutates) and becomes infectious in humans. When this happens the disease becomes a concern to humans, who have little or no immunity against it. This means the virus has the potential to spread quickly around the world. It also may be more difficult to treat than the usual, seasonal human flu viruses.

3 Steps to Fight H1N1 - CDC guidelines to protect against seasonal and H1N1 flu. [pdf]
Patient Flu Information - Information for patients about testing and treatment for influenza. [pdf]
H1N1 Vaccine Fact Sheet - Information for patients about the H1N1 Vaccine. [pdf]

Alternative Names
Swine flu; H1N1 flu

Causes
In the spring of 2009 cases of human infection with swine flu were confirmed in Mexico and in several states in the United States. Cases of infection in humans were also reported in other countries.

The most well known outbreak of swine flu occurred among soldiers in Fort Dix, New Jersey, in 1976. The virus caused disease and pneumonia in at least 4 soldiers and 1 death. All of the infected soldiers lived in close contact. The virus is thought to have circulated for a month and disappeared. The source of the virus, when it was introduced to Fort Dix, and the reasons why it did not spread more are unknown. Until now very few cases of swine flu had been reported since.

The swine flu virus is contagious and can spread from human to human. At this time it is not known how easily it can spread between people.

It is known that flu viruses can spread from pigs to people and from people to pigs. You cannot get the swine flu virus from eating pork.

Human-to-human infection with the swine flu virus likely occurs the same way as seasonal flu, as when an infected person coughs or sneezes into air that others breathe in. People may also get infected by touching something with the virus on it, such as a door knob or counter, and then touching their mouth or nose.

You can find an updated case count of confirmed swine flu infections in the U.S. at the Centers for Disease Control and Prevention (CDC) web site.

Symptoms
Symptoms of swine flu infection in humans are similar to classic flu-like symptoms, which might include:

  • Fever above 100.4 °F
  • Cough
  • Sore throat
  • Headache
  • Chills
  • Muscle aches
  • Diarrhea
  • Vomiting

Exams and Tests
If you think you have been exposed to swine influenza call your health care provider before your visit. This will give the staff a chance to take proper precautions to protect them and other patients during your office visit.
If the swine flu becomes widespread there will be little need to continue testing people, so your health care provider may decide not to test for the flu virus.
Your doctor may perform the following physical exam:

  • Auscultation (to detect abnormal breath sounds)
  • Chest X-ray

Treatment
Most people who get swine flu will likely recover without needing medical care. Doctors, however, can prescribe antiviral drugs to treat people who become very sick with the flu.
If you need treatment for swine flu the CDC recommends that your doctor give you zanamivir (Relenza) alone or osteltamivir (Tamiflu) combined with either amantadine or rimantadine. These drugs work best if you receive them within 2 days of becoming ill. You may get them later if you are very sick or if you have a high risk for complications.
To prevent infection with swine flu people living in the same house as someone diagnosed with the virus should ask their doctor if they also need a prescription for these medicines. Careful respiratory hygiene and frequent hand-washing are also recommended steps for reducing the risk of getting swine flu.
Aspirin or products that contain aspirin should not be given to anyone 18 years old or younger.

Outlook (Prognosis)
The outlook depends on the severity of the infection and the type of swine influenza virus that caused it.
The H1N1 swine flu outbreak in Mexico has resulted in 29 confirmed deaths thus far. At least one death had been reported in the U.S. at the time of this writing. Officials were preparing for more.
For more information, visit:

  • CDC - www.cdc.gov/swineflu
  • World Health Oganization - www.who.int/csr/disease/swineflu/en/index.html

Possible Complications
Severe illness may occur along with:

  • Pneumonia
  • Respiratory failure
  • Death

Swine flu, like seasonal flu, may make other chronic medical problems worse.
A vaccination used to treat swine flu in 1976 was associated with some cases of Guillain-Barre syndrome, a disorder that leads to nerve inflammation that causes muscle weakness.

When to Contact a Medical Professional
Seek emergency medical care if you are ill and have any of the following warning signs.

Emergency signs in children include:

  • Fast breathing or trouble breathing
  • Bluish or gray skin color
  • Not drinking enough fluids
  • Severe or persistent vomiting
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and a worse cough

Emergency signs in adults include:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms improve but then return with fever and a worse cough

Prevention
People who work with pigs who might be infected should use protective clothing and special breathing masks.
Other steps you can take:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. You may also use alcohol-based hand cleaners.
  • Avoid touching your eyes, nose, or mouth to avoid getting infected by germs.
  • Avoid close contact with sick people.
  • Consider staying home from work or school if you do get sick.

________________________________________
Review Date: 5/6/2009
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine (4/29/2009).
 
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