Pandemic Flu

The H1N1 Virus (Swine Flu): Talking With Your Doctor

H1N1 (sometimes called "swine flu") is a new influenza A virus causing illness in people. This virus was first detected in people in April 2009 in the United States. Other countries, including Mexico and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

This infection has spread worldwide and very easily such that the World Health Organization raised the outbreak of H1N1 to the "pandemic" level. This does not imply that it is more aggressive or associated with increased suffering and deaths. The outcomes associated with this virus are similar to what we see with seasonal flu.

Not Like Seasonal Flu

Swine flu is more likely to spread through communities of people than the seasonal flu that comes each year for several reasons.

1. Seasonal Flu is a Human Virus - The seasonal flu viruses that are commonly passed between people – "human" viruses. Because of previous exposure to the seasonal flu and past vaccination, there is some degree of protection that has been built up in the population as a whole.

2. Seasonal Flu Vaccines Increase Exposure - Vaccines to the specific seasonal flu virus that occurs each year generally give some protection for each year's virus. Because this virus is completely new to the human population, no natural protection has been built up except one third of individuals over the age of 60 appear to have protection.

Symptoms

Swine flu is generally mild to moderate in its severity in humans, and is commonly characterized by:

cough
fever
fatigue
headache
sore throat
runny nose
chills
muscle aches
nausea, stomach ache, and diarrhea may also occur

Talking With Your Doctor

Your doctor will decide whether to test and/or treat for the H1N1 virus ("swine flu") depending on your personal history and symptoms. Your doctor needs as much information as you can offer. Tell your doctor if you have:

Any of the symptoms listed above
Had contact with someone who has been diagnosed or highly suspected as having the H1N1 ("swine flu") virus

Diagnosis

Depending on your history and symptoms, here are some of the things your doctor may do:

Test you for the H1N1 virus
Test you for the regular seasonal flu virus
If your symptoms are mild or improving he/she may have you observe to see if they get worse
Treat you for flu

Testing for the H1N1 Virus

The doctor will get a sample from your nose, throat or both. He/she may do a "rapid test" as well as a culture which will be sent to the lab.

Rapid Test - The rapid test gives results in about 15 minutes but has some limits:

Doesn't Confirm H1N1 - The rapid tests confirms only that a virus is present. The rapid test cannot tell for certain that the H1N1 virus is there.
False Negatives - It is also possible in many cases that the test will be negative even though a person is infected.

To get complete results, a sample will be sent to the lab for further testing.

Treatment

Medications

Treatment for swine flu is available with medications, Tamiflu® or Relenza®. Tamiflu® is taken by mouth (as a pill or liquid) and Relenza® is the same kind of medicine in an inhaled form. It is encouraging to note that these antiviral medications (particularly Tamiflu®) are effective in treating this virus with rare instances of Tamiflu resistance being reported worldwide, which was not the case in this past human influenza season (2008-2009) where 95% of human influenza A strains were Tamiflu® resistant.

Both Tamiflu® and Relenza® are from a particular group called 'neuraminidase inhibitors.' The way these medicines work is to 'inhibit' the virus particles – stopping them in their tracks – so that they cannot reproduce. While it doesn't kill the virus (cure the flu) these medicines can make the symptoms less severe, the time of illness shorter and decrease the shedding of virus and thus the risk of infecting others.

Who Should Be Treated Preventively?

Sometimes Tamiflu® and Relenza®. will be given to prevent people from being infected with the H1N1 (swine flu) virus. This includes:

People who live in a household with someone who has been diagnosed with having the virus, especially household members who are children under the age of 5, pregnant women, persons 65 or older, or persons with certain medical conditions such as chronic heart or lung disease.
Children attending school or daycare who are at high risk for complications on influenza AND who had close contact with a confirmed, suspected, or probable case.
Travelers returning from Mexico.
First responders who are at a high risk of influenza complications.
Healthcare workers put at risk while providing clinical care.
Health care workers at high risk for complications of influenza (certain chronic medical conditions, pregnancy, age >65 years) who are working with confirmed or suspected case.

Stay Home If You Think You Are Sick

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. If you get sick with influenza like symptoms such as fever, cough, sore throat, headaches, body aches, the CDC recommends that you stay home from work or school and limit contact with others to avoid spreading infections (including influenza and other respiratory illnesses).

Wearing a Mask – What to Do?

If you need to be seen at a healthcare facility, you should mention your symptoms right away at reception or triage, and will hopefully be given a mask, especially if you have to spend some time in a waiting area. Ill individuals are being first advised to not go out. The area where there is the most concern for influenza spread related to sneezing and coughing is within 6 feet of an infected person.

Avoid Getting Sick

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread that way.
Try to avoid close contact with sick people.

H1N1 Vaccine

Research - Many studies are currently being done to look at the safety and effectiveness of the H1N1 vaccine and such issues
Availability - There are plans to have available H1N1 vaccine by late October 2009
Who should be vaccinated - High priority groups have been identified as those that should first get the vaccine including:

Pregnant women
Healthcare workers
Emergency recue personnel
Adults in households with infants less than 6 months of age
Persons between the ages of 6 months and 24 years old
People ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems

Administering the vaccine - It may be necessary to receive 2 injections of the H1N1 vaccine for full protection

More Information

To learn more, check out these NetWellness features:

In addition, you can review the Centers for Disease Control and Prevention website H1N1 Flu (Swine Flu):

For more information:

Go to the Pandemic Flu health topic, where you can:

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This article is a NetWellness exclusive. NetWellness Article

Last Reviewed: Sep 04, 2009

Amy J Ray, MD
Clinical Instructor and Division Chief
University Hospitals Richmond Medical Center
Infectious Diseases Division
University Hospitals
School of Medicine
Case Western Reserve University

Robert A Salata, MD
Professor and Division Chief
Infectious Diseases Division
University Hospitals
School of Medicine
Case Western Reserve University