November 2009

Swine Flu

Author: Jame F. Gigante, M.D.

The H1N1 swine flu virus has sent a panic through many people in our country. The virus emerged here at the end of the last U.S. flu season and wreaked havoc both in the Americas and abroad. Now, as we head into the height of the flu season, many people are asking what is ahead for Americans.

Influenza is circulating unusually early this year with cases in all 50 states—but with a large concentration in the Southeast—nearly all the swine flu variety. According to data published by the CDC, novel H1N1 viruses currently make up 98 percent of all subtyped influenza A viruses analyzed by the U.S. WHO/NREVSS collaborating laboratories. Given this information, patients with influenza-like illness can reasonably be assumed to have novel H1N1 Influenza A virus unless another cause is identified.

In an average year in America, over 30,000 people die of complications from the “regular” influenza virus, and many more get it and get over it. With the swine flu, we don’t know exactly what its impact will be. Some estimates say that one in five Americans will be infected, others that half the population will be affected.

The reason we don’t know is that the swine flu virus has acted in a somewhat unusual manner. When this virus was first detected in people in the U.S., we were already nearing the end of our traditional flu season. Yet H1N1 continued to spread in our country and across the Northern Hemisphere during the spring and summer months—seasons when flu usually ebbs to nearly undetectable levels.

We can base some of our predictions, on what has happened over the past few months in the Southern Hemisphere, which is currently experiencing its winter and flu season. Most nations there have seen large numbers of H1N1 swine flu cases. But their doctors are also reporting that the incidences of death have not been overwhelming and that many people who contract the virus become only mildly sick and many also recover without treatment.

One difference between the “regular flu” and swine flu is that the regular flu kills mostly the very young, the very old or the infirm. What has come as a shock to many is that swine flu infections are 20 times more common in the five- to 24-year-old group than in the over 65 crowd. Speculation is that the older generation has built up a natural resistance, in all likelihood because of past exposure to similar viruses.

At this time, there does not seem to be any indication that this swine flu bug has mutated and become more deadly, more resistant to new flu drugs, or less likely to be stopped by the H1N1 swine flu vaccine now in production.

Keep a look out for general flu symptoms that include, but are not limited to, fever, cough, sore throat, runny nose, body aches, headache, chills, and fatigue. Many people with swine flu have also reported having diarrhea and vomiting.

Nearly everyone that contracts the flu will have at least two of these symptoms. But each of these symptoms alone, or in conjunction with one another, can also be caused by many other conditions. What that means is that neither you nor your doctor can definitively know, just based on your symptoms, if you have swine flu.

If you are in one of the groups at high risk of severe outcome from the flu, contact your doctor at the first sign of flu-like illness. In such cases, the CDC recommends that people call or e-mail their doctor before rushing to an emergency room.

After your examination, your doctor may take a sample from you and send it to a state health department lab for testing to see if it’s swine flu. Should your doctor suspect swine flu, you will in all likelihood receive a prescription for Tamiflu or Relenza. These antiviral medications are most effective when taken within 48 hours of the start of flu symptoms. But not everyone needs those drugs, and many U.S. swine flu patients have made a full recovery without antiviral drugs.

Most importantly, you should know that there is a swine flu vaccine being manufactured in large quantities, and millions of doses will be available as the flu season continues on. Furthermore, the flu shot that you should be receiving every year is available, and you should also avail yourself of that at your doctor’s office.

Hilton Head Hospital is preparing according to South Carolina Department of Health and Environmental Control guidelines. According to SCDHEC nearly every county in South Carolina has reported at least one case of the new strain of flu. As of press time, we have already seen several cases of swine flu in the emergency room of Hilton Head Hospital, and there are more suspected cases on the island.

Nobody knows how bad the swine flu will be during the Northern Hemisphere flu season. But the CDC is warning Americans to prepare for a bad flu season this fall, predicting that just about every U.S. community will have H1N1 swine flu cases.

I think it’s better to over-prepare and look a little silly if nothing happens than to be unprepared for an emergency. I recommend that you check out the following websites for more information and to monitor the flu season in South Carolina:

James F. Gigante, M.D. is a Board Certified Doctor of Internal Medicine. He can
be reached at (843) 681-2222.


Swine Flu at a Glance

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. But relatively few swine flu cases have been seen in people over age 65.
• 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

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 irritable to the point of not wanting 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

How can you 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—being within six 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 six 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.

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.

Regional Public Health Office:
Beaufort, Colleton, Hampton, Jasper
219 S. Lemacks Street
Walterboro, SC 29488
Phone: (843) 525-7603 ext. 108
Fax: (843) 549-6845
Nights/Weekends: 1-800-614-4698

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