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First Aid

Swine flu (H1N1)

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Does this describe your symptoms?

Definition
  • Swine Flu is a viral respiratory infection that affects the nose, throat, trachea, and bronchi.
  • You think you have Swine Flu because other close contacts (e.g., family members, friends) have it or because Swine Flu is very common currently in your community. Use this guideline only if you have symptoms that match Swine Flu (Novel H1N1 Virus).

Symptoms of Swine Flu include:

  • There is usually a sudden onset of fever, chills, feeling sick, muscle aches, and headache.
  • Respiratory symptoms are similar to a common cold: runny nose, sore throat, and a bad cough.
  • The fever is usually higher (102 - 104° F; 38.9 - 40° C) with Swine Flu than with a cold. Headaches and muscle aches are also worse with Swine Flu.

General Information about Swine Flu (H1N1)

  • Swine flu viruses normally do not infect humans. Cases of swine flu spread from pigs to humans in Mexico during March 2009. An outbreak of swine flu in humans occurred in the U.S. and Canada April 2009 and started spreading person-to-person.
  • Incubation Period: After exposure, a person will come down with swine flu symptoms in 1 to 4 days. The longest incubation period is thought to be 7 days.
  • Symptoms: The symptoms of swine flu are similar to those of regular human influenza. The main symptoms are runny nose, sore throat, cough, and fever. Other common symptoms are muscle pain, headache and fatigue. Some people also have vomiting and diarrhea.
  • Prognosis and Symptom Severity: Symptoms of swine flu can be mild to severe, just as with regular human influenza. Thus far in the US and Canada, the symptoms have generally been mild; it is hoped that complications will be uncommon and death will be rare.
  • Complications: The worst complications are pneumonia and respiratory distress or failure. Complications are more likely to occur in certain high risk patients (see list below)
  • Expected Course: The expected course will probably be similar to regular human influenza: fever for 2-3 days, runny/congested nose for 7-14 days, and the cough for 2-3 weeks.
  • Contagiousness: The swine flu virus is spread via airborne droplet, from sneezing and coughing, just like other influenza viruses. It also can be transmitted by hands contaminated with secretions. Swine flu is NOT transmitted by eating pork.
  • Contagious Period: A person is contagious for 1 day prior to and for 7 days after the onset of symptoms (e.g., fever, cough).
  • Treatment - Antiviral Medications: See below.
  • Prevention - Vaccine: Last winter’s human influenza vaccine offers no protection against the swine flu virus. A vaccine against swine flu is being developed; it will probably be available in Fall 2009.

Some individuals are at higher risk for complications like pneumonia. Individuals at HIGH RISK include:

  • Persons 65 years and older
  • Children younger than 5 years old
  • Children and adolescents (less than 19 years old) who are receiving long-term aspirin therapy (Reason: at risk for Reye's syndrome)
  • Pregnant women
  • Chronic medical conditions, including: cardiovascular (not hypertension), chronic pulmonary conditions (e.g., asthma, emphysema), immunosuppression (e.g., chemotherapy, HIV), renal failure, hematologic (e.g., sickle cell disease) and diabetes mellitus.
  • Residents of nursing homes and chronic care facilities.

Anti-Viral Medications for Swine Flu

  • Two medications licensed in the U.S. and Canada are believed to be effective against the swine influenza virus: zanamivir (Relenza), and oseltamavir (Tamiflu).
  • Treatment: Treatment is recommended for symptomatic patients who require hospitalization and symptomatic patients at HIGH RISK for complications. Treatment is not generally recommended for influenza-like illness in most healthy patients. [May 9, 2009 CDC Interim Guidance on Antiviral Recommendation]
  • Post-Exposure (Prevention): These medications can also be taken prophylactically to prevent illness. Two groups that may especially benefit from prophylaxis are [a] health care workers and [b] patients at higher risk of complications who have had a close contact with someone with suspected or confirmed Swine Flu.
  • Reference: http://www.cdc.gov/h1n1flu/recommendations.aspx

If not, see these topics
  • Swine Flu exposure (close contact) and you have no fever or respiratory symptoms, use SWINE FLU EXPOSURE
  • COUGH and you have had no exposure (Close Contact), or your cough begins over 7 days after exposure
  • COLD symptoms (e.g., runny nose, nasal congestion) and you have had no exposure (Close Contact), or your symptoms begin over 7 days after exposure
  • SORE THROAT and you have had no exposure (Close Contact), or your soar throat begins over 7 days after exposure

First Aid:

N/A

When to Call Your Doctor

Call 911 Now (you may need an ambulance) If
  • Severe difficulty breathing (e.g., struggling for each breath, unable to speak)
  • Lips or face are blue
  • Difficult to awaken or acting confused
Call Your Doctor Now (night or day) If
  • You feel weak or very sick
  • Headache and stiff neck (can't touch chin to chest)
  • Difficulty breathing
  • Wheezing is present
  • Fever of 103° F (39.4° C) or higher
  • Fever of 100.5° F (38.1° C) or higher and you
    • Are over 60 years of age OR
    • Have diabetes mellitus or a weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR
    • Are bedridden (e.g., nursing home patient, stroke, chronic illness, recovering from surgery)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
  • You are at HIGH RISK (e.g., age over 64 years, pregnant, HIV+, or chronic medical condition) for complications of flu
  • Sinus pain or pressure (around cheekbone or eyes)
  • Fever present for more than 3 days
  • Earache is present
  • You have been sick less than 48 hours and think that you need treatment with anti-viral medications
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Cough lasts more than 3 weeks
  • Nasal discharge lasts more than 10 days
Self Care at Home If
  • Mild flu symptoms and you don't think you need to be seen
  • Swine Flu, questions about
  • Swine Flu prevention, questions about
HOME CARE ADVICE FOR SWINE FLU (H1N1) EXPOSURE

General Care Advice for Respiratory (Cold/Flu) Symptoms
  1. For a Runny Nose With Profuse Discharge - Blow the Nose:
    • Nasal mucus and discharge helps to wash viruses and bacteria out of the nose and sinuses.
    • Blowing the nose is all that is needed.
    • Apply petroleum jelly to the nasal openings to protect them from irritation (cleanse the skin first).
  2. For a Blocked Nose - Use Nasal Washes:
    • Step 1: Put 2-3 drops of warm water or saline in each nostril (Reason: To loosen up the dried mucus)
    • Step 2: Blow each nostril separately (Pinch one nostril shut while blowing your nose then repeat while pinching the other nostril).
    • Step 3. Repeat nose drops and blowing until discharge is clear.
    • Notes: Use a medicine dropper so you have control over how many drops you put in the nose. If you don't have one, you can use a dropper that came with ear drops, eye drops, or another medicine. You can purchase a dropper at a pharmacy. Do nasal washes four times a day or whenever you can't breathe through your nose. Another option instead of nasal washes is to take a hot shower. Breathe in the moist air through the nose and then blow each nostril.
    • How to Make Saline Nose Drops: Add 1/2 tsp of table salt to 8 oz (240 ml) of warm water.
  3. For Cough:
    • Use cough drops (Available OTC).
    • Or, you can try sucking on a piece of hard candy.
  4. For Coughing Spasms:
    • Drink warm fluids. Inhale warm mist (Reason: both relax the airway and loosen up the phlegm).
    • Suck on cough drops or hard candy to coat the irritated throat.
  5. For All Fevers:
    • Drink cold fluids to prevent dehydration.
    • Dress in 1 layer of lightweight clothing and sleep with 1 light blanket.
    • For fevers less than 101° F (38.3° C), fever medicines are usually not necessary.
  6. Pain and Fever Medication:
    • For pain and fever relief, take acetaminophen or ibuprofen.
    • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
    • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
    • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
    • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • CAUTION: Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  7. For Sore Throat:
    • Sip warm chicken broth or apple juice.
    • Suck on hard candy or a throat lozenge (OTC).
    • Gargle with warm salt water four times a day. To make salt water, put 1/2 teaspoon of salt in 8 oz (240 ml) of warm water.
    • Avoid cigarette smoke.
  8. Call Your Doctor If:
    • Difficulty breathing
    • Fever lasts more than 3 days
    • Nasal discharge lasts more than 10 days
    • Cough lasts more than 3 weeks
    • You become worse
Swine Flu Questions
  1. Swine Flu - General Information and Reassurance:
    • An outbreak of swine flu in humans started in the U.S. and Canada in April 2009. By June 2009, it had spread to most countries in the world.
    • For healthy people, the symptoms of Swine Flu are similar to those of the common cold. However, with Swine Flu, the onset is more abrupt and the symptoms are more severe. Feeling very sick for the first 3 days is common.
    • The treatment of Swine Flu depends on your main symptoms and is usually no different from that used for other viral respiratory infections. Most people who have been sick with this virus have recovered at home without treatment.
    • If you have flu-like symptoms, please stay at home until at least 24 hours after your are free of fever.
  2. Swine Flu - Symptoms:
    • The symptoms of swine flu are the same as those seen with regular human influenza.
    • The main symptoms are fever, cough, sore throat and runny nose.
    • Fever must be present to make this diagnosis (CDC).
    • Other common symptoms are muscle pain, headache and fatigue.
    • Some people also have vomiting and diarrhea, but never as the only symptom.
  3. Swine Flu - Treatment with Antiviral Medications:
    • There are two anti-viral medications that are possibly helpful in treating this infection: oseltamivir (brand name Tamiflu) and zanamivir (brand name Relenza).
    • Treatment is recommended for HIGH RISK patients (e.g., age > 64 years, pregnant, HIV+, or chronic medical condition) with Swine Flu or any patient with severe symptoms. (per CDC).
    • Treatment is typically not recommended for mild to moderate Swine Flu illness that occurs in most healthy patients (per CDC).
    • Most patients recover without taking antiviral medications.
  4. Swine Flu - Contagiousness:
    • Symptoms usually start within 4-6 days of exposure to a person with swine flu (7 days is an outer limit). If more than 7 days pass from exposure without you developing symptoms, you should be safe and not get swine flu.
    • A person with swine flu is contagious for 7 days after the onset of symptoms (e.g., fever, cough).
    • The swine flu virus is spread by airborne droplets, from sneezing and coughing, just like other influenza viruses. It also can be transmitted by hands contaminated with secretions.
    • Swine flu is NOT transmitted by eating pork.
  5. Call Your Doctor If:
    • You have other questions or concerns
    • You become worse.
Preventing Swine Flu
  1. How to Protect Yourself From Getting Sick:
    • Wash hands often with soap and water.
    • Alcohol-based hand cleaners are also effective.
    • Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way.
    • Try to avoid close contact with sick people.
    • Try to avoid unnecessary visits to the emergency department and urgent care centers because those are the places where you are more likely to be exposed to Swine Flu, if you don't have it.
  2. How To Protect Others - Stay Home When Sick:
    • Cover the nose and mouth with a tissue when coughing or sneezing.
    • Wash hands often with soap and water, especially after coughing or sneezing.
    • Limit contact with others to keep from infecting them.
    • Stay home from school or work for at least 24 hours after the fever is gone (CDC, August 2009).
  3. Face Masks:
    • Face masks refer to disposable masks labeled as surgical or dental masks.
    • For healthy people, face masks may help reduce the risk of getting swine flu in crowded settings, if swine flu becomes prevalent (CDC).
    • Avoiding sick people and frequent hand washing are more effective preventive measures.
    • At the present time, face masks are not needed in the U.S. for healthy people. (Possible exception: households where a family member has Swine Flu).
    • Sick people should wear a face mask if they must leave their home to seek medical care.
  4. Swine Flu Vaccine:
    • A vaccine against Swine Flu is in development.
    • It is supposed to be available in Fall 2009.
    • The CDC will provide guidelines regarding who should get the vaccine.
  5. Preventing Swine Flu - Antiviral Medications:
    • Two medications licensed in the U.S. and Canada are believed to be effective in PREVENTING the swine influenza virus: zanamivir (Relenza), and oseltamavir (Tamiflu).
    • Possible indications: Recent close contact with person with confirmed Swine Flu AND the exposed person is in a HIGH RISK group (e.g., age > 64 years, pregnant, HIV+, or chronic medical condition).
    • It is effective only while you are taking it and ceases once you stop taking it.
    • You should only take one of these antiviral medications if your physician recommends it.
  6. Call Your Doctor If:
    • You have other questions or concerns
    • You become worse.
Internet Resources
  1. Information from the World Health Organization (WHO) about Swine Flu
  2. Internet Resource for U.S.
  3. Internet Resource for Canada

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 8/9/2009

Last Revised: 8/26/2009

Content Set: Adult HouseCalls Online

Copyright 2000-2009 David A. Thompson, M.D.

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