Preparing for a swine flu epidemic

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Published: April 30, 2009

Regular readers of the eDocAmerica Health Tips will remember reading periodic updates on the status of avian influenza ("bird flu") during the past couple of years.

Surprisingly, it is not the bird flu that has taken recent headlines, but instead a type of influenza A (H1N1) known as "swine flu." A swine flu outbreak that started in Mexico appears to have infected more than 1,500 people there, with at least 150 deaths suspected as being a result of the virus.

The virus has crossed the border into the U.S. also, with 64 confirmed cases (as of April 28) in California, Texas, Kansas, Ohio and New York.

With sporadic cases occurring internationally and confirmation of person-to-person spread of the virus, the World Health Organization has issued an alert regarding the possibility of a worldwide pandemic (an epidemic spread over a wide geographical area) of swine flu.

Events related to this outbreak of influenza are occurring rapidly, and it will be some time before we know the severity and extent of this disease.

Nevertheless, with questions about swine flu coming into the eDoc Website, this seems to be an appropriate time to educate our clients.

What is swine flu?

Most everyone is familiar with seasonal influenza, the common type of "flu" that occurs in epidemics, usually in the winter. Swine flu is a form of the influenza A virus that causes a similar type of flu, mostly in pigs.

Occasionally, humans can contract the swine flu virus, which is what happened with the current outbreak. This new strain of swine flu virus appears to be a genetic mixture of viruses that have infected pigs and birds as well as humans.

How does it spread?

In this recent outbreak, human-to-human spread of the swine influenza virus has been confirmed by the U.S. Centers for Disease Control.

The mechanism for spreading the virus is thought to be via droplets of infected fluid when people cough or sneeze.

As of now, no one really knows how easily the virus is able to spread between people, a key issue when considering the likelihood of a wide-spread epidemic.

What are the symptoms?

Swine flu symptoms are similar to those of the seasonal flu and consist of fever, chills, muscle aches, headache, coughing and sometimes diarrhea and vomiting.

Like seasonal flu also, the severity of the illness varies from mild to severe. In most people the illness is self-limited and complete recovery occurs.

Those at greatest risk for serious complications (e.g. pneumonia and respiratory failure) are the very young, the elderly and those people whose immunity is impaired.

Is a vaccine available to prevent it?

Unfortunately, no. A swine flu vaccine was developed in the past, but there is no vaccine currently available that matches the genetic makeup of the virus responsible for the current outbreak.

Furthermore, the seasonal flu shot provides no protection against the swine flu. Almost certainly, vaccine manufacturers are in the process of isolating this current strain of swine flu virus with plans to produce a vaccine, but this process could take several months.

Is there a treatment?

Two antiviral medications, Tamiflu (oseltamivir) and Relenza (zanamivir) are effective for fighting the swine flu virus. Since both medications are available only by prescription, evaluation by a physician is necessary prior to starting one of these.

Evaluation and treatment should occur early into the illness since the medications are most effective when started within 48 hours of the onset of symptoms.

The benefits of taking antiviral medications include lessening the severity of the illness, reducing the duration of symptoms and helping to prevent serious complications associated with the flu.

What can I do about this illness?

For the most part, measures to prevent the swine flu are similar for those to prevent the seasonal flu. The Centers for Disease Control recommends the following:

• 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.

• Since influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people, try to avoid close contact with sick people.

• If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possibly for up to 7 days following illness onset.

Closing Comments: It should be recognized that there have been outbreaks of swine flu in the U.S. previously. In 1976, it was feared that an outbreak of swine flu in this country could lead to a pandemic. Widespread vaccination and preventive measures were initiated, but it was later learned that the virus was not as dangerous as originally thought.

Since then, swine flu infections have occurred on occasion, but again, no large outbreaks developed. This strain of virus could be different and certainly the World Health Organization and the U.S. Centers for Disease Control are taking this outbreak seriously.

The current swine flu virus and the strain of virus responsible for the 1918 Spanish Flu pandemic that killed around 50 million people are both of the H1N1 subtype and both came from animal sources.

We will have to be vigilant and wait to know the outcome of this current outbreak, but by taking the precautions discussed above, we can hopefully limit our risk of this illness.

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