Swine Flu Factfile And Treatment

SWINE FLU FACTFILE What are the symptoms? Swine flu symptoms are similar to the symptoms of regular flu and include fever of over 100.4°F, fatigue, lack of appetite, and cold. Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea. Nearly everyone with flu has at least two of these symptoms. So, how do you know if you have flu or just cold? There is one clue: when you have the flu, you feel flu symptoms sooner than you would cold symptoms, and they come on with much greater intensity. With the flu, you may feel very weak and fatigued for up to 2 or 3 weeks. You'll have muscle aches and periods of chills and sweats as fever comes and goes. You may also have a stuffy or runny nose, headache, and sore throat. Can I compare flu symptoms with cold symptoms? Yes. The following chart can help you compare flu symptoms with cold symptoms. Use it to lean the differences and similarities between flu and cold symptoms. Then, if you get flu symptoms, call your doctor and ask about an antiviral drug. Symptoms

Cold

Flu

Fever

Rare

Characteristic, high 100-102 degrees F); lasts 3-4 days

Headache

Rare

Prominent

General aches, pains

Slight

Usual; often severe

Fatigue, Weakness

Quite mild

Can last up to 2-3 weeks

Extreme Exhaustion

Never

Early and prominent

Stuffy Nose

Common

Sometimes

Chest Discomfort,Cough Mild to moderate; hacking cough Common; can become severe You cannot confirm if you have swine flu just based on your symptoms. Like seasonal flu, pandemic swine flu can cause neurologic symptoms in children. These events are rare, but, as cases associated with seasonal flu have shown, they can be very severe and often fatal. Doctors may offer a rapid flu test, but what you need to understand is a negative result doesn't necessarily mean you don't have the flu. Only lab tests can definitively show whether you've got swine flu. State health departments can do these tests. Source: WebMD

What should you do immediately? Those of you who have travelled from the affected countries in the past ten days and show symptoms swine flu like fever, cough, sore throat and difficulty in breathing should immediately contact the telephone number given below or visit the nearby Government Hospital. Important contact numbers: Outbreak Monitoring Cell (Control Room, NICD): 011-23921401 Websites: www.mohfw.nic.in and www.nicd.nic.in You can also contact a toll free number 2392 1401 at the National Institute of Communicable Disease Contact number for each cities: Mumbai Kasturba Hospital, Arthur Road, Sane Guruji Marg, Mumbai 400011 Ph: 022- 23083901 / 23092458 / 23000889 Source: Swine Flu India website

What is the treatment? Antiviral drugs can be used to treat swine flu or to prevent infection with swine flu viruses. The anti-viral medicines oseltamivir (Tamiflu) and zanamivir (Relenza) are being used to treat people with swine flu. Antiviral drugs work by preventing the flu virus from reproducing. To be effective you need to take them within 48 hours of the symptoms beginning. These flu drugs can decrease the duration of the flu by 1 to 2 days if used within this early time period. These antivirals are usually given for a period of about 5-7 days. It's unclear whether these drugs can prevent complications of the flu. Tamiflu is approved for prevention and treatment in people 1 year old and older. Relenza is approved for treatment of people 7 years old and older and for prevention in people 5 years old and older. These medications must be prescribed by a health care professional.

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Side effects: Side effects of antiviral drugs may include nervousness, poor concentration, nausea, and vomiting. Relenza is not recommended for people with a history of breathing problems, such as asthma, because it may cause a worsening of breathing problems. Discuss side effects with your doctor. Self medication: Antibiotics are a no-no. Chances are that antibiotics will not help your flu symptoms. That's because flu, colds, and most sore throats and bronchitis are caused by viruses. In addition, taking antibiotics when you have a virus may do more harm than good. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment. Antibiotics only cure certain infections due to bacteria -- and if taken carelessly, you may get more serious health problems than you bargained for. Is there a vaccine to treat swine flu virus? No, there isn’t a vaccine yet. But vaccines are being made in large quantities. Clinical tests will begin in August 2009. Depending on how long federal officials wait for the results of these tests, tens of millions of doses of swine flu vaccine could be ready as soon as September 2009, with more vaccine becoming available each month thereafter. The first doses of vaccine likely will go to pregnant women and young children ages 6 months to 4 years, with older school kids to follow. Source: Centres for Disease Control and Prevention (CDC), National Health Service, UK website, WebMD

Who is at risk? Those who are more at risk from becoming seriously ill with swine flu are people with: chronic (long-term) lung disease, including people who have had drug treatment for their asthma within the past three years,

• • • • • • • • •

chronic heart disease, chronic kidney disease, chronic liver disease, chronic neurological disease (neurological disorders include motor neurone disease, Parkinson's disease and multiple sclerosis), suppressed immune systems (whether caused by disease or treatment), diabetes, pregnant women, people aged 65 or older, and young children under five.

Source: National Health Service, UK website

How does it spread? The new swine flu virus is highly contagious, that is it spreads from person to person. The virus is spread through the droplets that come out of the nose or mouth when someone coughs or sneezes. If someone coughs or sneezes and they do not cover it, those droplets can spread about one metre (3ft). If you are very nearby you might breathe them in. Or, if someone coughs or sneezes into their hand, those droplets and the virus within them are easily transferred to surfaces that the person touches, such as door handles, hand rails, telephones and keyboards. If you touch these surfaces and touch your face, the virus can enter your system, and you can become infected. Source: National Health Service, UK website

Can it be prevented? Influenza antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with swine influenza. When used to prevent the flu, antiviral drugs are about 70% to 90% effective. When used for prevention, the number of days that they should be used will vary depending on a person’s particular situation. Follow this general procedure to reduce the risk of catching or spreading the virus, you should:

• • • • • • • •

Cover your mouth and nose when coughing and sneezing, using a tissue Throw the tissue away quickly and carefully Wash your hands regularly with soap and water Clean hard surfaces (like door handles and remote controls) frequently with a normal cleaning product Keep away from others as much as possible. This is to keep from making others sick. Do not go to work or school while ill Stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.) Drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated Wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others.

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Source: CDC, National Health Service, UK website

Will it help to wear a mask? Information on the effectiveness of facemasks and respirators for decreasing the risk of influenza infection in community settings is extremely limited. So, it is difficult to assess their potential effectiveness in decreasing the risk of Swine Flu virus transmission in these settings. However, a well-fitted, FDA-approved mask together with other preventive measures MAY reduce the risk of contracting the flu. Those who are sick or caring for someone who is ill should consider using a mask or respirator if leaving the house becomes necessary. Source: CDC

What precautions should one take at home? Two things - soap and water can reduce the chance of infection by 30 per cent. All you need to do is keep washing your hand with soap and water frequently. Wash hands frequently with soap and water or use alcohol-based hand cleaner when soap and water are not available. Avoid touching your eyes, nose and mouth Eat healthy: Proteins are essential to help your body maintain and build strength. Lean meat, poultry, fish, legumes, dairy, eggs, and nuts and seeds are good sources of protein. The Food and Drug Administration recommends that adults eat 50 grams of protein per day. Pregnant and nursing women need more. By eating foods high in protein, we also get the benefit of other healing nutrients such as vitamins B6 and B12, both of which contribute to a healthy immune system. Vitamin B6 is widely available in foods, including protein foods such as turkey and beans as well as potatoes, spinach, and enriched cereal grains. Proteins such as meats, milk, and fish also contain vitamin B12, a powerful immune booster. Minerals such as selenium and zinc work to keep the immune system strong. These minerals are found in protein rich foods such as beans, nuts, meat, and poultry. Exercise: Regular exercise may help prevent the flu. According to recent findings, when moderate exercise is repeated on a near daily basis, there is a cumulative immune-enhancing effect. That is, your strong immune system can fight flu better. When you exercise, your white blood cells -- the blood cells that fight infections in the body -- travel through your body more quickly, fighting bacteria and viruses (such as flu) more efficiently. To maintain good health, experts recommend at least 30 minutes of aerobic activity such as walking, swimming, biking, or running each day. Source: Flu India website, CDC, WebMD

What precautions should one take at schools? Avoid close contact with people who are sick :--People who are sick with an influenza-like illness should stay home and keep away from others as much as possible, including avoiding travel, for at least 24 hours after fever is gone except to get medical care or for other necessities. (Fever should be gone without the use of fever-reducing medicine). Cover your mouth and nose with a tissue when coughing or sneezing (1)Wash your hands often(2)Avoid touching your eyes, nose or mouth

Is it safe to travel? Avoid travelling unnecessarily. However, if you must travel, check how the country you're going to handles swine flu. Although, the WHO doesn't recommend travel restrictions, many countries have set up their own H1N1 policies, and some travellers have been screened or quarantined in other countries because of swine flu concerns.

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Table: Recommended Daily Dosage of Seasonal Influenza Antiviral Medications for Treatment and Chemoprophylaxis for the 2008-09 Season—United States Note: New as of April 25, 2009 - Antiviral resistance testing results for cases of swine influenza A (H1N1) virus infection detected in the United States.

Note: On December 19, 2008, CDC issued Interim Recommendations for the Use of Influenza Antivirals for the 2008-09 Season. The interim results of antiviral resistance testing performed on influenza viruses tested by CDC for the 2008-09 influenza season are summarized in the table below. Swine Influenza As of April 25, 2009

Isolates

Resistant Viruses,

Isolates

Resistant

tested

Number (%)

tested

Viruses,

(n)

Number (%)

(n) Oseltamivir Zanamivir

Adamantanes* Swine Influenza A

7

0

0

15

15

(H1N1) Data from October 1, 2008 March 29, 2009

Isolates

Resistant Viruses,

Isolates

Resistant Viruses,

tested (n)

Number (%)

tested (n)

Number (%)

Oseltamivir Zanamivir

Adamantanes*

Influenza A (H1N1)

654

649 (99.2%)

0 (0)

605

3 (0.5%)

Influenza A (H3N2)

94

0 (0)

0 (0)

94

94 (100%)

274

0 (0)

0 (0)

N/A*

N/A*

Influenza B

For updated CDC antiviral resistance testing data, see http://www.cdc.gov/flu/weekly/. * The adamantanes (amantadine and rimantadine) are not effective against influenza B viruses. The table below provides the daily dosage information for the four FDA approved influenza antiviral medications for treatment and chemoprophylaxis of seasonal influenza in the United States for the 2008-09 season. On December 19, 2008, CDC issued interim recommendations for the use of influenza antiviral medications for the 2008-09 Season based on information about antiviral resistance among circulating influenza viruses.

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Antiviral agent

Age group (yrs) 1-6

Zanamivir*

7-9

10-12 10 mg (2

13-64

65 and older

Treatment, influenza A N/A†

10 mg (2

10 mg (2

10 mg (2

and B

inhalations) twice inhalations)

inhalations)

inhalations)

daily

twice daily

twice daily

twice daily

Chemoprophylaxis,

Ages 1-4

Ages 5-9

10 mg (2

10 mg (2

10 mg (2

influenza A and B

N/A

10 mg (2

inhalations)

inhalations)

inhalations)

inhalations) once

once daily

once daily

once daily

daily Oseltamivir

Treatment†, influenza

Dose varies by

Dose varies by

Dose varies by 75 mg twice

75 mg twice

A and B

child's weight§

child's weight§

child's

daily

daily

weight§ Chemoprophylaxis,

Dose varies by

Dose varies by

Dose varies by 75 mg/day

influenza A and B

child's weight¶

child's weight¶

child's

75 mg/day

weight¶ Amantadine**

Treatment, influenza A 5 mg/kg body

5 mg/kg body

weight/day up to weight/day up to

Rimantadine¶¶

150 mg in 2

150 mg in 2

divided doses††

divided doses††

Prophylaxis, influenza

5 mg/kg body

5 mg/kg body

A

weight/day up to weight/day up to

Treatment#, influenza

150 mg in 2

150 mg in 2

divided doses††

divided doses††

N/A##

N/A

100 mg twice

100 mg twice

less than or

daily§§

daily

equal to 100 mg/day

100 mg twice

100 mg twice

less than or

daily§§

daily§

equal to 100 mg/day

N/A

A

100 mg twice

100 mg/day

daily§§$

Prophylaxis, influenza

5 mg/kg body

A

weight/day up to weight/day up to

5 mg/kg body

150 mg in 2

150 mg in 2

divided doses††

divided doses††

100 mg twice

100 mg twice

daily§§

daily§

Duration of

Treatment

Recommended duration for antiviral treatment is 5 days.

Treatment

Chemoprophylaxis

Recommended duration is 5-7 days after the last known exposure.

100 mg/day$$

For control of outbreaks in long-term care facilities and hospitals, CDC recommends antiviral chemoprophylaxis for a minimum of two weeks, and up to one week after the last known case was identified. NOTE: Zanamivir is manufactured by GlaxoSmithKline (Relenza — inhaled powder). Zanamivir is approved for treatment of persons aged 7 years and older and approved for chemoprophylaxis of persons aged 5 years and older. Oseltamivir is manufactured by Roche Pharmaceuticals (Tamiflu® — tablet) Oseltamivir is approved for treatment or chemoprophylaxis of persons aged 1 year and older. Amantadine manufacturers include Endo Pharmaceuticals (Symmetrel® — tablet and syrup); Geneva Pharms Tech (Amantadine HCL — capsule); USL Pharma (Amantadine HCL — capsule and tablet); and Alpharma, Carolina Medical, Copley Pharmaceutical, HiTech Pharma, Mikart, Morton Grove, and Pharmaceutical Associates (Amantadine HCL — syrup), and Sandoz. Rimantadine is manufactured by Forest Laboratories (Flumadine® — tablet and syrup); Corepharma, Impax Labs (Rimantadine HCL — tablet), and Amide Pharmaceuticals (Rimantadine HCL — tablet). No antiviral medications are approved for treatment or chemoprophylaxis of influenza among children younger than 1 year of age. This information is based on data published by the Food and Drug Administration (FDA). * Zanamivir is administered through oral inhalation by using a plastic device included in the medication package. Patients will benefit from instruction and demonstration of the correct use of the device. Zanamivir is not recommended for those persons with underlying airway disease. † A reduction in the dose of oseltamivir is recommended for persons with creatinine clearance less than 30 mL/min. § The treatment dosing recommendation for children who weigh 15 kg or less is 30 mg twice a day. For children who weigh

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more than 15 kg and up to 23 kg, the dose is 45 mg twice a day. For children who weigh more than 23 kg and up to 40 kg, the dose is 60 mg twice a day. For children who weigh more than 40 kg, the dose is 75 mg twice a day. ¶ The chemoprophylaxis dosing recommendation for children who weigh less than 15 kg is 30 mg once a day. For who weigh more than 15 kg and up to 23 kg, the dose is 45 mg once a day. For children who weigh more than 23 kg and up to 40 kg, the dose is 60 mg once a day. For children who weigh more than 40 kg, the dose is 75 mg once a day. ** The drug package insert should be consulted for dosage recommendations for administering amantadine to persons with creatinine clearance less than or equal to 50 mL/ min/1.73m2. †† 55 mg/kg body weight of amantadine or rimantadine syrup = 1 tsp/22 lbs. §§ Children aged 10 years and older who weigh less than 40 kg should be administered amantadine or rimantadine at a dosage of 5 mg/kg body weight/day. ¶¶ A reduction in dosage to 100 mg/day of rimantadine is recommended for persons who have severe hepatic dysfunction or those with creatinine clearance less than 10 mL/min. Other persons with less severe hepatic or renal dysfunction taking 100 mg/day of rimantadine should be observed closely, and the dosage should be reduced or the drug discontinued, if necessary. # Only approved by FDA for treatment among adults. ## Not applicable. $Rimantadine is approved by FDA for treatment among adults. However, certain specialists in the management of influenza consider rimantadine appropriate for treatment among children. Studies evaluating the efficacy of amantadine and rimantadine in children are limited, but they indicate that treatment with either drug diminishes the severity of influenza A infection when administered within 48 hours of illness onset. $$ Older nursing-home residents should be administered only 100 mg/day of rimantadine. A reduction in dosage to 100 mg/day should be considered for all persons aged 65 years and older, if they experience possible side effects when taking 200 mg/day.

Related Links •

Prevention & Control of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2008

•

Prevention & Control of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2004

Treatment resistant swine flu detected in US (AFP) – 5 days ago (09 aug 2009) WASHINGTON — Health officials said they had found cases of Tamiflu-resistant swine flu along the US border with Mexico, as India and South Africa announced their first deaths from the A(H1N1) virus. 6

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the Pan-American Health Organization office in La Jolla, California. Cases of A(H1N1) that were resistant to the anti-viral medicine have now been found in the United States, Canada, Denmark, Hong Kong and Japan. Experts had gathered in La Jolla on Monday to discuss the response to the outbreak, and warned that resistant strains were likely emerging because of overuse of antivirals like Tamiflu. "In the United States Tamiflu is sold with a prescription, but in Mexico and Canada it is sold freely and taken at the first sneeze. Then, when it is really needed, it doesn't work," said Cerqueira. The Tamiflu-resistant cases were reported as South Africa and India both announced their first fatalities from the A(H1N1) virus, which emerged in Mexico in April and has since spread worldwide, gaining pandemic status. In South Africa, health authorities said Ruan Muller, a 22-year-old student at Stellenbosch University near Cape Town, had died after contracting the virus. "He died on the 28th (of July), but there had to be some testing done to ensure the cause of death. It was the A(H1N1) influenza," said Fidel Hadebe, spokesman for South Africa's Department of Health. With the world's highest number of HIV/AIDS-affected people -- nearly 19 percent of a 49-million-person population -- South Africa is considered particularly at risk because people with compromised immunity are more likely to fall prey to the disease. South Africa's swine flu caseload has increased fourfold since the country's first case was reported on June 14. The government has said its stockpile of Tamiflu will only be used for the seriously ill, but that schools may also be closed on a case-by-case basis. In India, authorities said a 14-year-old girl in the western city of Pune became the country's first fatality from the virus. The teenager first felt unwell on July 21, complaining of a sore throat, runny nose and headaches. She returned to school the following day after the general symptoms improved, the Ministry of Health and Family Welfare said. She then developed a fever again on July 25 and two days later was admitted to a private clinic for treatment. She was put on a ventilator in an intensive care unit and was treated with Oseltamivir, a generic brand of Tamiflu. "Her condition deteriorated again with multi-system involvement and (she) expired on the evening of 03.08.09," the ministry said in a statement. Meanwhile, the Russian state health agency warned the country's football fans to stay away from the national team's World Cup qualifying tie with Wales in Cardiff on September 9. "This would be an extremely unnecessary and inappropriate undertaking at a time of a flu epidemic," the head of Russia's state health agency Gennady Onishchenko said, according to local news agencies. Onishchenko expressed fear that "the expressions of emotion on the part of football fans involving intense shouting" could lead to the airborne transmission of the flu virus. Russia has to-date been relatively spared by the swine flu pandemic, with just 55 confirmed cases in the country. 7

Experts remain puzzled as to why different countries have not always been affected to the same degree, with England and Scotland both heavily hit proportionately, yet neighboring France's tally appearing light by comparison. Some have argued that gargantuan sums being spent by rich economies on a disease that is no more lethal than seasonal flu are grotesquely disproportionate when thousands die each day of diseases which receive less media coverage. Copyright © 2009 AFP. All rights reserved. More » Related articles • • •

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