H1N1 Swine Flu

Topics Covered in this Article: Does Extra Vitamin D prevent H1N1? What is swine flu? What is a pandemic? What are the symptoms? What do to if you get sick? What are the emergency warning signs? Do I need to go the emergency room if I am only a little sick? Are there medicines to treat 2009 H1N1? What are anti-viral drugs? Anti-viral Drugs and Children What can I do to avoid it? Steps to Lessen the Spread of Flu in the Home What To Do To Build Your Immune System

What is swine flu? Swine flu is a respiratory disease of a similar kind to the flu virus that crops up each winter. This particular strain of flu is known as H1N1, but it's commonly called swine flu because it often infects pigs. In the past it's been rare for humans to fall ill with swine flu, but the strain that started in Mexico does affect us. The biggest difference between swine flu and seasonal flu is our ability to fight it off - very few humans have ever had swine flu before, meaning we haven't had chance to build up immunity. The disease can be passed from human to human via the droplets of moisture we spray from our noses and mouths when we sneeze or cough. What is a pandemic? back to top A pandemic is when a larger-than-expected number of people throughout the world become infected with a particular disease. Swine flu has become a pandemic because of our low resistance to it and the ease with which it can be spread. You can see the number of swine flu cases worldwide here. People only die from the disease if they develop complications, such as pneumonia. What are the symptoms? back to top The symptoms of swine flu are very similar to the symptoms of regular flu and can include: fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, and sometimes vomiting and diarrhea. It’s important to note that not everyone with flu will have a fever. Like seasonal flu, 2009 H1N1 flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with 2009 H1N1 flu infection. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections. . Symptom Regular Cold H1N1 Flu Fever Fever is rare with a cold. Fever is usually present with the flu in up to 80% of all flu cases. A temperature of 100F or higher for 3 to 4 days is associated with the H1N1 flu. Chills Chills are uncommon with a cold. 60% of people who have the H1N1 flu experience chills. Sudden Symptoms Cold symptoms tend to develop over a few days. The H1N1 flu has a rapid onset within 3-6 hours. The flu hits hard and includes sudden symptoms like high fever, aches and pains. Headache A headache is fairly uncommon with a cold. A headache is very common with the H1N1 flu, present in 80% of flu cases. Aches Slight body aches and pains can be part of a cold. Severe aches and pains are common with the H1N1 flu. Chest Discomfort Chest discomfort is mild to moderate with a cold. Chest discomfort is often severe with the H1N1 flu. Coughing A hacking, productive (mucus- producing) cough is often present with a cold. A non-productive (non-mucus producing) cough is usually present with the H1N1 flu (sometimes referred to as dry cough). Stuffy Nose Stuffy nose is commonly present with a cold and typically resolves spontaneously within a week. Stuffy nose is not commonly present with the H1N1 flu. Sneezing Sneezing is commonly present with a cold. Sneezing is not common with the H1N1 flu Sore Throat Sore throat is commonly present with a cold. Sore throat is not commonly present with the H1N1 flu. Tiredness Tiredness is fairly mild with a cold. Tiredness is moderate to severe with the H1N1 flu. Vomiting and Diarrhea Vomiting and diarrhea are not commonly present with a cold. Vomiting and diarrhea may be present with the H1N1 flu. What do to if you get sick? back to top If you get sick with flu-like symptoms this flu season, you should stay home and avoid contact with other people except to get medical care. Most people with 2009 H1N1 have had mild illness and have not needed medical care or anti-viral drugs and the same is true of seasonal flu. See also Beat the Winter Bugs and Flu What to Do However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are: Children younger than 5, but especially children younger than 2 years old People 65 and older Pregnant women People who have: Cancer Blood disorders (including sickle cell disease) Chronic lung disease [including asthma or chronic obstructive pulmonary disease (COPD)] Diabetes Heart disease Kidney disorders Liver disorders Neurological disorders (including nervous system, brain or spinal cord) Neuromuscular disorders (including muscular dystrophy and multiple sclerosis) Weakened immune systems (including people with AIDS) Also, it’s possible for healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care provider. There are emergency warning signs. Anyone who has them should get medical care right away. What are the emergency warning signs? back to top In children Fast breathing or trouble breathing Bluish skin color Not drinking enough fluids Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms improve but then return with fever and worse cough Fever with a rash In adults Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Do I need to go the emergency room if I am only a little sick? back to top No. The emergency room should be used for people who are very sick. You should not go to the emergency room if you are only mildly ill. If you have the emergency warning signs of flu sickness, you should go to the emergency room. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. If you go to the emergency room and you are not sick with the flu, you may catch it from people who do have it Are there medicines to treat 2009 H1N1? back to top Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “anti-viral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, anti-viral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether anti-viral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or anti-viral drugs and the same is true of seasonal flu. What are anti-viral drugs? back to top Influenza anti-viral drugs are prescription drugs (pills, liquid, or inhaler) that decrease the ability of flu viruses to reproduce. While getting a flu vaccine each year is the first and most important step in protecting against flu, anti-viral drugs are a second line of defense in the prevention and treatment of flu.   Anti-viral drugs can help with the symptoms of flu. They will also reduce the amount of time a person is ill, usually by around one day, and help to guard against further complications. At this time, treatment with oseltamivir (trade name Tamiflu®) or zanamivir (trade name Relenza®) is recommended for all people with suspected or confirmed influenza who require hospitalization. The recommended duration of treatment is five days. However, hospitalized patients with severe infections might require longer treatment courses. Anti-viral drugs may be especially important for people who are very sick (hospitalized) or people who are sick with the flu and who are at increased risk of serious flu complications, such as pregnant women, young children and those with chronic health conditions. Once the decision to administer anti-viral treatment is made, treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Evidence for benefits from anti-viral treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of oseltamivir treatment of hospitalized patients with seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset. When treatment is indicated, health care providers generally should not wait for laboratory confirmation of influenza to begin treatment with anti-viral drugs because laboratory testing can delay treatment and because a negative rapid test for influenza does not rule out influenza. The sensitivity of rapid influenza diagnostic tests can range from 10-70% for 2009 H1N1 virus. Anti-viral Drugs and Children back to top Can children take anti-viral drugs? Yes. The two drugs recommended for use against influenza (including 2009 H1N1) this season can be used in children. As an aside warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome. Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin and avoid them. Oseltamivir (Tamiflu®) is approved by the Food and Drug Administration (FDA) for use in children 1 year of age or older. In addition, in July 2009, the FDA issued an Emergency Use Authorization (EUA) for the use of Tamiflu Adobe PDF file® in pediatric patients younger than 1 year of age. Zanamivir (Relenza®), is approved for treatment in children 7 years and older, but is licensed only for use in people without underlying respiratory or heart disease, including people with asthma. What kind of anti-viral drugs are available for children? Oseltamivir (Tamiflu®) comes in an oral suspension (liquid) for children. It also comes in capsules at children’s dosages. Zanamivir (Relenza®) is an inhaled powder that comes with a disk inhaler. What are the recommendations for the use of anti-viral drugs in young children? The September 22, 2009 updated interim recommendations for the use of anti-viral drugs provides additional clarification regarding the increased risk for flu-related complications for young children. Children younger than 2 years old should be considered for early empiric treatment with the anti-viral drug oseltamivir if they have suspected or confirmed flu. Hospitalization data available found that children younger than 2 years old were at increased risk for flu-related complications compared to older populations. During April through August 2009, hospitalization rates for lab-confirmed 2009 H1N1 influenza in children younger than 2 years old was 2.5 times higher than the rates for children 2 years to 4 years old. In studies of seasonal influenza, the risk for hospitalization is also highest for infants, with the risk decreasing as a child gets older. Given this increased risk for hospitalizations, children younger than 2 years are generally recommended for anti-viral treatment. Children ages 2 years to 4 years old without high risk conditions and who are not severely ill do not necessarily need anti-viral treatment. While children 2 years to 4 years old are more likely to require hospitalizations or urgent medical care for influenza compared with older children, this risk is much lower than the risk for children younger than 2 years old. Providers should use clinical judgment to guide treatment decisions for healthy children. What if the pediatric oral suspension (liquid formulation) is not available and the child cannot swallow a capsule? In the absence of oral suspension (liquid formulation) of Tamiflu® for pediatric patients who cannot swallow capsules, the children’s doses of Tamiflu® capsules may be opened and mixed with sweetened liquids such as regular or sugar-free chocolate syrup. What if there is no oral suspension (liquid formulation) and there are no pediatric doses of Tamiflu® capsules available? In the absence of both oral suspension and pediatric capsules of Tamiflu®, there is another option to meet the need for a pediatric prescription of Tamiflu®. Adult dose (75 mg) capsules can be compounded by a health care professional to create a pediatric formulation. Compounding is the mixing of drugs by a health care professional to fit the unique needs of a patient. The FDA has a statement on their website at http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htmExternal Web Site Icon to remind health care providers and pharmacists of the FDA-approved instructions for the emergency compounding of an oral suspension from Tamiflu® 75mg capsules as described in the FDA approved manufacturer package insert for oseltamivir (Tamiflu ®). Compounding an oral suspension from Tamiflu® 75mg capsules provides an alternative oral suspension when commercially manufactured oral suspension formulation is not readily available. What are the side effects of anti-viral drugs in children? Reported side effects of oseltamivir are nausea and vomiting. Among children treated with oseltamivir in clinical studies, 14% had vomiting, compared with 8.5% of children getting a “placebo.” (A placebo is an inactive substance that looks the same as, and is given in the same way as, a drug in a clinical trial.) Nausea and vomiting might be less severe if oseltamivir is taken with food. In addition, there have been reports of self-injury or delirium among persons with influenza who take oseltamivir. Most of these reports have been in teenagers from Japan, and it is still not certain whether oseltamivir or the influenza virus was responsible for these behavior changes. The U.S. Food and Drug Administration advises that people taking either of the two medications recommended for influenza (oseltamivir and zanamivir) be monitored closely for abnormal behavior. Side effects from zanamivir have been reported in fewer than 5% of people participating in clinical trials and have been reported at the same rate in people receiving zanamivir as those being given a “placebo.” Reported side effects have included diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections. Also, zanamivir should not be used in people with underlying respiratory disease, including asthma. What are the benefits of anti-viral treatment in children? Anti-viral drugs work best if started soon after getting sick (within two days of symptoms starting.) Anti-viral drugs can make flu symptoms milder and can shorten the duration of illness. Early treatment of influenza with anti-viral drugs also has been shown to reduce the incidence of ear infections and the need for antibiotics in children between the ages of 1 and 12 years old. Studies in adults show that treatment with anti-viral drugs may reduce more serious flu-related complications like pneumonia and hospitalizations. While no such studies have been done on children, anti-viral drugs may be similarly helpful for reducing more serious flu-related complications in children. Treatment with influenza anti-viral drugs could be particularly important for children at high risk of flu-related complications, including children younger than 2 years old and children of any age with chronic health conditions like asthma, diabetes, or heart or lung disease. This season, anti-viral drugs are being prioritized for hospitalized patients (including children) and high risk patients who are sick with the flu. What do other experts say about anti-viral drugs and children? The American Academy of Pediatrics (AAP) recommends anti-viral drugs to treat influenza in children who are at higher risk of serious flu-related complications and who have moderate-to-severe influenza. These children in particular may benefit from a decrease in the duration of their symptoms. For more information on the AAP recommendations, visit http://www.pediatrics.org/cgi/content/full/119/4/852. What can I do to avoid it? back to top The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands. Make sure you always sneeze or cough into a tissue and then throw the tissue away. This will help prevent the flu virus spreading. The virus can also live for some time outside of the human body, so it's important to regularly wash your hands with soap and hot water and to clean surfaces that are touched regularly, such as door handles or computer keyboards. Some countries have advised people to wear face masks, but there's no evidence that masks prevent people from becoming infected. People with 2009 H1N1 flu who are cared for at home should: check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema check with their health care provider about whether they should take anti-viral medications 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.) get plenty of rest drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated cover coughs and sneezes. Wash hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. wear a face mask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza. be watchful for emergency warning signs that might indicate you need to seek medical attention. Steps to Lessen the Spread of Flu in the Home back to top When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to: keep the sick person away from other people as much as possible (see “placement of the sick person”) especially others who are at high risk for complications from influenza remind the sick person to cover their coughs, and clean their hands with soap and water often. If soap and water are not available, they should use an alcohol-based hand rub*, especially after coughing and/or sneezing have everyone in the household clean their hands often, using soap and water (or an alcohol-based hand rub*, if soap and water are not available). Children may need reminders or help keeping their hands clean contacts who may be pregnant or have chronic health conditions—should take anti-viral medications such as oseltamivir (Tamiflu®) or zanamivir (Relenza®) to prevent the flu If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a face mask or respirator, if available and tolerable. Infants should not be cared for by sick family members. For more information, see the Interim Recommendations for Face mask and Respirator Use Placement of the sick person Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed. Unless necessary for medical care or other necessities, 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 a fever-reducing medicine). This is to keep from making others sick. Children, especially younger children, might potentially be contagious for longer periods. If persons with the flu need to leave the home (for example, for medical care), they should wear a face mask, if available and tolerable, and cover their nose and mouth when coughing or sneezing Have the sick person wear a face mask – if available and tolerable – if they need to be in a common area of the house near other persons. If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant (see below). Protect other persons in the home The sick person should not have visitors other than caregivers. A phone call is safer than a visit. If possible, have only one adult in the home take care of the sick person. People at increased risk of severe illness from flu should not be the designated caretaker, if possible. If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a face mask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Face mask and Respirator Use. Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of influenza-related complications and immunity can be suppressed during pregnancy). Avoid having sick family members care for infants and other groups at high risk for complications of influenza. All persons in the household should clean their hands with soap and water frequently, including after every contact with the sick person or the person’s room or bathroom. Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person. If soap and water are not available, persons should use an alcohol-based hand rub. If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.). Anti-viral medications can be used to prevent the flu, so check with your health care provider to see if some persons in the home should use anti-viral medications. If you are the caregiver Avoid being face-to-face with the sick person. When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face. Clean your hands with soap and water after you touch the sick person or handle used tissues, or laundry. If soap and water are not available, use an alcohol-based hand rub Talk to your health care provider about taking anti-viral medication to prevent the caregiver from getting the flu. If you are at high risk of influenza associated complications, you should not be the designated caretaker, if possible. If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. Designate a person who is not at high risk of flu associated complications as the primary caretaker of household members who are sick with influenza, if at all possible. If close contact with a sick individual is unavoidable, consider wearing a face mask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Face mask and Respirator Use Monitor yourself and household members for flu symptoms and contact a telephone hotline or health care provider if symptoms occur. Using Face masks or Respirators Avoid close contact (less than about 6 feet away) with the sick person as much as possible. If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a face mask (for example, surgical mask) or N95 disposable respirator. An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a face mask, but compared with a face mask it is harder to breathe through an N95 mask for long periods of time. Face masks and respirators may be purchased at a pharmacy, building supply or hardware store. Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor. Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible. Used face masks and N95 respirators should be taken off and placed immediately in the regular trash so they don’t touch anything else. Avoid re-using disposable face masks and N95 respirators, if possible. If a reusable fabric face mask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer. After you take off a face mask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer. Household Cleaning, Laundry, and Waste Disposal Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste. Keep surfaces (especially bedside tables, surfaces in the bathroom, and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label. Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid “hugging” laundry prior to washing it to prevent contaminating yourself. Clean your hands with soap and water right after handling dirty laundry. If soap and water are not available, use an alcohol-based hand rub. Eating utensils should be washed either in a dishwasher or by hand with water and soap. Testimonials on the Efficacy of Vitamin D in preventing H1N1 back to top *Dr. Cannell: Your recent newsletters and video about Swine flu (H1N1) prompted me to convey our recent experience with an H1N1 outbreak at Central Wisconsin Center (CWC). Unfortunately, the state epidemiologist was not interested in studying it further so I pass it on to you since I think it is noteworthy. CWC is a long-term care facility for people with developmental disabilities, home for approx. 275 people with approx. 800 staff. Serum 25-OHD has been monitored in virtually all residents for several years and patients supplemented with vitamin D. In June, 2009, at the time of the well-publicized Wisconsin spike in H1N1 cases, two residents developed influenza-like illness (ILI) and had positive tests for H1N1: one was a long-term resident; the other, a child, was transferred to us with what was later proven to be H1N1. On the other hand, 60 staff members developed ILI or were documented to have H1N1: of 17 tested for ILI, eight were positive. An additional 43 staff members called in sick with ILI. (Approx. 11–12 staff developed ILI after working on the unit where the child was given care, several of whom had positive H1N1 tests.) So, it is rather remarkable that only two residents of 275 developed ILI, one of which did not develop it here, while 103 of 800 staff members had ILI. It appears that the spread of H1N1 was not from staff-to-resident but from resident-to-staff (most obvious in the imported case) and between staff, implying that staff were susceptible and our residents protected. Sincerely, Norris Glick, MD Central Wisconsin Center Madison, WI *Dr. Cannell: Thanks for your update about the hospital in Wisconsin. I have had similar anecdotal evidence from my medical practice here in Georgia. We are one of the 5 states with widespread H1N1 outbreaks. I share an office with another family physician. I aggressively measure and replete vitamin D. He does not. He is seeing one to 10 cases per week of influenza-like illness. In my practice— I have had zero cases. My patients are universally on 2000–5000 IU to maintain serum levels 50–80 ng/ml. Ellie Campbell, DO Campbell Family Medicine 3925 Johns Creek Court Ste A Suwannee GA 30024 * Excerpts from The Vitamin D Newsletter September 2009 — Special Report from the VitaminDCouncil.org A Minnesota nursing home story. On 11/2/09, we were talking with a nurse at a MN nursing home who had just gotten over H1N1 and said it was the worst 10 day flu she had ever had. She reported that all the residents in her home were regularly supplemented with large doses of Vitamin D and none of them had gotten the flu. But, the staff, who were not regular Vitamin D users, had many cases of the H1N1 flu and seemed to give it to each other. This is another high indicator that supplementing with Vitamin D does help prevent H1N1. Carol Dunn Hopkins Technology Hopkins MN What To Do To Build Your Immune System back to top Here are the steps that ehow.com suggests: 1) Take Vitamin D which improves immunity to H1N1 flu by increasing production of antimicrobial agents in the body. These antimicrobials can fight swine flu and other types of influenza. It’s no coincidence that flu season coincides with the lowest annual levels of Vitamin D. To ramp up your immune system, take 2000-5000 mg a day of Vitamin D. The best form of Vitamin D to use is D3. 2) Take Vitamin C as it not only boosts levels of infection fighting white blood cells, but it also increases the number of interferon antibodies which work to keep the swine flu from even entering cells. Aim for 200 mg ingested over the course of day either in food or supplements. 3) Take Vitamin E which fosters production of natural killer cells that seek out and destroy swine flu germs. It’s hard to eat enough food to reach therapeutic levels of Vitamin E, so consider a supplemental dose between 100-400 mg. 4) Eat foods rich in Vitamin A to boost immune response, however, because high levels can be toxic, avoid supplements and eat your carrots. Be especially careful of Vitamin A intake if you are pregnant as high levels can hurt a fetus. 5) Eat foods rich in bioflavonoids. Bioflavonoids fill up cell receptor sites so H1N1 flu germs can’t get into your cells and cause infection. Bioflavonoids are found in white and green teas, wine, dark chocolate, peppers, garlic, blueberries, and citrus fruits. For best results, combine with foods rich in vitamin C and calcium. 6) Take a zinc supplement. Zinc doesn’t just increase immune response, it makes it fight the swine flu more aggressively. Supplement with 15 to 25 mg a day and don’t go over 75 mg as that can actually weaken your immune system.