Swine Flu Exposure

Symptoms

DEFINITION

• Exposure to Swine Influenza (Swine Flu; Novel H1N1 influenza virus)
• You have no respiratory symptoms (i.e., cough, runny or stuffy nose, sore throat)
• Questions about Swine Influenza

Exposure (Close Contact) to Swine Influenza, is defined as:

• Household Close Contact: Living in the same house (household contacts) with a person with confirmed, probable, or suspected Swine Flu (H1N1).
• Other Close Contact (within 3 feet, 1 meter; touching distance) with a person with confirmed, probable, or suspected Swine Flu (H1N1). Examples of such close contact include kissing or embracing, sharing eating or drinking utensils, carpooling, close conversation, performing a physical examination (relevant to health care providers), and any other direct contact with respiratory secretions of a person with Swine Flu.

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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
• Asthma
• Neurological and neuro-developmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].
• Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
• Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
• Blood disorders (such as sickle cell disease)
• Endocrine disorders (such as diabetes mellitus)
• Kidney disorders
• Liver disorders
• Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
• Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids)

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. Three groups that may especially benefit from prophylaxis are [a] pregnant women, [b] health care workers, and [c] 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.htm

Staying Home from Work and School

• The CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]).
• More information on this is available at: http://www.cdc.gov/h1n1flu/guidance/exclusion.htm

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See More Appropriate Topic (instead of this one) If

• Swine Flu exposure (Close Contact) in past 7 days and you have any respiratory symptoms (e.g., cough, runny nose), use SWINE FLU
• 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

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• You feel weak or very sick

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Swine Flu EXPOSURE (Close Contact) within last 7 days AND you are a health care worker, public health worker, or first responder (EMS)
• Swine Flu EXPOSURE (Close Contact) within last 7 days AND you are at HIGH RISK (e.g., age over 64 years, pregnant, HIV+, or chronic medical condition) for complications of flu
• Patient lives with confirmed or suspected Swine Flu case (ongoing Close Contact) AND no respiratory symptoms

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Swine Flu EXPOSURE (Close Contact) more than 7 days ago AND no respiratory symptoms
• Swine Flu, questions about
• Swine Flu prevention, questions about

Care at Home

HOME CARE ADVICE FOR SWINE FLU (H1N1) EXPOSURE

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 is usually present
   • 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 helpful in treating this infection: oseltamivir (brand name Tamiflu) and zanamivir (brand name Relenza).
   • Treatment is recommended for HIGH RISK patients (e.g., age over 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.
   • The benefits are limited: antiviral medications may reduce the time you are sick by 1 to 1.5 days. It helps reduce the symptoms, but does not cure the disease.
   • For best results, antiviral medications should be started within 48 hours of the onset of flu symptoms.
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.
   • 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.
   • A person is potentially contagious (virus may be in respiratory secretions) from 1 day prior to and for 7 days after the onset of symptoms (e.g., fever, cough). The CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F or 37.8°C).
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 handwashing 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 DoctorIf:
   • You have other questions or concerns
   • You become worse.

Internet Resources

1. Information from the World Health Organization (WHO) about Swine Flu
   • On June 11, 2009, the WHO signaled that a global pandemic of novel influenza A (H1N1) was underway by raising the worldwide pandemic alert level to Phase 6.
   • WHO Swine Influenza (H1N1) Website http://www.who.int/csr/disease/swineflu/en/index.html
   • WHO complete list of guidance documents: http://www.who.int/csr/disease/swineflu/guidance/en/index.html
2. Internet Resource for U.S.
   • Centers for Disease Control and Prevention, United States (CDC)
   • For most up to date information, visit CDC's Swine Flu Web site at http://www.cdc.gov/swineflu/
   • Swine Flu Video PodCast by Joseph Bresee MD, Chief, Epidemiology & Prevention Branch, CDC Influenza Division: http://www.youtube.com/watch?v=-nTQDs7ZQG0
3. Internet Resource for Canada
   • Health Canada
   • http://www.phac-aspc.gc.ca/alert-alerte/swine_200904-eng.php

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