Swine Flu: Top 20 Answers You Need to Know

With more outbreaks of the new strain of swine flu come outbreaks of misinformation and rumor. Below are 20 questions answered by infectious disease expert Charles Ericsson, MD, professor of internal medicine and director of travel medicine at the University of Texas Medical School at Houston. Also, Robert Emery, DrPH, vice president for safety, health, environment and risk management at UT Health Science Center and associate professor in the UT School of Public Health explains common sense preparedness and prevention of illness.

1. How do symptoms of swine flu differ from other types of flu?

None, really, although this flu might include gastrointestinal symptoms (diarrhea and vomiting), as well as the usual respiratory symptoms. The basic symptoms for swine flu are similar to the seasonal flu we are vaccinated for each year, which may include:

*Fever (greater than 100°F or 37.8°C)

*Sore throat

*Cough

*Stuffy nose

*Chills

*Headache and body aches

*Fatigue

2. If I felt flu-like, how would I know if I had swine flu?

You wouldn't really, nor would your physician know for sure without a respiratory specimen taken within the first four to five days. The specimen would then be sent to the Centers for Disease Control and Prevention (CDC). The cases so far in the U.S. have been relatively mild compared to the illness described in patients in Mexico. We do not yet know why the U.S. cases have been milder. The important point is to call your doctor if you think you have the flu. Prescription anti-viral drugs such as TamiFlu or Relenza can be called in by your doctor. Unless you are:

*exceptionally ill with flu-like symptoms

*are chronically ill

*immune-suppressed

*quite elderly

*or have a very young child, under age 2

It is best not to report to the hospital, clinic or doctor's office, where you could risk spreading the disease. Again, call your doctor first to get instructions as to what you need to do next.

3. How long are people contagious?

Adults are potentially contagious for the length of time one has symptoms, up to seven days following the beginning of illness. The “shedding stage” of the virus is during the first four to five days of illness. Children can be considered contagious longer, up to 10 days. The initial incubation period is 24 to 48 hours.

4. Is there medication for this?

Yes, Tamiflu or Relenza have shown to be effective against these recently reported strains of swine flu. Altogether, there are four anti-viral drugs that we commonly use to treat various strains of flu.

5. Can I start taking medicine for it now, just in case I get it later?

That is not presently advised. Preventive medication might be advised for very special circumstances where a person had to expose themselves to potentially ill people during an epidemic (which we do not yet have here). Such people might include ER workers. An outbreak in a nursing home, for instance, might lead to protecting all the other residents with a drug like TamiFlu. For the general public, the current answer is no to prophylactic (preventative) use with anti-viral medications. Its coverage time is limited. Do not confuse over-the-counter “cold and flu” preparations for anti-flu medications that require a prescription.

6. Are the symptoms in children different from adult symptoms?

Though the basic symptoms are similar, the signs of potentially life-threatening complications differ. The CDC advises those with these symptoms to seek emergency care immediately:

Emergency warning signs in children are:

*Fast breathing or trouble breathing

*Bluish skin color

*Not drinking enough fluids

*Not waking up or interacting

*Being very irritable

*Fever with a rash

Emergency warning signs in adults are:

*Difficulty breathing or shortness of breath

*Pain or pressure in the chest or abdomen

*Sudden dizziness

*Confusion

*Severe or persistent vomiting

7. Is there a vaccine?

Not yet, but the CDC has this current strain of virus and will consider whether to add it to next year’s flu vaccine as time goes on.

8. If I took the swine flu vaccine in the swine flu scare during the 70s, would that cover me? What about this year's flu shot I just took?

We don’t know yet. Previous vaccines could be expected to afford only partial, incomplete protection at best. This new strain of the swine flu virus (H1N1) actually has a mixture of swine and avian components (not to be confused with the deadly avian flu of Southeast Asia).

9. Can I catch it from pigs?

No. This strain is one that is communicable through human-to-human contact. It is a mutated form of a swine virus.

10. Can I catch it from eating pork?

Absolutely not! Swine flu is not transmitted by food. It is not a so-called foodborne illness. Bacon, ham and other pork products are safe to eat, assuming they are prepared properly. An internal temperature of 160 degrees for cooked meat will kill any bacteria or virus. Swine flu is transmitted by airborne droplets from an infected person’s sneeze or cough; or from germs on hands, or germ-laden surfaces. Eating pork will not give you swine flu any more than eating chicken will give you bird flu.

11. How does it cross from a pig to a human?

The swine virus mutates so that it can infect humans and be spread by humans.

12. Can it kill me?

Deaths have been reported from the Mexico City outbreak. So far the cases in the U.S. have been mild and there have been no deaths as of this writing (April 27) We do not know all the factors geographically and demographically that may contribute to the mildness or severity of this flu. But, like seasonal flu, there is the potential for serious outcomes.

13. Why the big concern if the regular flu kills 35,000 people a year, which is why we are all encouraged to get a flu shot?

This is a new flu strain that our bodies have not been exposed to before. The flu strains that the CDC creates a vaccine for each year all have the potential to cause great harm, especially in elderly, pediatric and chronically ill patients. This particular flu strain has struck seemingly healthy, young adults, with some resulting in death in Mexico. It also appears to be quite contagious. We will know more about this strain in the coming days.

14. How is it different from avian (bird) flu?

Avian flu so far has had difficulty infecting humans unless they are exposed intensely to birds, because the virus has not mutated in a way that makes it transmissible by humans to other humans. This virus has origins genetically from both pigs and birds, and the big difference from the avian flu is that this swine virus can be transmitted readily from human to human.

15. Is this just another scare that will go away like bird flu?

Bird flu is a theoretical threat and will need a mutation to be able to be transmitted among humans to become a serious threat. The present "swine/avian" virus clearly has already caused a major outbreak in Mexico City and San Luis Potosi, Mexico and has spread to places in the U.S. (California, New York, Texas, Kansas and Ohio). What is not clear yet is whether this virus will result in a so-called pandemic—worldwide spread with major outbreaks -- or whether it will fizzle out. But, even if it fizzles out, there is logical concern that it might re-emerge next flu season.

16. Should I cancel my vacation to Mexico?

At this writing, the situation is very fluid, changeable. I suggest checking frequently with the CDC Web site for possible travel alerts. I probably would not travel to Mexico City for a vacation that could easily be rescheduled, if for no other reason than the city has tried to limit access to crowded or public places where transmission might be facilitated. That does not sound like a very pleasant vacation to me! Having said that, there are more than 4,000 flights to Mexico from the US and none have been cancelled as of this writing. However, some international airports in Europe and Asia are stepping up precautions and issuing alerts. Again, check the CDC’s Travel Alerts page.

17. What if I'm on a plane? Should I wear a mask?

Not necessary. The air on a plane is filtered. Transmission might occur if someone sitting close to you coughs or sneezes on you. The newer designs of aircraft airflow keep the air in a top-down flow, not forced air from front to back. However, if you do have a respiratory illness, it might be best not to travel.

18. How long does the germ live on surfaces, like on my desk if someone sneezes in my office?

Influenza virus survives only minutes on inanimate objects or hands, so these are very inefficient ways to spread the illness. Influenza is most easily spread by droplets that come into contact with our mucus membranes such as when someone coughs or sneezes in our faces. If we shake hands with an infected person who has just wiped their nose and then we rather quickly rub our nose or eyes with our own hand, then we could get the flu. So, good hand washing does play a role in diminishing the spread of the disease.

19. Other than hand washing and covering my mouth if I sneeze or cough, what can I do to take care of myself and others?

If you are ill, stay home. Control your sneezes and coughs. If you cough into your hand, remember the virus could be live on your hand at least for a few minutes, so wash your hands before touching anyone else. If you get symptoms suggesting the flu, call your doctor, who can call in a prescription for medication to treat the flu. Resist going to the doctor’s office or a hospital ER for influenza symptoms unless you are seriously ill. You do not want to spread the disease to others.

20. What else can I do?

Keep in touch with the most recent CDC messages through the following links:

http://www.cdc.gov/swineflu/investigation.htm

http://www.cdc.gov/swineflu/general_info.htm

http://www.cdc.gov/swineflu/whatsnew.htm

Go to the sources of verifiable information such as WHO (World Health Organization) or the CDC.

Most important, be alert, not panicked.

“There is a huge difference between preparedness and paranoia”, says Dr. Robert Emery, occupational health expert at the UT School of Public Health at Houston. “Although we’re dealing with a new strain of flu, a set of universally applicable preventive measures exist that can be employed right away by everyone to help stop the spread of this disease”

Proper hand hygiene:

There’s a right way and useless way to wash hands—and wash away—micro-organisms. The object is to break down the protective membranes of germs, dislodge them from your hands and let them go down the drain. Plain soap in the right hands is strong stuff.

*Lather well with a bar of soap or squirt a coin size of liquid soap in the palm of your hand.

*Vigorously rub your hands together, soap up between your fingers, AND your wrists, front and back for 15 seconds. Sing the first chorus of any song you know and that’ll take you through the 15 seconds.

*Rinse under warm, RUNNING water. Remember, the object is to dislodge germs. The force of water is key.

*Dry thoroughly your hands with a disposable towel or under the blower, again, rubbing your hands together.

*Discard the towel.

If you’re using alcohol-based gels as hand cleansers:

Put a dime-sized amount in one hand:

*Vigorously rub your hands together and in between your fingers until the GEL IS DRY—about 30 seconds.

*DO NOT touch your face!

Once your hands are clean, do not touch your face, nose, eyes or lips.

Rubbing your eyes and nose provides a freeway for microorganisms and good breeding ground once they’ve arrived.

Cover your cough

If you must cough or sneeze, cover your mouth with a tissue, your sleeve or your hand.

Throw the tissue away in a waste basket. Do not leave discarded tissues on your desk or other surfaces.

Then, wash you hands thoroughly.

The throw-it-away part is essential.

Microorganisms live a life span from a few seconds to days on inanimate surfaces such as desks, table tops, faucets...tissues. If your tissues are scattered on your coffee table, they then are in contact with community surfaces. Both the tissues and the surface it sits on can spread germs to the person who touches the coffee table.

If you begin to feel ill: feverish, achy, have a dry, painful cough, sore throat, go home from school or work and call your healthcare provider for further instructions.

If you feel sick with flu-like symptoms and you care for the very young or the very elderly or the chronically ill, inform your healthcare provider when you call their office.

If you have recently traveled to Mexico or to one of the areas worldwide that has reported a swine flu outbreak, inform your healthcare provider. He or she may prefer to treat you with prescription anti-viral medications from home, or may request that you come in for a visit. Follow instructions from your healthcare providers.