Many of my patients are calling for more information about about the new Swine Flu. This is what I tell them.

Pigs, birds, and humans are each susceptible to lots of influenza viruses. Typically, these viruses infect only one species. However, sometimes the viruses swap genes, creating new viruses that have the capacity to infect more than one species. That’s why having taken the human flu vaccine last season may theoretically help you in with this flu-but only a bit because this new strain of influenza virus has been identified as containing a combination of two parts swine, one part avian, and one part human influenza virus genes.

How is this New Virus Transmitted?
The World Health Organization and the CDC have confirmed that the new swine flu virus is transmitted between humans. It is not clear yet how transmissible it is, nor how it is transmitted. Almost surely, like other flu viruses, it can be transmitted by aerosol and by skin-to-skin contact with an infected person. There is no vaccine yet for the new virus.

The 20 confirmed cases in the U.S. young students are all recovering (with only 1 case requiring hospitalization) in contrast to many of the deaths in Mexico which seem to have occurred in healthy young adults, a pattern seen in past pandemics — not young children and the frail elderly, as is most often seen with the flu.

Precautions
The usual precautions for patients apply:

• Sneeze and cough into tissues and throw the tissues in the trash.
• Wash your hands or use alcohol-based hand cleaners frequently.
• On greeting people, don’t shake hands or exchange kisses.

Contagious period
People should be considered contagious until at least 7 days after the start of symptoms; with children, it may be 10–14 days. If a global pandemic ensues, governments may well close schools and public places, require as many people as possible to work from home, warn any people who develop symptoms to isolate themselves at home.More updated information from the CDC is available at http://www.cdc.gov/swineflu/.

Symptoms
The initial symptoms with this swine flu virus are like those with the annual flu viruses: fever, sore muscles, running nose, and sore throat. Nausea, vomiting, and diarrhea may be more common with this flu than with regular flu. Also dizziness has been a prominent symptom. A symptom indicating a more severe disease is breathlessness. If this occurs seek medical attention immediately.

Treatment
The new virus is resistant to amantadine and rimantadine, but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Based on experience with other flu viruses, treatment would be most effective if given within two days of the onset of symptoms.

A public health emergency was declared today in the U.S. as 20 cases of the disease were confirmed in this country. The Centers for Disease Control, in a news conference in Washington stated, “We expect to see more cases of swine flu. Homeland Security Secretary Janet Napolitano, speaking at the same news conference called the emergency declaration a “declaration of emergency preparedness.” However, experts at the WHO will wait until Tuesday before meeting to decide if it should increase its rating of the seriousness of the pandemic potential from the current level three to level four - which would indicate a "significant increase in risk of a pandemic.”

Officials said they had confirmed eight cases in New York, seven in California, two in Kansas, two in Texas and one in Ohio, and that the cases looked to be similar to the deadly strain of swine flu that has killed more than 80 people in Mexico and infected 1,300 more. This was amid further reports of potential new cases from New Zealand to Hong Kong to Spain, raising concerns about the potential for a global pandemic. Canada also confirmed six cases of the flu. Swine flu was also likely in 10 New Zealand students.

WHAT TO LOOK FOR:
The symptoms of swine flu are nearly identical to the symptoms of other influenza, including high fever, aches, coughing, and congestion. It appears to spread through human-to-human contact and human contact with live pigs but not by eating pork products.

WHAT TO DO if pandemic is declared by WHO
-Interim Guidance for Swine influenza A (H1N1)

• Wash hands frequently

• Stay home

• Don't board airplanes, if you feel sick

• Keep sick children out of school.

• Use Facemasks

• 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 facemask (for example, surgical mask)

• An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods.

• 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 facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they do not touch anything else.

• Avoid re-using disposable facemasks and N95 respirators if possible.

• If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.

• After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.

• Ask your doctor whether you are a candidate for Tamiflu or Relenza.

• Do not take any drugs or medications prophylactically without your doctor’s permission.

Is Mexico city ground zero for a global epidemic of a new kind of flu — a strange mix of human, pig and bird viruses?

The illnesses breaking out in Mexico currently have epidemiologists at the U.S. Centers for Disease Control and Prevention deeply concerned. The World Health Organization [W.H.O.] says there have been a growing number of swine flu cases in Mexico in recent weeks, over 80 of them fatal. Doctors have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals. The most notorious flu pandemic, thought to have killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults. Scientists have long been concerned that a new killer flu could evolve when different viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.

Most of Mexico’s dead are  young, healthy adults, and none were over 60 or under 3 years old, the World Health Organization said. That alarms health officials because seasonal flus cause most of their deaths among infants and bedridden elderly people, but pandemic flus — like the 1918 Spanish flu, and the 1957 and 1968 pandemics — often strike young, healthy people the hardest. The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs. But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.

FACTS:

·      Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs.

·      Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.

·      From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States.

·      Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California, Texas, and Mexico have been identified. An investigation into these cases is ongoing.

·      The C.D.C. said that eight nonfatal cases had been confirmed in the United States, and that it had sent teams to California and Texas to investigate.

·      Still, only a small number have been confirmed as cases of the new H1N1 swine flu, according to , a W.H.O. spokesman.

·      Tests show 20 people in Mexico have died of the new swine flu strain, and that 48 other deaths were probably due to the same strain.

·      The caseload of those sickened has grown to 1,004 in Mexico.

·      The same virus also sickened at least eight people in Texas and California, though there have been no deaths yet in the U.S.

·      If the confirmed deaths are the first signs of a pandemic, then cases are probably incubating around the world by now, says a pandemic flu expert.

·      The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said the Centers for Disease Control and Prevention.

·      This similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases.

This swine flu and regular flu can have similar symptoms — mostly fever, cough and sore throat, though some of the U.S. victims who recovered also experienced vomiting and diarrhea.

UP-TO-DATE ACTIONS ON SWINE FLU

The World Health Organization has convened an emergency expert panel to consider whether to declare the outbreak an international public health emergency — a step that could lead to travel advisories, trade restrictions and border closures.

·      The CDC and Canadian health officials were studying samples sent from Mexico, and some governments around Latin America said they would monitor passengers arriving on flights from Mexico.

·      No vaccine specifically protects against swine flu, and it is unclear how much protection current human flu vaccines might offer.

·      Actually producing the vaccines could take months.

·      The  relatively good news is--CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.

·      Anyone with a fever, a cough, a sore throat, shortness of breath or muscle and joint pain should seek medical attention.

·      When a new virus emerges, it can sweep through the population.

·      The Spanish flu is believed to have infected at least 25 percent of the United States population, but killed less than 3 percent of those infected.

·      Among the swine flu cases in the United States, none had had any contact with pigs; cases involving a father and daughter and two 16-year-old schoolmates convinced the authorities that the virus was being transmitted from person to person.

 LINKS TO MORE FACTS

General Information about Swine Flu
Questions and answers and guidance for treatment and infection control

Human Swine Flu Investigation Apr 24, 2009
Information about the investigation of human swine flu in California

•  Swine Flu

Swine Influenza: General Information

Swine Flu and You Apr 24, 2009
What is swine flu? Are there human infections with swine flu in the U.S.? …

Swine Flu Video Podcast Apr 25, 2009
Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.

Key Facts about Swine Influenza (Swine Flu) Apr 24, 2009, 5:45 PM ET
How does swine flu spread? Can people catch swine flu from eating pork?

Follow me on twitter: http://twitter.com/DrPerryHookman

In-flight medical emergencies are increasing, and this is partly due to more people with medical conditions traveling by air. It is very important to note that unique environmental and physiological changes occur as a result of changes in pressure during routine commercial air travel. These changes can exacerbate preexisting medical conditions, such as cardiac and lung conditions.

Passengers should always notify a flight attendant whenever they are having a health problem. Although the flight crew has only very basic training on responding to medical emergencies, they have the ability to communicate via satellite phones to physicians on the ground, and several tele-medical companies routinely assist flight crews during in-flight medical emergencies by providing instructions on what to do. Many times there are medically trained fellow passengers who also readily volunteer to assist whenever the flight crew broadcasts a call for help.

All U.S–based commercial aircraft that carry more than 85 passengers, and most international air carriers, carry an automated external defibrillator, as well as both a basic and enhanced emergency medical kit. Only medical professionals or flight crew instructed by on-ground physicians are allowed access to the enhanced medical kit, which carries various emergency medications to deal with serious in–flight medical emergencies. The captain of the aircraft has the ultimate authority as to whether or not to divert the aircraft, but they tend to side with caution and what is in the best interest of the stricken passenger.

Individuals with any cardiac, lung or blood diseases, diabetes or cancer, as well as those who have undergone any surgery within a 14-day period prior to travel, must check with their doctor to make sure they are fit for air travel. As a rule of thumb ,one should be able to walk a distance of 150 feet and climb one flight of stairs without developing any chest pain or severe shortness of breath.

Follow me on twitter: http://twitter.com/DrPerryHookman
Read my blog: http://drperryhookman.blogspot.com/

Like the more well-known methicillin-resistant Staphylococcus aureus, C. difficile is associated with the use of antibiotics, which provide room for “bad” bacterium in your gut, like C. difficile, to take over. In other words, although the antibiotic you take for an illness may make you feel better, it may also trigger the development of C. difficile. C. difficile is particularly alarming because: 

• Up to two-thirds of hospitalized patients may be infected with it.
• The rate of C. difficile infection among hospital patients doubled between 2001 and 2005, according to a recent article on the subject in the “Science Times” section of The New York Times: http://www.nytimes.com/2009/04/14/health/14well.html?_r=1&ref=science
• Individuals who have C. difficile but are asymptomatic, and who are admitted to healthcare facilities, can transmit the organism to other susceptible patients.
• It has begun to appear in seemingly healthy adults who in some cases were never in a hospital or long term care facility.
• It is becoming more deadly because of the emergence of a new hyper-virulent strain. To protect yourself and your loved ones from C. difficile, I recommend first and foremost that you limit your use of antibiotics. I also advise that if you are hospitalized you:
• Confirm that the walls of your hospital room and especially its bathroom and toilet have been washed thoroughly with chlorine bleach before you move into your hospital room.
• Ask your doctor to wipe the flat surface on his stethoscope to remove germs before he uses it to examine you.
• Ask everyone who comes to visit you at the hospital to wash their hands when they enter your room and to not sit on your bed. Ideally, they should not use your bathroom either.

Follow me on Twitter at http://twitter.com/DrPerryHookman

Check out my blog at http://drperryhookman.blogspot.com/