Questions and Answers on Influenza A H1N1 (Swine Flu)
1. What is AH1N1 flu?
Influenza is a virus, a package of genetic material (RNA) covered with an envelope. H1 and N1 refer to proteins on the surface of the envelope. N is neuraminidase – it helps the virus break off from one cell and jump to another cell. Tamiflu is an anti-viral drug that blocks this effect.
This particular strain of flu is new; it was created as a result of a Eurasian swine flu strain combining with another swine flu with characteristics of a bird, swine, and human flu virus. Pigs are known as a mixing vessel for flu, they are a Grand Central Station for flu and other viruses.
2. What is a pandemic?
A pandemic occurs when a new strain of flu is spreading easily from human to human in several areas of the world at once. AH1N1 is on the verge of being considered a pandemic because it has spread to 40 countries with more than 10,000 confirmed cases. But since there is NO designation for severity, this appears to be a very mild pandemic at this point, with only 79 confirmed deaths.
3. Do my children or I have any immunity?
There have been other H1 viruses circulating before 1957 and since 1976, and they have been targeted in previous flu vaccines that many of us have had. So adults we may well have partial immunity, but one of the reasons the flu is spreading so easily among our children is that they have less or no immunity to the virus.
4. How does flu spread?
Flu is a respiratory virus and it spreads on droplets through the air. It is especially vigorous in cold low humidity weather when it can travel farther (with sneezes and coughs) which is one of the reasons we are hopeful that it might diminish in the coming months. It can also live on most surfaces for at least a day, and can then be transferred from hand to mouth and sneezed or coughed around. This particular strain appears to spread fairly easily, comparable to the yearly flu that infects 25% of people who come in contact with it.
5. Why are schools being closed?
Schools have been well studied as places where flu spreads. In Japan from the 1960s to the 1980s, when flu vaccines were mandatory among school children for most of that time, deaths on the island decreased by close to one million. At schools, children and teachers are close together, and can pass flu viruses around easily.
When a suspected case or cases occur at a school like Horace Mann, it is reasonable to close the school to help prevent spread. Even though the virus is mild in most cases, it is somewhat unpredictable and it is better with children with chronic conditions not be exposed.
6. Since the virus is so mild, why not deliberately infect people to provide immunity?
Because flu spreads too easily; it will spread outside the group you deliberately infect and could infect someone who has an underlying medical problem like asthma or heart disease that puts them at a greater risk of a complication.
7. Why don’t we close schools when there’s an outbreak of the regular flu?
Because in that instance we can protect children and teachers with vaccinations which we don’t have now. Also, since this is a new strain, even though its virulence is low and most of the infections are mild so far, it is still somewhat unpredictable.
8. When will there be a vaccine?
The Centers for Disease Control have already cultured the virus and begun preparation for a vaccine. Manufacturers are now involved and you can expect a vaccine by the early Fall. Even though a flu vaccine against an H1 swine flu virus in 1976 previously appeared to cause a rare side effect (1/100,000 with ascending paralysis or Guillain Barre Syndrome), the benefits will be much much greater than the risks if there is a second wave of this virus in the fall when flu season hits.
9. What can I do in the meantime?
The thing that works best for flu or any virus is to isolate sick people and their close contacts. You should not go to school or work if you have flu symptoms. Tamiflu is useful to decrease severity of symptoms if it is given early in the course, and can also be useful if given to contacts of those who are suffering from the flu.
10. Can I be tested for it?
Rapid influenza flu tests (nasal swabs) are available. Tests may also be sent to labs and take 24 hours to determine if it is an Influenza A. If the subtype cannot be determined, it is suspicious for AH1N1 and can be sent to the CDC for confirmation, though there has been a backlog of cases waiting for analysis at the CDC.
11. What are the symptoms of this flu?
They’re similar to regular flu viruses, but the gastrointestinal symptoms are more severe. Symptoms may vary, but they include:
• Severe fatigue • Headache • Sore throat • Nasal congestion • Vomiting • Diarrhea • Nausea ***Keep in mind regular flu season is over, so if you are experiencing flu-like symptoms, call your doctor. Do NOT go to the ER.*** 12. How is it treated?
There’s no ‘cure’ for it, but you need:
• Isolation/Rest • Fluids • Keep fever down
Consider anti-viral drugs such as Tamiflu and Relenza, but keep in mind this strain is resistant to many older anti-viral drugs.
13. How do you protect yourself from getting it?
• Frequent hand-washing • Avoid sick people • Don’t cough or sneeze on others • Stay home if you’re sick! 14. Can you catch it from eating pork products? NO. While people in Mexico likely contracted this from handling infected pigs, eating pork products should be safe. Keep in mind to cook pork to a temperature of 160° Fahrenheit to kill any viruses. 15. How long does this flu last?
The virus can incubate a day or two before symptoms occur. It takes about a week to recover from the full-blown virus. If children are staying home with it, please keep in mind that they may be shedding the virus for days after they are feeling better.
16. Is this real or hype? Do I need to be worried?
The danger is getting a lot of hype, but it is real. Keep in mind that careful planning and preparation, as has been shown by the public health authorities and by Dr. Kelly here at Horace Mann, helps greatly to diminish fear. People also take more precautions when they are calm. When you are afraid you tend to overpersonalize the risk and exaggerate the danger.
Marc Siegel MD is an associate professor of medicine at NYU Langone Medical Center. He is the Medical Director of Doctor Radio at Sirius/XM powered by NYU Langone. Dr. Siegel is a Fox News Medical Contributor. He is a health columnist for the LA Times. Dr. Siegel is the author of Bird Flu: Everything You Need to Know About the Next Pandemic, and False Alarm, The Truth About the Epidemic of Fear. He is a parent of students at Horace Mann School.
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