Novel H1N1"Swine Flu" Information

Highland Family Medicine recieves occasional shipments of H1N1 vaccine from the state.  Please call to see what our current supplies are. 

The Novel H1N1 flu that appeared in 2009 is here to stay. 

We were fortunate last fall in that this new flu was not as dangerous as it might have been, and we have seen little sign of the infection in our practice since early December.  But the virus continues to circulate and mutate, and will almost certainly return, whether this Spring, or in the Fall of 2010. 

We still want to get as many of our citizens vaccinated against Novel H1N1 as possible.  Even if you already had the infection in 2009, we would love to see you get vaccinated. 

And with the New Year will come the inevitable Seasonal Flu.  Symptoms and treatment of both Novel H1N1 and Seasonal Flu are the same, and are outlined below. 

Since the Novel H1N1 Flu is an evolving problem, please follow the links in the green box below for the most accurate and up-to-date information from the CDC:

 

 

 

Click here for Novel H1N1 Patient Information from UpToDate, a very reliable medical resource.

For more general information, read this summary last updated 2/2/10 by Dr. Roszell

Vaccine

Based on guidelines from the Louisville Metro Department of Public Health and Wellness, we are currently in Phase Four of our vaccination plan:

Phase One:  When Flu vaccine availability is limited initially, immunizations are prioritized to:

• Health care workers
• All children 6 months through 4 years of age,
• Children 5-18 years of age with underlying medical conditions,
• Pregnant women
• Persons who will be in consistent close contact with infants under 6 months of age

Phase Two: Once these initial groups have been vaccinated, we broaden coverage to the full list of patients the CDC wants immunized:

• Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
• Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus;
• Healthcare workers and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;
• All people from 6 months through 24 years of age:
  Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
  Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
• Persons aged 25 through 64 years who have serious health conditions associated with higher risk of medical complications from influenza.

Phase Three: Once the demand for vaccine for these prioritized groups has been met, programs and providers extend vaccination of all patients from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups.

Phase Four: Once vaccine demand among younger age groups has been met, programs and providers extend vaccination to people 65 or older.  At that point, we would love to get vaccine to all patients over the age of 6 months.

General:

The Kentucky Medical Association says:

• If you are experiencing severe symptoms including cough, fever, fatigue, sore throat, chills, headaches, body aches possibly along with diarrhea and vomiting, you should stay home from work and school and see your physician.
• Spread of influenza can be prevented through proper handwashing, coughing in one's elbow and avoiding contact with sick persons.
• Although antiviral drugs can reduce the consequences if you already have the flu, they should only be used for confirmed cases. 

The CDC in its May 15th update noted:

"Not all patients with suspected novel influenza (H1N1) infection need to be seen by a health care provider. Patients with severe illness and those at high risk for complications from influenza should contact their medical provider or seek medical care. "

"Not all people with suspected novel influenza (H1N1) infection need to have the diagnosis confirmed, especially if the person resides in an affected area or if the illness is mild. "

"Groups at higher risk for seasonal influenza complications include:

• Children less than 5 years old;
• Persons aged 65 years or older;
• Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;
• Pregnant women;
• Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders;
• Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
• Residents of nursing homes and other chronic-care facilities."

Definition: 

Novel H1N1 'Swine Flu' is a Febrile respiratory illness caused by swine influenza (H1N1) viruses.  

It is caused by a virus, which is NOT a living thing, and can’t be killed with antibiotics such as Zpak and Amoxicillin.  This is a virus that used to live in animals, and has recently jumped over to humans. As such, human have no natural immunity to this new flu strain.

The symptoms are similar to other human flu: fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting. The majority of these cases resolve without serious complications, as all flues do.

It appears now that 2009's Novel H1N1 flu is no more or less severe a disease than the seasonal flus we are used to dealing with each winter.  For the majority of patients, Swine Flu infections will just be a few days spent in bed feeling lousy. 

As with all flu, some number of cases can progress to severe pneumonia, which is the danger we worry about, and which causes the deaths that are related to flu. The symptoms of pneumonia, in which the infection is actually deep in the tissue of the lungs, are high fever, difficulty breathing, and productive cough. Patients with pneumonia are clearly ill when you look at them: they will have fevers above 102, fast breathing, fast heart rates and appear quite sick.

Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

Transmission:

Influenza is primarily transmitted from person-to-person via large virus-laden droplets that are generated when infected persons cough or sneeze; these large droplets can then settle on the mucosal surfaces of the upper respiratory tracts of susceptible persons who are near (e.g., within about 6 feet) infected persons.

We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks.

Transmission may also occur through direct contact or indirect contact with respiratory secretions such as when touching surfaces contaminated with influenza virus and then touching the eyes, nose or mouth.

The incubation period, the time between contractingthe illness and developing symptoms, appears to be 1-7 days. 

Adults may be able to spread influenza to others from 1 day before getting symptoms to approximately 5-7 days after symptoms start.

Children and people with weakened immune systems may be infectious and able to spread influenza to others for 10 or more days after symptoms begin.

Transmission does NOT take place from eating or contact with pork products. ONLY by contact with secretions from infected people.

Presentation:

Symptoms Warranting Medical Evaluation & Treatment

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children, emergency warning signs:

• Fast breathing or trouble breathing
• Bluish skin color
• 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

In adults, emergency warning signs:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

Diagnosis:  

Patients who have a febrile respiratory infection will be tested for influenza here in the office with a Rapid Flu test. Patients positive for influenza A, or those with serious disease or have traveled to areas confirmed Swine Flu, or contact with a confirmed case, w should have a nasopharyngeal swab sent to Quest for further characterization.  Quest will send specimens on to the state department of public health for confirmation.

Treatment:

Novel H1N1 flu AT THIS TIME is sensitive to oseltamivir (Tamiflu) or zanamivir (Relenza).

Oseltamivir (30,45,75; 60/5 mL)
Adults		Treatment 75-mg capsule twice per day for 5 days	Prevention 75 mg capsule once per day
Children ≥ 12 months	15 kg or less	60 mg per day divided into 2 doses	30 mg once per day
	16-23 kg	90 mg per day divided into 2 doses	45 mg once per day
	24-40 kg	120 mg per day divided into 2 doses	60 mg once per day
	>40 kg	150 mg per day divided into 2 doses	75 mg once per day

Novel H1N1 flu is resistant to amantadine and rimantadine.

We will ONLY treat patients whom we strongly suspect have Swine Flu, or those with serious symptoms such that we are concerned for their safety.

Close contacts (ie. family members) with a confirmed, probable or suspected case of novel influenza A (H1N1) virus infection should also be given anti-viral drugs, for a duration of 10 days.

At this time, NO ONE will receive medicine simply to prevent them from catching Swine Flu out in the community.  This includes our providers and staff.  These medicines are only to be used in confirmed cases adn their close contacts.

Children with febrile illnesses should NEVER receive aspirin.

Here is a CDC link with information about caring for a confirmed case of Novel H1N1 Flu.

Isolation:

The CDC recommends that suspected cases remain home and away from others until 24 hours after their symptoms pass. 

UpToDate says that "household contacts who are well should minimize contact in the community, designate a single household member as the ill person's caregiver, and remain home at the earliest sign of illness should it develop. Pregnant women should avoid caring for the ill person."

Use of a face mask or N95 respirator is NOT recommended for the routine care of individuals who are not at increased risk for influenza complications in the community or at home, even when caring for an individual with an influenza-like illness (fever with cough or sore throat)

So it would seem that family contacts of sick patient , who are not sick themselves, can probably continue daily activities while taking care to wash hands and avoid exposing others.

Prevention:  For Patients

The seasonal influenza vaccine is NOT expected to provide protection against the swine flu H1N1 viruses.

• Persons with febrile respiratory illness should stay home from work or school to avoid spreading infections (including influenza and other respiratory illnesses).
• Frequent hand washing can lessen the spread of respiratory illness.
• CDC recommends that people avoid travel to affected areas at this time.

Prevention: Healthcare facilities

• Tissues: Provide tissues and no-touch receptacles for used tissue disposal.
• Hand Washing: Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e., soap, disposable towels) are consistently available.
• Masking: offer masks to persons who are coughing. Either procedure masks (i.e., with ear loops) or surgical masks (i.e., with ties) may be used
• Separation: encourage coughing persons to sit at least three feet away from others in common waiting areas.