From Our 2009 Archives

Swine Flu Breaks Out Across U.S.

Flu Hot Spot: College Campuses

By Daniel J. DeNoon
WebMD Health News

Reviewed By Louise Chang, MD

Sept. 8, 2009 -- Outbreaks on college campuses are signaling swine flu hot spots as fast-spreading H1N1 swine flu gives an early start to the fall flu season.

The Latest on
H1N1 Swine Flu

College campuses as far apart as Emory in urban Atlanta and Washington State in rural Pullman report explosive outbreaks of swine flu. The action isn't all on campus: Elementary and high schools are also seeing a lot of flu; 24 schools last week dismissed 25,000 students because of flu outbreaks.

One of the CDC's main indicators of flu season is the number of people seeing a doctor for flu-like illness. That statistic last week shot sharply up. That uptick was mainly because of swine-flu hot spots in the Southeastern U.S., with flare-ups in widely separated communities across the nation.

"It is time to pay attention," the CDC's disease chief, Anne Schuchat, MD, said today at a news conference.

The CDC can't predict where swine flu will strike next, how long it will linger in communities, or when it will come back. Yet so far, the pandemic is developing very much as experts expected:

  • The vast majority of swine flu cases have been mild, with people getting over the worst of it in three to five days.
  • Swine flu spreads most quickly among children, teens, and young adults.
  • In every nation, the pandemic appears as a series of widely separated community hot spots that flare up and die down -- not as a wave moving from east to west or north to south.
  • Children and adults at risk for flu complications -- those with lung conditions (including asthma), neurologic conditions, heart conditions, immune suppression, pregnancy, or under 5 years old -- tend to be those with the most severe disease.
  • Because some previously healthy children and adults have died of swine flu, it's important to be on the lookout for severe symptoms in anyone who has a flu-like illness. This is particularly true for children under 2.

Even though things are turning out as expected, Schuchat says the CDC is not ready to relax. And neither should we.

"Our prediction is it is going to be a busy and long flu season," Schuchat said. "We need to be prepared through the fall and winter and even into the spring."

One reason the CDC can't relax is that flu viruses can change with remarkable speed. They can become more or less virulent. And as often happens with seasonal flu bugs, they eventually get around flu vaccines.

"The H1N1 influenza viruses that have been tested as recently as a couple of weeks ago are close matches, essentially the same as those in the vaccine," Schuchat said. "That does not mean that in a couple of months or weeks from now that won't change."

Community swine flu outbreaks are popping up faster than the CDC can issue specific warnings. The CDC's flu-tracking system issues a report every Friday, but by then, the data are a week old.

The same goes for information being provided by the 189 colleges reporting data to the American College Health Association. As of the end of August, the ACHA had reports of just over 2,000 college flu cases. But this weekend, Washington State University alone reported that many presumed cases.

There have been no deaths on college campuses, but flu deaths continue to occur. In the U.S., from mid-April through Aug. 29, there were 593 deaths.

Who Needs Tamiflu for Swine Flu?

Because pregnant women, very young children, and those with underlying health conditions are at risk of severe disease, the CDC today reissued its advice that doctors should treat any flu-like illness in these people with Tamiflu or Relenza.

The drugs work best when given within 48 hours of symptoms. Doctors should rely on their clinical judgment -- and not on the results of rapid or lab-based flu tests -- in providing at-risk patients prompt antiviral treatment.

A big change in the guidelines is that the CDC now recommends that doctors give at-risk patients a prescription for Tamiflu or Relenza. If these patients get flu-like symptoms, they need only call their doctor to get a go-ahead to fill the prescription.

Although the CDC is trying to make sure that at-risk people get prompt treatment, it's also warning those at lower risk to avoid using the drugs.

"If all those people take antiviral meds, things might actually get worse. We have seen a bit of resistance, and we are optimistic this won't take off, but it is critical to use these drugs properly," Schuchat said. "The vast majority of kids can be cared for with Mom's chicken soup, rest, and plenty of fluids."

SOURCES: CDC web site. American College Health Association web site. CDC news conference with Anne Schuchat, MD, director, National Center for Immunization & Respiratory Diseases, CDC, Atlanta.

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