Swine Flu FAQ
WebMD provides answers to your questions about swine flu.
By Daniel J. DeNoon
Louise Chang, MD
The swine flu virus in the U.S. is the same one causing a deadly epidemic in Mexico. What is swine flu? What can we do about it?
What is swine flu?
Swine flu, also known as 2009 H1N1 influenza,
is a human disease. People get the disease from other people, not from
The disease originally was nicknamed swine flu because the virus that causes
the disease came to humans from pigs. The virus contains genes from swine,
bird, and human flu viruses. Scientists are still arguing about what the virus
should be called, but most people know it as the H1N1 swine flu virus.
The swine flu viruses that spread among pigs aren't the same as human flu
viruses. Swine flu doesn't often infect people, and the rare human cases that
have occurred in the past have mainly affected people who had direct contact
with pigs. But the current "swine flu" outbreak is different. It's caused by a
new swine flu virus that has changed in ways that allow it to spread from
person to person -- and it's happening among people who haven't had any contact
That makes it a human flu virus. To distinguish it both from flu viruses
that infect mainly pigs and from the seasonal influenza A H1N1 viruses that
have been in circulation for many years, the CDC calls the virus "2009 H1N1
Many people have at least partial immunity to seasonal H1N1 viruses because
they've been infected with or vaccinated against this flu bug. These viruses
"drift" genetically, which is why the flu vaccine has to be tweaked from time
But the H1N1 swine flu is not the usual "drift variant" of H1N1. It's come
to humans from a different line of evolution. That means very few people have
any natural immunity to H1N1 swine flu. The normal seasonal flu shot offers no
protection against this new virus.
Some people who may have had seasonal H1N1 flu before 1957 might have a
little bit of protective immunity against the new virus. That's because
seasonal H1N1 flu strains that circulated before 1957 (and which were replaced
by the 1957 pandemic flu bug) were genetically closer to the 2009 H1N1 swine
flu. This protection, if it truly exists, is not complete. While relatively few
elderly people have had H1N1 swine flu, many of those who did get the disease
became severely ill.
The Latest on
H1N1 Swine Flu
Learn about H1N1 swine flu:
What are swine flu symptoms?
Symptoms of H1N1 swine flu are
like regular flu symptoms and include fever, cough, sore throat, runny nose, body aches, headache, chills, and fatigue. Many people with
swine flu have had diarrhea and vomiting. Nearly everyone with flu has at least two
of these symptoms. But these symptoms can also be caused by many other
conditions. That means that you and your doctor can't know, just based on your
symptoms, if you've got swine flu. Health care professionals may offer a rapid
flu test, although a negative result doesn't necessarily mean you don't have
the flu. The accuracy of the test depends on the quality of the manufacturer's
test, the sample collection method, and how much viral sample a person is
shedding at the time of testing.
Like seasonal flu,
pandemic swine flu can cause neurologic symptoms in children. These events are
rare, but, as cases associated with seasonal flu have shown, they can be very
severe and often fatal. Symptoms include seizures or changes in mental status
(confusion or sudden cognitive or behavioral changes). It's not clear why these
symptoms occur, although they may be caused by Reye's syndrome. Reye's syndrome
usually occurs in children with a viral illness who have taken aspirin --
something that should always be avoided.
Only lab tests can definitively show whether you've got swine flu. State
health departments can do these tests. But given the large volume of samples
coming in to state labs, these tests are being reserved for patients with
severe flu symptoms. Currently, doctors are reserving antiviral drugs for
people with or at risk of severe influenza.
Who is at highest risk of H1N1 swine flu?
Most U.S. cases of H1N1 swine flu
have been in children and young adults. It's not clear why, and it's not clear
whether this will change.
But certain groups are
at particularly high risk of severe disease or bad outcomes if they get the
- Pregnant women are six times more likely to have severe flu disease than
women who are not pregnant.
especially those under 2 years of age
cardiovascular conditions (except high blood pressure)
People with liver
People with kidney
People with blood
disorders, including sickle cell disease
People with neurologic
People with metabolic
disorders, including diabetes
People with immune
suppression, including HIV infection and medications that suppress the immune
system, such as cancer chemotherapy or anti-rejection drugs for
Residents of a nursing
home or other chronic-care facility
Elderly people are at
high risk of severe flu disease -- if they get it. Relatively few swine flu
cases have been seen in people over age 65.
People in these groups
should seek medical care as soon as they get flu symptoms.
A striking number of
adults who developed severe swine flu complications have been morbidly obese.
However, obesity itself does not seem to be the issue. The vast majority of
extremely obese people suffer respiratory problems and/or diabetes, which seem
to be the underlying reason for their severe flu complications.
If I think I have swine flu, what should I do? When should I see my doctor?
If you have flu symptoms, stay home, and when you cough or sneeze, cover your
mouth and nose with a tissue. Afterward, throw the tissue in the trash and wash
your hands. That will help prevent your flu from spreading. If you can do it
comfortably, wear a surgical mask if you must be around others.
If you have only mild
flu symptoms, you do not need medical attention unless your illness gets worse.
But if you are in one of the groups at high risk of severe disease, contact
your doctor at the first sign of flu-like illness. In such cases, the CDC
recommends that people call or email their doctor before rushing to an
But there are emergency warning signs.
Children should be given urgent medical attention if they:
- Have fast breathing or trouble breathing
- Have bluish or gray skin color
- Are not drinking enough fluid
- Are not waking up or not interacting
- Have severe or persistent vomiting
- Are so irritable that the child does not want to be held
- Have flu-like symptoms that improve but then return with fever and a worse
- Have fever with a rash
Have a fever and then
have a seizure or sudden mental or behavioral change.
Adults should seek urgent medical attention if they have:
Keep in mind that your doctor will not be able to determine whether you have
H1N1 swine flu, but he or she may take a sample from you and send it to a state
health department lab for testing to see if it's swine flu. If your doctor
suspects swine flu, he or she would be able to write you a prescription for Tamiflu or Relenza.
These antiviral medications aren't a question of life or death for the vast
majority of people. Most U.S. swine flu patients have made a full recovery
without antiviral drugs.
How does swine flu spread? Is it airborne?
The new H1N1 swine flu virus
apparently spreads just like regular flu. You could pick up germs directly from
airborne droplets from the cough or sneeze of an infected person. You could
also pick up the virus by touching an object contaminated by the cough or touch
of an infected person and then touching your eyes, mouth, or nose. That's why
you should make washing your hands a habit, even when you're not ill. Infected
people can start spreading flu germs up to a day before symptoms start, and for
up to seven days after
getting sick, according to the CDC.
The H1N1 swine flu
virus, like the seasonal flu virus, can become airborne if you cough or
sneeze without covering your nose and mouth, sending germs into the air. Ferret
studies suggest that swine flu spreads less easily by small, airborne droplets
than does seasonal flu. But it does spread by this route, and it may begin to
spread even more readily as the new virus fully adapts to humans.
The H1N1 swine flu
virus is a human virus spread by people and not by pigs. The only way to get
the new swine flu is from another person.
How is swine flu treated?
H1N1 swine flu virus is sensitive to the
antiviral drugs Tamiflu and Relenza. These antiviral drugs are most effective
when taken within 48 hours of the start of flu symptoms. It's resistant to
older flu drugs.
Not everyone needs treatment with
these anti-flu drugs. Most people who come down with H1N1 swine flu
recover fully -- without antiviral treatment.
But the CDC strongly recommends
antiviral treatment for people at risk of severe flu complications who come
down with flu-like symptoms. Since it's very important to start these drugs
soon after symptoms appear, doctors should offer treatment to at-risk patients
if they suspect they have the flu. Doctors should not rely on rapid flu tests
(they are too unreliable for definitive diagnosis) or wait for results of
lab-based tests (because they take too long).
Early treatment is so important
that the CDC suggests doctors offer a Tamiflu or Relenza prescription to
at-risk patients. If these patients develop flu-like symptoms, they would call
their doctor, and based on the doctor's clinical judgment, the patient could
then simply fill the prescription.
Many people who have died of H1N1 swine flu had bacterial co-infections,
particularly pneumococcal infections. There's a vaccine against pneumococcal
infections. It's routine for children and recommended for adults with
underlying health conditions, smokers, or people over age 65. If your flu
symptoms get worse after getting better, call your doctor. You may need
treatment with antibiotic medications.
Is there enough Tamiflu and
Relenza to go around? Federal and state stockpiles are large enough to treat
at-risk patients with flu symptoms. But there isn't enough to offer treatment
to otherwise healthy people who may have the flu. And health officials have
asked people not to hoard Tamiflu or Relenza.
Tamiflu and Relenza can prevent
swine flu, but the CDC urges even at-risk people to try to avoid using the
drugs in this way. Not only is supply insufficient for preventive use, but
preventive use appears to be a major factor in the few cases of drug-resistant
H1N1 swine flu that have appeared.
There are situations in which
preventive use of Tamiflu or Relenza may be appropriate for an at-risk person
who must come into close contact with someone who has the flu. But the CDC
suggests that doctors consider a "watchful waiting" approach. In this case, the
at-risk person would wait to fill the prescription only if she or he actually
developed flu symptoms.
Is there a vaccine against the new swine flu virus?
The vaccine is being made in large quantities and
shipped as soon as possible. By mid-October, 40 million doses shipped to some
90,000 sites across the U.S. Another 20 million doses should ship each week,
apportioned to states on the basis of population. By the end of December, all
of the vaccine will have shipped.
The U.S. has purchased 251 million
doses of the vaccine, and has promised 10% of the vaccine to developing
nations. That leaves enough vaccine for every U.S. resident who wants it. The
vaccine is free. Although some providers may charge for vaccine administration,
the government is urging them to waive that charge. Even if some providers
charge, several large insurance companies said they'd cover the
Clinical tests show the vaccine works remarkably well. People age 10 and
older need only one dose of the vaccine. Protection begins about eight days
after vaccination. Kids under age 10 years will need two vaccinations, given
three weeks apart.
There have been no safety issues with the vaccine in early clinical trials.
That's no surprise. It's made exactly the same way as the seasonal flu shots
given to tens of millions of people each year. That's why it's approved by the
FDA. Like the seasonal flu vaccine which is tweaked each year, the H1N1 swine
flu vaccine is just a slightly tweaked version of the seasonal vaccine, made
with the same technology by the same manufacturers.
Does that mean it's 100% safe? No.
Rare vaccine reactions do happen, even with the seasonal flu vaccine. But flu
experts at the National Institutes of Health, the CDC, and the FDA note that
getting the flu is far more risky than getting the vaccine.
Spurred by the safety concerns
that sank vaccination efforts during the 1976 swine flu scare (a scare caused
by a very different generation of flu vaccine against a very different swine
flu virus), federal officials are increasing efforts to track the safety of the
H1N1 swine flu vaccine. In addition to beefing up the CDC's and
FDA's vaccine adverse-event surveillance system, health care organizations
and the U.S. military will be helping track vaccine safety.
The vaccine will be available to all U.S. residents. As we're all in this
together, nobody will be asked to provide proof of citizenship or legal
Vaccination is not mandatory for most U.S. residents. Active-duty military
and Defense Department personnel are required to get the vaccine. And
health-care workers may be required to get the vaccine by their employers or by
I had a flu vaccine this season. Am I protected against swine flu?
No. This season's flu vaccine does not protect against the new swine flu
If you want to avoid the flu this winter, you'll need both a seasonal flu
shot or spray AND an H1N1 swine flu shot or spray.
You can get both kinds of flu shot at the same time. But you have to wait
three weeks between doses of the FluMist H1N1 swine flu vaccine and the FluMIst
seasonal flu vaccine. While health officials tell WebMD it's best to get
the same kind of vaccine for both vaccinations, they say there's probably no
problem with getting one flu vaccine as a nasal spray and the other flu vaccine
as a shot, even on the same day.
In 2010, the flu vaccine for the Southern Hemisphere will include the H1N1
swine flu in the seasonal flu vaccine. Health officials will wait to see what
happens this winter before deciding whether to include H1N1 swine flu in next
year's seasonal flu vaccine.
How can I prevent swine flu infection?
The CDC recommends taking these
Wash your hands
regularly with soap and water, especially after coughing or sneezing. Scrub for
at least 20 seconds and rinse thoroughly.
If soap and water are
not available, wash your hands with an alcohol-based hand gel. Rub your hands
together until the alcohol dries completely.
Avoid close contact --
that is, being within 6 feet -- with people who have flu-like
Avoid touching your
mouth, nose, or eyes. That's not easy to do, so keep those hands
If you have flu-like
symptoms -- fever plus at least cough or sore throat or other flu symptoms --
stay home for seven days after symptoms begin or until you've been symptom-free
for 24 hours -- whichever is longer.
Wear a face mask
(consider using an N95 respirator) if you must come into close contact with a
sick person. "Close contact" means within 6 feet. Note: There is no definitive
proof that a face mask prevents flu transmission. Do not rely solely on a face
mask to prevent infection.
Wear an N95 respirator
if helping a sick person with a nebulizer, inhaler, or other respiratory
treatment. Note: There is no definitive proof that a respirator prevents flu
transmission. Do not rely solely on a respirator to prevent
People who have or are
suspected of having swine flu should wear a face mask, if available and
tolerable, when sharing common spaces with other household members, when
outside the home, or when near children or infants.
with swine flu symptoms should express their breast milk, and the child should
be fed by someone else.
Should I wear a face mask or respirator?
Maybe. Face masks and respirators may very well offer extra protection, but
should not be your first line of defense against either pandemic or seasonal
Every day, newspapers
carry pictures of people wearing face masks to prevent swine flu transmission.
But very little is known about whether face masks actually protect against the
There's a difference
between a face mask and a respirator. A face mask does not seal tightly to the
face. Face masks include masks labeled as surgical, dental, medical procedure,
isolation, or laser masks. Respirators are N95- or higher-rated filtering face
pieces that fit snugly to the face. Respirators filter out virus particles when
correctly adjusted -- which is not as simple as it sounds. But it's hard to
breathe through them for extended periods, and they cannot be worn by children
or by people with facial hair.
People who have
flu-like symptoms should carry disposable tissues to cover their coughs and
sneezes. When going out in public, or when sharing common spaces around the
home with family members, they should put on a face mask -- if one is available
People not at risk of
severe flu illness can best protect themselves from swine flu with frequent
hand washing and by staying at least 6 feet away from people with flu symptoms.
But if swine flu is circulating in the community, a face mask or respirator may
be protective in crowded public places.
People at increased
risk of severe flu illness -- pregnant women, for example -- should add a face
mask to these tried-and-true precautions when providing assistance to a person
with flu-like illness. And anyone else who cannot avoid close contact with
someone who has swine flu (if you must hold a sick infant, for example) may try
using a face mask or respirator.
How long does the flu virus survive on surfaces?
Flu bugs can survive for hours on
surfaces. One study showed that flu viruses can live for up to 48 hours on
hard, nonporous surfaces such as stainless steel and for up to 12 hours on
cloth and tissues. The virus seems to survive for only minutes on your hands --
but that's plenty of time for you to transfer it to your mouth, nose, or
Can I still eat pork?
You can't get swine flu by eating pork, bacon, ham, or other foods that come
What else should I be doing during the swine flu pandemic?
informed of what's going on in your community. Your state and local health
departments may have important information if swine flu develops in your area.
For instance, parents might want to consider what they would do if their
child's school temporarily closed because of flu. Don't panic, but
a little planning wouldn't hurt.
Here's the advice from the U.S. government's pandemicflu.gov web site:
To plan for a pandemic:
- Store a two-week supply of water and food. During a pandemic, if you cannot
get to a store, or if stores are out of supplies, it will be important for you
to have extra supplies on hand. This can be useful in other types of
emergencies, such as power outages and disasters.
- Periodically check your regular prescription drugs to ensure a continuous
supply in your home.
- Have any nonprescription drugs and other health supplies on hand, including
pain relievers, stomach remedies, cough and cold medicines, fluids with
electrolytes, and vitamins.
- Talk with family members and loved ones about how they would be cared for
if they got sick, or what will be needed to care for them in your home.
- Volunteer with local groups to prepare and assist with emergency
- Get involved in your community as it works to prepare for an influenza
Items to have on hand for an extended stay at home:
Examples of food and non-perishables
Examples of medical, health, and emergency supplies
• Ready-to-eat canned meats, fish, fruits, vegetables, beans, and soups
• Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
• Protein or fruit bars
• Soap and water, or alcohol-based (60-95%) hand wash
• Dry cereal or granola
• Medicines for fever, such as acetaminophen or ibuprofen
• Peanut butter or nuts
• Dried fruit
• Anti-diarrheal medication
• Canned juices
• Fluids with electrolytes
• Bottled water
• Cleansing agent/soap
• Canned or jarred baby food and formula
• Pet food
• Other non-perishable items
• Portable radio
• Manual can opener
• Garbage bags
• Tissues, toilet paper, disposable diapers
How severe is swine flu?
severity of cases in the current
swine flu outbreak has varied widely, from mild cases to fatalities. Most U.S.
cases have been mild, but there have been a number of tragic deaths and
hundreds of hospitalizations -- mostly in young people aged 5 to 24. Pregnant
women have been particularly vulnerable to severe flu and death.
Like seasonal flu,
children who get swine flu can have serious neurological complications such as
seizures and Reye's syndrome. But as with seasonal flu, these complications
fortunately are rare.
Studies of the swine
flu virus show that it is more infectious to lung cells than are seasonal flu
viruses. But studies also suggest that the swine flu virus is less well adapted
to humans and may be harder to inhale deep into the lungs.
Flu viruses change all
the time, and the way the pandemic swine flu virus evolved suggests that it is
particularly liable to swap gene segments with other flu viruses. But so far
the swine flu virus hasn't changed much. That's good news, as the vast majority
of swine flu cases have been mild. And it's also good news for the swine flu
vaccine, which is based on swine flu strains isolated early in the
It's impossible to know
whether the virus will become more deadly. Scientists are watching closely to
see which way the new swine flu virus is heading -- but health experts warn
that flu viruses are notoriously hard to predict.
But there's a lot of
planning you can do. CDC officials predict that just about every U.S. community
will have H1N1 swine flu cases. It's possible some schools in your community
may temporarily close, or even that major gatherings may be canceled. So make
contingency plans just in case you are affected. For more information on
preparedness planning, see the U.S. government's pandemicflu.gov web
Have there been previous swine flu oubtreaks?
Yes, but never before has there been a swine flu pandemic. Pigs can be
infected with a wide range of flu viruses. Once in a while, a person in close
contact with pigs becomes infected. It's not possible to get swine flu from
In 1976, there was an outbreak of swine-origin flu among military recruits
in Ft. Dix, N.J. Some of these young men died. Health experts on the
lookout for the next flu pandemic thought the infection would spread further
and launched a vaccination campaign. As it turned out, the virus never
spread and disappeared on its own. Because the vaccine appeared to carry a
small risk of severe neurological problems -- and because there was no benefit
in a vaccine for a pandemic that never happened -- the vaccination campaign was
I was vaccinated against the 1976 swine flu virus. Am I still protected?
not. The new swine flu virus is different from the 1976 virus. And it's not
clear whether a vaccine given more than 30 years ago would still be
How many people have swine flu?
no longer possible to answer, because so
many people have become infected that most nations can no longer test everyone
suspected of having H1N1 swine flu. The CDC counts hospitalizations and deaths.
But instead of misleading case counts, the CDC offers a map showing where flu
is widespread and charts showing whether unusual numbers of people are showing
up in doctors' offices with flu-like symptoms and whether there are unusually
high numbers of deaths from pneumonia and influenza.
How serious is the public health threat of a swine flu epidemic?
U.S. government has declared swine flu to
be a public health emergency. The World Health Organization considers it a
It remains to be seen how severe
swine flu will be in the U.S. and elsewhere, but countries worldwide are
monitoring the situation closely and preparing for worst-case
The World Health Organization has
declared swine flu to be a pandemic. That means that all nations can expect to
see swine flu infections -- and should prepare for them -- but does not mean
the virus has become more severe. The word "pandemic" refers to the geography
of a disease, not to the severity of a disease.
The H1N1 swine flu outbreak came
at the end of the U.S. flu season. The virus spread across the nation and
around the globe in the spring and summer, seasons when flu usually ebbs to
nearly undetectable levels in the Northern Hemisphere. It's very unusual for
this to occur.
In the Southern Hemisphere, most
nations have seen large numbers of H1N1 swine flu cases. Fortunately, there's
no sign that the pandemic flu bug has become more deadly, more resistant to new
flu drugs, or less likely to be stopped by the H1N1 swine flu vaccine now in
Nobody knows how bad the swine flu
will be during the Northern Hemisphere flu season. But the CDC is warning
Americans to prepare for a bad flu season this fall. It's better to
over-prepare and look a little silly if nothing happens than to be unprepared
for an emergency.
WebMD senior writer Miranda Hitti contributed to this report.
World Health Organization.
Reviewed on October 5, 2009
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