From Our 2009 Archives

Swine Flu FAQ

WebMD provides answers to your questions about swine flu.

By Daniel J. DeNoon
WebMD Feature

Reviewed by 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 pigs.

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 with pigs.

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 virus."

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 to 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.

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 flu:

  • Pregnant women are six times more likely to have severe flu disease than women who are not pregnant.
  • Young children, especially those under 2 years of age
  • People with cardiovascular conditions (except high blood pressure)
  • People with liver problems
  • People with kidney problems
  • People with blood disorders, including sickle cell disease
  • People with neurologic disorders
  • People with neuromuscular disorders
  • 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 transplants
  • 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 emergency room.

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 cough
  • 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?

Pandemic 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?

Yes. 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 cost.

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 immigration.

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 state regulations.

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 virus.

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 steps:

  • 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 symptoms.
  • Avoid touching your mouth, nose, or eyes. That's not easy to do, so keep those hands clean.
  • 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 infection.
  • 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.
  • Breastfeeding mothers 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?

Short answer: 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 flu.

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 flu.

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 and tolerable.

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 eyes.

Can I still eat pork?

Yes. You can't get swine flu by eating pork, bacon, ham, or other foods that come from pigs.

What else should I be doing during the swine flu pandemic?

Keep 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 response.
  • Get involved in your community as it works to prepare for an influenza pandemic.

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

• Thermometer

• Dried fruit

• Anti-diarrheal medication

• Crackers

• Vitamins

• Canned juices

• Fluids with electrolytes

• Bottled water

• Cleansing agent/soap

• Canned or jarred baby food and formula

• Flashlight

• Pet food

• Batteries

• Other non-perishable items

• Portable radio

• Manual can opener

• Garbage bags

• Tissues, toilet paper, disposable diapers

How severe is swine flu?

The 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 pandemic.

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 site.

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 eating pork.

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 stopped.

I was vaccinated against the 1976 swine flu virus. Am I still protected?

Probably 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 effective.

How many people have swine flu?

That's 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?

The U.S. government has declared swine flu to be a public health emergency. The World Health Organization considers it a global emergency.

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 scenarios.

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 production.

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.

SOURCES:

CDC.

World Health Organization.

Pandemicflu.gov

Reviewed on October 5, 2009

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