According to the CDC, the signs and symptoms in humans infected with the H1N1 swine flu were similar to those of influenza. These include a fever and chills, cough, sore throat, congested eyes, myalgia, shortness of breath, weight loss, chills, sneezing, headache, rhinorrhea, coughing, dizziness, abdominal pain, decreased appetite, and fatigue.
The H1N1 strain also showed an increased number of people reporting vomiting and diarrhea as well. Because most of these symptoms are not exclusive to swine flu, a detailed history must also be taken to take into account the differential diagnosis of swine flu if the patient has directly contacted someone with confirmed swine flu or has been in an area that had documented cases of swine flu.
Respiratory failure was the most common cause of death in severe cases. Other causes included high fever causing neurological problems , pneumonia causing sepsis , dehydration and severe hypotension from vomiting and diarrhea , electrolyte imbalance associated complications, and kidney failure. More severe cases and fatalities were more likely observed in children younger than 5 years of age and elderly patients older than 60 years.
Other risk factors for severe disease include lung disorders such as chronic obstructive pulmonary disease COPD , bronchial asthma, pneumonia, currently pregnant women, obesity, patients undergoing immunosuppressive therapy due to cancer or autoimmune disease, and underlying medical issues such as diabetes.
Pregnant women acquired the infection during their third trimester were at greater risk for complications. Influenza A H1N1 virus infection could be encountered in a wide range of clinical settings and may result in variable pathologic findings. H1N1 should be one of the differential diagnosis in patients who present with unexplained flu-like symptoms or acute pneumonia in an area with known swine flu cases. Routine investigations should be performed for the patient who presents with these symptoms.
These usually include hematological, microbiological, biochemical and radiologic tests. A respiratory sample simple nose or throat swab is required for a confirmed diagnosis of swine flu. In humans, these tests include the Reverse transcriptase-polymerase chain reaction test RT-PCR , virus isolation test, and assays to detect a 4-fold increase in influenza virus antigens. The routine tests done to detect human influenza viruses, including the rapid test kits, do not always detect zoonotic viruses.
An indication that a novel, possibly zoonotic swine influenza virus could be present, is a detection of the influenza A virus, but not of the hemagglutinins in the seasonal human influenza viruses.
The zoonotic influenza virus infections can sometimes be diagnosed retrospectively by serology, but potential cross-reactivity with human influenza viruses can complicate this diagnosis. Another concern is that the neuraminidase NA and hemagglutinin HA of some swine influenza viruses the main target of the antibodies originated from human influenza viruses, to which people could have already been exposed.
State, regional, and national public health laboratories do generally test for the novel influenza viruses. The initial and best step in management should be to prevent swine flu. Specifically, with the prevention of swine flu in swine, prevention of transmission of swine flu from swine-to-humans, and prevention of human-to-human spread. The best-known prevention method against swine flu is getting the H1N1 swine flu vaccine. In September , the FDA permitted the new swine flu vaccine, and various studies by the National Institute of Health NIH showed that a single dose was enough to create sufficient antibodies to protect against the virus within 10 days.
The vaccination is contraindicated in people who had a previous severe allergic reaction to the influenza vaccination. Those who are moderate to severely ill, including those with or without a fever, should take the vaccination when they recover or are asymptomatic. The management for infected patients depends on the severity of symptoms of influenza, mild to moderate influenza can be treated at home with rest, oral hydration and symptomatic treatment with antipyretics like paracetamol, antihistaminic for nasal congestion and rhinitis and NSAIDS or Paracetamol for headaches and body aches.
Patients with progressive or severe symptoms should be admitted to hospitals and preferably in intensive care units ICU if there are signs suggestive of impending respiratory failure or sepsis or multiorgan dysfunction. Aggressive supportive measures like intravenous IV hydration, correction of electrolyte imbalances, antibiotics for concomitant bacterial infections.
Patients developing acute respiratory distress syndrome ARDS secondary to influenza should be treated with noninvasive or invasive mechanical ventilation. The antiviral medications: zanamivir, oseltamivir, and peramivir have been documented to help reduce, or possibly prevent, the effects of swine flu if the medication is taken within 48 hours of the onset of symptoms. Known side effects of oseltamivir comprise skin conditions that are occasionally severe and sporadic transient neuropsychiatric events.
These possible side effects are the reason the use of oseltamivir is cautioned in the elderly and individuals that have a higher risk of developing these side effects. An allergy to eggs is the only contraindication to zanamivir. Beginning October 1, , the CDC tested seasonal influenza A H1N1 collected viruses for resistance to the drugs oseltamivir and zanamivir.
It concluded that Pregnant women who contract the H1N1, are at a greater risk of complications because of the body's hormonal changes, physical changes and changes to their immune system to accommodate the growing fetus. For these reasons, the CDC recommends that all pregnant women get vaccinated to prevent the swine influenza virus.
Swine influenza in pregnant women can be treated using antiviral medications: oseltamivir and zanamivir neuraminidase inhibitors. It has been demonstrated that these 2 drugs are most effective when taken within 2 days of becoming sick. Evaluation of data reveals that some patients admitted with swine flu are at risk for sepsis, ARDS and death. Predictors of death include chronic lung disease, obesity, underlying neurological diseases, delayed admission, and other co-morbidity.
Swine flu is very contagious and is easily spread from humans after contact with pigs. The infection rapidly leads to moderate to severe symptoms and deaths are not rare. The key is to prevent the infection in the first place. For best results, an interprofessional team should provide for the evaluation and care of patients with Swine flu.
The team should be aware of patients at a high risk of becoming seriously ill if infected including you children, the elderly, those immunocompromized, gestating females, and those suffering from chronic debilitating diseases. Today, the primary care provider, pharmacist and nurse practitioner should recommend the H1N1 vaccine to children and adults at risk.
In addition, all pregnant women should be urged to get vaccinated to prevent the high mortality of the infection. The school nurse should encourage closure of the school even if only one case of H1N1 is identified. Parents should be encouraged to get the children vaccinated and prevent them from interacting with others; pharmacists are empowered to perform this function in many US states.
To prevent the spread of influenza virus it is important to keep surfaces especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children clean by wiping them down with a household disinfectant according to directions on the product label.
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Linens such as bed sheets and towels should be washed by using household laundry soap and tumbled dry on a hot setting.
Individuals should avoid "hugging" laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.
You cannot get infected with HIN1 from eating pork or pork products. Eating properly handled and cooked pork products is safe. Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza.
It is likely that other influenza viruses such as H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water. Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses.
No research has been completed on the susceptibility of H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. It is likely that other influenza viruses such as H1N1 virus would also be similarly disinfected by chlorine. Yes, recreational water venues are no different than any other group setting.
The spread of this H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. In addition to humans, live swine and turkeys, a small number of ferrets which are highly susceptible to influenza A viruses , domestic cats and dogs have been infected with H1N1 virus.
In addition, H1N1 virus infection was reported in a cheetah in the United States. CDC is working closely with domestic and international public and animal health partners to continually monitor reports of H1N1 in animals and will provide additional information to the public as it becomes available. Pet ferrets with naturally occurring H1N1 infection have exhibited illness similar in severity to that seen in ferrets exposed to seasonal influenza viruses and to H1N1 virus in laboratory settings.
Clinical signs exhibited have included sneezing, inactivity, and weight loss. Of the reported cases, most of the pets have recovered fully with supportive care, although some have died. Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options. Protecting People. Search The CDC. Note: Javascript is disabled or is not supported by your browser. You have a fever if your body temperature rises above its normal range of However, there are a number of symptoms of having a fever.
Some of which may include the following: [15] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source Sweating. Muscle aches. Loss of appetite. General weakness. Listen for a cough. A cough happens when something is irritating your throat or airway. Be wary if your cough persists or you cough up discolored or bloody mucus. This means you should not be coughing up mucus or blood.
If you do cough or sneeze, it is important that you limit the spread of germs. Cough or sneeze into the inside of your elbow to limit the spread of germs. You may experience shortness of breath due to your cough.
Note that you will not experience a sore throat. While a sore throat is the most common symptom of a viral infection, patients with H1N1 generally do not report a sore throat. Recognize aches and pains. Pain or stiffness may be a symptom of H1N1 and is the most common symptom of H1N1. These pains may also be a sign of a fever. You might feel fatigue or aches in both your head and body. Feel for stomach distress.
While common symptoms of illness on their own, nausea and diarrhea can be a sign of the flu. This is known as viral gastroenteritis and is your body's way of trying to rid itself of irritants. If you have diarrhea, nausea, or vomiting, you may have the flu. Method 4. Treat your fever. To treat a fever, put a cool, damp washcloth on your forehead. Wash your body with cool water; this will help lower your body temperature and make you feel better. You can also take mg of acetaminophen every six to eight hours not to exceed mg in 24 hours or — mg of ibuprofen not to exceed mg in 24 hours.
If your kidneys or liver are compromised, speak with your doctor before taking acetaminophen or ibuprofen. Stay home from work or school. Since H1N1 is spread through microorganisms, you should avoid contact with other people for at least twenty-four hours after you start to notice symptoms. Cancel plans and stay home while you recover.
Try and stay as isolated as possible in your home to avoid getting other members of your household ill. Your body is trying to fight off this illness. Strenuous activity can make you feel worse and prohibit healing. Rest as much as possible if you think you are getting the flu or even already show symptoms. Recognize worsening symptoms. Immunity may be acquired via infection or via immunization. Host factors and poor vaccine match can significantly reduce immunity.
Influenza epidemics follow predictable patterns over time. This general behavior can be modeled using estimates of immunity, transmissibility, and generation time. Corollary : Many of the parameters needed to model epidemics are difficult to obtain; models work best in retrospect.
Surveillance information can help guide appropriate practice. There is a delicate interplay between the infectivity of a virus and the population's level of pre-existing immunity. For transmission to occur, susceptible persons in the exposed population are needed. Reducing the likelihood of contact with a susceptible person reduces the infectivity of a virus. Corollary : Novel influenza viruses are unconstrained by factors of immunity and achieve high infectivity potential.
As late fall and winter return, H1N1 influenza may become significantly worse. Corollary : Whereas basic rules can set the conversation for planning activities, ongoing surveillance and modification of response are necessary for influenza prevention and control efforts. Clinical application : Family physicians are at the front line of influenza care in the United States. They need to keep abreast of changing information to best care for their patients and communities.
Suspected cases have an epidemiologic link to a confirmed case or to a community in which H1N1 influenza has been confirmed. The Centers for Disease Control and Prevention CDC provides excellent guidance to case identification, laboratory testing, and treatment. Influenza prevention and control depends on the appropriate interaction between public health practice and clinical interventions. Attention to reducing transmission through social distancing, use of face masks, and frequent handwashing are important initial steps in outbreak mediation as surveillance activities are undertaken, vaccines are developed, and antiviral options are formulated.
These public health measures should help combat H1N1 influenza. In addition, the CDC recommends the use of the neuraminidase inhibitors oseltamivir Tamiflu or zanamivir Relenza for the primary treatment of H1N1 influenza.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Temte serves on the Advisory Committee on Immunization Practices. The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Advisory Committee on Immunization Practices.
Address correspondence to Jonathan L.
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