Swineflu H1N1 Flu

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Dos and Donts & a Primer on Swine Flu

FLU F.A.C.T.S.

Flu symptoms can be mild or severe, and can come on suddenly be

sure you know your flu treatment options so you can be prepared. Symptoms

generally appear 1 to 4 days after exposure to the virus.

Symptoms of the flu include chills, fever, aches, and tiredness.

The common symptoms of the flu/H1N1 Influenza

What to Do if You Think You Have H1N1 Swine Flu Virus

If you've got fever, cough, or one of the other symptoms of the flu, you may be

wondering if you have contracted the H1N1 swine flu virus. The reality is that it

isn't possible to know unless specialized testing is ordered, and for

uncomplicated cases of the flu in non-hospitalized patients, routine testing forthe H1N1 virus is not being carried out.

Swine flu (H1N1 and H3N2v influenza virus) facts

Swine flu is a respiratory disease caused by influenzaviruses that infect the

respiratory tract of pigs and result in a barking cough, decreased appetite,

nasal secretions, and listless behavior the virus can be transmitted to

humans.

Swine flu viruses may mutate (change) so that they are easily transmissible

among humans.

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Symptoms of swine flu in humans are similar to most influenza infections:

fever(100 F or greater), cough, nasal secretions, fatigue, and headache.

Vaccination is the best way to prevent or reduce the chances of becoming

infected with influenza viruses.

Two antiviral agents, zanamivir(Relenza) and oseltamivir(Tamiflu), have

been reported to help prevent or reduce the effects of swine flu if taken

within 48 hours of the onset of symptoms.

The most serious complication of the flu is pneumonia.

Clinical features of an ILI(InfluenzaLike Illness)include:

Fever(100F or greater)

Headache

Muscle aches

Chills

Tiredness

Cough

Runny nose(more common in children than adults)

If you have one or more of these symptoms, it could be the flu.So if you have

similar complaints seek advice from a doctor. Influenza (the flu) is a

contagious viral infection primarily of the nose, throat, and lungs.

Infuenza or Flu:Flu is caused only by the influenza virus, but many people

confuse illnesses caused by other viruses or bacteria, including severe colds

(rhinovirus) or the stomach flu (norovirus and other viruses and bacteria) with

influenza.

How does the flu spread?

Flu viruses are thought to spread mainly from person to person

through droplets made when people with flu cough, sneeze, or talk. Fluviruses also may spread when people touch something with flu virus on it

and then touch their mouth, eyes, or nose. Many other viruses spread these

ways too.

People infected with flu may be able to infect others beginning 1 day

before symptoms develop and up to 5-7 days after becoming sick. That

means you may be able to spread the flu to someone else before you

know you are sick as well as while you are sick.

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Young children, those who are severely ill, and those who have

severely weakened immune systems may be able to infect others for longer

than 5-7 days.

Preventing the Flu: Good Health HabitsCan Help Stop Germs

The best way to prevent seasonal flu is to getvaccinatedeach year, but good

health habits like covering your cough and washing your hands often can help

stop the spread of germs and prevent respiratory illnesses like the flu. There also

are flu antiviral drugsthat can be used to treat the flu.

1. Avoid close contact.

Avoid close contact with people who are sick. When you are sick, keep your

distance from others to protect them from getting sick too.

2. Stay home when you are sick.

If possible, stay home from work, school, and errands when you are sick. You

will help prevent others from catching your illness.If you or your child gets

sick with flu-like illness,It is recommended that you (or your child) stay

home for at least 24 hours after the fever is gone except to get medical care

or for other necessities. The fever should be gone without the use of afever-reducing medicine.

3. Cover your mouth and nose.

Cover your mouth and nose with a tissue when coughing or sneezing. It may

prevent those around you from getting sick.

4. Clean your hands.

Washing your hands often will help protect you from germs. If soap and water

are not available, use an alcohol-based hand rub.

5. Avoid touching your eyes, nose or mouth.

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Germs are often spread when a person touches something that is contaminated

with germs and then touches his or her eyes, nose, or mouth.

6. Practice other good health habits.

a) Clean and disinfect frequently touched surfaces at home, work or school,

especially when someone is ill.

b) Get plenty of sleep, be physically active, manage your stress, drink plenty

of fluids, and eat nutritious food.

c) The best way to prevent seasonal flu is to getvaccinatedeach year, but

good health habits like covering your cough and washing your hands often can

help stop the spread of germs and prevent respiratory illnesses like the flu.

DOING THE RIGHT THING DURING FLU SEASON

How Etiquette Can Protect You from Becoming That Guy with Flu

Knowingappropriate flu etiquette is an important step in preventing flu

transmission.

Why? Because no one wants to be That Guy who spreads the flu to others.

Following are flu etiquette tips :

Be proactive. Protect yourself from seasonal influenza by getting vaccinated

every year.

Lend a helping hand. Keep hand sanitizer and tissues with you at all times. If

you end up with a cougher or sneezer next to you, just ask them to protect

others by offering a tissue or spritz of alcoholbased sanitizer.

Share space, not the flu. Flu is highly contagious. Covering sneezes and

coughs is a good habit all year round, especially during flu season. The flu viruscan spread up to six feet away from coughing, sneezing, or even just talking.

Hands downthe way to go. Its classic good manners to keep your hands

below your shoulders when in public. The idea is to avoid touching your face,

which may also help keep you from getting sick after rubbing your nose, mouth

or eyes with unclean hands.

Be informed and show concern. Flu may be treatable with prescription flu

medicines. If someone near you is exhibiting signs of the flu fever, aches,chills, tiredness encourage them to see a doctor quickly. Dont feel

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uncomfortable. Just tell them, Im worried about you. I think you should see a

doctor.

Travel Flu Etiquette

Keep your hands to yourself. Going on a cruise? Check your cruise ships policy

about handshakes.

Some ships request guests refrain from shaking hands to keep the spread of illness down.

Instead, make eye contact, smile, nod your head, and say, Its so nice to meet you.

Should you be on the no fly list? Travel can be unavoidable, even when youre sick.

If staying home isnt an option, wash your hands often and show fellow travelers you have

their health in mind by bringing tissues and hand sanitizer on the flight.

Parenting Flu Etiquette

Support your children and the school system. An able body supports an

able mind. Dont send sick kids to schooltheyll easily spread the flu virus.

Instead, take them to the doctor as soon as possible. They may get a

prescription for an antiviral flu medicine.

Cover your mouth! doesnt cover it anymoreAt least, not with your

hands. Teach kids to sneeze or cough into a tissue and throw it away, or, ifthey dont have one, into their elbow. Encourage kids to do so by calling this

the Dracula Cough.

Your house, your rules. Its okay to ask your childs friends to wash up

when they are at your house for a play date. Include them in the request

from the beginning, Okay kids, please both go wash your hands before

dinner.

Help another mother out. If youre in charge of someone elses child andthey have flu symptoms, call his or her parents right away. Your daughter is

running a fever and feels achy, and Im worried for her and for the other kids.

How soon can you pick her up?

Make a team effort. Once your child has been diagnosed with flu, be sure

his teachers and coaches know why they are out. Influenza is highly

contagious. Viruses can spread through a sports team or scout troop in the

blink of an eye. Talk to kids about not sharing team water bottles and let

coaches and other activity leaders know right away if your child is diagnosed

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with the flu so these adults can be on alert for a possible flu outbreak that

may sideline the other students.

Society Flu Etiquette

Keep your distance.Normally it would be rude to cancel on a dinner party or

big event at the last minute, but if youre sick, call with your regrets and

instead, go see your doctor. If your spouse is healthy, encourage them to go

to the event alone.

Call it off. When youre the host, cancelling a party because youre sick after

weeks of planning feels like a drag. But youll be better off resting up and

your friends will thank you for keeping them healthy.

No double dipping! Thank you for making this common knowledge. Also, avoid

sharing food or drinks with anyone else, since this is an easy way to spread the flu

virus.

Spread the news, not the flu. After having spent the evening out with friends,

if you are diagnosed with the flu, be sure to let the hostess know. There is a chance

you were contagious before you felt sick, as many adults are contagious one day

before experiencing symptoms.

Stop the sick cycle. When you are home sick, let your Facebook network know

you have the flu. This will bring you lots of get well messages, and it will allow

you to help alert others nearby that influenza is circulating and they should be alert

to symptoms.

Workplace Flu Etiquette

Work your options. Sick days were invented for a reason! If youre under the

weather, dont be a herostay home. Even if you feel well enough to go in, its

better to work remotely than to spread the flu virus and get others sick.

Its me, not you. If your client offers their hand to you after coughing or

sneezing into it, you have two options. Shake hands and then go wash up, or

simply smile and say, Forgive me, I cant shake hands, but its nice to see you.

Dont delay. If you have flu symptoms at work, let your boss know right away

that you need to get to the doctor. Just let him or her know, I dont feel wellI

need to see a doctor. I think I might have the flu. Better to have others pitch in

while youre gone than to have the whole team out.

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o If you work in an office, say, Ive got the flu, and will be out for the next few

days. Ill call and check in, and as Im feeling better Ill work remotely and join

meetings via conference call.

o As a manager, say, Its important to visit your doctorit might be the flu. I

want you to stay homeno sense getting anyone else sick!

ABC GUIDELINES

1. Categorization

Category A- mild fever plus cough / sore throat with or without body ache,

headache,diarrhoea and vomiting

Category-B (Bi) Category-A plus high grade fever and severe sore throat

(Bii) Category- Any mild ILI in

Pregnant women

Lung/ heart / liver/ kidney / neurological disease, blood disorders/ diabetes/cancer /HIV-AIDS

On long term steroids

Children -- mild illness but with predisposing risk factors.

Age 65 years+.

Category-C

Breathlessness, chest pain, drowsiness, fall in blood pressure, haemoptysis,

cyanosis

Children with ILI (influenza like illness) with red flag signs(Somnolence, high/persistent fever, inability to feed well, convulsions,

dyspnoea /respiratory distress, etc).

Worsening of underlying chronic conditions.

2. H N Testing

ILI- Cat- A- No testing needed

ILI -Cat-B- No testing for Category-B (i) and (ii)

Cat-C- Test may be needed**, but do not wait for test results .

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** (Testing now needs to be done only for epidemiological purposes, eg.-

unusual inpresentation, area of residence, failure to respond even after 5 days

extension of Oseltamivirtherapy, institutional spread, etc)

Community spread- MOHFW guidelines

If there is 25 or more epidemiologically linked suspect cases of

Pandemic Influenza A -H1N1 of which at least one or more are

laboratory confirmed for Pandemic Influenza AH1N1, in two or more

cities, over a period of two weeks, then the State would be

considered to be having community spread.

Kerala has community spread

Application

The curative approach

(i) To screen Influenza like illness in designated health facilities

(ii) Categorization into A, B and C categories,

(iii) home isolation for category A and B

(iv) hospitalization for Category C.

(v) Treatment with Oseltamivir indicated for Category B and Category C (refer

to patient categorization guidelines ).

Chemoprophylaxis to family, school and social contacts of a positive case-No mass contact prophylaxis advised

For those with high risk Eg. pregnancy/ diabetes/

Asthma/immunosuppressed/very low or high age-- Start OD dose Oseltamivir x

10 days

Others assess category, if and when symptomatic, then treat as per ABC

guidelines

Guidelines for schools / educational institutions

1. Assembly to be limited to once a week or preferably less, till the

pandemic is over.

2. Screening of each student in the class by class teachers for

symptoms of flu.

3. Home isolation for teachers and other employees if they develop flu

like symptoms

Nitty gritty of Treating Influenza/Flu:

Some concerns

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Do you have Asthma, Diabetes or Chronic Heart Disease?

If so, you are at high risk of serious illness if you get the flu. In past flu

seasons, as many as 80 percent of adults hospitalized from flu

complications had a long-term health condition, as did about 50 percent of

hospitalized children.

Asthma, diabetes and chronic heart disease were among the most

common of these.

Treatment with an influenza antiviral drug can mean the difference

between having milder illness instead of very serious illness that could

result in a hospital stay.

.

Why am I at greater risk of serious flu complications?

Your medical condition makes it more likely that you will get

complications from the flu, like pneumonia.

.

The flu also can make long-term health problems worse, even if they arewell-managed. People with asthma or chronic congestive heart failure

may experience worsening of their conditions. Diabetes (type 1

and 2) can make the immune system less able to fight the flu. Also,

flu illness can raise blood sugar levels.

Can the flu be treated?

Yes. There are prescription medications called antiviral drugs that canbe used to treat influenza illness.

Antiviral drugs fight influenza viruses in your body. They are different

from antibiotics, which fight against bacterial infections.

What should I do if I think I have the flu?

If you get the flu, antiviral drugs are a treatment option. Check with

your doctor promptly if you have a high risk condition and you get flusymptoms.

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Management:

ILI- Category- A- No Oseltamivir

--Symptomatic treatment

--Good supportive measures

Plenty of warm nourishing oral fluids,

Good food intake

Complete rest

--Monitor progress

--Reassess , at 24 to 48 hours--Self isolation at home, and telephone follow up for the next 2-3 days

--Any suggestion of deterioration/ failure to improve?-- report in person stat.

ILI Category-B

(Bi) ----------------- Home isolation

---Oseltamivir to be started

(Bii) ----------------Start Oseltamivir immediately

-----Self isolation at home, and telephone follow up for the next 2-3 days

--Any suggestion of deterioration/ failure to improve?-- report in person stat.

ILI Category-C

Hospitalization stat

Start Oseltamivir immediately, without waiting for test results

Intensive supportive management is usually necessary

Should I still get a flu vaccine?

Yes. Antiviral drugs are not a substitute for getting a flu vaccine. While flu

vaccines can vary in how they work,flu vaccination is the first and best

way to prevent influenza. Antiviral drugs are a second line of defense to

treatthe flu if you get sick.

Dosage:

Adults-It should be administered as a single 0.5 mL intramuscular injection.

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How it should be taken : It comes as a solution for injection to be administered

by a healthcare provider into the large muscle.

Warnings and Precautions :

Caution should be exercised in patients with history of asthma or otherbreathing problems, nervous system disorder, blood disorder (e.g., hemophilia,

low blood platelet levels), cancer, poor immunity, receiving any treatment for

cancer, fever, respiratory tract infection, any allergy, who are taking other

medications, children, during pregnancy and breastfeeding.

It should not be used in children with severe respiratory problems.

Side Effects :

Local- Tenderness, pain, redness and swelling.

Most common - Headache, uneasiness, nausea, vomiting, fever and muscle

pain.

Respiratory- Cough, runny nose, throat pain, wheezing and shortness of

breath.

Gastrointestinal- Diarrhea, loss of appetite and sore throat.

Skin- Itching, hives and rash.

Other Precautions :

Avoid excess dosage.

Storage Conditions :

Stored in refrigerator (2-8C), should not not freeze it.

What are the benefits of antiviral drugs?

When used for treatment, antiviral drugs can lessen symptoms and

shorten the time you are sick by 1 or 2 days.

Antiviral drugs also can prevent serious flu-related complications (like

pneumonia).This is especially important for people with a high-risk health

condition, like asthma, diabetes or chronic heart disease.

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What are the possible side effects of antiviral drugs?

Some side effects have been associated with the use of influenza antiviral

drugs, including nausea, vomiting, dizziness, runny or stuffy nose, cough,

diarrhea, headache and some behavioral side effects. These are

uncommon.

When should antiviral drugs be taken for treatment?

Studies show that flu antiviral drugs work best for treatment when they

are started within 2 days of getting sick. However, starting them later can

still be helpful, especially if the sick person has a high-risk healthcondition (see list below) or is very sick from the flu (for example,

hospitalized patients). Follow your doctors instructions for taking these

drugs.

What antiviral drugs are recommended?

These are oseltamivir &zanamivir

(Zanamivir should NOT be used in anyone with breathing problems, like

asthma or COPD, for example.)

There are no generic flu antiviral drugs.

How long should antiviral drugs be taken?

To treat flu medications are usually taken for 5 days, although peoplehospitalized with the flu may need the medicine for longer than 5 days.

Can children and pregnant women take antiviral drugs?Yes. Children and pregnant women can take antiviral drugs.

Who should take antiviral drugs?

Its very important that antiviral drugs be used early to treat the flu in:

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People who are very sick with the flu (for example, people who are in the

hospital).

People who are sick with the flu and have a high-risk health condition

like asthma, diabetes or chronic heart disease. (See the full list of high-risk

conditions).

.

Following is a list of all the health and age factors that are known to

increase a persons risk of getting serious complications from the flu:

People younger than 19 years of age on long-term aspirin therapy

People with Chronic Obstructive Pulmonary Disease (COPD)

Weakened immune system due to disease or medication (such as people

with HIV or AIDS, or cancer, or those on chronic steroids)

Other people at high risk from the flu:

Adults 65 years and older ,Children younger than 5 years old, but

especially children younger than 2 years old

Pregnant women and women up to 2 weeks after the end of pregnancy,

Asthma ,Blood disorders (such as sickle cell disease)

Chronic lung disease (such as chronic obstructive pulmonary disease

[COPD] and cystic fibrosis) Endocrine disorders (such as diabetes

mellitus)

Heart disease (such as congenital heart disease, congestive heart failure

and coronary artery disease) Kidney disorders Liver disordersMetabolic disorders (such as inherited metabolic disorders and

mitochondrial disorders) Morbid obesity

Neurological and neurodevelopmental conditions

Be Wise & Stay Healthy!