Swine Flu and the Alpha-1 Community

Medical Advisory from Robert A. Sandhaus, MD, PhD, FCCP
Medical Director, AlphaNet

Swine Flu and the Alpha-1 Community

This special article is intended to answer some of the concerns Alphas may have regarding the swine flu and what can be done to decrease the risks of contracting this infectious disease.

Introduction
Swine Flu is an influenza virus (flu) that infects swine (pigs) causing respiratory illness with symptoms very much like “flu” symptoms in humans. The swine influenza virus was first isolated in the United States in 1930’s and while there are many types of swine flu viruses the most recently isolated influenza viruses from pigs have been influenza A (H1N1) viruses. Although swine flu viruses do not normally infect humans, sporadic human infections with swine flu have occurred. These infections have typically occurred in cases where persons had direct contact with infected pigs; however the virus can also be transmitted from person to person in much the same way as is regular seasonal flu: by people infected with the influenza virus coughing or sneezing, or by touching something with flu viruses on it and then touching your mouth or nose.

There is no doubt that a “swine flu” outbreak in humans has come to North America. Cases have now been reported in Mexico, the United States and Canada with countries in Europe and around the world also reporting suspected or confirmed cases of swine flu infection in humans.

The United States Department of Health and Human Services has recently declared a “public health emergency” as a precautionary measure. While there is reason for concern, this declaration provides no reason for panic; rather it simply means that the US government and all of us must take reasonable steps to protect against the transmission and spread of this type of influenza. There is tremendous uncertainty, however, about how wide spread a swine flu epidemic may be and how severe infections with swine flu may become. To date, Mexico is reporting incidences of severe illness while cases in the United States have been mild.

The major concerns regarding this virus are:
1. Will I get infected by eating pork?
2. What steps should I take to protect against contracting swine flu?
3. When should I see my doctor and how do I know if I have swine flu rather than “regular” flu?
4. What can I do to treat an infection with this virus?

Is the Alpha-1 community at special risk?
Symptoms of infection with swine flu are very similar to symptoms of regular human seasonal influenza. The “flu” usually starts suddenly and may include fever (usually high), headache, lethargy or tiredness (may be extreme), lack of appetite, coughing, and body aches. People with this swine flu have reported that high fever is generally the first thing they notice, followed by dizziness, nausea and vomiting. Runny nose, sore throat, and diarrhea can also be prominent. An infected person is contagious from one day before symptoms start until 7 days after symptoms start.

Because it is difficult to distinguish swine flu from regular seasonal flu on the basis of symptoms alone, you should contact your healthcare provider if you develop flu-like symptoms, particularly a fever, and are at high risk of complication of the flu. Your healthcare provider should consider the possibility of swine flu in persons presenting with a febrile respiratory illness especially if there is a travel history within 7 days to Mexico, Southern California, Texas, Arizona, or New Mexico or contact within 7 days with someone with confirmed swine influenza A (H1N1) or contact with someone with a new onset respiratory illness who has travelled to Mexico, Texas, Southern California, Arizona, or New Mexico Your healthcare provider may ask you for a respiratory specimen particularly if your visit is less than 5 days from when you first became sick.

Individuals over the age of 65, pregnant women, young children and those with underlying chronic disease, especially lung disease, are at greater risk of serious complications, including death, if they become infected. The same is true for any flu that infects humans. There is no reason to believe that individuals with Alpha-1 are at greater risk of catching this virus than other individuals.

Measures to reduce the chances of infection
It is important to get your annual influenza vaccine. This will not protect you against getting the swine flu from influenza A (H1N1) swine viruses, but it may offer partial protection from other common flu viruses such as influenza A (H3N1). Most importantly however, it significantly reduces your risk of contracting regular seasonal human influenza. In addition, there are some components of seasonal flu in this current strain of swine flu and there is a possibility that some immunity will be conveyed by the current flu vaccine.

A note about eating pork. According to the Center for Disease Control, you cannot catch swine flu from eating pork or pork products as the swine influenza viruses are not transmitted by food. Properly handled and cooked pork is safe. Cooking pork to an internal temperature of 160 F kills the swine flu virus as it does other bacteria and viruses.

Important measures to prevent contracting or transmitting the swine flu are the same for regular seasonal flu and include;

• Avoid close contact with people who are sick, or if you are sick stay away from others.
• Stay home if you are sick. Take sick days from work, or keep your children out of school or day care or other activities
• Cover your mouth and nose when coughing or sneezing.
• Wash your hands often.
• Avoid touching your nose, mouth or eyes as contact with any contaminated item may spread the virus to you.

Alphas should keep up to date on the situation in the news and consider avoiding crowds or anyone with signs of a cold, flu or other infection especially if they live in areas where swine flu cases have been reported. Many Alphas ask about the use of facemasks for reducing the risk of infection; however facemasks and respirators are of limited value in reducing the risk of infection unless their use is combined with the simple actions listed above. For areas where confirmed human cases of swine influenza A (H1N1) have been reported, the CDC has issued three specific recommendations with regards to facemasks and/or respirators.
1. Whenever possible, rather than relying on the use of facemasks or respirators, close contact with people who might be ill and being in crowded setting should be avoided.
2. Facemasks should be considered for use by individuals who enter crowded setting, both to protect their nose and mouth from other people’s coughs and to reduce the wearers’ likelihood of coughing on others; the time spent in crowded setting should be as short as possible.
3. Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person at home.
(Respirators are different than facemasks. If you find yourself in this situation speak with your healthcare provider about obtaining a respirator.)

Consider asking your physician for a prescription for the flu treatment, Tamiflu®.
Tamiflu has two uses:

• It can be taken prophylactically by individuals who have been exposed to the flu virus to prevent infection.
• It can be taken when someone is infected (has developed symptoms consistent with influenza or virus exposure with known cases in your area) to shorten the duration and intensity of the infection.

If you have a known exposure to a case of the flu (no symptoms of infection), you should start Tamiflu by taking one capsule a day and continue for 10 days. In some situations where there is known continued exposure, such as living or working in a nursing home, the once a day regimen can be continued until the risk is past.

It is important to note that when considering the use of Tamiflu in someone who has the flu; the benefit is minimal if you don’t start Tamiflu within the first 48 hours of the start of symptoms. The earlier you start Tamiflu within the first 48 hours, the bigger the benefit. To take Tamiflu to treat the flu, the dose is one capsule, twice a day for 5 days. Taking it longer than five days provides no additional benefit. Anyone considering taking an antiviral medication like Tamiflu should consult his/her physician. These medications require a prescription and have known side effects that must be considered before using. (A second and related antiviral drug called Relenza® can be used to treat this swine flu. However, this drug, which can only be administered by inhalation, is not recommended for people with lung disease such as COPD or asthma as it may make respiratory symptoms worse.)

The Future
Keep an eye on the newspapers, TV news, and the Internet. Check out the Center for Disease Control website for the most up to date information especially if you’re planning to travel. For travel to foreign countries check the United States Department of State website for travel advisories. Be in touch with your AlphaNet Coordinator. Stay informed. We promise to keep you up to date.