Swine flu: top 20 answers you need to know

With more outbreaks of the new strain of swine flu come outbreaks of misinformation and rumor. Below are 20 questions answered by infectious disease expert Charles Ericsson, MD, professor of internal medicine and director of travel medicine at the University of Texas Medical School at Houston. Also, Robert Emery, DrPH, vice president for safety, health, environment and risk management at UT Health Science Center and associate professor in the UT School of Public Health explains common sense preparedness and prevention of illness.

1. How do symptoms of swine flu differ from other types of flu?

None, really, although this flu might include gastrointestinal symptoms (diarrhea and vomiting), as well as the usual respiratory symptoms. The basic symptoms for swine flu are similar to the seasonal flu we are vaccinated for each year, which may include fever (greater than 100°F or 37.8°C), sore throat, cough, stuffy nose, chills, headache and body aches and fatigue.

2. If I felt flu-like, how would I know if I had swine flu?

You wouldn’t really, nor would your physician know for sure without a respiratory specimen taken within the first four to five days. The specimen would then be sent to the Centers for Disease Control and Prevention (CDC). The cases so far in the U.S. have been relatively mild compared to the illness described in patients in Mexico. We do not yet know why the U.S. cases have been milder. The important point is to call your doctor if you think you have the flu. Prescription anti-viral drugs such as TamiFlu or Relenza can be called in by your doctor. Unless you are exceptionally ill with flu-like symptoms, are chronically ill, immune-suppressed, quite elderly or have a very young child, under age 2.

It is best not to report to the hospital, clinic or doctor’s office, where you could risk spreading the disease. Again, call your doctor first to get instructions as to what you need to do next.

3. How long are people contagious?

Adults are potentially contagious for the length of time one has symptoms, up to seven days following the beginning of illness. The “shedding stage” of the virus is during the first four to five days of illness. Children can be considered contagious longer, up to 10 days. The initial incubation period is 24 to 48 hours.

4. Is there medication for this?

Yes, Tamiflu or Relenza have shown to be effective against these recently reported strains of swine flu. Altogether, there are four anti-viral drugs that we commonly use to treat various strains of flu.

5. Can I start taking medicine for it now, just in case I get it later?

That is not presently advised. Preventive medication might be advised for very special circumstances where a person had to expose themselves to potentially ill people during an epidemic (which we do not yet have here). Such people might include ER workers. An outbreak in a nursing home, for instance, might lead to protecting all the other residents with a drug like TamiFlu. For the general public, the current answer is no to prophylactic (preventative) use with anti-viral medications. Its coverage time is limited. Do not confuse over-the-counter “cold and flu” preparations for anti-flu medications that require a prescription.

6. Are the symptoms in children different from adult symptoms?

Though the basic symptoms are similar, the signs of potentially life-threatening complications differ. The CDC advises those with these symptoms to seek emergency care immediately. Emergency warning signs in children are fast breathing or trouble breathing, bluish skin color, not drinking enough fluids not waking up or interacting, being very irritable, fever with a rash. Emergency warning signs in adults are difficulty breathing or shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness, confusion, severe or persistent vomiting.

7. Is there a vaccine?

Not yet, but the CDC has this current strain of virus and will consider whether to add it to next year’s flu vaccine as time goes on.

8. If I took the swine flu vaccine in the swine flu scare during the 70s, would that cover me? What about this year’s flu shot I just took?

We don’t know yet. Previous vaccines could be expected to afford only partial, incomplete protection at best. This new strain of the swine flu virus (H1N1) actually has a mixture of swine and avian components (not to be confused with the deadly avian flu of Southeast Asia).

9. Can I catch it from pigs?

No. This strain is one that is communicable through human-to-human contact. It is a mutated form of a swine virus.

10. Can I catch it from eating pork?

Absolutely not! Swine flu is not transmitted by food. It is not a so-called foodborne illness. Bacon, ham and other pork products are safe to eat, assuming they are prepared properly. An internal temperature of 160 degrees for cooked meat will kill any bacteria or virus. Swine flu is transmitted by airborne droplets from an infected person’s sneeze or cough; or from germs on hands, or germ-laden surfaces. Eating pork will not give you swine flu any more than eating chicken will give you bird flu.

11. How does it cross from a pig to a human?

The swine virus mutates so that it can infect humans and be spread by humans.

12. Can it kill me?

Deaths have been reported from the Mexico City outbreak. So far the cases in the U.S. have been mild and there have been no deaths as of this writing (April 27) We do not know all the factors geographically and demographically that may contribute to the mildness or severity of this flu. But, like seasonal flu, there is the potential for serious outcomes.

13. Why the big concern if the regular flu kills 35,000 people a year, which is why we are all encouraged to get a flu shot?

This is a new flu strain that our bodies have not been exposed to before. The flu strains that the CDC creates a vaccine for each year all have the potential to cause great harm, especially in elderly, pediatric and chronically ill patients. This particular flu strain has struck seemingly healthy, young adults, with some resulting in death in Mexico. It also appears to be quite contagious. We will know more about this strain in the coming days.

14. How is it different from avian (bird) flu?

Avian flu so far has had difficulty infecting humans unless they are exposed intensely to birds, because the virus has not mutated in a way that makes it transmissible by humans to other humans. This virus has origins genetically from both pigs and birds, and the big difference from the avian flu is that this swine virus can be transmitted readily from human to human.

15. Is this just another scare that will go away like bird flu?

Bird flu is a theoretical threat and will need a mutation to be able to be transmitted among humans to become a serious threat. The present “swine/avian” virus clearly has already caused a major outbreak in Mexico City and San Luis Potosi, Mexico and has spread to places in the U.S. (California, New York, Texas, Kansas and Ohio). What is not clear yet is whether this virus will result in a so-called pandemic - worldwide spread with major outbreaks - or whether it will fizzle out. But, even if it fizzles out, there is logical concern that it might re-emerge next flu season.

16. Should I cancel my vacation to Mexico?

At this writing, the situation is very fluid, changeable. I suggest checking frequently with the CDC Web site for possible travel alerts. I probably would not travel to Mexico City for a vacation that could easily be rescheduled, if for no other reason than the city has tried to limit access to crowded or public places where transmission might be facilitated. That does not sound like a very pleasant vacation to me! Having said that, there are more than 4,000 flights to Mexico from the US and none have been cancelled as of this writing. However, some international airports in Europe and Asia are stepping up precautions and issuing alerts. Again, check the CDC’s Travel Alerts page.

17. What if I’m on a plane? Should I wear a mask?

Not necessary. The air on a plane is filtered. Transmission might occur if someone sitting close to you coughs or sneezes on you. The newer designs of aircraft airflow keep the air in a top-down flow, not forced air from front to back. However, if you do have a respiratory illness, it might be best not to travel.

18. How long does the germ live on surfaces, like on my desk if someone sneezes in my office?

Influenza virus survives only minutes on inanimate objects or hands, so these are very inefficient ways to spread the illness. Influenza is most easily spread by droplets that come into contact with our mucus membranes such as when someone coughs or sneezes in our faces. If we shake hands with an infected person who has just wiped their nose and then we rather quickly rub our nose or eyes with our own hand, then we could get the flu. So, good hand washing does play a role in diminishing the spread of the disease.

19. Other than hand washing and covering my mouth if I sneeze or cough, what can I do to take care of myself and others?

If you are ill, stay home. Control your sneezes and coughs. If you cough into your hand, remember the virus could be live on your hand at least for a few minutes, so wash your hands before touching anyone else. If you get symptoms suggesting the flu, call your doctor, who can call in a prescription for medication to treat the flu. Resist going to the doctor’s office or a hospital ER for influenza symptoms unless you are seriously ill. You do not want to spread the disease to others.

20. What else can I do?

Most important, be alert, not panicked.

Proper hand hygiene:

There’s a right way and useless way to wash hands - and wash away - micro-organisms. The object is to break down the protective membranes of germs, dislodge them from your hands and let them go down the drain. Plain soap in the right hands is strong stuff.

*Lather well with a bar of soap or squirt a coin size of liquid soap in the palm of your hand.

*Vigorously rub your hands together, soap up between your fingers, AND your wrists, front and back for 15 seconds. Sing the first chorus of any song you know and that’ll take you through the 15 seconds.

*Rinse under warm, RUNNING water. Remember, the object is to dislodge germs. The force of water is key.

*Dry thoroughly your hands with a disposable towel or under the blower, again, rubbing your hands together.

*Discard the towel.

If you’re using alcohol-based gels as hand cleansers:

Put a dime-sized amount in one hand:

*Vigorously rub your hands together and in between your fingers until the GEL IS DRY—about 30 seconds.

*DO NOT touch your face!

Once your hands are clean, do not touch your face, nose, eyes or lips.

Rubbing your eyes and nose provides a freeway for microorganisms and good breeding ground once they’ve arrived.

Cover your cough

If you must cough or sneeze, cover your mouth with a tissue, your sleeve or your hand.

Throw the tissue away in a waste basket. Do not leave discarded tissues on your desk or other surfaces.

Then, wash your hands thoroughly.

The throw-it-away part is essential.

Microorganisms live a life span from a few seconds to days on inanimate surfaces such as desks, table tops, faucets...tissues. If your tissues are scattered on your coffee table, they then are in contact with community surfaces. Both the tissues and the surface it sits on can spread germs to the person who touches the coffee table.

If you begin to feel ill: feverish, achy, have a dry, painful cough, sore throat, go home from school or work and call your healthcare provider for further instructions.

If you feel sick with flu-like symptoms and you care for the very young or the very elderly or the chronically ill, inform your healthcare provider when you call their office.

   If you have recently traveled to Mexico or to one of the areas worldwide that has reported a swine flu outbreak, inform your healthcare provider. He or she may prefer to treat you with prescription anti-viral medications from home, or may request that you come in for a visit. Follow instructions from your healthcare providers.

PNEUMONIA

Pneumonia is a specific acute respiratory disease which involves an entire lung or a part of a lung. It may occur at any time of year, but it is frequent in the months of damp and chilly weather.

Factors that predispose to pneumonia include exposure to smoking, malnutrition, asthma, chronic kidney or liver disease. Bottle-fed infants are at additional risk as compared to those breast-fed.

Pneumonia is usually caused by viruses or bacteria. Mixed infections with both viruses and bacteria may often occur. The disease is airborne, spreading during coughing or sneezing. Lungs may also become infected if viruses or bacteria present in the child’s nose or throat get breathed into the lungs.

Bacterial and viral cases of pneumonia are usually present with similar symptoms.

The disease sets in abruptly, often after a preceding upper respiratory infection with a cough. The main symptoms are chill, fever, general weakness and persistent dry cough which can’t be relieved by common measures. The typical signs in children under five are fever, cough, and fast or difficult breathing.The child usually has poor appetite, disturbed sleep. Sometimes children have local chest pains or stomachache. Young infants suffer from shortness of breath.

Pneumonia is typically diagnosed by a combination of physical signs and a chest X-ray.

A variety of complications may occur. Sometimes empyema develops after the seventh day of the disease. Otitis media and mastoiditis are usually found in children. Other complications are pleuritis, lung abscess, acute cardio-pulmonary failure, endocarditis, myocarditis, meningitis, sepsis, a toxic shock etc.

Proper nursing should include bed rest, fresh air and nutritious food. The disease responds very well to specific medication with appropriate antibiotics (amoxicillin etc). Different cough syrups or herbs can relieve cough. Mustard plasters are always administered, sometimes cups as well. The child should be given vitamins C, A and others.

Prevention includes vaccination, environmental measures and proper treatment of other health problems.

Vaccination can prevent certain bacterial and viral types of pneumonia, both in children and adults.

 

SOME FACTS ON PNEUMONIA

Pneumonia is a form of acute respiratory infection involving lungs. Pneumonia is an inflammatory condition affecting primarily the minute air sacs known as alveoli. In a healthy person alveoli are filled with air. In pneumonia they are filled with fluid and pus making breathing painful and limiting oxygen supply.

It is the cause of death of 15% of children under 5 all over the world. It can be caused by such bacteria as:

· streptococcus pneumonia е, it isthe most common cause of bacterial pneumonia in children;

· haemophilus influenzae type b (Hib), it is the second most frequent cause of bacterial pneumonia;

· respiratory- cinticial virus, it is a common cause of viral pneumonia;

·  in HIV-infected children one of the most common causes of pneumonia is pneumocystis jiroveci.

There are several waysof the spread of infection. Some viruses or bacteria may be present in the child’s nose or throat. Sometimes they get to the lungs with the air breathed in, and so infect the alveoli in the lungs. The microorganisms are transmitted by droplet infection from a sick person with cough or sneezing. Pneumonia can be transmitted through blood, especially in childbirth.

Upper respiratory infections (measles as well) may be complicated by pneumonia. The child susceptibility to pneumonia increases under the following conditions:

· Air indoors contaminated with cooking;

· Living in overcrowded setting;

· Parents smoling;

· Unbalanced nutrition;

· Chronic disease of an inner organ;

· Bottle-fed infants are at additional risk as compared to those breast-fed.

Young infants may become unconscious and have convulsions in severe cases of pneumonia.

Pneumonia is typically diagnosed on the basis of a combination of physical signs and a chest X-ray.

The World Health Organisation has defined pneumonia in children clinically based on either a cough accompanied by high temperature or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness.

Prevention includes vaccination (against Hib, pneumococcus, measles, and whooping cough), environmental measures and appropriate treatment of other health problems.

 

Words to be memorized:

Nouns: fever, chill, lung, chest, stomachache, weakness, sweating, expectoration.

Verbs: to involve, to set in, to complicate, to last, to consist, to administer, to remain.

Adjectives: entire, frequent, chief=main, nutritious, common.

Other words: abruptly, chiefly.

Exercises

I. Answer the following questions:

1. What kind of disease is pneumonia?

2. In what seasons does it occur?

3. What are the chief predisposing factors to this disease?

4. What are the main symptoms of pneumonia?

5. How long does it last?

6. Are there any complications after pneumonia?

7. What is the commonest complication?

8. What does the treatment of pneumonia consist of?

9. What medicine is prescribed for pneumonia?

10. What procedures are administered for severe cases of pneumonia?

11. When are vitamins given to the pneumonia patient?

12. What diseases are complicated by pneumonia?

II.  Read the text and say what new information it contains as compared with the previous text:

Pneumonia almost always sets in abruptly with a high fever. Children often complain of stomachaches and pain in the chest. Sometimes children expectorate bloody sputum. The cough is at first very mild, in some cases it is absent altogether. Respiration is accelerated. The disease lasts 7-14 days. In older children complications are rare, and prognosis is very good. Proper treatment and nutrition lead to complete recovery.

III. Match the underlined words with their Russian equivalents and translate the sentences:

1. This food is very nutritious.                             а) частый

2. The disease sets in abruptly.                                      b) корь

3. During this season the disease is very frequent.              с) резко, внезапно

4. Pneumonia may complicate whooping cough.       e) коклюш

5. Measles may also be complicated by pneumonia.          d) питательный

IV  Speak about: a) symptoms and course of pneumonia; b) complications of pneumonia; c) treatment of pneumonia; d) care for a pneumonia patient.

CHICKEN-POX

Chicken-pox is a very contagious disease of children. The disease occurs in epidemics, especially in children under the age of ten years. Children of the first four years of life are the most susceptible. Chickenpox is also contagious to adults who haven’t had the disease or have not been vaccinated against it. Today a vaccine is available that protects children against chickenpox.

Chickenpox is caused by the varicella-zoster virus (the Herpes virus family). The disease is airborne, the virus spreads during coughing, sneezing or talking getting on the mucous membranes of the nose, mouth or throat.

There is an incubation period of 14—21 days, most frequently 17 days.

The first symptoms are the following: a slight fever, headache and sometimes pains in the back and legs. Almost at the same time with the first symptoms (within twenty four hours) a characteristic eruption appears on different parts of the body. It is found very frequently on the scalp (the hairy part of the head).

The virus causes an itchy rash with small, fluid-filled blisters. The eruption starts as red macules quickly progressing to papules and vesicles. Soon they become crusted. The brownish crusts dry up and the scabs scale in two – three weeks. The child becomes infectious 2 days before the appearance of the rash and remains infectious 5-7 days after that.

The number of vesicles may be very variable. In a mild case the child may have only several vesicles, but sometimes, in severe cases their number may amount to several hundred.

In the majority of cases there is no difficulty in making a diagnosis, but a doctor must learn to differentiate chicken pox from other skin disorders.

Chicken-pox is one of the mildest of acute infectious diseases of children. Children remain feverish for 2 – 3 days, while new vesicles still appear, and after that they feel well. The recovery is usually complete. Complications are rare.

In patients with weak immunity the disease is complicated by stomatitis with little ulcers, pyodermatitis, as well as bacterial infections of the skin, rarely affecting softe tissues, bones or even causing sepsis. Encephalitis may occur in uncommonly severe cases. Isolation is necessary to protect other children from infection. The child should stay in bed as long as he has any fever while new eruption continues to appear.

In the majority of cases no medicine is required for treatment. The lesions should be treated with a disinfective solution (e.g. brilliant green).

 

Words to be memorized:

Nouns: vomiting, eruption, vesicles, crust, scab, disorder, complication, lesion.

Verbs: to appear, to amount, to dry up, to fall off, to scale, to include, to require.

Adjectives: contagious, susceptible, slight, brownish, variable, severe, complete, rare, eruptive, common.

Other words and expressions: frequently, almost.

 

Exercises

I. Answer the following questions:

1. What kind of disease is chicken-pox?

2. What is the most characteristic symptom?

3. What age is affected by the disease?

4. Is the incubation period long?

5. What are the first symptoms?

6. When does the eruption appear?

7. What does the eruption consist of?

8. On what part of the body does the eruption appear?

9. How many vesicles may be on the skin?

10. What is the duration of this disease?

11. What treatment is required?

12. Is it difficult to make a diagnosis?

13. What must the doctor keep in mind making a diagnosis?

14. Is chicken-pox usually mild or severe? What shows this?

II.  Translate the following sentenses:

a) 1. No special treatment is required in case of chicken-pox.

2. Chicken-pox does not occur in vaccinated adults.

3. Chicken-pox is not a dangerous disease.

4. The doctor found no eruption on the back of the patient.

5. The sick boy did not attend school during 5 days.

6. As a rule chicken-pox has no complications.

7. The patient was not taken to the hospital because he had no symptoms of any infectious disease.

8. The patient had no symptoms of scarlet fever. There was no rash on his neck, chest or extremities.

9. The child felt no pain in the throat.

 

b) 1. There should be an immunity after a spontaneous attack of chicken-pox.

2. There may or may not be a preceding upper respiratory infection with cough.

3. In a mild case of chicken-pox there may be eight or ten vesicles, but in a severe case there may be six or seven hundred of them.

4. There may occur such complications as nephritis, pneumonia and encephalitis.

5. If there is chicken-pox, there must be skin eruption.

 

c) 1. Chicken-pox is known to be transmitted by droplets.

2. Treatment of chicken-pox must be aimed at controlling the fever and relieving the itching.

3. Where is Dr.Brown? He may be examining a child with some rash admitted to the hospital.

4. She must have been treated in hospital because of the severe complication after chicken-pox.

5. Chicken-pox may be a serious disease for adults who may have been infected with AIDS; it may be treated with ciclovir.