Sunday, May 03, 2009

All the brouhaha about swine flu

How important is Swine Flu really?

Is it likely to be a pandemic?

Is it going to kill millions of people like the infamous flu pandemic of 1918?

Unfortunately no one has the answers. Lots of speculations, guesses, and opinions. However a few regularly asked questions that have specific answers are what I am going to answer here, and provide a couple of excellent resources for self reading.

What are the symptoms of Swine Flu? Symptoms include at least 2 of the following:

  • Rhinorrhea or nasal congestion;

  • Sore throat;

  • Cough; and

  • Fever.

In addition, persons with swine flu may have other typical symptoms of influenza, including body aches, headache, chills, fatigue, and possibly diarrhea and vomiting.

Can you get this from eating cooked pork? No.

Can my pets get this? No.

Should I avoid traveling to swine flu affected areas at present ? Yes if you can avoid it.

Should I postpone my trip to US/ Mexico? It's too soon to know; follow travel-advisory information from the CDC closer to the event.

Will there be a vaccine? Work is under way to make a safe and effective vaccine that hopefully will be available by next flu season.

Is there enough medication? For those who may truly need it, yes, but most infected persons in the United States & worldwide (except Mexico) have not required intensive medical intervention.

What should I do to protect myself and my family? Take these everyday steps to protect your health:
  • Avoid touching your eyes, nose or mouth. Germs spread this way.

  • Try to avoid close contact with sick people.
    • Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
    • Is the nation/state/city prepared for a pandemic? Public health authorities are more prepared than ever before, supported with some (more is needed) government funding and shaped over time by events, including the 1918 flu disaster, 2001 anthrax attack, the ongoing threat of avian flu, and Hurricane Katrina. The global community, however, is far from ready.
Is it time to panic? It is never time to panic. While it's no surprise that a circulating, airborne, invisible virus causes anxiety for many, panic serves no useful role in public health.

I am planning to travel to USA, what should I do? Avoid it if possible, otherwise take regular precautions like washing hands, covering mouth and avoid crowded places and report to a doctor if you have flu like symptoms. Talk to your doctor about carrying Tamiflu as a preacutionary measure if traveling to an area with high incidence of Swine Flu.

Should I take prophylaxis with TAMIFLU if am traveling to the USA? Chemoprophylaxis is recommended for 7 days after the last known exposure to a confirmed case of swine influenza A (H1N1) virus. The CDC recommends that the following populations receive chemoprophylaxis:

  1. Household close contacts of a confirmed or suspected case who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  2. School children who are at high risk for complications of influenza (persons with certain chronic medical conditions) who have had close contact (face-to-face) with a confirmed or suspected case.

  3. Travelers to Mexico who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  4. Border workers (Mexico) who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  5. Healthcare workers or public health workers who have had unprotected close contact with a person with confirmed swine influenza A (H1N1) virus infection during the infectious period. (Detailed guidance on this topic is available at

So the answer to that question is NO, if you are a healthy person traveling to USA, you may not take prophylaxis, because the risk of serious disease is virtually negligible.

What is the dose for Tamiflu? Tamiflu is NOT recommended for children less than 1 year. While a syrup form is available in the USA, I believe that none is available in India.
The dose is 2.5 mg/kg twice a day for treatment, while it is 2.5 mg/kg once a day for prophylaxis. For adults the dose is 75 mg once a day for prophylaxis and twice a day for treatment.

Here are a few excellent resources that will provide updated information about Swine Flu.

Medscape Resource Center for Clinicians

CDC Swine Flu Website


UPDATE: NEJM has created a new center of H1N1 virus, the one causing Swine Flu. You can get latest news about this here
NEJM H1N1 Influenza Center

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