Answers to questions about swine flu - | WBTV Charlotte

Answers to questions about swine flu

The following questions and answers concerning swine flu were compiled by Kevin Soden, MD.  If you would like more information about Soden, go to www.kevinsodenmd.com.

What is the "infectious period" for a confirmed case of H1N1?  

Infectious period for a confirmed case of swine influenza A (H1N1) virus infection is defined as 1 day prior to the case's illness onset to 7 days after onset.

People are concerned about "close contact" with infected persons. How does the CDC define this?  

Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine influenza A (H1N1) virus infection during the case's infectious period.

Passing by a person's office or seeing them in the hall is not close contact but being within 6 feet of a person at a meeting in an office would be considered close contact. Driving in a car with someone would also be close contact. Likewise, if you share phones, keyboards or office equipment with someone, then you are considered close.

What is the CDC recommending that physicians do for confirmed, suspected or probable cases of H1N1 (swine flu) influenza A?  

Obviously, recommendations may change as data of antiviral susceptibilities become available. Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Evidence for benefits from treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. Recommended duration of treatment is five days.

How useful are masks for preventing infection with H1N1 influenza A?  

Guidelines posted this week by the federal Centers for Disease Control and Prevention recommend that people avoid close contact and crowded conditions rather than relying on faces masks for protection from infection during a flu pandemic. But they also suggest that face masks might reduce risk if it's impossible to avoid crowds or people who are already infected.

"Very little is known about the benefits of wearing face masks or respirators to help control the spread of pandemic flu," the CDC notes. Whether or not face masks protect against viruses such as the swine flu depends greatly on what kind of masks people use and how well they wear them.

There are basically two kinds of face masks: loose-fitting surgical or medical masks made of soft, thin cloth that sell for pennies apiece, and form-fitting masks, also known as N-95 respirators, made of spun plastic fibers that filter small particles. They sell for a few dollars each. One problem with the N-95 masks is that although they filter microscopic particles, they also impede breathing, making them uncomfortable to wear for extended periods of time.

Masks need to be used along with other preventive measures. The level of protection depends on whether the masks are worn properly - over both the mouth and nose, for instance - and whether they are worn consistently. But if these conditions aren't met, people are better off tossing both kinds of masks and avoiding the illusion they're protected at all and focusing more efforts on preventive measures.

When should antiviral chemoprophylaxis be considered for post-exposure or    pre-exposure cases of H1N1?  

Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir (Tamiflu) or zanamivir (Relenza) is recommended for the following individuals:

  1. Household close contacts who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) of a confirmed, probable or suspected case.
  2. School children who are at high-risk for complications of influenza (children with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed, probable, or suspected case.
  3. Travelers to Mexico who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women).
  4. Health care workers or public health workers who were not using appropriate personal protective equipment during close contact with an ill confirmed, probable, or suspect case of swine influenza A (H1N1) virus infection during the case's infectious period.

Pre-exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following:

  1. Any health care worker who is at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) who is working in an area of the healthcare facility that contains patients with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness.
  2. Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.   

When should a person use a facemask? (surgical mask type)  

Facemasks should be considered for use by individuals who enter crowded settings, 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 settings should be as short as possible.  

When should a respirator mask be used? (N-95 type)

Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. First responders or emergency brigade members fall into this category.   

Are anti-viral medicines recommended for the swine flu?  

The CDC states the following: "Empiric antiviral treatment should be considered for confirmed, probable or suspected cases of swine influenza A (H1N1) virus infection. Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Evidence for benefits from treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset. Recommended duration of treatment is five days.  

Is anti-viral chemoprophylaxis being recommended?

Yes, the CDC is now recommending anti-viral treatments in certain instances. For antiviral chemoprophylaxis of swine influenza A (H1N1) virus infection, either oseltamivir or zanamivir are recommended. Duration of antiviral chemoprophylaxis post-exposure is 10 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. For pre-exposure protection, chemoprophylaxis should be given during the potential exposure period and continued for 10 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection.

Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir is recommended for the following individuals:

  1. Household close contacts who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) of a confirmed, probable or suspected case.
  2. School children who are at high-risk for complications of influenza (children with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed, probable, or suspected case.
  3. Travelers to Mexico who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women).
  4. Health care workers or public health workers who were not using appropriate personal protective equipment during close contact with an ill confirmed, probable, or suspect case of swine influenza A (H1N1) virus infection during the case's infectious period.

Pre-exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following:

  1. Any health care worker who is at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) who is working in an area of the healthcare facility that contains patients with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness.
  2. Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.

What can be done to reduce the likelihood of a person contracting the swine flu (H1N1) if there are cases in there immediate area?  

In areas with confirmed human cases of swine influenza A (H1N1) virus infection, the risk for infection can be reduced through a combination of actions. No single action will provide complete protection, but an approach combining the following steps can help decrease the likelihood of transmission. These actions include frequent handwashing, covering coughs, and having ill persons stay home, except to seek medical care, and minimize contact with others in the household. Additional measures that can limit transmission of a new influenza strain include voluntary home quarantine of members of households with confirmed or probable swine influenza cases, reduction of unnecessary social contacts, and avoidance whenever possible of crowded settings.  

What advice does the CDC have to protect myself and those I care about?

Practice healthy habits to stop the spread of germs

  • Wash your hands often with soap and water.  This removes germs from your skin and helps prevent diseases from spreading.
  • Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap is not available and hands are not visibly dirty.
  • Cover your mouth and nose with a tissue when you cough or sneeze and put your used tissue in a wastebasket.
  • If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
  • Wash your hands after coughing or sneezing, using soap and water or an alcohol-based hand gel.

Seek medical care if you feel sick

  • If you become sick with a fever plus a cough and sore throat or have trouble breathing, seek medical care right away.  Tell your doctor if you have had contact with a sick person or farm animals while traveling. 
  • You should avoid further travel until you are free of symptoms, unless traveling locally for medical care.

After you return from Mexico

  • Pay close attention to your health for 7 days.
  • If you become sick with a fever plus a cough, sore throat or have trouble breathing, see a doctor.
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