Swine Influenza and You

[okarol]

Swine Influenza and You

What is swine flu?

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

Are there human infections with swine flu in the U.S.?

In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well. An updated case count of confirmed swine flu infections in the United States is kept at http://www.cdc.gov/swineflu/investigation.htm CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?

CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?

Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How can someone with the flu infect someone else?

Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?

First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?  Renal patients...please check with your doctor first!

Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?

People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?

We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What can I do to protect myself from getting sick?

There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

    * Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
    * Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
    * Avoid touching your eyes, nose or mouth. Germs spread this way.
    * Try to avoid close contact with sick people.
    * If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. Wash with soap and water. or clean with alcohol-based hand cleaner. we recommend that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?

If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

    * Fast breathing or trouble breathing
    * Bluish skin color
    * Not drinking enough fluids
    * Not waking up or not interacting
    * Being so irritable that the child does not want to be held
    * Flu-like symptoms improve but then return with fever and worse cough
    * Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

    * Difficulty breathing or shortness of breath
    * Pain or pressure in the chest or abdomen
    * Sudden dizziness
    * Confusion
    * Severe or persistent vomiting

How serious is swine flu infection?

Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

Can I get swine influenza from eating or preparing pork?

No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

http://www.cdc.gov/swineflu/swineflu_you.htm

[Hanify]

Do you know if dialysis patients should get a flu injection?

[Chris]

I was told to get one while on dialysis and the CDC reccommends it also here in the US.

[Wattle]

I have the Flu Vaccine every year. I also make my husband and kids have it.

[kitkatz]

From what I have heard this is a new flu virus coming through. The flu vaccine is not be effective against swine flu..

[David13]

Yes, flu shots are generally recommended for dialysis patients, but this swine flu is in a whole different league. 

[Chris]

Yes Kitkatz, but still good to have while on dialysis.

According to the news, the govt here is releasing a stock pile or something of Tamaflu and a couple other medications. It was on the 3 am news,and wasn't fully paying attention to the names.

So if I feel sick and go to the ER and say I think I have the flu, will I go in front of the line and be seen first? (morbid sense of humor)

[hurlock1]

Boy, Okarol, that was Some Thorough letter with thr questions and answers and everything, I thought I was reading different letters. It seemed to go on and on and on. I don't know if this helps, besides it being the number one news story on every network, and local news program, and possibly world news, But at my center, they gave us a flu shot, and they said on the news, that the swine flu didn't resist the current flu shots, so it seems like you could spend your time worrying about more important things. . .Like Ninjas

[rocker]

Like Ninjas

Ninjas? ? ? ?

Have the ninjas been spotted? ? ?

RRRRUUUUUUUUUUUUUUUNNNNNNNNNNNNNNNNNNNN!!!!!!!!!!!

[Bill Peckham]

Boy, Okarol, that was Some Thorough letter with thr questions and answers and everything, I thought I was reading different letters. It seemed to go on and on and on. I don't know if this helps, besides it being the number one news story on every network, and local news program, and possibly world news, But at my center, they gave us a flu shot, and they said on the news, that the swine flu didn't resist the current flu shots, so it seems like you could spend your time worrying about more important things. . .Like Ninjas

The seasonal flu vaccine has no impact on the novel H1N1 influenza virus that has everyone worried. This is something that will be a part of our lives for many months. The soonest a vaccine could be manufactured is 12 to 24 weeks but that would also require that the virus not mutate into a different strain and people on dialysis are in the thrid priority group to receive vaccine so you should not expect it to be available to you until 2010.

The critical question is how sick will this make you. If this virus causes people to get sick enough to require hospitalization then the provision of dialysis would be at risk. If you need dialysis you can not stay home to wait this out (unless you are on home dialysis).

[Bill Peckham]

Yes Kitkatz, but still good to have while on dialysis.

According to the news, the govt here is releasing a stock pile or something of Tamaflu and a couple other medications. It was on the 3 am news,and wasn't fully paying attention to the names.

So if I feel sick and go to the ER and say I think I have the flu, will I go in front of the line and be seen first? (morbid sense of humor)

There is not going to be Tamiflu for you unless you can get sick very soon. Many states - such as Florida - did not participate in the Tamiflu stockpile program, and the federal stockpile will quickly be used up by first responders if this continues to go in the direction it is heading.  I live in a county that has it's own Tamiflu stockpile (one of the few local municipalities to have a stockpile), in a state that participated in purchasing their allotment of antivirals and my dialysis provider has enough for every staff person and patient but even then it is just one bullet.

This is going to last longer then the stockpiles. If you can you should try to buy your own personal protective equipment - for instance N95 masks. There may be just enough time to find some if you act quickly.

[okarol]

Ninjas? Damn!

Bill is right - you still need your flu shot every fall - but there's no vaccine for the Swine Flu.

[rocker]

The first reports I heard were that this strain was preferentially fatal to the young and healthy.  There are two possible reasons: either the flu vaccine provides some protection (the young are the least likely to be vaccinated), or the fatalities are due to an immune system overreaction (the stronger the immune system, the stronger the reaction).

Either way, it is encouraging news for dialysis patients....as much as any of this news can be encouraging.

[Bill Peckham]

The first reports I heard were that this strain was preferentially fatal to the young and healthy.  There are two possible reasons: either the flu vaccine provides some protection (the young are the least likely to be vaccinated), or the fatalities are due to an immune system overreaction (the stronger the immune system, the stronger the reaction).

Either way, it is encouraging news for dialysis patients....as much as any of this news can be encouraging.

Except people on incenter dialysis rely on those 20 to 40 year olds to provide their treatment and to drive them to their treatment. If the dialysis unit is closed or your ride isn't available it won't matter what state your immune system is in.

[hurlock1]

Like Ninjas

Ninjas? ? ? ?

Have the ninjas been spotted? ? ?

RRRRUUUUUUUUUUUUUUUNNNNNNNNNNNNNNNNNNNN!!!!!!!!!!!

No, that's why we have to worry.  They're so sneaky! If they were on the news. . .

[RightSide]

Except people on incenter dialysis rely on those 20 to 40 year olds to provide their treatment and to drive them to their treatment. If the dialysis unit is closed or your ride isn't available it won't matter what state your immune system is in.

In any bad cold/flu season, there will be dialysis staff who are out sick.  Dialysis centers have contingency plans for such things.

At my center, last February, we had 3 or 4 nurses and techs who were out sick at any one time, due to a bad cold that was sweeping our community.  Yet dialysis service didn't suffer one iota.

I asked my own neph about all this swine flu panic.  He said not to worry.  I agree.  Most of the victims caught the bug in Mexico, apparently.  And now that we're getting into the warmer weather, we don't congregate indoors as much and that makes it harder to spread the virus.

Let's just add it on to the list of other conditions we dialysis patients must deal with, such as

uremia
congestive heart failure
secondary hyperparathyroidism
pericarditis
peritonitis
renal osteodystrophy
uremic neuropathy
adynamic bone disease
dialysis-related amyloidosis
calciphylaxis

[jbeany]

They reported the first 3 cases in Michigan today.  I'm hoping it stays downstate misses up here.  They are working on a vaccine - it's just going to take time.

[kellyt]

I put in a call to my nephrologist yesterday and asked if I should hold off on stopping my Valcyte (supposed to stop on the 30th).  He said to go ahead and continue the Valcyte for an additional ten days.  I'm within a few miles of the noted swine flu cases here in San Antonio.

[Bill Peckham]

Except people on incenter dialysis rely on those 20 to 40 year olds to provide their treatment and to drive them to their treatment. If the dialysis unit is closed or your ride isn't available it won't matter what state your immune system is in.

In any bad cold/flu season, there will be dialysis staff who are out sick.  Dialysis centers have contingency plans for such things.

At my center, last February, we had 3 or 4 nurses and techs who were out sick at any one time, due to a bad cold that was sweeping our community.  Yet dialysis service didn't suffer one iota.

I asked my own neph about all this swine flu panic.  He said not to worry.  I agree.  Most of the victims caught the bug in Mexico, apparently.  And now that we're getting into the warmer weather, we don't congregate indoors as much and that makes it harder to spread the virus.

Let's just add it on to the list of other conditions we dialysis patients must deal with, such as

uremia
congestive heart failure
secondary hyperparathyroidism
pericarditis
peritonitis
renal osteodystrophy
uremic neuropathy
adynamic bone disease
dialysis-related amyloidosis
calciphylaxis

Doctor Pollyanna is your Neph? How this effects you will depend on where you are - how well your community prepared, how well your dialysis provider prepared, how severe the disease presents in your community and how seriously you took your adult responsibility to prepare.

If you're in Connecticut where the Governor just announced that he was deploying 10,000 units of their 11,000 unit Tamiflu stockpile you're not in an area as well prepared as say my county which has 190,000 doses of Tamiflu stockpiled and prearranged for another 260,000 doses from the federal government stockpile. That's my county. The State has its own stockpile and my dialysis provider has their own stockpile of Tamiflu, plus I am sure some individuals have their own stockpile. Just like optimal dialysis, pandemic preparation will depend on your zip code. And speaking of optimal dialysis.

The issue people on dialysis have to deal with is chronic kidney disease - when you get enough dialysis to treat your CKD you largely avoid your list of complications from uncontrolled CKD.

[RichardMEL]

I had a flu shot at work just last week. Yes, it has nothing to do with the swine flu, and in fact a Melbourne company (CSL) is working on the vaccine which will take at least 3 months, but I have had the shot for the past 4  yeaers - on the recommendation of the neph of course. It's important to prevent as much as possible so I have no issue getting the shot. Plus I get to laugh at my fellow employees who are scared of the jab.. "that's not a needle...." I want to say to them!!! haha

[MandaMe1986]

Plus I get to laugh at my fellow employees who are scared of the jab.. "that's not a needle...." I want to say to them!!! haha

  Yeah my dad was scared of those little needles before, he is in for a big suprise when they start using his fistula

[paddbear0000]

I am still trying to figure out what all the panic is about. The regular flu evolves into a new strain every year and the vaccines we get are just a guess and may or may not protect against that year's flu strain anyway. Plus, the regular flu spreads just as fast as the swine flu is, and kills thousands every year. This swine flu seems like a minor problem in comparison.

[rose1999]

Yes but it's a great way for the Government (I'm talking UK but they are probably all as bad)  to take our minds off the recession and MPs' allowances   

[Bill Peckham]

There are a couple problems because this is a novel virus. Without any natural immunity this could make many more people sick than would get sick in a normal flu season. Typically seasonal flu causes between 5% and 20% of the population to get sick. This novel virus could cause many more people to become ill - if 30% of your town's population is sick at once who is going to be going to work?

Seasonal flu causes death and hospitalizations in people like us - those with compromised immune systems. This is why we should get a flu shot every year. A novel flu virus can cause sever illness in people who are young and otherwise healthy. In Mexico this is how the disease presented. It's too early to say that severe illness won't happen here in the US. Many of the deaths and hospitalizations in Mexico came after the person seemed to be getting better - 10 to 14 days after the initial symptoms.

Novel viruses are a problem for a long time. This virus will likely be vacationing in the southern hemisphere for the next several months, where it is just coming into the flu season. My concern is that this will reemerge in our flu season making this a bad year. I think the reason pandemics are always very serious is that these viruses change and can get worse (or better) with time. In 1918 the first cases of flu were mild - with only a few deaths. When it came back in the fall is when it was deadly.

I think one way to think about this is to imagine what it was like dealing with hurricanes before satellites and international communication. Back then you didn't know where exactly the storm would hit and you had no idea how strong it would be - from your point of view on shore the hurricanes look the same but clearly there is a huge difference between a category 2 and a category 4, and one that brushes by and one that is a direct hit. We don't know what this virus storm is going to be like. We don't know how strong it is going to be or anything else. We can all hope it is just a mild disease but is that what we should plan on?

I think we have to plan for a severe outbreak, while we hope that it is mild. This is going to be a marathon, a year long marathon (maybe longer). It's just started.

I can say that what has me most concerned (and disappointed) is the lack of preparation in the dialysis community. I think NKC is the only dialysis provider with N95 masks, Tamiflu and pandemic policies and procedures in the units and ready to go. NKC is one of the few providers to have an established close working relationship with their local emergency planning agency. Right now is a hell of a time for dialysis providers to be making first contact with their local emergency planning entity. And they are misguided if they think there are stockpiles of masks and Tamiflu available to equip dialysis units.

[Wallyz]

"that's not a needle...." I want to say to them!!! haha

I totally heard this in your best Mick Dundee voice.  Awesome sauce.