Frequently Asked Questions (FAQs) about Swine Flu

Swine flu is an infectious disease caused by a type of virus called flu virus H1N1. This flu virus belongs to a group of virus known as influenza virus. The influenza viruses mainly affect birds (avian influenza virus), pigs (swine influenza virus) and humans (human influenza virus).

The swine flu/influenza virus has also been termed as the novel influenza (novel H1N1) virus because of its difference from the previous influenza virus (H1N1) which commonly results in seasonal influenza. The rise of this novel influenza virus has been attributed to its increased ability to affect humans.

The novel H1N1 influenza virus is commonly known as swine influenza as it was known to affect pigs more commonly. Swine flu was initially more common in pigs. The ability of the virus to undergo changes has made it capable enough to affect humans. Once a human being is affected he becomes a carrier of the virus and can infect other human beings.

Most of the people are immune to the seasonal influenza virus due to its occurrence every year or because of vaccinations. Being immune means that the body has produced certain specialized proteins called antibodies in response to a virus. Such antibodies once formed against a specific virus are capable of detecting and destroying the virus if it tries to attack our body again. The antibodies work on the principle of identifying certain proteins on the outer covering of the virus and then initiating reactions against it. The novel H1N1 influenza virus has undergone modifications in its protein structure which can easily evade the existing antibodies for seasonal influenza virus and result in an infection. Therefore if an individual is immune or resistant to seasonal influenza it does not meant he/she is immune to swine flu.

The ability of the novel H1N1 influenza virus to undergo modifications has hastened its spread in the current situation. Since most of the individuals have never been exposed to this virus before, the number of individuals getting ill due to the novel H1N1 influenza virus is rapidly rising. With the number of people travelling around the world for various reasons having increased in the last few decades, more people are expected to be affected by the novel H1N1 influenza at a faster pace.

Pandemic in simple terms means a disease or condition that affects thousands of people across various regions at the same period of time.

An interesting but disturbing feature noted in the swine flu pandemics is the variation of the structure of the influenza virus. The protein structure of the influenza virus had undergone modifications in the last two pandemic years 1957 and 1968 and same holds true for the recent pandemic in 2009.

The rapid rise in the number of people infected by the swine flu all over the world prompted the World Health Organization to declare swine flu as the pandemic of the year 2009.

According to the reports received by the WHO, swine flu has spread all over the US widely since its first confirmed report in the month of April this year. Reports about the nature of spread are yet to be ascertained in other parts of world. Nevertheless, swine flu is affecting a large number of people at a rapid pace creating panic among people. The risk of death associated with swine flu has made it a dreaded infection.

According to the recent most update (31 Jul 2009) released by the World Health Organization, swine flu has been reported in about 168 countries with about 9 countries newly added to the list. The number of people infected according to the official records is about 162,380 with about 1,154 deaths. However, the WHO itself believes that the actual numbers may be much more and may not have been reported due to various reasons. Nevertheless, the number of people getting infected with the swine flu is increasing at a very rapid pace which accentuates the need for prevention.

The signs and symptoms of swine flu are almost similar to any other flu or the seasonal influenza and are characterized by the following:
• High fever (commonly above 100.4° F)
• Mild to severe cough
• Soreness in the throat
• Mild to moderate headache
• Body ache
• Chills

Certain other features that are considered characteristic of sweneflu when present with other symptoms listed above include:

• Vomiting
• Diarrhea (loose, watery stools)

In cases where the resistance of the individual is low, these symptoms and signs may be of high severity and can result in death if left untreated.

Swine flu like other flu’s mainly affects the upper respiratory tract which includes: the nose, portion of the mouth at the throat, throat and the tubes that lead into the lungs. Symptoms such as sore throat and cough can vary in severity depending upon the resistance of an individual. Children, older adults and individuals suffering from underlying medical disorders are more prone to have severe symptoms as their ability to resist such diseases is reduced. Healthy adolescents and adults may suffer from less severe symptoms.

Emergency symptoms of swine flu observed in children are:

• Rapid breathing or difficulty in breathing
• Skin becomes bluish or gray in color
• Not drinking enough fluids
• Not waking up or not interacting
• Increased irritability
• Flu-like symptoms improve but fever recurs and cough worsens

Pandemic in simple terms means a disease or condition that affects thousands of people across various regions at the same period of time.

An interesting but disturbing feature noted in the swine flu pandemics is the variation of the structure of the influenza virus. The protein structure of the influenza virus had undergone modifications in the last two pandemic years 1957 and 1968 and same holds true for the recent pandemic in 2009.

Swine flu spreads through the respiratory secretions or from the drops of water released into the air when an infected individual coughs or sneezes. These droplets or secretions can spread the virus through air or can help the virus to settle on any objects such as door handles, table tops, car steering, etc. The virus may gain entry into our body when a healthy person touches such contaminated objects and then touches his nose or mouth. The exact mode of transmission of the virus may not be detectable in many individuals. Each sneeze has been noted to release 40,000 droplets and is considered to be the potential spreaders of infectious organisms.

Swine flu spreads from infected pigs to humans in the same manner as it spreads from humans to humans. Infected humans can infect other humans and the pigs when they come in close contact with them.

The swine flu or the influenza viruses are killed when the pork is cooked at temperatures around 167-212°F or 75-100°C. Hence it is safe to eat pork that has been cooked well. The origin of the swine flu infection has been a much debated topic. While many believe that swene flu spreads by eating pork, it actually is not so.

• The swine flu H1N1 influenza survives and remain potent to infect a healthy individuals up-to 2-8 hours after being deposited on surfaces such as door knobs, counter tops etc
• Heat (167-212°F or 75-100°C) range can kill the H1N1 virus
• Common household cleaning agents, soaps, alcohol based hand cleansers can kill the virus effectively.
• Washing hands with soap or alcohol based cleansers and cleaning the house with cleaning agents on a regular basis can reduce the spread of infection among the family members
• It is safe to eat pork that has been cooked well
• The H1N1 virus does not spread through drinking water that is appropriately treated
• Risk of infection is more in highly crowded places

The influenza viruses were first noted among birds. Such influenza viruses with an ability to affect only birds were called as avian influenza viruses. It caused widespread infection among birds resulting in their death in large numbers. However, these viruses were not capable enough to cause similar symptoms in humans or other animals initially.

Further, the avian influenza viruses over a period of time underwent changes in its structure and became potent enough to cause an infection in humans and pigs. Such modified influenza viruses were known as human influenza virus or swine influenza virus depending upon the organism it affected.

The avian influenza virus and human influenza virus were both capable of infecting pigs. Pigs functioned as a grooming organism for the influenza viruses. Further the influenza viruses were able to form a new strain by mixing the proteins present in avian and human viruses. Thereby pigs served as ‘mixing vessels’ for the influenza virus that led to the formation of the novel H1N1 influenza virus that is capable of infecting both humans and pigs.

Cleanliness starts from home, general steps to be followed to prevent the spread of swine flu in your home include the following:

• Wash your hands regularly with soap, especially if you have been outside; alternatively you can use alcohol based hand rubs
• Avoid touching your mouth or nose frequently
• Use proper disinfectant or house hold cleaning agents to mop the floors
• Keep the windows open to allow for proper circulation of air and prevent pooling of infected air.
• Cover your mouth and nose with a tissue while sneezing; discard the used tissues as directed by the health authorities. Wash your hands afterwards.

Some of the general measures to be followed at office include:

• Cover your mouth and nose while sneezing or coughing
• Keep your desk clean
• Avoid touching your mouth and nose frequently; you would have touched surfaces such as door knobs, chairs, stationary etc which may carry virus for long hours
• Wash your hands with soap at regular intervals
• You can keep an alcohol based hand rub at your table as hand washing may not possible at frequent intervals
• Instruct your co-workers to stay at home if they notice any symptoms of swine flu

At the time when work is critical one cannot avoid going to office unless he/she is infected. If you get infected avoid going to the office for the next 7-10 days until all the symptoms are cleared. This will prevent the spread of swinflu among other members of your office. Check out for options of working from home if your work is critical.

• Restrict the number of caregivers; preferably only one member should take care of the needs
• Ask the infected member to wear a mouth mask
• Wear a mouth mask while attending the affected child or adult
• Clean the room regularly with house hold cleaners
• Discard or disinfect the mouth mask after every single use
• Wash your hands with soap after removing the mouth mask; alcohol rubbing solution can be used as an alternative
• Wash the clothes and utensils thoroughly with detergent before reusing; wash your hands as instructed before

These steps are to be followed to protect yourself and other family members if you are caring for a house member who is affected by swine flu

Steps to be followed while travelling to prevent the swine flu are:

• Infected individuals must defer their travel plans if infected.
• You must also contact your healthcare provider to know about the national and international guidelines to prevent the spread of infection.
• Preferably postpone your meetings being held in infected areas or use other modes of communication such as phone, fax, videoconferencing etc., to complete your works that need you to travel.
• Follow the general instruction of hand care, cover your mouth and nose while sneezing or coughing
• You can use a disposable mask and remember to discard it following single use.

• Ask your child to wear a mouth mask if you come to know that a few others have been infected
• Instruct the child to close the mouth and nose while sneezing or coughing
• Instruct the child to avoid touching your mouth and nose frequently
• Avoid close contact with other children until the threat subsides
• Instruct the child to wash hands with soap after returning from school

Schools are considered as one of the potential places where mass infection of swine flu can occur. Do not send your child to the school if he/she is infected. Speak to the school authorities about the measures that are being taken at the school premises for protection from swinefl.

Some of the steps you can follow if you are living in locality wherein many members are suffering from swine flu have been listed below.

• Reduce the number of mass gatherings
• Avoid visiting crowded places
• Wear a mouth mask while going out and discard or disinfect it after every single use
• Wash your hands with soap after visiting others
• Cover your mouth and nose while sneezing or coughing
• Help spread the awareness about the health etiquettes
• Keep yourself updated about the situation in your community and the guidelines being followed

One must follow all the instructions provided by the local health authorities to prevent the spread of swine flu among other members of the community.

The use of mouth masks can decrease the spread of swine flu virus to a great extent as it helps in controlling the major mode of transmission of the influenza virus. The wearing of mouth masks is preferred by individuals who feel a threat about the spread of the swine flu. However, proper steps must be followed while using mouth masks as improper wear or use can itself lead to the spread of the infection.

It is advisable to wear a mouth mask if:

• You are suffering from swine flu
• You are going to crowded places
• Many individuals in your community or locality are suffering from swine flu
• You are going to meet an infected individual; avoid this whenever possible
• You are attending to an infected individual

The mask should be worn such that the mouth and nose are completely covered. The surgical mouth masks come with a thin metal foil within the top portion of the mask to be adapted around the nose. See to it that you press it accordingly and make sure the mask is fitting snugly. Some of the masks come with elastic bands which offer better fit.

If you are planning to tie a scarf or a piece of cloth, make sure that it covers your mouth and nose completely and you are able to breathe freely with the scarf on your nose. Tie a firm knot over the back of your head to prevent the slippage of the scarf while moving around. Wash your hands as instructed for the mask wear.

Disposable surgical mouth masks are being widely used across the world by many people as a preventive method. However, these types of masks do not offer complete protection.

Certain sophisticated masks known as N95, N100 mouth masks offer complete protection against influenza viruses. The disposable or reusable surgical masks are quite effective when worn in the correct manner with proper care being taken towards disinfection. If these are not available then you can opt for clean and washed scarves or other clothes to protect yourself from being infected.

• Most mouth masks are designed for single use; discard it after a single use
• Wash your hands with soap after wearing the mask
• Do not touch your mask after wearing it properly
• Change the mask if it has become soggy or wet
• Wash your hands with soap after removing the mask
• Reusable masks or cloths must be thoroughly washed with a detergent before reuse
• Change the filters as instructed (if you are using one of those sophisticated masks)
• Wear a mask while attending or meeting an affected individual.
• Remove the mask immediately after meeting and wash your hands with soap or use a alcohol based hand rub

The WHO recommends washing with soap and water if the hands are visibly soiled. If your hands are not soiled or dirty, you can use any alcohol based hand rubs available over the counter.

Following points will help you recollect about hand washing requirements.

Wash your hands with soap and water or use an alcohol based rub:
• At regular intervals
• After caring for an affected individual
• After coming from outside (return from work, school, shopping, etc)
• After wearing a mouth mask
• After removing a mouth mask
• After washing clothes, utensils

Check the symptoms that you are suffering from. It should be kept in mind that these symptoms may also be noted if you are suffering from common flu or seasonal influenza.

• High fever (commonly above 100.4° F)
• Mild to severe cough
• Soreness in the throat
• Mild to moderate headache
• Body ache
• Chills
• Vomiting
• Diarrhea (loose, watery stools)

Seek immediate medical attention if you notice any of the following signs or symptoms.

• Breathing difficulty
• Pain or pressure in the chest
• Abrupt dizziness
• Confusion
• Vomiting severely or continuously
• Flu-like symptoms improve but fever recurs and cough worsens

Seek immediate medical attention if you notice any of the following signs or symptoms in your child.

• Rapid breathing or difficulty in breathing
• Skin becomes bluish or gray in color
• Not drinking enough fluids
• Not waking up or not interacting
• Increased irritability
• Flu-like symptoms improve but fever recurs and cough worsens

The influenza viruses have a unique ability to undergo modifications in their protein structure when they come in contact with: medicines, or vaccines, or with other similar viruses from different animals. While there are vaccines that have been developed to prevent the occurrence of seasonal influenza they are not effective against the novel H1N1 influenza due to its difference in the protein structure. Mixing of the protein structure in the pigs has created a newer variety of virus that needs to be studied to develop a vaccination for it. Further, the antiviral drugs for influenza virus were also developed to treat the seasonal influenza virus and may not offer complete protection against the novel influenza virus. Therefore, it is difficult to prevent swine flu.

According to CDC (Centers for Disease Control and Prevention) the risk groups for severe swine flu illness are:

• Children below the age of 5 years
• Adults above 65 years
• Adolescents or children below 18 years and receiving certain medications for certain chronic conditions
• Pregnant women
• Immunocompromised individuals
• Patients admitted for chronic care

Rest is advised for all individuals with swine flu. Medications to relieve the symptoms such as fever, pain, vomiting and diarrhea may be administered. These medications may be available with or without prescription. Individuals who feel tired with repeated vomiting or diarrhea may also need to take certain oral rehydration solutions.

The affected individuals may need to stay at the hospital until their health status is stabilized. Such individuals are generally administered antiviral drugs that have been found to be effective against swine flu. Mechanical support for breathing with the help of an equipment known as ventilator may be required in individuals who develop severe breathing difficulties. Underlying conditions are managed appropriately while life saving measures is undertaken.

Antiviral drugs those are available in the form of pills, liquids or inhalers. The antiviral drugs being administered to combat swine flu may be beneficial in relieving the signs and symptoms of swine flu. Among the four antiviral drugs (oseltamivir, zanamivir, amantadine and rimantadine) available to treat flu caused by influenza viruses, only two drugs have been found to be effective against swine flu. These include:

• Oseltamivir (brand name Tamiflu ®)
• Zanamivir (brand name Relenza ®)

The antiviral drugs decrease the severity of the infection and are most effective when administered within two days of the onset of swine flu.

It has also been noted to prevent the occurrence of swine flu in about 70-90% of the individuals who are in close contact with infected individuals.

In certain rare instances the administration of antiviral drugs may be associated with adverse effects. These include:

• Sudden confusion
• Delirium (brief state of excitement and mental confusion)
• Hallucinations (having illusions)
• Unusual behavior
• Self-injury

Further, symptoms such as vomiting, diarrhea, headache, eye discomfort and sleeplessness may also be noted in some individuals.

Individuals who are pregnant, or are suffering disorders of the lung, heart, or kidneys must inform the healthcare provider before consuming these antiviral drugs. Individuals who may be suffering from other chronic disorders or who are already consuming other medications must inform their healthcare providers about these.

There are no specific vaccines available presently to prevent the occurrence of swin flu. Although vaccinations are available to prevent the occurrence of seasonal influenza, these are not effective against the novel H1N1 influenza virus. Efforts are on to develop a new vaccine within the next few months. However the steps involved in the production of the vaccine and amount of time required for mass production may hinder the effective supply of these vaccines all over the world.

Avoid being in places which have reported high incidence of swine flu; if you have to be in such places then take precautionary measures such as wearing a mask

• Wash your hands with soap or rub an alcohol based hand rub after wearing a mask, removing a mask, meeting people, or visiting the supermarket
• Follow precautionary measures while meeting or attending an infected individual
• Close your mouth and nose while sneezing or coughing; dispose the tissues after single use
• Do not go to office, work or school if you are suffering from or if you suspect swine flu until the symptoms subside completely (a minimum of 7-10 days)
• Meet a healthcare provider if you suspect swine flu or have severe signs and symptoms
• Children, pregnant women, adults above 50-60 years, individuals suffering from chronic disorders need to be rushed to the hospital to prevent complications
• Use antiviral drugs only after a doctor prescribes them
• Educate your family, neighbors, friends and colleagues about swineflu and its preventive measures