Swine flu symptoms: Cough, fever, sore throat, stuffy or runny nose, body aches, headache, chills, fatigue, vomiting, diarrhea
From 2009 onwards we have been increasingly seeing media reports on swine flu (H1N1). Swine flu is contagious. Influenza viruses infect the cells lining your nose, throat and lungs. It spreads in the same way as the seasonal flu. The virus spreads when you touch an infected surface or breathe cough and sneeze droplets in the air. People who have swine flu can be contagious one day before they have any symptoms, and as many as 7 days after they get sick.
Cough, fever, sore throat, stuffy or runny nose, body aches, headache, chills, fatigue, vomiting, diarrhea are some of its symptoms. Young children, pregnant women, and older adults are more likely to develop complications. Swine flu can lead to more serious complications, including pneumonia and respiratory failure. And it can make conditions like diabetes or asthma worse. It can also lead to neurological conditions ranging from confusion to seizures.
The author in conversation with Dr Sujeet K Rajan – MD (Chest) Bom. (D.E.T.R.D, D.N.B. Respiratory Medicine) – Consultant Chest-Physician and Specialist in Sleep-Disorders, Mumbai India.
Is H1N1 a truly new phenomenon or it is just that we are aware of it now? How does it spread?
Virus has been there for sometime but we are getting to know because of awareness and media attention. Thankfully mortality rate has decreased from last year, it was 25% in 2014 while earlier this year it was reduced to 7%, early diagnosis and better treatment at the specialist level – and general awareness, early start of the treatment are responsible to bring down the mortality. The trouble is that sometimes the General Physicians fail to diagnose it
The answer to your question about how it spreads, any flu is an airborne disease, and the virus enters through your respiratory system. H1N1 influenza virus can spread from one person to another through small droplets of saliva that are expelled into the air when an infected person coughs or sneezes. The virus can also be passed through contact with objects the infected person has touched, such as a door handle or other surfaces. One must wash hands with soap after returning home from outside.
Why do you feel that the General Physicians fail to treat H1N1 patients?
With huge crowd in their clinics which can be overwhelming, they sometimes fail to take the patient’s complete history – and when they notice the symptoms of flu all they advise is to go home, hydrate and rest (with some symptomatic treatment like fever reducing agents). The General Physicians are also wary of ‘flu’ patients in their clinic (because ‘flu’ is highly contagious) so the patients are disposed off quickly. I would like to advise all the General Practitioners to ask if their flu patient has diabetes, or he/she is immune-compromised*, or she is pregnant. They must pay special attention to elderly (above 65).
Other risk-groups are small children and obese individuals. If such people get flu and if that is H1N1 they are at a greater risk to fall ill, very ill and the flu can also prove fatal.
General Practitioners must ask them to do a CBC* count to find out if the illness is of viral or bacterial origin and treat accordingly, with antibiotics or antiviral.
If the test is non equivocal (confusing), the General Practitioner must depend on his clinical judgment and start the treatment without delay.
Note – Immuno-compromised individuals mean people whose immune system is not functioning as it should, hence they can sometimes be prone to more serious infections and/or complications than healthy people. This can happen due to genetic defects, infections such as HIV, and certain cancers, chronic diseases like kidney disease, diabetes and liver disease. Medications such as steroids, chemotherapy, radiation and immunosuppressant medicines given to transplant patients (so that they do not reject the organ) reduce our immune responses. Physical state such as pregnancy is also one of the reasons that weakens our immune system
The white blood cell differential is often used as part of a complete blood count (CBC) as a general health check. It may be used to help diagnose the cause of a high or low white blood cell (WBC) count, as determined with a CBC
Does this mean that you recommend antiviral medication to all the patients diagnosed with flu?
Sure, I recommend antiviral medications such as oseltamivir or zanamavir to all the patients with flu and especially the high risk patients. It is almost impossible to take swabs from all the patients with flu by all the doctors treating them – and send them for testing for H1N1, because the sheer number of samples will overwhelm the laboratories. It is LIFE-SAVING to treat each case of flu properly and consider each patient of flu as a potential victim of H1N1. It will save many lives we are losing to H1N1. We do recommend antibiotics to people with bacterial infections, similarly we must give antiviral for flu to contain the symptoms and spread of the disease.
How do these medicines act and stop the spread?
Oseltamivir is an oral medication used for treating and preventing flu. Oseltamivir suppresses and decreases the spread of influenza A and B viruses, the viruses responsible for the flu. It does this by blocking the action of neuraminidase, an enzyme produced by the viruses that enables the viruses to spread from infected cells to healthy cells. By preventing the spread of virus from cell to cell, the symptoms and duration of influenza infection are reduced. On average, oseltamivir reduces the duration of symptoms by one and a half days if treatment is started within forty-eight hours of the beginning of symptoms. Zanamivir is an inhaled drug that is used for treating and preventing influenza (flu). The action of zanamivir to stop the spread of influenza from infected cell to healthy cell is same as oseltamivir. By preventing the spread of virus from cell to cell, the symptoms and duration of influenza infection are reduced. On average, zanamivir reduces the duration of symptoms by one day if treatment is started within forty-eight hours after symptoms begin. Both the medicines are very effective in the treatment of H1N1, provided …..
Provided?
Provided the patients start the treatment within 48 hours the symptoms appear. Those 48 hours are most crucial – and for many patients with H1N1 virus, it can be life-saving. As we say – those 48 hours could make all the difference – between life and death.
Let me get this clear, you say that anyone with flu symptoms must start with these medicines? Are they available in our medical shops like painkillers are?
Unfortunately these are schedule drugs and that means one can get them only with a doctor’s prescription – to avoid indiscriminate use. In the UK these are easily available. In India one can get ‘second line anti TB drugs’ more easily than medications for flu. In Mumbai I know of only one medical shop these medicines are kept.
(Source: Wikimedia)
That’s ridiculous, what about rural areas?
Please do not ask me this question, it is very upsetting.
Why so, is the indiscriminate use of these medicine cause resistance? Do these medications have adverse effects on humans?
The resistance of circulating flu viruses (now seen) to these drugs is low, but one never knows what happens in the future. Every medicine has some adverse reactions and so do these medications. Oseltamivir may cause nausea and vomiting. If one has sever skin reaction one must immediately consult the doctor.
Zanamavir, being an inhaler can treat asthma like symptoms. Adverse events may include diarrhoea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose and throat infections.
But as I say, it is double whammy. The General Practitioners are not aware that antiviral is not a luxury but a life saving necessity. Even antibiotics have sie-effects but we give them to our deserving patients. Why not antiviral? It is the right of every flu patient from urban and rural area to get these, find them easily available in the friendly neighbourhood medical shop.
All this can be prevented if one takes a flu vaccine, right?
With the spurt in swine flu, the Union Health ministry of India has recommended vaccination for healthcare workers. Experts, including doctors and scientists in the Indian Council of Medical Research (ICMR), say vaccination is still not recommended for the “general public”, barring special groups such as children under the age of five, elderly and immune-compromised patients, besides healthcare workers who are handling patients. But I feel that whoever can take the vaccine must take it. Centre of Disease Control (CDC USA) recommends a yearly flu vaccination for anyone above six months. It gives 60 to 80% protection against flu.
Symptoms of Swine Flu (Source: Wikipedia)
Tell us about the vaccine
The injectable vaccine (that also protects us from H1N1) is a “killed virus” vaccine. The vaccine that can be inhaled is also available in a nasal spray form, which is a “live virus” vaccine. As all the other vaccines these work by exposing us to a small dose of the virus, which helps our body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body.
Is it safe? What do you advise, take vaccine and prevent or take medicines when sick?
Becoming infected with H1N1 is much more dangerous to us than receiving the vaccine to protect against it. Most people with H1N1 influenza have recovered, but the virus has killed many. Like any medicine, this vaccine can cause side-effects, but the risk of serious side-effects is extremely low. Remember there are cases of getting ‘flu’ even after vaccination. But the numbers are very few. My advice will always be a yearly vaccination, but it also depends on people’s attitude, some like maintenance management and some ‘crash management’.
For your readers’ information, vaccines are made freely available in some government hospitals for pregnant women – one can always approach a private hospital for a vaccine that will cost about a thousand rupees.
So many ‘cures’ of H1N1 appear on social media, what do you have to say to that?
All I can say is that without scientific evidence, no one should ‘play’ with their and their loved ones’ health.
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