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Global Fever…

Being covered 24/7 by news networks is the latest health scare…swine flu. The World Health Organization (WHO) has declared it a phase 4 pandemic alert (confirmed person-to-person spread of a new influenza virus able to cause “community-level” outbreaks”).  As I watch the news to try and understand what is going on, I’m given images of people in masks, especially in Mexico City, travelswine-flu-outbreak-in-mex-001 alerts for those planning traveling in and out of the United States, and a clean bill of health for President Obama after his recent travel to Mexico and overseas. But lost in all of this is actual information is relevant information of what the swine flu is, how it came to be, what to look for, and why are we freaking out about it.

The swine influenza virus is a virus found to be endemic amongst pigs. There are 2 of the 3 viruses that are responsible for swine flu can also affect humans. Those who work with poultry and pigs are at risk of infection if the animals carry the virus that can infect humans. However, the virus is usually not passed from human to human, unless a mutation has taken place. This is the theory behind the current outbreaks that have taken place. Epidemiologists believe that the initial spread may have occurred at a swine farm outside of Mexico City. Spread of the disease has occurred as people have traveled into Mexico City affecting locals and travelers, who then travel out of Mexico and to other countries.

Mexico Swine FluSymptoms are very similar to that of the common influenza virus that we are familiar with…fever, fatigue, coughing, sneezing, lack of appetite, vomiting, diarrhea, generalized body aches. As with most viruses, it is spread through casual contact and well as respiratory droplets (coughing, sneezing). Usual hygeine practices (such as frequent hand washing with soap and water!) can greatly reduce the spread of any influenza virus. There have been no reported cases of transmission of the virus within pork products.

Treatment that is currently recommended include using Tamiflu (oseltamivir) or Relenza (zanamivir), as resistance has been seen with amantidine and rimantidine. This bears the question of who should be treated. Currently it is recommended that those with recent travel areas to Mexico or exposure to reported cases and influenza symptomatology should undergo nasal swab testing. If the nasal swab is positive for influenza A and have severe symptoms, including multiple comorbities, these patients should be admitted with respiratory droplet precautions, and started on olseltamivir. Those with less severe symptoms can be treated as an outpatient and provided with a respiratory mask. Those that test positive for Influenza B should be given supportive treatment for influenza. High index of suspicion is key….make sure you obtain a good history including start of symptoms and exposure risks.

Why is this flu so concerning? Reportedly, there have been deaths in otherwise young, healthy individuals that would otherwise not get so sick from an influenza virus. In addition, cases reported from 5 states in the United States, as well as Scotland, Spain, Canada, New Zealand, and Israel are creating concern for quick global spread.04-27-2009n1a_27flugul2k4kf31

Working in a busy emergency room, it is expected that we are going to have many patients concerned about the swine flu and seeking treatment for their symptoms. Patient education will be key, as many will flu-like symptoms, but will most likely not have the swine flu. The best thing you can do is educate yourself, educate your patients, and take into consideration symptomatology, risk factors and exposures, and patient comorbidities.

Here’s a global photo gallery courtesy of National Public Radio

For more information:
Centers for Disease Control
World Health Organization

Dr. Marjan Siadat is a second-year Emergency Medicine resident at Detroit Receiving Hospital, Wayne State University. She is the editor of the public health section for Receiving.

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