Swine Flu (H1N1)

General Care Advice for Respiratory (Cold/Flu) Symptoms

1. For a Runny Nose With Profuse Discharge - Blow the Nose:

   • Nasal mucus and discharge helps to wash viruses and bacteria out of the nose and sinuses.

   • Blowing the nose is all that is needed.

   • Apply petroleum ointment to the nasal openings to protect them from irritation (cleanse the skin first).

2. For a Blocked Nose - Use Nasal Washes:

   • Step 1: Put 2-3 drops of warm water or saline in each nostril (Reason: To loosen up the dried mucus)

   • Step 2: Blow each nostril separately (Pinch one nostril shut while blowing your nose then repeat while pinching the other nostril).

   • Step 3. Repeat nose drops and blowing until discharge is clear.

   • Notes: Use a medicine dropper so you have control over how many drops you put in the nose. If you don't have one, you can use a dropper that came with ear drops, eye drops, or another medicine. You can purchase a dropper at a pharmacy. Do nasal washes four times a day or whenever you can't breathe through your nose. Another option instead of nasal washes is to take a hot shower. Breathe in the moist air through the nose and then blow each nostril.

   • How to Make Saline Nose Drops: Add 1/2 tsp of table salt to 8 oz (240 ml) of warm water.

3. For Cough:

   • Use cough drops (Available OTC).

   • Or, you can try sucking on a piece of hard candy.

4. For Coughing Spasms:

   • Drink warm fluids. Inhale warm mist (Reason: both relax the airway and loosen up the phlegm).

   • Suck on cough drops or hard candy to coat the irritated throat.

5. For All Fevers:

   • Drink cold fluids to prevent dehydration.

   • Dress in 1 layer of lightweight clothing and sleep with 1 light blanket.

   • For fevers less than 101° F (38.3° C), fever medicines are usually not necessary.

6. Pain and Fever Medication:

   • For pain and fever relief, take acetaminophen or ibuprofen.

   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.

   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.

   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.

   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.

   • CAUTION: Do not take acetaminophen if you have liver disease.

   • Read the package instructions thoroughly on all medications that you take.

7. For Sore Throat:

   • Sip warm chicken broth or apple juice.

   • Suck on hard candy or a throat lozenge (OTC).

   • Gargle with warm salt water four times a day. To make salt water, put 1/2 teaspoon of salt in 8 oz (240 ml) of warm water.

   • Avoid cigarette smoke.

8. Call Your Doctor If:

   • Difficulty breathing

   • Fever lasts more than 3 days

   • Nasal discharge lasts more than 10 days

   • Cough lasts more than 3 weeks

   • You become worse

Swine Flu Questions

1. Swine Flu - General Information and Reassurance:

   • An outbreak of swine flu in humans started in the U.S. and Canada in April 2009. By June 2009, it had spread to most countries in the world.

   • For healthy people, the symptoms of Swine Flu are similar to those of the common cold. However, with Swine Flu, the onset is more abrupt and the symptoms are more severe. Feeling very sick for the first 3 days is common.

   • The treatment of Swine Flu depends on your main symptoms and is usually no different from that used for other viral respiratory infections. Most people who have been sick with this virus have recovered at home without treatment.

   • If you have flu-like symptoms, please stay at home until at least 24 hours after you are free of fever.

2. Swine Flu - Symptoms:

   • The symptoms of swine flu are the same as those seen with regular human influenza.

   • The main symptoms are fever, cough, sore throat and runny nose.

   • Fever is usually present.

   • Other common symptoms are muscle pain, headache and fatigue.

   • Some people also have vomiting and diarrhea, but never as the only symptom.

3. Swine Flu - Treatment with Antiviral Medications:

   • There are two anti-viral medications that are helpful in treating this infection: oseltamivir (brand name Tamiflu) and zanamivir (brand name Relenza).

   • Treatment is recommended for HIGH RISK patients (e.g., age over 64 years, pregnant, HIV+, or chronic medical condition) with Swine Flu or any patient with severe symptoms (per CDC).

   • Treatment is typically not recommended for mild to moderate Swine Flu illness that occurs in most healthy patients (per CDC). Most patients recover without taking antiviral medications.

   • The benefits are limited: antiviral medications may reduce the time you are sick by 1 to 1.5 days. It helps reduce the symptoms, but does not cure the disease.

   • For best results, antiviral medications should be started within 48 hours of the onset of flu symptoms.

4. Swine Flu - Contagiousness:

   • Symptoms usually start within 4-6 days of exposure to a person with swine flu (7 days is an outer limit). If more than 7 days pass from exposure without you developing symptoms, you should be safe and not get swine flu.

   • The swine flu virus is spread by airborne droplets, from sneezing and coughing, just like other influenza viruses. It also can be transmitted by hands contaminated with secretions. Swine flu is NOT transmitted by eating pork.

   • A person is potentially contagious (virus may be in respiratory secretions) from 1 day prior to and for 7 days after the onset of symptoms (e.g., fever, cough). The CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F or 37.8°C).

5. Call Your Doctor If:

   • You have other questions or concerns

   • You become worse.

Preventing Swine Flu

1. How to Protect Yourself From Getting Sick:

   • Wash hands often with soap and water.

   • Alcohol-based hand cleaners are also effective.

   • Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way.

   • Try to avoid close contact with sick people.

   • Try to avoid unnecessary visits to the emergency department and urgent care centers because those are the places where you are more likely to be exposed to Swine Flu, if you don't have it.

2. How To Protect Others - Stay Home When Sick:

   • Cover the nose and mouth with a tissue when coughing or sneezing.

   • Wash hands often with soap and water, especially after coughing or sneezing.

   • Limit contact with others to keep from infecting them.

   • Stay home from school or work for at least 24 hours after the fever is gone (CDC, August 2009).

3. Face Masks:

   • Face masks refer to disposable masks labeled as surgical or dental masks.

   • For healthy people, face masks may help reduce the risk of getting swine flu in crowded settings, if swine flu becomes prevalent (CDC).

   • Avoiding sick people and frequent hand washing are more effective preventive measures.

   • At the present time, face masks are not needed in the U.S. for healthy people. (Possible exception: households where a family member has Swine Flu).

   • Sick people should wear a face mask if they must leave their home to seek medical care.

4. Vaccine:

   • The best way to prevent Swine (H1N1) Flu is to get a yearly seasonal flu vaccine.

   • This year, H1N1 is included in the regular flu vaccine and no separate flu shot is needed.

5. Preventing Swine Flu - Antiviral Medications:

   • Two medications licensed in the U.S. and Canada are believed to be effective in PREVENTING the swine influenza virus: zanamivir (Relenza), and oseltamivir (Tamiflu).

   • Possible indications: Recent close contact with person with confirmed Swine Flu AND the exposed person is in a HIGH RISK group (e.g., age > 64 years, pregnant, HIV+, or chronic medical condition).

   • It is effective only while you are taking it and ceases once you stop taking it.

   • You should only take one of these antiviral medications if your physician recommends it.

6. Call Your Doctor If:

   • You have other questions or concerns

   • You become worse.

Internet Resources

1. Information from the World Health Organization (WHO) about Swine Flu

   • On June 11, 2009, the WHO signaled that a global pandemic of novel influenza A (H1N1) was underway by raising the worldwide pandemic alert level to Phase 6.

   • WHO Swine Influenza (H1N1) Website http://www.who.int/csr/disease/swineflu/en/index.html

   • WHO complete list of guidance documents: http://www.who.int/csr/disease/swineflu/guidance/en/index.html

2. Internet Resource for U.S.

   • Centers for Disease Control and Prevention, United States (CDC)

   • For most up to date information, visit CDC's Swine Flu Web site at http://www.cdc.gov/swineflu/

   • Swine Flu Video PodCast by Joseph Bresee MD, Chief, Epidemiology & Prevention Branch, CDC Influenza Division: http://www.youtube.com/watch?v=-nTQDs7ZQG0

3. Internet Resource for Canada

   • Health Canada

   • http://www.phac-aspc.gc.ca/alert-alerte/swine_200904-eng.php

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.