Swine Flu Update
 

 

Several cases of swine influenza were recently recognized in Mexico, the United States and elsewhere.  It does not appear at the present time that people with MG are at increased risk of contracting swine flu; however, it is likely that individuals taking steroids or immunosuppressive drugs such as Cellcept or immuran would be at increased risk to contract swine flu.  Since swine flu has prominent respiratory symptoms, people with MG who have respiratory impairment will likely be more severely affected.  The infection is spread primarily by respiratory droplet spread – coughing, sneezing etc.  People with MG should consider avoiding airplane travel, particularly to Mexico until the outbreak is resolved.  The reason is that air in an airplane is continually being recirculated, which could result in one individual with swine flu exposing the other passengers in an airplane to droplets containing the swine flu virus.

 

Information from the Centers for Disease Control (CDC) and other federal health care agencies is summarized below. 

 

For the most current US information see www.cdc.gov/swineflu

 

Background

• CDC has confirmed 20 human cases of infection with a novel swine influenza (flu) virus (Influenza A H1N1) in the United States. Seven cases have been in California (San Diego area), 2 in Texas (San Antonio), 8 in New York (Queens), 2 in Kansas and 1 in Ohio. Age range of the first seven cases was 7 to 54 years of age. Because there is no epidemiological connection that explains the current pattern of transmission; the strain of swine flu appears to be identical; and, there is no reported history of contact with infected swine or poultry, CDC believes there is human-to-human transmission.
• One US case was hospitalized – a patient on immunosuppressants for autoimmune hepatitis. The other US cases had mild illness, as far as we know at this writing.
• Note that these case counts are likely to change on a daily basis.
• Media is reporting many cases of respiratory illness in Mexico City and the State of Mexico with rumors of 57 deaths. These numbers have not been confirmed. Fourteen laboratory samples were sent to CDC, where seven were confirmed as swine flu. Preliminary tests suggest an identical strain to the one in the US. The clinical status of the fourteen patients is unknown.
• Both the United States and Mexico continue to experience seasonal influenza activity with influenza A and B subtypes.

 

Clinical Information from US Cases

• Based on the limited experience with known cases in the US, this strain of swine flu appears to have an incubation period of 1-7 days and presents with symptoms typical of influenza-like illness including fever, headache, cough, sore throat, and myalgias. Additional symptoms associated with past swine flu cases in humans such as runny nose, nausea, vomiting and diarrhea have also been reported. The illness appears to last for 4-6 days.
• The swine flu strain appears to be sensitive to neuraminidase inhibitors. If antiviral treatment is warranted, the recommended treatment is oseltamivir 75mg twice a day for five days. Zanamivir can also be used at a dose of 2 inhalations of 5mg each twice a day for five days.
• High-risk group for complications of influenza is defined as: a person who is at high-risk for complications of seasonal influenza: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e717a1.htm. However, it too early to ascertain what persons are at high-risk for complications of swine influenza A (H1N1) virus infection.

 

The following public health steps are recommended to contain the influenza outbreak:

• Cover your coughs with tissues (then throw them away) or your sleeve
• Keep your hands clean: Wash them with soap and water, or use an alcohol-based hand gel frequently.
• Stay several feet away from someone with a respiratory illness
• Stay home when sick