Swine Flu and Chronic Conditions

Experts explain the risks of swine flu for people with chronic health conditions.

From the WebMD Archives

Confused about swine flu? Even the name of this flu can be puzzling. Usually called swine flu, you'll also hear it called 2009 H1N1 flu and novel influenza A (H1N1). No wonder we're all a little baffled.

But swine flu isn't that hard to understand; it's a lot like seasonal flu. It has similar symptoms, such asfever, cough, sore throat, stuffy nose, body aches, headache, chills, and fatigue. As a matter of fact, it's hard to tell swine flu from seasonal flu without a lab test.

To learn more about this flu, and to find out if pregnant women or people with chronic conditions like asthma, diabetes, neurologic disease, lung disease, or heart disease should be particularly concerned, WebMD went to experts in internal medicine and gerontology for answers about the H1N1 virus.

Is swine flu a particular concern for adults with chronic illnesses?

Yes, says Joseph W. Stubbs, MD, FACP, president of the American College of Physicians and a doctor of internal medicine. That's because pregnant women and people with chronic conditions are more susceptible to severe flu, and are also more prone to flu complications, such as secondary infections and severe pneumonia.

According to the CDC, about two thirds of H1N1 hospitalizations and deaths have been in people with underlying conditions.

Are children with chronic conditions also susceptible to swine flu?

Swine flu, which seems as contagious as the seasonal flu, is spreading fastest among the young. In the U.S. and around the world, young people are most severely affected. Unlike seasonal flu, in which 90% of severe flu cases are in people over age 65, 90% of severe H1N1 flu cases have been in people under age 65.

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Is everyone with a chronic condition at equal risk for swine flu?

"Anything that can affect the health of a person is going to be more of a concern for people with underlying illnesses," says Aaron E. Glatt, MD, president and CEO of New Island Hospital in New York, and a professor of clinical medicine. "People who're at an especially higher risk are those with underlying heart and lung diseases, or a compromised immune system."

Also at greater risk are "people whose immune systems are not well," says Stubbs, such as those coping with AIDS or chemotherapy, as well as children under 5. Because children this age haven't been exposed to as many viruses, "we put them in the same category as those with chronic illnesses," Stubbs says.

If you're coping with a chronic illness, you "should take the risk of this flu very seriously," says Glatt.

Should people with chronic conditions get a swine flu vaccine, when it's available?

In the U.S., H1N1 swine flu vaccine started to become available in October 2009, although vaccine production was much slower than predicted. Until there's enough vaccine for everyone, experts are recommending that the vaccine should first be given to:

  • Pregnant women
  • Health care workers and emergency medical responders
  • People caring for infants under 6 months of age
  • Children and young adults from 6 months to 24 years
  • People aged 25 to 64 years with underlying medical conditions, such as asthma or diabetes

As with the seasonal flu vaccine, there may be people who shouldn't get the swine flu vaccine, including those with severe egg allergies or allergies to previous flu vaccines, the very young, and those with extremely compromised health.

The swine flu vaccine won't protect against seasonal flu, so it's important to remember that you'll need two flu vaccinations this season, not one.

How can those with a chronic illness protect themselves until a swine flu vaccine is available?

Swine flu spreads like the seasonal flu: primarily through droplets from coughs and sneezes. That's why tips for avoiding the swine flu are the same as those for avoiding the seasonal flu, and include:

  • Wash your hands frequently.
  • Avoid people sick with the flu.
  • When a vaccine becomes available, get vaccinated.

And if you're not feeling well, stay home until at least 24 hours after your symptoms go away.

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What about people with chronic conditions that may be institutionalized or attending school?

The same precautions should be taken for those in institutionalized settings like nursing homes and schools.

It's also important to separate sick people from healthy people, and avoid shared resources like towels and cups. With regard to "practicing good infection control -- one cannot talk often enough about washing your hands," says Glatt. "If you're caring for someone in an institutional setting and you leave the room, wash your hands -- that's what you should always be doing anyway, but people just sometimes need to be reminded."

What type of treatment should high-risk groups with swine flu follow? Can they take antivirals?

Antiviral drugs are prescription medicines that can make the flu milder in those that are sick, and they may also prevent serious flu complications.

Right now the antivirals recommended as effective against novel H1N1 flu are oseltamivir (Tamiflu) and zanamivir (Relenza). These are "useful for people who have symptoms of the swine flu or any flu", says Stubbs.

Tamiflu and Relenza are most effective if given within 48 hours of the first symptoms. But the drugs still benefit patients if given more than 48 hours after symptom onset.

Glatt adds that no over-the-counter flu medications are proven to work against swine flu virus or any other flu virus. However, medications to help with the flu symptoms are available. To stay well "you really need to do all the things your mother told you to do: Eat well, sleep well, exercise, stay as healthy as possible."

What preventative measures should caregivers of people with chronic conditions take to protect them from swine flu?

"This is a very good question, and it's very important that people take proper precautions," says Glatt, who recommends that caregivers avoid taking care of people if they are sick themselves. If that's impossible -- for instance, a person taking care of a sick spouse -- Glatt suggests these steps:

  • Wear an appropriate face mask.
  • Wash your hands very, very frequently (after each contact/care episode) and avoid touching your face.
  • Be appropriately careful with secretions and body fluids.

Other preventative measures recommended for caregivers include:

  • Separate the sick person from common areas if possible.
  • Consult with a physician regarding the benefits and risks of taking antiviral medication for prevention.

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What are the warning signs that I may need emergency medical care for swine flu?

If you do come down with the flu, you may be sick for a week or longer, say the experts at the CDC. During that time they suggest staying home from work or school for at least 24 hours after fever is gone except if you need medical care or other necessities. The fever should be gone on its own, without the use of a fever-reducing drug.

If children experience any of these signs while having the flu, the CDC advises getting them to urgent medical care:

  • Fast breathing or trouble breathing
  • Bluish or gray skin color
  • Not drinking enough fluids
  • Severe or persistent vomiting
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough

Adults need emergency care if they experience any of these signs:

  • Problems breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms improve but then return with fever and worse cough

WebMD senior writer Daniel DeNoon contributed to this report.

WebMD Feature Reviewed by Louise Chang, MD on August 20, 2009

Sources

SOURCES:

Joseph W. Stubbs, MD, FACP, president, American College of Physicians.

Aaron E. Glatt, MD, FACP, FIDSA, FSHEA, president and CEO, New Island Hospital; professor of clinical medicine, Bethpage, N.Y.

Sean X. Leng, MD, PhD, assistant professor of medicine, division of geriatric medicine and gerontology, Johns Hopkins University School of Medicine.

Thomas Yoshikawa, MD, professor of medicine, David Geffen School of Medicine at UCLA; editor-in-chief, Journal of the American Geriatrics Society.

CDC: "A Pandemic Is Declared," "Q&A: Novel H1N1 Influenza Vaccine," "What to Do If You Get Flu-Like Symptoms," "What Pregnant Women Should Know About H1N1 (Formerly Called Swine Flu) Virus."

World Health Organization: "What Is the New Influenza A(H1N1)?" "What Can I Do?" "Pandemic (H1N1) 2009 Briefing Note 4." July 24, 2009. "Pandemic (H1N1) 2009 Briefing Note 2." July 17, 2009.

PandemicFlu.gov: "H1N1 (Swine Flu) Immunization Campaign."

WebMD Medical Reference: "Flu Complications."

CDC web site.

© 2009 WebMD, LLC. All rights reserved.

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