Influenza A (H1N1), or swine flu, is a respiratory illness caused by type A influenza viruses. Outbreaks of this type of flu are most common in pigs. In the past, transmission between humans has been rare. People in direct contact with pigs are more commonly infected with H1N1 flu. Transmission may occur in similar ways that other flu viruses are spread, such as through coughing or sneezing, or by touching something with the virus on it and then touching one's mouth or nose. A person can't get this new HIN1 virus from eating pork or pork products. H1N1 flu was first detected in people in the United States in April 2009.
In this article, I'll give you an overview of H1N1 flu, including recommended treatment and proper patient education, so you'll be prepared.
Pandemic: What's in a word?
In response to the increasing number of people in the United States infected with H1N1 flu, the World Health Organization (WHO) has raised the worldwide pandemic alert level to phase 6. What does this mean?
The WHO uses a six-phased approach to describe pandemics. Phases 1 through 3 have to do with preparedness, whereas phases 4 through 6 focus on the need for response. Let's break this down even further:
* phase 1: no viruses circulating among animals have been reported to cause infections in humans
* phase 2: a circulating animal influenza virus is known to have caused infection in humans
* phase 3: an animal or human-animal influenza virus has caused sporadic cases or small clusters of disease in people; limited human-to-human transmission may occur
* phase 4: verified human-to-human transmission of an animal or human-animal influenza virus able to cause "community-level outbreaks;" this marks a significant upwards shift in the risk for a pandemic
* phase 5: characterized by human-to-human spread of the virus into at least two countries in one WHO region; strong signal that a pandemic is imminent
* phase 6: community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in phase 5; a global pandemic is under way.
Alert!! Signs and symptoms
At present, it has been determined that H1N1 flu is contagious; however, it's unclear how easily the virus is spreading between people. A person may be able to infect another person 1 day before symptoms develop and for 7 or more days (longer for children) after becoming sick.
Symptoms of H1N1 flu include:
* fever
* cough
* sore throat
* runny or stuffy nose
* body aches
* headache
* chills
* fatigue
* diarrhea
* vomiting.
Gotta-have guidelines
The CDC has outlined specific antiviral guidelines for prevention and treatment of confirmed, probable, and suspected cases of patients with H1N1 flu and their close contacts. Medications recommended for prophylaxis and treatment are oseltamivir (Tamiflu) and zanamivir (Relenza). These antiviral medications may also prevent serious complications. For treatment, antiviral drugs work best if started within 2 days of symptom onset. See Medications used to prevent and treat H1N1 flu for dosing recommendations.
Talk to your healthcare provider to see if you should be vaccinated against H1N1 flu. The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that the following groups be vaccinated:
* pregnant women
* people who live with or care for children less than age 6 months
* healthcare and emergency services personnel
* people between ages 6 months and 24
* people ages 25 to 64 who are at higher risk for novel H1N1 flu because of chronic health disorders or compromised immune systems.
In the event of a vaccine shortage, the ACIP recommends that the following groups receive the vaccine before others:
* pregnant women
* people who live with or care for children less than age 6 months
* healthcare and emergency services personnel with direct patient contact
* children between ages 6 months and 4
* children ages 5 to 18 who have chronic medical conditions.
To decrease the incidence of secondary pneumococcal pneumonia, the CDC is also recommending prophylactic administration of 23-valent pneumococcal polysaccharide vaccine during the outbreak of novel H1N1 flu. The recommendations of the ACIP are as follows:
* vaccination for all persons over age 65
* vaccination for persons ages 2 to 64 with the following medical conditions:
- chronic cardiovascular disease (congestive heart failure and cardiomyopathies)
- chronic pulmonary disease, including chronic obstructive pulmonary disease and emphysema
- diabetes
- alcoholism
- chronic liver disease, including cirrhosis
- cerebrospinal fluid leaks
- functional or anatomical asplenia, including sickle cell disease and splenectomy
- immunocompromised conditions, including HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy, chronic renal failure, and nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant
* vaccinations for persons ages 19 to 64 who have asthma or smoke.
A single revaccination at least 5 years after initial vaccination is recommended for people age 65 and older who were first vaccinated before age 65, as well as for people at the highest risk, such as those who have no spleen, and those who have HIV infection, AIDS, or malignancy.
Teacher, teacher!!
Here's what to teach your patients about H1N1 flu.
Tell your patient to contact her healthcare provider if she has flu symptoms and lives in an area where swine flu has been identified to see if she should be tested. Instruct her to stay home and avoid contact with other people to avoid spreading the illness; at least 24 hours after her fever is gone or, if possible, until her cough is gone. Stress that she should seek emergency medical care for any of the following warning signs.
In children:
* fast breathing or trouble breathing
* bluish skin color
* not drinking enough fluids
* not waking up or not interacting
* being so irritable that the child doesn't want to be held
* flulike symptoms improve but then return with fever and worse cough
* severe or persistent vomiting.
In adults:
* difficulty breathing or shortness of breath
* pain or pressure in the chest or abdomen
* sudden dizziness
* confusion
* severe or persistent vomiting
* flulike symptoms improve but then return with fever and worse cough.
Teach your patient that she can reduce her risk of H1N1 flu and other influenza viruses by:
* avoiding close contact with people who have respiratory symptoms, such as coughing or sneezing
* staying home when she's sick
* washing her hands often with soap and water for 15 to 20 seconds; using alcohol-based hand cleansers is also acceptable
* not touching her eyes, nose, or mouth because this is how germs get into the body
* keeping surfaces and objects (especially tables, counters, doorknobs, and toys) that can be exposed to the virus clean
* practicing other good health habits, including getting plenty of sleep, staying active, drinking plenty of fluids, and eating healthy foods.
For the most up-to-date information about H1N1 flu, see On the Web for links to the CDC, WHO, Flu.gov, and American Nurses Association websites or visit http://www.nursingcenter.com/H1N1.
Not just for pigs anymore
As we get deeper into flu season, be sure to keep yourself educated on the latest developments. Follow recommendations for vaccination, treatment, and infection control specific to your area of practice and patient population. Keep yourself and your patients safe!!
Medications used to prevent and treat H1N1 flu
Current antiviral dosing recommendations are as follows:
oseltamivir (Tamiflu)
To prevent influenza A (H1N1):
* adults: 75 mg capsule P.O. once daily for 10 days
* children 12 months and older weighing greater than 40 kg: 75 mg P.O. once daily for 10 days
* children 12 months and older weighing 24 to 40 kg: 60 mg P.O. once daily for 10 days
* children 12 months and older weighing 16 to 23 kg: 45 mg P.O. once daily for 10 days
* children 12 months and older weighing 15 kg or less: 30 mg P.O. once daily for 10 days
* infants 6 to 11 months: 25 mg P.O. once daily for 10 days
* infants 3 to 5 months: 20 mg P.O. once daily for 10 days
* infants less than 3 months: Not recommended unless situation judged critical due to limited data on use in this age group.
To treat influenza A (H1N1):
* adults: 75 mg capsule P.O. twice daily for 5 days
* children 12 months and older weighing greater than 40 kg: 150 mg P.O. per day divided into two doses for 5 days
* children 12 months and older weighing 24 to 40 kg: 120 mg P.O. per day divided into two doses for 5 days
* children 12 months and older weighing 16 to 23 kg: 90 mg P.O. per day divided into two doses for 5 days
* children 12 months and older weighing 15 kg or less: 60 mg P.O. per day divided into two doses for 5 days
* infants 6 to 11 months: 25 mg P.O. twice daily for 5 days
* infants 3 to 5 months: 20 mg P.O. twice daily for 5 days
* infants less than 3 months: 12 mg P.O. twice daily for 5 days.
zanamivir (Relenza)
To prevent influenza A (H1N1):
* adults: Two 5 mg inhalations (10 mg total) once per day for 10 days
* children age 5 and older: Two 5 mg inhalations (10 mg total) once per day for 10 days.To treat influenza A (H1N1):
* adults: Two 5 mg inhalations (10 mg total) twice per day for 5 days
* children age 7 and older: Two 5 mg inhalations (10 mg total) twice per day for 5 days.
Source: Centers for Disease Control and Prevention. Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 season. http://www.cdc.gov/h1n1flu/recommendations.htm#table1.
did you know?
* 10 H1N1 flu planning tips for outpatient settings
The CDC has issued guidance to help medical offices and other outpatient facilities prepare for a potential surge in H1N1 flu patients. Visit http://www.cdc.gov/h1n1flu/10steps.htm for more information.
* Guidance for H1N1 flu in obstetrics settings
The CDC has issued guidance for preventing and managing H1N1 flu infection in inpatient and outpatient obstetric settings. Visit http://www.cdc.gov/h1n1flu/guidance/obstetric.htm for more information.
* 2009 H1N1 flu vaccination campaign planning checklist
The CDC has released several documents to help healthcare providers and others plan H1N1 flu vaccination campaigns. Visit http://www.cdc.gov/H1N1flu/vaccination/statelocal/planning_checklist.htm for more information.
* Social media on H1N1 flu
The CDC has launched a social media campaign to encourage information sharing about H1N1 flu. Visit http://www.cdc.gov/SocialMedia/Campaigns/H1N1/index.html for more information.
* Respiratory protection against H1N1 flu
Healthcare workers exposed to patients with suspected or confirmed H1N1 flu should wear N95 respirators that have been tested to fit the wearer, according to a new report from the Institute of Medicine. Visit http://www.iom.edu/CMS/3740/71769/72967.aspx for more information.
On the Web
* American Nurses Association:http://www.nursingworld.org/H1N1
* CDC:http://www.cdc.gov/h1n1flu/
* Flu.gov:http://www.flu.gov
* World Health Organization:http://www.who.int/csr/disease/swineflu/en/.