Dealing with swine flu

Noni MacDonald MD MSc (Section Editor, Population and Public Health); and Diane Kelsall MD MEd (Deputy Editor, Clinical Practice)

Swine influenza in humans is spread in the same manner as typical influenza — through secretions. Thus, patients should be reminded to cover their mouth when coughing and sneezing, put used tissues into a waste basket, wash their hands regularly and not go to work or attend school if ill with the flu.

Symptoms of swine flu are similar to those of typical influenza — fever, lethargy, cough and lack of appetite, sometimes accompanied by a runny nose, sore throat, vomiting and diarrhea — and range from mild to severe. It is not clear yet how frequently severe disease occurs, but the age group currently reported to have the most severe disease and deaths is young adults. This pattern differs from that of typical influenza, where severe disease is most often seen in the very young and the very old.

Clinicians should consider the possibility of swine influenza in patients presenting with febrile respiratory illness, especially if they have recently returned from Mexico or have been in contact with someone suspected of having swine flu. Clinicians should be vigilant and immediately report any unusual cases or clusters of influenza-like illness or severe respiratory illness to their local public health office.

There currently is no influenza vaccine that covers this virus. For serious illness, this strain of influenza A (H1N1) virus is sensitive to the neuraminidase inhibitors zanamivir and oseltamivir. However, it is resistant to the adamantane antiviral medications amantadine and rimantadine.

Resources for physicians and patients

Below are websites that we have found useful for learning more about swine flu. Most of these sites provide updates on the latest spread of swine flu and answers to frequently asked questions (FAQ), as well as links to other physician and patient resources.

World Health Organization (WHO)

www.who.int/csr/disease/swineflu/en/index.html

This website provides a global perspective on swine flu, with specific guidance on surveillance. It also provides a useful FAQ page. 

Government of Canada

Hotline: 1-800-454-8302

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

Use this website for regular updates on swine flu in Canada and a useful FAQ page for patients.

www.fightflu.ca

This website is an excellent resource for patient information.

www.voyage.gc.ca

This is a useful website for your patients who are planning to travel.

Centres for Disease Control and Prevention (CDC)

www.cdc.gov/swineflu/

This website provides regular updates on swine flu in the United States. It also provides guidance for patients, families and clinicians on key issues. You will find information on how to take care of a sick person at home, antiviral recommendations for patients with confirmed or suspected swine flu, and infection control measures.

Canadian Paediatric Society

http://www.cps.ca/

General information on influenza and specific information on influenza A/Mexico/2009 (H1N1) in children is available on this website in English and French.

Provincial and Territorial Ministries of Health (Canada)

The following websites provide specific information on swine flu in individual provinces and territories. Most provide toll-free numbers for clinicians and patients. We have also highlighted some useful general resources for clinicians.

British Columbia
http://www.healthlinkbc.ca/healthfiles/hfile108.stm

Alberta
www.health.alberta.ca/health-info/swine-flu.html

Saskatchewan
www.health.gov.sk.ca/influenza-monitor

Manitoba
www.gov.mb.ca/health/publichealth/sri/index.html

This website has links to several downloadable brochures for patients on infection control measures.

Ontario
www.health.gov.on.ca/english/providers/program/emu/ihn.html

This website has a downloadable sign for medical offices and a useful summary of information for clinicians, including case definition, procedures for infection control and treatment options

Québec
http://msss.gouv.qc.ca/sujets/prob_sante/influenza/index.php?accueil

New Brunswick
www.gnb.ca/cnb/promos/swineflu/index-e.asp

Nova Scotia
http://gov.ns.ca/hpp/cdpc/swine-influenza.asp

Prince Edward Island
www.gov.pe.ca/health/index.php3

Newfoundland and Labrador
www.health.gov.nl.ca/health/
                       
Northwest Territories
www.hlthss.gov.nt.ca/english/services/communicable_disease_control_program/human_swine_flu.htm

Yukon
www.hss.gov.yk.ca/programs/nursing/health_officer/swine_influenza/

Nunavut
www.gov.nu.ca/health/

(There was no specific information posted as of April 28)