Swine Flu

What is swine flu?

Swine flu is a type of flu (influenza). It usually affects pigs but it can also affect humans. The virus can be transmitted from human-to-human. Before spring 2009, the virus rarely passed from human-to-human.

A new strain of the swine influenza virus called influenza H1N1v that spreads easily from human-to-human emerged in Mexico in spring 2009. It has now spread to affect people in other countries, including the UK. When a strain of influenza spreads easily between humans and causes many cases in several countries, this is called a pandemic.

What are the symptoms of swine flu?

The symptoms are similar to the symptoms of 'ordinary' flu. Typically, people with swine flu have a high temperature (38 °C or greater). They also have at least two of the following symptoms: cough, sore throat, headache, runny nose, general aches and pains, vomiting or diarrhoea. These symptoms usually last for a few days and then usually completely go away. The incubation period (that is, the time between contracting the virus and the development of symptoms) is thought to be between two and five days, but may be up to seven days.

How is swine flu diagnosed?

The diagnosis is made by the typical symptoms. Because so many people now possibly have swine flu, a swab test to confirm the diagnosis is now impractical. Therefore, a 'probable' diagnosis is made by the typical symptoms.

What should I do if I think that I may have swine flu?

If you think you may be developing swine flu then government policy is that you should not visit your GP or hospital in the first instance. This is to reduce the risk of passing on the virus to others. Your first 'port of call' should be either by telephone or by using the internet:

For people living in England

If you live in England you should contact the National Pandemic Flu Service either:

• By phone - 0800 1 513 100 (textphone 0800 1 513 200) - or
• Via the internet: www.direct.gov.uk/pandemicflu

You will be asked to answer a series of questions to try to clarify if you are likely to have swine flu. If you have swine flu symptoms then treatment with antiviral medication will be discussed (see below in the Treatment section).

Note: you should contact your GP surgery directly rather than using the National Pandemic Flu Service if:

• You have a serious underlying illness.
• You are pregnant.
• You suspect your child under one year old has swine flu.
• Your condition suddenly gets much worse or you suspect a complication is developing (see below).
• Your condition is still getting worse after seven days (five for a child).

For people living in Scotland

If you live in Scotland and think you may have swine flu then you should contact your GP surgery or call NHS 24 on 08454 24 24 24.

For people living in Wales

If you live in Wales and think you may have swine flu then you should contact your GP surgery or call NHS Direct on 0845 4647.

For people living in Northern Ireland

If you live in Northern Ireland and think you may have swine flu then you should contact your GP surgery or call the Northern Ireland helpline on 0800 0514 142.

What are the possible complications of swine flu?

So far, experience with this virus suggests that most people fully recover. However, complications occur in some people and they can be serious and life-threatening. The most serious complication is pneumonia (lung infection) which may develop and may be fatal. Consult a doctor if you are concerned that a complication is developing. For example, if symptoms become severe or if other serious symptoms develop such as:

• Fast breathing or shortness of breath.
• Chest pains.
• Coughing up blood.
• Drowsiness or confusion.

What is the treatment of swine flu?

If it is suspected that you have swine flu then treatment with antiviral medication such as Tamiflu® will be discussed. In particular, people considered at higher risk of developing complications are recommended to take antiviral medication. People at higher risk include:

• Children under five years old.
• Adults over 65 years old.
• Pregnant women.
• People of any age with:
  • A poor immune system (for example, if you have HIV/AIDS, if you are receiving chemotherapy or steroid treatment).
  • Chronic (ongoing) lung disease or asthma which has been medically treated within the last three years.
  • Heart disease.
  • Diabetes or another metabolic disorder.
  • Chronic (ongoing) liver disease.
  • Cystic fibrosis.
  • Neurological conditions such as cerebral palsy, stroke, multiple sclerosis or muscular dystrophy.
  • Sickle cell disease.
  • Renal (kidney) disease.

If you are not at higher risk of developing complications (most people who are normally well), you may still be offered antiviral medication if you wish to take active treatment.

Antiviral medication does not kill the virus but interferes with the way the virus multiplies. Therefore, antiviral medication does not cure swine flu, or offer long term protection against swine flu. But, it may reduce the severity and duration of symptoms and may prevent complications. Usually, treatment is taken for five days.

Antiviral medication is generally considered safe. However, as with any drug, there is a small risk from side-effects or reactions. For example, a small number of people who take Tamiflu® develop nausea, vomiting, diarrhoea, abdominal pain, and headache. These are usually temporary and usually soon go away. Serious side-effects such as dangerous allergic reactions (anaphylaxis) have been reported, but are rare. If you are prescribed an antiviral drug, read the information that comes with the drug for a full list of possible side-effects and cautions.

Unless you become very ill you will be treated at home. This will reduce the risk of the virus spreading to other people.

Pregnant women with swine flu are usually given Relenza®, which is an alternative to Tamiflu®. As this drug is inhaled it means that less of the drug is absorbed into the blood stream so is safer to take in pregnancy. Treatment with antiviral medication when you are pregnant will help to reduce symptoms such as fever and this may benefit the developing baby. If you are breast-feeding then you can still take an antiviral drug.

Treatment with antiviral medication should start as soon as possible, ideally within 12-48 hours of the onset of symptoms. If you are prescribed an antiviral drug you will be given a unique access number and told where the nearest antiviral collection point is. You should then ask a friend or relative who doesn't have swine flu to go and pick up the antiviral drug. The friend or relative must show their own ID as well as that of the patient.

As with other flu-like illnesses, paracetamol and/or ibuprofen will lower your temperature, and also ease aches and pains.

Should those who have been in contact with people with swine flu be treated as a precaution?

Giving treatment to all contacts is not currently recommended. The current recommendation is that if you are in a high-risk group (detailed above) and have been in prolonged contact with a person with swine flu, then treatment with antiviral medication may be considered.

Examples of 'prolonged contact' include that you are living and/or sleeping in the same household, you are a pupil in the same dormitory, or you are a boy/girlfriend of a person with swine flu. The only exception is children under the age of one year, as there is less evidence to support the use of antivirals for the prevention of flu in this age group.

How can swine flu be prevented?

People with symptoms of flu should stay at home until they feel better. General hygiene is important to reduce the spread of swine flu (and other diseases). This includes:

• Covering your nose and mouth when coughing or sneezing, using a tissue when possible.
• Disposing of tissues promptly.
• Washing your hands frequently with soap and water.
• Cleaning hard surfaces (such as door handles and work surfaces) frequently.
• Ensuring children also follow this advice.

It is thought that the flu vaccine may offer some protection against swine flu. Further tests are being done to confirm this. Development of a vaccine for swine flu is underway.

Is wearing masks effective to protect from swine flu?

There is no evidence that wearing normal face masks provides any protection from swine flu or other types of influenza. It is not recommended that you wear them.

There are some facts about wearing face masks that need to be considered, including:

• Wearing a mask may actually give you false reassurance that you are protected from the flu. This may mean that you are less likely to carry out good hand hygiene (washing your hands with soap and water).
• If face masks are worn, then you need to change them regularly and also dispose of them properly. You need to wash your hands after removing a mask.
• When masks are worn, even for a short period of time, the masks become saturated with your exhaled breath so they become damp and even less effective.
• It has been recommended that face masks be used by healthcare professionals who are treating people with either suspected or confirmed swine flu. The face masks for healthcare professionals to wear when treating people with swine flu need to have a special filter. These masks need to be fitted to the face and are uncomfortable.

Should I have a supply of Tamiflu® just in case I develop flu?

This is not necessary and is not recommended. Antiviral medication is only given to people who have symptoms suggestive of swine flu. Using Tamiflu® when it is not necessary may lead to the virus becoming resistant to this medication. This may mean that Tamiflu® may not work when it is needed to in people with proven swine flu.

The Health Protection Agency does not advise the use of antiviral medication as a precautionary measure when travelling to countries affected by swine flu.

Further help and advice

National Pandemic Flu Service and Symptom Checker

Web: www.direct.gov.uk/pandemicflu
Information - Tel: 0800 1 513 513
Treatment - Tel: 0800 1 513 100

If you have severe symptoms which are not like flu, contact your GP or call:

NHS Direct in England - Tel: 0845 4647 Web: www.nhs.uk
NHS 24 in Scotland - Tel: 08454 24 24 24 Web: www.nhs24.com
NHS Direct Wales - Tel: 0845 4647 Web: www.nhsdirect.wales.nhs.uk
In Northern Ireland - Tel: 0800 0514 142 Web: www.dhsspsni.gov.uk

If you are planning to travel abroad

Check the Foreign and Commonwealth Office travel advice at:
Web: www.fco.gov.uk/travel or call 0845 850 2829