Health Officials Warn to use Antiviral Medications Cautiously
To date, the there has been 40 reported cases of swine influenza A (H1N1) confirmed in U.S. - 28 in New York City, 7 in California, 2 in Kansas, 2 in Texas and 1 in Ohio. There have been no reported deaths in the United States.
Two of four antiviral drugs, Tamiflu (oseltamivir) and Relenza (zanamivir), appear to be effective against the strain of swine flu circulating in the United States. The US Centers for Disease Control and Prevention (CDC) said Monday it was sending 12 million dosages of Tamiflu and Releneza to California and other states that have reported swine flu infections.
That represents nearly one-quarter of a stockpile the United States built in recent years in response to fears of a deadly avian flu.
“These drugs can treat people who are ill and those people who have been exposed, so they are a good weapon,” said Dr. Anne Moscona, an infectious disease specialist at Weill Cornell Medical Center. “But the concern is about misuse. There is a danger in using these drugs in a way that encourages the development of drug-resistant viruses.”
A vaccination would be the best approach to constrain an outbreak. But according to CDC officials it would take up to six months to create a swine flu vaccine. Therefore, antivirals are used to contain transmission in the early days of an outbreak.
Influenza viruses can become resistant to antiviral drugs, so doctors should be judicious in how the drugs are prescribed if the swine flu outbreak should widen, said Dr. John Flaherty, associate chief of infectious diseases at Northwestern University’s Feinberg School of Medicine.
“The last thing you want to do is get panicked and start taking Tamiflu haphazardly,” Flaherty said. “We need to save it and use it in targeted situations.”
The drugs can be used to prevent infection before exposure; to prevent infection after exposure and to treat those who are already sick.
Tamiflu and Relenza belong to a class of drugs known as neuraminidase inhibitors that do not ‘kill’ the flu virus but merely slow the virus replication down to a level where the immune system can more easily destroy it, thus reducing the severity and duration of a flu illness.
These drugs generally work best when taken at the first signs of infection or in the early stages of the illness. A rush to obtain drugs and begin taking them may lead to inappropriate use, Flaherty said.
"The sooner these drugs are started, the better,” Flaherty said. “The only problem is, that may cause people to run to the doctor or hospital with any symptom, however mild to request the medications."
But doctors are still unsure if Tamiflu and Releneza, even if used properly, will work against swine flu in the same way they work against seasonal influenza.
The CDC has issued interim guidance that may change as the outbreak evolves and includes:
* Recommended for an ill person suspected to have swine influenza A (H1N1)
* Recommended as a preventive measure for people at high risk for complications from the flu who have close contact with a confirmed or suspected case; travelers to Mexico at high risk of complications; and healthcare workers or public health workers who have had unprotected close contact with a person ill from swine flu.
More information can be found on the CDC’s swine flu Web site.
Signs and Symptoms of Swine Flu in People
Regular human flu and swine flu share similar symptoms including cough, body aches, headache fever, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness such as pneumonia and respiratory failure and in some cases death, have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause worsening of an underlying chronic medical condition.
In children emergency warning signs that need urgent medical attention include:
- Fast breathing or trouble breathing
- Bluish skin color
- Not drinking enough fluids
- 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
- Fever with a rash
In adults, emergency warning signs that need urgent medical attention include:
- Difficulty breathing or shortness of breath
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Severe or persistent vomiting
How to Avoid Getting the Flu
First and foremost, wash your hands regularly with warm water and soap, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
Stay in good health by getting plenty of sleep, manage your stress, drink plenty of fluids, eat nutritious food and be physically active. Try to avoid surfaces that may be contaminated with the flu virus. And avoid close contact with people who are sick.
Lastly, if you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. Avoid touching your eyes, nose or mouth. Germs spread this way. #