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Swine-origin Influenza A (H1N1) - Columbia, SC

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The "swine flu" which caused a local outbreak in Mexico since February has now been confirmed in many countries around the world. Due to relatively small numbers and, at the current time, incomplete data our knowledge base remains somewhat limited. It is clear, however, that a new virus has emerged that is different enough that most of the population's previous exposures to influenza viruses and vaccines will not provide sufficient immunity. It should also be expected that first responders and primary care providers will face a significant portion of the potentially considerable case load.

So far, public health authorities are meeting this challenge fully prepared and equipped. The anthrax attack and the bird flu scare have resulted in significant improvements in infrastructure and communication capabilities. A national laboratory network was created, funded, and equipped to deal with exactly these kind of situations. While during the anthrax attack only limited communication channels were used, live updates of the current outbreak can be disseminated or received via webcasts, podcasts, blogs, e-mail or phone alerts, and even Twitter. Global, national, and state pandemic influenza plans are in place. CDC and DHEC are working tirelessly to implement these well designed plans. Locally, the city of Columbia, USC, and Palmetto Health several years ago created their own plans which supplement and support public health efforts.

We do not know have sufficient information to predict how severe this particular strain will be (so far most cases in the US range from mild to moderate) but patients with comorbidities or pregnancy, the extremes of ages (the very young, the very old), and immunocompromised patients could be at higher risk of severe disease when they contract this strain.

The symptoms appear to be identical to a regular influenza. Typically patients have a very rapid onset ("I was fine at 8 AM and at 9 AM I felt like a truck hit me") of a febrile illness with significant body aches, cough, and congestion. The incubation period appears to be short with as little as 48 hours having been reported in SC cases. All outbreak strains appear to be fully susceptible to oseltamivir (Tamiflu®) and zanamivir (Relenza®).

Many patients are worried by the ongoing press coverage and will seek advice or care. Patients who are expected to do well or are already recovering should be encouraged NOT to come to clinics or emergency rooms but to follow the recommendations listed below as the highest risk of exposure is likely in areas where ill patients are concentrated, i.e. in clinics and waiting rooms. Testing or treatment of such patients including the writing of "back-up scripts" will consume valuable resources and increase the risk for everyone. Patients or staff who feel they have the flu should stay at home, rest, and try not to expose others. Patients with severe disease (shortness of breath, altered mental status, etcetera) should attempt to contact their physician via phone.

While the outbreak is still somewhat limited, it appears justified to reinforce healthy behaviors. We encourage frequent hand washing or use of alcohol hand rubs, avoiding contact with people who are ill, avoiding touching of eyes, nose or mouth, good cough hygiene (cough into sleeve not into hands), and resting/staying at home when patients are ill. These and additional recommendation can be found at the CDC web site: http://www.cdc.gov/flu/protect/habits.htm

Recommending staying at home or wearing masks when patients are healthy does not appear justified at the moment. This is and hopefully will remain a treatable illness. It is also important to note that there is no evidence that patients can acquire swine flu from handling or eating pork.

Pertinent internet links and websites for patients and providers can be found here.