Swine Flu Symptoms | Symptoms of Swine Flu

Swine flu is a respiratory infection. Cases in the United States have generally been mild. Among the first 40 cases, there has been only one brief hospitalization and no deaths. The CDC recommends that swine influenza be considered in people who have fever and respiratory symptoms, especially cough or a sore throat. Ill people may also experience fatigue, chills, headache, or body aches. Less commonly, nausea, vomiting, or diarrhea has occurred in people with swine flu.





In Mexico, some people have experienced serious respiratory illness, including pneumonia or respiratory failure leading to death. Some of these cases have been confirmed to have had swine influenza infection. It is not clear if the deaths were due to the influenza virus directly or if the influenza virus weakened the lung, allowing bacteria to proliferate. If the latter is true, it would not be unusual since secondary bacterial infection is a known cause of human death during a routine human influenza season.

People with chronic medical conditions are always at higher risk for complications from influenza, and swine influenza is likely to pose a similar risk. Chronic medical conditions include asthma, chronic lung disease, heart disease, diabetes, kidney failure, etc.

People with swine influenza are assumed to be contagious for seven days after the onset of symptoms or at least 24 hours after all symptoms resolve (whichever is longer). Children may be infectious for longer periods (for example, 10 days).

Management of patients with above symptoms

Follow the current guidance algorithm:1,4

* Initially manage the patient by telephone where possible - avoid patient coming to surgery.

* Consider patient for antivirals:

o Give priority to early treatment with antivirals of people in higher risk groups:5
+ Chronic lung disease
+ Chronic heart disease
+ Chronic kidney disease
+ Chronic liver disease
+ Chronic neurological disease
+ Immunosuppression (whether caused by disease or treatment)
+ Diabetes mellitus
+ Patients who have had drug treatment for their asthma within the past three years
+ Pregnant women
+ People aged 65 years and older
+ Young children under 5 years old. Children below 1 year of age may be treated with low dose oseltamivir (seek paediatric advice if any concerns).

o In considering treatment of people aged 5-64 years with no underlying illness, doctors are advised to take a precautionary approach and offer antivirals to patients with symptoms strongly suggestive of swine flu. It is acknowledged that doctors must use their clinical judgement and will not usually choose to offer antivirals in circumstances where there are minor or unrelated respiratory symptoms.

o Prophylaxis should not usually be offered to contacts of cases unless, for example, a household member has serious underlying health problems or there are other special circumstances.

* If severe or life-threatening illness refer to hospital for further management. Apply algorithm to see whether admission criteria are met - and refer those patients to hospital:6

1. Severe respiratory distress

o Adult: severe breathlessness, e.g. unable to complete sentences in one breath. Use of accessory muscles, supra-clavicular recession, tracheal tug or feeling of suffocation.

o Child: lower chest wall indrawing, sternal recession, grunting, or noisy breathing when calm.

2. Increased respiratory rate measured over at least 30 seconds:
o Adult: over 30 breaths per minute.

o Child: ≥ 50 breaths per minute if under 1 year, or ≥ 40 breaths per minute if ≥ 1 year.

3. Oxygen saturation ≤ 92% on pulse oximetry (breathing air). Absence of cyanosis is a poor discriminator for severe illness.

4. Respiratory exhaustion:
o Adult: new abnormal breathing pattern, e.g. alternating fast and slow rate or long pauses between breaths.

o Child: respiratory exhaustion or apnoeic episode - apnoea defined as a ≥ 20 second pause in breathing.

5. Evidence of severe clinical dehydration or clinical shock:
o Adult: systolic blood pressure <> 2 seconds, reduced skin turgor.

o Child: evidence of severe clinical dehydration or clinical shock. Sternal capillary refill time > 2 seconds, reduced skin turgor, sunken eyes or fontanelle.

6. Altered conscious level:
o Adult: new confusion, striking agitation or seizures.

o Child: strikingly agitated or irritable, seizures, or floppy infant.

7. Causing other clinical concern to their own GP or clinical team: e.g. a rapidly progressive or an unusually prolonged illness.

Inform local Flu Response Centre7 by phone, e-mail or fax to ensure access to antiviral treatment.