Swine Flu: INTRO
Swine influenza is a highly contagious respiratory disease of pigs caused by one of several swine influenza A viruses. Outbreaks are common in pigs year-round, but infection in humans historically is a result of close contact with infected animals. This current virus is a novel influenza A virus, more properly termed a new subtype of influenza A (H1N1) that was not previously detected in swine or humans. More important is that this new strain appears to be spread by human-to-human transmission.
Swine Flue: How it Can Be Diagnosed?
Preferred specimens: If swine flu is suspected, clinicians should obtain a respiratory specimen for analysis. In an ideal situation, the best method is via nasal pharyngeal aspirate or nasal wash aspirate into viral culture media; however, some experts are recommending the use of Dacron nasal swabs to decrease aerosolization of the virus. If these specimens cannot be collected, a combined nasal swab with an oropharyngeal swab is also acceptable and will be feasible in most settings. (Ideally, swab specimens should be collected using swabs with a synthetic tip and an aluminum or plastic shaft. Swabs with cotton tips and wooden shafts are not recommended. Specimens collected with swabs made of calcium alginate are not acceptable.)
The specimen should be placed in a 4°C refrigerator (not a freezer) or immediately placed on ice or cold packs for transport to the laboratory. Once collected, make contact with the state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
The specimen should be placed in a 4°C refrigerator (not a freezer) or immediately placed on ice or cold packs for transport to the laboratory. Once collected, make contact with the state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
Recommended tests. The CDC currently recommends "real-time RT-PCR for influenza A, B, H1, H3 conducted at a State Health Department Laboratory. Currently, swine influenza A (H1N1) virus will test positive for influenza A and negative for H1 and H3 by real-time RT-PCR. If reactivity of real-time RT-PCR for influenza A is strong (e.g., Ct ≤ 30) it is more suggestive of a novel influenza A virus." Confirmation as swine influenza A (H1N1) virus is now performed at the CDC but may be available in state public health laboratories soon.
Rapid influenza testing. Rapid testing for swine flu likely is similar to that for seasonal flu, meaning that sensitivities range between 50% and 70% of cases (no better than using fever and cough as a marker in a patient during influenza season), depending on the manufacturer. Therefore, negative rapid tests should not indicate a lack of influenza. Rapid tests can distinguish between influenza A and B viruses. A patient with a positive rapid test for influenza A may meet criteria for a probable case of swine flu, but again, a negative rapid test could be a false negative and should not be assumed a final diagnostic test for swine influenza infection.
Other tests. Immunofluorescence (DFA or IFA) tests can distinguish between influenza A and B viruses. A patient who is positive for influenza A by immunofluorescence may meet criteria for a probable case of swine influenza. However, a negative immunofluorescence could be a false negative and should not be assumed a final diagnostic test for swine influenza infection.
Isolation of swine influenza A (H1N1) virus by viral culture is also diagnostic of infection but may not yield timely results for clinical management. A negative viral culture does not exclude infection with swine influenza A (H1N1) virus.
Isolation of swine influenza A (H1N1) virus by viral culture is also diagnostic of infection but may not yield timely results for clinical management. A negative viral culture does not exclude infection with swine influenza A (H1N1) virus.
Swine Flue: How It Can Be Treated?
According to the CDC, swine influenza A (H1N1) is susceptible to the neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. It is resistant to amantadine and rimantadine. Treatment recommendations are as follows:
Suspected cases: Treat with zanamivir alone or with a combination of oseltamivir and either amantadine or rimantadine as soon as possible after the onset of symptoms and for a duration of 5 days.
Confirmed cases: Zanamivir or oseltamivir should be administered for 5 days.
Pregnant women: Antiviral medications are in Pregnancy Category C, so they should be used during pregnancy only if the potential benefit outweighs the potential risk to the embryo or fetus.
Children younger than 1 year: Because infants typically have high rates of morbidity and mortality from influenza, infants with swine influenza A (H1N1) infections may benefit from treatment with oseltamivir.
Detailed guidance on antiviral treatment for swine flu may be found here: http://www.cdc.gov/swineflu/recommendations.htm
According to the CDC, swine influenza A (H1N1) is susceptible to the neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. It is resistant to amantadine and rimantadine. Treatment recommendations are as follows:
Suspected cases: Treat with zanamivir alone or with a combination of oseltamivir and either amantadine or rimantadine as soon as possible after the onset of symptoms and for a duration of 5 days.
Confirmed cases: Zanamivir or oseltamivir should be administered for 5 days.
Pregnant women: Antiviral medications are in Pregnancy Category C, so they should be used during pregnancy only if the potential benefit outweighs the potential risk to the embryo or fetus.
Children younger than 1 year: Because infants typically have high rates of morbidity and mortality from influenza, infants with swine influenza A (H1N1) infections may benefit from treatment with oseltamivir.
Detailed guidance on antiviral treatment for swine flu may be found here: http://www.cdc.gov/swineflu/recommendations.htm
What Infection-Control Precautions Should Be Taken in Healthcare Settings?
Patients who have a suspected or confirmed case of swine flu and who need to be hospitalized should:
Patients who have a suspected or confirmed case of swine flu and who need to be hospitalized should:
Be placed in a single-patient room with the door kept closed.
Wear a mask when outside the room
Standard, droplet, and contact precautions should be implemented and maintained by healthcare professionals for 7 days after the illness onset or until symptoms have resolved
Sources: Medscape Infectious Diseases
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