Let us help you stay updated about influenza A(H1N1) (swine flu). Review key facts, stay in-the-know about WHO alerts, get the latest drug recommendations for treatment and prophylaxis, and more.
Lisa Bonsall, MSN, RN, CRNP
NursingCenter.com's Clinical Editor
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Key Facts About influenza A(H1N1) |
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- Swine flu is a respiratory illness caused by type A influenza viruses.
- Transmission may occur in similar ways that other flu viruses spread, such as through coughing or sneezing, or touching something with the virus on it and then touching one's mouth or nose.
- A person cannot get this new HIN1 virus from eating pork or pork products.
- Symptoms of swine flu include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, diarrhea, and vomiting.
- As of September 3, 2009 there are 9,079 hospitalized cases of H1N1 influenza in the U.S. and there have been 593 deaths. Get the latest summary of the situation.
- Medications recommended for prophylaxis and treatment are oseltamivir (Tamiflu) and zanamivir (Relenza).
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In response to the increasing numbers of people in the U.S. infected with influenza A(H1N1) (swine flu), the World Health Organization has raised the worldwide pandemic alert level to Phase 6. What does this mean?
The WHO uses a 6-phased approach to describe pandemics. Phases 1-3 have to do with preparedness, while phases 4-6 focus on the need for response. Let's break this down even further:
Phase 1: no viruses circulating among animals have been reported to cause infections in humans
Phase 2: a circulating animal influenza virus is known to have caused infection in humans
Phase 3: an animal or human-animal influenza virus has caused sporadic cases or small clusters of disease in people; limited human-to-human transmission may occur
Phase 4: rified human-to-human transmission of an animal or human-animal influenza virus able to cause “community-level outbreaks.” This marks a significant upwards shift in the risk for a pandemic.
Phase 5: characterized by human-to-human spread of the virus into at least two countries in one WHO region; strong signal that a pandemic is imminent
Phase 6*: community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5; a global pandemic is under way. *Currently at this level
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The CDC has outlined specific antiviral guidelines for prevention and treatment of confirmed, probable, and suspected cases of patients with influenza A(H1N1) and their close contacts.
Current antiviral dosing recommendations are as follows:
oseltamivir (Tamiflu)
To prevent influenza A(H1N1).
Adults: 75 mg capsule by mouth (P.O.) once daily for 10 days
Children 12 months and older weighing greater than 40 kg: 75 mg P.O. once daily for 10 days
Children 12 months and older weighing 24 kg to 40 kg: 60 mg P.O. once daily for 10 days
Children 12 months and older weighing 16 kg to 23 kg: 45 mg P.O. once daily for 10 days
Children 12 months and older weighing 15 kg or less: 30 mg P.O. once daily for 10 days
Infants 6 to 11 months: 25 mg P.O. once daily for 10 days
Infants 3 to 5 months: 20 mg P.O. once daily for 10 days
Infants less than 3 months: Not recommended unless situation judged critical due to limited data on use in this age group.
To treat influenza A(H1N1).
Adults: 75 mg capsule P.O. twice daily for 5 days
Children 12 months and older weighing greater than 40 kg: 150 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 24 kg to 40 kg: 120 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 16 kg to 23 kg: 90 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 15 kg or less: 60 mg P.O. per day divided into two doses for 5 days
Infants 6 to 11 months: 25 mg P.O. twice daily for 5 days
Infants 3 to 5 months: 20 mg P.O. twice daily for 5 days
Infants less than 3 months: 12 mg P.O. twice daily for 5 days /span>
Click here for complete prescribing information for oseltamivir (Tamiflu).
Click here for drug information from NDH2009
zanamivir (Relenza)
To prevent influenza A(H1N1).
Adults: Two 5 mg inhalations (10 mg total) once per day for 10 days
Children 5 years and older: Two 5 mg inhalations (10 mg total) once per day for 10 days
To treat influenza A(H1N1).
Adults: Two 5 mg inhalations (10 mg total) twice per day for 5 days
Children 7 years and older: Two 5 mg inhalations (10 mg total) twice per day for 5 days
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When the vaccine for influenza A(H1N1) becomes available, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends that the following groups be vaccinated:
- pregnant women
- people who live with or care for children less than 6 months old
- health care and emergency services personnel
- people between the ages of 6 months through 24 years of age
- people ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems
In the event of a vaccine shortage, the ACIP recommends that the following groups receive the vaccine before others:
- pregnant women
- people who live with or care for children less than 6 months of age
- health care and emergency services personnel with direct patient contact
- children between 6 months and 4 years of age
- children ages 5 through 18 years of age who have chronic medical conditions
To decrease the incidence of secondary pneumococcal pneumonia, the CDC is also recommending prophylactic administration of 23-valent pneumococcal polysaccharide vaccine (PPSV23) during the outbreak of novel influenza A(H1N1). The recommendations of the CDC's Advisory Committee on Immunization Practices (ACIP) are as follows:
- Vaccination for all persons over 65 years of age
- Vaccination for persons 2 to 64 years with the following medical conditions:
- Chronic cardiovascular disease (congestive heart failure and cardiomyopathies)
- Chronic pulmonary disease, including COPD and emphysema
- Diabetes mellitus
- Alcoholism
- Chronic liver disease, including cirrhosis
- Cerebrospinal fluid leaks
- Functional or anatomical asplenia, including sickle cell disease and splenectomy
- Immunocompromised conditions, including HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant
- Vaccinations for persons 19 to 64 years who have asthma or smoke.
*Note: A single revaccination at least five years after initial vaccination is recommended for people 65 years and older who were first vaccinated before age 65 years as well as for people at highest risk, such as those who have no spleen, and those who have HIV infection, AIDS or malignancy.
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You may be hearing a lot about influenza A(H1N1) (swine flu), not only through the media, but also from the patients that you are seeing in your practice. Use the following printable patient education guide to educate yourself and your patients about influenza A(H1N1).
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Centers for Disease Control and Prevention (CDC)
World Health Organization (WHO)
Food and Drug Administration (FDA)
PandemicFlu.gov
American Nurses Association (ANA)
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