What are swine flu symptoms?

Symptoms of swine flu are like regular flu symptoms and include fever, cough, sore throat, runny nose, body aches, headache, chills, and fatigue. Many people with swine flu have had diarrhea and vomiting. Nearly everyone with flu has at least two of these symptoms. But these symptoms can also be caused by many other conditions. That means that you and your doctor can't know, just based on your symptoms, if you've got swine flu. Health care professionals may offer a rapid flu test, although a negative result doesn't necessarily mean you don't have the flu.

Like seasonal flu, pandemic swine flu can cause neurologic symptoms in children. These events are rare, but, as cases associated with seasonal flu have shown, they can be very severe and often fatal. Symptoms include seizures or changes in mental status (confusion or sudden cognitive or behavioral changes). It's not clear why these symptoms occur, although they may be caused by Reye's syndrome. Reye's syndrome usually occurs in children with a viral illness who have taken aspirin -- something that should always be avoided.

Only lab tests can definitively show whether you've got swine flu. State health departments can do these tests. But given the large volume of samples coming in to state labs, these tests are being reserved for patients with severe flu symptoms. Currently, doctors are reserving antiviral drugs for people with or at risk of severe influenza.

Who is at highest risk from H1N1 swine flu?

U.S. cases of H1N1 swine flu have been in older children and young adults. It's not clear why, and it's not clear whether this will change.

But certain groups are at particularly high risk of severe disease or bad outcomes if they get the flu:

• Young children, especially those under 12 months of age
• Elderly people are at high risk of severe flu disease. But relatively few swine flu cases have been seen in people over age 65.
• People with cardiovascular conditions (except high blood pressure)
• People with liver problems
• People with kidney problems
• People with blood disorders, including sickle cell disease
• People with neurologic disorders
• People with neuromuscular disorders
• People with metabolic disorders, including diabetes
• People with immune suppression, including HIV infection and medications that suppress the immune system, such as cancer chemotherapy or anti-rejection drugs for transplants
• Residents of a nursing home or other chronic-care facility

People in these groups should seek medical care as soon as they get flu symptoms.

A striking number of adults who developed severe swine flu complications have been morbidly obese. However, obesity itself does not seem to be the issue. The vast majority of extremely obese people suffer respiratory problems and/or diabetes, which seem to be the underlying reason for their severe flu complications.

If I think I have the flu, what should I do? When should I see my doctor?

If  you have flu symptoms, stay home, and when you cough or sneeze, cover your mouth and nose with a tissue. Social isolation is one of the best ways for people with the flu to avoid spreading their illness to others. People should stay home from work, school, travel,shopping, social events, and public gatherings until they have been fever-free for at least 24 hours without the use of fever-reducing medications. People who work in healthcare settings should stay home for 7 days after the onset of symptoms or until symptoms disappear, whichever is longer. Patients who must leave home are advised by the CDC and the RI Department of Health to wear a facemask if they have one, cover their coughs and sneezes with a tissue, and wash their hands often.

The Health Dept. has developed a guidance for those caring for sick persons at home. See the following:

http://www.health.ri.gov./news/H1N1Advisories/Briefings/provider092309.pdf

Afterward, throw the tissue in the trash and wash your hands. That will help prevent your flu from spreading

If you have only mild flu symptoms, you do not need medical attention unless your illness gets worse. But if you are in one of the groups at high risk of severe disease, contact your doctor at the first sign of flu-like illness. In such cases, the CDC recommends that people call or email their doctor before rushing to an emergency room.

But there are emergency warning signs.

Children should be given urgent medical attention if they:

• Have fast breathing or trouble breathing
• Have bluish or gray skin color
• Are not drinking enough fluid
• Are not waking up or not interacting
• Have severe or persistent vomiting
• Are so irritable that the child does not want to be held
• Have flu-like symptoms that improve but then return with fever and a worse cough
• Have fever with a rash
• Have a fever and then have a seizure or sudden mental or behavioral change.

Adults should seek urgent medical attention if they have:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve, but then come back with worsening fever or cough

Keep in mind that your doctor will not be able to determine whether you have swine flu, but he or she may take a sample from you and send it to a state health department lab for testing to see if it's swine flu. If your doctor suspects swine flu, he or she would be able to write you a prescription for Tamiflu or Relenza.

These antiviral medications aren't a question of life or death for the vast majority of people. Most U.S. swine flu patients have made a full recovery without antiviral drugs.

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