Interim Guidance for H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home

This document provides interim guidance and will be updated as needed.

Swine influenza A virus infection (swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with swine flu infection. Certain groups might be more likely to develop a severe illness from swine flu infection, such as persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.

The following information can help you provide safer care at home for sick persons during a flu pandemic.

How Flu Spreads

The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

People with swine flu who are cared for at home should:

• check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
• check with their health care provider about whether they should take antiviral medications
• stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer
• get plenty of rest
• drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
• cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands.
• avoid close contact with others – do not go to work or school while ill
• be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention

Sicker People More Vulnerable to Swine Flu: CDC

Underscoring the belief that the new H1N1 swine flu is no more dangerous than regular flu, U.S. health officials said Tuesday that people hospitalized for swine flu who have underlying health problems fare worse than otherwise healthy people who also have been hospitalized.

And that mirrors trends seen with seasonal -- or regular -- flu, officials said.

In an early release of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, California health authorities reported on 30 people hospitalized for the H1N1 swine flu. One striking difference between these patients and patients with seasonal flu was their average age. At 27, the swine flu patients were much younger than most patients with seasonal flu who required hospitalization.

Health officials in both the United States and abroad have previously reported that the H1N1 swine flu seems to be targeting teens and young adults, unlike the regular flu which usually strikes hardest at the elderly and the very young.

Also, about two-thirds of the hospitalized patients in California had at least one underlying medical condition that put them at higher risk for influenza and its complications, Dr. Anne Schuchat, the CDC's interim deputy director for science and public health program, said during an afternoon teleconference. "The most common conditions were chronic lung disease, conditions associated with immunosuppression, chronic heart disease, obesity and pregnancy. There were five pregnant women in this series of patients," she said.

"Although the majority of hospitalized people infected with this new H1N1 virus recovered without complications, certain people did have severe and prolonged disease," Schuchat said. "None of these patients died. There are still some of these patients in the hospital, so we don't know whether they will make it or not."

Meanwhile, the World Health Organization said Tuesday that production of an H1N1 swine flu vaccine could not begin until mid-July at the earliest, which is weeks later than previous estimates. It would then take months before a vaccine would be available, the Associated Press reported.

The reason: swine flu virus isn't growing very fast in laboratories, making it hard for scientists to get the key ingredient they need for a vaccine -- the "seed stock" from the virus, WHO officials said, the AP reported.

Vaccine experts estimated that, under the best of conditions, they could produce nearly 5 billion doses of swine flu vaccine over a year after beginning full-scale production.

The WHO's director-general, Dr. Margaret Chan, said it would be impossible to produce enough vaccine for all 6.8 billion people on the planet -- a potential scenario that could pit rich countries against poorer ones as they bid for the vaccine, the AP said.

WHO officials were meeting Tuesday at their headquarters in Geneva, Switzerland, with representatives from about 30 drug companies to discuss the potential need for a vaccine and how best to produce it.

One factor complicating a decision on a swine flu vaccine is that most flu vaccine companies can only make limited amounts of both seasonal flu vaccine and pandemic vaccine, such as that needed for swine flu, and not at the same time. The producers also can't make large quantities of both types of vaccine because that would exceed manufacturing capacity.

Testing has found that the swine flu virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza, according to the CDC.

In the United States, while most cases of swine flu continue to be no worse than seasonal flu, the death rate from the new H1N1 virus is slightly higher than that seen with seasonal flu, U.S. health officials said Monday.

"Our best estimate right now is that the fatality [rate] is likely a little bit higher than seasonal influenza, but not necessarily substantially higher," Schuchat said.

Schuchat added that the spread of the swine flu is far from over and could continue through the summer. "H1N1 is not going away, despite what you've heard," she said.

On Tuesday, the CDC was reporting 5,469 U.S. cases of swine flu in 48 states, and six deaths.

The World Health Organization on Tuesday was reporting 9,830 diagnosed cases in 40 countries, including at least 79 deaths, mostly in Mexico, believed to be the source of the outbreak.

The swine flu is a highly unusual mix of swine, bird and human flu viruses. Experts worry that, if the new flu virus mutates, people would have limited immunity to fight the infection.

The CDC is concerned with what will happen as the H1N1 virus moves into the Southern Hemisphere, where the flu season is about to start. The agency is also preparing for the virus' likely return in the fall to the Northern Hemisphere.