Important update just in from the State of Connecticut Department of Health

Exclusive breastfeeding is protective because of antibody transmission. If a woman is combination feeding, it should be encouraged to increase the amount of breastfeeding or try and express breast milk with a pump if an infant is too sick to feed from the breast.

1. What exactly is swine flu?

   Swine flu (the proper name is H1N1 flu) is caused by a new type of influenza virus. This virus belongs to the type A influenza family that originated in pigs and changed to its present form allowing it to infect humans. Humans contract the disease from one another and not from pigs or from pork meat.

   

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   The epidemic was first detected in Mexico where it caused over 100 deaths. From there it spread rapidly to the U.S. and has been detected in over 20 states. It appears as if the U.S. form of the flu is not as virulent as the one in Mexico. Swine flu has now been detected in other countries but the bulk of the infections are still in North America. Domestic and international travel has facilitated the spread of the flu.

2. Are pregnant women more susceptible to H1N1 flu? Pregnant women (and also very young children—under the age of 5) are at increased risk of complications from getting infected with swine flu, as judged from previous epidemics. This is probably due to the fact that the pregnant woman’s immune system is somewhat suppressed. Reports have shown a higher rate of influenza associated deaths in pregnant women and also increased rates of spontaneous abortion and preterm birth, especially with women that acquired pneumonia. Fetal distress associated with maternal illness and delivery complications have also been reported in the past.
   

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3. What are the symptoms associated with swine flu? Most symptoms include typical flu-like symptoms such as fever, cough, muscle aches and pains, headache, runny nose, and in some instances gastrointestinal symptoms. The majority of women have an uncomplicated course. However, some women have developed a secondary bacterial infection leading to pneumonia. Pneumonia is the leading cause of death from influenza.
4. What is the length of time a person is considered infectious? The incubation time of swine flu (the time from exposure to the development of symptoms) is only a few days. Once symptoms develop the person is highly contagious and continues to be so for the duration of their symptoms or at least for 7 days after the onset of symptoms.
5. What precautions should I take to prevent swine flu? Take the following precautions with ANY flu virus;
   

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   1. Good hand washing with an antibacterial soap, especially after coughing or sneezing.
   2. Cover the nose and mouth when you cough or sneeze and discard used tissues.
   3. Stay home from work if you are sick and avoid contact with others that are sick. If close contact is necessary, wear a surgical mask. Avoid crowded places if influenza has been reported your community.
6. How is the diagnosis made? The laboratory should test pregnant women with suspicion of infection. A nasopharyngeal swab/aspirate or nasal wash/aspirate or combination of the two should be collected using special swabs with a synthetic tip and an aluminum or plastic shaft. (Swabs with cotton tips and wooden shafts are not recommended) and placed in viral media and sent for rapid influenza testing. Those specimens positive for influenza A are then sent to the state for sub typing. The real-time (RT-PCR) for influenza A, B, H1, and H3 is the standard test. This test picks up small amounts of the viral gene. It is very sensitive and gives rapid results so treatment can begin quickly. If testing is highly positive, confirmation at the CDC is obtained. Viral cultures can also be done but the results take much longer.
7. Treatment in Pregnancy

Pregnant women with confirmed, probable, or suspected infection as well as those who are in close contacts with other individuals with suspected, probable, or confirmed cases, should receive antiviral treatment. The recommended drugs are two antiviral agents zanamivir (Relenza) and oseltamivir (Tamiflu). Fever should be treated with acetaminophen (Tylenol).

Treatment should be start immediately after the onset of symptoms and continued for five days.

Prevention treatment is for 10 days. The safety of both drugs has not been established in pregnancy and they are therefore classified as Category C. Even though clinical studies have not proven the safety of the drugs in pregnancy, to date no adverse outcomes in pregnant women have been reported when given in therapeutic doses. These recommendations may change as more data in pregnancy becomes available.

Tamiflu is the preferred drug if symptoms are already present and Relenza may be preferable drug if prevention is the goal because of its limited absorption into the blood stream. Potential benefits must outweigh the risks for treatment to be initiated.

Herbal treatments like echinacea which have been used to prevent colds and stimulate the immune system have not been shown to cause toxicity in the limited studies that have been done.

8. Are anti-viral drugs safe while breast feeding? Women who breast feed can continue taking the antiviral medications. If a mother is ill, all precautions should be taken to prevent newborn infection including hand washing and use of a mask. Transmission of virus through breast milk is unknown.
9. Will the flu vaccination protect me against the swine flu? There is a good possibility that there is some measure of protection that the current vaccine has because of cross-reactivity but it may not be sufficient to prevent illness. Vaccines have to be changed nearly every year because of the ability of the influenza virus to mutate. Availability of a new vaccine specifically for this strain of the swine flu will probably be available within the next 6 months.

Pregnant women (and also very young children under the age of 5) are at increased risk of complications from getting infected with swine flu, as judged from previous epidemics. This is probably due to the fact that the pregnant woman’s immune system is somewhat suppressed.