One of my close family members was apparently “diagnosed” recently with the “swine flu” by a private-practice pediatrician (IOW, no huge hospital with a convenient lab nearby). Some of my family is freaking out, convinced that death is near despite very mild symptoms (the patient in question is a child who was sent home from preschool with a fever). Patient has been on a course of Tamiflu, and has been fever-free for about a day-and-a-half.
In any case, upon researching the general risks of H1N1 contraction, I ran across this apparent oddity:
:dubious:
Now then. There’s tons of misinformation out there about H1N1/“Swine flu”. But one thing I believe I know about it is that its symptoms are commonly (not invariably) super-mild. Therefore, you can’t say “oh, little Johnny’s barely got any symptoms … can’t be swine flu”.
But … if the pediatrician could not make a diagnosis of H1N1 infection … what diagnosis DID she make? A covering diagnosis of “could be H1N1, so let’s be safe and treat it as such?”
Could my family feasibly expect a call in a few days saying “not to worry … it wasn’t really H1N1 after all!”
The cost of the test is hundreds of dollars. The only reason they were testing was to see how it was spreading. The Wisconsin state health services currently is not testing . People can still pay for a test if they wish, but what is the point of it?
Will them calling and telling you in a couple days it was or wasn’t the Swine Flu make any difference to you? I’m not sure what you are looking for in this thread.
There’s no quick-and-easy test to distinguish swine flu from the usual seasonal flu. However, the CDC is testing random samples from reported flu cases, and they do have the ability to identify specific flu strains. They’re finding that the vast majority of flu cases currently are H1N1; ergo, if a given patient shows up to a doctor with the flu, it’s most likely that they have H1N1.
My understanding is that H1N1 isn’t that much more harmful than the usual seasonal flu for most people. It IS a bigger public health problem, since H1N1 appears to be much more transmissible.
ETA: From a treatment point of view, there’s no difference between H1N1 and ordinary flu. Just bed rest, fluids, OTC drugs for symptoms, in most cases, and antivirals in more severe cases.
Wow, I work in a place where this kind of stuff is common knowledge, so it always surprises me when the public at large doesn’t know.
Swine flu (H1N1) is a particular strain of Influenza A. It is not very accurately picked up with rapid bedside nasal swab influenza testing (something like 20% sensitive). That being said, anyone with convincing flu-like symptoms right now is more than likely to have H1N1 since that’s just about the only strain we’re currently seeing in the US. We just haven’t hit the seasonal flu season yet. When December/January roll around we’re going to be less sure.
That being said, H1N1 appears to be less dangerous overall than the typical seasonal flu except in a few select populations (young children, pregnant women and those with other chronic underlying illnesses). Interestingly the elderly seem to be relatively more protected from H1N1 than seasonal flu which may be due to residual immunity from the H1N1 outbreak in 1977.
When a child comes to my ER with fever and upper respiratory symptoms (and/or GI symptoms) without any other obvious source (strep throat, ear infection, pneumona etc) I tell them it is probably H1N1, but I also make it clear that we don’t have a quick and accurate test for it. We’re asked to only send H1N1 tests to the regional lab for patient’s who have been admitted. Since H1N1 follows the same course as season flu in most patients, there is not much else that can be done. The CDC keepscurrent recommendations for those who should receive Tamiflu.
My impression from the boards and from talking to patients is that practitioners in many clinics are continuing prescribe Tamiflu to patients who likely don’t need it. Unfortunately in my region we’ve already seen several cases of H1N1 that are resistant to Tamiflu.
Bottom line… if you have a fever, body aches, cough, etc and you’re otherwise healthy it’s likely you have H1N1 and there really is much else that can be done for you. That being said, there are still young healthy patients with H1N1 who will develop a severe infection and require hospitalization. We cannot predict who those people will be. So if you think you need to be seen, call your doctor.
Thanks, USCDiver. The bolded above is the missing piece of information – I was under the impression that H1N1 was decidedly outnumbered by other strains.
I kinda wish that the pediatrician would have just told my family “no worries … just regular ol’ flu. Treat with fluids & TLC.” No one would be freaking out.
How common is Vomiting and Diarrhea with the H1N1? Almost always when I have a flu I get those, and I am trying to determine my chances for already having had it a couple weeks ago, when I was sick, but didn’t get em.
Obviously I’m not asking for a diagnosis just curious if it is common to have it without Vomiting and Diarrhea.
It’s been crazy in my community. One of my students, a 14 year old with no underlying problems, passed away a couple weeks ago. As horrible as that was, we now have all kind of people (NOT his family), using him as their example of why the schools should be closed, and how horrible the school board is for not “doing anything” and “not caring” and crap like that. People are threatening to pull their kids out to be homeschooled (I haven’t heard of anyone actually doing it though). We do have a crazy absence list right now. The first day back at school after the boy died, we were missing about 30% of our students (although a lot of that was kids leaving through out the day). The next day we opened school missing over 1/3 and it got to be pretty cose to half by the end of the day. School population is about 1900.
It’s important to distinguish between ‘a flu’ and Influenza. The terms stomach flu and flu-like illness are catch-all terms for viral illness, not necessarily caused by the Influenza virus. In past years, if you showed up in my ER with flu like symptoms in the summer, I wouldn’t even consider influenza because it used to be incredibly rare that time of year. This year was simply different because of the H1N1 strain.
I haven’t read any specific studies regarding symptom frequency, but I have read that gastrointestinal symptoms are MORE common with H1N1 than with typical seasonal flu. In my experience, fever is relatively uncommon in run of the mill viral gastroenteritis and influenza almost always includes significant fever (>101F) along with upper respiratory symptoms (runny nose, sore throat, cough etc), body aches and general malaise. The increased incidence of GI symptoms with H1N1 confounds that a little bit, but I would be less suspicious of H1N1 in a patient with GI symptoms, but no URI symptoms.
ETA: to answer your specific question… influenza is more likely NOT to include GI symptoms
Thanks for the excellent information. It sounds like then that only a relatively small percentage of cases get the true honest-to-God test to verify H1N1, and the rest it’s just assumed it is based on the currently available info. re the vector patterns of the virus.
Influenza is primarily a clinical diagnosis. Testing is generally superfluous. We know from testing done by hospitals and by sentinel clinics that almost all influenza around right now is H1N1.
I beg to differ with the commonly accepted and oft repeated mantra that H1N1 is “less dangerous overall than the typical seasonal flu”. It is just that the population most likely to die from influenza, the elderly, are not catching this one. OTOH we have already had more children die from H1N1 than die in most entire flu seasons, and it has only just begun. Australia (coming out of their winter season) had 15x more influenza admissions from H1N1 than they normally experience, and 20% of those admitted to their ICUs died. Canada, in just the initial wave during the spring, experienced enough to max out their ICUs in some towns for periods of time. Critically ill H1N1 patients experienced multiorgan failure and difficult to treat shock; something not generally seen in seasonal influenza. Those that survived also stayed in the ICU longer. It is not just effecting “young children, pregnant women and those with other chronic underlying illnesses” - in fact there have already been more laboratory proven influenza admissions for children 5-17 years old than there usually are by the end of the influenza season, and for the 18-49 yo group too. Only those only 50 are getting off easy. 45% of those who have died have NO preexisiting condition. I have grave fears that our Peds ICUs will not be able to handle the peak surge which is due in roughly 6 - 7 weeks … and what happens to the kid who needs an ICU and a vent when there is none to be had?
But back to the op … a difficulty for us pediatricians is how to make that diagnosis clinically in children under 2 yo, who are advised to be on Tamiflu within 48 hours of symptoms onset if you suspect influenza H1N1. High fevers with cough and URI symptoms is how influenza shows up … it is also amazingly common for kids under two to have that with ANY virus. This is going to be messy.
This can’t be emphasized loud enough or long enough, frankly. (BTW, thanks for the excellent post, DSeid.)
I really, really hope we get the target groups vaccinated very, very rapidly. This virus has the potential to overwhelm our health system in the US.
Of course, if we get everyone vaccinated who is willing to get it, and manage to contain this thing with minimal disruption, I’m sure we won’t hear the end of how the crisis was overblown, confabulated, done so doctors could make money, etc.
I agree but unfortunately there are far too many people who can’t afford the cost of the vaccine and even the free places they give them are hard to get to, make you wait in very long lines or have limits. I’ve already seen people saying H1N1 shots free, then in small print $24.99 administrative cost.
If you’re not working or in a low paying job (like fast food, where germs can be easily spead) you’re not gonna get a flu shot, unless it’s free and convenient
H1N1 vaccination, no matter where you get it, will be at no cost to you for the vaccine. The government has bought it for you and all providers are given it to give to you. Yes, there will be a nominal administration charge. More commonly under $10 bucks. And if you are someone who can’t afford that fee, say you work in fast food, then you are really someone who cannot afford to miss a week or two of work with straight-up uncomplicated influenza.
Why can’t they just hand out needles for you to stick on your own time? Why does someone with too much schooling have to be paid $25 for 5 minutes of their time? Medicine is such a ripoff, even when it’s “cheap”…
Btw, are all the “flu vaccine” ads for H1N1? I haven’t been following the news, I just assumed they were for seasonal flu.
Thanks for your input, DSeid. I wasn’t aware of the most recent numbers apparently. I’ll echo your concern about overwhelming the system. My hospital system is putting up tents in the parking lots outside the ER to triage all ILIs (influenza like illnesses). The sick patients will be sent inside to be seen by the providers there. Others will be sent home directly from the tent with a pat on the back, a bottle of hand sanitizer and a work note.
Much sobbing and gnashing of teeth would just up and disappear if the family got a phone call like that.
just curious if it is common to have it without Vomiting and Diarrhea.