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Ask Dr. Gordon
By Kilbourn Gordon III, MD
Reducing the Risk of Swine Flu
The H1N1 “swine flu” virus is still very much on the minds of patients in the local community, particularly pregnant women and parents of young children. Awareness of the virus and taking steps to avoid it make sense, especially since the preventive steps can be effective against regular seasonal flu and other viral illnesses as well. H1N1 symptoms look much the same as the regular flu: severe body aches (sometimes making it difficult to get out of bed), fever (often 101–102 degrees and above), sore throat, dry cough and fatigue. Diarrhea and vomiting can also be symptoms, but are uncommon. To prevent H1N1, be sure to stay at least five feet from others who are sick. Remember that in its early stages, H1N1 can look a lot like other common viral illnesses and you may not be able to tell the difference. Avoid touching your nose, mouth or eyes as these are the common routes for H1N1 to enter your body. Should you need to touch these areas, you should thoroughly wash your hands, even in the absence of sick people in your home. All members of your family should cover their mouth and nose when sneezing and should dispose of the tissues. Although I would like to be able to allay fears about H1N1 and pregnancy, the Centers for Disease Control Web site (www.cdc.gov/H1N1FLU) does describe situations in which pregnant women have a higher complication rate than non-pregnant women. Pneumonia, in particular, must be considered a risk for pregnant women who have H1N1. Treating the symptoms of H1N1 is best done within the first two days of infection for all patients. Herein lies an important point: because many of the rapid tests done in the office are not as accurate as we would like them to be, and because time delays can be associated with sending these tests out of the office, many physicians will treat the patient empirically. Empiric treatment means that the decision to treat is made in the absence of a test result following a physical exam and review of the patient’s medical history. Another category for treatment is the group of patients who have been exposed to the disease, yet do not exhibit symptoms. This is called post-exposure chemoprophylaxis (administering medication to prevent disease or infection). Because of the greater potential for H1N1 to cause complications in pregnant women, many physicians will more actively propose post-exposure chemoprophylaxis in this group of patients. Although there is little objective data regarding pregnancy complications due to the use of the leading anti-flu medicines oseltamivir (Tamiflu) or zanamivir (Relenza), the day-to-day practice of prescribing these medicines has not shown problems with their use. Hope these thoughts are helpful to you in the coming months. Dr. Gordon is the medical director of the Fairfield Urgent Care Center, 309 Stillson Road, Fairfield, CT. He welcomes readers’ comments or questions at askdrgordon@bpthosp.org.

Source: http://www2.bridgeporthospital.org/Portals/12/Images/9/Reducing_the_Risk_of_Swine_Flu.pdf

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UNDER EMBARGO UNTIL OCTOBER 20, 2009, 12:01 AM LOCAL TIME Novel Influenza A (H1N1) Outbreak at the U.S. Air Force Academy Epidemiology and Viral Shedding Duration Catherine Takacs Witkop, MD, MPH, Mark R. Duffy, DVM, MPH, Elizabeth A. Macias, PhD,Thomas F. Gibbons, PhD, James D. Escobar, MPH, Kristen N. Burwell, MPH, Kenneth K. Knight, MD, MPHThe U.S. Air Force Academy is an undergraduate inst

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