Outbreaks of swine influenza are common in pigs year-round. Historically, when humans have become infected, it is a result of close contact with infected pigs. However, the current virus is a novel influenza A (H1N1) virus not previously identified in humans, and it appears to be spread by human-to-human transmission. The WHO has raised its pandemic alert level for swine influenza to phase 4, which signifies sustained community-wide outbreaks of human-to-human transmission.
In the current 2009 outbreak in the United States, preliminary testing has shown that, in all cases, the viruses have the same genetic pattern. The virus is being described as a new subtype of influenza A/H1N1 not previously detected in swine or humans.
Clinicians should consider the possibility of swine influenza virus infections in patients who present with febrile respiratory illness. The CDC criteria for suspected swine influenza are as follows:5
- Acute febrile respiratory illness in a person who resides in a community with onset (1) within 7 days of close contact with a person who has a confirmed case of swine influenza A (H1N1) virus infection or (2) within 7 days of travel to community (within the United States or internationally) where one or more swine influenza A (H1N1) cases have been confirmed.
- Acute febrile respiratory illness in a person who resides in a community where at least one swine influenza case has been confirmed.
If swine flu is suspected, the clinician should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact his or her state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
Laboratories should send all influenza A specimens that they are unable to subtype to the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division as soon as possible for further diagnostic testing.
- CDC. Guidance for Clinicians & Public Health Professionals. http://www.cdc.gov/swineflu/guidance/. Available at http://www.cdc.gov/swineflu/guidance/. Accessed April 27, 2009.
- CDC. Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/swineflu/recommendations.htm. Accessed April 28, 2009.
- WHO. Swine Influenza Frequently Asked Questions. World Health Organization. Available at http://www.who.int/csr/swine_flu/swine_flu_faq_26april.pdf. Accessed April 27, 2009.
- CDC. Interim Guidance on Specimen Collection and Processing for Patients with Suspected Swine Influenza A (H1N1) Virus Infection. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/swineflu/specimencollection.htm. Accessed April 28, 2009.
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