No Fever for Swine Flu

It will make our airport scanners almost useless.

http://seattletimes.nwsource.com/html/nationworld/2009213391_flu13.html

Odd swine flu feature: No fever in some cases

Many people suffering from swine influenza, even those who are
severely ill, did not have fever, an odd feature of the new virus that
could...

By lawrence k. Altman

The New York Times

Related

* WHO: Europe uses more drugs against swine flu

Swine-flu developments
Pregnancy advice: Pregnant women should take prescription flu
medicines for swine flu, health officials said Tuesday. Flu poses
added risks for pregnant women because of their weakened immune
systems, said Dr. Anne Schuchat of the U.S. Centers for Disease
Control and Prevention (CDC). A 33-year-old pregnant Texas woman who
had swine flu died last week, after giving birth by cesarean section.

More cases: Thailand and Finland reported their first confirmed cases
Tuesday, in people just arrived from Mexico. Cuba also confirmed its
first case — a Mexican student at medical school. Mexico's toll rose
Tuesday to 58 deaths and 2,282 confirmed cases. The World Health
Organization (WHO) has confirmed nearly 6,000 cases worldwide, with 63
deaths. The United States has the most — 3,009, with 3 deaths —
according to the CDC, followed by Mexico and 330 in Canada, where one
died. There was one death in Costa Rica.

Drugs: Swiss pharmaceuticals company Roche will donate enough Tamiflu
for 5.65 million people to WHO. Tamiflu and Relenza are the only two
anti-viral drugs known to be effective against swine flu.

Seattle Times news services

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Many people suffering from swine influenza, even those who are
severely ill, did not have fever, an odd feature of the new virus that
could increase the difficulty of controlling the epidemic, said a
leading U.S. infectious-disease expert who examined cases in Mexico
last week.

Fever is a hallmark of influenza, often rising abruptly to 104 degrees
at the onset of illness. Because many infectious-disease experts
consider fever the most important sign of the disease, the presence of
fever is a critical part of screening patients.

But about a third of the patients at two hospitals in Mexico City
where the U.S. expert, Dr. Richard Wenzel, consulted for four days
last week had no fever when screened, he said.

"It surprised me and my Mexican colleagues, because the textbooks say
that in an influenza outbreak the predictive value of fever and cough
is 90 percent," Wenzel said from Virginia Commonwealth University in
Richmond, where he is chairman of the department of internal medicine.

While many people with severe cases went on to develop fever after
they were admitted, about half of milder cases did not; nearly all
patients had coughing and malaise, Wenzel said.

Also, about 12 percent of patients at the two Mexican hospitals had
severe diarrhea in addition to respiratory symptoms like coughing and
breathing difficulty, said Wenzel, who is also a former president of
the International Society for Infectious Diseases.

Wenzel said he urged his Mexican colleagues to test the stools for the
presence of the swine virus, named influenza A (H1N1). "If the virus
goes from person to person and there is virus in the stool, infection
control will be much more difficult," particularly if it spreads in
poor countries, he said.

Complicating matters, five different flu viruses have been circulating
in Mexico simultaneously in recent months, he said.

Pneumonia rates at one of the hospitals Wenzel visited — the National
Institute for Respiratory Diseases — reached 120 per week recently
compared with 20 per week in the past two years, suggesting a possible
relation to swine flu.

The pneumonias that the flu patients developed did not resemble the
staphylococcal lung infections that were believed to be a common
complication in the1918-1919 influenza pandemic, Wenzel said.

He said the two Mexican hospitals were well-prepared for an outbreak.
"We have a lot to learn from the Mexican experience," he said.

For example, when the first cases were detected and the virus seemed
particularly severe, Mexican doctors activated a program to allay
anxiety among staff members.

Hospital officials made it clear they would care for staff members,
offering them information, a hotline, psychological support and
medical examinations.

"This aspect of epidemic response is not well-appreciated in the
United States yet is critical for success," Wenzel said. "We haven't
put nearly enough into managing fear among health workers."

Hospital officials had good measures to screen workers and arriving
patients, including supplies of alcohol sponges for people to clean
their hands. Healthy nonessential workers were told to go home.
Hospital officials also made sure there were enough breathing machines
and oxygen canisters for patients in respiratory distress.

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