Wake Up Call
Understanding influenza and pandemics, and how to help your customers prepare
By Nancy Andrews, RDH, BS
Editor’s Note: This is part one of a two-part series looking at swine flu. Part one looks at influenza (flu), how it is transmitted, how to avoid exposure and the role of the dental industry in supplying products customers need. Part two will deal with personal preparation for pandemics: vaccinations, supplies and strategies.
This year’s first pandemic, the "swine flu", emphasizes the power of microbes in a connected modern world - and the power of being prepared - or being afraid. The recent outbreak of a swine flu in Mexico, and the rapid spread to other countries, shows how efficiently the virus can be transmitted. This organism is a "novel" virus because it is not similar to past human flu species, so people do not have immunity to it.
Influenza Type A originates in birds. Most strains stay in birds, but some are able to jump to other species (pigs, cats, seal, whales and others). The new strain was created when two Swine Influenza Type A (H1N1) viruses that commonly infect pigs (and sometimes humans who contact pigs) mixed with human flu and bird flu in swine that were exposed to all four Type A viruses. This sharing of genetic material caused a dramatically different new strain of influenza with the important ability to spread between humans. Based on past flu pandemics, scientists have been predicting a flu pandemic (world-wide crisis), fearing a highly lethal new strain. In 2004, the deadly avian flu spread globally in birds and was able to directly infect humans who contacted birds, but has not yet acquired the ability to spread repeatedly from human to human.
Swine flu can spread rapidly between people, but appears to be more like seasonal influenza in severity. It is important to remember, however, that seasonal flu is serious. Every year, in late fall and winter, 10 to 20 percent of the U.S. population gets the flu, about 226,000 are hospitalized, and about 36,000 die. Young children, people over 65, pregnant women and people with other conditions that weaken them are most at risk for becoming severely ill or dying from both seasonal and swine flu. Swine flu cases are expected to fade during the summer and rise again in the fall with the seasonal flu. When it re-emerges, swine flu may be more dangerous. Of course, researchers are working hard to create a vaccine by the time it returns.
How flu is transmitted
Flu is transmitted primarily through airborne large-particle (5 micron or larger) respiratory droplets from sneezing or coughing in close contact (6 feet or closer), smaller aerosols traveling greater distances or contact with respiratory-droplet contaminated surfaces. Inhalation, direct personal contact, and touching eyes, nose or mouth with contaminated objects or hands are the most likely ways the flu is transmitted. Like other respiratory viruses, influenza viruses attach to ciliated epithelial cells lining the respiratory tract where they penetrate and replicate. Common cold viruses (such as rhinovirus) are heat sensitive, so they infect only the upper respiratory tract. Influenza is able to infect respiratory tissue in warmer areas, so it can cause more severe infections deeper: in the trachea, bronchi and lungs. Swine flu has not been shown to be transmitted by ingestion of food, including pork. It is not considered reasonable to slaughter domestic swine as a precaution against the novel swine flu.
An infected person can transmit the virus one day before symptoms develop, and at least seven days after onset. Children may remain infectious for longer. During pandemics asymptomatic people spread the infection, and exposure in public is likely.
Symptoms
Diagnosis is presumptive, based on symptoms, or confirmed by CDC laboratory-confirmed tests. Look for these sudden (rapid onset) flu symptoms:
- Fever (Babies 100.4 degrees, others 101.1)
- Cough
- Sore throat
- Intense body aches
- Headache
- Chills
- Fatigue
- Nausea, diarrhea, vomiting.
It is important to distinguish a flu infection from a common cold, because antiviral medication taken within the first two days of the flu is very effective at shortening the illness and reducing symptoms.
The antiviral medication, Tamiflu, was stockpiled by many countries and individuals during the avian flu scare. Many people took it preventively, and the annual flu developed resistance to it. Luckily, however, swine flu appears sensitive to two antivirals: oseltamivir (Tamiflu), and zanamivir (Relenza). If you develop flu symptoms, visit a physician who can prescribe these antiviral medications. Serious complications may require emergency treatment.
Personal and professional swine flu precautions
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash your hands often with soap and water or apply a waterless hand-sanitizer, especially after you cough or sneeze or touch possibly contaminated surfaces. Wash thoroughly: lather for 20 seconds. Apply hand sanitizer over all hand surfaces, using enough to remain wet for 15 to 20 seconds (the time needed for effective microbial kill).
- Avoid touching your eyes, nose and mouth. Hands can transmit viruses from contaminated surfaces.
- Do not share items such as pens, eating utensils or cosmetics.
- Try to avoid contact with sick people. Stay home if you are sick for seven days after symptoms begin, or until you have been symptom-free for 24 hours.
- Follow public health advice regarding isolation, social distancing, event and school closures.
- Be prepared to stay home for about a week. Have a supply of medications, hand rubs, tissues and other supplies such as thermometers.
- Have personal protective supplies; masks, gloves, eyewear.
- If you must be close to symptomatic people, wear a mask. Be aware of mask limitations; change after 20 minutes in humidity, or after an hour. Do not touch the outside of the mask with contaminated hands. Select an ASTM high barrier mask that fits well, or a NIOSH N-95 respirator that fits tightly.
- If you are in a high-risk category, avoid people with febrile respiratory illness. If contact is unavoidable, wear a disposable NIOSH N-95 respirator that fits tightly.
Products dentists need
Now is the time to check infection control supplies of customers. During pandemics, special contact, droplet and airborne precautions may be expected. Additional infection control efforts will require a generous supply of these basic items:
- Gloves
- Masks
- Disposable gowns (Consider new products with antimicrobial capabilities)
- Face shields and eyewear
- Gentle, foaming hand soap to lather rapidly and protect skin during frequent use
- Waterless hand sanitizers with water-based emollients to protect skin during frequent use
- Paper towels and facial tissue
- Waste receptacles
- Disposable barriers for room surfaces
- Surface disinfectant sprays and/or wipes
- Single-use patient eyewear, bib-clips or self-adhesive patient bibs; any items for cross-contamination control.
The swine flu pandemic is a wake-up call to the dental industry. Support customers now and look for ways to help them prepare for possible increased flu risks. Reps should know how to protect themselves, their family and their customers while avoiding unnecessary fear and panic.
Stay updated and connected by accessing these Web sites
www.cdc.gov
www.OSAP.org
www.PandemicFlu.gov
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