April 30th, 2009
06:00 AM ET

Why should we be worried about this flu?

As the international outbreak of swine flu, or 2009 H1N1 virus, continues, CNN is answering more of your questions.

Q: The common flu kills tens of thousands every year, and there has been one swine flu death in the country.  Why is there such concern about the swine flu?

CNN: Experts are nervous that, as a new strain, the swine flu will be harder to stop because there aren't any vaccines to fight it and that over time, it might transform into something more deadly as it passes from human to human.

Dr. Margaret Chan, director general of the World Health Organization, said Wednesday that a new virus “is evolving rather quickly.”

“It’s important to take this very seriously and to maintain our vigilance and to track the virus,” she said.  Chan warned against panicking. “It is important not to overkill.  We need to maintain a level of calmness so that we will continue to manage this in a rational manner.”

For more: Regular flu has killed thousands since January

Q: Will face masks keep me safe?

CNN: We’ve received a lot of questions about face masks.  CNN.com’s article Masks keep you from spreading illness addressed this question.  A World Health Organization official said the masks are mainly useful to prevent spreading the virus, “not so much to stop people from catching the virus."

Q: Are hand sanitizers as effective as soap?

CNN: The purpose is to kill germs on your hands.  When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work. The alcohol in it kills the germs on your hands, according to the Centers for Disease Control and Prevention.

Q: Will a flu shot help prevent swine flu?

CNN: The seasonal flu vaccine doesn't protect against the strain of swine flu. “At this point we don't see that there was a protective value from that vaccine for this new strain,” said Dr. Richard Besser, the acting CDC director at a news conference Tuesday.

Check back on the blog for answers to viewers' frequently asked questions.

Filed under: Global Health • H1N1 Flu

April 29th, 2009
03:54 PM ET

How can you get protection from the flu?

By David S. Martin
CNN Medical Senior Producer

The details we heard this morning were vague but heartbreaking nonetheless: a 22-month-old from Mexico died from the swine flu in Texas. As a parent, the loss of a child is the worst imaginable tragedy. For those of us living in the United States, the toddler’s death lets us know that we do not necessarily have protection against this new virus that had until now resulted in deaths in Mexico but nowhere else.

There’s something else. Something history is warning us. The four deadliest pandemics in the last 120 years arrived at the end of a flu season, dissipated and then returned with a vengeance the following winter. That’s what happened in the deadliest pandemic ever: the so-called Spanish flu, which arrived in March 1918 but took its devastating toll in the winter of 1918-19. More than 20 million died worldwide. Worldwide flu outbreaks in 1889, 1957 and 1968 also followed this pattern. The virus’ second appearance in the winter was in each case much more deadly than the initial outbreak in the spring.

This history is no doubt on the mind of Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention in Atlanta, Georgia. At his briefing Tuesday, he said the CDC was considering making a swine flu vaccine. But it isn’t simply a matter of adding this vaccine to the seasonal vaccine offered each fall.

The seasonal flu vaccine for the winter of 2009-10 is already in production, and the government has already chosen which three flu strains to protect us against. The swine flu isn’t among them, and the process doesn’t allow for simply adding a fourth strain to the mix. That means a swine flu vaccine would have to be separate shot.

If a separate swine flu shot became available this fall, would you take it?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

April 29th, 2009
02:33 PM ET

How should the new flu be treated?

Here are some of your most frequently asked questions about treatment and medication for the swine flu. The Centers for Disease Control and Prevention announced Wednesday that it would begin referring to the illness as the 2009 H1N1 virus.

What medicine is available if I get sick with the swine flu?

CNN: The antiviral medicines Tamiflu (oseltamivir) and Relenza (zanamivir) have shown they can kill the new flu strain. You should take the medicine within two days of contracting the flu. The medicine is more effective when taken in the early phase of the infection.

At this time, CDC recommends the use of Tamiflu or Relenza for the treatment and/or prevention of infection with swine influenza viruses. The federal government is releasing nearly 13 million doses of antiviral medications to states to stem the spread of swine flu.

Meanwhile, national health officials said in a news conference Wednesday that efforts are under way to create a vaccine against the new strain of flu.

Should I take an anti-viral medicine now to be safe?

CNN: The Centers for Disease Control and Prevention recommends taking Tamiflu or Relenza as a precaution only for people living in households with someone who may be sick with swine flu. Even then, the CDC recommends these medicines for those under 5, over 65, or pregnant.

The CDC also recommends the drugs for schoolchildren with chronic medical conditions who have had face-to-face contact with a confirmed, probable or suspected swine flu case. Also, old, young, or pregnant travelers to Mexico, or those traveling to Mexico with chronic medical conditions. Health care workers, first responders, and border workers in areas with confirmed cases of swine flu should also be considered taking anti-viral medication as a precaution, the CDC says.

How would a pregnant woman be treated for the swine flu?

CNN: The CDC recommends that pregnant women who meet current case definitions for confirmed, probable or suspected swine flu infection should receive treatments that are used for people who are at higher risk of complications.  Treatment guidance for clinicians treating pregnant women is on the CDC Web site.

Q: What does it mean for a global pandemic?

CNN: The worst global pandemic in modern times was the influenza pandemic of 1918 to 1919. It affected about a third of the human race, and killed at least 40 million people in less than a year, according to the Harvard Medical School. The economy went into a deep recession and the average length of life dropped for 10 years.

As of Wednesday, the WHO phase of the current pandemic alert is 4, on a scale of 1-6, which acknowledges increased risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.  Phase 6 is a global pandemic.

For more information, see our previous posts and the latest about the first confirmed swine flu death in the United States.

Filed under: Global Health • H1N1 Flu

April 29th, 2009
02:07 PM ET

April 29th, 2009
06:00 AM ET

How are symptoms different from a common flu?

This morning, CNN answers questions from viewers who are concerned about symptoms and their travel history.  As we learn more about the swine flu, we are using CNN's newsgathering resources to help answer some of our viewers' most frequently asked questions.

Q: How can you tell whether you have a common flu or swine flu?

CNN: The symptoms of the current swine flu and seasonal flu are very similar. Reports suggest that this flu virus may result in nausea, vomiting and diarrhea more often than the typical flu. CNN's Dr. Sanjay Gupta says doctors in Mexico have reported seeing sudden dizziness as well. There’s no way to tell for sure without getting tested. If you’re feverish or have other flu-like symptoms such as a cough or a sore throat, you should see a doctor.

One positive aspect is that the swine flu cases appeared near the end of influenza season, Dr. Richard Besser, the acting CDC director told a news conference Tuesday. Had the outbreak occurred in January or February, public health officials would have had greater difficulty because of the number of people infected with the common flu.

Q: My family returned from Mexico this week. We aren't sick, but aren't sure if we should stay away from other people. Can we spread the virus even if we feel ok?

CNN: In general, people who are not sick probably do not put other people at risk, said Dr. Arthur Reingold, head of epidemiology in the School of Public Health at the University of California, Berkeley.  There is no recommendation from the Centers for Disease Control and Prevention or the World Health Organization that they should be quarantined.

Q: Will the current economic situation make the swine flu outbreak worse because of unemployment or uninsured Americans who may delay going to the doctor because of their current financial situation?

CNN: If more people go untreated because they lack insurance or the money to pay to see a doctor, it would likely cause those people to become sicker than they would have been otherwise. Lack of care would not affect the spread of the disease if those people remained isolated and avoided close contact with others, as the CDC has recommended.

Q: How long can the virus survive on objects? If someone sneezes and touches a grocery cart how will that cart carry the virus?

CNN: The virus survives on surfaces certainly for a number of hours. Even though the virus can survive on surfaces, the likelihood of it being transmitted from one person to another via a phone or surface is slim. It needs to get down into your lungs to make you sick, said Dr. Arthur Reingold, head of epidemiology in the School of Public Health at the University of California, Berkeley. “I personally would not have a major fear of environmental contamination,” he said.  “Virtually all influenza is transmitted from sneezing and coughing.”


For more information, see our previous posts and Facts about swine flu and check back on Dr. Gupta’s blog for more answers.

Filed under: Global Health • H1N1 Flu

April 28th, 2009
04:16 PM ET

More of what you wanted to know about swine flu

We're using CNN's newsgathering and research resources to get answers to some of our viewers' most frequently asked questions. This post focuses on prevention methods and protecting yourself and your family. For more topics, see our previous posts.

Q: What effective tools are there for preventing the spread of the virus?

CNN: As simple as it sounds, hand washing is a very effective tool for preventing the spread of the virus. Wash your hands with soap and water or an alcohol-based hand cleaner. Avoid touching your mouth, eyes and nose as much as possible. Also, if you cough or sneeze, cover your mouth and nose with a tissue or your sleeve. If you're sick, stay home and avoid close contact with others.

Q: How long can viruses live on surfaces?

CNN: Some viruses and bacteria can live two hours or longer on surfaces such as ATMs, doorknobs, computer keyboards and money.

Q: How long are people contagious?

CNN: The Centers for Disease Control and Prevention recommends those who become sick not go out for at least seven days after the symptoms start. The CDC says you should stay home an extra day after you feel better. Children are considered to be contagious longer than adults, possibly up to 14 days.

Q: Should people avoid taking public transportation, such as the subways?

CNN: There's no reason to avoid public transportation or other crowded places unless you live in a community that has been affected.

Q: Should parents restrict their children from public places? How long should they be removed from situations with a lot of people and other children?

CNN: Scientists don't know whether the outbreak will escalate.  For now, parents should use reasonable discretion, said Dr. Anne Moscona, an infectious disease expert at Cornell University.  If large gatherings are not essential, they should be avoided.  The situation is being closely monitored and there have been no warnings issued in the United States, but parents should be aware of any updates from their local officials.

For more information, go to "How should I protect myself?" and check back on Dr. Gupta's blog for answers to frequently asked question.

Filed under: Global Health • H1N1 Flu

April 28th, 2009
12:37 PM ET

More swine flu answers

CNN is helping you get answers about the outbreak of swine flu. Here are more of the most frequently asked questions from viewers.

Q Is it still safe to eat pork?

CNN: Yes, pork is safe to eat. You cannot catch swine flu from food, according to U.S. Department of Agriculture scientists. Also, there is no evidence touching raw pork infected with the virus poses a risk, the USDA says. Cooking pork to an internal temperature of 160 degrees kills all viruses.

Q: Is there any type of vaccine that exists for this virus?
CNN: There is no vaccine that has been developed specifically for this virus.

Q: Different news sources have conflicting information about the number of countries affected so far. How many countries have been affected by this outbreak?
CNN: By midday Tuesday, the World Health Organization had confirmed cases in Mexico, the United States, Canada, the United Kingdom, Spain and New Zealand. The Israeli health ministry is reporting two cases.

Q: I am traveling to Mexico. Are there any precautions that we should take to protect ourselves?

CNN: At this time, Centers for Disease Control and Prevention recommends that U.S. travelers avoid all nonessential travel to Mexico. Changes to this recommendation will be posted on the CDC Web site .

If you must travel to an area that has reported cases of swine flu, the CDC recommends anyone at high risk of severe illness from influenza –people with chronic conditions such as diabetes, lung disease, heart disease and the elderly - are urged to take prescription antiviral medications - Tamiflu or Relenza - for prevention of swine influenza during travel. Practice healthy hygiene, such as washing your hands often with soap and water, using hand sanitizers with at least 60 percent alcohol, and avoid close contact with sick people, to help stop the spread of swine flu.
Travel expert Peter Greenberg gives advice to the question: “Should people avoid travel?”

For more information, go to Answers to swine flu questions.
and check back on Dr. Gupta’s blog for answers to frequently asked questions.

Filed under: Global Health • H1N1 Flu

April 27th, 2009
04:40 PM ET

CNN answers your FAQs on swine flu

CNN wants to help its viewers and online users get answers surrounding the outbreak of swine flu in Mexico. We've had an outpouring of questions come in. The following are among the most frequently asked questions.

Q: Why is it more deadly in Mexico than anywhere else it’s surfaced?

CNN: The short answer is investigators don’t know. The deaths have occurred in healthy people, as opposed to those usually most at risk from the flu: the young, the old and those with compromised immune systems. The same thing happened in recent years with the SARS and avian flu outbreaks. The spreading virus starts a cascade within the body as the immune system overreacts. Fluid builds up in the lungs and inflammatory cells throughout the body react to the infection.

Q: Does the normal influenza vaccine offer protection against swine flu virus?

CNN: It may offer some. This particular virus seems to be a combination of several different strains: two strains of swine flu, one strain of bird flu and one strain of human flu. It's the human flu portion of the virus that that the flu vaccine may offer some protection against.

Q: Can animals, such as dogs or cats, contract the swine flu? If so, can they transfer it to humans?

CNN: There is no evidence that dogs and cats can contract swine flu. Still, this is a new strain of swine flu virus, and investigators can’t rule it out until more tests are done. In the past, the avian H5N1 flu has infected domestic cats and at least one dog in Thailand, according to the scientific literature. In 2004, the equine H3 virus appeared to infect dogs. There have been no reports of dogs or cats spreading the flu to people.

Q: How long will it take if a person has the flu before they show symptoms?

CNN: The typical incubation period for influenza is 1-4 days, according to the Centers for Disease Control and Prevention. The symptoms are similar to the common flu. They include fever, lethargy, lack of appetite, coughing, runny nose, sore throat, nausea, vomiting and diarrhea.

Q: How does a person contract swine flu? Does it come from pigs?

CNN: Swine flu may have come from pigs originally, but it is now being spread from among people. The virus spreads the same way the seasonal flu does. When an infected person coughs or sneezes around another person, the latter is put at risk. People can become infected by touching something with the flu virus on it and then touching their mouth, nose or eyes. An infected person can pass the virus to another before any symptoms even develop

Q: Should I avoid traveling to Mexico because of the swine flu?

CNN: The U.S. Centers for Disease Control and Prevention has recommended that Americans avoid all "non-essential" travel to Mexico.

Q: The swine flu has been labeled as  H1N1. The strain that killed millions of people in 1918 was also labeled H1N1; is it the same virus?

CNN: It is not the same virus. The current strain is a new variation of an H1N1 virus, which is a mix of human and animal versions. H1 refers to type of hemagglutinin, which is involved in the virus gaining entry into a target cell. N1 refers to neuraminidase, an enzyme that allows the release of copies of the virus from infected cells. A new variation can be created when an animal is infected with two or more different viruses at the same time. The viruses can exchange genes. This can be particularly dangerous because people may not have any immune defense against it.

You may have heard to this swine flu virus refered to as "Type A." There are three general types of influenza, Type A, Type B and Type C. Type A occurs in many species and historically has been the sole cause of pandemics.

Q: Where did this swine flu come from?  How did the outbreak occur in Mexico?

CNN: Researchers do not know yet know. People usually get swine flu from infected pigs. For example, farmers handling infected pigs can contract the virus. However, some human cases have occurred without contact with pigs or places they inhabited.

CNN will continue to answer your questions as the story progresses.

Filed under: Global Health • H1N1 Flu

April 27th, 2009
12:32 PM ET

Deciphering swine flu in Mexico

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

It's 4:30 a.m. here in Mexico City, and we are outside the largest public hospital in the city. Some of the earliest cases of swine flu were brought here and many of them died.

It is clear to us now that for the first several days, the doctors had no idea what was killing their patients. At first, they told me, they thought it was just a late-season flu, but one thing kept nagging at them: Patients who typically die from flu are elderly or very young. But this flu was striking people in their 20s, 30s and 40s. I immediately recalled my reporting on SARS and avian flu. It’s counterintuitive; typically, someone with a weakened immune system would be most at risk - the elderly and young - but in this case, it is people with the strongest immune systems. Why? At least in the cases of SARS and avian flu, it was not so much the virus that did the killing, as the body’s response to it – an overwhelming immune response, with inflammation that was deadly to the patients. Think about that. A stronger immune system means a stronger response and a more likely death. The same thing was seen during the 1918 pandemic that killed at least 50 million people worldwide.

In Mexico City, doctors were mystified, until someone brought up the possibility of this being caused by a virus the world had never seen. Two weeks of testing later, this new variant of the swine flu was discovered. The symptoms are similar to the more common flu, but there seem to be more gastrointestinal symptoms and it often appears with a sudden onset of dizziness.

This is not a pandemic, not yet. But, it is an outbreak and doctors here are scrambling to figure out where it started. They guess a pig farm, but there are no pig farms in Mexico City, so the search has to be broadened. Most likely Patient Zero came from a small city outside Mexico City. But, from where? And is it possible to contain it? We are investigating in Mexico City.

April 25th, 2009
09:41 AM ET

Kissing a cleft lip goodbye- Adnan's Journey, Part I



By Nicole Lapin

CNN.com Live anchor


[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/images/04/24/art.blog.adnan-saleh.jpg caption="Mohammed Saleh brought his son, Adnan, to Operation Smile. "I just want my son to have the chance,"he said."]In the middle of a crowded hospital hallway in Alexandria, Egypt, Adnan's  blue eyes pop.  He is sitting on the lap of his father, Mohammed Saleh.  Saleh looks at me and then at his pregnant wife next to him.  "I hope the new one doesn't have this condition," he says in his broken English.


 "This condition" refers to his son's cleft lip.   The Salehs are one of the more than 200 families who showed up at Shark Al Madina Hospital to try to receive free treatment for their child's cleft lip and/or palate.  It is Operation Smile's first mission in this city and the turnout is higher than expected.  


“I don’t know why he has it,” Saleh mutters as he kisses his 7-month-old son’s forehead.  I wish I had an answer for him.  I try telling him in my broken Arabic that the organization says it’s a combination of genetic, environmental and nutritional factors.  It means little to a father just trying to fix whatever caused his son’s deformity.


The global rate of cleft lip and/or palate is about 1 in every 750 births.  Unlike in the United States, the corrective surgery is costly and hard to come by in countries like Egypt.  I am here with an Operation Smile volunteer group- a mix of accomplished plastic surgeons, nurses and pediatricians from all over the world- aiming to change that for kids like Adnan. 


Running on adrenaline and Turkish coffee, the volunteers transformed one corner of the hospital into an eight-step screening process on the first day of the mission.  Benches turned into registration centers.  Markers and recycled paper became locator signs: “Vitals,” “Dental,” “Anesthesiologist.”  A bed sheet, beach ball and coloring book looked like an indoor playground in no time.


Women dressed in full hijab wait hours for their children to have a chance at getting the surgery.  An older woman walks up to me so fast she nearly stumbles over her long skirt.  “My grandson, my grandson, look, look,” she yells, holding the advertisement that appeared in a local paper in one hand and a wallet full of his pictures in the other.


The team will do approximately 175 surgeries during this mission.  Not everyone from two days of screening receives an operation.  The organization prioritizes the kids getting screened based on their chances for a successful recovery. 


The Salehs are Number 27 in this process.  I start following them when they got their number at 7 a.m.  They finish around noon and before they leave I ask Adnan’s father what he wants his son to be when he grows up.   Saleh answers quickly, “Whatever will make him happy.”  I say, “So, a doctor, lawyer, policeman…?”  He nods, “I just want my son to have the chance.”


A child whose cleft lip goes untreated will carry a social stigma in much of the world.  Some cultures believe it is “a curse” or “God’s will.”  A child  whose cleft palate, an actual split on the roof of his or her mouth, goes untreated can have difficulty eating and speaking.  In some pockets of the globe where malnutrition is prevalent, some of those youngsters won’t survive.   


I hear the last prayer call of the day echo outside the seaside hospital – that means it is 8 in the evening.  I just found out that Adnan has been accepted to surgery.  It’s scheduled for Saturday morning.  I can’t wait to see what he looks like when he smiles with more than just his eyes. 


 Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

Filed under: Children's Health • Global Health • Parenting • Pregnancy

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About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.