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By Theresa Tamkins

WEDNESDAY, April 29, 2009 (Health.com) — Swine flu seems to be rapidly spreading, and experts say they expect more illnesses and deaths before the epidemic—and most likely pandemic—is over. However, the severity of infections is likely to vary widely. Flu in general can range from very mild to quite severe.

About 36,000 people die of seasonal flu each year, which is why high-risk groups such as the elderly, children, and those with weakened immune systems are told to get flu shots each year.

Unfortunately, this year’s flu shot doesn’t protect against swine flu, also known as H1N1. If you get sick, however, there are things you can do. The symptoms of swine flu include fever, headache, chills, muscle aches, runny nose, fatigue, and coughing. In some cases, symptoms have also included diarrhea and vomiting.

However, children may have different symptoms than adults; for example, they are less likely to have fever and cough. Babies, on the other hand, may have a fever and lethargy, without other symptoms.

So far, most infections outside of Mexico have been mild, and may be no more severe than an average respiratory infection. Experts say that all of the reported deaths so far have occurred in Mexico or in people who had recently traveled from that country (including a 23-month-old toddler who died in Texas), although it’s not clear why.

The risk of severe illness may depend on several factors, including your age, whether or not you’re pregnant, and the strength of your immune system.

Next page: When to stay home and when to go to the hospital

The CDC currently says that if you're a generally healthy person and you start having flu symptoms, the best thing you can do is to check with your doctor and stay home until you feel better. If you live in an area with active swine flu cases (check this Google map for updates on cases) and a member of your family is ill, you should consider staying home as well.

How long should you stay home? Experts say you should avoid people both while you have symptoms and for at least one additional symptom-free day. It’s hard to tell how long people remain infectious; some groups, such as children, may shed virus for a longer time period than others. In general, adults should stay home for seven days after symptoms begin, and children should stay home for 10 days.

If you’re taking care of someone who's sick or are staying home due to symptoms, the CDC recommends that you get help if the symptoms get worse, including difficulty breathing or chest pain, a purple or blue tinge to your lips, vomiting with an inability to keep liquids down, dehydration (symptoms include dizziness or in babies, a lack of tears when crying), seizures, or confusion.

If someone in your household has swine flu, there's a long list of things you can do to limit the infection. The sick person should stay in one room separate from the rest of the house and use  his or her own bathroom, if possible; one adult (someone who isn't pregnant, if possible) should care for the sick person; and all household members should clean their hands frequently using soap and water or alcohol-based hand gels.

When it comes to CDC recommendations for face masks (such as surgical masks or N95 disposable respirators, which can be purchased at pharmacies and hardware stores), the sick person should wear one if he or she needs to leave the house to see a doctor. Caregivers should wear one while taking care of a sick person or when leaving the house, although staying home as much as possible is recommended. (Such face masks should be used once and then discarded; don’t re-use masks.)

Next page: Who should take antiviral drugs

People in a high-risk groups, such as young children (particularly those under 5 or with high-risk medical conditions) and pregnant women, may need special consideration and treatment.

For example, the CDC recommends that doctors treat children age 1 or older with oseltamivir (Tamiflu) or zanamivir (Relenza) if they have a confirmed or a probable case of swine flu. Children under age 1 are trickier—they’re at higher risk of flu complications than other youngsters (particularly if they are six months or younger), but antiviral drugs haven’t been approved for this age group.

The Food and Drug Administration recently approved oseltamivir for kids under age 1 under an Emergency Use Authorization; an analysis suggests the benefits of the drug outweigh the risks for those who contract swine flu.

Because flu viruses can become resistant to antiviral drugs, experts say you generally shouldn’t take the drugs to prevent the flu, or even to recover from the flu if you don’t need them.

"Most people do not need these antiviral drugs to fully recover from the flu," according to the CDC. "However, persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization, might benefit from antiviral medications."

Some people who don't have swine flu symptoms may be considered candidates for antiviral medication, including:

—People at high risk of complications, including children under 5 years old, pregnant women, people 65 years or older, people who have certain chronic medical conditions, and people who live with someone with a confirmed or suspected cases of swine flu.

—Children in school or those who attend daycare and have had face-to-face contact with someone with swine flu.

—Children who traveled to Mexico who are at high-risk for complications of influenza.


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