SWINE FLU IN INDIA & WORLD

The WHO has raised the Influenza Pandemic Alert to the highest level which is 6. Already India has seen over 40 confirmed cases of Swine Flu and the threat of a full blown epidemic in India is very real. The best we citizens can do is keep ourselves informed about the happenings and the steps we can take to prevent the spread of the flu. With most of the affected people fitting the profile of a person with internet access, we believe the internet is the first place that people would come looking for information like symptoms, who to contact etc. Swine Flu India is an attempt to bring all the necessary information in one place. India cannot afford to fall sick. Keep yourself and others informed.


Total Confirmed Cases in India

1928**
Total Deaths in India

29***
Total Confirmed Cases Worldwide

177457*
Total Deaths Worldwide

1462*
Last Updated Date and Time

19/08/2009 11:30 IST
Sources :

http://mohfw.nic.in/press_releases_on_swine_flu.htm

SWINE FLU CASES IN INDIAN STATES

SWINE FLU IN INDIAN STATES-ANALYSIS

Influenza H1N1-List of State Nodal Officers and contact details of Control Room

Andhra Pradesh
Office of The Addl. Director (Health Services), Hyderabad Nodal Officer:Dr Ramswarup [09989923781]
Arunachal Pradesh
SSU IDSP, Directorate of Health Services, Naharlagun, Arunachal Pradesh. Tel: 0360-2245460Telefax: 0360-2244271Nodal Officer:Dr.L.Jampa [09436055743]

Assam
Office of the Director (Health Services), Guwahati.0361-2235577 0361-2261630Nodal Officer:Dr Doley, 0361-2642008, 09854066560

Bihar
Office of the Executive Director,State Health Society, Sheikhpura, Patna. 0612-2280562,0612-2281232,0612-2290322(F)Nodal Officers:Mr. Santosh Mathew (IAS)Dr D K Gupta (Addl.Nodal officer)- 09430057795Control Room In-charge (Dr BK Singh: 9470003023)

CHHATISHGARH
State Surveillance Unit (IDSP),Directorate Health services,Old Nurses Hostel, DKS Mantralya Campus,RaipurNodal Officers:Dr T K Agarwal (Deputy Director, Epidemic)-Nodal officer: 09926624162Dr S N M Murti (Addl.N.O), 09425564418

GUJARAT
Office of Dy.Director (Epid)Commisionerate of Health Services Block No:5,Dr.Jivaraj Mehta Bhawan, Old Sachivalaya Ahmedabad, GujaratNodal Officer:Dr.S.J.Gandhi [09825342899]

GOA
Call Centre: 0832- 2458458Nodal Officer:Dr.Tamba (09822123801)

HIMACHAL PRADESH
IDSP Cell, Directorate of Health Services,Kasumti, Shimla-9Nodal Officer:Dr.Vinod Mehta(09418163500)

HARYANA
Office of the Director (Health Services),Sector-6, Panchkula0172-2587346[During office hours]Nodal Officer:Dr.Aparajita Sondh (Nodal Officer) 09417931024[24x7]

JAMMU-KASHMIR
Office of DHS, Srinagar, J& KTel/Fax. No (0194) 2452697 (main)Nodal Officers:Dr.M.Ahmed (09419012355), Dr.Bashir Ahmed Dar (Addl.N.O) (09419017716)

JHARKHAND
RIMS, RANCHIChamber of Dr. A. K. Mathur (HOD Medicine)Nodal Officers:Dr C.B Sharma (094311740820),Dr.Pradeep Baski

KERALA
Office of Addl.DHS (Public Health),Near Govt. General Hospital TrivandrumTF:(0471) 2466828[24X7]Nodal Officers:Dr. Amar (09447451846), DR. SHAUKAT ALI (Joint Director,NICD)-09447702444

KARNATAKA
Office of the Director (Health and Family Welfare),Anand Rao Circle, Bangalore-9Phone no: 080-1056 [24X7]Nodal Officers:Dr.Chelluraj-09901060584, Dr.Vasudev Murthi-09880024329

MAHARASHTRA
MumbaiRoom no.137,First Floor,Swasthaya Bhawan,Mumbai.022-22029070 ,022-22025830Nodal Officers:Dr. Gawande-09420711426,Dr Awate-09423337556PuneOffice of the Joint Director (Health Services),Central Building , Pune020-26124299 [24X7]Nodal Officers:Dr. Desai-09822429266, Dr. Suresh Bohatre-09881364656

MEGHALAYA
Office of DHS, Medical InstitutionsNokrek Bldg. 3rd Secretariat,Nodal Officer:Dr.R.R.Lanong,(09436102763)

MANIPUR
Medical Directorate, Office of DHS, ManipurRoom no-23, Lamphelpat Manipur-795004Nodal Officer:Dr Bhubon Chandra[09436021607]

MADHYA PRADESH
State Surveillance Unit, Directorate Health Services, Satpura Bhavan, Bhopal0755-4094192(TF)[Office hours only]Nodal Officer:Dr. B N Chauhan-09826282249

MIZORAM
Civil hospital,Aizwal0389-2322318Nodal Officer:Dr Sangawalar, 0389-2313721

NAGALAND
SSU IDSP, Directorate of Health Services& FW,T.R .Hill, KOHIMA-797001.Tel:(0370)2245016[Office hours only]Nodal Officer:Dr.Kebichusa(09436000463)[24x7]

ORISSA
State Surveillance Unit, Director of Health Services, Heads of the Department Buildings, Bhubaneshwar.0674-2390466 (TF)[24x7] Nodal Officer:Dr. V. Patnaik-0674-2390466

PUNJAB
Pariwar Kalyan Bhawan,Sector-34A, Chandigarh.Tel:(0172) 2621506Nodal Officer:Dr. Deepak Bhatia-09814302403 [24x7]0172-2621506(0)/0172-2620234(Fax)

RAJASTHAN
Office of the Director (Public Health), Swasthaya Bhawan, Jaipur.0141-2225624,0141-2224831(F) Nodal Officers:Mr. R K Meena ,IAS, Principal Sect.(Health)- Nodal OfficerDr. O P Gupta(Addl.Nodal Officer)-0141-2229858

SIKKIM
SSU IDSP, Health & F.W.Govt. of SikkimNodal Officer:Dr.Y.D.Chingappa(09832079576)

TRIPURA
DHS buildingPN BuildingNodal Officers:Dr P Chatterjee (09436120711),Dr.R.K. Dhar

TAMILNADU
Office of the Director (Public Health &Preventive Medicine),Central Malaria Laboratory,359,Annasalai,Chennai-6Nodal Officer:DR. Elango, DHS,(09940610123)

UTTARAKHAND
Office of DHS, IDSP,107,Chander Nagar, DehradunTF: 0135-2721792,0135-2729897Nodal Officer:Dr.Pankaj Jain(09412969502)[24x7]

UTTAR PRADESH
Swasthaya Bhawan,LuknowControl Room No-Tel:(0522)2616482Fax:(0522)2622819Nodal Officer:Dr Pyaremohan Srivastava,0522-2629106(TF)(09415181629)

WEST BENGAL
Chamber of Joint Director (Health Services), Swasthaya Bhawan,Sector-5,GN Block, Kolkata-91(033)-23571192Nodal Officer:Dr.Bhaskar Bhattacharya,033-23330180,(09831187818)

ANDAMAN AND NICOBAR
G.B.Pant Hospital, Port BlairTel:03192-230622,233473Dr.Abhijit Roy,Dy.Director(H)(09474269315),T/F: (03192-232797)

CHANDIGARH
Govt. Multispecialty Hospital,Sector-16, Chandigarh.Call Centre:102Nodal Officer:Mr. H.C. Gera (09988212139),(0172)-2740408

DADRA
Office of DHS, Silvassa.Nodal Officer:Dr.L.M.Patra DHS

DAMAN AND DIU
CHC, Daman.Tel:(0260)2230080Nodal Officer:Dr.B.Hansraj (Daman)(09825142600)

DELHI
DHS OfficeNodal Officer:Dr.R.P.Vashist

LAKSHADWEEP
Office of DHS,Tel:(04896)262316 [Office hours only]Nodal Officer:Dr.K P Hamza Koya (DHS)(09496429027,04896-262113),04896-262089,04896-262209(F)

PUDUCHERRY
Call Centre:(24X7) -Tel: (0413)1070Nodal Officer:Dr.G.S.Naidu (09443729783

SWINE FLU IN INDIA (WHO REPORT)

1. Activity: Updated information as of 09 August 2009:
Cumulative confirmed cases as of today: 864 cases
4 deaths
Age range of confirmed cases:
0-4 y.o. = 5%
5-14 y.o. = 33.97%
15-34 y.o. = 41.6%
35-59 y.o. = 18%
60+ y.o. = 1.5%
No Info age
Sex
Male: 49%
Female: 51%
2. Transmission: Local – localized clusters in household and schools reported in New Delhi and Pune.

3. Geographic Spread: Localized.

4. Trend: Slight increase in activity compared to last week

5. Intensity is Moderate

6. Impact : Low

DISTRIBUTION IN INDIA

Infection prevention and control in health care for confirmed or suspected cases

Background
On 11 June 2009, WHO raised its pandemic alert level from phase 5 to phase 6 and characterized the outbreak of pandemic (H1N1) 2009 as moderate. Since the first recorded cases in April 2009, the virus has spread rapidly across the globe resulting in sustained community transmission in numerous countries and at least two WHO regions.
Health-care facilities (HCF) face the challenge of providing care for patients infected with the pandemic (H1N1) 2009 virus. It is critical that health-care workers (HCW), patients, and visitors follow the appropriate infection control (IC) precautions in order to minimize the possibility of transmission associated with health care.
IC measures for pandemic (H1N1) 2009 should be in harmony with other IC measures and strategies in health care. It is particularly important to acknowledge and quickly identify other respiratory diseases that may require different IC measures (e.g. pulmonary tuberculosis) and that have the potential for being overlooked due to large numbers of patients with respiratory symptoms.
Human-to-human transmission of the pandemic (H1N1) 2009 virus appears to be primarily through droplets. Therefore, IC precautions for patients with suspected or confirmed pandemic (H1N1) 2009 virus infection, as well as those with influenza-like symptoms or illnesses, should ensure control of the spread of respiratory droplets. The document “Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care - WHO Interim Guidelines”1 provides detailed information on infection prevention and control precautions for influenza virus with sustained human-to-human transmission applicable for the current pandemic (H1N1) 2009. This guidance note summarizes and highlights the main issues contained in the aforementioned document.
This document has been developed to meet the urgent need for guidance and the recommendations are only valid until new guidance becomes available, at the latest until the end of 2009.

Fundamentals of infection prevention strategies
Administrative controls are key components in infection prevention strategies and include implementation and facilitation of IC precautions; patient triage for early detection, patient placement and reporting; organization of services; policies on rational use of available supplies; policies on patient procedures; and strengthening of IC infrastructure.
Environmental/engineering controls, such as basic HCF infrastructure,2 adequate environmental ventilation, proper patient placement and adequate environmental cleaning can help reduce the spread of some pathogens during health care.
Rational use of available personal protective equipment (PPE) and appropriate hand hygiene also help reduce spread of infection.
1 Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care WHO Interim Guidelines. WHO, 2007. Available at http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html.
2 Essential environmental health standards in health care. WHO, 2008. Available at http://whqlibdoc.who.int/publications/2008/9789241547239_eng.pdf.

3 WHO Guidelines on Hand Hygiene in Health Care. WHO 2009. Available at http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf.
4 Standard Precautions: Basic precautions designed to minimize direct, unprotected exposure to potentially infected blood, body fluids or secretions applicable to all patients. Available at www.who.int/csr/resources/publications/standardprecautions/en/index.html.
5 PPE for Droplet Precautions: Health-care workers to wear medical mask if working within approximately 1 meter of the patient.
6 Groups at high risk: Infants and young children <5>65 years), nursing home residents, pregnant women, and patients with co-morbid conditions such as cardiovascular, respiratory or liver disease, diabetes, and those with immunosuppression related to malignancy, HIV infection or other diseases.
7 Details on the correct use of PPE are available at: http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html
Critical infection control measures
Several measures are recommended in the context of pandemic (H1N1) 2009 and other epidemics. First, avoid crowding patients together (maintain a minimum distance of >1 metre between patients). Second, promote respiratory etiquette and hand hygiene by providing necessary supplies and training individuals in the proper use of medical masks and hand hygiene immediately after contact with respiratory secretions. Third, apply Standard4 and Droplet5 Precautions. Last, consider special arrangements for vulnerable groups at high risk6 for complications from pandemic (H1N1) 2009 viral infection.

Summary of infection control precautions in specific situations
1. Caring for patients with suspected or confirmed infection
For staff providing care for patients with suspected or confirmed pandemic (H1N1) 2009 infection and for patients with influenza-like symptoms, the following precautions should be taken.
1.1 When working in direct contact with patients, Standard and Droplet Precautions should always be applied.
As per Droplet Precautions:
• wear a medical mask, if working within or <>12 air changes per hour);
• avoid permitting unnecessary individuals into the room; and
• perform hand hygiene before and after patient contact, and after PPE removal.

8WHO Information for Laboratory Diagnosis of New Influenza A (H1N1)Virus in Humans. WHO, 2009. Available at http://www.who.int/csr/resources/publications/swineflu/diagnostic_recommendations/en/index.html.
Aspiration of the respiratory track may be associated with increased risk for disease transmission. Nasopharyngeal swabbing and the vigorous swabbing of tonsils for sample collection may trigger intense cough at very close distance to the person doing the procedure.
Clinical management of human infection with avian influenza A (H5N1) virus. WHO, 2007. Available at http://www.who.int/csr/disease/avian_influenza/guidelines/clinicalmanage07/en/index.html
PPE for Contact Precautions: Health-care workers should wear gowns and clean gloves when providing direct care.
IC recommendations for avian influenza in health-care facilities is available at: http://www.who.int/csr/disease/avian_influenza/guidelines/aidememoireinfcont/en/index.html .
2. Collection of laboratory specimens
Upper respiratory tract specimens are the most appropriate samples for laboratory testing of pandemic (H1N1) 2009 virus in humans. Samples should be taken from the deep nostrils (nasal swab), nasopharynx (nasopharyngeal swab), nasopharyngeal aspirate, and/or throat or bronchial aspirate. Blood samples may be used for serologic purposes (either during the acute or convalescent phases). In addition to Standard Precautions, specific IC precautions should be taken when collecting patient specimens as follows.
2.1 Nasal swab and nasal wash:
• use face protection (either a medical mask and eye-visor or goggles, or a face shield);
• wear a gown and clean gloves; and
• perform hand hygiene before and after patient contact, and immediately after removal of PPE.

2.2 Collection of nasopharyngeal aspirate, nasopharyngeal swab, throat swab or bronchial aspirate:
• follow the same precautions as for Aerosol generating procedures (above).

2.3 For the collection of blood:
• use a medical mask (if performed during the acute infectious phase);
• use clean gloves;
• perform hand hygiene before and after patient contact, and immediately after removal of PPE.

3. Infection control precautions for patient care in regions where both avian influenza A (H5N1) and pandemic (H1N1) 2009 have been reported Patients presenting with influenza-like illness (ILI) might be infected with different types of influenza virus (e.g. avian influenza A (H5N1) or pandemic (H1N1) 2009), as well as other respiratory pathogens. Epidemiological and clinical10 clues should be used in triage areas to identify and apply the appropriate infection prevention and control measures in accordance with the most likely diagnosis. Laboratory diagnosis should be pursued for etiological clarification. A laboratory confirmed diagnosis is not always available or might be delayed, but clinical clues and epidemiological link(s), such as contact with infected patients or animal exposures, can aid in the presumptive diagnosis of avian influenza A (H5N1) and pandemic (H1N1) 2009. For laboratory confirmed or suspect cases of avian influenza A (H5N1) infection, Standard plus Droplet plus ontact11 Precautions and eye protection should be applied when providing routine care.

KEY ELEMENTS FOR INFECTION PREVENTION IN HEALTH CARE

1. Basic infection control recommendations for all health-care facilities Standard and Droplet Precautions should be used when caring for a patient with an acute, febrile, respiratory illness.
2. Respiratory hygiene/cough etiquette Health-care workers, patients and family members should cover their mouth and nose with a
3 Interim WHO guidance for the surveillance of human infection with swine influenza A (H1N1) virus. WHO, 2009. Available at: http://www.who.int/csr/disease/swineflu/WHO_case_definition_swine_flu_2009_04_29.pdf
4 Mothers and newborn infants should be kept together unless absolutely necessary. The benefits of not separating a mother and her newborn baby and of breastfeeding outweigh the potential risks.
5 Laboratory Biosafety Manual - Third Edition. WHO, 2004. Available at: http://www.who.int/csr/resources/publications/biosafety/WHO_CDS_CSR_LYO_2004_11/en/index.html.
disposable tissue when coughing, then discard the tissue in a receptacle and perform hand hygiene afterwards.
6.Triage, early recognition and reporting of pandemic (H1N1) infection Consider assessing pandemic (H1N1) 2009 virus infection in patients with acute, febrile, respiratory illness in places where community-level spread is occurring or in patients who have been in an affected region within one week prior to symptom onset and who have been exposed to pandemic (H1N1) 2009 by an infected patient.13
7. Placement of suspected and confirmed pandemic (H1N1) 2009 infected patients Place patients with the same diagnosis in wards keeping at least 1 metre distance between beds.14 All persons entering the isolation area should adhere to Standard and Droplet Precautions. For health services targeting healthy populations, such as pregnant women, children attending immunization services or regular check-ups, measures must be taken to avoid exposing healthy people to suspected or confirmed cases.
8. Additional measures to reduce pandemic (H1N1) 2009 virus transmission associated with health care Limit the number of health-care workers/family members/visitors exposed to the pandemic (H1N1) 2009 patient. Implement rooming-in policies to keep mothers and babies together.
9. Specimen transport/handling within health-care facilities Follow applicable transport regulations and requirements and use Standard Precautions for specimen transport to the laboratory. Health-care facility laboratories should follow good biosafety practices.15
10. Family member/visitor recommendations Family members/visitors should be limited to those essential for patient support and should use the same IC precautions as health-care workers.
11. Patient transport within health-care facilities Suspected or confirmed pandemic (H1N1) 2009 patients should wear a medical mask or cover their cough and practice appropriate hand hygiene while being transported within health-care facilities.
12. Pre-hospital care (e.g. transportation to hospital). When transporting patients to hospital, IC precautions are similar to those practiced during hospital care for all involved in the care of suspected pandemic (H1N1) 2009 patients.
13. Occupational health Monitor health of health-care workers exposed to pandemic (H1N1) 2009 patients. Health-care workers with symptoms should stay at home. Vulnerable groups at high risk for complications of pandemic (H1N1) 2009 infection should carefully follow recommended infection-control measures. In addition, alternatives such as reassignment to other duties should be considered. Antiviral prophylaxis should follow local policy.
14. Waste disposal Standard Precautions should be used when handling and disposing of sharps and contaminated items.
15. Dishes/eating utensils Wash using routine procedures with water and detergent. Use non-sterile rubber gloves.
16. Linen and laundry Wash with routine procedures, water and usual detergent; avoid shaking linen/laundry during handling before washing. Wear non-sterile rubber gloves.
17. Environmental cleaning Ensure that appropriate and regular cleaning is performed with water and usual detergent on soiled and/or frequently touched surfaces (e.g. door handles).
18. Patient care equipment Ensure cleaning and disinfection of reusable equipment between patients. ²

19. Duration of pandemic (H1N1) 2009 infection control precautions Until further information becomes available, IC precautions should be practiced for seven days from the onset of symptoms. For prolonged illness with complications (i.e. pneumonia), control measures should be used during the duration of acute illness. Children may shed the virus longer than adults, and personal hygiene and separation from immunologically naive family members is recommended for at least one week after the resolution of fever.
20. Patient discharge If the pandemic (H1N1) 2009 patient is still infectious upon hospital discharge (i.e. discharged within the period of IC precautions: see 16 above), instruct family members on appropriate IC precautions in the home.
21. Prioritization of PPE when supplies are limited Medical masks and hand hygiene supplies should be prioritized for the care of all pandemic (H1N1) 2009 patients.
22. Health-care facility (HCF) engineering controls The HCF spaces should be well ventilated. Aerosol-generating procedures should be performed in adequately-ventilated rooms (>12 air changes per hour).
23. Mortuary care Mortuary staff and the burial team should apply Standard Precautions, i.e. perform proper hand hygiene and use appropriate PPE according to the risk of exposure to body fluids (e.g. gown, gloves, and facial protection if there is a risk of splashes from patient's body fluids/secretions onto staff member's body and face).
24. Health-care facility managerial activities Development of procedures to ensure proper implementation of administrative controls, environmental controls and use of PPE, including adequate staffing and supplies, training of staff, education of patients and visitors and a strategy for risk communication.
25. Health care in the community Limit contact with the person with influenza-like symptoms as much as possible. If close contact is unavoidable, use the best available protection against respiratory droplets and perform hand hygiene.

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 6 August 2009

EPIDEMOLOGY OF SWINE FLU

Qualitative indicators (as of Week 30: 20 July - 26 July 2009 and Week 31: 27 July - 2 August 2009)

As a part of WHO ongoing efforts to monitor the pandemic, qualitative indicators were developed to accommodate several types of data sources. Using these indicators, countries at different stages of the pandemic can participate in the monitoring effort, regardless of their surveillance and laboratory capacity. The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.
Interim WHO guidance for the surveillance of human infection with A(H1N1) virus
A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.
The attached maps display information on the qualitative indicators reported for weeks 30 and 31. Information is available for approximately 50 to 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

Epidemiological Update on the Global Situation

Pandemic influenza H1N1 has now been reported in over 170 countries and territories worldwide. While the case counts no longer reflect actual disease activity, WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states. Of particular interest is the situation in temperate countries of the Southern Hemisphere, which are now passing through their winter season. This season, pandemic H1N1 has been the predominant influenza virus in nearly all of the temperate regions of Southern Hemisphere, with South Africa being a notable exception. Australia and countries in the southern part of South America experienced rapid increases in cases of pandemic influenza early in their winter season. These same areas are now starting to report decreases in the numbers of people seeking care and being admitted to hospital. Although the virus is still circulating in these areas as it moves into areas not affected earlier, the overall national trends are downward. South Africa, in contrast, experienced an early influenza season with a seasonal subtype, influenza A (H3N2). As the influenza season in South Africa reached its peak in early to mid June and began to decline, pandemic influenza H1N1 appeared and has now become the dominant subtype seen there as well. In the temperate areas of the northern hemisphere which experienced early outbreaks of pandemic H1N1 influenza, including countries in North America and Europe, the virus continues to spread to new areas and cause intense local outbreaks. However, the overall national trend in cases is downward in the Americas. Tropical regions of the world, which typically experience year round transmission of influenza viruses with peak transmission at different and often multiple times in a year, are now seeing increases in cases, for example in tropical areas of Central and South America and in South and South East Asia. In summary, the overall picture of transmission globally is one of declining transmission in the temperate regions of the Southern Hemisphere with the exception of southern Africa. The season in these areas was characterized by rapid rise and fall of respiratory disease numbers, as is seen in a normal influenza season. The impact and severity of the season in these areas in terms of proportion of cases which developed severe disease and the load imposed on health care infrastructure is still being evaluated but generally appeared slightly worse than a normal influenza season in most places with increased hospitalization requiring respiratory critical care. The northern hemisphere is experiencing continued spread of the virus but declining activity is being observed in areas affected early in the course of the pandemic. Tropical areas of the world are now experiencing increasing numbers of cases at a time when the usual seasonal peaks would occur. As the pandemic H1N1 influenza virus is now the dominant strain in most areas of the world, it can be expected to persist into the coming influenza season in the Northern Hemisphere. Additionally, there is a risk of further spread of virus in highly populated areas as community spread starts occurring in Asia and Africa.

Pandemic influenza in pregnant women

Pandemic (H1N1) 2009
Research conducted in the USA and published 29 July in The Lancet [1] has drawn attention to an increased risk of severe or fatal illness in pregnant women when infected with the H1N1 pandemic virus.
Several other countries experiencing widespread transmission of the pandemic virus have similarly reported an increased risk in pregnant women, particularly during the second and third trimesters of pregnancy. An increased risk of fetal death or spontaneous abortions in infected women has also been reported.

Increased risk for pregnant women
Evidence from previous pandemics further supports the conclusion that pregnant women are at heightened risk.
While pregnant women are also at increased risk during epidemics of seasonal influenza, the risk takes on added importance in the current pandemic, which continues to affect a younger age group than that seen during seasonal epidemics.
WHO strongly recommends that, in areas where infection with the H1N1 virus is widespread, pregnant women, and the clinicians treating them, be alert to symptoms of influenza-like illness.

WHO recommendations for treatment
Treatment with the antiviral drug oseltamivir should be administered as soon as possible after symptom onset. As the benefits of oseltamivir are greatest when administered within 48 hours after symptom onset, clinicians should initiate treatment immediately and not wait for the results of laboratory tests.
While treatment within 48 hours of symptom onset brings the greatest benefits, later initiation of treatment may also be beneficial. Clinical benefits associated with oseltamivir treatment include a reduced risk of pneumonia (one of the most frequently reported causes of death in infected people) and a reduced need for hospitalization.
WHO has further recommended that, when pandemic vaccines become available, health authorities should consider making pregnant women a priority group for immunization.

Danger signs in all patients
Worldwide, the majority of patients infected with the pandemic virus continue to experience mild symptoms and recover fully within a week, even in the absence of any medical treatment. Monitoring of viruses from multiple outbreaks has detected no evidence of change in the ability of the virus to spread or to cause severe illness.
In addition to the enhanced risk documented in pregnant women, groups at increased risk of severe or fatal illness include people with underlying medical conditions, most notably chronic lung disease (including asthma), cardiovascular disease, diabetes, and immunosuppression. Some preliminary studies suggest that obesity, and especially extreme obesity, may be a risk factor for more severe disease.
Within this largely reassuring picture, a small number of otherwise healthy people, usually under the age of 50 years, experience very rapid progression to severe and often fatal illness, characterized by severe pneumonia that destroys the lung tissue, and the failure of multiple organs. No factors that can predict this pattern of severe disease have yet been identified, though studies are under way.
Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:
shortness of breath, either during physical activity or while resting
difficulty in breathing
turning blue
bloody or coloured sputum
chest pain
altered mental status
high fever that persists beyond 3 days
low blood pressure.
In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.

Preliminary information important for understanding the evolving situation

The number of human cases of pandemic (H1N1) 2009 is still increasing substantially in many countries, even in countries that have already been affected for some time.
Our understanding of the disease continues to evolve as new countries become affected, as community-level spread extends in already affected countries, and as information is shared globally. Many countries with widespread community transmission have moved to testing only samples of ill persons and have shifted surveillance efforts to monitoring and reporting of trends. This shift has been recommended by WHO, because as the pandemic progresses, monitoring trends in disease activity can be done better by following trends in illness cases rather than trying to test all ill persons, which can severely stress national resources. It remains a top priority to determine which groups of people are at highest risk of serious disease so steps to best to protect them can be taken.
In addition to surveillance information, WHO is relying on the results of special research and clinical studies and other data provided by countries directly through frequent expert teleconferences on clinical, virological and epidemiological aspects of the pandemic, to gain a global overview of the evolving situation.

Average age of cases increasing
In most countries the majority of pandemic (H1N1) 2009 cases are still occurring in younger people, with the median age reported to be 12 to 17 years (based on data from Canada, Chile, Japan, UK and the United States of America). Some reports suggest that persons requiring hospitalization and patients with fatal illness may be slightly older.
As the disease expands broadly into communities, the average age of the cases is appearing to increase slightly. This may reflect the situation in many countries where the earliest cases often occurred as school outbreaks but later cases were occurring in the community. Some of the pandemic disease patterns differ from seasonal influenza, where fatal disease occurs most often in the elderly (>65 years old). However, the full picture of the pandemic's epidemiology is not yet fully clear because in many countries, seasonal influenza viruses and pandemic (H1N1) 2009 viruses are both circulating and the pandemic remains relatively early in its development.
Although the risk factors for serious pandemic disease are not know definitively, risk factors such as existing cardiovascular disease, respiratory disease, diabetes and cancer currently are considered risk factors for serious pandemic (H1N1) 2009 disease. Asthma and other forms of respiratory disease have been consistently reported as underlying conditions associated with an augmented risk of severe pandemic disease in several countries.
A recent report suggests obesity may be another risk factor for severe disease. Similarly, there is accumulating evidence suggesting pregnant women are at higher risk for more severe disease. A few preliminary reports also suggest increased risk of severe disease may be elevated in some minority populations, but the potential contributions of cultural, economic and social risk factors are not clear.

Vaccine situation
The development of new candidate vaccine viruses by the WHO network is continuing to improve yields (currently 25% to 50 % of the normal yields for seasonal influenza for some manufacturers). WHO will be able to revise its estimate of pandemic vaccine supply once it has the new yield information. Other important information will also be provided by results of ongoing and soon-to be-initiated vaccine clinical trials. These trials will give a better idea of the number of doses required for a person to be immunized, as well as of the quantity on active principle (antigen) needed in each vaccine dose.
Manufacturers are expected to have vaccines for use around September. A number of companies are working on the pandemic vaccine production and have different timelines.

CENTERS FOR DISEASE CONTROL AND PREVENTION(CDC)

Disease Characteristics
When the novel H1N1 flu outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the novel H1N1 outbreak. On July 24, 2009 official reporting of individual cases of confirmed and probable novel H1N1 infection was discontinued.
This situation report provides an update to the international situation as of August 14, 2009. World Health Organization (WHO) regions have reported 177,457 laboratory-confirmed cases of novel 2009-H1N1 influenza virus (new H1N1) with 1,462 deaths. The laboratory-confirmed cases represent an underestimation of total cases in the world as many countries have shifted to strategies of clinical confirmation and prioritization of laboratory testing for only persons with severe illness and/or high risk conditions. The new H1N1 influenza virus is the dominant influenza virus in circulation in the world. According to a WHO Global Influenza Surveillance Network (GISN) report dated August 4th, 71% of all influenza viruses currently detected globally are the new H1N1. The new H1N1 accounts for 66% of influenza viruses in the Northern Hemisphere and 89% of influenza viruses in the Southern Hemisphere. There are indications that disease may be decreasing in South America and part of Australia. Disease associated with new H1N1 influenza is continuing to increase in southern Africa.
Selected Highlights
The new H1N1 influenza virus is the predominate influenza virus in circulation worldwide.
The epidemiology of the disease caused by the novel 2009-H1N1 influenza virus in the Southern Hemisphere is very similar to that described in the United States this past spring.
Isolates sequenced at WHO and CDC suggest that circulating novel 2009-H1N1 influenza viruses look similar to A/California/07/2009 (the reference virus selected by WHO as a potential candidate for the new H1N1 vaccine).

H1N1 Flu (Swine Flu): General Information
H1N1 Flu & YouWhat is novel H1N1 flu?
What To Do if You Get Flu-Like Symptoms
Antiviral Drugs
Taking Care of a Sick Person in Your Home
Novel H1N1 Vaccine: Q & A
Facemask & Respirators

Vaccination Recommendations
With the new H1N1 virus continuing to cause illness, hospitalizations and deaths in the US during the normally flu-free summer months and some uncertainty and about what the upcoming flu season might bring, CDC's Advisory Committee on Immunization Practices has taken an important step in preparations for a voluntary novel H1N1 vaccination effort to counter a possibly severe upcoming flu season. On July 29, ACIP met to consider who should receive novel H1N1 vaccine when it becomes available

Novel H1N1 Flu: Background on the Situation

A Pandemic Is Declared
On June 11, 2009, the World Health Organization (WHO) signaled that a global pandemic of novel influenza A (H1N1) was underway by raising the worldwide pandemic alert level to Phase 6. This action was a reflection of the spread of the new H1N1 virus, not the severity of illness caused by the virus. At the time, more than 70 countries had reported cases of novel influenza A (H1N1) infection and there were ongoing community level outbreaks of novel H1N1 in multiple parts of the world.
Since the WHO declaration of a pandemic, the new H1N1 virus has continued to spread, with the number of countries reporting cases of novel H1N1 nearly doubling. The Southern Hemisphere’s regular influenza season has begun and countries there are reporting that the new H1N1 virus is spreading and causing illness along with regular seasonal influenza viruses. In the United States, significant novel H1N1 illness has continued into the summer, with localized and in some cases intense outbreaks occurring. The United States continues to report the largest number of novel H1N1 cases of any country worldwide, however, most people who have become ill have recovered without requiring medical treatment.
Given ongoing novel H1N1 activity to date, CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this pandemic in the United States over the summer and into the fall and winter. The novel H1N1 virus, in conjunction with regular seasonal influenza viruses, poses the potential to cause significant illness with associated hospitalizations and deaths during the U.S. influenza season.
A Virus Emerges
Novel influenza A (H1N1) is a new flu virus of swine origin that first caused illness in Mexico and the United States in March and April, 2009. It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects and then touching your nose or mouth. Novel H1N1 infection has been reported to cause a wide range of flu-like symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, many people also have reported nausea, vomiting and/or diarrhea.
The first novel H1N1 patient in the United States was confirmed by laboratory testing at CDC on April 15, 2009. The second patient was confirmed on April 17, 2009. It was quickly determined that the virus was spreading from person-to-person. On April 22, CDC activated its Emergency Operations Center to better coordinate the public health response. On April 26, 2009, the United States Government declared a public health emergency and has been actively and aggressively implementing the nation’s pandemic response plan
By June 19, 2009, all 50 states in the United States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands have reported novel H1N1 infection. While nationwide U.S. influenza surveillance systems indicate that overall influenza activity is decreasing in the country at this time, novel H1N1 outbreaks are ongoing in parts of the U.S., in some cases with intense activity.
CDC is continuing to watch the situation carefully, to support the public health response and to gather information about this virus and its characteristics. The Southern Hemisphere is just beginning its influenza season and the experience there may provide valuable clues about what may occur in the Northern Hemisphere this fall and winter

Novel H1N1 Flu (Swine Flu) and You

Are there human infections with novel H1N1 virus in the U.S.?

Yes. Human infections with the new H1N1 virus are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment. CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.

Is novel H1N1 virus contagious?CDC has determined that novel H1N1 virus is contagious and is spreading from human to human.

How does novel H1N1 virus spread? Spread of novel H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.

What are the signs and symptoms of this virus in people?The symptoms of novel H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Severe illnesses and death has occurred as a result of illness associated with this virus.

How severe is illness associated with novel H1N1 flu virus?Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.
In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this novel H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.
One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of novel H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to novel H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against novel H1N1 flu by any existing antibody.

How does novel H1N1 flu compare to seasonal flu in terms of its severity and infection rates?With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.
When the novel H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the novel H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that novel H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this novel H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.

How long can an infected person spread this virus to others?People infected with seasonal and novel H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

Prevention & Treatment

What can I do to protect myself from getting sick?

There is no vaccine available right now to protect against novel H1N1 virus. However, a novel H1N1 vaccine is currently in production and may be ready for the public in the fall. As always, a vaccine will be available to protect against seasonal influenza There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

Take these everyday steps to protect your health:

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, especially after you cough or sneeze. Alcohol-based hand cleaners* are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.

Other important actions that you can take are:
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs,* tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious

What is the best way to keep from spreading the virus through coughing or sneezing?If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

If I have a family member at home who is sick with novel H1N1 flu, should I go to work?Employees who are well but who have an ill family member at home with novel H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners are also effective.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.

What is the best technique for washing my hands to avoid getting the flu?Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner*. CDC recommends that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. 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.

What should I do if I get sick?

If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.
If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.
If you become ill and experience any of the following warning signs, seek emergency medical care.

In children, emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing
Bluish or gray skin color
Not drinking enough fluids
Severe or persistent vomiting
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
Flu-like symptoms improve but then return with fever and worse cough

Are there medicines to treat novel H1N1 infection?Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with novel H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs during is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.

What is CDC’s recommendation regarding "swine flu parties"?"Swine flu parties" are gatherings during which people have close contact with a person who has novel H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity novel H1N1 flu virus that might circulate later and cause more severe disease.
CDC does not recommend "swine flu parties" as a way to protect against novel H1N1 flu in the future. While the disease seen in the current novel H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.
CDC recommends that people with novel H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.

CONTAMINATION & CLEANING

How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.
What kills influenza virus?

Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.
*What if soap and water are not available and alcohol-based products are not allowed in my facility?

Though the scientific evidence is not as extensive as that on hand washing and alcohol-based sanitizers, other hand sanitizers that do not contain alcohol may be useful for killing flu germs on hands.
What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.
How should waste disposal be handled to prevent the spread of influenza virus?

To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
What household cleaning should be done to prevent the spread of influenza virus?

To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
How should linens, eating utensils and dishes of persons infected with influenza virus be handled?

Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.
Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Exposures Not Thought to Spread Novel H1N1 Flu

Can I get infected with novel H1N1 virus from eating or preparing pork?

No. Novel H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.
Is there a risk from drinking water?

Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.
Can novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of novel H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as novel H1N1 virus would also be similarly disinfected by chlorine.

Can novel H1N1 influenza virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of this novel H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Note: Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to novel H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available.
For general information about influenza in pigs (not novel H1N1 flu) see Background Information on Influenza in Pigs.
Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

What to Do If You Get Flu-Like Symptoms

Background
The novel H1N1 flu virus is causing illness in infected persons in the United States and countries around the world. CDC expects that illnesses may continue for some time. As a result, you or people around you may become ill. If so, you need to recognize the symptoms and know what to do.
Symptoms
The symptoms of novel H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with novel H1N1 flu virus also have reported diarrhea and vomiting. The high risk groups for novel H1N1 flu are not known at this time, but it’s possible that they may be the same as for seasonal influenza. People at higher risk of serious complications from seasonal flu include people age 65 years and older, children younger than 5 years old, pregnant women, people of any age with chronic medical conditions (such as asthma, diabetes, or heart disease), and people who are immunosuppressed (e.g., taking immunosuppressive medications, infected with HIV).
Avoid Contact With Others
If you are sick, you may be ill for a week or longer. You should stay home and keep away from others as much as possible, including avoiding travel and not going to work or school, for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of fever-reducing medicine.) If you leave the house to seek medical care, wear a facemask, if available and tolerable, and cover your coughs and sneezes with a tissue. In general, you should avoid contact with other people as much as possible to keep from spreading your illness, especially people at increased risk of severe illness from influenza. With seasonal flu, people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. People infected with the novel H1N1 are likely to have similar patterns of infectiousness as with seasonal flu.
Treatment is Available for Those Who Are Seriously III
It is expected that most people will recover without needing medical care.
If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed. Be aware that if the flu becomes widespread, less testing will be needed, so your health care provider may decide not to test for the flu virus.
Antiviral drugs can be given to treat those who become severely ill with influenza. These antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including novel H1N1 flu virus. These medications must be prescribed by a health care professional.
There are two influenza antiviral medications that are recommended for use against novel H1N1 flu. The drugs that are used for treating novel H1N1 flu are called oseltamivir (trade name Tamiflu ®) and zanamivir (Relenza ®). As the novel H1N1 flu spreads, these antiviral drugs may become in short supply. Therefore, the drugs may be given first to those people who have been hospitalized or are at high risk of severe illness from flu. The drugs work best if given within 2 days of becoming ill, but may be given later if illness is severe or for those at a high risk for complications.
Aspirin or aspirin-containing products (e.g., bismuth subsalicylate – Pepto Bismol) should not be administered to any confirmed or suspected ill case of novel influenza A (H1N1) virus infection aged 18 years old and younger due to the risk of Reye’s syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs. For more information about Reye’s syndrome, visit the National Institute of Health website.
Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.
Children 5 years of age and older and teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms.
Children younger than 4 years of age should NOT be given over-the-counter cold medications without first speaking with a health care provider.

Emergency Warning Signs
If you become ill and experience any of the following warning signs, seek emergency medical care.
In children, emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing
Bluish or gray skin color
Not drinking enough fluids
Severe or persistent vomiting
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
Flu-like symptoms improve but then return with fever and worse cough

Protect Yourself, Your Family, and Community
Stay informed. Health officials will provide additional information as it becomes available. Visit the CDC H1N1 Flu website.
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, especially after you cough or sneeze. Alcohol-based hand cleaners* are also effective.

Avoid touching your eyes, nose and mouth. Germs spread this way.
Try to avoid close contact with sick people.
If you are sick with a flu-like illness, stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of fever-reducing medicine.) Keep away from others as much as possible. This is to keep from making others sick.
If you are sick and sharing a common space with other household members in your home, wear a facemask, if available and tolerable, to help prevent spreading the virus to others. For more information, see the Interim Recommendations for Facemask and Respirator Use.
Learn more about how to take care of someone who is ill in "Taking Care of a Sick Person in Your Home"
Follow public health advice regarding school closures, avoiding crowds, and other social distancing measures.
If you don’t have one yet, consider developing a family emergency plan as a precaution. This should include storing a supply of extra food, medicines, and other essential supplies. Further information can be found in the "Flu Planning Checklist"

Antiviral Drugs and H1N1 Flu (Swine Flu)

Antiviral Drugs
Antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including swine influenza viruses. Antiviral drugs can be used to treat swine flu or to prevent infection with swine flu viruses. These medications must be prescribed by a health care professional. Influenza antiviral drugs only work against influenza viruses -- they will not help treat or prevent symptoms caused by infection from other viruses that can cause symptoms similar to the flu.
There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir, amantadine and rimantadine). The swine influenza A (H1N1) viruses that have been detected in humans in the United States and Mexico are resistant to amantadine and rimantadine so these drugs will not work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1) viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir.

Benefits of Antiviral Drugs
Treatment: If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. Influenza antiviral drugs work best when started soon after illness onset (within two [2] days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.
Prevention: Influenza antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with swine influenza. When used to prevent the flu, antiviral drugs are about 70% to 90% effective. When used for prevention, the number of days that they should be used will vary depending on a person’s particular situation.

CDC Recommendation
CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.
Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent influenza A and B virus infection in people one year of age and older.
Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older.
Recommendations for using antiviral drugs for treatment or prevention of swine influenza will change as we learn more about this new virus.
Clinicians should consider treating any person with confirmed or suspected swine influenza with an antiviral drug. Visit: Interim Guidance on Antiviral Recommendations

Interim Guidance for Novel H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home

This document has been updated in accordance with the CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others . This document provides interim guidance and will be updated as needed.
Novel H1N1 flu virus infection (formerly known as swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with novel H1N1 flu. Like seasonal flu, novel H1N1 flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with novel H1N1 flu infection. Certain groups might be more likely to develop a severe illness from novel H1N1 flu infection, such as pregnant women and persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.
The following information can help you provide safer care at home for sick persons during a flu outbreak or flu pandemic.

The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.
People with novel H1N1 flu who are cared for at home should:
check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
check with their health care provider about whether they should take antiviral medications
keep away from others as much as possible. This is to keep from making others sick. Do not go to work or school while ill
stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.)
get plenty of rest
drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands
wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza. For more information, see the Interim Recommendations for Facemask and Respirator Use
be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention.

Medications to Help Lessen Symptoms of the Flu

Check with your healthcare provider or pharmacist for correct, safe use of medications
Antiviral medications can sometimes help lessen influenza symptoms, but require a prescription. Most people do not need these antiviral drugs to fully recover from the flu. However, persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization, might benefit from antiviral medications. Antiviral medications are available for persons 1 year of age and older. Ask your health care provider whether you need antiviral medication.
Influenza infections can lead to or occur with bacterial infections. Therefore, some people will also need to take antibiotics. More severe or prolonged illness or illness that seems to get better, but then gets worse again may be an indication that a person has a bacterial infection. Check with your health care provider if you have concerns.
Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome. For more information about Reye’s syndrome, visit the National Institute of Health website .
Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.
Children 5 years of age and older and teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms.
Children younger than 4 years of age should NOT be given over-the-counter cold medications without first speaking with a health care provider.
The safest care for flu symptoms in children younger than 2 years of age is using a cool-mist humidifier and a suction bulb to help clear away mucus.
Fevers and aches can be treated with acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®, Nuprin®) or nonsteroidal anti-inflammatory drugs (NSAIDS). Examples of these kinds of medications include:
Generic Name
Brand Name(s)
Acetaminophen
Tylenol®
Ibuprofen
Advil®, Motrin®, Nuprin®
Naproxen
Aleve
Over-the-counter cold and flu medications used according to the package instructions may help lessen some symptoms such as cough and congestion. Importantly, these medications will not lessen how infectious a person is.
Check the ingredients on the package label to see if the medication already contains acetaminophen or ibuprofen before taking additional doses of these medications—don’t double dose! Patients with kidney disease or stomach problems should check with their health care provider before taking any NSAIDS.
Check with your health care provider or pharmacist if you are taking other over-the-counter or prescription medications not related to the flu. For more information on products for treating flu symptoms, see the FDA website.

When to Seek Emergency Medical Care
Get medical care right away if the sick person at home:
has difficulty breathing or chest pain
has purple or blue discoloration of the lips
is vomiting and unable to keep liquids down
has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
has seizures (for example, uncontrolled convulsions)
is less responsive than normal or becomes confused

Steps to Lessen the Spread of Flu in the Home

When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to:
keep the sick person away from other people as much as possible (see “placement of the sick person”) especially others who are at high risk for complications from influenza
remind the sick person to cover their coughs, and clean their hands with soap and water or an alcohol-based hand rub often, especially after coughing and/or sneezing
have everyone in the household clean their hands often, using soap and water or an alcohol-based hand rub. Children may need reminders or help keeping their hands clean
ask your health care provider if household contacts of the sick person—particularly those contacts who may be pregnant or have chronic health conditions—should take antiviral medications such as oseltamivir (Tamiflu®) or zanamivir (Relenza®) to prevent the flu
If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. Infants should not be cared for by sick family members. For more information, see the Interim Recommendations for Facemask and Respirator Use
Placement of the sick person
Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed.
Unless necessary for medical care or other necessities, people who are sick with an influenza-like-illness should stay home and keep away from others as much as possible, including avoiding travel, for at least 24 hours after fever is gone except to get medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine). This is to keep from making others sick. Children, especially younger children, might potentially be contagious for longer periods.
If persons with the flu need to leave the home (for example, for medical care), they should wear a facemask, if available and tolerable, and cover their nose and mouth when coughing or sneezing
Have the sick person wear a facemask – if available and tolerable – if they need to be in a common area of the house near other persons.
If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant (see below).

Protect other persons in the home
The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
If possible, have only one adult in the home take care of the sick person. People at increased risk of severe illness from flu should not be the designated caretaker, if possible.
If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use.
Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of influenza-related complications and immunity can be suppressed during pregnancy).
Avoid having sick family members care for infants and other groups at high risk for complications of influenza.
All persons in the household should clean their hands with soap and water or an alcohol-based hand rub frequently, including after every contact with the sick person or the person’s room or bathroom.
Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
Antiviral medications can be used to prevent the flu, so check with your health care provider to see if some persons in the home should use antiviral medications.
If you are the caregiver
Avoid being face-to-face with the sick person.
When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
Clean your hands with soap and water or use an alcohol-based hand rub after you touch the sick person or handle used tissues, or laundry.
Talk to your health care provider about taking antiviral medication to prevent the caregiver from getting the flu.
If you are at high risk of influenza associated complications, you should not be the designated caretaker, if possible.
If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. Designate a person who is not at high risk of flu associated complications as the primary caretaker of household members who are sick with influenza, if at all possible. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use
Monitor yourself and household members for flu symptoms and contact a telephone hotline or health care provider if symptoms occur.

Using Facemasks or Respirators
Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask) or N95 disposable respirator.
An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods of time. More information on facemasks and respirators can be found at H1N1 Flu (Swine Flu) website.
Facemasks and respirators may be purchased at a pharmacy, building supply or hardware store.
Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor. Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they don’t touch anything else.
Avoid re-using disposable facemasks and N95 respirators, if possible. If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.
For more information, see the Interim Recommendations for Facemask and Respirator Use