Swine Flu: The Facts about the H1N1 virus
Swine Flu Facts For
There is a great deal of speculation going on at the moment about SWINE FLU, so I thought it might be useful for hub-pages visitors and readers to have a factual hub where all their questions can be answered in one place.
In the USA, the Center for Disease Control and Prevention is being cautious - no doubt in an endeavour to prevent some kind of mass panic amongst the population (when will governments and quangos learn that most voters are grown-ups who are perfectly capable of rational thought?). The Centers for Disease Control and Prevention website says (6th July 2009):
CDC is still learning about the severity of novel H1N1 flu virus. At this time, there is not enough information to predict how severe novel H1N1 flu outbreak will be in terms of illness and death or how it will compare with seasonal influenza.
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.
So far, with novel H1N1 flu, the largest number of novel H1N1 flu confirmed and probable cases have occurred in people between the ages of 5 and 24-years-old. At this time, there are few cases and no 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.
In Britain, things appear to be stated somewhat more factually with less “spin”. For example, the National Health Service website says (6th July 2009):
There have been 7,447 cases confirmed in the UK since the outbreak started two months ago. Of these, over 100 have involved hospitalisation, and four people have died as a result of complications associated with swine flu.
"Cases are doubling every week and, on this trend, we could see over 100,000 cases per day by the end of August" said Andy Burnham, Health Secretary.
So what exactly is the so-called “swine flu” and how can it be contained and treated? What follows is the information and advice given by Britain's National Health Service on their website at: http://www.nhs.uk/Conditions/Pandemic-flu/
What is swine flu?
Swine influenza is a disease in pigs. The virus currently transmitting among people is now generally referred to as swine flu, although the origin of the disease is still under investigation. There is no evidence of this strain of the disease circulating in pigs in the UK.
There are regular outbreaks of swine influenza in pigs worldwide. It does not normally infect humans, although this occasionally does occur - usually in people who have had close contact with pigs.
Swine influenza viruses are usually of the H1N1 subtype. The swine flu that has spread to humans is a version of this virus.
Why is swine flu affecting humans?
Because the swine flu virus has mutated (changed) and is now able to infect humans and transmit between them.
Which people are most vulnerable from swine flu?
Those who are more at risk from becoming seriously ill with swine flu are:
people with chronic lung disease,
people with chronic heart disease,
people with chronic kidney disease,
people with chronic liver disease,
people with chronic neurological disease,
people with suppressed immune systems (whether caused by disease or treatment),
people with diabetes,
people who have had drug treatment for their asthma within the past three years,
pregnant women,
people aged 65 years and older, and
young children under five years old.
How is swine flu infection diagnosed?
Diagnosis of swine flu is now based on an assessment of the person's symptoms, rather than having to wait for a swab test result. Health professionals will continue to test some patients to ensure they keep getting up-to-date information about the virus.
Is the new swine flu virus contagious?
The Health Protection Agency (HPA) says the new swine flu virus is highly contagious and is spreading from person to person.
Swine flu spreads in the same way as ordinary colds and flu. The virus is spread through the droplets that come out of the nose or mouth when someone coughs or sneezes.
If someone coughs or sneezes and they do not cover it, those droplets can spread about one metre (3ft). If you are very close to the person you might breathe them in.
Or, if someone coughs or sneezes into their hand, those droplets and the virus within them are easily transferred to surfaces that the person touches, such as door handles, hand rails, telephones and keyboards. If you touch these surfaces and touch your face, the virus can enter your system, and you can become infected.
How long does the virus live on surfaces?
The flu virus can live on a hard surface for up to 24 hours, and a soft surface for around 20 minutes.
What is the incubation period for swine flu?
According to the Health Protection Agency, the incubation period for swine flu (time between infection and appearance of symptoms) can be up to seven days, but is most likely to be between two and five days. It is, however, too early to be able to provide details on virus characteristics, including incubation period, with absolute certainty at this time.
When are people most infectious?
People are most infectious to others soon after they develop symptoms, although they continue to shed the virus (for example, in coughs and sneezes) for up to five days (seven days in children). People become less infectious as their symptoms subside, and once their symptoms are gone, they are no longer considered infectious to others.
How quickly is swine flu spreading?
Swine flu is now widespread in the UK and spreading rapidly. The number of new cases in the UK is doubling every seven days. Most of these are because people are catching swine flu in their local community and not as the result of foreign travel.
Should I avoid contact with people suspected of having swine flu?
All suspected cases who have swine flu symptoms will have been asked to self-isolate at home and restrict their contact with people. The vast majority of people should go about their normal activities, including going to school or work. This includes children who attend a school with a confirmed case of swine flu.
There is no need on risk grounds to avoid contact with people who might simply have come into contact with those having the illness, such as the parents of children at schools with a confirmed case but who are not themselves ill.
How dangerous is it?
It is difficult to judge this at the moment. While there have been deaths in Mexico and a small number outside of Mexico, including the UK, symptoms exhibited by most infected people have not been severe.
It appears that early doses of antiviral medicines such as Tamiflu are effective in helping people to recover. In the UK we have enough antivirals to treat half the population if they were to become ill. Also, orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.
What are the symptoms of swine flu?
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal flu and include fever, fatigue, lack of appetite and coughing. Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea.
How long are symptoms expected to last?
As with any sort of influenza, the severity and duration of symptoms will vary depending on treatment and individual circumstances. Most cases reported in the UK to date have been relatively mild, with those affected starting to recover within a week.
How does swine flu cause death?
Like any other type of flu, people can die from swine flu if they develop complications, like pneumonia.
Has the swine flu virus developed resistance to Tamiflu?
Not at the moment. Routine sampling of the virus in the UK has shown that there is currently no resistance to either Tamiflu or Relenza.
One flu H1N1 virus strain showing Tamiflu resistance was reported in a patient in Denmark who had received treatment - however, Tamiflu resistance in individual patients does occur in a low percentage of cases and is of limited public significance. The Health Protection Agency is monitoring whether such viruses are being transmitted from person to person.
Will the swine flu virus become resistant to antivirals in the future?
It is possible. The virus may mutate (change) and become less susceptible or resistant to the antiviral drug, and then spread from person to person. If the virus does develop resistance, it’s more likely to be to Tamiflu, the main antiviral treatment. If this happens, the government has a stockpile of Relenza that could be used instead.
Should we expect a more severe second wave of the pandemic in the winter?
Features of previous flu pandemics suggest that the current viral strain will become even more widespread in the autumn or winter, causing more illness and death. It is possible that the virus will mutate (change) into a more potent strain.
Is it possible to catch swine flu twice?
Yes, because the virus can mutate (change). If you become infected with the swine flu virus, your body produces antibodies against it, which will recognise and fight off the virus if the body ever encounters it again. However, if the virus mutates, your immune system may not recognise this different strain and you may become ill again, although you may have some 'cross protection' due to encountering a similar virus previously.
Should I have a 'swine flu party' or try and catch swine flu now, so I will be immune to more serious strains that may emerge later?
No – it is irresponsible to purposefully catch the virus as you may perpetuate the spread. Also, as we don't yet know the profile of the virus, it is too soon to assume it is only a mild infection. And catching swine flu will not necessarily protect you from strains that may emerge later.
What can I do?
You can reduce, but not eliminate, the risk of catching or spreading swine flu by:
Always covering your nose and mouth with a tissue when coughing or sneezing.
Disposing of dirty tissues promptly and carefully.
Maintaining good basic hygiene, for example washing hands frequently with soap and warm water to reduce the spread of the virus from your hands to face, or to other people.
Cleaning hard surfaces, such as door handles, frequently using a normal cleaning product.
You should also prepare now by:
Confirming a network of ‘flu friends’ – friends and relatives – who could help you if you fall ill. They could collect medicines and other supplies for you so you do not have to leave home and possibly spread the virus.
Knowing your NHS number and those of other family members and keeping them in a safe place. It is not essential to have your NHS number in order to receive treatment, but it can help NHS staff to find your health records. You will be able to find your NHS Number on your medical card or other items such as prescribed medication, GP letter or hospital appointment card/letter.
Making sure you have adequate quantities of cold and cough remedies in your medicine cupboard in case you or your family are affected by swine flu.
Who should be wearing a facemask?
The Health Protection Agency (HPA) recommends that healthcare workers should wear a facemask if they come into close contact with a person with symptoms (within one metre) to reduce their risk of catching the virus from patients.
However, the HPA does not recommend that healthy people wear facemasks to go about their everyday business.
Why shouldn't the general public wear facemasks?
Because there’s no conclusive evidence that facemasks will protect healthy people in their day-to-day lives.
The virus is spread by picking up the virus from touching infected surfaces, or by someone coughing or sneezing at very close range – so unless you are standing close to someone with the virus, wearing a facemask will not make a difference.
There are concerns about the risks posed by not using facemasks correctly.
Facemasks must be changed regularly as they are less effective when dampened by a person’s breath. People may infect themselves if they touch the outer surface of their mask, or may infect others by not disposing of old masks safely.
Finally, wearing a facemask may encourage complacency. People need to focus on good hand hygiene, staying at home if they are feeling unwell, and covering their mouth when they cough or sneeze.
So why have other countries gone down this route?
This is an issue which each government has considered separately. France is encouraging the general public to buy their own masks for use as a precaution, but it is not stockpiling masks centrally from government funds and neither is the US.
In other countries there is an existing culture of wearing facemasks for either the prevention of spreading illness or preventing the risks of pollution; this is not the case in the UK.
What should I do if I think I’m infected?
If you have flu-like symptoms, stay at home and call your GP, who will assess you over the phone. If your GP confirms swine flu, they will give you a voucher reference number which your healthy relative or friend can use to pick up antivirals from your local collection centre - normally a pharmacy or community centre.
In the meantime, take paracetamol-based cold remedies to reduce fever and other symptoms, drink plenty of fluids and get lots of rest.
Do not go into your GP surgery, or to a hospital, as you may spread the disease to others. Ask your 'flu friend' to go out for you.
If I have been in close contact with an infected person, do I need treatment?
You only need antiviral treatment if you have been diagnosed with swine flu and your doctor decides it is necessary, or if a doctor decides that you are at serious risk of developing severe illness.
The government is no longer trying to contain the virus because it is now widespread in the UK. It is not effective to give antivirals to people who are not ill, as they will be repeatedly exposed to the virus in the community.
Is swine flu treatable?
Testing has shown that the swine flu can be treated with the antiviral medicines oseltamavir (brand name Tamiflu) and zanamivir (Relenza). However, the drugs must be administered at an early stage to be effective.
The UK already has a stockpile of antivirals sufficient to treat half the population. Also, orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.
What do antivirals do?
Antivirals are not a cure, but they help you to recover by:
relieving some of the symptoms,
reducing the length of time you are ill by around one day, and
reducing the potential for serious complications, such as pneumonia.
How large is the UK's stockpile of antivirals?
The government has 23 million treatments of Tamiflu and 10.5 million treatments of Relenza. Orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.
Is one of the antivirals more appropriate for pregnant women and people with certain kidney conditions?
Relenza is an inhaled drug that will be used for pregnant women and people with certain kidney conditions who are unable to take Tamiflu.
Will antivirals be given to people without flu symptoms?
In most cases, no - the virus is now widespread and it is no longer appropriate to try and contain the spread of the disease. Antivirals will generally only be given, at a doctor's discretion, to people who have been diagnosed with swine flu.
Doctors should not offer antiviral medication as prophylaxis (prevention) to contacts of cases unless, for example, a household member has serious underlying health problems or there are other special circumstances.
Will my child experience nausea if they take Tamiflu?
As is the case with many medicines, nausea is a known side effect of Tamiflu, in a small number of cases. Symptoms may lessen over the course of the treatment. It may help to take Tamiflu either with or immediately after food, and drinking some water may also lessen any feelings of nausea.
How are those with confirmed swine flu getting access to antivirals?
If antivirals are required, the person's GP will give them a voucher reference number over the phone.
A healthy friend or relative can then use this to pick up antivirals from the person's local collection centre - usually a pharmacy or community centre.
Should people be stockpiling their own antivirals?
No. The government has a stockpile of antivirals sufficient to treat half the population, and is taking steps to increase this to cover 80% as an extra precaution. Therefore, antivirals should be available for everyone who gets ill in the pandemic and there is no need for people to buy their own.
Does Tamiflu go out of date?
The government has a programme to replace any expired doses under a 'rolling stock' system.
If I take an antiviral and have side effects, whom should I inform?
The Medicines and Healthcare products Regulatory Agency (MHRA) and the Commission on Human Medicines run the UK's suspected adverse drug reaction reporting scheme - called the Yellow Card Scheme. This receives reports of suspected adverse drug reactions from healthcare professionals, and was recently extended to include direct reporting by patients. People can report any suspected adverse effects on-line by going to http://yellowcard.mhra.gov.uk.
Is there a vaccine?
No, not at the moment. Influenza viruses change very quickly. For a vaccine to provide adequate protection it needs to be adapted to the particular strain in circulation.
Scientists are making good progress in developing a new vaccine for swine flu and we are expecting the first batches of vaccines in August. Further stocks will arrive in the autumn, but it may well be next year before we can vaccinate everyone.
The government has ordered enough vaccines for the whole population, but to reduce the impact of swine flu, the NHS is focusing on those at the greatest risk first.
Why does it take several months to produce a swine flu vaccine?
The flu vaccine production process is long and complicated. Production technology is labour-intensive. The government's plans include two manufacturers, thus maximising chances of early development.
If other countries are also being given advance supply guarantees, will we get ours first?
The UK has a binding contractual agreement in place to ensure its supply.
Does the current seasonal flu vaccine work?
The current seasonal flu vaccine is designed to protect against H1N1, but it is unclear as yet whether this will offer any protection against the current strain of swine flu.
How many stocks are available of seasonal vaccine?
Flu vaccine is produced each year for the seasonal flu. Discussions are ongoing with manufacturers about how much may still be available. However, the government has determined that there are 430,000 doses of vaccine available in the UK.
Who will be a priority for vaccination with the H1N1 swine flu vaccine?
The Joint Committee on Vaccination and Immunisation has previously advised that the priority groups in relation to H5N1 (the bird flu vaccine) should be assumed to be:
frontline health and social care workers (to help ensure the NHS functions well),
older people and those in clinical risk groups, as flu can be more serious in these groups, and
under-16s, as protecting children can slow the spread of the virus in the population.
The priority groups would be reviewed in light of evidence on the virulence and severity of the new virus in different groups.
The government will still aim to achieve universal vaccination, but because the vaccine will have to be delivered over time, it is right that we start thinking now about groups to be prioritised.
Will the vaccine still provide people with protection if the swine flu virus mutates between now and the autumn?
At this stage, it is impossible to predict if or how the H1N1 swine flu virus will mutate (change). However, experiences with the H5N1 vaccine (bird flu vaccine) would suggest that an H1N1 vaccine (produced using the same processes) would also provide a high level of immunity against closely related strains. The level of cross-protection is expected to be greatest for more closely related strains.
Does the NHS have enough syringes to administer the swine flu vaccine?
Yes, orders have been placed to ensure there are enough syringes to administer the vaccine.
What extra antibiotics have been purchased?
Orders have been placed for 15.2m courses of antibiotics. They will play an important part in the response to the pandemic.
Why do you need antibiotics in a pandemic?
While antivirals may reduce the number of complications, there are still likely to be significant numbers of complications occurring in the pandemic. Some of the most common include bacterial infections in the respiratory tract and lungs, such as pneumonia. Antibiotics are needed to treat such complications.
Antibiotics will be used to treat people in the community if they develop complications. In hospitals, antibiotics will be used to treat the sickest patients and may reduce the length of hospitalisation.
Does swine flu pose special risks in pregnant women?
During pregnancy, you may have an increased risk of complications from any type of flu, especially in the second and third trimester.
Can I take antiviral drugs if I am pregnant?
Yes, on the advice of a doctor. The Department of Health has purchased Relenza, an inhaled antiviral drug that treats flu without reaching the developing fetus.
An expert group reviewed the risk of antiviral treatment in pregnancy, which is extremely small - much smaller than the risk posed by the symptoms of swine flu.
Will pregnant women get preference for a swine flu vaccine?
It will be months before a swine flu vaccine becomes available. When it is available, there will be guidelines on which groups of people are a greater priority for vaccination.
Should I stop breastfeeding if I need to take antiviral drugs?
Women who are breastfeeding should continue to do so while receiving antiviral treatment, as this is not contraindicated. If a mother is ill, she should continue breastfeeding and increase feeding frequency. If she becomes too ill to feed, then expressing milk may still be possible. Antiviral drugs are excreted into breast milk in very small (insignificant) amounts.
Can children take antivirals?
Yes, on the advice of a doctor. Tamiflu is safe for infants aged one and older, at a reduced dose. Relenza (an inhaler) can be used by children aged five and older under the supervision of an adult.
Can babies under the age of one take antivirals?
Tamiflu and Relenza are not licensed for use in babies under the age of one. However, after evaluating all the available evidence, the European Medicines Agency has advised that children under one may be treated with Tamiflu, considering that:
the appropriate dosage to treat children aged under one is 2-3mg/kg twice daily for five days,
children are preferably treated under medical supervision, and
dilution of the capsule content can be used to prepare the dose.
Post-exposure prophylaxis (prevention) of children aged under one should be very carefully considered. The appropriate dose for prevention should be 2-3mg/kg once a day for 10 days (but should not exceed 10 days).
I’m on immunosuppressants. Am I more at risk from swine flu?
Yes. If you take immunosuppressants you have a greater risk of becoming infected with any virus, including swine flu, and will be less able to fight it off once you have it.
Will my dose of immunosuppressants be altered in the event of an outbreak?
Your doctor may advise that your dose of immunosuppressants needs to change. The appropriate dose will vary from patient to patient.
Can I take antivirals if I’m on immunosuppressants?
Yes, on the advice of a doctor it is safe for you to take Tamiflu or Relenza.
Am I more at risk of catching swine flu if I have HIV?
Probably not. Although HIV infects CD4 cells and reduces their number and function, there are other parts of the immune system that are able to fight flu.
Am I more likely to suffer complications if I have HIV and catch swine flu?
If you have a low CD4 count (under 200), you may be more likely to suffer complications like pneumonia from any type of flu, including swine flu.
Can I take antivirals if I have mild to moderate kidney disease?
Yes. If you have stage 1 to 3 kidney disease, or your glomerular filtration rate (GFR) is above 30, you will be treated as any other person would be. This means you can take Relenza or Tamiflu, if necessary.
Can I take antivirals if I have severe kidney disease?
Yes. If you have stage 4 or 5 kidney disease, or your glomerular filtration rate (GFR) is below 30, you will probably be under the care of a kidney specialist. Relenza (an inhaler) is safe to take. If you find this tricky to use, your doctor may give you a reduced dose of Tamiflu tablets instead.
Will people with long-term conditions get preference for a swine flu vaccine?
It will be months before a swine flu vaccine becomes available. When it is available, there will be guidelines on which groups of people are a greater priority for vaccination.
Are people with asthma or chronic obstructive pulmonary disease (COPD) more at risk from swine flu?
You are no more likely to catch swine flu than anyone else. However, if you do catch a respiratory infection, including swine flu, it may add to the breathing difficulties you may have.
What advice is there for people with asthma or COPD?
Your condition places you at greater risk if you catch the disease. It is therefore all the more important that you follow good hygiene practices and react quickly if you develop flu-like symptoms.
Can I take antivirals if I have asthma or COPD?
Yes - Tamiflu is safe to take. However, Relenza (an inhaler) is usually not given to people with asthma as on rare occasions it can cause breathing complications.
I have diabetes. Am I at more at risk from swine flu?
You are no more likely to catch swine flu than anyone else. However, if you do catch it, your blood glucose may increase and your diabetes treatment may need to be adjusted accordingly.
What should I do if my blood glucose increases?
If you find your blood glucose has increased, or you develop thirst and are urinating more, call your GP. If you are on insulin and testing your own blood glucose, you may be advised to do this more often so you can adjust your dose according to the results. If you start to vomit or become increasingly unwell, call your GP as soon as possible.
Is there any advice for people with liver disease?
If you have liver disease you are no more likely to catch swine flu than anyone else. If you do catch it, antivirals are safe to take – there is no interaction between these and antivirals you may already be taking to treat hepatitis.
Can I take antivirals if I am on epilepsy treatment?
Yes. It is thought that antiviral treatments will not affect medicines taken to control epilepsy.
I look after someone who is very ill/disabled. What if I become too ill to care for them?
As a carer, you should probably begin planning for an emergency caring situation as soon as possible. The best way to get help with planning for a caring emergency is to arrange a carer's assessment from your local authority.
If you have time you may be able to arrange for formal respite care, but you may want to talk to friends, neighbours and relatives about forming a network of ‘flu friends’ who can help out and look after you if you are ill.
Are older people more likely to catch swine flu?
It is not yet known, but the vast majority of cases so far in the UK have been in those younger than 60. It is speculated that some older people may have partial resistance to the swine flu virus, due to being exposed to a similar flu virus in a previous pandemic.
Are older people more at risk of complications if they do catch it?
Older and frail people are more likely to develop complications from any type of flu, and are generally less able to fight it off.
What advice are you giving to travellers?
Before travelling, they should check the Foreign and Commonwealth Office (FCO) website for information specific to the country they are visiting.
What advice are you giving to people with flu who want to travel by plane?
The Health Protection Agency is advising anyone in the UK who is symptomatic not to travel until they are no longer infectious. Similarly, any British nationals abroad with flu who want to fly home should only travel when they are no longer infectious.
Is it safe to use public transport now we are in a pandemic?
Yes. Public transport has not been closed during previous pandemics, and while there is a small additional risk to the public, this is no greater than using other public places. Anyone who has the flu or feels unwell should stay at home and not travel.
What is the definition of WHO Phase 6?
The technical definition of Phase 6 is human-to-human spread of the virus into at least two countries in one World Health Organisation region, with community level outbreaks in at least one other country in a different WHO region.
Because the virus has been spreading for some time in North America, the decision that ‘community level outbreaks’ were occurring in other regions means that the criteria for Phase 6 have been fulfilled.
I am about to go on holiday to a country affected by swine flu - what should I do?
Make sure you consult the overseas travel advice on the Foreign & Commonwealth Office website, and take sensible precautions.
What should I do if I become ill on holiday or on the flight home?
If you experience flu-like symptoms during a stay in a country affected by swine flu, contact a health professional and tell them your symptoms.
If you become ill on your flight home, alert the cabin crew to your symptoms. There are procedures in place for dealing with passengers who become unwell on flights, and the airline will advise port health officials on the ground that a passenger requires a health assessment and may need treatment.
To access the Department of Health Swine Flu Information line when abroad, call 00 44 207 928 1010.
Is it a mild infection and therefore no cause for concern?
Don’t be complacent, as it is too soon to assume it will be a mild infection. We don’t know the profile of the virus and are closely monitoring each case that comes up. Everyone who has been infected with the virus in this country has so far been diagnosed early and treated with antivirals, which reduce the severity of symptoms.
The flu virus changes character very rapidly. It can pick up and swap genetic material, which can dramatically change its character, increasing the severity of symptoms. The virus could change in the autumn, so we need to plan for this.
Will hospital capacity be adequate?
Most flu sufferers can be cared for appropriately at home. The UK has well developed plans in place for managing extra demand on the healthcare system during the pandemic.
Is it safe to eat pig meat?
Yes. The WHO says there is no evidence that swine flu can be transmitted through eating meat from infected animals. However, it is essential to cook meat properly. A temperature of 70°C (158°F) would be sure to kill the virus. Pig meat includes pork, bacon, ham and pork products.
Note: The foregoing is copied straight from the NHS website and copyright is acknowledged. For the full text and associated links, please visit:
http://www.nhs.uk/Conditions/Pandemic-flu/
In the USA, the Center for Disease Control and Prevention is being cautious - no doubt in an endeavour to prevent some kind of mass panic amongst the population (when will governments and quangos learn that most voters are grown-ups who are perfectly capable of rational thought?). The Centers for Disease Control and Prevention website says (6th July 2009):
CDC is still learning about the severity of novel H1N1 flu virus. At this time, there is not enough information to predict how severe novel H1N1 flu outbreak will be in terms of illness and death or how it will compare with seasonal influenza.
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.
So far, with novel H1N1 flu, the largest number of novel H1N1 flu confirmed and probable cases have occurred in people between the ages of 5 and 24-years-old. At this time, there are few cases and no 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.
In Britain, things appear to be stated somewhat more factually with less “spin”. For example, the National Health Service website says (6th July 2009):
There have been 7,447 cases confirmed in the UK since the outbreak started two months ago. Of these, over 100 have involved hospitalisation, and four people have died as a result of complications associated with swine flu.
"Cases are doubling every week and, on this trend, we could see over 100,000 cases per day by the end of August" said Andy Burnham, Health Secretary.
So what exactly is the so-called “swine flu” and how can it be contained and treated? What follows is the information and advice given by Britain's National Health Service on their website at: http://www.nhs.uk/Conditions/Pandemic-flu/
What is swine flu?
Swine influenza is a disease in pigs. The virus currently transmitting among people is now generally referred to as swine flu, although the origin of the disease is still under investigation. There is no evidence of this strain of the disease circulating in pigs in the UK.
There are regular outbreaks of swine influenza in pigs worldwide. It does not normally infect humans, although this occasionally does occur - usually in people who have had close contact with pigs.
Swine influenza viruses are usually of the H1N1 subtype. The swine flu that has spread to humans is a version of this virus.
Why is swine flu affecting humans?
Because the swine flu virus has mutated (changed) and is now able to infect humans and transmit between them.
Which people are most vulnerable from swine flu?
Those who are more at risk from becoming seriously ill with swine flu are:
people with chronic lung disease,
people with chronic heart disease,
people with chronic kidney disease,
people with chronic liver disease,
people with chronic neurological disease,
people with suppressed immune systems (whether caused by disease or treatment),
people with diabetes,
people who have had drug treatment for their asthma within the past three years,
pregnant women,
people aged 65 years and older, and
young children under five years old.
How is swine flu infection diagnosed?
Diagnosis of swine flu is now based on an assessment of the person's symptoms, rather than having to wait for a swab test result. Health professionals will continue to test some patients to ensure they keep getting up-to-date information about the virus.
Is the new swine flu virus contagious?
The Health Protection Agency (HPA) says the new swine flu virus is highly contagious and is spreading from person to person.
Swine flu spreads in the same way as ordinary colds and flu. The virus is spread through the droplets that come out of the nose or mouth when someone coughs or sneezes.
If someone coughs or sneezes and they do not cover it, those droplets can spread about one metre (3ft). If you are very close to the person you might breathe them in.
Or, if someone coughs or sneezes into their hand, those droplets and the virus within them are easily transferred to surfaces that the person touches, such as door handles, hand rails, telephones and keyboards. If you touch these surfaces and touch your face, the virus can enter your system, and you can become infected.
How long does the virus live on surfaces?
The flu virus can live on a hard surface for up to 24 hours, and a soft surface for around 20 minutes.
What is the incubation period for swine flu?
According to the Health Protection Agency, the incubation period for swine flu (time between infection and appearance of symptoms) can be up to seven days, but is most likely to be between two and five days. It is, however, too early to be able to provide details on virus characteristics, including incubation period, with absolute certainty at this time.
When are people most infectious?
People are most infectious to others soon after they develop symptoms, although they continue to shed the virus (for example, in coughs and sneezes) for up to five days (seven days in children). People become less infectious as their symptoms subside, and once their symptoms are gone, they are no longer considered infectious to others.
How quickly is swine flu spreading?
Swine flu is now widespread in the UK and spreading rapidly. The number of new cases in the UK is doubling every seven days. Most of these are because people are catching swine flu in their local community and not as the result of foreign travel.
Should I avoid contact with people suspected of having swine flu?
All suspected cases who have swine flu symptoms will have been asked to self-isolate at home and restrict their contact with people. The vast majority of people should go about their normal activities, including going to school or work. This includes children who attend a school with a confirmed case of swine flu.
There is no need on risk grounds to avoid contact with people who might simply have come into contact with those having the illness, such as the parents of children at schools with a confirmed case but who are not themselves ill.
How dangerous is it?
It is difficult to judge this at the moment. While there have been deaths in Mexico and a small number outside of Mexico, including the UK, symptoms exhibited by most infected people have not been severe.
It appears that early doses of antiviral medicines such as Tamiflu are effective in helping people to recover. In the UK we have enough antivirals to treat half the population if they were to become ill. Also, orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.
What are the symptoms of swine flu?
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal flu and include fever, fatigue, lack of appetite and coughing. Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea.
How long are symptoms expected to last?
As with any sort of influenza, the severity and duration of symptoms will vary depending on treatment and individual circumstances. Most cases reported in the UK to date have been relatively mild, with those affected starting to recover within a week.
How does swine flu cause death?
Like any other type of flu, people can die from swine flu if they develop complications, like pneumonia.
Has the swine flu virus developed resistance to Tamiflu?
Not at the moment. Routine sampling of the virus in the UK has shown that there is currently no resistance to either Tamiflu or Relenza.
One flu H1N1 virus strain showing Tamiflu resistance was reported in a patient in Denmark who had received treatment - however, Tamiflu resistance in individual patients does occur in a low percentage of cases and is of limited public significance. The Health Protection Agency is monitoring whether such viruses are being transmitted from person to person.
Will the swine flu virus become resistant to antivirals in the future?
It is possible. The virus may mutate (change) and become less susceptible or resistant to the antiviral drug, and then spread from person to person. If the virus does develop resistance, it’s more likely to be to Tamiflu, the main antiviral treatment. If this happens, the government has a stockpile of Relenza that could be used instead.
Should we expect a more severe second wave of the pandemic in the winter?
Features of previous flu pandemics suggest that the current viral strain will become even more widespread in the autumn or winter, causing more illness and death. It is possible that the virus will mutate (change) into a more potent strain.
Is it possible to catch swine flu twice?
Yes, because the virus can mutate (change). If you become infected with the swine flu virus, your body produces antibodies against it, which will recognise and fight off the virus if the body ever encounters it again. However, if the virus mutates, your immune system may not recognise this different strain and you may become ill again, although you may have some 'cross protection' due to encountering a similar virus previously.
Should I have a 'swine flu party' or try and catch swine flu now, so I will be immune to more serious strains that may emerge later?
No – it is irresponsible to purposefully catch the virus as you may perpetuate the spread. Also, as we don't yet know the profile of the virus, it is too soon to assume it is only a mild infection. And catching swine flu will not necessarily protect you from strains that may emerge later.
What can I do?
You can reduce, but not eliminate, the risk of catching or spreading swine flu by:
Always covering your nose and mouth with a tissue when coughing or sneezing.
Disposing of dirty tissues promptly and carefully.
Maintaining good basic hygiene, for example washing hands frequently with soap and warm water to reduce the spread of the virus from your hands to face, or to other people.
Cleaning hard surfaces, such as door handles, frequently using a normal cleaning product.
You should also prepare now by:
Confirming a network of ‘flu friends’ – friends and relatives – who could help you if you fall ill. They could collect medicines and other supplies for you so you do not have to leave home and possibly spread the virus.
Knowing your NHS number and those of other family members and keeping them in a safe place. It is not essential to have your NHS number in order to receive treatment, but it can help NHS staff to find your health records. You will be able to find your NHS Number on your medical card or other items such as prescribed medication, GP letter or hospital appointment card/letter.
Making sure you have adequate quantities of cold and cough remedies in your medicine cupboard in case you or your family are affected by swine flu.
Who should be wearing a facemask?
The Health Protection Agency (HPA) recommends that healthcare workers should wear a facemask if they come into close contact with a person with symptoms (within one metre) to reduce their risk of catching the virus from patients.
However, the HPA does not recommend that healthy people wear facemasks to go about their everyday business.
Why shouldn't the general public wear facemasks?
Because there’s no conclusive evidence that facemasks will protect healthy people in their day-to-day lives.
The virus is spread by picking up the virus from touching infected surfaces, or by someone coughing or sneezing at very close range – so unless you are standing close to someone with the virus, wearing a facemask will not make a difference.
There are concerns about the risks posed by not using facemasks correctly.
Facemasks must be changed regularly as they are less effective when dampened by a person’s breath. People may infect themselves if they touch the outer surface of their mask, or may infect others by not disposing of old masks safely.
Finally, wearing a facemask may encourage complacency. People need to focus on good hand hygiene, staying at home if they are feeling unwell, and covering their mouth when they cough or sneeze.
So why have other countries gone down this route?
This is an issue which each government has considered separately. France is encouraging the general public to buy their own masks for use as a precaution, but it is not stockpiling masks centrally from government funds and neither is the US.
In other countries there is an existing culture of wearing facemasks for either the prevention of spreading illness or preventing the risks of pollution; this is not the case in the UK.
What should I do if I think I’m infected?
If you have flu-like symptoms, stay at home and call your GP, who will assess you over the phone. If your GP confirms swine flu, they will give you a voucher reference number which your healthy relative or friend can use to pick up antivirals from your local collection centre - normally a pharmacy or community centre.
In the meantime, take paracetamol-based cold remedies to reduce fever and other symptoms, drink plenty of fluids and get lots of rest.
Do not go into your GP surgery, or to a hospital, as you may spread the disease to others. Ask your 'flu friend' to go out for you.
If I have been in close contact with an infected person, do I need treatment?
You only need antiviral treatment if you have been diagnosed with swine flu and your doctor decides it is necessary, or if a doctor decides that you are at serious risk of developing severe illness.
The government is no longer trying to contain the virus because it is now widespread in the UK. It is not effective to give antivirals to people who are not ill, as they will be repeatedly exposed to the virus in the community.
Is swine flu treatable?
Testing has shown that the swine flu can be treated with the antiviral medicines oseltamavir (brand name Tamiflu) and zanamivir (Relenza). However, the drugs must be administered at an early stage to be effective.
The UK already has a stockpile of antivirals sufficient to treat half the population. Also, orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.
What do antivirals do?
Antivirals are not a cure, but they help you to recover by:
relieving some of the symptoms,
reducing the length of time you are ill by around one day, and
reducing the potential for serious complications, such as pneumonia.
How large is the UK's stockpile of antivirals?
The government has 23 million treatments of Tamiflu and 10.5 million treatments of Relenza. Orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.
Is one of the antivirals more appropriate for pregnant women and people with certain kidney conditions?
Relenza is an inhaled drug that will be used for pregnant women and people with certain kidney conditions who are unable to take Tamiflu.
Will antivirals be given to people without flu symptoms?
In most cases, no - the virus is now widespread and it is no longer appropriate to try and contain the spread of the disease. Antivirals will generally only be given, at a doctor's discretion, to people who have been diagnosed with swine flu.
Doctors should not offer antiviral medication as prophylaxis (prevention) to contacts of cases unless, for example, a household member has serious underlying health problems or there are other special circumstances.
Will my child experience nausea if they take Tamiflu?
As is the case with many medicines, nausea is a known side effect of Tamiflu, in a small number of cases. Symptoms may lessen over the course of the treatment. It may help to take Tamiflu either with or immediately after food, and drinking some water may also lessen any feelings of nausea.
How are those with confirmed swine flu getting access to antivirals?
If antivirals are required, the person's GP will give them a voucher reference number over the phone.
A healthy friend or relative can then use this to pick up antivirals from the person's local collection centre - usually a pharmacy or community centre.
Should people be stockpiling their own antivirals?
No. The government has a stockpile of antivirals sufficient to treat half the population, and is taking steps to increase this to cover 80% as an extra precaution. Therefore, antivirals should be available for everyone who gets ill in the pandemic and there is no need for people to buy their own.
Does Tamiflu go out of date?
The government has a programme to replace any expired doses under a 'rolling stock' system.
If I take an antiviral and have side effects, whom should I inform?
The Medicines and Healthcare products Regulatory Agency (MHRA) and the Commission on Human Medicines run the UK's suspected adverse drug reaction reporting scheme - called the Yellow Card Scheme. This receives reports of suspected adverse drug reactions from healthcare professionals, and was recently extended to include direct reporting by patients. People can report any suspected adverse effects on-line by going to http://yellowcard.mhra.gov.uk.
Is there a vaccine?
No, not at the moment. Influenza viruses change very quickly. For a vaccine to provide adequate protection it needs to be adapted to the particular strain in circulation.
Scientists are making good progress in developing a new vaccine for swine flu and we are expecting the first batches of vaccines in August. Further stocks will arrive in the autumn, but it may well be next year before we can vaccinate everyone.
The government has ordered enough vaccines for the whole population, but to reduce the impact of swine flu, the NHS is focusing on those at the greatest risk first.
Why does it take several months to produce a swine flu vaccine?
The flu vaccine production process is long and complicated. Production technology is labour-intensive. The government's plans include two manufacturers, thus maximising chances of early development.
If other countries are also being given advance supply guarantees, will we get ours first?
The UK has a binding contractual agreement in place to ensure its supply.
Does the current seasonal flu vaccine work?
The current seasonal flu vaccine is designed to protect against H1N1, but it is unclear as yet whether this will offer any protection against the current strain of swine flu.
How many stocks are available of seasonal vaccine?
Flu vaccine is produced each year for the seasonal flu. Discussions are ongoing with manufacturers about how much may still be available. However, the government has determined that there are 430,000 doses of vaccine available in the UK.
Who will be a priority for vaccination with the H1N1 swine flu vaccine?
The Joint Committee on Vaccination and Immunisation has previously advised that the priority groups in relation to H5N1 (the bird flu vaccine) should be assumed to be:
frontline health and social care workers (to help ensure the NHS functions well),
older people and those in clinical risk groups, as flu can be more serious in these groups, and
under-16s, as protecting children can slow the spread of the virus in the population.
The priority groups would be reviewed in light of evidence on the virulence and severity of the new virus in different groups.
The government will still aim to achieve universal vaccination, but because the vaccine will have to be delivered over time, it is right that we start thinking now about groups to be prioritised.
Will the vaccine still provide people with protection if the swine flu virus mutates between now and the autumn?
At this stage, it is impossible to predict if or how the H1N1 swine flu virus will mutate (change). However, experiences with the H5N1 vaccine (bird flu vaccine) would suggest that an H1N1 vaccine (produced using the same processes) would also provide a high level of immunity against closely related strains. The level of cross-protection is expected to be greatest for more closely related strains.
Does the NHS have enough syringes to administer the swine flu vaccine?
Yes, orders have been placed to ensure there are enough syringes to administer the vaccine.
What extra antibiotics have been purchased?
Orders have been placed for 15.2m courses of antibiotics. They will play an important part in the response to the pandemic.
Why do you need antibiotics in a pandemic?
While antivirals may reduce the number of complications, there are still likely to be significant numbers of complications occurring in the pandemic. Some of the most common include bacterial infections in the respiratory tract and lungs, such as pneumonia. Antibiotics are needed to treat such complications.
Antibiotics will be used to treat people in the community if they develop complications. In hospitals, antibiotics will be used to treat the sickest patients and may reduce the length of hospitalisation.
Does swine flu pose special risks in pregnant women?
During pregnancy, you may have an increased risk of complications from any type of flu, especially in the second and third trimester.
Can I take antiviral drugs if I am pregnant?
Yes, on the advice of a doctor. The Department of Health has purchased Relenza, an inhaled antiviral drug that treats flu without reaching the developing fetus.
An expert group reviewed the risk of antiviral treatment in pregnancy, which is extremely small - much smaller than the risk posed by the symptoms of swine flu.
Will pregnant women get preference for a swine flu vaccine?
It will be months before a swine flu vaccine becomes available. When it is available, there will be guidelines on which groups of people are a greater priority for vaccination.
Should I stop breastfeeding if I need to take antiviral drugs?
Women who are breastfeeding should continue to do so while receiving antiviral treatment, as this is not contraindicated. If a mother is ill, she should continue breastfeeding and increase feeding frequency. If she becomes too ill to feed, then expressing milk may still be possible. Antiviral drugs are excreted into breast milk in very small (insignificant) amounts.
Can children take antivirals?
Yes, on the advice of a doctor. Tamiflu is safe for infants aged one and older, at a reduced dose. Relenza (an inhaler) can be used by children aged five and older under the supervision of an adult.
Can babies under the age of one take antivirals?
Tamiflu and Relenza are not licensed for use in babies under the age of one. However, after evaluating all the available evidence, the European Medicines Agency has advised that children under one may be treated with Tamiflu, considering that:
the appropriate dosage to treat children aged under one is 2-3mg/kg twice daily for five days,
children are preferably treated under medical supervision, and
dilution of the capsule content can be used to prepare the dose.
Post-exposure prophylaxis (prevention) of children aged under one should be very carefully considered. The appropriate dose for prevention should be 2-3mg/kg once a day for 10 days (but should not exceed 10 days).
I’m on immunosuppressants. Am I more at risk from swine flu?
Yes. If you take immunosuppressants you have a greater risk of becoming infected with any virus, including swine flu, and will be less able to fight it off once you have it.
Will my dose of immunosuppressants be altered in the event of an outbreak?
Your doctor may advise that your dose of immunosuppressants needs to change. The appropriate dose will vary from patient to patient.
Can I take antivirals if I’m on immunosuppressants?
Yes, on the advice of a doctor it is safe for you to take Tamiflu or Relenza.
Am I more at risk of catching swine flu if I have HIV?
Probably not. Although HIV infects CD4 cells and reduces their number and function, there are other parts of the immune system that are able to fight flu.
Am I more likely to suffer complications if I have HIV and catch swine flu?
If you have a low CD4 count (under 200), you may be more likely to suffer complications like pneumonia from any type of flu, including swine flu.
Can I take antivirals if I have mild to moderate kidney disease?
Yes. If you have stage 1 to 3 kidney disease, or your glomerular filtration rate (GFR) is above 30, you will be treated as any other person would be. This means you can take Relenza or Tamiflu, if necessary.
Can I take antivirals if I have severe kidney disease?
Yes. If you have stage 4 or 5 kidney disease, or your glomerular filtration rate (GFR) is below 30, you will probably be under the care of a kidney specialist. Relenza (an inhaler) is safe to take. If you find this tricky to use, your doctor may give you a reduced dose of Tamiflu tablets instead.
Will people with long-term conditions get preference for a swine flu vaccine?
It will be months before a swine flu vaccine becomes available. When it is available, there will be guidelines on which groups of people are a greater priority for vaccination.
Are people with asthma or chronic obstructive pulmonary disease (COPD) more at risk from swine flu?
You are no more likely to catch swine flu than anyone else. However, if you do catch a respiratory infection, including swine flu, it may add to the breathing difficulties you may have.
What advice is there for people with asthma or COPD?
Your condition places you at greater risk if you catch the disease. It is therefore all the more important that you follow good hygiene practices and react quickly if you develop flu-like symptoms.
Can I take antivirals if I have asthma or COPD?
Yes - Tamiflu is safe to take. However, Relenza (an inhaler) is usually not given to people with asthma as on rare occasions it can cause breathing complications.
I have diabetes. Am I at more at risk from swine flu?
You are no more likely to catch swine flu than anyone else. However, if you do catch it, your blood glucose may increase and your diabetes treatment may need to be adjusted accordingly.
What should I do if my blood glucose increases?
If you find your blood glucose has increased, or you develop thirst and are urinating more, call your GP. If you are on insulin and testing your own blood glucose, you may be advised to do this more often so you can adjust your dose according to the results. If you start to vomit or become increasingly unwell, call your GP as soon as possible.
Is there any advice for people with liver disease?
If you have liver disease you are no more likely to catch swine flu than anyone else. If you do catch it, antivirals are safe to take – there is no interaction between these and antivirals you may already be taking to treat hepatitis.
Can I take antivirals if I am on epilepsy treatment?
Yes. It is thought that antiviral treatments will not affect medicines taken to control epilepsy.
I look after someone who is very ill/disabled. What if I become too ill to care for them?
As a carer, you should probably begin planning for an emergency caring situation as soon as possible. The best way to get help with planning for a caring emergency is to arrange a carer's assessment from your local authority.
If you have time you may be able to arrange for formal respite care, but you may want to talk to friends, neighbours and relatives about forming a network of ‘flu friends’ who can help out and look after you if you are ill.
Are older people more likely to catch swine flu?
It is not yet known, but the vast majority of cases so far in the UK have been in those younger than 60. It is speculated that some older people may have partial resistance to the swine flu virus, due to being exposed to a similar flu virus in a previous pandemic.
Are older people more at risk of complications if they do catch it?
Older and frail people are more likely to develop complications from any type of flu, and are generally less able to fight it off.
What advice are you giving to travellers?
Before travelling, they should check the Foreign and Commonwealth Office (FCO) website for information specific to the country they are visiting.
What advice are you giving to people with flu who want to travel by plane?
The Health Protection Agency is advising anyone in the UK who is symptomatic not to travel until they are no longer infectious. Similarly, any British nationals abroad with flu who want to fly home should only travel when they are no longer infectious.
Is it safe to use public transport now we are in a pandemic?
Yes. Public transport has not been closed during previous pandemics, and while there is a small additional risk to the public, this is no greater than using other public places. Anyone who has the flu or feels unwell should stay at home and not travel.
What is the definition of WHO Phase 6?
The technical definition of Phase 6 is human-to-human spread of the virus into at least two countries in one World Health Organisation region, with community level outbreaks in at least one other country in a different WHO region.
Because the virus has been spreading for some time in North America, the decision that ‘community level outbreaks’ were occurring in other regions means that the criteria for Phase 6 have been fulfilled.
I am about to go on holiday to a country affected by swine flu - what should I do?
Make sure you consult the overseas travel advice on the Foreign & Commonwealth Office website, and take sensible precautions.
What should I do if I become ill on holiday or on the flight home?
If you experience flu-like symptoms during a stay in a country affected by swine flu, contact a health professional and tell them your symptoms.
If you become ill on your flight home, alert the cabin crew to your symptoms. There are procedures in place for dealing with passengers who become unwell on flights, and the airline will advise port health officials on the ground that a passenger requires a health assessment and may need treatment.
To access the Department of Health Swine Flu Information line when abroad, call 00 44 207 928 1010.
Is it a mild infection and therefore no cause for concern?
Don’t be complacent, as it is too soon to assume it will be a mild infection. We don’t know the profile of the virus and are closely monitoring each case that comes up. Everyone who has been infected with the virus in this country has so far been diagnosed early and treated with antivirals, which reduce the severity of symptoms.
The flu virus changes character very rapidly. It can pick up and swap genetic material, which can dramatically change its character, increasing the severity of symptoms. The virus could change in the autumn, so we need to plan for this.
Will hospital capacity be adequate?
Most flu sufferers can be cared for appropriately at home. The UK has well developed plans in place for managing extra demand on the healthcare system during the pandemic.
Is it safe to eat pig meat?
Yes. The WHO says there is no evidence that swine flu can be transmitted through eating meat from infected animals. However, it is essential to cook meat properly. A temperature of 70°C (158°F) would be sure to kill the virus. Pig meat includes pork, bacon, ham and pork products.
Note: The foregoing is copied straight from the NHS website and copyright is acknowledged. For the full text and associated links, please visit:
http://www.nhs.uk/Conditions/Pandemic-flu/
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