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20090430-8

The New York Times, April 30, 2009, by Liz Robbins The World Health Organization raised the alert level of the fast-spreading swine flu virus on Wednesday afternoon, indicating that a “pandemic is imminent,” on the day that a Mexican toddler who had been hospitalized in Houston became the first person to die from the disease on United States soil.

Dr. Margaret Chan, the director general of the organization, said that the “phase 5” alert out of a possible 6 levels signified that at least two countries have spread the virus by human to human contact, and that the highest phase 6 was probably imminent.

“It is really all of humanity that is under threat during a pandemic,” Dr. Chan said. “We do not have all the answers right now. But we will get them.”

By Wednesday afternoon, nine countries had confirmed cases of swine flu, the strain known as the H1N1 virus. Several European nations were making plans to regulate travel involving Mexico, where more than 150 people are suspected to have died and at least 2,400 are suspected to have been infected as a result of the swine flu.

In the United States, Janet Napolitano, the secretary of homeland security, said at an afternoon news conference: “We have been preparing all along as if this is going to be Stage 6. Our efforts have been to stay ahead of the number.”

She added: “We are preparing for the worst, hoping for the best.”

Earlier on Wednesday, President Obama recommended that schools in the United States with confirmed or suspected cases of the disease “strongly consider temporarily closing.”

Texas heeded the warning. It was one of 10 states that had confirmed cases on Wednesday — bringing the number of people infected by the swine flu to 91, according to Dr. Richard E. Besser, acting director of the Centers for Disease Control and Prevention, up from 66 cases in 5 states that were confirmed on Tuesday.

More than half of the cases were in New York, 51, with 16 in Texas and 14 in California. Other states reporting cases were Massachusetts, Michigan, Arizona, Nevada, Indiana, Kansas and Ohio.

But even as Dr. Besser was acknowledging how swiftly the numbers were increasing, Gov. John E. Balducci of Maine reported that there were three confirmed cases in his state, and Illinois was awaiting final confirmation from the centers after its own laboratories identified nine people who were affected by what was probably the same virus strain.

In Texas, which has bore the brunt of the disease in the United States, state officials intensified their efforts to control the virus, shutting schools in five districts in and around San Antonio, Rio Grande (bordering Texas) and Dallas, which would keep about 53,000 students home for two weeks, according to the Texas Education Agency.

Texas also suspended all sporting events until May 11, when it hopes the virus will be under control.

So far in the United States, the 22-month-old Mexican boy who died was one of only five known people to have been hospitalized for the disease.

The youth had traveled with his family on April 4 on a flight from Mexico City to Matamoros, Mexico, and then crossed the border to Brownsville in south Texas, according to the Texas Department of State Health Services. He had “several underlying health problems,” according to the department, developed a fever on April 8, and on April 13 was admitted to the hospital in Brownsville. The next day he was transferred to Texas Children’s Hospital in Houston, where he died on Monday.

The C.D.C. confirmed on Wednesday that the child was “in fact infected with the swine virus,” Dr. David E. Persse, director of emergency medical services in Houston, said in a nationally televised news conference.

That said, Dr. Persse and other officials in Houston tried to calm fears of an outbreak, noting that no other members of the boy’s family had shown symptoms of the virus. And Kathy Barton, a spokeswoman for the Houston Department of Health and Human Services, emphasized that the boy had not posed “any additional risks to the community” after his hospitalization more than two weeks ago.

Still, Texas Gov. Rick Perry declared a state of emergency to be able to better combat the disease, as Texas became the second state after California to do so.

In New York, the state health commissioner Dr. Richard F. Daines, said that officials have confirmed 3 possible new cases in addition to the 51 recorded by the centers in Orange, Cortland and Suffolk Counties. At an afternoon news conference, New York City health officials confirmed 49 cases, up from 44 Tuesday, said Dr. Thomas R. Frieden, the city health commissioner.

The five newly confirmed cases involve three students at St. Francis Preparatory Academy in Queens, the epicenter of the outbreak in New York, a 19-month-old child in the Bronx who has been hospitalized, and a young woman in Brooklyn who was briefly hospitalized and has now been discharged.

“Right now we have no evidence that this is more severe than a garden variety flu in New York City today,” Dr. Frieden said.

In Illinois, officials said Wednesday afternoon that nine people – ages 6 to 57 – appeared to have swine. One of them, a 12-year-old, has been hospitalized, the officials said, adding that most of the cases appeared to be fairly mild. Five of the people are from Chicago, and the rest from nearby suburbs.

One public elementary school, on the North Side of Chicago, closed for the day because of a probable case, and the school officials in Chicago said they were conducting checks on attendance data from all of the city’s schools to determine whether other closures may be needed.

Mr. Obama, in his most extensive remarks to date on the spread of the swine flu, which he referred to as the H1N1 virus, spoke a day after asking Congress to provide $1.5 billion in emergency funds to fight the disease, and his comments appeared to reflect a deepening sense of the risk the still ill-understood flu might pose.

By urging parents to make contingency plans in the event of school closings — simply placing children in crowded day-care centers was “not a good solution,” he noted — Mr. Obama indicated that his administration was contemplating the possibility, at least, of a serious increase in the flu’s prevalence.

Kathleen Sebelius, at her first news conference since being sworn in on Tuesday as President Obama’s secretary of health and human services, echoed the President’s concern.

“Unfortunately, we’re likely to see additional deaths from this outbreak,” Ms. Sebelius said Wednesday.

Officials around the world seem to be girding themselves for the worst, as well. In France, the health minister took the extraordinary step of calling for a suspension of all flights from the European Union to Mexico.

France’s request to suspend all flights from the European Union to Mexico will be made at a meeting of European Union health ministers, scheduled for Thursday in Luxembourg, French Health Minister Roselyne Bachelot said. The World Health Organization has argued against such travel bans, contending that they are an ineffective way to stop to spread of the disease.

Cuba and Argentina have both banned flights to Mexico, while Americans have been advised only to “avoid all nonessential travel to Mexico.”

Mexico City, one of the world’s largest cities, has taken drastic preventative steps, shutting down schools, gyms, swimming pools, restaurants, and movie theaters. Many people on the streets have donned masks in hopes of protection.

Mexico’s health secretary, Jose Cordova said late Tuesday that emergency measures to curb the disease’s spread there appeared to be working and that the death toll was “more or less stable.” The confirmed number of deaths held at 7, the health ministry said, although 159 deaths were attributed to flu-related causes. Germany confirmed three cases of the disease and Austria had one confirmed, as four European nations have now reported cases. Germany’s disease control agency, the Robert Koch-Institut, said the three include a 22-year-old woman hospitalized in Hamburg; a man in his late 30s being treated at a hospital in Regensburg, north of Munich, and a 37-year-old woman from another southern town.

Health and airport authorities in Munich said the first direct flight carrying vacationers back to Germany since the outbreak of the disease in Mexico was expected and might be quarantined if passengers showed symptoms of swine flu.

Austria’s health ministry said a 28-year-old woman who recently returned from a month-long trip to Guatemala via Mexico City and Miami has the virus but is recovering, according to The Associated Press.

Spain said Wednesday that the number of confirmed cases of the flu had risen to 10, including one person who had not recently visited Mexico, according to Reuters. In addition, the health ministry said authorities were observing 59 suspected cases.

In London, Prime Minister Gordon Brown told Parliament that three more cases of swine flu had been confirmed in Britain, one of them a 12-year-old girl, in addition to a Scottish couple, bringing the total to five. All three had recently travelled from Mexico, had mild symptoms and were responding to treatment, he said. A school attended by the 12-year-old in southwest England had been temporarily closed, he added.

Canada has 13 confirmed cases, all of which are mild, Canada’s chief public health officer, Dr. David Butler-Jones, said Tuesday.

New Zealand officials said on Wednesday that 14 cases had been confirmed there. New Zealand has been screening all arriving air passengers, and Dr. Fran McGrath, the deputy director of public health, said that five foreign travelers were being treated under quarantine for mild cases of the flu. All five were being “kept in isolation” at an undisclosed location in Auckland.

Also on Wednesday, at least 10 countries — including China, Russia, Ukraine and Ecuador — banned the importation of all pork products despite a declaration from the W.H.O. that “there is no risk of infection from this virus from consumption of well-cooked pork and pork products.”

Egypt went even further, ordering the culling of all pigs in the Arab country as a precaution against swine flu, the country’s health minister said. While most Egyptians are Muslim and do not eat pork, it is available, and is mostly consumed by the Christian minority and foreigners.

“It is decided to slaughter all swine herds present in Egypt, starting from today,” Health Minister Hatem el-Gabali said in a statement published by state news agency MENA.

20090430-61

 

 

 

Transcript to Press

Statement by WHO Director-General, Dr Margaret Chan
30 April 2009

Swine influenza

Ladies and gentlemen,

Based on assessment of all available information, and following several expert consultations, I have decided to raise the current level of influenza pandemic alert from phase 4 to phase 5.

Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world.

On the positive side, the world is better prepared for an influenza pandemic than at any time in history.

Preparedness measures undertaken because of the threat from H5N1 avian influenza were an investment, and we are now benefitting from this investment.

For the first time in history, we can track the evolution of a pandemic in real-time.

I thank countries who are making the results of their investigations publicly available. This helps us understand the disease.

I am impressed by the work being done by affected countries as they deal with the current outbreaks.

I also want to thank the governments of the USA and Canada for their support to WHO, and to Mexico.

Let me remind you. New diseases are, by definition, poorly understood. Influenza viruses are notorious for their rapid mutation and unpredictable behaviour.

WHO and health authorities in affected countries will not have all the answers immediately, but we will get them.

WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels.

The results of these ongoing assessments will be issued as public health advice, and made publicly available.

All countries should immediately activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.

At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace.

I have reached out to donor countries, to UNITAID, to the GAVI Alliance, the World Bank and others to mobilize resources.

I have reached out to companies manufacturing antiviral drugs to assess capacity and all options for ramping up production.

I have also reached out to influenza vaccine manufacturers that can contribute to the production of a pandemic vaccine.

The biggest question, right now, is this: how severe will the pandemic be, especially now at the start?

It is possible that the full clinical spectrum of this disease goes from mild illness to severe disease. We need to continue to monitor the evolution of the situation to get the specific information and data we need to answer this question.

From past experience, we also know that influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries.

No matter what the situation is, the international community should treat this as a window of opportunity to ramp up preparedness and response.

Above all, this is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic.

As I have said, we do not have all the answers right now, but we will get them.

Thank you.

HHS Secretary Kathleen Sebelius and Homeland Security Secretary Janet Napolitano will host a Webcast to answer questions from the American people regarding the H1N1 flu on Thursday at 1:00 PM EDT. Sebelius and Napolitano will be joined by Acting Director of the Centers for Disease Control and Prevention, Dr. Rich Besser. The Webcast can be viewed at www.hhs.gov.

 

Below is a helpful video discussion about preparedness

20090430-5

Mental Health Services and Their Role in Pandemic Planning, Response and Recovery – 60 minutes

· Brian McKernan, SAMHSA

· Dr. Dana R.Taylor, SAMHSA

· Linda Ligenza, SAMHSA

20090430-4

This preliminary negative stained transmission electron micrograph

depicts some of the ultrastructural morphology of the A/CA/4/09

swine flu virus. Courtesy of CDC/ C. S. Goldsmith and A. Balish.

Medscape.com, April 29, 2009, by Robert Lowes In her first day on the job, Health and Human Services Secretary Kathleen Sebelius announced during a news conference that development of a vaccine for the new swine influenza virus is in “full gear.”

“The process is more speedy than it’s ever been before,” said Ms. Sebelius, whose appointment was confirmed by the US Senate yesterday.

However, she also sought to allay fears of a repeat of the 1976 swine flu scare, when a vaccine led to higher rates of Guillain-Barré syndrome. “We’ll work quickly, but safety will be our top priority,” Ms. Sebelius said.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said at today’s news conference that the federal government, working with pharmaceutical manufacturers, is on track to produce a pilot vaccine “in a few months.” Clinical trials in humans will determine “whether or not we have the right dose, whether or not we have the immune response we want, and whether or not it is safe,” said Dr. Fauci, adding that these trials will last several months.

The urgency in their statements reflected the worsening of the swine flu outbreak, which has resulted in 91 confirmed cases in 10 states and the death of a 23-month-old child in Texas, according to the US Centers for Disease Control and Prevention (CDC). Confirmed cases have emerged in a total of 8 countries, including Mexico, where the number of deaths likely caused by the virus has reached 159, according to the New York Times.

Despite the grim statistics, Ms. Sebelius and other public health officials at the news conference cautioned against taking draconian but unproductive measures against the swine influenza A (H1N1) virus. Ms. Sebelius, for example, said that the CDC continues to recommend that schools be closed only if they experience a laboratory-confirmed case of swine flu. Closing schools when there are no confirmed cases, she said, creates a “ripple effect” of complications. “What happens to their parents? Where do their children go?” she said, referring to the logistical problems of ad hoc childcare.

Likewise, CDC acting director Richard Besser, MD, also said it was a bad idea to close the border with Mexico, as some have suggested. “We’ve learned a lot from previous [infectious disease] outbreaks,” said Dr. Besser. “Intensive efforts at border screening and entry aren’t effective in preventing the introduction of an infectious disease. Closure would tie up resources. We want to do things that have the greatest impact.”

However, public officials are not ignoring what happens at the Mexican border, he said. Customs and border guards are on the look-out for visitors who appear sick and are distributing leaflets that describe swine influenza symptoms and recommend steps to take if someone seems to be infected.

While the CDC and other agencies take short-term measures, such as investigating the exact nature of the swine flu deaths in Mexico and distributing the antiviral drugs zanamivir (Relenza) and oseltamivir (Tamiflu) to state governments, work proceeds on a swine flu vaccine.

Medscape,com, April 29, 2009, Emma Hitt The swine influenza outbreak shows no signs of slowing down, but, for now at least, the World Health Organization (WHO) has stopped short of increasing the pandemic alert level from phase 4 to phase 5.

“Phase 5 is a significant milestone, and we are trying to make absolutely sure that we are dealing with sustained transmission in 2 or more countries,” Keiji Fukuda, MD, MPH, assistant director-general ad. interim for Health Security and Environment at the WHO, said during a press conference today.

“In New York City, we are seeing a person-to-person transmission occurring in a high school, but we are looking for transmission among people in neighborhoods and communities before we move to phase 5,” he said.

The worldwide pandemic alert level was raised on Monday of this week to phase 4, which is defined as confirmed person-to-person spread of a new influenza virus able to cause “community-level” outbreaks.

According to Dr. Fukuda, as of 11:00 am EDT today, 114 cases have been officially reported to the WHO. In Mexico, 26 confirmed cases and 7 deaths have been reported, although Mexican authorities are reporting that swine flu is now suspected in more than 100 deaths and nearly 2500 illnesses. Earlier today, the first American fatality was reported — a 23-month-old toddler in Texas.

Swine Flu Mostly Similar to Seasonal Flu

Dr. Fukuda pointed out that the current outbreak is characteristic of typical seasonal influenza, with the possible exception of more diarrhea cases with swine flu than with seasonal influenza.

A WHO-led conference call of several influenza specialists across the globe was ongoing at the time of the press briefing. According to Dr. Fukuda, the discussion by participants on the conference call was helping to confirm their initial impressions of the outbreak. “There is nothing to suggest that our preliminary assessments are incorrect,” he said.

Dr. Fukuda noted that the epidemiologic evidence clearly suggests that the virus is being transmitted from person to person. “Studies are underway to look further at the transmissibility of this virus, and I expect this info to unfold over days and weeks,” he said.

He emphasized that the swine virus had moved from swine to humans, but that consumption of pork and other meats do not pose a risk. In addition, no coinfections are thought to be occurring with the swine flu infections.

Unanswered Questions

An important question that remains to be answered is the potential severity of the illness. Currently, the spectrum ranges from very mild to fatal, which is in keeping with other influenza infections. “We do not know the likelihood of developing mild vs fatal illness or the risk factors among those people who develop fatal illness,” he said. Also unknown is information about mutations that might have allowed the virus to jump from swine to human transmission.

For the most part, the virus is in keeping with normal seasonal influenza viruses, but Dr. Fukuda emphasized that it is premature to think of this as a mild or severe pandemic, since “we cannot predict what the course will be. It is possible that this epidemic could suddenly stop, but it is unlikely.”

He added that the worst pandemic of the past century, in 1918, started out mild in the springtime, was fairly quiet during the summer, and then in the fall it “really exploded into a much more severe form — so we just don’t know what the future is going to hold. The most important point now is that countries really have a warning and have time to prepare.”

Myron S. Cohen, MD, director of the Institute for Global Health and Infectious Diseases and associate vice chancellor for global health at the University of North Carolina in Chapel Hill, noted that national guidelines will be developed shortly, but “in this transitional period, individual hospitals and physician clinics certainly need to evaluate their resources and manage their practices carefully.”

“There are real decisions that need to be made on the ground,” he told Medscape Infectious Diseases in a phone interview. “Who gets a mask and who doesn’t get a mask? Who gets lab testing and who does not? Who gets [oseltamivir] or [zanamivir] and who does not?”

Dr. Cohen recommends that clinicians define potential case patients broadly, considering any patient with symptoms consistent with flu, not just those who have traveled to Mexico or who have been in contact with infected people.

According to Dr. Cohen, the outbreak could go away quickly or it could become a “sustained, pretty big problem.”

“The good news is that there is no doubt we are going to be able to make a vaccine, and so the time frame in which we will have to deal with this is only a few months,” he said. “There is a chance of resistance developing toward antiviral drugs, depending on how much the agent is used, but let’s hope that does not happen.”

 

29 April 2009 — The situation continues to evolve rapidly. As of 18:00 GMT, 29 April 2009, nine countries have officially reported 148 cases of swine influenza A/H1N1 infection. The United States Government has reported 91 laboratory confirmed human cases, with one death. Mexico has reported 26 confirmed human cases of infection including seven deaths.

The following countries have reported laboratory confirmed cases with no deaths – Austria (1), Canada (13), Germany (3), Israel (2), New Zealand (3), Spain (4) and the United Kingdom (5).

Further information on the situation will be available on the WHO website on a regular basis.

WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.

There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

FDA News

FOR IMMEDIATE RELEASE

April 29, 2009
Consumer Inquiries:
888-INFO-FDA

FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans

The U.S. Food and Drug Administration, in response to requests from the U.S. Centers for Disease Control and Prevention, has issued Emergency Use Authorizations (EUAs) to make available to public health and medical personnel important diagnostic and therapeutic tools to identify and respond to the swine flu virus under certain circumstances. The agency issued these EUAs for the use of certain Relenza and Tamiflu antiviral products, and for the rRT-PCR Swine Flu Panel diagnostic test.

The EUA authority allows the FDA, based on the evaluation of available data, to authorize the use of unapproved or uncleared medical products or unapproved or uncleared uses of approved or cleared medical products following a determination and declaration of emergency, provided certain criteria are met. The authorization will end when the declaration of emergency is terminated or the authorization revoked by the agency.

Currently, Relenza is approved to treat acute uncomplicated illnesses due to influenza in adults and children 7 years and older who have been symptomatic for less than two days, and for the prevention of influenza in adults and children 5 years and older. Tamiflu is approved for the treatment and prevention of influenza in patients 1 year and older.

The EUAs allow for Tamiflu also to be used to treat and prevent influenza in children under 1 year, and to provide alternate dosing recommendations for children older than 1 year. In addition, under the EUAs, both medications may be distributed to large segments of the population without complying with the label requirements otherwise applicable to dispensed drugs, and accompanied by written information pertaining to the emergency use. They may also be distributed by a broader range of health care workers, including some public health officials and volunteers, in accordance with applicable state and local laws and/or public health emergency responses.

In authorizing an EUA for the rRT-PCR Swine Flu Panel diagnostic test, the FDA has determined that it may be effective in testing samples from individuals diagnosed with influenza A infections, whose virus subtypes cannot be identified by currently available tests. This EUA allows the CDC to distribute the swine flu test to public health and other qualified laboratories that have the needed equipment and the personnel who are trained to perform and interpret the results.

The test amplifies the viral genetic material from a nasal or nasopharyngeal swab. A positive result indicates that the patient is presumptively infected with swine flu virus but not the stage of infection. However, a negative result does not, by itself, exclude the possibility of swine flu virus infection.

The EUA authority is part of Project BioShield, which became law in July 2004.

Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of this product to the FDA’s MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.
Online: www.fda.gov/MedWatch/report.htm
Regular Mail: use postage-paid FDA form 3500 available at: www.fda.gov/MedWatch/getforms.htm and mail to MedWatch,
5600 Fishers Lane, Rockville, MD 20852-9787
Fax: (800) FDA-0178
Phone: (800) FDA-1088

For more information:
FDA’s Emergency Use Authorization of Medical Products Guidance, go to
www.fda.gov/oc/guidance/emergencyuse.html
.

April 29, 2009 update

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

Are there human infections with swine flu in the U.S.?
In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well. An updated case count of confirmed swine flu infections in the United States is kept at http://www.cdc.gov/swineflu/investigation.htm CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?
CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?
Spread of this swine influenza A (H1N1) virus 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.

How can someone with the flu infect someone else?
Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?
First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) 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. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?
People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

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 and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?
We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against swine flu. 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 get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

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. we recommend 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 swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

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 skin color

·  Not drinking enough fluids

·  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

·  Fever with a rash

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

How serious is swine flu infection?
Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

Can I get swine influenza from eating or preparing pork?
No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

April 29, 2009 011:00AM ET

This document provides interim guidance and will be updated as needed.

Detailed background information and recommendations regarding the use of masks and respirators in non-occupational community settings can be found on PandemicFlu.gov in the document Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic

Transcript From Podcast, April 28, 2009

Hi. I’m Dr. Joe Bresee with the CDC’s Influenza Division. I’m here to speak with you today about the symptoms of swine flu infections and what to do if you get sick. Since March 2009, persons with infection caused by a new strain of swine flu virus have been identified in the U.S. and other countries. It’s important that people recognize the symptoms of swine flu and seek medical care if necessary.

For many years, we’ve known that swine flu occasionally infects humans, so we know the typical symptoms of swine flu. The symptoms are similar to the symptoms of regular human flu and can include fever, cough, sore throat, body aches, headache, chills, or fatigue. Some people with swine flu have also reported diarrhea or vomiting. In the past, severe illness, such as pneumonia or respiratory failure, as well as death has been reported with swine flu infections in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

If you live in an area where swine flu infections have been reported, and if you become ill with flu-like symptoms you may want to contact your health care provider, particularly if you’re worried about your symptoms. Your health care provider will determine whether swine flu testing or treatment is needed.

If you become ill and experience any of the following warning signs, get emergency medical care. In children, emergency warning signs that need urgent medical attention include: fast breathing or trouble breathing, bluish skin color, not drinking enough fluids, not waking up or not interacting, being so irritable that the child does not want to be held, fever with a rash, or flu-like symptoms that improve but then return with fever or 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, or severe or persistent vomiting.

People with swine flu can infect others and could be contagious as long as they are symptomatic, and possibly for up to seven days following the onset of illness. Children, especially younger children, might potentially be contagious for longer periods.

Fortunately, there are medicines that can be used to treat swine flu. Antiviral drugs are prescription medicines, such as pills, liquids, or an inhaler 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 can make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started within two days of symptoms. CDC recommends the use of oseltamivir, which is also called Tamiflu®, or zanamivir, which is also called Relenza®, for the treatment or prevention of infection with these swine flu viruses.

If you get sick with swine flu, CDC recommends that you stay home from work or school and limit contact with others to reduce the chance of transmitting the infection. Avoid touching your eyes, nose, or mouth because germs can spread that way. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.

For more information about swine flu, visit www.cdc.gov/swineflu.

For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO, 24/7.

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