Saudi official: 5 dead from swine flu at hajj

Tens of thousands of Muslim pilgrims move around the Kaaba inside the Grand Mosque during the annual Hajj in Mecca, Saudi Arabia, Saturday, Nov. 28, 2009. (AP Photo/Hassan Ammar)

MINA, Saudi Arabia — Five people died from the H1N1 flu virus during the hajj, the Saudi health minister said Sunday — a relatively small number considering the event is the largest annual gathering of people in the world and is seen as an ideal incubator for the virus.

Speaking on the final day of the Islamic pilgrimage, Abdullah al-Rabeeah said authorities recorded 73 cases — including the five deaths — of H1N1, commonly known as swine flu, during the pilgrimage. He said only 10 percent of the some 3 million pilgrims were vaccinated against the virus.

"Our safety precautions have secured a very successful and safe hajj for pilgrims from around the world with no infectious disease outbreaks," al-Rabeeah said.

Saudi officials, along with American and international health experts, worked to curb any outbreak during the hajj. Health officials circulated among the sprawling tent camp at Mina where the pilgrims lived and gave the faithful cheek swabs for testing later. They also placed hand sanitizer dispensers on walls in the camps, near public bathrooms and at ritual sites, while pilgrims arriving at Saudi airports were scanned using a thermal camera and offered a free vaccine.

But authorities also are using the pilgrimage as a test case to build a database, watch for mutations and look for lessons on controlling the flu at other large gatherings like the 2010 soccer World Cup in South Africa.

Despite the relatively minor impact of the virus during the hajj, some experts warn it is likely spreading silently among pilgrims — and the true extent of the push that hajj has given to the virus won't be known until later, after the faithful have returned to their home countries around the world.

Al-Rabeeah brushed aside such concerns Sunday, saying pilgrims have been in the country for almost a month, far longer than the weeklong incubation period.

"They've had enough time to show symptoms of swine flu, and that hasn't happened," he said.

But he also stressed Saudi authorities will continue to monitor pilgrims until they leave the country, and urged other countries monitor the pilgrims upon their return home.

On Sunday, Muslim pilgrims performed the hajj's final ritual at the cube-shaped Kaaba — Islam's holiest shrine.

After three days of throwing stones at walls in the desert valley of Mina in a symbolic rejection of Satan's temptation, some 3 million pilgrims crammed into buses and trucks for the short trip back to Mecca to circle the Kaaba, marking the traditional end of the hajj.

Many of the men making the pilgrimage had shed their traditional white robes in favor of Western clothing. Many had shaved heads, done on the first day of stoning as a symbol of renewal.

The Muslims believe that they are cleared of all sins if they perform a sincere pilgrima

H1N1 precautions for holiday travelers

What are airlines doing to stop spread of disease

PROVIDENCE, R.I. (WPRI) - The holiday travel season is days away. And this year, some passengers may come with some extra baggage of the "viral kind."

Of all places where you don't want to be if someone has H1N1 is on a cramped airplane or bus. There's no doubt with the H1N1 outbreak we're all feeling a little tentative, especially if you're traveling on an airplane.

The concern is real

"First of all it is true you can get infectious diseases while flying or on the train or on the bus," said Dr, Tim Flanigan, Director of Infectious Diseases at The Miriam and Rhode Island Hospitals . "There's been good data showing the risk of infection depends on the proximity or how close you're sitting to the person who might be infected."

• See more on preventing the spread of H1N1 flu virus

Knowing the risk, holiday traveler Carolyn Sears is ready to board her flight prepared.

"I'm vaccinated. We're having a baby so we're lucky we're vaccinated and a whole lot safer," Sears said.

What are airlines doing to keep passengers safe?

Of the airlines contacted, American and United have created new response plans because of H1N1. Both supply all their aircraft with "medical kits containing masks, gloves, hand sanitizer wipes, and thermometer strips."

United Airlines said its "aircraft air re-circulation systems are equipped with filters that are hospital grade."

If you have to cancel

If you have to cancel a flight because you have the flu, most airlines require you get a physician's note.However, a refund may not be in the cards. The airline policies haven't changed because of the flu. Most non-refundable tickets can be used for future travel. But most airlines charge a fee if you cancel or change a flight.

• Links to airline refund & sick passenger policies

Airline crews are given the right to ask passengers too sick to travel to get off the plane; a move doctors couldn't agree with more.

"If you have a temperature over 100 you shouldn't be flying," Dr. Flanigan said. "It doesn't make sense, you're putting others at risk, and it's really not good for your health."

Technorati Tags: H1N1 precautions for holiday travelers

CDC Official: Vaccine Distribution Remains 'Bumpy'

The shortage of H1N1 swine flu vaccine in some parts of the country continues to be a concern of the federal government's vaccination authorities, immunologist Anne Schuchat said this afternoon during a briefing for bloggers on the pandemic. "This has really been bumpy," Schuchat said as she fielded questions from California and other places where supplies of the vaccine has been extremely difficult for people to find. "As of today, 58.9 million doses of H1N1 vaccine have become available for the states to order."

I participated in the hour-long "bloginar," which was held by the Department of Health and Human Services. Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, answered questions for an hour submitted over email and Twitter.

There are 43 states in which influenza is categorized as widespread, compared to zero at this time in a normal year, she said. Children, pregnant women and health care professionals are among the high-risk groups urged to get vaccinated. She encouraged bloggers to share a Flu Vaccine Locator widget from its Flu.Gov web site, which helps people find the vaccine in their area.

http://www.flu.gov/widgets/vaccinelocator.html

When asked about the safety of the swine flu vaccine, Schuchat said that it's no different than the seasonal flu vaccines that have been offered for years. "It is produced exactly the same way," she said. The companies that are producing the vaccine use the same production process and undergo "the same kind of oversight with FDA inspections and visits."

Another blogger asked about the decision not to include an adjuvant in the vaccine. Adjuvants are "substances that are put in vaccines to improve the immune response," Schuchat explained. The federal government bought adjuvant to store in case it was needed, but has found that the normal 15-microgram dose of antigen in the current swine flu vaccine has been sufficient.

Current vaccine producers are not licensed to include an adjuvant in the United States, she said. This means that an "emergency use authorization" would have been required to make use of them to fight swine flu. "We worried that the use of adjuvants at this point wouldn't be acceptable to people," she said.

I posed this question to Schuchat: What can you say to address the concerns of people who believe the long-term health effects of flu vaccines have not been adequately studied?

Schuchat replied that "influenza vaccines have a very good safety track record," pointing out that 100 million doses are dispensed per year. "I'm not aware of any problems about long-term safety." The National Institutes of Health are funding studies to observe whether any concerns arise for pregnant women who have been given the swine flu vaccine this year.

As someone who's gotten vaccinated along with my wife and children, I was passing along a concern raised by a reader on the Drudge Retort. I've been surprised by the number of people who get the yearly flu shot but have been hesitant to get the swine flu vaccine. The vaccine is currently available in several places here in St. Augustine and Jacksonville, though I have friends and family in Texas and California who can't find it anywhere.

An archived broadcast of the briefing can be viewed on Flu.Gov, which has other resources for people who have questions about the flu pandemic and vaccine. The site has a self-evaluation tool for people who are battling flu-like symptoms and a fraudulent H1N1 products widget that a DHHS official urged bloggers and social networking users to share.

Technorati Tags: influenza A,h1n1,vaccine,swine flu vaccine

When to take a sick child to the ER

Children and youths are especially hard-hit by swine flu. It is important to watch for danger signs, as the onset of respiratory failure can be swift.

For parents worried about a child sick with the flu, deciding when to head to the emergency room can be difficult.
Unlike the typical seasonal flu, which is generally most dangerous to infants and the elderly, the H1N1 strain has hit children, teenagers and young adults unusually hard and with little warning.
The U.S. Centers for Disease Control and Prevention estimated earlier this month that more children have died from the H1N1 flu than people over 65, about 540 children as of mid-October compared to 440 seniors. And the agency recently reported that flu-related pediatric deaths were continuing to rise. An estimated 2,900 adults between 18 and 64 have died. Most years, 90% of people who die of the flu are 65 or older, officials said.
Life-threatening cases, however, remain unusual. As concern grows about the danger of H1N1, doctors also are seeing an uptick in what they call the "worried well," parents who seek emergency care for perfectly healthy children.
So when should you take your child to the emergency room? Doctors say parents and guardians should assess how sick a child is in part based on experience.
"Is there something really different about your child that's different from the seven or eight viral infections your kid gets every year? Those are the changes to look out for," said Dr. Mark Morocco, associate residency director for emergency medicine at UCLA.
Warning signs include significant difficulty breathing; inability to drink fluids or urinate for more than six hours; change in the color of the mouth or lips; or unusual behavioral changes, such as a crying child who cannot be consoled, or a child who doesn't wake up or walk or talk normally.
If any of those symptoms show up in children, parents should take them to the emergency room, Morocco said, noting that "respiratory infections are often things that are the most life-threatening in children."
Lung inflammation is particularly dangerous to infants and young children because their airways are smaller. According to the California Department of Public Health, the flu virus replicates in the airways and lungs, causing them to swell. The inflammation makes it difficult for the lungs to work, reducing the body's ability to take oxygen into the bloodstream.
In California, the most common causes of deaths associated with H1N1 flu have been viral pneumonia and acute respiratory distress syndrome, state health officials wrote in a recent report in the Journal of the American Medical Assn. Experts are telling clinicians to treat the H1N1 strain differently than the seasonal flu.
In a Journal of the American Medical Assn. editorial published earlier this month, former CDC director Julie Louise Gerberding wrote that patients who have a five- or six-day history of flu-like illness and whose ability to breathe is worsening "appear to be at risk for rapid deterioration" and should be treated with antiviral drugs and admitted to the hospital.
"Clinicians should not be falsely reassured by previous good health, young age and absence of major comorbidities because these characteristics do not exclude the potential for respiratory failure and death," Gerberding wrote.
The CDC has also warned that some physicians are not prescribing antiviral drugs to H1N1 patients, pointing to studies that show that about 25% of hospitalized patients with lab-confirmed H1N1 did not receive Tamiflu or similar drugs.
Even among those who did get antiviral drugs, medication was often delayed for one or two days after they were admitted to a hospital, the CDC said. California health officials have also said that antiviral medication can reduce mortality even when given late, which is defined as more than 48 hours after symptoms begin.
Although most people who are hospitalized or have died from H1N1 have underlying medical conditions, a significant proportion of H1N1 victims are otherwise healthy.
"What's surprising about this flu is . . . we're seeing patients between the ages of 10 and 47 with no underlying medical problems that are getting into trouble. And that's scary for us, because it's hard to know who is going to get in trouble," said Dr. Gail Carruthers, director of the pediatric emergency department at Long Beach Memorial Medical Center and Miller Children's Hospital.
Sometimes, patients will report flu-like symptoms for as little as three hours or as long as two weeks, then quickly become significantly worse. Their lungs begin to fail and fill up with fluid, requiring intensive care.
Carruthers recalled two recent patients, a teenager and a middle-aged person, whose lungs began failing even though they had no underlying medical conditions.
"It's almost like watching them drown," Carruthers said. "They feel like they can't get any air." But, Carruthers added, "if you don't feel short of breath, and you have a dry cough, you're probably fine staying at home."

Two more Iowans die from H1N1 flu virus

The Iowa Department of Public Health reported Wednesday that two more Iowans have died from the H1N1 flu virus. Both were adults — one from Floyd County and another from Linn County. Each had risk factors that increased their risk of complications, officials said.
A total of 21 Iowans have died from the H1N1 virus, and more than 600 people have been hospitalized with flu-like illness since Sept. 1, officials said.

The occurrence of H1N1 deaths mirrors Iowa’s population, with all age groups and all major racial and ethnic groups affected. About half the victims were morbidly obese.

While obesity by itself is not a risk factor, morbidly obese people often have underlying conditions that may put them at a higher risk of complications, state officials said.

When Solving H1N1, Flu Facts Are in Short Supply

 

Influenza is a common virus with a long history. Then why do we know so little about it?

There is a joke among flu researchers: "If you've seen one flu season, you've seen…one flu season." The translation, for those not up on epidemiological humor: the joke is wry commentary on the unpredictable nature of the flu virus. Every year it looks different, and every strain follows its own pattern. This is not just a quirk that frustrates scientists—it's the reason new strains like H1N1 are impossible to anticipate and fully prepare for.

"I know less about influenza today than I did 10 years ago," quips Dr. Michael Osterholm, director of the Minnesota Center of Excellence for Influenza Research and Surveillance and a former adviser to the U.S. Department of Health and Human Services. "Every stone we've turned over, we get more questions than we do answers."

The flu returns every season and the world periodically experiences catastrophic pandemics, but epidemiologists still do not understand why some strains evolve to infect people and others do not; they are not entirely sure about how the flu is transmitted; nor do they understand why some patients become fatally ill while others develop minimal symptoms. As a result, when a new strain shows up—like H1N1—they often have little information to fall back on, and the lessons of previous pandemics are only somewhat helpful. While epidemiologists are still putting together a complete picture of H1N1, for example, its most striking difference with the seasonal flu is that the elderly are not the most vulnerable population. And when H1N1 does cause serious illness, patients develop different complications (that are more difficult to treat) than those with seasonal flu. "It's a very different death," says Osterholm.

The Centers for Disease Control currently maintains six different categories of flu-surveillance programs, but has rolled out new measures this year in order to monitor H1N1's most worrying features. The backbone of its routine surveillance systems is not designed to count individual flu cases, but rather to get general indicators of how widespread the flu is and which strains are in circulation. Uncertainty about the fast-moving H1N1 prompted the CDC to begin asking state health departments to report the number of hospitalizations and deaths caused by influenza, and it is still adjusting the methods for calculating the disease's impact. Even the methods for counting the number of those who died of H1N1 is uncertain: on Tuesday, The New York Times reported that the CDC will revise its estimates of H1N1 deaths to 4,000 from 1,200. This revised figure is the result of a new calculation that encompasses fatal cases confirmed via lab tests to have been caused by H1N1, as well as hospital reports of deaths that "appear to have been brought on" by the flu.

H1N1 Destroying UV Wand

While vaccines for the H1N1 flu virus is ready to be used, not all countries are going to get it. Still, the initial fear of catching this potentially fatal virus has somewhat died down, with less and less people being seen wearing face masks these days when outdoors. As for folks who do not want to take the chance, there is the H1N1 Destroying UV Wand from Hammacher to help you out. 

This UV wand eliminates the H1N1 virus from surfaces using safe UV-C light – the same technology trusted to sanitize hospital surfaces. Tests performed by an independent antimicrobial testing laboratory showed the wand destroyed 99.98% of the H1N1 virus after a five-second exposure when held 3/4″ above the contaminated surface. Also capable of killing MRSA, mold, and dust mites, the UV-C light penetrates viral and bacterial membranes and destroys their DNA, rendering the microorganisms incapable of reproduction and survival. Unlike liquid disinfectants, UV-C light can sanitize keyboards, upholstered furniture, cell phones, or any delicate surface that harbors germs. The cordless wand shuts off automatically if the light is turned upward. Operates for 90 minutes after an eight-hour charge via AC.

$69.95 for the H1N1 Destroying UV Wand sure beats paying hefty hospital bills if you were to be admitted, but what are the odds of you catching it? Also, isn’t this a case of being a little too late? We’re pretty sure it might’ve done much better when released at the peak of the virus’ spread.

Illinois reports 12 new deaths from H1N1 swine flu

November 13, 2009 2:36 PM

Illinois is reporting 12 new deaths and 368 new hospitalizations from swine flu in the last week.
Friday's update brings to 48 the number of Illinois swine flu deaths since April. Nearly 1,400 Illinois residents have been hospitalized since the global epidemic began.

Illinois Department of Public Health spokeswoman Melaney Arnold says some health departments have enough nasal spray vaccine, but still need injectable vaccine. The Tribune reported today that Will County health officials have turned away people seeking the vaccine, while more than 8,000 vaccine doses sit unused by neighboring Kendall County's health department.
The state says it is helping coordinate the transfer of unused nasal spray vaccine to areas where it can be used.
More than 1.2 million doses of vaccine have been shipped to Illinois. County health departments have most of them.
The state also is ordering vaccine for doctors serving patients most at risk for complications.

H1N1 has hit the state earlier in the year than regular seasonal flu usually does. The state health department found in the last week of October that the proportion of people with flu-like symptoms visiting outpatient health clinics is four times higher than usual for this time of year.

Nationally, the Centers for Disease Control and Prevention estimated this week that as of Oct. 17, as many as 153,000 people had been hospitalized and as many as 6,200 have died from H1N1.

-- Associated Press, staff

Two die in China after H1N1 Swine Flu vaccination

The government released information on Saturday that two people in China have died after receiving the H1N1 Swine Flu vaccination.

Last week, Digital Journal reported that a Virginia teen was diagnosed with Guillain-Barre syndrome. A German news outlet released information that a French teenage girl was also diagnosed with the paralysis syndrome. Now, according to China Daily, two Chinese people have died from the H1N1 Swine Flu vaccine.

The government issued a statement on Saturday saying that the two Chinese citizens died after receiving a domestically manufactured H1N1 vaccine. A preliminary report concludes that one of the victims suffered a sudden cardiac death, however the results of the second victim are still being processed, reports the Sunday Pioneer.

A spokesperson for the Health Ministry, Deng Haihua, said, according to Channel News Asia, “Specialists say that it is unavoidable that several serious adverse reactions will happen amid the more than 10 million people who have received the vaccine, and the 20, 30, 150 million who will in the future.”

As the Associated Press notes, China’s Health Ministry has stated that 43 deaths have occurred from the Swine Flu and more than 65,000 cases have been reported.

H1N1 has killed 3,900 Americans

A patient is given a H1N1 swine flu vaccination at the University College London hospital. — Reuters pic

 

WASHINGTON, Nov 13 — H1N1 swine flu killed an estimated 3,900 Americans from April to October, including more than 500 children, US health officials said yesterday.

More complete data and more comprehensive calculations than previously released now show that, in the first six months of the pandemic, H1N1 infected an estimated 22 million Americans and put 98,000 in the hospital, the US Centers for Disease Control and Prevention said.

Of these totals, children account for 8 million of the infected, 36,000 of those in hospital and 540 deaths.

“I have already seen a larger number of deaths than we have had for several years,” the CDC’s Dr. Anne Schuchat told reporters. “I do believe the pediatric death toll from this pandemic will be extensive and much greater than what we see with seasonal flu.”

In an average flu season, about 82 children die in the United States, the CDC says. But those are lab-confirmed cases, which Schuchat points out are far lower than the kinds of estimates released yesterday.

For the first six months of this pandemic, 129 US children who died had lab-confirmed H1N1 flu.

The CDC said swine flu is causing the worst flu season in the United States since 1997, when current measurements started.

“What we are seeing in 2009 is unprecedented,” Schuchat said. “Influenza is really serious. The vaccines we have are the best way to protect patients.”

But the vaccines are being produced and distributed slowly. Schuchat said 41.6 million doses were available or had been distributed but this is far below what had been expected.

“Last week we did mention that we had been led to expect about 8 million doses this week,” Schuchat said. “Based on what we have today, we aren’t expecting to meet that estimate that the manufacturers gave us.”

Many things can go wrong with flu vaccine production, Schuchat noted.

The CDC said doctors need to treat cases of severe flu quickly with the antiviral drugs Tamiflu, made by Roche AG, Relenza, made by GlaxoSmithKline, or for severe hospitalized cases, peramivir, made by BioCryst.

But a team of CDC experts said in a report released yesterday that only about 75 per cent of hospitalized patients with laboratory-confirmed pandemic H1N1 get them.

Schuchat stressed that the pandemic is not worsening but noted that it takes time to gather data on flu cases and deaths. Thursday’s count is not an actual reckoning of deaths but is an extrapolation based on detailed data from 10 states.

CDC’s precise count of confirmed flu deaths is 1,265.

“For influenza it’s virtually impossible to find every case with a lab test. So the estimation method we are using now we believe gives a bigger picture, a probably more accurate picture of the full scope of the pandemic,” Schuchat said.

In an average flu season, about 36,000 Americans die and 200,000 are hospitalized. But 90 per cent of these are people over 65.

With H1N1, the opposite is true — 90 percent of those infected and seriously ill are younger adults and children.

And Schuchat pointed out that it is only November. “We have a long flu season ahead of us,” she said. The US flu season usually runs from October to May.

Most of the confirmed flu cases are H1N1 flu and about 30 per cent of people who show up at the doctor’s office and are actually tested for influenza turn out to have flu, as opposed to some other infection. — Reuters

Turkey reports 36 deaths of A/H1N1 flu

ANKARA, Nov. 11 (Xinhua) -- Turkey recorded six more deaths from A/H1N1 flu, bringing the death toll in the country's pandemic to 36, Turkish media reported Wednesday.

    The most recent victims included an infant, the semi-official Anatolia news agency quoted a Ministry of Health statement as saying. The report didn't give further details.

    Turkey has witnessed a fast rise of A/H1N1 flu deaths during the past few weeks.

    Turkey registered the first A/H1N1 flu case on May 15. The first death case was a 28-year-old male hospital janitor in Ankara, who died on Oct. 24.

    Authorities began last week to vaccinate vulnerable groups against the flu, starting from health workers and Muslim pilgrims preparing to travel to Mecca for the annual hajj.

Why parents shouldn't ignore certain H1N1 symptoms

 

• Mary McDermott
• Edited by Hyacinth Williams

INDIANAPOLIS (WISH) - The death of a South Bend girl this week possibly because of the H1N1 virus shows just how serious this illness may be. And it's leading parents to this question: How will I know if this virus is threatening my child's life?

A Fishers doctor 24-Hour News 8 spoke with said there is one very important thing you can focus on; your child's breathing.
"Watch your child's respiratory rate," said Scott Ries, M.D.

Dr. Ries is with the American Health Network practice in Fishers.

"If your child seems to be breathing fast, real labored breathing, that's the biggest thing we're seeing probably in some of these cases - a higher incidence of pneumonia or a bacterial infection on top of influenza virus. For some reason that seems to be happening a little more frequently with this strain of influenza than the typical seasonal influenza,” said Dr. Ries.

A sixth-grader in South Bend, Mercedes Lewis, died Tuesday after being admitted to the hospital Monday morning.

Her symptoms included a sore throat.

The girl reportedly was healthy before Monday, without any other medical complications.

"She was loved greatly by not only me, her uncles, her grandparents; I mean she was greatly loved by everyone," said the girl's aunt.
The Indiana Department of Health reported Tuesday that it was investigating a suspected death from flu-related complications in St. Joseph County.

The health department has not identified the victim.

Dr. Ries told 24-Hour News 8 said he is seeing a lot of cases he suspects are H1N1.

"Probably just in our office about 12 to 15 cases a day; there'd probably be more, but we just don't have capacity for those patients on a daily basis. A lot of calls," Dr. Ries said.
He emphasized the difference between flu symptoms a child will likely work through on his own and those that will likely need medical treatment.

"They're going to have coughing either way, they're going to have some coughing spells, but if they seem okay between the coughing spells and do all right, then they're probably going to do okay,” said Dr. Ries. “But if they have a high fever, a lot of cough, again, get them to the doctor. Let's find out because we can put them on some medicine to shorten that course right now, especially for the children."

So far, four people in Indiana have died from the virus.

Influenza A(H1N1) and your family

Written for BabyCenter Malaysia
Approved by the BabyCenter Malaysia Medical Advisory Board

 

• What is H1N1 flu?
  
• What are the symptoms of H1N1 flu?
  
• How does H1N1 flu spread?
  
• What should I do if my child shows symptoms of H1N1 flu?
  
• Is there any treatment for H1N1 flu?
  
• What can I do to avoid H1N1 flu?
  
• How long will I be contagious if I have H1N1 flu?
  
• Is there a vaccine for H1N1 flu?
  
• Where can I find more information?
  

What is H1N1 flu?

Influenza A(H1N1) is a very contagious respiratory disease. It is also called swine flu because it is a new form of a virus that affects pigs. However, the virus that has caused the current outbreak can also affect people. Usually, people affected by swine flu have been in direct contact with pigs. The reason why there is such concern about the current outbreak of H1N1 flu is that it is now spreading from person to person -- and this is happening in Malaysia, too. That's why the World Health Organisation has raised a worldwide pandemic alert.

What are the symptoms of H1N1 flu?

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H1N1 flu has different effects in different people. Some people who catch the virus only have mild symptoms. But others can develop complications and in extreme cases H1N1 flu can cause death.
The symptoms of H1N1 flu are very similar to regular flu symptoms:
• fever;
• tiredness;
• cough;
• headache;
• muscles and joint pain.
H1N1 flu can also cause:
• acute abdominal pain;
• diarrhoea;
• vomiting.
A fever caused by H1N1 flu can be very high: if you have regular flu, your fever is unlikely to go above 39 degrees C (102.2 degrees F). If you have H1N1 flu it could reach 39 degrees C and higher.

How does H1N1 flu spread?

H1N1 flu spreads from person to person in the same way as other flu viruses: through coughing and sneezing of people who are infected. H1N1 flu is very contagious and spreads easily, particularly in enclosed spaces where there is close contact between infected people and healthy people.
Swine viruses are not spread from eating or preparing pork.

What should I do if my child shows symptoms of H1N1 flu?

Call your doctor and explain what's happening. Tell her how old your child is and whether he, or anyone else in your household, has any other health problems. H1N1 flu can be more severe in people with compromised immune systems. Because the virus is very contagious, your doctor will tell you whether you should go to the clinic or if you should stay at home.
You may be asked to take your child to hospital to have a sample taken from his respiratory system. This will be analysed in order to find out if his symptoms are caused by H1N1 flu.

Is there any treatment for H1N1 flu?

There is no cure for H1N1 flu but antiviral drugs will relieve the symptoms and help you to recover faster. We don't yet know for certain that the antiviral drugs that are used to treat H1N1 flu are safe to take in pregnancy. Your doctor will only suggest treatment if she feels that the potential benefit justifies the possible risk to your baby.

What can I do to avoid H1N1 flu?

Just as with regular flu, there are some things you can do to avoid infection and minimise the spread of the disease:
• Cover your nose and mouth with a disposable tissue when you cough and sneeze, and throw it away after using it.
• If you don't have a tissue to hand, cover your mouth with the inner part of your elbow when you cough or sneeze. This will avoid spreading the infection to your hand and will minimise spreading the disease.
• After coughing and sneezing, wash your hands with warm water and soap. Rub both sides of your soapy hands for at least for 15 seconds and rinse with lots of water. If soap and water are not available, use alcohol-based disposable hand wipes or gel sanitisers.
• Don't touch your eyes, nose or mouth because the germs spread very quickly.
• Wash your hands frequently – the virus can live for up to two hours on surfaces like doorknobs and telephones.
• Eat a healthy diet, including plenty of fresh fruit, vegetables and wholegrain foods – a balance of these will give you minerals and antioxidant vitamins, such as vitamin C, which help to fight infections.

How long will I be contagious if I have H1N1 flu?

If you have the H1N1 flu virus you can be contagious for up to seven days after the start of the illness. Children, especially younger ones, may be contagious for longer periods.

Is there a vaccine for H1N1 flu?

Not at the moment. Researchers are working on an effective vaccine for H1N1 flu but it will take several months to produce. We do not yet know if it will be offered to pregnant women. During pregnancy it's not usually recommended that you have a flu vaccine unless your doctor advises you otherwise or you are a healthcare professional working directly with patients.

Where can I find more information?

You can call the Health Ministry's information hotline, 03-88810200 or 03-88810300.
Read more about H1N1 flu in pregnancy.

Novel H1N1 Influenza A Swine Flu

What is swine flu (novel H1N1 influenza A swine flu)?

Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans. Unfortunately, this cross-species situation with influenza viruses has had the potential to change. Investigators think the 2009 swine flu strain, first seen in Mexico, should be termed novel H1N1 flu since it is mainly found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type1). Recent investigations show the eight RNA strands from novel H1N1 flu have one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains.

Why is swine flu (H1N1) now infecting humans?

Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans.

First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus (see Figure 1). It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes in an individual RNA segment in flu viruses are termed antigenic drift and result in minor changes in the virus. However, these can accumulate over time to produce enough minor changes that cumulatively change the virus' antigenic makeup over time (usually years).

Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a "mixing pot" for flu RNA segments (see Figure 1). Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment and seem to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.

Figure 1.