Symptoms of Swine Flu

This information is for pregnant women who work in jobs where they are more likely to be exposed to people with confirmed, probable, or suspected novel H1N1 virus infection.

Schools and Child Care Workers

Pregnant women working in school settings (e.g. teachers, day care workers) should follow the same guidance as nonpregnant school workers and the general public.

H1N1 Flu (Swine Flu) and You
Guidance for Schools K-12 
Alert for institutions of higher learning

Health Care Workers

All health care workers in direct patient care, including pregnant women, should follow standard precautions with all patients, regardless of infection status (http://www.osha.gov/Publications/OSHA_pandemic_health.pdf, page 15). 
Health care workers treating patients with suspected or known illness easily transmitted by contact, droplet, or airborne transmission (e.g. influenza viruses) should do a risk assessment to determine the type of transmission-based precautions needed. Contact, droplet, or airborne precautions may be indicated (http://www.osha.gov/Publications/OSHA_pandemic_health.pdf, pages 16-17).

Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage.

If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza, including the following procedures:

• Endotracheal intubation
• Aerosolized or nebulized medication administration
• Diagnostic sputum induction
• Bronchoscopy
• Airway suctioning
• Positive pressure ventilation via face mask (e.g., BiPAP and CPAP)
• High-frequency oscillatory ventilation

Guidance on pre-exposure and post-exposure chemoprophylaxis with antiviral agents, including for pregnant women

For additional guidance for health care providers please see guidelines on infection control.

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Should you strap on a face mask, keep your kid off the schoolbus, or start an emergency food stash? Here, the panicky woman’s guide to navigating the swine flu hype.

After a few days of non-stop swine flu coverage, many of us are starting to feel a bit panicky: Is this just media hype, or should we really be worried? Is there anything else I should be doing to keep my family safe? After all, when Vice President Joe Biden declares he’s told his family to stop flying and avoid subways because of swine flu fears, why shouldn’t you do it too?

To find out what’s really worth the worry—and what’s a waste of your time—we talked Dos and Don’ts with Myron S. Cohen, MD, director of the Institute of Global Health and Infectious Disease at UNC Chapel Hill. “Overall, it’s about doing what makes you comfortable, as long as it’s not crazy,” he says. Here’s what else he had to say:

DO:

Germ-proof your skin: Wash your hands well and often. Not every 10 minutes, but when it makes sense, like after using the bathroom, touching common objects at work—like the microwave or printer—or returning home from the grocery store. Use warm water and soap, and rub your hands together for about 20 seconds.

Pack Purell in your kid’s backpack: The classic germ-killer can be 99% effective in 20 seconds, says Cohen. Slathering it on throughout the day can minimize the chance that your child will transmit potential germs on his hands to his mouth and nose, where the virus enters the body. Keep a bottle in your purse too.

Keep your distance. ”Critical closeness—less than 6 to 10 feet—is required to catch airborne viruses,” explains Cohen. That means avoiding close contact with people who are coughing or sneezing, but it doesn’t mean you should hole up at home and never go out in public until the swine flu passes.

Call the doctor if you think it’s flu. ”Some people think everything that’s an infection is the flu, but there’s actually a very specific cluster of symptoms to worry about,” he says. These include:

• Almost always: Fever, cough, muscle aches, and headaches
• Sometimes: Runny nose, red eyes, nausea and vomiting

 Take the right meds: Antivirals like Tamiflu will only help if you actually have the flu. They’re most effective in the first 2 days of illness onset, so if you have suspicious symptoms, call your doctor right away. Your doctor may also recommend a fever-reducer like Tylenol or an NSAID like ibuprofen for muscle pain relief.

Remember, never give aspirin to children or teens with the flu (or any virus); this can cause a rare but serious condition called Reye’s Syndrome.

DON’T:

• Skip public transportation or cancel air travel: ”I think this is going overboard for right now,” says Cohen, despite VP Biden’s advice to the contrary. “Remember, at this point only .0001% of the population has swine flu.”

• Keep your kid out of school. Schools with individual cases are being closed. If you live in a community or state with no instances of swine flu, there’s no need to keep your child home.

• Banish the schoolbus. Wondering whether it’s safer to chauffeur your child to school yourself? Don’t feel like you have to, says Cohen. “If it makes you feel more comfortable, there’s no downside, but this not something I’d recommend yet.” 

• Stock up on face masks. The CDC has said they’re not necessary for people who don’t work in healthcare jobs, and Cohen agrees. “Wear a face mask if you have swine flu, so the virus is contained better. For the rest of us, you’re much better off just focusing on hand washing and avoiding people who are visibly sick.”

• Start an emergency food and water stash. ”That is crazy, crazy, crazy,” he says. “You have to be rational about this. There’s no evidence that we are going to have influenza so vast and out of control that we have to shut down grocery stores. There is nothing to support this.”

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Mexico began an unprecedented nationwide lockdown today after the government ordered most of the economy to be shut down and for people to stay indoors for five days.

The nation of 111 million people will grind to a halt until 5 May in an effort to stifle the spread of swine flu, which is on the brink of becoming a global pandemic.

“There is no safer place than your own home to avoid being infected with the flu virus,” Felipe Calderón, Mexico’s president, said in a television address.

Shutting down government offices and businesses not essential to the economy was a painful but vital step towards preventing further infections, he said. “I know many of you have had to suspend your activities and may have seen your earnings fall but it is worth it if we can look after the health of our loved ones and protect Mexico from this evil,” he said.

Functions such as transport, policing, supermarkets and hospitals will continue but otherwise the country will largely come to a standstill. It is already operating at half-strength since earlier this week when schools, cinemas, restaurants, gyms and other services were closed or access to them was heavily restricted.

Celebrations for Dia del Nino, Day of the Child, have been cancelled today.

Such drastic measures were needed to break the reproductive cycle of the virus, the health minister, José Ángel Córdova, said.

At least 12 deaths in Mexico have been confirmed as being caused by swine flu, although authorities suspect that the actual figure is closer to 180. Many of the deaths occurred before proper tissue samples were taken. Last night health authorities revised official figures of swine flu cases, confirming 300 diagnoses among a total of 679 people tested so far.

The shutdown will be painful for Mexico’s economy, which is already suffering from recession and a bloody drug war. Central bank analysts suggest the economy may have shrunk by as much as 8% in the first three months of the year, compared to the same period in 2008.

The peso weakened sharply against other currencies after the government announced the new emergency measures.

Flu is costing the capital £59m a day, according to the mayor, Marcelo Ebrard, and unemployment could rocket if temporary lay-offs become permanent.

Tourism, worth 8% of Mexico’s GDP, has evaporated. Several countries in the region have cut or restricted flights to and from Mexico and the EU could follow suit at the behest of France.

Cancún airport has been flooded by tourists trying to get out. The state of Quintana Roo, where Cancún is located, has yet to report cases of swine flu but several tourists were found to be infected after returning home. Archaeological sites have been shut.

Surgical masks have become so ubiquitous that even a major drug trafficker, Gregorio Sauceda Gamboa, alias El Caramuela, who was captured on Wednesday, was pictured wearing one, surrounded by heavily armed federal police wearing theirs.

Supplies of masks are running out, prompting newspapers to publish diagrams and instructions to make homemade ones from cloth.

The announcement of the shutdown was Calderón’s first address since the crisis broke. He has been criticised for staying out of public view while his government battled the epidemic.

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WASHINGTON - U.S. authorities are pledging to eventually produce enough swine flu vaccine for everyone but the shots couldn’t begin until fall at the earliest.

Worries about the spread of the virus mounted Thursday as the nation’s swine flu caseload passed 100, and nearly 300 schools closed across the country. Federal officials had to spend much of the day reassuring the public it’s still safe to fly and ride public transportation after Vice President Joe Biden said he wouldn’t recommend it to his family.

Clinics and hospital emergency rooms in New York, California and some other states are seeing a surge in patients with coughs and sneezes that might have been ignored before the outbreak.

Scientists were racing to prepare the key ingredient to make a vaccine against the new flu strain, in case it is ultimately needed. But it will be several months before the first batches begin human testing to ensure the vaccine is safe and effective. If all goes well, broader production could start in the fall.

“We think 600 million doses is achievable in a six-month time frame” from that fall start, Health and Human Services Assistant Secretary Craig Vanderwagen told lawmakers.

“I don’t want anybody to have false expectations. The science is challenging here,” Vanderwagen told reporters. “Production can be done, robust production capacity is there. It’s a question of can we get the science worked on the specifics of this vaccine.”

Until a vaccine is ready, the government has stockpiled anti-viral medications that can ease flu symptoms or help prevent infection. The medicines are proving effective.

An estimated 12,000 people logged onto a Webcast where the government’s top emergency officials sought to cut confusion by answering questions from the public: Can a factory worker handling parts from Mexico catch the virus? No. Can pets get it? No.

And is washing hands or using those alcohol-based hand gels best? Washing well enough is the real issue, answered Dr. Richard Besser, acting chief of the Centers for Disease Control and Prevention. He keeps hand gel in his pocket for between-washings but also suggested that people sing “Happy Birthday” as they wash their hands to make sure they’ve washed long enough to get rid of germs.

Although it is safe to fly, anyone with flu-like symptoms shouldn’t be traveling anywhere unless they need to seek medical care.

The swine flu outbreak penetrated over a dozen states and even touched the White House, which disclosed that an aide to Energy Secretary Steven Chu apparently got sick helping arrange President Barack Obama’s recent trip to Mexico. But Chu did not fly on Air Force One and never posed a risk to the president.

So far U.S. cases are mostly fairly mild, with one death, a Mexican toddler who visited Texas with his family — unlike in Mexico, where more than 160 suspected deaths have been reported. Most of the U.S. cases so far haven’t needed a doctor’s care, officials said.

Still, the U.S. is taking extraordinary precautions — including shipping millions of doses of anti-flu drugs to states. The World Health Organization is warning of an imminent pandemic because scientists cannot predict what a new virus might do. A key concern is whether this spring’s outbreak will reappear in the fall.

The CDC confirmed 109 cases Thursday, and state officials confirm 22 more. Cases now are confirmed in New York, Texas, California, South Carolina, Kansas, Massachusetts, Indiana, Ohio, Arizona, Michigan, Nevada, New Jersey, Delaware, Maine, Colorado, Georgia and Minnesota.

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The World Health Organization (WHO) has officially confirmed 331 cases of influenza A (H1N1), the technical name for the virus commonly known as swine flu, in 11 countries.

The United States has reported over 120 laboratory confirmed human cases, including one death. Mexico has reported 312 human cases of infection, including 12 deaths. The difference in some reported figures and those of the WHO may be down to the fact that not all countries have had all their cases confirmed by the global body.

Laboratory confirmed cases with no fatalities were reported in Austria (1), Canada (34), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8).

The WHO raised its alert level for a swine flu pandemic from 4 to 5, one step short of a full-scale pandemic on Thursday.

Although the illness has so far claimed few lives, the outbreak has sparked a number of dramatic media reports suggesting future death tolls “could” be in the tens of thousands or even millions.

The global health body also said well-cooked pork and pork products carry no risk of infection from the virus.

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Wellington, May 1, More than 400 New Zealanders were in voluntary isolation Friday in an effort to limit contacts with potential victims of the influenza A(H1N1) strain which Health Minister Tony Ryall insisted he would keep calling swine flu because the public understood the term.

Ryall said four people had been confirmed with the disease and another 11 were probable victims, having tested positive for influenza A.

Another 121 were suspected cases of people displaying flu symptoms who have been to Mexico or North America recently.

The remainder were identified by officials as people in voluntary isolation and taking Tamiflu antiviral medication because of contact with suspects.

“I suspect those numbers will continue to rise,” Ryall told Radio New Zealand, pointing out that the country was entering its normal winter influenza period.

The numbers included 26 students in a New Zealand college orchestra and four teachers being treated as suspected victims after some developed flu-like symptoms when they returned from a trip to North America, including California.

The Lindisfarne College in Hastings sent most of the boys home but a number of boarding pupils were put into isolation at the school’s hostel, the Hawke’s Bay District Health Board said.

All were offered Tamiflu antiviral medicine and samples taken to test whether they have contracted the influenza A(H1N1) strain.

Cabinet Minister Nick Smith was cleared of swine flu Friday after testing positive for influenza A. He had gone into voluntary isolation and was taking Tamiflu as a precaution after developing a “wicked fever” on return from his honeymoon somewhere in Asia. The exact location of his trip was not disclosed.

Health officials said that all known cases were showing symptoms “around the mild end of the spectrum” for influenza.

New Zealand pharmacies were allowed to start selling Tamiflu without requiring a doctor’s prescription for the first time Friday, but only to people showing flu symptoms and buying it in person.

The health ministry rejected pharmacists’ claims that this risked spreading the disease and said it wanted to avoid panic buying which would run down stocks and create a black market for the product.

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Based on new information on circulation of a new influenza A (H1N1) virus among people in the US and Mexico first detected in April, 2009, this document provides updated interim planning guidance for State, territorial, tribal, and local communities.  This guidance includes recommendations on school dismissal for K – 12 schools and closure of childcare programs and facilitiesand updates previously issued guidance on community mitigation interventions for this disease (April 28, 2009,http://www.cdc.gov/swineflu/mitigation.htm).  School dismissal and childcare closures are an important part of a comprehensive, layered mitigation approach aimed at reducing disease transmission and associated morbidity and mortality during the 2009 H1N1 virus outbreak in the US. 

The goals of these strategies are to slow the spread of the disease in a community to 1) delay the peak of the disease in order to “buy time” for the production and distribution of a vaccine against this new virus, 2) decrease the number of people who get sick from this virus in a given community, thus reducing the “surge” on healthcare systems, and 3) reduce the total number of people who get sick or die.

It is prudent for communities to act based on available information to protect their citizens. These community mitigation interventions are scalable and flexible so that local public health authorities, working with their partners in a given State or community can use these tools based on the local situation. As public health officials in the United States learn more about this emerging virus, CDC will be reviewing these findings on a daily basis and updated guidance will be issued in conjunction with our State, local, tribal and territorial partners.

Schools play a critical role in protecting the health of their students, staff, and the community from contagious diseases such as H1N1 influenza.  Children are very susceptible to getting this new virus and schools may serve as amplification point for spread of this new virus in a community. The reason for closing schools during this H1N1 outbreak is to try to reduce the spread of the virus.  However, little information is available on what the effectiveness of a school closure might be in preventing further community spread of this new virus.  In addition, the risk of severe illness from this virus is not yet clear.

The authority for decisions regarding school dismissal and childcare closure may vary and resides in different sectors of State and local government including School Superintendents, Mayors, Governors, emergency management officials, and public health officials.

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CDC recommends that affected communities with laboratory-confirmed cases of influenza A (H1N1) virus infection consider activating school dismissal and childcare closure interventions according to the guidelines below.  “Affected communities” may include a U.S. State or proximate epidemiological region (e.g., a metropolitan area that spans more than one State’s boundary).  These guidelines address a flexible and scalable approach that States and local jurisdictions can use based on the situation in their communities (e.g. number of cases, severity of illness, affected groups).

Recommend Scalable and Incremental School Dismissal and Childcare Facility Closure in Affected Communities:

School districts must work closely and directly with their local and State public health officials to make sound decisions and implement strategies in a coordinated manner keeping in mind:

1.    Decisions to dismiss students and close childcare facilities and subsequent implementation of those measures should be made based on the extent and severity of illness;
2. That local authorities decide whether or not to dismiss schools or close childcare facilities; and;
3. That authority for decision-making may reside in multiple sectors of State and local government; these entities must be well coordinated.

Interim Recommendations

• Sick people (students, faculty and staff) should stay home unless they need to seek medical care and stay away from schools regardless of whether schools and childcare facilities are operating normally or have dismissed students or closed, respectively.
• Dismissal of students in a school and closure of childcare facilities should be considered in schools with one or more laboratory-confirmed or non-subtypable influenza A case among students, faculty or staff in order to decrease the spread of illness in the community.
• Dismissal of students from schools and closure of childcare facilities should be considered for a school district or part of a school district (e.g., a feeder school network or a geographic area) if more than 1 school in that district has confirmed or non-subtypable influenza A cases among their students, faculty or staff.  This would include pre-emptively dismissing students from schools in that district, including schools without current laboratory-confirmed cases.
• Neighboring school districts to those that dismiss students should also consider pre-emptively dismissing students from schools without current laboratory-confirmed cases. Issues to consider include geographic proximity and extent of mixing of student populations across district lines.  
• If a school dismisses students or a childcare facility closes, school or childcare related gatherings should also be cancelled.  Parents and students should be encouraged to avoid congregating in large numbers outside of the school setting.

If a school dismisses students or a childcare facility closes, schools and childcare facilities should dismiss students for a minimum of 14 days. Schools, in consultation with local and State public health officials, should evaluate daily the need for possible extension of the dismissal/closure based on local influenza surveillance information, and the occurrence of new infections and severity of illness in the community from this virus. This length of time is recommended because children are likely to be infectious for about 7 – 10 days after the onset of illness

To reiterate an important point, decisions regarding school dismissal within these communities are being left to the appropriate authorities but must involve consultation with local and State public health officials, taking into account the extent and severity of H1N1 disease in the community. Schools (K – 12) and childcare facilities should also consult with their local or State health departments for guidance on re-opening schools. When schools re-open, keep commonly touched surfaces such as stairway railings, elevator buttons and door handles clean by wiping them down with detergent-based cleaners or EPA registered disinfectants that are usually used in the school setting.  These products should be used according to directions on the product label.  Additional, extensive cleaning of schools by wiping down floors and walls prior to reopening is not necessary as it is unknown whether this would be helpful in decrease the spread of influenza.   

If students are dismissed from schools, they should be encouraged not to re-congregate outside of school in large numbers. If childcare facilities close and there is a need for childcare, families could plan to work together with two to three other families to supervise and provide care (using the same caregivers each day) for a small and consistent group of infants and young children while their parents are at work (studies suggest that childcare group size of five or fewer children may be associated with fewer respiratory infections). 

Schools and childcare facilities in unaffected areas should begin to prepare for the possibility of school dismissal or childcare facility closure. This includes asking teachers, parents and officials in charge of critical school-associated programs (such as meal services) to make contingency plans. Parents should plan for caring for children who may be dismissed from schools, as these decisions may be made very quickly based on emerging disease in the community.

For more information see: http://www.cdc.gov/h1n1/

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The situation continues to evolve rapidly. As of 06:00 GMT, 1 May 2009, 11 countries have officially reported 331 cases of influenza A(H1N1) infection.

The United States Government has reported 109 laboratory confirmed human cases, including one death. Mexico has reported 156 confirmed human cases of infection, including nine deaths.

The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (34), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8).

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.

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