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Questions and Answers about H1N1

2009 H1N1 (swine flu) Questions and Answers

What is the 2009 H1N1 virus?
The 2009 H1N1 virus is a new influenza virus that is causing illness in people. This virus is spreading from person-to-person worldwide, much the same way as the seasonal flu. The first case in the United States appeared in April. By June, the virus had spread around the world, and the World Health Organization therefore signaled that a pandemic of 2009 H1N1 was under way.

How is the 2009 H1N1 virus spread?
2009 H1N1 spreads in the same way that seasonal flu spreads, mainly from person-to-person through coughing or sneezing. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What is the incubation period from exposure to sickness?
Normal incubation - the time from exposure to symptoms - is usually from one to four days.

How severe have the cases been?
Occasionally any form of influenza can be serious. The cases of 2009 H1N1 influenza seen both nationally and at University of Missouri Health Care have been no worse than the seasonal flu.

What are the signs and symptoms of H1N1 influenza?
Like regular seasonal influenza, onset is often abrupt. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. Like seasonal flu, 2009 H1N1 may be more severe in infants and in people with underlying chronic medical conditions.

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
  • Symptoms that 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 long does the illness last?
Symptoms usually last about three to five days. Anti-viral medications are most effective if taken within the first 48 hours of onset of the illness.

 What if I have influenza symptoms now?

  • As with influenza under ordinary conditions, follow good hand hygiene, including using hand sanitizer gels and washing your hands
  • Cough or sneeze into a tissue or your sleeve
  • Avoid crowds and immune-compromised persons
  • Stay home if possible
  • Seek medical help as symptoms warrant
  • Health experts advise not going to work if you have flu symptoms
  • Health care workers should stay home from work until 24 hours after their fever (100°F or higher) is gone without the use of fever-reducing medications  

What medications are available to treat 2009 H1N1 influenza infections in humans?
There are two anti-viral medications available to treat the 2009 H1N1 strain of influenza, oseltamivir (Tamiflu, taken by mouth) and zanamivir (Relenza, taken by inhalation). MU Health Care facilities have these anti-viral medications available, plus ready access to the emergency state stockpile. 

Is 2009 H1N1 virus resistant to Tamiflu?
For now, Tamiflu remains an active anti-viral medication for treating the 2009 H1N1 strain of influenza.

Is there a vaccine for 2009 H1N1 available?
The U.S. Food and Drug Administration has approved vaccines against the 2009 H1N1 influenza virus. These vaccines are being distributed nationally with certain high-risk groups of people receiving the 2009 H1N1 vaccine first. Each week, more vaccine becomes available. We expect there will be H1N1 vaccine for essentially everyone who needs or wants to have it by mid-December.

Who should receive the 2009 H1N1 vaccine?
The Centers for Disease Control and Prevention (CDC) has recommended that certain people receive the 2009 H1N1 vaccine when it first becomes available. These key populations include pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel, persons between the ages of 6 months and 24 years of age, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems. The next group is people who live with or care for children under 5 years old and people over 64 years old. The final group is any people who wish to protect themselves against 2009 H1N1 influenza.

Is the H1N1 vaccine different from the seasonal flu vaccine?
The 2009 H1N1 influenza vaccine is made in the same way, in the same manufacturing facilities and with no new additives. It is different from the seasonal flu vaccine only because it protects against 2009 H1N1 and not seasonal strains, which may appear later in the winter. Conversely, the seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu.

When will a vaccine for 2009 H1N1 be available?
Both seasonal flu vaccine and the 2009 H1N1 vaccine are available now, although supplies still are sometimes limited.

Will there be a shortage of the 2009 H1N1 vaccine?
The shortage is lessening as more 2009 H1N1 vaccine is produced and made available in greater amounts. Seasonal influenza vaccine supplies have been limited at times because the demand has been high.

Are there any side effects known from the 2009 H1N1 vaccine?
Potential side effects of the 2009 H1N1 vaccine are expected to be similar to those of seasonal flu vaccines, which may include soreness at the injection site.

Should older people get the 2009 H1N1 vaccine?
People older than 65 are at a lower risk of getting infected with 2009 H1N1 than younger persons. As a result, older adults are a lower priority for receiving the 2009 H1N1 vaccine. Studies have shown they already have immunity to the virus, probably through previous exposure to a similar flu virus. However, they should still receive their yearly pneumonia and seasonal flu vaccines and may consider receiving the 2009 H1N1 vaccine now that more supplies have become available.

Where can I get the 2009 H1N1 vaccination?
You should consult your physician or health care provider. Health departments have been offering special immunization days. It is expected that health care workers will receive the vaccination from their employer.

Who should get the seasonal flu vaccine?
The seasonal flu vaccine is recommended for anyone who wants to reduce their risk of getting seasonal flu. There are two types of seasonal flu vaccines. The "flu shot" is given with a needle (usually in the arm) and is approved for people older than six months, including healthy people and people with chronic medical conditions. The nasal-spray flu vaccine is approved for use in health people ages 2-49, who are not pregnant.

What can I do to protect myself from getting sick?

  • Practice good hygiene and avoiding exposure are the best preventive methods
  • If you have a tissue, cover your nose and mouth with it when you cough or sneeze. If not, sneeze or cough into your sleeve, instead of your hand
  • 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 that way.
  • If you get sick, the CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them
  • Health care workers should stay home from work until 24 hours after their fever (100°F or higher) is gone without the use of fever-reducing medications 

Is MU Health Care monitoring the situation?
Yes. MU Health Care infection control experts and emergency preparedness officials on campus are monitoring the situation and planning strategies to deal with an unexpectedly large 2009 H1N1 influenza outbreak if that were to occur in central Missouri.

University of Missouri Health Care coordinates with local, county and statewide health organizations in developing a preparedness plan for any public health threat. This preparedness plan is not limited to the 2009 H1N1 virus. The coordination efforts include personal protection plans for preventing the spread of disease, vaccine distribution, flu testing, personal protective equipment and assuring adequate facilities and staffing. These plans are updated regularly and kept flexible to accommodate changing situations.

Where can I get more information on 2009 H1N1?
For up-to-date state and national information and guidelines, please visit http://www.dhss.mo.gov/BT_Response/_SwineFlu09.html and http://pandemicflu.gov/. E-mails are welcome to Michael Cooperstock, MD, MPH, medical director of MU Health Care's Infection Control Department, at cooperstockm@health.missouri.edu.

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