Swine Influenza (Swine Flu) H1N1 Outbreak

Update: 14th October 2009

I have had phone calls about this, so I am moved to comment on the email etc going round re the Swine Flu Vaccine …implying there is a conspiracy to poison the population, decrease our IQ etc etc with thimerosol ( spelled wrongly) and Squalene which are in the vaccine etc etc

In my view this email is grossly misleading and inflammatory (to put it politely!)

I wont go through every point of the email however a few points to consider

1. Thiomersal in the swine flu vaccine

Thiomersol is a compound used as a preservative in the vaccine. It is not mercury. It is certainly NOT the mercury compound that persists in the body and causes toxic effects.

The dangerous chemical is methylmercury. The vaccine contains a type of ethyl mercury.

Yes thiomersal does contain a mercury atom in the molecule, but we know that atoms behave differently depending on what they are bound to.

For example; Oxygen is flammable. Water has an OXYGEN molecule in the atom ( H2O) but water is NOT flammable like oxygen, because the oxygen behaves differently in a compound molecule.

Another analogy would be the arsenic in prawns – there is a type of asenic in prawns. ( If I need to do heavy metal screening on a patient, I have to request patients avoid eating prawns for several days prior to the test or they return a positive result. ….) Any of your friends have arsenic poisoning from prawns lately?

Here is the full report form the Wold Health Organisation for those who want the details.

2. Squalene in the swine flu vaccine?

Squalene is a naturally occurring substance found in plants, animals, and humans. It is manufactured in the liver of every human body and circulates in our bloodstream. Squalene is also found in a variety of foods, cosmetics, over-the-counter medications, and health supplements.

THERE IS NO SQUALENE IN THE AUSTRALIAN VACCINE

For the record, the Report on Squalene from World Health Organisation.

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Update: 1st October 2009

Australia has begun the national immunisation program against the 2009 H1N1 Influenza (swine flu). The vaccine is called Panvax.

Our flu season is basically finished, but swine flu is likely to continue spreading in Australia even in summer (as it has done in the northern hemisphere).

The World Health Organisation has announced the strains to be included in the 2010 southern hemisphere vaccine. Next years vaccine will include the swine flu strain, along with two other common influenza strains. This does not affect the current rollout of single strain swine flu vaccine to the population of Australia. The more people that have the vaccine now, the less the disease will be able to spread in this country. This will mean less illness and death.

Panvax is recommended for persons:

• with chronic medical conditions of chest, heart, kidneys, blood or nervous system, or
• who are immunosuppressed, overweight or pregnant
• who have diabetes, asthma, or cancer
• who work in the health care industry
• who are travelling into the northern hemisphere – their flu season is just beginning
• if they want to avoid getting this strain of influenza.

Panvax is only suitable for persons aged 10 and over. The vaccine is given in the top of the arm and a single dose only is required which will last until the strain changes (perhaps a year).

Panvax is made in the same way as the regular flu vaccine – the seed virus is just a different ‘shape’. The vaccine is a dead vaccine so it cannot give you the flu.

The most common side effect is a sore arm. Current and ongoing trials show the side effects are the same as the regular flu vaccine.

If you have already had swine flu confirmed, you do not need the vaccine, however if you have had the swine flu disease and did not know, and receive the vaccine, it will not hurt you ( but it is not necessary).

Panvax is available now free for all Australians who wish to receive it. Panvax is available in multi-dose vials so you may need to attend the clinic at a set time.

Please contact us to make an appointment if you would like to organise to have the vaccine or discuss with our doctor whether Panvax is recommended for you.

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Update: 24th July 2009

TOP 10 SWINE FLU TIPS

Now that the flu season has arrived, it is not surprising this new swine flu is spreading so quickly. We can all do our bit to stop the spread.

• Wash your hands – / Carry hand sanitiser. Wash hands after using public amenities, after the toilet and especially before touching your face or eating. The influenza virus can survive 2 days on surfaces. A common way to catch the flu is by touching something that has been coughed or sneezed upon by an infected person. For example, someone who used the shopping trolley before you may have had the flu.
• Carry tissues. Have tissues with you at all times. Cough or sneeze into tissues or hankies. If you get caught without them, cough into your elbow. Tissues are easy because they can be used once and thrown straight into the bin. Hankies are okay but after one use must be washed in hot water.
• Cover your cough. If you are in public, and you are coughing you should wear a mask. This will stop the disease spreading Masks are not very helpful at preventing influenza. Using a mask incorrectly may increase the risk of a well person catching the disease, rather than reduce it.
• Phone your doctor if you get sick. If you have sudden onset of a fever of over 38 degrees C, with cough, tiredness and lack of appetite then phone your doctor. If you have difficulty breathing as well, phone your doctor urgently, or go to the nearest casualty department. It is not possible to test everyone for swine flu at the present time as the labs are overwhelmed. Do not arrive at your doctors without calling first.
• Observe quarantine rules; stay at home if you are sick and keep children home if they are sick. Quarantine means staying home from work or school, avoiding public transport, the shops, the movies, the ekka, meeting friends at their house etc etc. This quarantine should last for 7 days if you have swine flu symptoms, and have not taken medication. For persons who have taken Tamiflu and are now without a fever, the recommended quarantine is for 3 days (6 doses of Tamiflu).
• Go home immediately if you become sick. The virus can spread even before you get symptoms but it spreads much more once you start coughing the virus into the environment. Quarantine yourself somewhere while you wait for transport. Surfaces you have coughed on should be cleaned.
• Avoid crowds if you have medical problems. Persons with medical problems should not expose themselves to crowds eg go to the exhibition (ekka) as the virus will be spreading there and you are more likely to get severe disease if you get swine flu ( or other flu)
• Only use antiviral drugs if prescribed by your doctor. Beware of internet purchases of antivirals, it is easy to receive fake drugs, risk your health and waste your money.
• Have the regular influenza vaccine – it wont stop swine flu, but will stop you looking like you have swine flu.
• Eat as much pork as you like! You cannot catch swine flu from properly cooked pork. The human swine flu virus is not circulating in pigs.

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Update: 11th June 2009

Why is Swine flu such a big deal in Australia at the moment ?

The flu season in the southern hemisphere is now winter. In Australia, flu usually peaks in July and August, so it is not surprising this new flu is spreading quickly. Also because it is new, people do not have background immunity to it, so it spreads more quickly. New viruses can behave unpredictably so it is hard to predict the path of this virus, which adds to uncertainty and worry. Fortunately, for the moment, this new strain is not life threatening for most people.

How serious is swine flu?

This is a new virus, so the authorities have to take it seriously just in case, because we are not sure how it will behave. In most people, the disease is mild. Australia has now has more than 1200 confirmed cases of swine flu. This compares to normal flu, where there are about 10,000 confirmed cases in Australia per year. About 2500 Australians tragically die every year from ‘normal’ influenza and its complications. Fortunately, there have been no deaths in Australia yet from human swine flu.

Why do some people get hospitalised with swine flu?

We currently do not know what kinds of underlying factors lead to fatal illnesses. Reports on 30 persons in the US who were hospitalised with swine flu showed most were admitted with pneumonia and dehydration. Two thirds had underlying medical problems like chronic lung disease, asthma, heart disease, diabetes, obesity. Five were pregnant. Their ages ranged from 27 days to 89 years. Most previously healthy patients recovered without complications in about 2.5 days.

How do I catch influenza?

Aside from being coughed or sneezed upon by an infected person, the most common way to catch the flu is by touching something which has been coughed or sneezed upon by an infected person. For instance, the person that used the shopping cart before you had the flu. They covered their mouth with their hand when they coughed, then used that hand to push the cart around the store. You touch the handle, and then without thinking while shopping, you rub your eye or nose the virus enters your body.

Does the current normal flu vaccine protect against this new swine flu virus?

No, However there is some intriguing research which has found some adults with partial background immunity to the new swine flu virus especially in persons aged >60 years. One possible explanation is that these people may have had exposure to an earlier influenza A virus or even an older vaccine that happened to be closely related to the new swine flu virus. This may be why older persons have been shown to be a little less affected by this virus, than in ‘normal’ flu.

Should I have a regular flu vaccine ?

Yes. There is no specific vaccine for swine flu yet. The normal flu vaccine does not protect against swine flu but is 80% effective against normal seasonal flu. Normal influenza is an inconvenient disease, which can be serious in anyone with medical problems, pregnant women and young children. Developing flu like symptoms at the moment can cause a drama even if it is normal flu.

When will there be a swine flu vaccine?

The vaccine will not be available for at least two months. Two doses may be required to ensure protection. Millions of eggs are needed to grow the swine flu virus for vaccine manufacture. A farm based near the fire-ravaged town of Kinglake West, northeast of Melbourne, has 170,000 hens that supply 150,000 eggs a day to CSL. This Australian company has won orders for tens of millions of doses of vaccine for home and abroad.

What about masks and the swine flu?

Masks are most useful if you are sick. They prevent accidentally coughing or sneezing into the environment. Masks are not very useful for prevention of influenza. Using a mask incorrectly may actually increase the risk of catching the disease, rather than reduce it. This is because masks are hard to use correctly and rather impractical. Good handwashing practices are much more important.

If you sneeze or cough. which is better to use? tissues or handkerchiefs?

The most important thing is cover your cough or sneeze. Either tissues or handkerchiefs are OK , provided they are used correctly. Tissues are easy -use them once and throw them directly into the bin. Handkerchiefs are fine, but they should be used once and then washed in hot water. Influenza can be transmitted by particles in the environment.

What about antiviral drugs such as Tamiflu and Relenza?

This new human swine flu is currently sensitive to these anti-viral medications. These drugs are prescription only, and currently used for treatment rather than prevention. BEWARE of internet purchases of anti-virals, it is very easy to receive fake drugs, risk your health and waste your money. Also be aware that 20% of persons taking tamiflu will vomit severely with the first dose.

What symptoms do I need to watch for??

The symptoms of swine flu are similar to the symptoms of regular human seasonal influenza and include:

• fever,
• cough
• tiredness,
• lack of appetite

Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea. If you develop a fever over 38°C and a cough, you need to phone your doctor. They will organise a test and treatment if necessary.

Will travel restrictions limit this pandemic?

It may be surprising, but travel restrictions have no place in reducing pandemic spread. This has been clearly demonstrated by extraordinarily detailed mathematical modeling, and provides the scientific basis for the decision by WHO, to make no attempt to reduce travel. It was demonstrated that travel restrictions are unlikely to delay spread by more than 2-3 weeks unless they are more than 99% effective.

Can I eat pork?

Yes. You cannot catch ‘swine flu’ from eating properly cooked pork. It is a little unfair to single out pigs. This human swine flu virus is not circulating in pigs. Influenza viruses affect many animals – e.g. people, birds, pigs and even snakes. Some swine flu viruses spread rapidly among pigs, usually causing a mild respiratory illness in winter. There is even a flu vaccine for pigs.

Should well adults be quarantined for 7 days after overseas travel?

Usually influenza is transmitted by sick persons coughing and sneezing viral particles into the environment. There is little evidence in the scientific literature that apparently healthy people can transmit the infection before they develop symptoms. The difficulty is that some persons get sick midway through a day and then start spreading the virus. It is important that work places have a policy to send staff home immediately they get sick.

Why are schools and childcare centres being closed after a case report?

Children are more likely to spread virus through unskilled infection control habits. They are less reliable at reporting immediately they feel sick, and harder to isolate immediately they develop symptoms, since parents have to come and collect them. Sick children have been found to be one of the major contributors to spreading normal influenza . Research in Japan on regular flu showed that vaccinating school children decreased flu in the whole community.

What should I do to protect myself?

There are 6 simple things:

• Have the regular flu vaccine.
• When you go out, take tissues or hankies – and if you get stuck, cough into your elbow.
• Hands should be kept clean and away from face – don’t touch eyes, nose and mouth. Use soap and water or hand sanitisers. Avoid shaking hands.
• Keep informed. Phone your doctor if you develop symptoms.
• Wear a mask and stay home if you are sick.
• Reduce contact with sick persons.

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Update: 11th May 2009

H1N1 novel influenza update

• More cases are being reported. WHO reports As of 07:30 GMT, 10 May 2009, 29 countries have officially reported 4379 cases of influenza A(H1N1) infection, with 49 deaths. WHO does not advise any travel restrictions.
• CDC has changed its travel warning from “Avoid travel to Mexico” to now say “Defer non-essential travel to Mexico”. CDC estimates the numbers of cases in the US have yet to peak. CDC makes no antiviral (tamiflu) recommendation for any traveler.
• The only person to test positive in Australia, had flu-like symptoms in the United States and she was better by the time she got here.
• If you are travelling; the advice outlined in the updates below still stands; Have the 2009 flu vaccine, use hand sanitiser regularly, you do not need to carry masks, most travellers do not need to carry tamiflu, keep abreast of the news.

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Update: 5th May 2009 8:30pm Brisbane

Novel Influenza A H1N1

As of 06:00 GMT, 5 May 2009, WHO notes that 21 countries have officially reported 1,124 cases of influenza A (H1N1) infection, including 26 deaths. – As more test kits become available the count is rising. There is currently no evidence of an increase in virilence or deadliness of the virus.

How infectious is this novel Influenza A H1N1?

Short answer – at the moment – not too different from the ‘usual flu’

Long answer – The reproduction, or transmissibility (RO) rates refer to the average number of secondary cases of disease generated by a typical primary case in a susceptible population; So far, this index in Mexico is estimated at 1.4, In the case of seasonal influenza, this rate is somewhat lower – 1.3.

Influenza viruses are genetically variable, and FUTURE transmissibility is hard to predict. With a novel flu virus, the R0 may be quite low at the beginning, and then the sub population of viruses that are more effective at hopping from person to person will survive and spread, while the less transmissable ones will die out. This survival of the fittest virus, can make the virus spread more quickly as time goes by. Pandemic plans need to be in place to stop the spread of the virus even if the virus does not seem very dangerous. We only have one chance to stop the spread – that is at the beginning. Once the ‘horse has bolted’ as it were, it is too late to try and get the animal back in the stable.

Vaccination

A specific swine flu vaccine is being worked on, but it will be months before it is available. “Normal’ Influenza is a serious disease – thats why so many doctors recommend annual influenza vaccines. Currently there is a shortage of regular flu vaccine in pharmacies and wholesale suppliers throughout Brisbane as the demand has suddenly increased. We still have supplies in our clinic for those who need it.

Handwashing

Aside from being actually coughed or sneezed upon by an infected person, the most common way to catch the flu is by touching something which has been coughed on or sneezed upon by an infected person. For instance, the person that used the shopping cart before you had the flu. They covered their mouth with their hand when they coughed then used that very hand to push the cart around the store. Now your hands are touching the same place. Without thinking while shopping, you rub your eye or nose and you have introduce the virus to your most vulnerable point of infection. Good hand washing does more to prevent the spread of flu than anything else. Carry hand sanitiser. If travelling on aircraft, make sure it is a small bottle – under 100mls.

Masks

More detailed information on mask use:

• Advice on the use of masks in the community setting in Influenza A(H1N1) outbreaks
• Workplace Pandemic Planning resource

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Update: 30th April 2009

Swine Influenza – Storm in a margarita glass?
A personal view – Dr Deb Mills Brisbane

Many of my patients have asked “Is this swine flu really as serious as some sectors of the media have implied?” and “Should I cancel my trip?”

Some media are using very emotionally charged words to report this story:

• Giant headlines scream WORLD BATTLES SWINE FLU AS DEATH TOLL RISES, and use words like …SHUTDOWN or …UNPREPARED.
• Saying the World Health Organisation has raised the “Threat Level” ( when it should say phase alert).
• Other articles talk of …readiness for the worst, ..increasing global anxiety, ..australians rushing to buy surgical masks as fears grow, Tassie braces for swine flu…, and even… Wolverine film postponed over swineflu.
• Reports give numbers like over 2000 infected and 150 deaths in Mexico – when the fine print from World health organisation says Mexico has reported 26 confirmed human cases of infection including 7 deaths

It’s hard not to get swept along in this wave of drama, but a few points of balance:

• Swine flu IS a new strain of influenza… but it is still influenza.
• Influenza infects many animals – even snakes.
• Influenza is not too deadly in its own animal host, but when it jumps between species, it can sometimes be more deadly. This is why the bird flu was and still is so serious. Bird flu is dangerous, but it is not very efficient at spreading from person to person.
• Over mankind’s history many human viruses originated in domestic animals and’ jumped’ into people. e.g that most famous recent new disease AIDS is thought to have jumped from monkeys. It is interesting to note that this new virus has not yet been isolated in samples taken from pigs in Mexico or elsewhere.

Influenza has the ability to mutate. Influenza viruses can swap bits of genetic material between different infuenza viruses. If this happened we could be faced with a super influenza germ that spreads easily but is more deadly than current influenza germs…… that would be a much bigger problem. Currently this is not the case. However, dealing with this swine flu is good practice for us all … preparing for the day when the superflu does appear.

Influenza is serious ALREADY – most people don’t realize how serious ‘ regular’ influenza can be. Many travellers decline flu vaccination because it is ‘just the flu’, or they have heard the MYTH that somehow the vaccine can give you the flu. The flu Vaccine is dead – it cannot give you the flu, – not unless the laws of physics and chemistry suddenly change.

Each year an estimated 2,500 Australians die from ‘normal’ influenza and its complications. The World Health Organization (WHO) estimates that worldwide 5-15% of the population are affected by influenza each year, there are between three and five million cases of serious illness and between 250,000 and 500,000 deaths.

WHO raising the pandemic phase alert caused a lot of excited reporting. The WHO pandemic Phase Alert process is an administrative tool. It reflects how the virus is spreading, regardless of how virulent (deadly) or otherwise the virus may be. it is a tool to help advise nations about the precautions they need to take. Some nations do strange things. (e.g. There are reports from Egypt that authorities are killing every pig in the country – This action is of course most unlikely to stop swine flu spreading from mexican airline passengers to the local population).

Each strain of influenza usually takes the name of the city where it was found. This years Southern hemisphere flu vaccine contains three strains:

• A/(H1N1): an A/Brisbane/59/2007 (H1N1) – like strain
• A/(H3N2): an A/Brisbane/10/2007 (H3N2) – like strain
• B/Florida/4/2006 – like strain

You will notice that the first strain is an influenza A H1N1 strain called Brisbane – it is not that different to the swine flu.

People are starting to discuss a new name for this virus. e.g. this disease could be called A(H1N1) Mexican flu – at least that might help the pigs.

Mask sales have skyrocketed, and mask manufacturers must be rubbing their hands in glee. I do not recommend travellers carry or wear normal surgical masks. Surgical maks are designed to be worn for short periods, and basically they are designed to stop surgeons and nurses etc accidentally coughing into a wound when they are scrubbed and sterile and unable to use tissues etc.

Wearing a mask looks very dramatic on a news snippet on TV but that does not mean it is recommended. Wearers of masks may feel warm and fuzzy that they are ‘doing something’ but really these surgical masks are next to useless. Wearers often also feel constricted and stuffy, and take their noses out of the top which further defeats the purpose. Unless a mask is sealed onto the face, the viral particles will enter via the side of the mask. Once the mask becomes moist from breathing, it becomes less effective. And what about if you want to take your mask off to eat your pork sausage?. it is relatively easy to contaminate your mask when putting the mask on, and taking the mask off. Wearers can accidentally get viral particles onto the eyes, nose or mouth, and illness will result. You would need to keep changing the mask.

The ohter type of mask ( N95 or P2 which are basicallly the same thing) are high tech masks designed to be used for brief periods in a hospital setting, when treating a single patient with an infectious disease, in conjunction with gown, gloves, cap etc. They do work very well, but they are very uncomfortable to wear for even short periods, and must be worn correctly and fit perfectly to be any use.

They have been trialed in a family setting but even though they work, they are still difficult to use (see ABC news story on masks). Remember that aircraft air whilst the plane is flying, is safer than air at your local shopping centre.

Everyone asks me what do I think will happen. I dont know , but the northern hemisphere flu season is now coming to a close, so climatic conditions should slow the spread of the virus in the northern hemisphere. More cases will be confirmed as the definitive test kits are distributed more widely. There will probably (and sadly) be more deaths. We do not have the medical information yet as to why the persons in Mexico seem to be dying from this flu, whilst persons in the USA and other developed countries experience only a minor illness. Everyone is waiting for this information.

As it stands at the moment – travellers do NOT need to cancel their overseas journeys. it is wise to avoid Mexico because of the guidelines, but also because potential disruption to your travel plans is probably a greater threat than catching swine flu. Travellers should have the regular flu vaccine, wash hands regularly, carry and use hand sanitisers and be alert for symptoms. They should discuss the use of tamiflu etc with their travel doctor. Everyone should stay at home if they are sick, and practice cough etiquette – whether there is a flu alert or not.

If you feel well after getting off a plane from somewhere (e.g. New Zealand) – you are well. If you feel well for 7 days, you are not going to get swine flu from your aircraft journey. If you feel sick, see a doctor. if you have a fever, cough, aches in joints, runny nose etc, call your doctor before you attend the surgery. If you feel well you do not have to quarantine yourself. You do not need to see a doctor to prove you are well – doctors are really too busy dealing with sick people. If you incubating the virus, and dont have any symptoms, the doctor wont be able to tell if you are going to get the flu tomorrow. There are no tests they can do. Work places that have staff that might hide their illness, could get a thermometer and thermally screen all staff on arrival at work.

Travellers should be aware of this disease, but the risk of having a motor vehicle accident is likely to be greater than your risk of contracting the ‘Mexican flu’.

As it says.. in large friendly letters …on the cover of the famous book, Dont Panic.

This situation is evolving. Tomorrow it could all be different – watch this space

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Update: 29th April 2009

9 countries are now affected with 148 confirmed cases. One death has been reported in Texas of a Mexican child who went to Houston for treatment. We are still waiting on detailed medical information to help us work out who is most susceptible to dying from this new strain of influenza A.

Supplies of Tamiflu are limited but should be available in the next few days.

FURTHER INFORMATION

• WHO Swine Flu update page
• Information on swine flu for travellers to Mexico

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Update: 28 April 2009

The World Health Organisation has now raised the Pandemic Phase Alert to 4. This means there is sustained human to human transmission. This phase alert 4 triggers many protocols and procedures to help deal with the situation. The world is taking every precaution.

Swine flu symptoms are similar to ‘regular’ flu symptoms. Some of the cases reported in Mexico and elsewhere may not be swine flu. We do not know yet. Many of the suspected cases across the planet have turned out to be something else … not swine flu. It is a slow process getting confirmation of cases as there are currently only two reference labs in the world (US and Canada) that can defintively confirm an influenza A strain IS the swine flu strain. More labs are coming online.

What do travellers need to do?

Discuss your particular situation with your travel doctor, but in essence:

• Carry hand sanitiser and use it regularly.
• Face Masks are of limited value.
• If you develop any symmptoms (cough, fever etc) seek medical attention, and practice cough etiquette.
• Monitor the WHO and CDC sites for the latest information

Incubation and period of contagion?

• Incubation period of swine flu is usually a few days.
• People are contagious from 1 day before symptoms to 7 days after symptoms develop.
• If you feel well and you have been in a country where the disease is confirmed, you do not have to do anything in particular.
• If you feel well up to 8 days after return, you are ‘in the clear’
• If you feel unwell after visiting an affected country, call the medical clinic before you attend, and tell them your symptoms and where you have been.

Antiviral drugs (e.g. Oseltamivir/Tamiflu)

Antiviral drugs are PRESCRIPTION medicines with activity against influenza viruses, including swine influenza viruses.

They can be taken in two different ways

• Prevention: High risk persons in infected areas may be recommended to take one daily to help prevent infection. They are 70% to 90% effective. Usually this group includes persons whose immune system is not working properly ( chronic medical conditions, elderly), household contacts of a case, or health care workers treating cases. it is taken for the risk period and 7 days after the risk period.
• Treatment: Low risk travellers to infected areas may be recommended to carry the medication in case they develop symptoms. The drugs must be commenced within 48 hours of symptoms, so it is useful to have the medication in your medical kit in case it is needed. It is usually taken for 5 days.

Information about the medication is available at www.cdc.gov/swineflu/antiviral_swine.htm

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Update: 26 April 2009

A new type of influenza known as swine flu has just been reported in several countries – first in Mexico, with subsequently some confirmed cases in different parts of the USA.

A New Zealand school group recently returned from a language trip to mexico, have symptoms of influenza and are being kept in isolation with their family members, whilst further tests are undertaken.

In Mexico, surveillance began detecting cases of influenza-like- illnesses starting on March 18th, 2009. The number of cases rose steadily through April and as of April 23rd, there were more than 854 cases of pneumonia from the capital. Of those, 59 have died. It is not yet known how many of these are confirmed to be due to swine flu.

Some reports from Mexico say 1300 are sick and 80 have died, although not all these cases are confirmed to be swine flu. All the confirmed swine flu cases in the USA to date are mild and no one has died. The suspect cases in New Zealand school group are also reported to be only mildly sick.

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. The World Health Organisation (WHO) is taking this matter very seriously.

On April 25 2009 the director-general of WHO determined that the current events regarding swine flu constitute a public health emergency of international concern under the WHO regulations.

This flu is important because:

• Person-to-person transmission is suspected. People do not normally get swine flu. Rare human cases typically involve people who have had direct contact with pigs.
• It has occurred at multiple sites – confirmed cases in Mexico, California, Kansas and Texas.
• It has affected healthy age groups, not just the very old or very young.

There is no specific vaccine for swine flu. The antiviral drug oseltamivir is effective against this strain It is safe to eat pork, you cannot catch swine flu by eating properly prepared pork.

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. There are many things you can to do preventing getting and spreading influenza:

There are everyday actions people can take to stay healthy:

• 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 hands cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way. Try to avoid close contact with sick people.
• Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
• If you get sick, it is recommended that you stay home from work or school and limit contact with others to keep from infecting them.

Vaccination is an effective way to prevent the commonly circulating strains of human influenza. This is especially important for travellers. Studies have shown about 1% of travellers are exposed to influenza on their journey.

Many workplaces have free flu vaccines for staff as this has been shown to decrease absenteeism and improve productivity in a work setting. Many travellers report that travel time is more precious than work time.