Swine Flu (H1N1/09)

The 2009 Pandemic Swine Flu, A-H1N1/09, the Type A influenza virus that was first identified in the early spring of 2009 in Mexico and then spread world wide to become a true Pandemic by June 2009. Different from other current seasonal strains of H1N1, and also not the same Swine Flu from prior epidemics or outbreaks (like in 1976), it is known by many different names in different places and settings, such as: H1N1, Novel H1N1, A/California/7/2009 (H1N1)v-like virus, la grippe porcine, The Mexican Flu, la epidemia, Schweinegrippe, and SOIV (Swine Origin Influenza Virus).

Asked in Cold and Flu, Infectious Diseases, Swine Flu (H1N1/09)

Can you catch the same flu twice?

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If you are exposed to an identical version of the flu that you had previously after you have recovered fully from it the first time, then your body should have developed immunity to all genetically identical kinds of flu and you would not get it a second time. However, the flu can change by mutations and if it does change enough that the immune system no longer sees it as identical, then you would not have immunity to the mutated strain. This is a similar concept to why we need different seasonal flu vaccine every year and why there are no vaccines for the common cold. You can get the flu twice in one season, but it would not be the same flu virus.
Asked in Cold and Flu, Swine Flu (H1N1/09), Tamiflu

How long are you contagious after taking Tamiflu?

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Tamiflu is an antiviral medicine and is mostly used to help you get better once you have already caught the flu. It shortens the duration of the symptoms and makes them less severe when taken within 48 hours of your first symptoms. So, the criteria for when you can consider yourself no longer contagious is the same with or without Tamiflu. But the length of time can vary from individual to individual. According to the CDC, you can consider yourself no longer contagious after 24 straight hours from your last fever (when not taking fever reducers). That will likely be sooner for someone taking tamiflu than it is for someone who is not.
Asked in Conditions and Diseases, Symptoms, Swine Flu (H1N1/09)

What are the symptoms of Swine Flu - Novel H1N1?

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Symptoms of H1N1/09 (Pandemic swine flu): Having a single one of these symptoms does not mean you have pandemic swine flu, but, you don't need to have all of these symptoms to suspect infection, either. The symptoms of swine flu in people are similar to the symptoms of regular human seasonal influenza. Watch for some combination of the following symptoms: Fever of 101°F (41°C) or higher Coughing Headache Sneezing Body Aches Fatigue Dizziness Chest pain Abdominal pain Shortness of breath Malaise Runny Nose Sore throat Vomiting Diarrhea Rigors (chills or shivers) Caution: If you suspect that you might have a flu infection, consult a physician as soon as possible. Don't wait! It is important for people who have chronic health conditions, women who are pregnant, and people with other high risk factors to pay special attention to warning signs. Influenza can make the symptoms, of other chronic medical conditions, worse For Children: who may need urgent medical attention, symptoms include: fast breathing or trouble breathing; blueish or gray skin color; not drinking enough fluids; severe, persistent vomiting; not waking up or not interacting; being so irritable that the child doesn't want to be held; flu-like symptoms, after improving, return later with greater intensity. These are warning signs that physicians think about all the time with respiratory infections and are good things for parents to have in mind at all times but especially with the Novel H1N1 strain. For Adults: who may need urgent medical attention, symptoms include: difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; sudden dizziness, confusion; persistent or severe vomiting that doesn't go away; and flu-like symptoms that improve, but then come back again with a fever or worsening of cough. Other underlying medical conditions* can create the potential for more severe illness, and it is for that reason that people who have these underlying conditions, or the family members who care for such people, need to remain vigilant about these warning signs emerging. For a list of the those at most risk of the swine flu and of complications due to it, see below. It's often best to contact a health care provider for advice before going to an office or care center and waiting for an appointment. That's also a better strategy than going to an emergency room, but these warning signs can help people differentiate a cough or cold or respiratory symptoms without warning signs, from the type of signs that might lead you to want to get help from a medical provider urgently. To prevent catching swine flu, colds or other strains of flu and viruses: If you live with or care for someone known to have the swine flu virus, you should assume that you, too, can spread the disease. Wear a surgical face mask (model N95) while contacting and tending to someone with a virus, especially children, in case they cough or sneeze when you are close to them. Wash hands always before you touch your face, nose, eyes and mouth and before (as well as after) you touch other people's faces, mucous tissue. You should also wash your hands after you cough or sneeze and always use a tissue to cover your mouth and nose. Immediately throw the tissue away after one use. Wash your hands after touching used tissues. Cough into your elbow if you do not have a tissue. Don't use your bare hand unless you wash hands immediately after and before you touch anything or anyone. To prevent spreading swine flu, colds or other strains of flu and viruses: Even if you do not yet have symptoms, you can have the virus and spread it before you know you have it for one or two days after catching the flu. When you know you have been exposed, or when you know the risk is high for catching it, wash hands very frequently. Stay home from work or errands when sick, and keep your kids home if they or others in your family have any symptoms. The schools will recommend if it is safe for your children to attend school if there are other children from the school infected. Be prepared with day care alternatives if the schools announce a closure. Flu virus can live for approximately two hours on hard surfaces, perhaps longer on moist or soft materials. Use disinfectants recommended for control of viruses on surfaces that are commonly touched, such as telephones, door knobs, light switches, TV remote controllers, chair arms, public pens and pencils (take your own), and grocery cart handles, as well as the lavatory knobs, handles, and surfaces. Remember: Wash hands very frequently and be alert to what you touch with them. Cover your mouth and nose with a tissue when sneezing and or coughing. Stay away from large groups of people and around 6. Don't touch your eyes nose or mouth without washing hands first. Stay home when sick so other people don't get it. For additional information on preventing exposure to and distribution of the flu viruses, see the related questions below. *Underlying Medical Conditions or Other Factors That Create Higher Risk: children younger than 5 years old; persons aged 65 years or older; children and adolescents (younger than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infections; pregnant women; adults and children who have pulmonary disorders (including asthma, for example) or who have cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders (such as diabetes); adults and children who have immunosuppression (including immunosuppression caused by medications like steroids and post-transplant drugs, or caused by HIV/AIDS), and; residents of nursing homes and other chronic-care facilities. people who are morbidly obese (see related question: Is obesity a risk factor for morbidity and mortality with Novel H1N1 - Swine Flu?) Information for those in the UK, from NHS: A doctor faced with a symptomatic patient cannot yet predict with certainty the course of their illness and whether or not they will be in the small proportion who may become more seriously ill. This is why antiviral medication is still being given to all those with swine flu in the UK, subject to their doctor's discretion. A doctor faced with a symptomatic patient cannot yet predict with certainty the course of their illness and whether or not they will be in the small proportion who may become more seriously ill. This is why antiviral medication is still being given to all those with swine flu in the UK, subject to their doctor's discretion. More information taken from the NHS website: It is important that as swine flu spreads, you know the symptoms of the disease so you can recognise it in yourself and others at an early stage. Please read the information about the swine flu on the NHS website and consider your symptoms carefully before using the National Pandemic Flu Service mentioned below. During the pandemic in 2009, most swine flu cases were mild, with symptoms similar to those of seasonal flu. Only a small number of people had more serious symptoms. If you or members of your family end up with a fever (high temperature over 38°C/100.4°F) along with two or more of the following symptoms, you may have swine flu: unusual tiredness, headache, runny nose, sore throat, shortness of breath or cough, loss of appetite, aching muscles, diarrhoea or vomiting. Checking For Symptoms: It makes sense to always have a working thermometer at home, as fever is one of the main signs of this and many other infectious diseases. The NHS website provides a National Pandemic Flu Service#. If you are concerned you may have swine flu, stay at home and check your symptoms using the online guides at the pandemic flu service. Call your GP directly if: you have a serious existing illness that weakens your immune system, such as cancer, you are pregnant, you have a sick child under one year old, your condition suddenly gets much worse, or your condition is still getting worse after seven days (five days for a child). # Note: the National Pandemic Flu Service is a new online service that will assess your symptoms and, if needed, provide an authorisation number that can be used to collect antiviral medication from a local collection point. For those who do not have internet access, the same service can be accessed by telephone on: Telephone: 0800 151 3100 Minicom: 0800 151 3200 For more information available on the National Pandemic Flu Service site go to Flu Service: Q&A. High-risk groups: For most people, swine flu is a mild illness. Some people get better by staying in bed, drinking plenty of water and taking over-the-counter flu medication. However, some groups of people are more at risk of serious illness if they catch swine flu, and will need to start taking antiviral medication as soon as it is confirmed that they have the flu. It is already known that you are particularly at risk if you have: chronic (long-term) lung disease, chronic heart disease, chronic kidney disease, chronic liver disease, chronic neurological disease (neurological disorders include motor neurone disease, multiple sclerosis and Parkinson's disease), immunosuppression (whether caused by disease or treatment)and/or diabetes mellitus. Also at risk are: patients who have had drug treatment for asthma within the past three years, pregnant women, people aged 65 and older, and young children under five years old. It is vital that people in these higher-risk groups who catch swine flu get antivirals and start taking them as soon as possible, preferrably within 48 hrs of first signs.
Asked in Conditions and Diseases, Cold and Flu, Swine Flu (H1N1/09)

What is the current situation with the H1N1-09 Pandemic Swine Flu?

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Update June 20, 2013: The CDC has issued the following media advisory: The Advisory Committee on Immunization Practices (ACIP) voted today, 13 to 0, in favor of recommending FluBlok during the 2013-2014 influenza seasons for vaccination of persons 18 through 49 years of age with egg allergy of any severity. FluBlok was licensed by the Food and Drug Administration (FDA) in January 2013. Unlike current production methods for other available seasonal influenza vaccines, FluBlok does not use the influenza virus or chicken eggs in its manufacturing process. _______________________________________________________________________________ Flu vaccines for the 2012-2013 flu season in the US: Flu vaccines have been around for decades, successfully preventing the flu, with very few untoward side effects. This year's trivalent seasonal flu vaccines will protect against the following three strains of influenza: Type A/California/7/2009 (H1N1) ~ the "swine flu vaccine", Type A/Victoria/361/2011 (H3N2), and Type B/Wisconsin/1/2010. There is also a new vaccine in the 2012-2013 flu season that is FluMist Quadrivalent. This new vaccine includes two Type B strains of flu instead of one. It contains B strains from both the B/Yamagata/16/88 and the B/Victoria/2/87 lineages in addition to the same strains of the Type A viruses (H1N1 and H3N2) that are included in the trivalent vaccines for this season. See the related questions below for more info. For the 2012-2013 Flu season in the US, the following vaccines for influenza are approved for use: AFLURIA Trivalent made by CSL/Merck AGRIFLU made by Novartis FLUARIX Trivalent made by GlaxoSmithKline Biologicals FLUMIST made by MedImmune Vaccines, Inc. FLUMIST QUADRAVALENT made by MedImmune Vaccines, Inc. FLULAVAL Trivalent made by ID Biomedical Corporation of Quebec FLUVIRIN Trivalent made by Novartis FLUZONE made by Sanofi Pasteur, Inc. FLUZONE - High Dose made by Sanofi Pasteur, Inc. FLUZONE-Intradermal made by Sanofi Pasteur, Inc. _____________________________________________________________________________ For the 2011-2012 flu season in the US, the Food and Drug Administration (FDA) announced the approval of six vaccines on July 18, 2011. These approved trivalent vaccines will all contain vaccine for the H1N1/09 "Swine Flu" and two other viruses suggested by CDC for this season (see more below). These approved vaccines are: Afluria (CSL Limited) Fluarix (Glaxo Smith Kline Biologicals) FluLaval (ID Biomedical Corporation) FluMist (MedImmune Vaccines, Inc.) Fluvirin (Novartis Vaccines and Diagnostics Limited) Fluzone, Fluzone High-Dose, Fluzone Intradermal (Sanofi Pasteur, Inc.) The Fluzone Intradermal is a new formulation for administration in the layers of the skin (intradermal injection) instead of the intramuscular (IM) injection. Fluzone Intradermal administration uses a microinjection system with a very fine needle. Approved for those aged 18 through 64. The CDC-approved trivalent vaccines for this flu season will protect against the following three virus strains: A/California/7/09 (H1N1)-like virus (Pandemic (H1N1) 2009 influenza virus) A/Perth/16/2009/ (H3N2)-like virus B/Brisbane/60/2008-like virus The H1N1/09 Swine Flu Pandemic is over, the world now has entered the post pandemic phase per the World Health Organization (WHO). World Health Organization's Director-General, Margaret Chan, announced on August 10, 2010 that the Pandemic Phase is over and we have entered the Post Pandemic Phase. The virus has killed more than 18,000 since April 2009, this figure is approximately 4% of the 250,000 to 500,000 annual influenza deaths. There may be some ongoing cases in limited locations around the world, however, the specifics and counts of cases are no longer being tracked by CDC, WHO, the US states, and most other countries, now that the pandemic has been declared over. Influenza cases are monitored, but specific H1N1/09 counts (and the lab tests needed to isolate the specific virus to be able to count them correctly) aren't routinely being done. The CDC publishes a weekly influenza surveillance report for the US called FluView that gives influenza-like illness statistics with some information from the US laboratories about results of testing they have done that gives a rough idea of the numbers of H1N1/09 still being found in positive lab tests. See the related question below or the related links section below for links to the weekly report. CDC also has an International Flu Report that you can access from the related question or link sections below. UPDATE March 26, 2011 International Flu Report from CDC: The CDC report indicates that the presence of H1N1/09 is still seen, but in fewer locations and smaller numbers. Those places that are still finding infections of this influenza virus are (see also the related links below for the full report): Europe According to WHO's EuroFlu, all reporting countries reported either low or medium influenza activity in Week 10. In 37 out of 47 reporting countries, influenza-like illness (ILI) activity peaked in recent weeks and is now declining. During Week 10, 42% of sentinel specimens (specimens routinely collected from designated health care facilities for surveillance purposes) tested positive for the influenza virus. Forty-six percent of those positive samples were influenza A (mainly 2009 H1N1) and 54% were influenza B. Asia According to WHO's Influenza Collaborating Center in China, influenza activity in China decreased sharply from peaks in Week 5 (northern China) and Week 4 (southern China). In Week 9, 17% of specimens tested in both regions were influenza-positive. The most common influenza subtypes in China were 2009 H1N1 and influenza B. In Mongolia, Japan and the Republic of Korea, influenza-like illness activity decreased. UPDATE on the week ending November 6, 2010 from WHO: 2010-2011 Influenza Season Week 44 ending November 6, 2010 All data are preliminary and may change as more reports are received. Synopsis: During week 44 (October 31-November 6, 2010), influenza activity remained low in the United States. * Of 2,704 specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division, 185 (6.8%) were positive for influenza. * Two human infections with novel influenza A viruses were reported. * The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold. * One influenza-associated pediatric death was reported and was associated with an influenza A virus for which the subtype was undetermined. * The proportion of outpatient visits for influenza-like illness (ILI), 1.3%, was below the national baseline, 2.5%. All 10 regions reported ILI below region-specific baseline levels; one state experienced low ILI activity, 49 states experienced minimal ILI activity. * Geographic spread of influenza in three states was reported as local; the District of Columbia, Puerto Rico, and 34 states reported sporadic activity; Guam and 13 states reported no influenza activity, and the U.S. Virgin Islands did not report. From the CDC November 2010 Influenza-Associated Pediatric Mortality in the US 2009 - Oct. 2010 One influenza-associated pediatric death was reported to CDC during week 44 (Texas). This death was associated with an influenza A virus for which the subtype was not determined. The death reported during week 44 occurred between October 24 and October 30, 2010. In the US in the 2009 - 2010 Pandemic and flu season there have been a total of 282 deaths of children. In the 2010-2011 flu season in the US there has been only one pediatric death from influenza through October 2010. July_2010">July_2010">July_2010">July 2010 Estimation of unreported cases based upon reported cases: Updated Estimates from April 2009 - January 16, 2010: On February 12, 2010, CDC updated the estimates to include the time period from April 2009 through January 16, 2010. CDC estimates that between about 8,330 and 17,160 2009 H1N1-related deaths occurred between April 2009 and January 16, 2010. The mid-level in this range is about 11,690 2009 H1N1-related deaths." 7/15/2010 Situation Update According to the final FluView for the 2009-2010 influenza season (May 16-22, 2010), flu activity in the United States declined again from the previous week and is about the same as what is normally seen during the summer in the United States. Only a small number of influenza viruses are being reported, most of which are 2009 H1N1. Flu is unpredictable, but sporadic cases of flu, caused by either 2009 H1N1 or seasonal flu viruses, will likely continue to occur throughout the summer in the United States. Internationally, 2009 H1N1 viruses are still circulating, including in the Southern Hemisphere, which is entering its flu season 7/9/2010 Situation Update from WHO 2009 H1N1 continues to actively circulate in certain areas of the tropics, including the Caribbean, West Africa, and South and Southeast Asia. In the Southern Hemisphere, influenza A (H3N2) viruses are currently co-circulating with 2009 H1N1. In the Northern Hemisphere, the number of influenza B viruses detected has exceeded reports of influenza A. Influenza type B and A (H3N2) viruses have been detected in South Africa at an increasing rate. Low levels of influenza-like illness (ILI) have been reported from several Southern Hemisphere countries, including Australia, New Zealand, Chile and Argentina. 2009 H1N1 and A (H3N2) viruses are currently co-circulating in certain Caribbean, Central America, and Southeast Asia countries. 2009 H1N1 is actively circulating in Southern and Western regions of India and Western regions of Africa. In Bangladesh, the seasonal influenza activity is shifting from 2009 H1N1 to influenza type B. Influenza type B continues to actively circulate in central and southern regions of Africa. 2/12/10 Estimated number of cases and deaths in the US from CDC: Cases: 57 million Deaths: 11,690 *Cumulative from April 2009 to January 16, 2010, plus CDC estimates of unreported cases based upon a calculated formula for *Cumulative from April 2009 to January 16, 2010, plus CDC estimates of unreported cases based upon a calculated formula for estimation of unreported/untested cases based on reported cases. June 17, 2010 Online Pharmacy Fraud, mislabeled drug TM-FLU sold as generic Tamiflu. FDA Announces Internet Scam A drug called TM-FLU from the online pharmacy called TRYDRUGS PHARMACEUTICALS PVT. LTD., at M.G. Road, Ahmedabad, Gujarat, does not contain Oseltamivir, which is the active ingredient of the well known brand of antiviral medicines, Tamiflu. This drug contains a different prescription medicine and should not be used as an OTC (Over the Counter) drug, it requires physician monitoring during its use. On June 17, 2010 the US FDA (Food and Drug Administration) declared that this "generic Tamiflu" called TM-FLU is fraudulent and does not contain Oseltamivir. It will not be effective for influenza. There is no FDA approved generic Tamiflu product. Worse, it does contain Cloxacillin (one of the antibiotics of the penicillin group). This can cause deadly allergic reactions in some people, and antibiotics are not effective against the viruses that cause influenza. The following advice is given in the FDA announcement (see link): Health care professionals and consumers are encouraged to report adverse events that may be related to the use of these fraudulent products to the FDA's MedWatch Program by phone at 800-FDA-1088, by fax at 800-FDA-0178, or by mail at: MedWatch, HF-2, FDA, 5600 Fishers Lane, Rockville, MD 20852-9787. You should not use this drug from this online pharmacy. You should discard any remaining quantity in the proper way for your location. This pharmaceutical company is fake and they are doing fraudulent business. See the links below for more information. June 3, 2010 Although the H1N1/09 Swine Flu Pandemic is still in effect, it is believed to have now passed the peak. There are still enough cases of the pandemic virus widespread across the world, that it is still considered a pandemic, but the peak seems to have passed and it is anticipated that the gradual shift to fewer and fewer cases will continue. From the CDC April 23, 2010 During the week of April 11 - 17, 2010, according to the CDC, most key indicators declined from the prior week. Visits to doctors for influenza-like illness (ILI) declined from last week and are low nationally, with all 10 U.S. regions reporting ILI below region-specific baseline levels. Laboratory-confirmed hospitalizations rates have leveled off and very few hospitalizations were reported by states during the week ending April 17. The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report increased over last week, but in general, are not higher than expected. Also, this indicator can lag behind the others. No pediatric deaths were reported this week. Since April 2009, CDC has received reports of 337 laboratory-confirmed pediatric deaths: 281 due to 2009 H1N1, 53 pediatric deaths that were laboratory confirmed as influenza A, but the flu virus subtype was not determined, and three pediatric deaths that were associated with seasonal influenza viruses. (Laboratory-confirmed deaths are thought to represent an undercount of the actual number. CDC has provided estimates about the number of 2009 H1N1 cases and related hospitalizations and deaths). No states reported widespread or regional influenza activity. This is the first week since the week ending December 13, 2008 that no states are reporting widespread or regional flu activity. The majority of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception. 3/5/10 From the World Health Organization (WHO): 5 March 2010 -- As of 28 February 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16455 deaths. Summary: In the temperate zone of the northern hemisphere, transmission of virus persists in some areas of Europe and Asia but influenza activity is declining and at low level in the most areas. The most active areas of transmission are currently observed in parts of Southeast Asia and East and South-eastern Europe. Recently, influenza type B is increasingly reported in Asia. 2/12/10 Estimated number of cases and deaths in the US*: Cases: 57 million Deaths: 11,690 *Cumulative from April 2009 to January 16, 2010, plus CDC estimates of unreported cases based upon a calculated formula for estimation of unreported/untested cases based on reported cases. Updated Estimates from April 2009 - January 16, 2010 On February 12, 2010, CDC updated the estimates to include the time period from April 2009 through January 16, 2010. "CDC estimates that between 41 million and 84 million cases of 2009 H1N1 occurred between April 2009 and January 16, 2010. The mid-level in this range is about 57 million people infected with 2009 H1N1. CDC estimates that between about 183,000 and 378,000 H1N1-related hospitalizations occurred between April 2009 and January 16, 2010. The mid-level in this range is about 257,000 2009 H1N1-related hospitalizations. CDC estimates that between about 8,330 and 17,160 2009 H1N1-related deaths occurred between April 2009 and January 16, 2010. The mid-level in this range is about 11,690 2009 H1N1-related deaths." Mortality Rates:UPDATE 03/07/10 The US Centers for Disease Control and Prevention (CDC) has estimated that, as of 2/12/10, since the beginning of the pandemic, the US has had approximately 57 million cases of A-H1N1/09 Pandemic Swine Flu and approximately 11,690 resulting deaths. Based upon this, an estimate of the mortality rate in the US from the pandemic is 0.02%. In comparison, the CDC and World Health Organization (WHO) have estimated that with seasonal flu, "we see over 30 million cases in the United States. We see 200,000 hospitalizations and, on average, 36,000 deaths." (During the entire fall and winter flu season.) Based upon this, the average mortality rate of seasonal flu in the US would be 0.12 %. The statistics of this mortality rate variation and other information gathered during the pandemic are under study by epidemiologists. It may be attributable to the fact that the especially vulnerable demographic group of the elderly (age 65 and older) suffers the majority of the cases and deaths from seasonal flu (because their weakened immune systems are unable to fight it off before their frail bodies must attempt to deal with the symptoms caused by another new strain of virus). In contrast, the majority of cases of the pandemic swine flu are among the younger and healthier demographic groups, so that, except for the very young and those with underlying medical conditions, most are able to survive the disease. It is not fully understood yet why the elderly do not contract this virus subtype as easily as the typical seasonal viruses, but speculation is that they may have acquired immunity through prior exposure to a similar virus strain. *All data are preliminary and may change as more reports are received. WORLD UPDATE Total................................Cases.......1562049.........Deaths......16665 As of 1/05/10* *Cumulative FROM THE WORLD HEALTH ORGANIZATION (WHO) MUTATED VIRUSES NOVEMBER 20, 2009 The Norwegian Institute of Public Health has informed WHO of a mutation detected in three H1N1 viruses. The viruses were isolated from the first two fatal cases of pandemic influenza in the country and one patient with severe illness. So far on additional testing, no further cases with this mutation have been found. WHO believes this suggests that the mutation is not widespread in Norway. All of the mutated H1N1 viruses still respond to Tamiflu and Relenza (oseltamivir and zanamivir, respectively), and the pandemic swine flu (A-H1N1/09) vaccines are still effectively providing immunization against these virus mutations as well. Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases. Laboratories in the WHO Global Influenza Surveillance Network closely monitor influenza viruses worldwide and will remain vigilant for any further changes in the virus that may have public health significance." IN THE UK NOVEMBER 20, 2009 FROM BBC, RESISTANT MUTANT STRAIN OF A-H1N1/09 IN FIVE PEOPLE IN WALES Five patients on the same unit of a University Hospital in Wales appear to have contracted the A-H1N1/09 "Swine Flu" infection when it spread among the patients on their unit. The unit they shared treats those with underlying severe health conditions, which would have made them at higher risk of getting the disease. The hospital is keeping them isolated, and health officials say there is no risk to others. The strain has been found to be resistant to Tamiflu, one of the anti-viral medicines used to treat the swine flu. Although mutations that are resistant to Tamiflu have been found in a small number of cases (several dozen) around the globe during the pandemic, until now, those strains were evaluated and had not been able to spread from person to person. See BBC report [see link below] PETS AND SWINE FLU UPDATE 12/31/09 The first dog to be found to have Swine Flu (which was caught from the owner) was diagnosed in New York on 12/21/09 by veterinarians. The dog had shown signs of coughing, not eating, and lethargy accompanied with a fever when the owners took it to the vet. The elderly (13 year old dog) was given two days of IVs and antibiotics before being allowed to go home and is now recovering. There is currently no vaccine for pets for H1N1/09 influenza, just for seasonal flu, but the safeguards of proper cough and sneeze etiquette and hand washing that you would take with a human child should also be taken to prevent the spread to your pets, according to the American Veterinary Medical Association (AVMA). So far, there have been very few cases among pet animals, but in all cases, the animal had been in close proximity to a person in the household with the H1N1/09 virus. The American Veterinary Medical Association (AVMA) has said if you are sick or a pet is sick with flu symptoms: "...isolate yourselves from each other, which we realize is only possible to some degree," said AVMA spokesman Michael San Filippo. An Animal Medical Center in New York representative recommends, "Don't play kissyface with your dog or your cat or your ferret. You wouldn't with your kids if you were sick, so don't do it with your pet." Unconfirmed cases of swine flu in a few dogs in China were reported on December 1, 2009, but the diagnosis had not yet been verified by lab results. ___________________________ The first dog to be found to have Swine Flu (which was caught from the owner) was diagnosed in New York on 12/21/09 by veterinarians. The dog had shown signs of coughing, not eating, and lethargy accompanied with a fever when the owners took it to the vet. The elderly (13 year old dog) was given two days of IVs and antibiotics before being allowed to go home and is now recovering. There have been several reported and confirmed cases of pet ferrets having contracted H1N1/09 pandemic swine flu from their owners. There is no evidence that the reverse has occurred (that a person got it from a ferret or any other pet). Also, there is now a case of a domestic house cat also with confirmed H1N1/09. It was in very close contact with the owner while the owner had the pandemic swine flu. It is suggested by the American Veterinary Medical Association that caution be taken with pets when anyone in the household has the flu. (The cat recovered fully from the flu). So far, no pot bellied pigs have been shown to have contracted the virus. Dogs do have their own strain of flu virus that is currently circulating and only a veterinarian can determine which type of flu they have, so watch your dog carefully for any signs of respiratory disease or distress. Keep your pets safe from the flu if a member of the household has the virus the same way you would protect other people by isolating the sick person as much as possible, avoid close contact with family and pets, and use good cough and sneeze etiquette and thorough frequent handwashing. If any pets show signs of the flu (respiratory cold-like symptoms), check with your veterinarian for advice. See more below at the related link for the American Veterinary Medical Association. VACCINE ADVERSE EFFECTS REPORT FROM CDC/FDA: As of a December 30, 2009 report of the Vaccine Adverse Event Reporting System (VAERS), 32 cases have been reported of serious adverse effects of the A-H1N1/09 vaccine resulting in, or related to, deaths of those 32 people. See the related links section for a link to that full report. 12/23/09 A SECOND H1N1/09 VACCINE RECALL A second round of recall of H1N1/09 Swine Flu vaccine occurred 12/23/09 when MedImmune, the maker of the US approved live vaccine for intra-nasal administration, recalled just under 5 million doses of the vaccine. The recall was like the first vaccine recall earlier in the month, it was not a safety recall, it is because the vaccine had been tested to have a slight decrease in the potency. (See Vaccine section below for more details on the first recall.) The US Federal Drug Administration (FDA) stated that it was not unusual for vaccines to lose strength over time. This type of vaccine usually has a shelf-life of around 4 months. The FDA also does not recommend re-vaccination of those who had a vaccination using the recalled lots since the vaccines were potent enough when given in the prior months. The maker of the vaccine, a subsidiary of AstraZeneca, has also said that the potency of vaccines already given would be well above the necessary strength to provide protection without any need to revaccinate. The loss of strength was measured during routine quality testing which is ongoing. 12/30/09 The CDC and FDA have issued a summary of the Adverse Events that have been reported through the Vaccine Adverse Event Reporting System about the H1N1/09 vaccine. See also above at the first of this answer and the related link section below for more information. The summary was developed based upon the information gathered by the FDA and CDC through the Vaccine Adverse Event Reporting System. This summary from the CDC is as of Dec 30, 2009, shows a possible link between 32 people's deaths and the vaccine. Almost 100 million doses have been distributed for use in the US alone. VAERS Summary: As of December 30, 2009, 99.3 million doses of 2009 H1N1 vaccine had been shipped to vaccination providers in the United States, although the precise number of vaccines administered is unknown. As of December 30, 2009, VAERS had received 7326 adverse event reports following 2009 monovalent H1N1 vaccination. The vast majority (94%) of adverse events reported to VAERS after receiving the 2009 monovalent H1N1 vaccine are classified as "non-serious" (e.g., soreness at the vaccine injection site). Of the 7326 reports, 440 (6%) were reports that were classified as "serious" health events (defined as life threatening or resulting in death, major disability, abnormal conditions at birth, hospitalization, or extension of an existing hospitalization)*. The percentage of reports involving what would be considered serious health events is not different between 2009 H1N1 and seasonal influenza vaccines. Additionally, no new or unusual events or pattern of adverse events have emerged. VAERS reports continue to be monitored as more vaccine is administered. Among the 440 reports of serious health events, there were 32 reports of death. As with all reports of serious adverse events and deaths, the 32 VAERS reports that involve deaths are under review by CDC, FDA and the states where the reported deaths occurred. Preliminary findings do not indicate a common cause or pattern (such as similarities in age, gender, geographic location, illness surrounding death, or underlying medical conditions) to suggest that these deaths were associated with the vaccine. These cases are under further review pending additional medical records (e.g., autopsy reports, medical files). 12/23/09 A Centers for Disease Control and Prevention (CDC) official, Dr. Anne Schuchat, estimated that 60 million Americans have now taken the vaccines with at least one dose. and said intense monitoring for side effects has not turned up any safety concerns As of today over 111 million doses of the four vaccines approved for distribution in the U.S. have been released for use. SECOND VACCINE RECALL 12/23/09 (also a non-safety recall) A second round of recall of H1N1/09 Swine Flu vaccine occurred 12/23/09 when MedImmune, the maker of the US approved live vaccine for intra-nasal administration, recalled just under 5 million doses of the vaccine. The recall was like the first vaccine recall earlier in the month, it was not a safety recall, it is because the vaccine had been tested to have a slight decrease in the potency. (See Vaccine section below for more details on the first recall.) VACCINE RECALL 12/15/09 The US Food and Drug Administration (FDA) announced the non-safety recall of certain lots of the H1N1/09 vaccine, totaling 1.2 million doses, on December 15, 2009. They determined that the vaccine in a particular lot of pre-filled syringes did not meet the range of potency (strength) that was specified by the FDA and the division of Merck and Company, Inc. for use in the US. Merck, whose division, Sanofi Pasteur, produced the vaccine, has confirmed that the recall affects 1.2 million doses. According to the Centers for Disease Control and Prevention (CDC) this non-safety issue has prompted the recall of swine flu vaccine that was prepared in single dose syringes for children under age three. These reports indicate that there is no safety issue and those who have already had the vaccination using these particular lots of vaccine do not need to have additional vaccine administered since the strength level is only slightly below what was required in the original approval by FDA. Only certain lots of the vaccine are included in the recall of December 15, 2009. In the manufacture of most medicines and vaccines, the recommended dose is based on a specified strength range that will be effective for the general population. Because a larger person may need slightly more and a smaller person slightly less, the exact measure of the recommended dose is adjusted based on clinical trials. These trials are used to determine the parameters of the dosage that can be effective for larger sized people, but still safe and not too much for the smaller sized people. In some types of medicines this dose must be more exact and then it is often based on the size of person, such as doses specified as so many milligrams or units per kg of weight. The doses of vaccines do not need to be as specific. But when the FDA has approved and expected delivery of a specific dose that will be safe and effective for the general population, instead of one which needs to be more finely adjusted by individual measurements, they will require the recall and expect the company to provide the drug exactly as stated in the approval documents. This is an indication that the ongoing monitoring of the H1N1/09 vaccine by the FDA is being carried out well and the watch is especially close. The recall is a reassuring indicator to medical professionals. The following statements were made by CDC: Should infants and children who received vaccines from these lots be re-vaccinated? No. The vaccine potency is only slightly below the "specified" range. The vaccine in these lots is still expected to be effective in stimulating a protective response despite this slight reduction in the concentration of antigen. There is no need to re-administer a dose to those who received vaccine from these lots. However, as is recommended for all 2009 H1N1 vaccines, all children less than 10 years old should get the recommended two doses of H1N1 vaccine approximately a month apart for the optimal immune response. Therefore, children less than 10 years old who have only received one dose of vaccine thus far should still receive a second dose of 2009 H1N1 vaccine. What action(s) should parents of children who have received vaccine from the recalled lots take? Parents of children who received vaccine from the recalled lots do not need to take any action, other than to complete the two-dose immunization series if not already completed. CDC has indicated that the following lots are included in the recall: 0.25 ml pre-filled syringes, 10-packs (NDC # 49281-650-25, sometimes coded as 49281-0650-25): UT023DA UT028DA UT028CB 0.25 ml pre-filled syringes, 25-packs (NDC # 49281-650-70, sometimes coded as 49281-0650-70): UT030CA VACCINE DISTRIBUTION Some states (such as Texas) are now allowing access to the A-H1N1/09 vaccine by the general public. The prioritization for high risk persons is no longer employed to determine eligibility for immunizations since production has caught up with the demand in those states. About 45 million doses have been released in the first round of vaccine distribution in the US according to the CDC and now the vaccine will be produced at a rate of approximately 20 million doses per week. The vaccines approved so far by the FDA for use in the US are those produced by Novartis, Sanofi, and CSL (who have produced the inactivated vaccines for injection), and MedImmune who has produced an attenuated (weakened) vaccine for administration in nasal spray for ages 2-49. The vaccines for Europe approved by EMEA, are two vaccines that are inactivated ("dead") and adjuvanted ("strengthened" so smaller doses can produce the same immunization to enable more doses). They are Focetria by Novartis and Pandemrix by GlaxoSmithKline and both are for administration by injection. Approval awaits for a third vaccine. (SEE ALSO VACCINE SECTION BELOW FOR MORE) HOW LONG ARE YOU CONTAGIOUS? New studies, on how long a person remains contagious, back up the previously reported CDC guidelines that one should be suspected to be capable of still spreading the Novel Swine Flu for one full week after the symptoms start, or until 24 hours after the fever subsides [while taking no fever reducers] which ever is longer, rather than the most recent CDC guidelines that waiting for 24 hours after fever subsides without taking fever reducers is long enough. The studies show that in some cases the virus remains in the nasal passages of patients for up to 16 days after symptoms begin. Below are some excerpts from the report: Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said. When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away. Using a very sensitive test to detect virus in the nose or throat, [the study] found that 80 percent had it five days after symptoms began, and 40 percent seven days after. Some still harbored virus as long as 16 days later. How soon they started on antiviral medicines such as Tamiflu made a difference in how much virus was found, but not whether virus was present at all. . . Doctors know that people can spread ordinary seasonal flu for a couple of days before and after symptoms start by studying virus that patients shed in mucus. The first such studies of swine flu are just coming out now, and they imply a longer contagious period for the novel bug. A-H1N1/09 Has 0.01% Mortality Rate According to recent studies Until now, it has been difficult to come up with an estimate of the mortality rates of Swine Flu (novel H1N1/09), since the case numbers were being drawn from known cases from hospitalized patients or other laboratory confirmed cases, which were known to be just a fraction of the total number of infections (because those figures excluded the unknown number of mild cases treated at home, untested, and unreported.) Very rough estimates of the mortality rate of the pandemic A-H1N1/09 influenza have now been calculated from statistics gathered by a French study in late August 2009 and reported in the Public Library of Science (PLOS). Based on their findings, it is estimated that Novel Swine Flu is 100 times more virulent than seasonal flu. The main cause of death with A-H1N1/09 is viral pneumonia with resulting ARDS (Adult Respiratory Distress Syndrome). Even though treated in a hospital ICU, approximately 50% of ARDS cases result in death. In the French study, the number of ARDS cases was found to be one in every 5000 cases, giving the estimate of ARDS deaths as 1 in 10,000 cases of infection. The number of deaths from ARDS in seasonal flu cases, based on empirical evidence in France, is calculated to be between 5 and 10 each year out of an average annual number of seasonal flu cases of 6 million infections. Until better counts of cases are available, that gives a rough estimate of the deaths due to ARDS resulting from seasonal influenza of one out of a million infected patients. The 1 death in 10,000 cases from A-H1N1/09 compared to 1 in 1,000,000 from seasonal flu strains gives the prior mentioned indications of A-H1N1/09 being 100 times more virulent than seasonal flu. (For the full article about the study, see the related links section below.) US Officials predicted in August 2009that there is a potential for 40% to 50 % of the US population to have had the A-H1N1/09 Virus over the course of the next two years. December 12, 2009 CDC UPDATE: Ongoing monitoring has continued to lead the CDC to conclusions that this virus is much different than the seasonal flu in the age of those affected. Those age 65 and older are much less at risk from 2009 H1N1 than with seasonal flu: "... this disease primarily affects people younger than 65 year old, with the number of cases, hospitalizations and deaths overwhelmingly occurring in people 64 years and younger. The risk of illness, hospitalization and death related to 2009 H1N1 is very age specific and very different from seasonal influenza. With seasonal influenza, about 60 percent of seasonal flu-related hospitalizations and 90 percent of flu-related deaths occur in people 65 years and older. The proportion of younger people being impacted by 2009 H1N1 is much greater than what occurs during seasonal flu and their risk of serious illness, including hospitalization and death from 2009 H1N1 is much greater than that for seasonal flu. People 65 and older are much less affected by this virus than what routinely occurs with seasonal influenza and therefore the risk of serious illness, hospitalization and death from 2009 H1N1 in people in this age group is much less than that posed by seasonal flu." See case and fatality numbers by US state below. WORLD UPDATE Totals: more than..........Cases......1562049.........Deaths......16665 As of 1/05/10* *Cumulative. (Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases, according to WHO). SOUTHERN HEMISPHERE From WHO 11/13/09 ""In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported in recent weeks. Of note, a cluster of pandemic influenza cases been reported in Argentina in the capital area. " WHO: Pandemic Phase (6) is still in effect. It is important to note that this does not indicate an increase in the severity, just that the criteria for Phase 6 regarding the spread of the Novel H1N1 Influenza have been met. 10/25/09 The President Barack Obama has declared a US National Emergency due to the increase in cases of H1N1/09 and concern about a potential over-burdening of the national health care infrastructure in the US. Update 12/13/09 The CDC is allocating doses of the vaccine to each state as the vaccine is produced and released by the drug companies. The allocation process is explained by them as: "The number of doses "allocated" for ordering is the amount that is at the distribution depots and ready for states to order. The quantity of vaccine allocated is based on the project area's population size. As an example, if 6 million doses total (3 million doses of nasal spray vaccine AND 3 million doses of injectable vaccine) are ready for ordering nationally and a state has 10% of the US population, then their allocation for today is 600,000 doses total (300,000 doses of the nasal spray vaccine and 300,000 doses of injectable vaccine)." Distribution at the point of service in some locations is still being made on a priority basis to those at highest risk first: pregnant women; individuals who live with or care for children under 6 months old; healthcare and emergency service workers; individuals between 6 months to 24 years old; and then adults 25 to 64 with chronic health conditions. There is a single injection for adults and children over 9 years old. Children under 10 will need two vaccinations, a second one approximately a month after the first one will provide the needed protection for these with immature immune systems. In adults fully immunity is usually developed within 8 to 10 days of the vaccination. In children who require two doses of vaccine, full immunity takes slightly longer after the second vaccination, approximately two weeks. The CDC and WHO recommend that people also get the seasonal flu shot as usual. It will have no protection against A-H1N1/09, and the swine flu shot will have no protection against the seasonal flu strains that are expected to be in the Northern Hemisphere this fall and winter as usual. The seasonal and H1N1 vaccines could be given on the same date, however, you should not wait to get the seasonal flu shot until the swine flu shot is available to your risk group. As soon as you have an opportunity to get the seasonal flu shot you should go ahead and get that done as soon as possible. The H1N1/09 vaccine is made from the pandemic strain of swine flu, but otherwise it is being made the same way and with the same preservatives, and medium for injection as has been used for decades now for seasonal flu shots. So there is no expectation of problems with getting the vaccination than that which would be normal for the seasonal flu injections. Over the decades of use of this type of vaccine, problems have been very low. There have been very few reactions or problems with this method of vaccine development and delivery and there is no scientific data to support the concerns that some have voiced about the preservative thimerosal. There is no cause and effect data linking autism to the thimerosal in scientific studies, or other problems. The minuscule amount of mercury in the preservative's compound ingredients is no more than would be obtained through a meal of fish. Some manufacturers have been developing single doses of vaccine that will not contain the thimerosal which may be available to those who have this concern. The larger 10cc vials will have to have the preservative added, but single dose vials and single dose pre-loaded syringes may be an option for some. Discuss this with your health care professional in advance of presenting for the vaccination if you have concerns. Vaccinations Are Voluntary In the US* August 21, 2009 excerpts from the press briefing by CDC: "The whole vaccination program is voluntary, whether or not a person receives vaccine and at the national level, there are no mandates for vaccination." * *Exception: In some states, such as NY, health care workers are required by law to get the vaccination if they work in a clinical practice with patients in their care. ". . . the protective effects of influenza vaccine or for the most part, almost any vaccine, are not immediate. The body has to take its time to generate some antibody, that usually occurs over a couple week period. So even with a very effective vaccine and even where only one dose is required, people should not presume that the minute they're immunized they're protected. Also, again, in the viewpoint of being very clear about influenza vaccines they are generally not like the other vaccines, polio or measles vaccine, many which are 95% plus effective in preventing disease if you're exposed to it, and influenza vaccines in healthy, young adults are not quite that protective. There's various estimates of protection, depending on the match of the strain, but, for example, with a well-matched strain in healthy, young adults, protection level is in the area of 70%, 80%, might be typical. . . " "That has important implications, even if you're vaccinated, wash those hands, cover those coughs, stay home if you're sick." August 21, 2009 excerpts from the press briefing about vaccine production by the Food and Drug Administration (FDA): ". . . with respect to safety, these are the studies of licensed vaccines from licensed manufacturers, where what's been changed is just the use of this particular H1 strain as opposed to other H1 strains we use in seasonal vaccines so there is a long, accumulated safety database about these products. . . " Manufacturers The manufacturers who were contracted and licensed by the US Health and Human Services to produce the H1N1/09 Vaccine are the same ones used by the US for seasonal flu since 2004: Novartis, GlaxoSmithKline, Sanofi Pasteur, CSL Biotherapies, and MedImmune. Taking precautions is a responsibility we all share. Protect yourself and others by getting a vaccination and by using proper hygiene. Visit Flu.gov to learn how you can help promote public awareness. Antiviral Medications VIRUSES RESISTANT TO OSELTAMIVIR (TAMIFLU) IDENTIFIED 11/20/09 Cluster of Tamiflu Resistant A-H1N1/09 virus reported 11/20/09 found in the US in a North Carolina hospital: Duke University Medical Center of Durham, NC has reported Tamiflu-resistant strains of A-H1N1/09 Swine Flu now found to have infected a few patients in the hospital. It is thought that the infections originated at the University hospital. Hospital officials say that they do not believe this indicates increased risks for the general population, since all four patients were extremely ill cancer patients, and on the same unit in the hospital. The reports of the Tamiflu resistant strains in the US came on the same day as similar reports from Norway and Wales, on Friday, 11/20/09 [for more information on the UK and Norway, see below and related links at the bottom of the page]. About 15 other situations with resistant mutated strains have been reported around the world since April, including four in the United States. Some cases proved fatal, but others caused only mild illnesses according to the CDC. According to the CDC 12/13/09: "To prevent the spread of antiviral resistant virus strains, CDC reminds clinicians and the public of the need to continue hand and cough hygiene measures for the duration of any symptoms of influenza, even while taking antiviral medications." Drug Resistant Strains of H1N1/09 Close to 1000 pandemic H1N1 viruses have been evaluated by the laboratories in the Global Influenza Surveillance Network for antiviral drug resistance. All other viruses have been shown sensitive to both oseltamivir and zanamivir. WHO and its partners will continue to conduct ongoing monitoring of influenza viruses for antiviral drug resistance. Therefore, based on current information, these instances of drug resistance appear to represent sporadic cases of resistance. At this time, there is no evidence to indicate the development of widespread antiviral resistance among pandemic H1N1 viruses. Based on this risk assessment, there are no changes in WHO's clinical treatment guidance. Antiviral drugs remain a key component of the public health response when used as recommended. Tamiflu Side Effects in Children 7/31/09 According to research from the European Programme for Intervention Epidemiology Training and colleagues from the Health Protection Agency (HPA) in London, which was published in Eurosurveillance, the peer-reviewed journal of the European Centre for Disease Prevention and Control, children are having neuropsychiatric side effects from Tamiflu such as nightmares, inability to concentrate, insomnia, and slight confusion. The article at the NHS web site (link is provided to the full article in the related links section below), states: ". . . more than half of children taking Tamiflu to combat swine flu suffer side effects such as nausea, insomnia and nightmares," said The Daily Telegraph. It also said the study suggests that one in five children who took part reported having a neuropsychiatric side effect." These were almost all in Japan and none so far have been reported in the US. % of High Risk Cases About 70% of individuals that are hospitalized with complications from A-H1N1/09 influenza have some kind of underlying disease. The most predominant of that is asthma. The second is diabetes. Other common underlying conditions believed to have contributed to the complications requiring hospitalization include Immunocompromised status, either through cancer chemotherapy or other compromising conditions (about 13%) and chronic underlying heart disease. Guidance Documents from the US Centers for Disease Control and Prevention (CDC) See related links section for links to the full CDC guidance documentation. US GUIDANCE FOR INSTITUTES OF HIGHER LEARNING FROM CDC 8/20/09 See the links below in the related links section for links to the following Guidance Papers: Guidance for Responses to Influenza for Institutions of Higher Education During the 2009 - 2010 Academic Year. This covers recommendations divided into two groups: Recommendations to use now, during this academic year, assuming a similar severity to the spring/summer H1N1 flu outbreak, and recommendations to consider adding if the flu begins to cause more severe disease. Preparing for the Flu: A communication Toolkit for Institutions of Higher Education. Includes Posters, Fact Sheets, Q&A Information, Templates for letters and announcements, and other communication resources. Technical Report on CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009 - 2010 Academic Year. Includes detailed explanations of the strategies presented in the CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009- 2010 Academic Year and suggestions on how to use them. The guidance is designed to decrease exposure to regular seasonal flu and 2009 H1N1 flu while limiting the disruption of day-to-day activities and the vital academic activities that go on in Institutions of Higher Education. Portions of this guidance pertaining to dormitories and residence halls may be useful for residential (boarding) schools providing primary and secondary education, with adaptations as needed for their younger population. US SCHOOL GUIDANCE FOR FALL TERM FROM CDC 8/7/09: (See related links section for a link to this information at the CDC web site.) GUIDANCE FOR BUSINESSES AND EMPLOYERS FROM CDC 8/19/09 Arrange for close regular monitoring of media health information and state and local updates to stay alert to changes in the community. CDC also provides Preparing for the Flu a Communication Toolkit for Businesses and Employers , see link to this information in related links section below. OTHER GUIDANCE DOCUMENTS Guidance Documents on other topics from the US Centers for Disease Control and Prevention (CDC) and WHO are available at their web sites, see links below. For an alphabetical listing of the WHO Guidance Document topics see the link below. Changes in A-H1N1/09 Activity Reports from CDC and WHO CDC follows suit with WHO, stops reports of numbers of cases of Novel H1N1, continues hospitalization and death counts and monitoring. They are now using a new methodology for estimating quantitative figures. See link below for methods. The statistics in the answer to this WikiAnswers question will have to be modified as availability of reliable data changes. Updates based on available data will continue. World Case Counts and Fatality Numbers By Country This section is no longer being updated~Last updates 1/5/10 Total...............................Cases.......1562049.........Deaths......16665 Cumulative totals (lab verified cases only*) *This will make totals vary from the estimated totals reported elsewhere in this Q&A -As of 1/05/10 World Case Counts and Fatality Numbers By Country Country Cases Deaths Afghanistan 853 17 Akrotiri & Dhekelia 88 0 Albania 350 6 Algeria 633 39 Andorra 1 0 Angola 37 0 Anguilla 14 0 Antigua and Barbuda 4 0 Argentina 142,592 617 Armenia 101 2 Aruba 13 0 Australia 37,642 191 Austria 964 5 Azerbaijan 14 2 Bahamas 29 4 Bahrain 1,346 7 Bangladesh 802 6 Barbados 154 3 Belarus 102 20 Belgium 76,973 17 Belize 42 0 Bermuda, UKOT 10 0 Bhutan 6 0 Bolivia 2,310 58 Bosnia & Herzegovina 558 7 Botswana 31 0 Brazil 58,178 2,105 Brit.Virgin Islands, UKOT 19 0 Brunei 971 1 Bulgaria 766 35 Cambodia 531 6 Cameroon 4 0 Canada 25,828 401 Cape Verde 62 0 Cayman Islands, UKOT 112 1 Chile 12,258 150 China* (Hong Kong) 33,109 50 China* (Mainland) 115,208 501 Colombia 3,288 193 Cook Islands 106 1 Costa Rica 1,596 47 Cote d'Ivoire 3 0 Croatia 526 22 Cuba 794 41 Cyprus 297 3 Czech Republic 1,207 48 Democratic Republic of Congo 78 0 Denmark 651 21 Djibouti 9 0 Dominica 36 0 Dominican Republic 491 23 Ecuador 2,251 96 Egypt 10,056 120 El Salvador 834 31 Estonia 628 7 Ethiopia 6 0 Falkland Islands 7 1 Faroe Islands 44 0 Fiji 234 0 Finland 6,122 36 France 5,000 221 France, New Caledonia, FOC 27 6 French Polynesia, FOC 4 0 French Guiana 126 2 Gabon 1 0 Georgia 759 6 Germany 209,885 132 Ghana 54 1 Gibraltar 35 0 Greece 8,768 60 Greenland 1 0 Grenada 20 0 Guadaloupe, FOC 2 0 Guam 269 2 Guatemala 1,170 18 Guernsey 17 0 Guyana 73 0 Haiti 91 0 Honduras 560 18 Hungary 283 37 Iceland 8,650 2 India 25,572 898 Indonesia 1,097 10 Iran, Islamic Republic 3,672 147 Iraq 2,868 40 Ireland 3,189 22 Isle Of Man 75 0 Israel 4,330 75 Italy 3,593 188 Jamaica 149 6 Japan 11,636 108 Jersey 234 0 Jordan 3,033 16 Kazakhstan 17 0 Kenya 417 0 Kiribati 4 0 Korea, North 50 47 Republic of Korea (South) 108,234 170 Kosovo 98 10 Kuwait 8622 27 Kyrgyzstan 61 1 Laos 242 2 Latvia 57 24 Lebanon 1838 5 Lesotho 65 0 Libya 223 1 Liechtenstein 13 0 Lithuania 68 14 Luxembourg 333 2 Macau 2,625 2 Macedonia 2600 14 Madagascar 877 3 Malawi 4 0 Malaysia 12,210 77 Maldives 25 1 Malta 718 5 Marshall Islands 115 1 Martinique, FOC 3 0 Mauritius 69 8 Mexico 67,982 823 Micronesia 79 0 Moldova 1,024 17 Monaco 36 0 Mongolia 1,073 26 Montenegro 119 2 Montserrat 21 0 Morocco 2,775 38 Mozambique 101 2 Myanmar 68 0 N. Mariana Islands 6 0 Namibia 72 1 Nauru 8 0 Nepal 112 1 Netherlands 1,473 51 Neth. Antilles, Curacao** 8 0 Neth. Antilles, Sint Maarten 2 0 New Caledonia, FOC 12 0 New Zealand 3,198 22 Nicaragua 2,172 11 Nigeria 2 0 Norway*** 12,654 29 Oman 6,029 30 Pakistan 121 10 Palau 46 0 Palestinian Territories 1,582 22 Panama 787 11 Papua New Guinea 12 0 Paraguay 855 52 Peru 9,003 205 Philippines 5,212 30 Poland 2,024 116 Portugal 166,922 58 Puerto Rico 908 49 Qatar 550 8 Republic of the Congo 21 0 Romania 5,421 42 Russia 24,299 580 Rwanda 331 0 Saint Kitts 6 2 Saint Lucia 55 1 Saint Maarten 2 0 Saint Vincent 17 0 Samoa 138 2 San Marino 5 0 Sao Tome & Principe 41 2 Saudi Arabia 14,532 97 Serbia 520 47 Seychelles 33 0 Singapore 1,217 19 Slovakia 955 25 Slovenia 990 13 Solomon Islands 4 1 Somalia 2 0 South Africa 12,642 93 Spain 22,379 256 Sri Lanka 422 23 Sudan 24 1 Suriname 138 2 Swaziland 5 0 Sweden 2,130 20 Switzerland 11,210 9 Syria 432 127 Taiwan 5,474 35 Tajikistan 16 0 Tanzania 677 1 Thailand 29,886 191 Timor-Leste 6 0 Tonga 20 1 Trinidad & Tobago 211 5 Tunisia 1200 15 Turkey 12,316 507 Turks & Caicos 44 0 Tuvalu 23 0 Uganda 251 0 Ukraine 57,862 213 United Arab Emirates 125 6 United Kingdom 27,826 303 United States of America 111,324 4,869 Uruguay 550 33 Vanuatu 3 0 Venezuela 1,973 121 Viet Nam 11,083 52 Virgin Islands (US) 80 1 West Bank & Gaza Strip ? ? Yemen 5,038 25 Zambia 726 0 Zimbabwe 1,318 0 Total 1,562,049 16,665 -As of 1/05/10 Cumulative figures are subject to revision Abbreviations: UKOT: United Kingdom Overseas Territory FOC: French Overseas Collectivity OT: Overseas Territory Netherlands Antilles, Curaçao **: 3 confirmed cases: The three confirmed cases are crew members of a cruise ship. They did not leave the boat during their illness nor during the 24 hours preceding the onset of symptoms. Norway***: 7 confirmed cases are cruise ship crew and passengers. None left the ship during the illness nor 24 hours before the onset of symptoms. CHANGES IN THE CDC REPORTING OF NOVEL H1N1 (A-H1N1/09) CASES 7/24/09 From CDC: "Because only a small proportion of persons with respiratory illness are tested for novel H1N1, at this time, confirmed and probable case counts represent a significant underestimation of the true number of novel H1N1 flu cases in the U.S., so the true benefit of reporting these numbers to track the course of the epidemic is questionable. In addition, because of the extensive spread of novel H1N1 flu within the United States, it has become extremely resource-intensive for states to count individual cases. Instead of reporting confirmed and probable novel H1N1 flu cases, CDC has transitioned to using its traditional flu surveillance systems to track the progress of both the novel H1N1 flu pandemic and seasonal influenza. These systems work to determine when and where flu activity is occurring, track flu-related illness, determine what flu viruses are circulating, detect changes in flu viruses and measure the impact of flu on hospitalizations and deaths in the U.S."" US Case Counts and fatality numbers by state This is being reported from various available sources, since the CDC is no longer publishing cases and deaths by state on a weekly basis. The timing of information about one state may be off slightly from that of another, the date at the top of the list will be applicable to most entries but beside each state there may be a different date, in which case, it will be the date of that particular state's information that is provided. 1/14/10 Estimated number of cases and deaths in the US*: Cases: 115431 Deaths: 10837 *Cumulative, plus CDC estimates of unreported cases This section is no longer being updated~Last updates 1/14/10 US Case Counts and fatality numbers by state - State Cases Deaths Alabama 2,453 39 Alaska 460 12 Arizona 8,545 140 Arkansas 154 20 California 10,031 470 Colorado 1,550 59 Connecticut 5,194 30 Delaware 381 6 District of Columbia 54 1 Florida 3,636 187 Georgia 886 41 Guam 338 2 Hawaii 2,221 11 Idaho 1,165 22 Illinois 4,416 86 Indiana 317 37 Iowa 739 40 Kansas 1,201 26 Kentucky 2,042 37 Louisiana 1,876 41 Maine 2,220 18 Maryland 1,284 41 Massachusetts 1,912 29 Michigan 3,166 76 Minnesota 2,174 60 Mississippi 1,279 14 Missouri 1515 11 Montana 949 19 Nebraska 430 14 Nevada 2,437 36 New Hampshire 722 9 New Jersey 1,414 40 New Mexico 308 50 New York 2,738 157 North Carolina 638 81 North Dakota 650 3 Ohio 227 33 Oklahoma 237 40 Oregon 1,105 75 Pennsylvania 10,934 75 Puerto Rico 908 49 Rhode Island 203 13 Samoa, American 85 1 South Carolina 1,634 41 South Dakota 2,081 23 Tennessee 1,163 50 Texas 11,403 203 Utah 988 44 Vermont 404 3 Virgin Islands 80 1 Virginia 327 35 Washington 658 91 West Virginia 1,214 20 Wisconsin 9,555 50 Wyoming 725 10 Total 115,431 10,837 -As of 1/14/10 *Numbers are likely under reported, see information above about CDC's new estimates. Travel Advice The CDC has recommended that anyone with flu like symptoms should not travel for 7 days following the beginning of the first symptoms or until there have been no symptoms for at least 24 hours [including no fever, without fever reducing drugs], whichever is longer. Some countries are screening incoming flights for people with symptoms of the flu (and especially those coming from the US) and putting those with possible H1N1 in quarantine or requiring other precautionary steps to be taken. See the related question link below for the following question for additional details of travel information and advice from the US Department of State and the CDC: See additional information in the related questions below for virus prevention techniques. See the CDC link below for state by state information from each state's health department. For a weekly report from the CDC with charts and graphs and lots of interesting data, see the related link below in related link section.A link to the CDC Novel H1N1 Influenza Information in Spanish is provided in links below as well as a link to a full listing of the other languages in which the CDC information is available.
Asked in Conditions and Diseases, Swine Flu (H1N1/09)

Where have there been deaths and cases of H1N1-09 Pandemic Swine Flu?

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October 2010, The World Health Organization (WHO) has declared the H1N1/09 Pandemic over, and reported that we are now in the Post Pandemic Phase of the WHO Pandemic Phases. The report included that the virus has caused cases in every country of the world now. There are still places with outbreaks, but not with epidemics or pandemics. Get your flu shot now in the US, it contains the vaccine for preventing this virus as well as for two other viruses and then through prevention of infection, the spread will be entirely halted. 3/5/10 From the World Health Organization (WHO): 5 March 2010 -- As of 28 February 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16455 deaths. Summary: In the temperate zone of the northern hemisphere, transmission of virus persists in some areas of Europe and Asia but influenza activity is declining and at low level in the most areas. The most active areas of transmission are currently observed in parts of Southeast Asia and East and South-eastern Europe. Recently, influenza type B is increasingly reported in Asia. In the US March 15, 2010, according to the CDC, key indicators of the state of the pandemic during the week of February 28 - March 6, 2010 included: No states reported widespread influenza activity. Five states reported regional influenza activity. They are: Alabama, Georgia, Maine, Mississippi and South Carolina. The majority of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception. Some influenza B viruses are circulating at low levels, and these viruses remain similar to the influenza B virus component of the 2009-10 seasonal flu vaccine. 2/12/10 Estimated number of cases and deaths in the US*: Cases: 57 million Deaths: 11,690 *Cumulative from April 2009 to January 16, 2010, plus CDC estimates of unreported cases based upon a calculated formula for estimation of unreported/untested cases based on reported cases. Updated Estimates from April 2009 - January 16, 2010 On February 12, 2010, CDC updated the estimates to include the time period from April 2009 through January 16, 2010. "CDC estimates that between 41 million and 84 million cases of 2009 H1N1 occurred between April 2009 and January 16, 2010. The mid-level in this range is about 57 million people infected with 2009 H1N1. CDC estimates that between about 183,000 and 378,000 H1N1-related hospitalizations occurred between April 2009 and January 16, 2010. The mid-level in this range is about 257,000 2009 H1N1-related hospitalizations. CDC estimates that between about 8,330 and 17,160 2009 H1N1-related deaths occurred between April 2009 and January 16, 2010. The mid-level in this range is about 11,690 2009 H1N1-related deaths." Mortality Rates: UPDATE 03/07/10 The US Centers for Disease Control and Prevention (CDC) has estimated that, as of 2/12/10, since the beginning of the pandemic, the US has had approximately 57 million cases of A-H1N1/09 Pandemic Swine Flu and approximately 11,690 resulting deaths. Based upon this, an estimate of the mortality rate in the US from the pandemic is 0.02%. In comparison, the CDC and World Health Organization (WHO) have estimated that with seasonal flu, "we see over 30 million cases in the United States. We see 200,000 hospitalizations and, on average, 36,000 deaths." (During the entire fall and winter flu season.) Based upon this, the average mortality rate of seasonal flu in the US would be 0.12 %. The statistics of this mortality rate variation and other information gathered during the pandemic are under study by epidemiologists. It may be attributable to the fact that the especially vulnerable demographic group of the elderly (age 65 and older) suffers the majority of the cases and deaths from seasonal flu (because their weakened immune systems are unable to fight it off before their frail bodies must attempt to deal with the symptoms caused by another new strain of virus). In contrast, the majority of cases of the pandemic swine flu are among the younger and healthier demographic groups, so that, except for the very young and those with underlying medical conditions, most are able to survive the disease. It is not fully understood yet why the elderly do not contract this virus subtype as easily as the typical seasonal viruses, but speculation is that they may have acquired immunity through prior exposure to a similar virus strain. WORLD UPDATE</a>Total................................Cases.......1562049.........Deaths......16665 As of 1/05/10* *Cumulative % of High Risk Cases About 70% of individuals that are hospitalized with complications from A-H1N1/09 influenza have some kind of underlying disease. The most predominant of that is asthma. The second is diabetes. Other common underlying conditions believed to have contributed to the complications requiring hospitalization include Immunocompromised status, either through cancer chemother Changes in A-H1N1/09 Activity Reports from CDC and WHO CDC follows suit with WHO, stops reports of numbers of cases of Novel H1N1, continues hospitalization and death counts and monitoring. They are now using a new methodology for estimating quantitative figures. See link below for methods. Other updates and information from CDC and other world sources will continue to be compiled here as it becomes available. From the World Health Organization (WHO): 16 JULY 2009 | GENEVA -- "WHO will no longer issue the global tables showing the numbers of confirmed cases for all countries. However, as part of continued efforts to document the global spread of the H1N1 pandemic, regular updates will be provided describing the situation in the newly affected countries." The statistics in the answer to this WikiAnswers question will have to be modified as availability of reliable data changes. Updates based on available data will continue. World Case Counts and Fatality Numbers By Country See also above Regional totals. Total...............................Cases.......1562049.........Deaths......16665 As of 1/05/10 Cumulative totals (lab verified cases only*) *This will make totals vary from the estimated totals reported elsewhere in this Q&A -As of 1/05/10 World Case Counts and Fatality Numbers By Country CountryCasesDeathsAfghanistan85317Akrotiri & Dhekelia880Albania350 6 Algeria633 39 Andorra10Angola370Anguilla140Antigua and Barbuda40Argentina142,592617Armenia101 2 Aruba130Australia37,642191Austria9645 Azerbaijan142Bahamas294Bahrain1,3467Bangladesh8026Barbados1543Belarus10220Belgium76,97317Belize420Bermuda, UKOT100Bhutan60Bolivia2,31058Bosnia & Herzegovina558 7 Botswana310Brazil58,1782,105Brit.Virgin Islands, UKOT190Brunei9711Bulgaria76635Cambodia5316 Cameroon40Canada25,828401 Cape Verde620Cayman Islands, UKOT1121Chile12,258150China* (Hong Kong)33,10950China* (Mainland)115,208501Colombia3,288193Cook Islands1061Costa Rica1,59647Cote d'Ivoire30Croatia52622 Cuba79441 Cyprus2973 Czech Republic1,207 48 Democratic Republic of Congo78 0Denmark65121 Djibouti90Dominica360Dominican Republic49123Ecuador2,25196 Egypt10,056120El Salvador83431 Estonia628 7 Ethiopia60Falkland Islands71Faroe Islands440Fiji2340Finland6,122 36 France5,000221France, New Caledonia, FOC276French Polynesia, FOC40French Guiana1262Gabon10Georgia759 6 Germany209,885132 Ghana54 1Gibraltar350Greece8,768 60 Greenland10Grenada200Guadaloupe, FOC20Guam2692Guatemala1,17018Guernsey170Guyana730Haiti910Honduras56018Hungary28337Iceland8,6502 India25,572898 Indonesia1,09710Iran, Islamic Republic3,672147Iraq2,86840Ireland3,18922 Isle Of Man750Israel4,33075 Italy3,593188 Jamaica1496Japan11,636108 Jersey2340Jordan3,03316Kazakhstan170Kenya4170Kiribati40Korea, North50 47 Republic of Korea (South)108,234170 Kosovo9810 Kuwait8622 27Kyrgyzstan611Laos2422 Latvia5724 Lebanon18385 Lesotho650Libya2231 Liechtenstein130Lithuania6814 Luxembourg3332Macau2,6252Macedonia2600 14Madagascar877 3 Malawi40Malaysia12,210 77Maldives25 1Malta7185Marshall Islands1151Martinique, FOC30Mauritius698Mexico67,982823Micronesia790Moldova1,02417 Monaco36 0Mongolia1,07326 Montenegro119 2 Montserrat210Morocco2,775 38 Mozambique1012Myanmar680N. Mariana Islands60Namibia721Nauru80Nepal112 1Netherlands1,47351 Neth. Antilles, Curacao**80Neth. Antilles, Sint Maarten20New Caledonia, FOC120New Zealand3,19822Nicaragua2,17211Nigeria2 0Norway***12,654 29Oman6,029 30 Pakistan121 10Palau460Palestinian Territories1,58222 Panama78711Papua New Guinea120Paraguay85552Peru9,003 205 Philippines5,21230Poland2,024 116 Portugal166,922 58 Puerto Rico908 49Qatar5508Republic of the Congo21 0Romania5,421 42Russia24,299 580 Rwanda331 0Saint Kitts62 Saint Lucia551Saint Maarten20Saint Vincent170Samoa1382San Marino5 0Sao Tome & Principe412Saudi Arabia14,532 97 Serbia520 47Seychelles330Singapore1,21719Slovakia955 25 Slovenia990 13Solomon Islands4 1Somalia20South Africa12,64293Spain22,379 256Sri Lanka422 23 Sudan241Suriname1382Swaziland50Sweden2,13020 Switzerland11,210 9 Syria432 127 Taiwan5,47435 Tajikistan160Tanzania677 1Thailand29,886191Timor-Leste60Tonga201Trinidad & Tobago2115Tunisia1200 15 Turkey12,316 507 Turks & Caicos44 0Tuvalu230Uganda251 0Ukraine57,862 213 United Arab Emirates1256United Kingdom27,826303 United States of America111,324 4,869Uruguay55033Vanuatu30Venezuela1,973121Viet Nam11,08352 Virgin Islands (US)80 1West Bank & Gaza Strip??Yemen5,038 25Zambia7260Zimbabwe1,3180Total1,562,04916,665 <center>-As of 1/05/10</center> Cumulative figures are subject to revision Abbreviations: UKOT: United Kingdom Overseas Territory FOC: French Overseas Collectivity OT: Overseas Territory Netherlands Antilles, Curaçao **: 3 confirmed cases: The three confirmed cases are crew members of a cruise ship. They did not leave the boat during their illness nor during the 24 hours preceding the onset of symptoms. Norway***: 7 confirmed cases are cruise ship crew and passengers. Cases:_115431__Deaths:10837">Estimated number of cases and deaths in the US*: Cases: 115431 Deaths:10837 *Cumulative, plus CDC estimates of unreported cases As of 1/14/10US Case Counts and fatality numbers by state -StateCasesDeathsAlabama2,45339Alaska46012Arizona8,545140Arkansas15420California10,031 470 Colorado1,55059Connecticut5,194 30Delaware3816 District of Columbia541Florida3,636187 Georgia886 41 Guam3382Hawaii2,22111Idaho1,16522 Illinois4,41686 Indiana31737Iowa73940 Kansas1,20126Kentucky2,042 37Louisiana1,87641Maine2,22018Maryland1,28441 Massachusetts1,91229Michigan3,16676 Minnesota2,17460 Mississippi1,27914Missouri151511 Montana94919Nebraska43014Nevada2,43736New Hampshire7229 New Jersey1,41440 New Mexico30850 New York2,738157North Carolina63881 North Dakota6503 Ohio22733Oklahoma23740 Oregon1,10575 Pennsylvania10,93475 Puerto Rico90849Rhode Island20313Samoa, American851South Carolina1,63441 South Dakota2,08123Tennessee1,16350 Texas11,403203 Utah98844Vermont404 3Virgin Islands801Virginia32735 Washington65891 West Virginia1,21420 Wisconsin9,55550 Wyoming72510Total115,43110,837 <center>-As of 1/14/10 *Numbers are likely under reported, see information above about CDC's new estimates. According to the CDC: "To prevent the spread of antiviral resistant virus strains, CDC reminds clinicians and the public of the need to continue hand and cough hygiene measures for the duration of any symptoms of influenza, even while taking antiviral medications." Taking precautions is a responsibility we all share. Protect yourself and others by getting a vaccination and by using proper hygiene. Visit Flu.gov to learn how you can help promote public awareness. See additional information in the related questions below for virus prevention techniques. See the CDC link below for state by state information from each state's health department. For a weekly report from the CDC with charts and graphs and lots of interesting data, see the related link below in related link section.A link to the CDC Novel H1N1 Influenza Information in Spanish is provided in links below as well as a link to a full listing of the other languages in which the CDC information is available. Mexico
Asked in Conditions and Diseases, Cold and Flu, Swine Flu (H1N1/09), The Difference Between, Viruses (biological)

What is the difference between a cold and the flu?

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They are caused by different viruses and have slightly different symptoms. See related question below for the symptoms of the A-H1N1/09 "Swine Flu". The symptoms of the cold and flu can be hard to differentiate, sometimes not even possible without a specific laboratory test to determine which virus is causing your symptoms. See the related link below for more information on this from US Flu website, Flu.gov. The primary differences are: The flu usually causes a high fever and a cold doesn't cause a fever except in rare circumstance. General aches and pains with the flu are usually present and can be severe, with a cold they are mild. You may feel very fatigued from the flu and this is unusual with a cold. Headaches are much more common with the flu. The usual cold symptoms of stuffy or runny nose, sneezing, and sore throat are only sometimes seen with the flu. A severe cough comes with the flu but is not as severe with a cold. Colds typically begin with a sore throat. Sometimes a mild fever, cough, and/or a stuffy nose are present. It is important to note the difference between a cold and an allergy because of the different treatments associated with each. Cold symptoms can usually be controlled through the use of a decongestant and anti-inflammatory medicine (e.g. Ibuprofen). Fever is not as common in colds as in the flu. Those with colds almost always have fevers under 101 degrees Fahrenheit. There are a few basic kinds of flu viruses but hundreds of cold viruses. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations, whereas this is possible with an infection with a flu virus. FLU LIKELY (>50% chance of these symptoms) fever 102 deg. F (39 deg. C) or higher (can reach up to 107 deg. F (42 deg. C) in extreme cases) dry hacking cough severe runny nose stuffiness chills (happen during fevers when body adjusts thermostat to raise it's set point) headache POSSIBLE (30-50% chance) sore throat RARE (< 30% chance) diarrhea vomiting COLD LIKELY (>50% chance) runny nose stuffiness coughing frequently POSSIBLE (30-50% chance) fever 99 deg. F to 101 deg. F (37.2 deg C to 38.3 deg C.) chills sore throat RARE (<30% chance) gastrointestinal symptoms like diarrhea and vomiting The 'flu - an abbreviation for "influenza" - is a viral infection of the respiratory passages causing fever, severe aching, and catarrh, and often occurring in epidemics. A cold, on the other hand, a common viral infection in which the mucous membrane of the nose and throat becomes inflamed. Influenza (the flu) is usually a more severe illness than the common cold, which is caused by other respiratory viruses. The 'flu typically showcases symptoms including headaches, chills and cough followed rapidly by a fever, appetite loss, muscle aches and tiredness. Cold symptoms are limited to the upper respiratory tract with runny nose, sneezing, watery eyes, and throat irritation.
Asked in Vaccinations, Lactation and Breastfeeding, Swine Flu (H1N1/09)

Is the H1N1 vaccine safe for breastfeeding mothers?

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Yes, flu vaccines, including the vaccine for the 2009 pandemic swine flu that is included in the seasonal flu vaccinations again for the 2012-2013 flu season, are considered safe and effective for breastfeeding mothers. The antibodies that are produced in response to the flu vaccines in the mother will also help protect the baby through the mother's milk. Also since infants under six months old can not be vaccinated yet due to their immature immune systems, it is recommended that anyone caring for these babies should be vaccinated, so they can not give the virus to the infant. This would include breastfeeding mothers. The Centers for Disease Control and Prevention gives the following related information (note that this information comes from the time of the initial H1N1/09 vaccine development for the 2009-2010 flu season. Since that time this vaccine is no longer needed to be given in a separate vaccination and has been included in the annual flu vaccine for the several years since then. No second vaccination is needed any longer. It is included in the 2012-2013 flu vaccine): Both seasonal flu and 2009 H1N1 monovalent influenza vaccines should be given to breastfeeding mothers. Breastfeeding is fully compatible with flu vaccination, and preventing maternal infection provides secondary protection to the infant. Maternal vaccination is especially important for infants less than 6 months old, who are ineligible for vaccination. In addition, transfer of vaccination-related antibodies by breastfeeding further reduces the infant's chances of getting sick with the flu. While pregnant women should just receive the inactivated injectable form of influenza vaccine, nursing mothers can receive either the injectable or nasal spray form. Pregnant women should not receive nasal spray vaccine for either seasonal flu or 2009 H1N1 flu. After delivery, women can receive the nasal spray vaccine, even if they are breastfeeding.
Asked in Conditions and Diseases, Swine Flu (H1N1/09)

How is Swine Flu spread?

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How Is A-H1N1/09 (Pandemic "Swine Flu") Spread in Humans? Like most viruses, it enters the body through the mucous membranes - the eyes, the nose or the mouth. Swine flu is spread just like the regular seasonal flu spreads. It goes from person to person through close contact and direct touch, indirect touch, or respiratory droplets carrying the virus from person to person or from person to environmental surfaces through coughs and sneezes. If you touch where a person with swine flu touches, you will most likely pick up the virus and get the swine flu. That is how it spreads indirectly. Stay a minimum of six feet away from someone with a known infection, avoid close contact from crowded places. You get direct spreading when you have skin to skin contact or direct person to person contact with an infected individual, such as shaking hands, kissing, or caring for a child or other infected person with hands-on care. You could be infected by getting too close to someone who has it. Do not hug people who have the swine flu. Wait for them to recover, then hug them. Do not share drinking glasses or eating utensils with someone, this can also spread the disease. There is some evidence to suggest that it can be spread through gastrointestinal means, such as saliva, emesis (vomit), and feces (stool). The importance of hand washing before and after eating, using the restroom, or providing personal care to an infected individual must be stressed. Teach your family proper hand washing technique. (See related question for this information). Flu viruses can also be spread by handling money. See the related question below. What Are Some Ways It Is NOT Spread? Swine flu is not spread by eating pork. Flu viruses are inactivated ("killed") by heating to temperatures of 167-212°F [75-100°C]. Swine flu has not been shown to be spread by drinking tap water that has been provided by a local municipality (regular drinking water). Swine flu is not spread through swimming in chlorinated pools, or by being in the water at recreational water parks that regularly treat the water. It is not spread in fountains that use purified water or spas. There is some risk of catching it at beaches, or at recreational water theme parks from people among the crowds and not in the treated water, just as in any other crowded public place. How Can the Spread Be Controlled? Protect yourself and others by getting your flu vaccination, it is the most important and most effective way to stay well and to avoid spreading the flu to your family, coworkers, and in public. It has been proven to be safe and effective during the 2009 flu season, and since it is made exactly like the flu vaccines in prior years, it has been proven safe and effective over decades of use. Another very important method of prevention is proper and frequent hand washing and regular hygiene. To help prevent swine flu, wash your hands frequently with soap and water, and avoid touching your face, eyes, nose, and mouth. When you have the virus on your hands and touch the tissues in those places, that is how the virus enters your body. See the related question below for additional information about protecting yourself from contracting this and other viruses. The most important protection is basic hand washing and hygiene as described in the related question below. If no warm water and soap is available for hand washing, the hand sanitizers with at least 60% alcohol content can be used (or even plain rubbing alcohol). How Long Can You Spread It When Infected? There are still studies in progress to determine the best answer to this question. The most conservative suggestion from studies by the Department of Homeland Security (DHS), on how long a person remains contagious, seem to back up the initially reported CDC guidelines that one should be suspected to be capable of still spreading the Novel Swine Flu for one full week after the symptoms start or until 24 hours after the fever subsides [while taking no fever reducers] whichever is longer. However, the most recent CDC guidelines indicate that waiting for 24 hours after fever subsides without taking fever reducers is long enough. According to the 9/19/09 DHS report: Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said. When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away. Using a very sensitive test to detect virus in the nose or throat, [the study] found that 80 percent had it five days after symptoms began, and 40 percent seven days after. Some still harbored virus as long as 16 days later. How soon they started on antiviral medicines such as Tamiflu made a difference in how much virus was found, but not whether virus was present at all. . . Doctors know that people can spread ordinary seasonal flu for a couple of days before and after symptoms start by studying virus that patients shed in mucus. The first such studies of swine flu are just coming out now, and they imply a longer contagious period for the novel bug. Where Has It Spread? Everywhere. It has infected people in every country of the world. This pandemic virus from 2009 (A-H1N1/09) spread faster than any other flu in the past and to every country in the world. It is now (Oct 2010) in the "Post Pandemic Phase" but it continues to be active in small outbreaks in some countries. The World Health Organization (WHO) has developed an interactive map showing the time line and progression of the spread of the Novel H1N1 across the world during the early phases of the pandemic. A link is provided to the map in the related links section below, a flash player is needed to view the map. How Does It Spread In Swine (Pigs)? The following answer is about the strain of H1N1 influenza that pigs get that is not the same as A-H1N1/09 pandemic flu: Swine Flu can be transmitted from a pig to a human, like the human flu passes to humans. For example, if a human touches the pig or something a pig that has swine flu sneezes or coughs on, and then touches his face, mouth, nose or eyes before washing his hands, that farmer could then get the swine flu that pigs get. It is rare, but it does happen every year, mainly to pig farmers. More Information? For more information about how the Pandemic Swine Flu A-H1N1/09 is spread, see the related questions below, links below, and browse the H1N1 Pandemic Swine Flu category for answers to hundreds of questions and answers. Or for encyclopedic reference material about the flu, see the Answers.com Reference Library.
Asked in Swine Flu (H1N1/09)

What caused the 2009 swine flu?

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It was caused by a particular strain of the influenza virus, just like any other flu. This particular strain A-H1N1/09 (aka: Influenza A, Novel H1N1 or 2009 Swine Flu virus) originated in pigs (swine) but has changed itself to be infective to humans. Swine flu is a virus that originally infected only pigs and they spread it from one infected hog to other hogs the same way it spreads in people, by direct contact or by droplets holding the virus in the air after a pig coughed or sneezed. Because pigs are physiologically very similar to humans, when they have been living closely with humans, some microbes that can infect them are able to be changed or mutated into strains that people can catch. These types of diseases that we can get from animals are called zoonotic diseases. Pigs contract swine flu from other infected swine, particularly in pigpens and herding areas. Flu viruses from birds and people may also infect pigs. Swine influenza passes quickly among pigs, and can cause major losses for pig farmers because of the rate of illness. It is now also possible for infected people to pass swine flu back to other pigs. Usually viruses that infect one kind of animal do not often infect others. However, if the animals are kept very closely together, it is more likely that mutations can occur that allow new strains to develop with the ability to cross from one type of animal to another. Viruses can mutate very rapidly. Since they are non-living sub-microscopic organisms (microbes), and not actually living organisms (like bacteria and microscopic fungi), they can combine with the cells of host animals and change the genetic material in those host cells to reproduce themselves. Sometimes that assimilation can also change the makeup to a new strain of virus (sub-microscopic particle microbe) which is then replicated by the damaged cells as well. This cross-family type of mutation is called a reassortant, or sometimes reassortment, of genetic material in viruses. It has happened in the past when ducks or other birds were kept very closely together with pigs. That is how the Avian (bird) flu became a problem for people. First bird flu was mutated to a strain that could be caught by the pigs they were closely around. Once infecting the pigs, other mutations occurred that allowed their bird flu-swine crossed viruses to mutate again to viruses that people who were in close contact with the pigs infected with the bird-swine virus could catch. This kind of "cross-contamination", through mutations of the viruses infecting the physiologically similar pigs, allows new strains to develop to which people have no inherited immunity (passed down from generation to generation) or prior exposure to a similar type that would have given them cross protection. It is considered potentially more dangerous than other types of influenza because the human population has not experienced this particular kind of Swine flu before. Therefore, it is anticipated that there will be few people with any natural resistance to it, whereas most people usually have some resistance to other strains of influenza once they are 10 years old or older. As a result of the lack of resistance, it can spread more easily and perhaps produce more severe symptoms. The 2009 Swine Flu was doubly difficult for us to create effective vaccines (which would help to teach our immune systems how to fight the virus). This is because the new strain of virus mutated within the pigs where it could first merge genetic materials of the bird viruses and swine viruses that the pigs had been exposed to and then it become infective to humans as well, from the additional close contact of pigs and humans who cared for them (triple reassortant). The reassortant process within the pigs combined the pig genetic material, the bird genetic material, and also human genetic material. The 2009 Pandemic Swine Flu virus (A-H1N1/09) contains genetic material that is from the bird flu as well as from three swine flu virus strains (Asian, American, and European), plus the human flu virus ("quintuple reassortant"). We would have had an easier time developing our vaccine for this flu virus if it had been formed from one or the other, and not with the five types of genetic material that it currently contains. As it is, we had to start "from scratch" to grow the right kind of virus to put into the vaccines. The whole process of infections can also work back the other way. So now we humans can get swine flu from each other, from infected pigs, and we can give it to pigs who can infect each other. In other words, because aspects of human viral strains are incorporated into the animal viral strains using the pig as a "middle man", newer viruses are developed that are able to cross the animal family boundaries. Over crowding, of people with each other and with pigs, and pigs with each other and with other animals, are the major reasons these "reassortant" viruses can occur. Farmers who work with swine must use very clean techniques to avoid catching and transmitting the swine flu. The CDC has guidelines for people who have these jobs or spend time around hogs, such as showing them in breed competitions. See the links below. As with any virus, very good hygiene, including thorough hand washing, is critical after contact or close proximity. See the related questions for steps to take to avoid contracting this virus.
Asked in Cold and Flu, Vaccinations, Swine Flu (H1N1/09)

What is attenuated flu vaccine?

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Attenuated simply means "weakened". An attenuated flu vaccine refers to vaccines made with live viruses (so you get a good immune response), but they have been weakened chemically so that they are unable to give you the flu. There are two types of flu vaccines available in the US. What is called inactivated, inactive or "dead" vaccine and what is called "live", weakened/attenuated vaccine. The injectable vaccines (intradermal and intramuscular) are made with "dead" viruses and the nasal spray is made with "live" attenuated viruses.
Asked in Conditions and Diseases, Sanitization and Germs, Swine Flu (H1N1/09)

What can you do to avoid getting swine flu?

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Avoiding the Swine Flu Get Vaccinated, it is the best protection. UPDATE For the 2012-2013 flu season in the US: For the 2012-2013 flu season in the US, the Food and Drug Administration (FDA) approved these vaccines for the seasonal flu, all contain vaccine for the H1N1/09 "Swine Flu" and two other viruses suggested by CDC for this season (see more below). There is also a new quadrivalent vaccine approved for use this year, FluMist Quadrivalent. Afluria (CSL Limited) Fluarix (Glaxo Smith Kline Biologicals) FluLaval (ID Biomedical Corporation) FluMist Trivalent, FluMist Quadrivalent (MedImmune Vaccines, Inc.) Fluvirin (Novartis Vaccines and Diagnostics Limited) Fluzone, Fluzone High-Dose, Fluzone Intradermal (Sanofi Pasteur, Inc.) The Fluzone Intradermal is a formulation new in the 2011 - 2012 flu season for administration in the layers of the skin (intradermal injection) instead of the intramuscular (IM) injection. Fluzone Intradermal administration uses a microinjection system with a very fine needle. Approved for those aged 18 through 64. The CDC-approved trivalent vaccines for this flu season will protect against the following three virus strains: A/California/7/09 (H1N1)-like virus (Pandemic (H1N1) 2009 influenza virus) A/Perth/16/2009/ (H3N2)-like virus B/Brisbane/60/2008-like virus FluMist Quadrivalent (Influenza Vaccine Live, Intranasal) is a live quadrivalent vaccine for administration by intranasal spray. FluMist Quadrivalent contains four vaccine virus strains: an A/H1N1 strain, an A/H3N2 strain and two B strains. FluMist Quadrivalent contains B strains from the lineages of: B/Yamagata/16/88 and B/Victoria/2/87. Avoid contact with others who may be sick Stay away from people who have the symptoms or a diagnosis of the A-H1N1/09 virus. Avoid large crowds and stay at least two meters (six feet) from anyone with symptoms or who is sneezing or coughing in public. The swine flu is highly contagious. Close skin-to-skin contact of any type can pass the virus from one person to the next. Such contacts as kissing, hugging, holding or shaking hands, etc. are the most common ways the virus is spread. You can also get it through more indirect contact like sharing drinks, touching doorknobs, light switches, ink pens, handling money, and touching other places and items that infected people have (or may have) touched recently (how recently is under some debate; see the Related Question below about how long viruses live on surfaces. Some reports say 2 hours, some say 2 days or more). How it is spread person to person Swine flu is spread in much the same way as the seasonal flu variations and common cold viruses that go around every year most often in the ways stated above. Similar precautions would be used. Don't give it to others if you are sick Avoid giving it to others; exercise responsible habits like staying out of crowds and public places when you are ill. You should really stay home if you are sick and for seven days afterward or for 24 hours after symptoms are gone, whichever is longer*. Only go out for necessary medical appointments prior to that. *The CDC has revised this guideline to say that after 24 hours of no fever without fever reducers it is OK to be out in public again. A report from the Dept. of Homeland Security suggests the original guidelines were better. If you will be around people who are at higher risk such as pregnant women, children (especially babies under 6 months old), the immuno-compromised, etc., then it may be better to take the safest approach and wait for which ever is longer: seven days after first symptoms; or 24 hours after the fever stops. Cover your coughs and sneezes If you have a runny nose, always use a tissue to wipe your nose. Cover your nose and mouth with a tissue when you cough or sneeze. Do not reuse tissues. Throw the tissue away in a trash container after one use. If you can not get a tissue in time, then cough or sneeze into the crook of your elbow held close to your face to fully cover your nose and mouth and prevent the spread of respiratory droplets. Wash your hands as soon as you dispose of used tissues. UK motto: "Catch It, Bin It, Kill It!" Keep your hands clean with frequent hand washing One of the easiest, most effective, and very simple ways to prevent the spread of the flu is to wash your hands regularly and keep them away from your face, especially your mouth, eyes, and nose. As a general rule of thumb, it is always safest to wash your hands immediately after you shake a person's hand, deal with money, before and after you prepare food, and when you come inside from being outside. Don't touch public things Avoid touching surfaces and items in public use, and wash you hands often if you cannot totally avoid these places. Carry hand sanitizer with you and use it often after touching people or things. Use as directed on the label (rub hands until totally dry). A sanitizer that is 60% alcohol content is most effective. Viruses can "live" on inanimate surfaces for around 2 hours (or up to 48 hours in some environmental conditions, see Related Questions below) after you or someone else touches the surface with the virus on your hands. The virus can also be left on the commonly touched areas if you allow respiratory droplets to get on the surfaces with uncovered coughs or sneezes. Make a habit of never touching your face, nose, mouth or eyes, or those of others, without properly washing hands or using a hand sanitizer that is at least 60% alcohol, both before and after touching public things. Proper hand-washing technique: Use warm water and regular soap; briskly wash and rub hands, under nails, and between fingers with suds for a minimum of 20-30 seconds; rinse and dry on a clean towel. To know if you have washed your hands long enough for the virus to be removed from your hands, sing two verses of "Mary Had a Little Lamb" or sing "Happy Birthday" quickly twice before you stop washing them with the soap suds. Friction is required to physically rub the virus particles off your hands. Face Masks Unless you wear a respirator grade face mask (called N95 type masks) or other specially made masks that can filter the sub-microscopic viruses to prevent your breathing them in, wearing any kind of surgical face mask, or other mask not designed as such (to fit correctly and filter correctly), will not help you avoid getting the flu since the virus is small enough to pass right through the masks or can be carried around the sides of the mask. Also, these masks need to be medically fitted and tested to be properly sealed on your face, or they will not stop you from inhaling the virus. Respirator masks are not recommended for men with beards or for children, since they cannot be made to fit appropriately in these people. Those who have allergies, asthma, lung disease or other trouble breathing often cannot use N95 type masks, since it can be difficult for them to breathe well with one on. Plain surgical masks could keep you from giving the flu to someone else, if you have to go in public when you have the virus, but they will not prevent your getting it from an infected person (except if you are close enough to them when they sneeze directly or cough directly on you). It can be recommended for caregivers and parents caring for sick children, or others who are in very close contact with the ill, to use a mask to keep the respiratory droplets from hitting their faces directly. For most situations and for surgical use, surgical masks are designed to keep the respiratory droplets from the wearer contained (like covering your mouth with a tissue does). Respirators and masks should be thrown away after a single use, like a tissue, and you should always wash your hands after touching them. See the Related Link below for the latest CDC recommendations about masks and respirators. Prophylactic use of anti-viral medications In some cases, a health care professional may prescribe anti-viral medicines, like Tamiflu, for others in the same household with a person diagnosed with the A-H1N1/09 virus, to be used as a prophylactic (preventive) medication to keep them from also getting ill from the virus. There are certain groups where this can be beneficial, especially if these people cannot be isolated from the ill person. Ask your health care professional if this is necessary for those who will be in regular contact or in close proximity to an ill person. Prophylactic use is not appropriate, however, in all situations; your health care professional will weigh the risks versus the benefits and make the best decision for your care. Pork handling and eating When you eat pork, make sure you cook it to the normal safe temperatures for eating pork products. The influenza virus is destroyed by temperatures of 167-212°F (75-100°C), so you need take no unusual precautions to be safe from any kinds of germs that may be in, or on, the meat. Always wash your hands as you would for all safe handling of meats. You can not get swine flu from eating cooked pork. These measures will assure that you will not get this flu by handling meats contaminated on the outside by the virus (which would be an unusually rare circumstance anyway). Keep your immune system healthy Make sure your immune system is in tip-top shape. Always get a full night's sleep. This will help you fight off any illnesses, and if you do happen to catch swine flu, will possibly help you recover faster. You can also take vitamins, especially vitamin C and others that boost your immune system, or drink citrus juice for the vitamin C that it contains. Vitamin C is thought to "boost" the immune system. However, no such studies have been done with the swine flu. Maintain good nutrition and vitamin intake, eat healthier foods such as fruits and vegetables, and laugh and exercise to help relieve stress. Avoid stress It is important not to overreact. Avoid stress as much as possible; it can lower your resistance to any disease. Use breathing techniques to calm yourself in stressful situations. If you have a minor headache or stomach ache, this does not mean you are dying of swine flu. Worrying can weaken your immune system and actually make you more prone to illness. Laugh Studies have actually made a connection between laughter and a healthy immune system. Whenever you can, lighten up and let loose a belly laugh. Even if something doesn't seem funny at first, make yourself start laughing. And if others are around, your laughing will be very contagious and, before you know it, you can have tears streaming and be laughing uncontrollably. This has very beneficial results for your health, especially your immune system. Mosquitoes? Currently (5/9/09), neither the CDC nor the WHO lists mosquitoes as a method of the spread of H1N1. There is no definitive information about this yet, but it is not likely. Usually mosquitoes do not carry the influenza viruses. They do carry some other viruses, such as West Nile Virus and St. Louis Encephalitis, but so far most people asked do not believe the swine flu will be spread by mosquitoes. But, the two viruses mentioned above (that are carried by them) are deadly, and caution should always be taken when mosquitoes are present. Wear long sleeves and use DEET repellent. Wear light-colored clothing, since mosquitoes are attracted to dark colors. And keep standing water, in which they lay eggs, emptied. Try to attract hummingbirds (they eat thousands in one day), bats (equally as good in hunting them), frogs and toads and dragonflies to your yard and garden. Purple Martin birds are also good for mosquito control, but they require more maintenance and very tall and specific houses to attract them. Stay Informed Monitor the web pages (see links below) for The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) or TV news channels and WikiAnswers for the latest recommendations about travel restrictions and other containment and prevention measures that may be put in place as the 2009 swine flu pandemic continues. The US State Department also issues warnings and information for specific travel destinations that will outline any needed information about quarantines or other safety measures the other country may have in place. Prior Information about flu vaccines: For the 2010-2011 flu season: For the 2010-2011 flu season in the US, it is included in the regular flu vaccination, so unlike 2009, it will only require a single vaccination to be protected against swine flu and two other types of flu that are expected to be circulating this season. For the 2009-2010 flu season: In the US, the vaccine is approved, has been released, and is being distributed in late 2009 from the Centers for Disease Control and Prevention (CDC) to public health organizations within each state. Immunization programs will be handled by health care providers and at the state government level by local health agencies. The vaccines are being released on a priority basis to those at highest risk of serious illness or death from the flu. Immunization is the No. 1 way to prevent infection with the flu. Stay alert to your state and local government press releases for information on if, when, and where you can get the flu shots (a single shot is all that is required for those over 10 years old, although younger children will need a series of two). See additional information in the Related Questions below about the immunization for "Swine Flu" (A-H1N1/09). In other countries, distribution of the selected, approved vaccines is also occurring with most countries using a similar priority of need protocol for the first batches. Contact your local health care professional if you are not aware of how to obtain the vaccine in your location. Get regular seasonal flu shot too Get the seasonal flu shot as soon as it is available, and then when the H1N1 vaccine is released to your risk group, take it as well. It will be necessary to take both types of flu shots to protect you from all strains of flu, in addition to the swine flu, that are expected to be circulating in the Northern Hemisphere in the 2009 fall and winter flu season. See the Related Questions below for more information about Vaccines for 2009. See the Related Questions below for more information on steps you can take to avoid the swine flu virus.
Asked in Conditions and Diseases, Vaccinations, Swine Flu (H1N1/09), Immune System

Does the H1N1 vaccine provide lifetime immunity?

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There are studies that suggest that over time the flu vaccines can lose some effectiveness. This is partially due to the original vaccine being less effective on mutated forms of the same virus. But for the same exact strain of H1N1 that is in the vaccine, and others that are very similar to it, many people do retain lifetime protection. One of the ways new viruses are created is through mutation of existing viruses. If the H1N1/09 Pandemic Swine Flu virus mutates to a strain that our immune systems do not detect as the same, then the body would have to either be vaccinated with a new vaccine that includes the new strain, or develop new immunity naturally by infection.
Asked in Swine Flu (H1N1/09)

How long is the incubation period and each stage of a swine flu infection?

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According to information from the Centers for Disease Control and Prevention (CDC): "The estimated incubation period... could range from 1-7 days, and more likely 1-4 days. "The typical incubation period for influenza is 1-4 days (average: 2 days). Adults shed influenza virus from the day before symptoms begin through 5-10 days after illness onset. However, the amount of virus shed, and presumably infectivity, decreases rapidly by 3-5 days after onset in an experimental human infection model. Young children also might shed virus several days before illness onset, and children can be infectious for 10 or more days after onset of symptoms. Severely immunocompromised persons can shed virus for weeks or months. "Uncomplicated influenza illness typically resolves after 3-7 days for the majority of persons, although cough and malaise can persist for >2 weeks. However, influenza virus infections can cause primary influenza viral pneumonia; exacerbate underlying medical conditions (e.g., pulmonary or cardiac disease); lead to secondary bacterial pneumonia, sinusitis, or otitis media; or contribute to coinfections with other viral or bacterial pathogens." Other responses from WikiAnswerers: Studies are continuing to determine the specific incubation period of the 2009 swine flu outbreak, but opinions of slight variations in the estimates are surfacing. For now, however, the official CDC information is as quoted above. Infected people may be able to pass on the flu to someone else ("shed virus") before they know they are sick, while they are sick, and for varying time periods after feeling well again. People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possibly for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods. Some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent hand washing will help you reduce the chance of getting contamination from these common surfaces. Don't go to public places if you have the flu symptoms. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms). This virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. Update 9/27/09 A Department of Homeland Security (DHS) report from 9/19/09 indicates that the period of infectivity of A-H1N1/09 is longer than originally believed, and longer than that of the seasonal flu. Studies on how long a person remains contagious back up the previously reported CDC guidelines that one should be suspected to be capable of spreading the Novel Swine Flu for one full week after the symptoms start or until 24 hours after the fever subsides [while taking no fever reducers] which ever is longer, rather than the most recent CDC guidelines that waiting for 24 hours after fever subsides without taking fever reducers is long enough. In fact, the best determination can probably be made by how long the cough lasts. The studies show that in some cases the virus remains in the nasal passages of patients for up to 16 days after symptoms begin. Below are some excerpts from the report: "Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said. When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away. Using a very sensitive test to detect virus in the nose or throat, [the study] found that 80 percent had it five days after symptoms began, and 40 percent seven days after. Some still harbored virus as long as 16 days later. How soon they started on antiviral medicines such as Tamiflu made a difference in how much virus was found, but not whether virus was present at all. . . Doctors know that people can spread ordinary seasonal flu for a couple of days before and after symptoms start by studying virus that patients shed in mucus. The first such studies of swine flu are just coming out now, and they imply a longer contagious period for the novel bug. "
Asked in Cold and Flu, Symptoms, Swine Flu (H1N1/09)

Why do you get the chills with flu?

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It is usually because you have a fever, and the way the body deals with a fever is by sweating to cool itself by evaporation, just like it does when you are out in the heat of summer and start sweating to cool off. Being hot also will dilate your blood vessels of the skin to move more heat out of the body faster. But you usually don't feel the chill (or as much) when you cool off if the heat is coming from the outside on a hot day, like you do when the heat is coming from the inside with a fever. A fever is an increase in the core body temperature and the extra heat from that (which the body uses as one of its ways to kill germs) radiates out of your body through the dilated vessels and cooling skin. Your hypothalamus gland (also called the "brain's brain") functions as the body's thermostat, among many other duties. And, because it is making its temperature control decisions based on the core body temperature, it will not stop the cooling measures until the core temperature comes down, even if your skin and outer layers are no longer hot. The skin then may feel the sensation of cooling from evaporation, which you can also feel to the touch. That can trigger shivering which the skin does in reaction to feeling cold. But since the hypothalamus uses the core temperatures, it continues to try to cool until the fever is gone. So in a sense two body systems are working against each other...but the hypothalamus wins. It takes longer to cool the inside of your body than it does to cool the outside. So, even though you can feel the cooling off on your skin, and even get the sensation of chills from drafts and being cold on the wet outside of your body, it is still trying to cool the core temperature deep inside. That can make you feel cold on the outside even though you are still too hot on the inside. Many people believe that if they feel a chill with a fever they should bundle up tight and get in bed and "sweat it out". This is a fallacy. This is especially important for infants. Do not wrap them up in blankets that way, since that can increase the fever. It also increases the perspiration and adds to dehydration from a fever if the liquids are not replaced. Any time infants have a fever, you should contact the pediatrician for advice and do not give them fever reducers without the professional advice to determine if it is appropriate.
Asked in Cold and Flu, Infectious Diseases, Swine Flu (H1N1/09), Viruses (biological)

Can you get the flu twice in the same season?

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Catching Flu Twice in a Season Yes, you can. But, it would have to be a different strain or type of the influenza-virus than you previously had (if you are otherwise healthy and have a well-functioning immune system). You would need to be exposed to a different flu virus to get it a second time because your body will have created antibodies to destroy that particular flu virus the first time you had it, and a second exposure that soon should not be able to reinfect you for that reason. There is some eventual loss of protection over the long term possible but not within the same season. Even after receiving the flu vaccine you can get the flu if you are exposed to a different type of flu virus than was in the vaccine, if your immune system is not functioning properly, or if you are exposed before the vaccine was able to create the proper antibodies from the vaccination (usually 2 weeks after the vaccination in most adults and longer in children - up to a month) . The flu vaccine is made with the viral particles of the top 3 flu virus strains that are expected to be circulating in that upcoming season for which the vaccine was developed. US CDC scientists determine each year what viruses should be in the following year's vaccine based on what viruses are circulating in Asia, since these will be moving west toward the US during the flu season. There are many strains, if the scientists do not predict the correct ones, you may still become ill despite a vaccination. You CANNOT get the flu from the flu vaccines. The viruses in the vaccines are killed (inactivated) or weakened, so you cannot get the flu from a flu vaccination. You can check out the NIH's website for more info.
Asked in Swine Flu (H1N1/09)

How long does it take for swine flu to heal?

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An unvaccinated adult who is otherwise healthy can usually fight off an uncomplicated influenza infection in 3 to 7 days. However, it is not unusual for symptoms (especially cough) to last as long as 14 days.
Asked in Cold and Flu, Vaccinations, Swine Flu (H1N1/09)

Can a flu shot cause cellulitis?

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Yes, there can be a local infection from a contaminated needle from a flu shot and that would be called cellulitis. However, many people can get a red, sore, slightly swollen area at the flu injection site from the desired immune response. This usually goes away in a few days. It gets better from exercising the muscle into which the shot was injected. If it is more than two days after the shot and the redness or inflammation is still increasing, then you should seek advice from your health care professional.
Asked in English to Latin, Swine Flu (H1N1/09)

What is the Latin word for Swine Flu?

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Since there was no swine flu like the H1N1/09 pandemic swine flu until discovered in 2009, there was not a specific Latin name for the disease. One could be created from literal translation and would be something like: Orthomyxoviridae porcus. See the related question links section below for other names of the pandemic swine flu.
Asked in Swine Flu (H1N1/09)

How is Swine Flu treated?

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There is no cure for flu viruses. The different methods of treatment of Swine Flu include: Symptomatic Treatment: In addition to the prevention with a vaccine, and treatment with anti-viral medications (see more below), the flu is treated symptomatically with medications (usually over-the-counter medications), and other symptom-relieving measures. Antibiotics do nothing for the flu viruses, antibiotics are only for bacterial infections and do not work for viral infections like swine flu. There are products to treat the specific signs and symptoms of the individual, such as anti-emetics for vomiting and medications to treat diarrhea, analgesics for the aches and pains, fever reducers, and other typical medications for cold and flu symptoms. The typical symptoms of H1N1/09 are similar to all viral influenza infections. Swine flu symptoms often include: Fever. Cough. Sore throat. Muscle and joint pain. Shortness of breath. Nausea and vomiting.Diarrhea. Treatment is relative to the severity of the symptoms and the symptoms can vary from person to person. In most cases, treatment is the same as it is for the seasonal flu. STAY HOME, REST, DRINK MORE LIQUIDS, Motrin or similar for fever and aches, and perhaps over the counter flu or cold medicines for comfort. Eating healthy foods is also important. An antibiotic may be prescribed to treat secondary bacterial infections such as bronchitis or pneumonia, but this is usually not needed. Other treatments can include anti viral medications prescribed by your doctor. In severe cases, hospitalization may be required for respiratory support and IV medications, but these complications are not the norm. Do not give aspirin for fever to children or teens. According to the US Centers for Disease Control and Prevention (CDC): Aspirin or aspirin-containing products should not be administered to any person aged 18 years old and younger with a confirmed or suspected case of influenza virus infection, due to the risk of Reye syndrome. Avoid dehydration: When the symptoms include fever with increased perspiration, nausea, vomiting or diarrhea, one of the most important treatments would be replenishing lost fluids by drinking plenty of water, or if tolerated, sports drinks. If drinking fluids is not tolerated, contact a health care provider to see if anti-emetics (medicines for vomiting) are needed. You may need medicines for the fever or diarrhea. Sometimes other forms of replacement of fluids may be necessary. Dehydration is a serious complication of viral disease, especially in the elderly or very young. Other simple measures to make you feel better: Proper hydration as mentioned above, a good diet (with supplements such as Vitamin C if needed), and proper rest can help boost the immune system and are also important. Showers and baths can be comforting for aching muscles and joints and for more humidity for inflamed mucous membrane tissue. Use facial tissue with lotion in it to help relieve a sore red nose from the runny nose, or apply scent-free baby lotion or even petroleum jelly (Vaseline) to your sore nose. Continue to follow all advice of the CDC and WHO for preventing the spread of this H1N1/09 flu and other flu viruses, such as frequent hand washing and good etiquette and control of spread of the flu using tissues for coughs and sneezes. Keep aware of the updates and announcements from those organizations and your local government health entities. Antiviral Medications to lessen the severity of symptoms, stop virus reproduction, and to speed recovery: The Centers for Disease Control and Prevention (CDC) information says that the swine flu can be treated if caught very early with two of the anti-viral medications oseltamivir (Tamiflu/Fluvir) and zanamivir (Relenza). Tamiflu is for treatment in adults and children aged 1 year and older, and should be taken within 48 hours of the first symptom for maximum effect, however, your health care professional can determine if it is appropriate to start this treatment even after that date, so contact them for advice if you have been exposed or have symptoms. There are currently 4 types of antiviral drugs that are licensed for use in the US for the treatment of influenza: Amantadine, Rimantadine, Oseltamivir and Zanamivir. While most swine influenza viruses have been susceptible to these drugs, the most recent swine-flu viruses isolated from humans, are resistant to Amantadine and Rimantadine. None of these drugs prevent us from getting the virus, but can lessen the severity of the symptoms and shorten their duration. If prescribed within the first 40 hours of symptoms, Tamiflu can also be used to prevent the H1N1/09 virus, in some cases. It is approved by the Food and Drug Administration (FDA) for this prophylactic (preventive) use. It can also be used for prescription to other members of a household, when one person is known to have the influenza, to prevent the rest from getting it. It is not a substitute for proper preventive hygiene techniques and other recommended ways to avoid getting the swine flu and should be used in combination with these measures when prescribed. October 2009: The US Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have approved three flu shot vaccines and one nasal mist vaccine for use in the US. The vaccines are now being distributed within the states by the local state governments, and provided to those at highest risk of complications first (e.g., pregnant women and children over 6 months old or those caring for these infants who cannot take the vaccines, etc.). Pregnant women and parents of young children should be proactive in finding where and when they can get their vaccinations. The risk of the flu, especially in these groups is much higher than any perceived risks of getting the vaccination. Contact your healthcare provider to determine if you fall into any of the first groups who will be offered the vaccine. If you plan to get the vaccination as recommended, ask your PCP (Primary Care Provider) if the shot or the mist is most appropriate for your use. They should be able to tell you how and where to get the immunization. But local news sources should also be announcing that to the public when this process of distribution is begun in your area. (See also the related questions below about which type of vaccine is best for different groups of people.) Other flu treatments in experimental trials: One of the most encouraging developments for all future flu and viral infections, is the "cure" or treatment currently in animal trials, that, unlike current antiviral medications, approaches the attack on the virus in a new way that can not only disable the specific strain of virus, but also prevent it from future mutations (that can allow it to be resistant to the treatment after it makes those modifications). Current antiviral medications affect the chemical "keys" on the viruses' coats to prevent them from attaching to the host cells. The current problem is that the virus can continue to mutate and adjust to chemically change its protein coating and render the anti-viral medication ineffective. The new approach attacks the virus at the stem, instead of at the protein coating. The stem is unable to mutate to a resistant version. The new drug is expected to work on the most deadly of current viral strains. * The manufacturer of the new antiviral treatment has announced that they hope to have the human trials completed and the medication in production in not too long, if all goes well in the current animal trials. Common Cold Vaccine Development--Not yet: Unfortunately, at least the first product being developed, that is mentioned above, is not expected to be effective against the rhinovirus (one of the most prolific viruses that cause the common cold). While it is anticipated by the manufacturer to be effective against our most deadly types of viruses, it is not being targeted to treat the rhino-viruses. We may continue to suffer future sniffles, for a while longer... but this can also be a good thing. It is an advantage to keep our immune systems "tuned" through battle with the more minor viral strains anyway. We are steps closer than ever to the cure for the common cold, though. Prevention is the best medicine! See additional information at the sites listed in the related links section below, and in the related questions, for techniques you can utilize to reduce the prospect of contracting the virus. TAMIFLU UPDATE JULY 31, 2009 Tamiflu Side Effects in Children According to research from the European Programme for Intervention Epidemiology Training and from colleagues from the Health Protection Agency (HPA) in London, which was published in Eurosurveillance (the peer-reviewed journal of the European Centre for Disease Prevention and Control), a small number of children are having neuropsychiatric side effects from Tamiflu such as nightmares, inability to concentrate, insomnia, and slight confusion. The article at the NHS web site (link is provided to the full article in the related links section below), states: '. . . more than half of children taking Tamiflu to combat swine flu suffer side effects such as nausea, insomnia and nightmares,' said The Daily Telegraph. It also said the study suggests that one in five children who took part reported having a neuropsychiatric side effect. However, this has been proven to be a limited complication and only in that age group. none yet I'm scared supposedly if you get a weak strain of swine flu you will become immune to even the more powerful strains PS: GET YOUR SHOT!!!!!
Asked in Swine Flu (H1N1/09)

Does picking your nose affect swine flu?

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If you pick your nose you can move the virus from the environment directly into your nose which will almost assure that you will catch the virus if your hands have been exposed to the virus. Likewise, if you have the flu and pick your nose, you will be much more likely to pass the virus to other people. Not only is picking your nose improper manners, but it is an unhealthy practice. You can get nasal saline spray at the drug store or grocery store to use to clear your nose of dried mucus. It is much more sanitary and you will be less likely to tear or scratch the mucous tissue, too.
Asked in Cold and Flu, Medication and Drugs, Infectious Diseases, Antibiotics, Swine Flu (H1N1/09), Tamiflu

Is Tamiflu an antibiotic?

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No. Tamiflu is an antiviral that makes it harder for the flu virus to spread within the body. Antibiotics fight bacteria which would be useless on the flu which is a virus not a bacteria.
Asked in Mexico, Swine Flu (H1N1/09)

Where were the first cases of the swine flu Novel H1N1 in Mexico and in the US?

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The illness is believed to have begun in La Gloria, a small town in southern Mexico, although it may have actually been a "silent epidemic" circulating unknown in Mexico from as far back as January 2008. The first confirmed and reported case was in Mexico City and was made public March 18, 2009. But it is thought that for at least several months prior to that, this strain of the H1N1 flu was infecting people in and around La Gloria, a village of about 3,000 people, and it is likely that the first human case may be able to be traced back to a young boy named Edgar Hernandez from La Gloria. He survived the virus. Also, although a particular pig farm in Mexico was thought to have perhaps had the first case of the flu among pigs, the Mexican government tested and found no evidence of that at the farm. It is now believed that the first case among pigs was more likely at a different farm in Texas. The first cases in the US were discovered very soon after the Mexican cases, with two children in Southern California. The first was discovered on April 14, 2009 in a child in San Diego County in California and another child a few days later in a town not far from the first was also reported. The next cases in the US began in Texas and became more and more widespread there as the sporadic outbreaks began and gradually spread.
Asked in Swine Flu (H1N1/09)

When did Swine Flu start?

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The first Swine flu viruses were isolated in 1930 in the United States in pigs. The most famous early swine flu outbreak in humans was in 1976 at Fort Dix, New Jersey where four soldiers who were previously healthy contracted the virus and developed pneumonia diagnosed by X-ray with other symptoms of the flu. One died as a result. The virus was thought to have circulated approximately a month in the close quarters of the group in basic training but not outside the group, then it disappeared. In the fall of 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine. The 2009 pandemic of Influenza A, Novel H1N1 "swine flu" was first detected in Mexico City and was made public March 18, 2009. This new strain of virus has been tracked back to a child from a small village in Mexico (where there was close proximity to hog farms) as the probable first infected individual. The village was La Gloria, a small town in southern Mexico. La Gloria has about 3,000 people, and it is now believed the first human cases of the Novel H1N1 Influenza probably started there. The first known person to have contracted the 2009 H1N1 Influenza was a young boy named Edgar Hernandez from La Gloria. He survived the virus. Although a particular pig farm in Mexico was thought to have perhaps had the first case of the flu among pigs, the Mexican government tested and found no evidence of that at the farm. It is now believed that the first case among pigs was more likely at a different farm in Texas. The first cases in the US were discovered in March and early April in Southern California and near San Antonio, Texas. The World Health Organization (WHO) declared a Pandemic. That means that it is world wide and spreading quickly from human to human. The pandemic continued with increasing spread human to human around the globe but has now been declared over, although there are still isolated outbreaks around the world in different locations from time to time.
Asked in Swine Flu (H1N1/09)

What are the swine flu virus and Novel H1N1 Influenza?

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Swine Flu (in Pigs) Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses including H1N1 and H3N2. Pigs that contract swine flu suffer from similar symptoms as do humans with influenza. It has mutated into the "Novel H1N1" (A-H1N1/09, Pandemic Swine Flu) form of the virus, which has the ability to be passed on to humans. This new form is highly contagious and can be passed from person to person and rarely from a person back to pigs. Human Flu Versus Swine Flu Human Influenza refers to one of the three major types of flu viruses ( Influenza type A,B,C) endemic to the human population (orthomyxoviridae). These are distinguished from animal flu passed to humans as a result of a mutation in an animal strain that allows it to be able to invade the cells of humans. Diseases that are able to pass from animals to humans are called zoonotic diseases. Swine Flu (in Humans) Additional Information about Type A Influenza Novel H1N1 (aka A-H1N1/09): The 2009 Swine Flu is also known by several other names world wide. In the US it is called Swine Flu, 2009 Swine Flu, Novel H1N1, New H1N1 Influenza, A H1N1, and more officially now by the CDC A-H1N1/09 Virus. It has different names in other countries as well, for example: it is called Schweinegrippe in Germany, la Grippe A in France, Mexican Flu in the Netherlands, SOIV (Swine Origin Influenza Virus) in Canada, and la epidemia in Mexico. It has genetic material from multiple strains of flu from pigs, one from Eurasian swine flu, also genetic material from North American swine flu, human flu, and Avian (bird) flu. This is called a "quadruple reassortant" virus, meaning it was made by mutations involving four genomes (or sometimes called quintuple if the European and Asian strains are counted separately). It has the potential to be a deadly flu, although the first wave has been mild. This is also the way the 1918 Spanish flu (a different H1N1 virus), that was so deadly, began. It became much more virulent in its second wave. The reason that it has potential to be worse than most Type A H1N1 virus strains that humans can get, is that there have not been strains even somewhat similar to this new one in the past, so there is no immunity from hereditary sources or from prior vaccinations or exposure. It is totally new, so people may have much more trouble with it than with the typical seasonal flu viruses. The outbreak seemed to begin in Mexico, but it may have actually started at a pig farm in the US and then mutated to a strain that humans caught and passed to other humans who took it to Mexico. A person who has this virus presents with typical seasonal flu symptoms, such as chills, fever, sore throat, and cough. The original Swine flu virus that pigs get does not ordinarily readily transmit from pig to human. It has happened with farm workers in very close contact with the pigs, but it has been rare. Because of the ability of viruses to rapidly evolve and mutate into new and different strains, when there is prolonged contact between humans and infected pigs or their environment, the virus can "morph" into a new kind that humans may also get. Once in the human host, it can then be passed to other people by close human to human contact. See the related questions below for more detail on what caused this unique virus to become infectious to humans. The A-H1N1/09 (2009 swine flu) virus is spread on respiratory droplets from uncovered coughs and sneezes, and by direct or close contact with an infected person. However, wearing ordinary surgical masks is not an effective preventive measure since a virus is sub-microscopic and can pass through these masks unfiltered. The masks can, however, be helpful in preventing a person already with the flu from spreading their virus by coughing or sneezing without covering their mouths. The masks will trap the droplets on the inside of the mask. There are respirators and specially designed face masks (N95) that can be effective to prevent the passage of the microbe in the air to you from others, when properly fitted to the face. Avoid people who are sneezing or coughing, keep a distance of approximately 6 feet from an infected person. Be very careful when touching public surfaces that others may have touched, and wash your hands frequently. See the related questions below for more information on protecting yourself from getting the flu, and for the proper method of washing hands to remove germs. If given within two days of the first symptoms, the Centers for Disease Control and Prevention (CDC) information says that treatment with either of these two of the anti-viral medications currently on the market, oseltamivir and zanamivir, can be effective in lessening the ability of the virus to invade cells and lessen the severity of the symptoms. Otherwise, the treatment is symptomatic (cough medicine if there is a cough, fever medicine for fever, etc.), the same as for other types of the seasonal flu viruses, unless severe respiratory distress is realized. See the related questions below for more information about treatment for swine flu and symptoms that may require urgent medical attention. Symptoms: Fever. Cough. Sore throat. Muscle and joint pain. Shortness of breath. Nausea and vomiting. Diarrhea. The illness may elevate to a severe respiratory illness within about five days. H1N1 is a type of influenza (flu) virus. Early on, H1N1 flu was referred to as swine flu. In 2009, H1N1 is causing illness in countries around the world.
Asked in Chemistry, Swine Flu (H1N1/09)

What are the exact ingredients in Di Cal?

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Di Cal is an abbreviation for Dicalcium Phosphate. The elemental makeup is CaHPO4 • 2H2O. Although it can be derived from natural sources, such as bone meal and egg shells, Dicalcium Phosphate is usually made using limestone and phosphoric acid in a chemical reaction.