PANDEMIC FLU (H1N1)

Frequently Asked Questions

What is H1N1 flu?

The pandemic H1N1 influenza (flu) is a variation of the Influenza A H1N1 virus.

This new virus was first detected in people in the United States in April 2009.

On June 11, 2009, the World Health Organization (WHO) declared that the H1N1 flu virus had spread to enough countries to be considered a global pandemic. (A pandemic is a worldwide outbreak of a new flu virus which people have little or no immunity and that spreads easily from person to person.) This pandemic stage does not mean that the disease is deadlier or more severe, just that it has spread to more countries.

This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. What are the symptoms of H1N1 flu?

The symptoms of H1N1 flu in people are similar to the symptoms of regular seasonal influenza and include fever, body aches, lack of energy, and lack of appetite, headache, fatigue, and coughing. Some people with pandemic flu also have reported runny or stuffy nose, sore throat, nausea, vomiting, and diarrhea. In general, illness in the U.S. has ranged from mild to severe, and most people that test positive for the virus recover without requiring medical treatment.

How do I know if I have H1N1 flu?

Since the symptoms for H1N1 flu are similar to symptoms for seasonal flu, the only way to know for sure that you have H1N1 flu is for your doctor to collect a nasal/pharageal specimen and send the sample to a laboratory for confirmation. But not all patients need to be tested unless they are in a high risk category or if it would alter treatment options.

How severe is H1N1 flu?

So far this H1N1 flu virus has been similar to the seasonal flu we see each year. During a regular flu season, influenza can cause mild to severe illness and sometimes leads to death. Each year, in the United States, on average 36,000 people die from flurelated complications and more than 200,000 people are hospitalized. Some people are more likely to become very ill if they catch this H1N1 flu virus. These include children under age 5, pregnant women, children who take medicines that contain aspirin, and people of any age with chronic medical conditions, such as asthma, heart or lung problems, diabetes, immune system problems, or other serious health problems. If your child has a serious medical condition, talk to your doctor or clinic about how to keep your child healthy in flu season.

However, influenza is unpredictable and the virus may change. Health officials are encouraging everyone to get their seasonal flu vaccine as soon as it is available. With the possibility that H1N1 may be in the mix, influenza activity may pick up sooner than usual this fall.

Should I call my doctor or go to the hospital?

If you have flu symptoms, stay home, and when you cough or sneeze, cover your mouth and nose with a tissue. Afterward, throw the tissue in the trash and wash your hands. That will help prevent your flu from spreading. If you have severe flu symptoms (see below) see a doctor. Keep in mind that your doctor will not be able to determine whether you have pandemic flu, but can take a sample from you and send it to a lab for testing to see if it’s pandemic flu.

What are the warning signs of serious influenza illness?

If you or your family become ill and exhibit the following warning signs, you should call your health care provider immediately.

In children, emergency warning signs that may need urgent medical attention include:

• Fever greater than 100 in combination with other symptoms
• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Not urinating or no tears when crying
• Severe or persistent vomiting
• Being very sleepy or confused, not waking up or interacting
• Being so irritable that nothing makes the child feel better
• Pain or pressure in the chest or stomach area
• Sudden dizziness
• Confusion
• Flulike symptoms improve but then return with fever and more severe cough

In adults, emergency warning signs that may need urgent medical attention include:

• Fever greater than 100 in combination with other symptoms
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flulike symptoms improve but then return with fever and more severe cough

To find out more about what do do if you sick from H1N1 or seasonal flu Click Here

How do I prevent my family and me from catching H1N1 flu?

Public Health officials recommend that you use the same precautions to prevent H1N1 flu as you would for seasonal flu. There are everyday actions people can take to stay healthy. It is important to teach your children how to reduce the risk of getting the flu and how to protect others from becoming infected.

• Wash your hands frequently or use an alcoholbased hand sanitizer and teach your family to do the same. When washing with soap and water, wash for at least 20 seconds, which is about as long as it takes to sing the “Happy Birthday” song twice. When using hand sanitizers make sure they contain at least 60 percent alcohol. Have everyone in your household wash their hands often.
• Cover your coughs and sneezes with tissues or by coughing into the inside of your elbow or sleeve. After blowing your nose or coughing into a tissue, properly dispose of the tissue. Then, make sure to wash your hands.
• Don’t share food, utensils or beverages with others.
• Avoid touching your nose, mouth, and eyes and keep your hands away from your face because that’s how viruses get into your body.
• Stay about six feet away from someone who has a respiratory infection when possible. Individuals can be infectious for seven days from onset of symptoms, but are most infectious until 24 hours after fever has passed.
• Practice a healthy lifestyle — get plenty of sleep, exercise regularly, and eat a healthy diet.

Are antivirals for influenza treatment available?

Things are changing rapidly with the availability of antivirals in the community.  Pediatric formulations of Oseltamivir (Tamiflu) have been placed on back order by the manufacturer and select pharmacies are opting to compound pediatric suspensions from 75mg capsules to meet patient care needs. 

Availability of the 75mg capsules has decreased (some retailers are reporting they've been placed on allotments) and we may see a back order from the manufacturer soon.   Walgreens pharmacy has reported they have product available to compound pediatric suspensions but they are not taking verbal orders for the medication.  They will compound based on a handwritten prescription, the patient can expect the prescription to be available for pick-up 
2-6 hours from the drop-off time.  

For inpatients, St. Luke's continues to have product available for admitted patients with influenza.  Take-home prescriptions upon discharge will need to be filled at a community pharmacy (St. Luke's outpatient pharmacies are an option for these patients).  

The Zanamivir (Relenza) inhaler is an option for influenza treatment.  This product remains available from wholesalers.  Clinicians should consider writing prescriptions that indicate the pharmacy may dispense Tamiflu OR Relenza when appropriate. 

Are influenza vaccinations for disease prevention available?     

Manufacturers for seasonal influenza vaccinations did not produce as many doses as anticipated for the 2009-2010 influenza season which, when combined with increased interest in vaccination, has resulted in a relative shortage of the vaccine. 

St. Luke's currently has product available to vaccinate admitted inpatients.   We will continue to screen inpatients and vaccinate eligible individuals based on our defined criteria.  We will also vaccinate upon clinician order.   2009 H1N1 vaccine is on allotment from the Central District Health Department, we are receiving small shipments weekly.  St. Luke's is vaccinating health care workers in prioritized groups.   High risk areas are being offered vaccine first.  Employee Health is working with department directors to notify providers when vaccine is available.  We do not have allotments for patient vaccinations at this time.

More Information

For more information about the HINI Flu visit the following Web sites or call the Central District Health Flu Hotline at 321-2222.

• www.cdc.gov/h1n1flu/
• www.flu.idaho.gov
• www.cdhd.idaho.gov
• www.cdhd.idaho.gov/CD/hottopics/dujour.htm
• www.publichealthidaho.com