H1N1 Flu: What’s the Latest?

BACKGROUND :
A Pandemic Is Declared
June 11, 2009: World Health Organization(WHO) signaled that a
global pandemic of novel influenza A (H1N1) was underway.
 Reflection of the spread of the new H1N1 virus, not the severity
of illness caused by the virus.
 H1N1 virus spread continues, with the number of countries
reporting cases of novel H1N1 nearly doubling.
 US continues to report the largest number of novel H1N1 cases of
any country worldwide
 most people who have become ill have recovered without requiring
medical treatment.
 H1N1 influenza and Seasonal influenza, working together
 Potential to cause significant illness, hospitalizations, and deaths
during the U.S. influenza season (October –March).
 What is H1N1 Flu?

Novel influenza A (H1N1) aka Swine Flu,

Pandemic Flu
New flu virus of swine origin that first caused illness
in Mexico and the United States in March and April,
2009.
Spreads in same way as regular seasonal influenza
viruses
 coughs and sneezes of people who are sick with the
virus,
 also by touching infected objects and then touching
your nose or mouth.
H1N1 Influenza in MA
As of October 1, 2009:
 1412 documented cases of H1N1 Flu (ie,
confirmed by testing)
 63% of cases are < age 18
 Age range 0-84 years; Median age is 14
 Equally affecting males and females
 182 Hospitalizations (13%)
 11 Deaths reported
 8 had underlying conditions
Signs & Symptoms
 fever
 cough
 sore throat
 body aches
 headache
 chills
 fatigue
 nausea
 vomiting
 diarrhea
How does H1N1 flu virus
spread?

Same way that seasonal flu spreads

Person to person through coughing or
sneezing by people with influenza.
Touching something with flu viruses on it
and then touching mouth or nose.
doorknobs, tables, countertops, toys, shaking
hands
Risk Factors –Seasonal Flu
In seasonal flu, certain people are at “high risk” of
serious complications.
65 years and older
children <5 years old
pregnant women
people of any age with certain chronic medical
conditions
About 70 percent of people hospitalized with novel
H1N1 virus have had one or more medical
conditions recognized as placing them at “high
risk” for seasonal flu-related complications.
Risk Factors- H1N1 Flu
Different from seasonal influenza
Adults 65 and older do not yet appear to be at increased risk
of novel H1N1-related complications
About 1/3 of adults >60 years old may have antibodies
against novel H1N1 virus
No children and few adults <60 years old have existing
antibody to novel H1N1 flu virus
 unknown how much protection there is against novel H1N1 flu
by any existing antibody.
Prevention
H1N1 Flu Vaccine
Clinical trials completed
Approved by FDA September 15, 2009
First shipments began October 2009
1 vaccination for age 10+,
2 for <age 10
Shot vs. Spray
Flu Shot Nasal Spray
 inactivated vaccine  live (weakened)
 approved in people vaccine
over 6 months of age  healthy people 2-49
 given by needle yrs old who are NOT
pregnant
 given via nose
Flu Vaccine Side Effects
Shot Nasal Spray
 soreness, redness  Adults: runny nose,
or swelling at headache, cough,
injection site sore throat
 low grade fever  Children: runny
 aches nose, headache,
mild fever,
wheezing, vomiting,
muscle aches
People who should NOT
get the vaccine
1. People who have a severe allergy to chicken
eggs.
2. People who have had a severe reaction to
the influenza vaccine in the past
3. People who developed Guillain Barre
Syndrome (GBS) within 6 weeks of getting a
previous influenza vaccine
4. Children <6 months of age
5. People who have a moderate or severe
illness should wait until their symptoms
lessen
Everyday steps to protect your
health:
Cover your nose and mouth with a tissue when
you cough or sneeze. Throw the tissue in the trash
after you use it.
Wash your hands often with soap and water,
especially after you cough or sneeze. Alcohol-based
hand cleaners (eg, Purell) also effective.
Avoid touching your eyes, nose or mouth. Germs
spread this way.
Try to avoid close contact with sick people.
FAQ‘s
How do we know how many get sick
with the Flu if not everyone is
tested?
Sentinel Sites
Provider offices across the US report the
amount of influenza-like illness (ILI) they
see in their patients each week during flu
season.   
Do not represent confirmed influenza
cases, only those with ILI.
Definition of ILI :fever above 100.0 0  F, plus
either cough or sore throat. 
ILI is a marker of influenza and is used
throughout the regular flu season to
monitor influenza activity since most
people are not tested.  

 Massachusetts ILI starting to increase

 Providers reporting more activity at this time of

year than during previous seasons
How is H1N1 flu different from
seasonal flu?
1. Seasonal flu is caused by different flu viruses than H1N1 flu.
2. Seasonal flu occurs every year, most often during the winter and early
spring.
3. Because H1N1 is a new virus, our bodies have not built up any
resistance to it. That is why so many people may get sick.
4. Pandemic flu, like H1N1 flu, occurs once every 30 years or so.
5. Seasonal flu most severely affects people 65 years and older.
6. H1N1 is currently being seen more often in children and young adults
between the ages of 5 and 24 years old.
7. A vaccine is available every year to help prevent seasonal flu.
8. H1N1 vaccine is expected to be available in October 2009.
What is the best way to keep from
spreading the influenza virus?

If you are sick with flu-like illness, CDC

recommends staying home for at least 24
hours after your fever is gone, except to get
medical care or for other necessities.
Your fever should be gone without the use of a
fever-reducing medicine. (Advil, Tylenol, etc.)
Keep away from others as much as possible to keep
from making others sick.
Cover your mouth and nose with a tissue when
coughing or sneezing. Put your used tissue in the
waste basket. Then, clean your hands, and do so
every time you cough or sneeze.
What is the best way to keep from
spreading the influenza virus?, cont.
Stay at home.
Don’t leave home except to seek medical care.
This means avoiding normal activities:
work
school
travel
shopping
social events
public gatherings
If I have a family member at home who is
sick with H1N1 flu, should I go to work?

Employees who are well but who have an ill

family member at home with novel H1N1
flu can go to work as usual. These
employees should:

monitor their health every day for

symptoms
take everyday precautions including
washing hands often, especially after
coughing or sneezing.
Is it necessary to wear a mask?
Not usually needed in community
settings
Sick people may wear masks when
close to other people:
breastfeeding a baby
waiting in a doctor’s office or emergency room
waiting in the school nurse’s office
Caregivers may choose to wear masks
when in close contact with a sick
person.
Can I get infected with novel H1N1 virus
from eating or preparing pork?

No. H1N1 viruses are not spread by food.

You cannot get infected from eating pork or
pork products. Eating properly handled and
cooked pork products is safe.
Contamination & Cleaning
How long can influenza virus stay
alive on objects (books and
doorknobs, etc.)?

Influenza virus can survive on

environmental surfaces and can infect a
person for 2 to 8 hours after being
deposited on the surface.
However, when respiratory secretions dry
out, virus no longer infectious.
What kills influenza virus?

Heat (167-212°F [75-100°C]).

Chemical germicides in proper
concentration
 chlorine
 hydrogen peroxide
 detergents (soap)
 iodophors (iodine-based antiseptics)
 alcohols (hand wipes or gels)
What cleaning should be done to
prevent the spread of influenza
virus?
Clean areas and items likely to have frequent
hand contact and/or visibly soiled
Wipe down with household disinfectant
according to directions on the product label.
 work surfaces
 bathroom surfaces
 counters
 toys
Usual cleaners OK,
No extraordinary disinfection needed
Signs & Symptoms to Look For
Is it a Cold or the Flu?
Cold Influenza
Onset: Gradual Onset: Sudden
Fever (> 100 F): Common
Fever: Rare
Headache: Prominent
Headache: Rare Body Aches: Prominent
Body Aches: Mild to Fatigue/Weakness: Severe
none Exhaustion: early, prominent

Fatigue/Weakness:
Mild
Exhaustion: Never
Is it Seasonal or H1N1
Flu?
Shared by both H1N1 Flu
• Fever Diarrhea
• Cough Vomitting
• Sore Throat
• Body Aches
• Fatigue,
Exhaustion
Difficult to determine
unless tested
Flu Symptom Check List
Does employee/student have :
 Cough?
 Sore Throat?
 Headache, Body Aches, or Chills?
 Vomiting or Diarrhea?
 Fever of > 100.4 degrees F ?

Students will be assessed and sent home at

the discretion of the school nurse.
If there is fever and one of the other
symptoms, person has Influenza-like
Illness (ILI), and should be sent home.
When can an
employee/student return?
After staying home for 7 days after
symptoms start
OR
Until completely well for 24 hours
fever-free for at least 24 hours without the
help of fever-reducing medicine (Tylenol,
Ibuprofen, etc)
Prevention
Prevention
Stay 3-6 feet away from people who are
coughing and sneezing
Stay home when you are sick
Cover your mouth and nose when coughing
or
sneezing
Avoid touching your eyes, nose, mouth

Handwashing!
Prevention
Follow public health advice regarding
school closures, avoiding crowds and other
social distancing measures.

Healthy Habits
Good eating, good sleep, good exercise
Limit Contact with Others
1. Stay home when you are sick (including
errands)
2. Keep your child home when they are sick
3. Do not allow visitors while people in your
home are sick
4. Person with the flu should stay in separate
room if possible and limit contact with
others for about 5-7 days
5. Do not share food, eating utensils or drinks.
6. No “group foods” during flu season
Treatment
Treatment of Flu
 Stay HOME
 Get lots of rest
 Drink plenty of fluids
 Fever Control (Do NOT give Aspirin)
 Treatment of Symptoms:
sore throat, stuffy nose, cough,
muscle aches
 Chicken Soup
 Know when to call the MD or go to ER
 Take antiviral drugs if prescribed
Fever
1. Keep room temperature comfortably cool

2. Dress in light weight clothes

3. Drink plenty of fluids

4. Sponge- lukewarm water

5. Antipyretics- NO Aspirin
 Fluids/Hydration
 Infants/Children/Elderly are at higher risk of
becoming dehydrated
 Symptoms: thirst, dry mouth, less urine
output or dark urine, dizzy/light headed, h/a,
in infants: less tears, less active
 Treatment:
1. Drink plenty of fluids
2. Give small amounts of fluid frequently
Symptomatic Relief
 Stuffy Noses
 drink plenty of fluids
 Cool mist humidifier/ Steam from
shower
 Raise HOB/crib
 No SMOKING in house
 Infants-bulb syringe
 Infants/Children: saline sprays
 Adults: decongestants and
antihistamines
Sore Throat and Cough
 Gargle with warm salt water
frequently

 Drink warm lemon water

 Throat lozenges

 Drink lots of fluids

 Avoid cigarette smoke

Muscle Aches
 Help change positions in bed

 Use pillows

 Help out of bed and walk 3-4X/day

 Maintain positions of comfort

 Tylenol, Advil, Motrin (NO Aspirin)

 Spend time at the bedside

Nutrition/Fluids
It as been shown that Chicken Soup is good
for the flu

Some fluids to give:

water vegetable juice
warm broth non caffeinated tea
real fruit juice frozen pops/jello

Some foods to try:

oatmeal toast applesauce rice
When to call the MD

INFANTS
Fever
-if < 3 mos, T >100.4
-if between 3 mos-2 yo T > 102
Cough lasts more than one week
Loss of appetite/refuses feedings
Vomits frequently w/coughing spells
Seems very irritable
Unusually sleepy or hard to arouse
When to seek immediate
medical attention
INFANTS and CHILDREN
Fast or difficult breathing
Bluish skin color
Not drinking enough fluids
Not waking up/engaging
Very irritable
Symptoms that improve, but then return
Fever with rash
When to call MD
OLDER CHILDREN AND ADULTS
Painful redness or swelling around the eyes/nose
Vision problems
Sinus pain or severe headache
Symptoms lasting longer than 7 days
Any breathing issues
Extreme agitation
Changes in color and/or consistency of mucus
Sudden or severe weakness/fatigue
Confusion or somnolence
When to seek immediate
medical attention
OLDER CHILDREN AND ADULTS
Difficulty breathing or shortness of breath

Pain or pressure in chest/abdomen

Sudden dizziness

Confusion

Persistent or severe vomiting

Green, rust colored or bloody sputum

How to care for yourself
Eat a well balanced diet, drink plenty of fluids, get
your exercise
Avoid drug/alcohol use
Get rest
Keep notes on each child
Be patient
Take breaks
Pace yourself, it may be a while to return to normal
Shopping List
1. Soap for hand washing
2. Alcohol based hand sanitizer
3. Medicines
a. Acetaminophen/Advil/Motrin
b. Cough/Cold medicines
c. Throat Lozenges
d. medicine spoon
4. Thermometer
5. Fluids
6. Foods easy to digest
7. Household disinfectants
8. Paper Towels
9. Trash Bags
H1N1 Vaccination
Vaccine Safety
 H1N1 vaccine in U.S. is being made by 5
manufacturers licensed by the FDA.

 H1N1 vaccine is made and tested the same way

as seasonal flu vaccine.

 Flu vaccine is safe for most people.

 Safety of H1N1 vaccine will be carefully

watched.
Who?
Recommended groups to get the first availability of
H1N1 vaccine:

Pregnant women
Household contacts and caregivers for children <6
months old
Healthcare and Emergency medical personnel
Everyone 6 months to 24 Years old
Those age 25-64 with health problems that place
them at risk for complications of flu
Once demand for above groups is met, then:
 Everyone 25-64 years old
When demand for above groups is met, then:
 Everyone 65+ years old
When?
Tentative!
 First shipments expected began in October, weekly shipments
 First vaccination to be followed by second one 3-4 weeks later
for < age 10
 Only 1 vaccination for ages 10+
• Plan is to Administer the H1N1 vaccine to students with signed
permission slips during the school day

Expected to have sufficient vaccine for all who

want one
High risk groups targeted for vaccination first
 Determined by CDC
H1N1 Vaccine not expected to protect
against Seasonal Flu
Get your seasonal flu immunization!

Possible for some children to receive up to

4 immunizations
1-2 Seasonal Flu immunizations
(children < 10 years old)
1-2 H1N1 Flu immunizations
How? In Natick…
School-based Vaccination Clinics
 Will take place during school hours
 If 2 H1N1 flu immunizations needed, ~ 4 weeks apart
 Clinics will be held in each school during the school day

Public Vaccination Clinics

 Prioritized for highest risk groups first
 Expected to have sufficient vaccine for ALL who want to be vaccinated

Details TBA
H1N1 Flu Vaccination is NOT
mandatory!

Children will not receive H1N1 vaccine in a

School Clinic without signed, written
consent form from parent/guardian

Any person, child or adult, will be required

to have a consent signed to receive the
H1N1 vaccination in any Public Clinic
 H1N1 Flu Vaccination is NOT
mandatory!
MEMORANDUM
To: Members of the General Court, Local and Municipal Elected Officials
From: John Auerbach, Commissioner of Public Health
Cc:
Re: False Rumors Regarding Mandatory Vaccination for H1N1 Influenza
Date: September 2, 2009
______________________________________________________________________
Many of you may have heard rumors that the Commonwealth of Massachusetts is planning to impose
mandatory vaccinations as part of our response to the H1N1 (swine) flu pandemic. These rumors are not true.
The Department of Public Health will not call for or authorize mandatory vaccination against the pandemic flu.
There are no public health officials on the state, national, or global level calling for forced vaccination for H1N1.
These rumors appear to be part of a deliberate effort to misinform concerned citizens about state and national pandemic
response efforts…
We are eager to offer the H1N1 vaccine to those most at risk who choose to be vaccinated when it becomes available in
mid-October.
Mandatory vaccination is not and has never been part of the plan or discussion in Massachusetts’ pandemic response.
For up-to-date, accurate information about H1N1 and the Commonwealth’s response, go to our webpage
at http://www.mass.gov/dph/swineflu or contact us at (617) 624-5200.
 Helpful Resources
Mass. Dept. of Public Health
•www.mass.gov/flu
•Mass 211: Dial 2-1-1

U.S. Dept. of Health & Human Services

•www.flu.gov

Centers for Disease Control & Prevention

•www.cdc.gov/h1n1flu