Monday, July 27, 2009

Swine Flu FAQ - NHS


What is swine flu?

Swine influenza is a disease in pigs. The virus currently transmitting among people is now generally referred to as swine flu, although the origin of the disease is still under investigation. There is no evidence of this strain of the disease circulating in pigs in the UK.

There are regular outbreaks of swine influenza in pigs worldwide. It does not normally infect humans, although this occasionally does occur - usually in people who have had close contact with pigs.

Swine influenza viruses are usually of the H1N1 subtype. The swine flu that has spread to humans is a version of this virus.

Why is swine flu affecting humans?

Because the swine flu virus has mutated (changed) and is now able to infect humans and transmit between them.

Which people are most vulnerable from swine flu?

Those who are more at risk from becoming seriously ill with swine flu are:

  • people with chronic lung disease, including people who have had drug treatment for their asthma within the past three years,
  • people with chronic heart disease,
  • people with chronic kidney disease,
  • people with chronic liver disease,
  • people with chronic neurological disease (neurological disorders include motor neurone disease, Parkinson's disease and multiple sclerosis),
  • people with suppressed immune systems (whether caused by disease or treatment),
  • people with diabetes,
  • pregnant women,
  • people aged 65 years and older, and
  • young children under five years old.

For specific advice on antiviral treatment for these groups, go to People with long-term conditions, Pregnancy and children andOlder people.

How is swine flu infection diagnosed?

There is now a new self-care service, called the National Pandemic Flu Service, which allows people to check their condition online or over the telephone (0800 1 513 100 or textphone 0800 1 513 200) and obtain antiviral medication if swine flu is confirmed.

The following people should call their GP directly for an assessment of their symptoms and a diagnosis:

  • those with a serious underlying illness,
  • pregnant women,
  • those who have a sick child under one year of age,
  • those with a condition that suddenly gets much worse, or
  • those with a condition that is still getting worse after seven days (five for a child).

For more information, go to the Flu Service - Q&A.

Is the new swine flu virus contagious?

The Health Protection Agency (HPA) says the new swine flu virus is highly contagious and is spreading from person to person.

Swine flu spreads in the same way as ordinary colds and flu. The virus is spread through the droplets that come out of the nose or mouth when someone coughs or sneezes.

If someone coughs or sneezes and they do not cover it, those droplets can spread about one metre (3ft). If you are very close to the person you might breathe them in.

Or, if someone coughs or sneezes into their hand, those droplets and the virus within them are easily transferred to surfaces that the person touches, such as door handles, hand rails, telephones and keyboards. If you touch these surfaces and touch your face, the virus can enter your system, and you can become infected.

See Causes for more information

How long does the virus live on surfaces?

The flu virus can live on a hard surface for up to 24 hours, and a soft surface for around 20 minutes.

What is the incubation period for swine flu?

According to the Health Protection Agency, the incubation period for swine flu (time between infection and appearance of symptoms) can be up to seven days, but is most likely to be between two and five days. It is, however, too early to be able to provide details on virus characteristics, including incubation period, with absolute certainty at this time.

When are people most infectious?

People are most infectious to others soon after they develop symptoms, although they continue to shed the virus (for example, in coughs and sneezes) for up to five days (seven days in children). People become less infectious as their symptoms subside, and once their symptoms are gone, they are no longer considered infectious to others.

How quickly is swine flu spreading?

Swine flu is now widespread in the UK and spreading rapidly. The number of new cases in the UK is doubling every seven days. Most of these are because people are catching swine flu in their local community and not as the result of foreign travel.

Go to the Latest on swine flu for a current list of all the countries affected by swine flu.

Should I avoid contact with people suspected of having swine flu?

All suspected cases who have swine flu symptoms will have been asked to self-isolate at home and restrict their contact with people. The vast majority of people should go about their normal activities, including going to school or work. This includes children who attend a school with a confirmed case of swine flu.

There is no need on risk grounds to avoid contact with people who might simply have come into contact with those having the illness, such as the parents of children at schools with a confirmed case but who are not themselves ill.

How dangerous is it?

It is difficult to judge this at the moment. While there have been deaths, symptoms exhibited by most infected people have not been severe.

It appears that early doses of antiviral medicines such as Tamiflu are effective in helping people to recover. In the UK we have enough antivirals to treat half the population if they were to become ill. Also, orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.

What are the symptoms of swine flu?

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal flu and include fever (a high body temperature of 38C/100.4F or over), fatigue, lack of appetite and coughing (see Symptoms). Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea.

How long are symptoms expected to last?

As with any sort of influenza, the severity and duration of symptoms will vary depending on treatment and individual circumstances. Most cases reported in the UK to date have been relatively mild, with those affected starting to recover within a week.

How does swine flu cause death?

Like any other type of flu, people can die from swine flu if they develop complications, like pneumonia.

Has the swine flu virus developed resistance to Tamiflu?

Not at the moment. Routine sampling of the virus in the UK has shown that there is currently no resistance to either Tamiflu or Relenza.

One flu H1N1 virus strain showing Tamiflu resistance was reported in a patient in Denmark who had received treatment - however, Tamiflu resistance in individual patients does occur in a low percentage of cases and is of limited public significance. The Health Protection Agency is monitoring whether such viruses are being transmitted from person to person.

Will the swine flu virus become resistant to antivirals in the future?

It is possible. The virus may mutate (change) and become less susceptible or resistant to the antiviral drug, and then spread from person to person. If the virus does develop resistance, it’s more likely to be to Tamiflu, the main antiviral treatment. If this happens, the government has a stockpile of Relenza that could be used instead.

Should we expect a more severe second wave of the pandemic in the winter?

Features of previous flu pandemics suggest that the current viral strain will become even more widespread in the autumn or winter, causing more illness and death. It is possible that the virus will mutate (change) into a more potent strain.

Should I go to work or school if I have been in contact with someone who I know has swine flu?

Yes, as long as you do not have flu-like symptoms. If you are feeling well, you should go about your normal activities, including going to school or work.

It can take up to seven days (normally two to five days) after infection for swine flu symptoms to develop. If you develop symptoms, stay at home and follow the general advice (see What should I do if I think I’m infected?).

Is it possible to catch swine flu twice?

Yes, because the virus can mutate (change). If you become infected with the swine flu virus, your body produces antibodies against it, which will recognise and fight off the virus if the body ever encounters it again. However, if the virus mutates, your immune system may not recognise this different strain and you may become ill again, although you may have some 'cross protection' due to encountering a similar virus previously.

Should I have a 'swine flu party' or try and catch swine flu now, so I will be immune to more serious strains that may emerge later?

No – it is irresponsible to purposefully catch the virus as you may perpetuate the spread. Also, as we don't yet know the profile of the virus, it is too soon to assume it is only a mild infection. And catching swine flu will not necessarily protect you from strains that may emerge later (see Is it possible to catch swine flu twice?).

Can my pet catch swine flu?

There is currently no evidence that pets are susceptible to this new strain of flu. The swine flu virus appears to be passing only from person to person or from human to swine. In general, flu viruses commonly infect just one species; for example, dogs and cats do not get seasonal flu from their owners.

What is the National Pandemic Flu Service and how does it work?

The National Pandemic Flu Service is a new self-care service that will give people with swine flu symptoms fast access to information and antivirals.

It is a dedicated website and a phoneline (0800 1 513 100 or textphone 0800 1 513 200) for people to get information, check their symptoms and get a unique number that will give them access to antivirals if necessary.

When you are given your unique access number, you will be told where your nearest antiviral collection point is. You should then ask a flu friend - a healthy friend or relative - to go and pick up the antiviral medication.

If you think you have swine flu, do not go out to your GP or A&E.

What documents are needed to be able to collect the antivirals?

The flu friend must show their own ID as well as that of the patient. The authorisation number and ID information will be checked to ensure it matches the information provided when the assessment of symptoms was completed.

The ID includes:

  • a utility bill,
  • passport,
  • a credit or debit card,
  • driving licence, or
  • NHS card.

Why has the government brought in this new service?

This new service will free up GPs, enabling them to deal with other illnesses that need their urgent attention.

Do I use the National Pandemic Flu Service if I'm in a high-risk group?

You should contact your doctor directly rather than using the National Pandemic Flu Service if:

  • you have a serious underlying illness,
  • you are pregnant,
  • you have a sick child under one year of age,
  • your condition suddenly gets much worse, or
  • your condition is still getting worse after seven days (five for a child).

How well trained are the Flu Service staff?

Experienced call operators have been trained for a minimum of three hours. Less experienced call operators have received one day's training. Agents are not medically trained and will not be able to answer any other questions, but they will be supported by healthcare professionals.

There will be NHS Direct trainers present in each call centre for the first two days. There will not be healthcare workers in attendance. Call centre managers will be able to contact the National Pandemic Flu Service clinical on-call desk with urgent issues.

Doctors from the Royal College of GPs will have a special liaison role with each of these call centres and will feed back problems or concerns that arise during the operation of the service.

Strict industry standard regulations are in place when employing staff. These include the right to work in the UK (therefore no illegal immigrants), satisfactory employment references and satisfactory character references.

A wide range of people are being recruited from all round the country and all are required to be able to speak English.

Will the algorithm distinguish between swine and other flu?

The algorithm is designed to identify cases of swine flu. However, the symptoms of seasonal flu are very similar and therefore there is likely to be some overlap with other circulating flu cases. As swine flu becomes more common, a higher proportion of influenza-like illness will be swine flu.

What can I do?

You can reduce, but not eliminate, the risk of catching or spreading swine flu by:

  • Always covering your nose and mouth with a tissue when coughing or sneezing.
  • Disposing of dirty tissues promptly and carefully.
  • Maintaining good basic hygiene, for example washing hands frequently with soap and warm water to reduce the spread of the virus from your hands to face, or to other people.
  • Cleaning hard surfaces, such as door handles, frequently using a normal cleaning product.

You should also prepare now by:

  • Confirming a network of ‘flu friends’ – friends and relatives – who could help you if you fall ill. They could collect medicines and other supplies for you so you do not have to leave home and possibly spread the virus.
  • Knowing your NHS number and those of other family members and keeping them in a safe place. It is not essential to have your NHS number in order to receive treatment, but it can help NHS staff to find your health records. You will be able to find your NHS Number on your medical card or other items such as prescribed medication, GP letter or hospital appointment card/letter.
  • Making sure you have a thermometer and adequate quantities of cold and cough remediesin your medicine cupboard in case you or your family are affected by swine flu.
  • Who should be wearing a facemask?

    The Health Protection Agency (HPA) recommends that healthcare workers should wear a facemask if they come into close contact with a person with symptoms (within one metre) to reduce their risk of catching the virus from patients.

    However, the HPA does not recommend that healthy people wear facemasks to go about their everyday business.

    Why shouldn't the general public wear facemasks?

    Because there’s no conclusive evidence that facemasks will protect healthy people in their day-to-day lives.

    The virus is spread by picking up the virus from touching infected surfaces, or by someone coughing or sneezing at very close range – so unless you are standing close to someone with the virus, wearing a facemask will not make a difference.

    There are concerns about the risks posed by not using facemasks correctly.

    Facemasks must be changed regularly as they are less effective when dampened by a person’s breath. People may infect themselves if they touch the outer surface of their mask, or may infect others by not disposing of old masks safely.

    Finally, wearing a facemask may encourage complacency. People need to focus on good hand hygiene, staying at home if they are feeling unwell, and covering their mouth when they cough or sneeze.

    So why have other countries gone down this route?

    This is an issue which each government has considered separately. France is encouraging the general public to buy their own masks for use as a precaution, but it is not stockpiling masks centrally from government funds and neither is the US.

    In other countries there is an existing culture of wearing facemasks for either the prevention of spreading illness or preventing the risks of pollution; this is not the case in the UK.

    What should I do if I think I’m infected?

    If you have flu-like symptoms and are concerned that you may have swine flu:

    • Stay at home, read up on swine flu symptomsand check your condition using the National Pandemic Flu Service.
    • Call your GP directly if:
      - you have a serious underlying illness,
      - you are pregnant,
      - you have a sick child under one year old,
      - your condition suddenly gets much worse,
      - your condition is still getting worse after
      seven days (five for a child).

    The National Pandemic Flu Service is a new online service that will assess your symptoms and, if required, provide an authorisation number which 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 1 513 100
    • Minicom: 0800 1 513 200

    For more information, go to the Flu Service - Q&A.

    If swine flu is confirmed, ask a healthy relative or friend to pick up your antiviral medication for you.

    In the meantime, take paracetamol-based cold remedies to reduce fever and other symptoms, drink plenty of fluids and get lots of rest.

    Do not go into your GP surgery, or to a hospital, as you may spread the disease to others.

    If I have been in close contact with an infected person, do I need treatment?

    You only need antiviral treatment if you have been diagnosed with swine flu or if a doctor decides that you are at serious risk of developing severe illness (see Will antivirals be given to people without flu symptoms?).

    Is swine flu treatable?

    Testing has shown that the swine flu can be treated with the antiviral medicines oseltamavir (brand name Tamiflu) and zanamivir (Relenza). However, the drugs must be administered at an early stage to be effective. See Treatment for more information.

    The UK already has a stockpile of antivirals sufficient to treat half the population. Also, orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.

    What do antivirals do?

    Antivirals are not a cure, but they help you to recover by:

    • relieving some of the symptoms,
    • reducing the length of time you are ill by around one day, and
    • reducing the potential for serious complications, such as pneumonia.

    How large is the UK's stockpile of antivirals?

    The government has 23 million treatments of Tamiflu and 10.5 million treatments of Relenza. Orders of Tamiflu have been placed to increase UK supplies to 50m doses, enough to treat 80% of the population.

    Is one of the antivirals more appropriate for pregnant women and people with certain kidney conditions?

    Relenza is an inhaled drug that will be used for pregnant women and people with certain kidney conditions who are unable to take Tamiflu. See the section on Pregnancy and children.

    Will antivirals be given to people without flu symptoms?

    In most cases, no. Antivirals will generally only be given to people who have been diagnosed with swine flu.

    Doctors should not offer antiviral medication as prophylaxis (prevention) to contacts of cases unless, for example, a household member has serious underlying health problems or there are other special circumstances.

    Will my child experience nausea if they take Tamiflu?

    As is the case with many medicines, nausea is a known side effect of Tamiflu, in a small number of cases. Symptoms may lessen over the course of the treatment. It may help to take Tamiflu either with or immediately after food, and drinking some water may also lessen any feelings of nausea.

    How are those with confirmed swine flu getting access to antivirals?

    If antivirals are required, the National Pandemic Flu Service will provide you with an authorisation number which can be used to collect antiviral medication from a local collection point (see How is swine flu infection diagnosed?); or, if you are in a high-risk group, your GP will advise you over the phone on how to collect your antivirals.

    A healthy friend or relative can then pick up the antivirals for you from your local collection centre - usually a pharmacy or community centre.

    Should people be stockpiling their own antivirals?

    No. The government has a stockpile of antivirals sufficient to treat half the population, and is taking steps to increase this to cover 80% as an extra precaution. Therefore, antivirals should be available for everyone who gets ill in the pandemic and there is no need for people to buy their own.

    Does Tamiflu go out of date?

    The government has a programme to replace any expired doses under a 'rolling stock' system.

    If I take an antiviral and have side effects, whom should I inform?

    First, see your healthcare professional to check that you are ok. Then, report your suspected drug reaction to the Medicines and Healthcare products Regulatory Agency (MHRA) via their new online system (links to external site).

    This new webpage, based on the Yellow Card Scheme, helps the MHRA to monitor the safety of Tamiflu and Relenza.

    Anyone who does not have access to the internet can ask their healthcare provider to send a report on their behalf.

    When will there be a vaccine?

    Vaccines are complex and difficult to manufacture in large numbers. However, the Government has already signed contracts to get enough vaccine for the entire country as soon as it is available.

    While the first batches of vaccine will start to arrive in the autumn it will take several months to get enough vaccine for everyone. It will also take time to fully test the vaccine and to organise the vaccination of everyone in the country.

    To reduce the impact of swine flu, the NHS is focusing on those at the greatest risk first (see Who will be a priority for vaccination with the H1N1 swine flu vaccine?).

    Why does it take several months to produce a swine flu vaccine?

    The flu vaccine production process is long and complicated. Production technology is labour-intensive. The government's plans include two manufacturers, thus maximising chances of early development.

    If other countries are also being given advance supply guarantees, will we get ours first?

    The UK has a binding contractual agreement in place to ensure its supply.

    Does the current seasonal flu vaccine work?

    The current seasonal flu vaccine is designed to protect against H1N1, but it is unclear as yet whether this will offer any protection against the current strain of swine flu.

    How many stocks are available of seasonal vaccine?

    Flu vaccine is produced each year for the seasonal flu. Discussions are ongoing with manufacturers about how much may still be available. However, the government has determined that there are 430,000 doses of vaccine available in the UK.

    Who will be a priority for vaccination with the H1N1 swine flu vaccine?

    The Joint Committee on Vaccination and Immunisation has previously advised that the priority groups in relation to H5N1 (the bird flu vaccine) should be assumed to be:

    • frontline health and social care workers (to help ensure the NHS functions well),
    • older people and those in clinical risk groups (see Which people are most vulnerable from swine flu?), as flu can be more serious in these groups, and
    • under-16s, as protecting children can slow the spread of the virus in the population.

    The priority groups would be reviewed in light of evidence on the virulence and severity of the new virus in different groups.

    The government will still aim to achieve universal vaccination, but because the vaccine will have to be delivered over time, it is right that we start thinking now about groups to be prioritised.

    Will the vaccine still provide people with protection if the swine flu virus mutates between now and the autumn?

    At this stage, it is impossible to predict if or how the H1N1 swine flu virus will mutate (change). However, experiences with the H5N1 vaccine (bird flu vaccine) would suggest that an H1N1 vaccine (produced using the same processes) would also provide a high level of immunity against closely related strains. The level of cross-protection is expected to be greatest for more closely related strains.

    Does the NHS have enough syringes to administer the swine flu vaccine?

    Yes, orders have been placed to ensure there are enough syringes to administer the vaccine.

    What extra antibiotics have been purchased?

    Orders have been placed for 15.2m courses of antibiotics. They will play an important part in the response to the pandemic.

    Why do you need antibiotics in a pandemic?

    While antivirals may reduce the number of complications, there are still likely to be significant numbers of complications occurring in the pandemic. Some of the most common include bacterial infections in the respiratory tract and lungs, such as pneumonia. Antibiotics are needed to treat such complications.

    Antibiotics will be used to treat people in the community if they develop complications. In hospitals, antibiotics will be used to treat the sickest patients and may reduce the length of hospitalisation.

    How do I tell if my child has swine flu?

    Call your GP immediately if your child has any of the following symptoms and a temperature of 38°C or above or feels hot:

    • tiredness
    • headache,
    • runny nose and sneezing,
    • sore throat,
    • shortness of breath,
    • loss of appetite,
    • vomiting and diarrhoea, or
    • aching muscles, limb and joint pain.

    Of course, if you are worried about your child you should always call your GP for advice.

    One thing you can do right now is to make sure you have a digital thermometer to take your child’s temperature.

    If my child has swine flu, what should I do?

    If your GP confirms that your child has swine flu, they should stay at home and you should treat their symptoms like any other cold or flu. Make sure they drink plenty of liquids, get lots of rest and take over-the-counter cold and flu remedies to help control their temperature.

    Your GP will tell you whether your child should also take antiviral drugs. Antivirals, such as Tamiflu, shorten the symptoms by about a day and can reduce the risk of complications. Antivirals are only effective if taken within 48 hours of symptoms starting. If you are worried about your child, do not delay, call your GP immediately.

    However, antivirals can also have side effects. If your child’s swine flu symptoms are mild, you may not wish to give them antivirals. Your GP can advise you on this.

    Can children take antivirals?

    Yes, on the advice of a doctor. Tamiflu is safe for infants aged one and older, at a reduced dose. Relenza (an inhaler) can be used by children aged five and older under the supervision of an adult.

    What should I do if I become ill on holiday or on the flight home?

    Make sure you check in advance so you know where you can get medical advice if you or your family feel unwell on holiday. And make sure you have over-the-counter medication for flu, such as paracetamol or ibuprofen. Remember that children should not take aspirin.

    If you are travelling to Europe, make sure you have your free European Health Insurance Card (EHIC). This entitles you to any necessary medical treatment, including for swine flu, during a visit to another European Economic Area country. You can get an EHIC application form from the post office, by calling 0845 606 2030, or by applying online.

    If you do experience flu-like symptoms, keep away from public places to avoid spreading it. Then contact a health professional and tell them your symptoms.

    If you become ill on your flight home, alert the cabin crew to your symptoms. There are procedures in place for dealing with passengers who become unwell on flights, and the airline will advise port health officials on the ground that a passenger requires a health assessment and may need treatment.

    To access the Department of Health Swine Flu Information line when abroad, call 00 44 207 928 1010.

    Are the reports that 65,000 people are going to die true?

    It is wrong to suggest there will be a particular number of deaths per day. Scientific and clinical experts can use sophisticated modelling techniques to help us understand how the virus may behave, but that is all they can do - be a guide, not a prediction.

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