Novel H1N1 (swine flu) Questions and Answers

What is the novel H1N1 virus?
The novel H1N1 virus is a new influenza virus that is causing illness in people. This virus is spreading from person-to-person worldwide, much the same way as the seasonal flu. The first case in the United States appeared in April. By June, the virus had spread around the world, and the World Health Organization therefore signaled that a pandemic of novel H1N1 was under way.

How is the novel H1N1 virus spread?
H1N1 spreads in the same way that seasonal flu spreads, mainly from person-to-person through coughing or sneezing. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What is the incubation period from exposure to sickness?
Normal incubation - the time from exposure to symptoms - is usually from one to four days.

How severe have the cases been?
The cases seen both nationally and at University of Missouri Health Care have been no worse than the seasonal flu.

What are the signs and symptoms of H1N1 influenza?
Like regular seasonal influenza, onset is often abrupt. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. Like seasonal flu, H1N1 may be more severe in infants and in people with underlying chronic medical conditions.

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

  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Symptoms that improve but then return a day or two later with fever and worse cough
  • Fever with a rash

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

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting

How long does the illness last?
Symptoms usually last about three to five days. Anti-viral medications are most effective if taken within the first 48 hours of onset of the illness.

What if I have influenza symptoms now?

  • As with influenza under ordinary conditions, follow good hand hygiene, including using hand sanitizer gels and washing your hands.
  • Cough or sneeze into a tissue or your sleeve
  • Avoid crowds and immune-compromised persons
  • Stay home if possible
  • Seek medical help as symptoms warrant.
  • Health experts advise not going to work if you have flu symptoms.
  • Health care workers need to stay home for seven days, or 24 hours after their fever is gone, whichever is longer.

What medications are available to treat H1N1 influenza infections in humans?
There are two anti-viral medications available to treat the H1N1 strain of influenza, oseltamivir (Tamiflu, taken by mouth) and zanamivir (Relenza, taken by inhalation). MU Health Care facilities have these anti-viral medications available, plus ready access to the emergency state stockpile.

Is H1N1 virus resistant to Tamiflu?
For now, Tamiflu remains an active anti-viral medication for treating the H1N1 strain of influenza.

Is there a vaccine for H1N1 available?
Clinical trials are currently underway at 11 sites across the country. These trials will determine whether the H1N1 vaccine is safe for children and adults.

Is the H1N1 vaccine different from the seasonal flu vaccine?
The H1N1 vaccine is different from the seasonal flu vaccine. The seasonal flu vaccine is not expected to protect against the novel H1N1 flu. The seasonal flu vaccine requires only one dose, while the H1N1 is expected to require two doses.

What will be the recommended interval between the first and second dose of the H1N1 vaccine?
This will not be known until clinical trials are complete. The time frame is expected to be 21-28 days between the first and second vaccination.

When will a vaccine for H1N1 be available?
While seasonal flu vaccine will be readily available starting in late September, the H1N1 vaccine is not expected until mid-to-late October.

Who should receive the H1N1 vaccine?
The Centers for Disease Control and Prevention (CDC) has recommended that certain people receive the novel H1N1 vaccine when it first becomes available. These key populations include pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel, persons between the ages of 6 months and 24 years of age, and people ages of 25 through 64 years of age who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

Will there be a shortage of the H1N1 vaccine?
The novel H1N1 vaccine is now in production. At this point, the CDC is not expecting a shortage.

Should older people get the H1N1 vaccine?
People older than 65 are not recommended to receive the H1N1 vaccine. Studies have shown they already have immunity to the virus, probably through previous exposure to a similar flu virus. However, they should still receive their yearly pneumonia and seasonal flu vaccines.

Where can I get the H1N1 vaccination?
When the H1N1 vaccination becomes available, you should consult your physician or health care provider. It is expected that health care workers will receive the vaccination from their employer.

Who should get the seasonal flu vaccine?
The seasonal flu vaccine is recommended for anyone who wants to reduce their risk of getting seasonal flu. There are two types of seasonal flu vaccines. The "flu shot" is given with a needle (usually in the arm) and is approved for people older than six months, including healthy people and people with chronic medical conditions. The nasal-spray flu vaccine is approved for use in healthy people ages 2-49, who are not pregnant.

What can I do to protect myself from getting sick?

  • Practicing good hygiene and avoiding exposure are the best preventive methods.
  • If you have a tissue, cover your nose and mouth with it when you cough or sneeze. If not, sneeze or cough into your sleeve, instead of your hand.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.
  • If you get sick, the CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
  • Health care workers need to stay home for seven days, or 24 hours after their fever is gone, whichever is longer.

Is MU Health Care monitoring the situation?
Yes. University Hospital infection control experts and emergency preparedness officials on campus are monitoring the situation and planning strategies to deal with an unexpectedly large H1N1 influenza outbreak if that were to occur in central Missouri.

University of Missouri Health Care coordinates with local, county and statewide health organizations in developing a preparedness plan for any public health threat. This preparedness plan is not limited to the H1N1 virus. The coordination efforts include personal protection plans for preventing the spread of disease, vaccine distribution, flu testing, personal protective equipment and assuring adequate facilities and staffing. These plans are updated regularly and kept flexible to accommodate changing situations.

Where can I get more information on H1N1?
For up-to-date state and national information and guidelines, please visit http://www.dhss.mo.gov/BT_Response/_SwineFlu09.html and http://pandemicflu.gov/. E-mails are welcome to Michael Cooperstock, MD, MPH, medical director of MU Health Care's Infection Control Department, at cooperstockm@health.missouri.edu.