Influenza type A, H1 N1(Swine Flu): Questions & Answers

What are the symptoms of swine influenza?

The symptoms of swine influenza are similar to the symptoms of common human seasonal influenza infection and include sudden fever (a high body temperature of 38C/100.4F or above), and sudden cough. Other symptoms may include headache, tiredness, chills, aching muscles, limb or joint pain, diarrhoea or stomach upset, sore throat, runny nose, sneezing, and loss of appetite.

Swine flu is only diagnosed currently with a fever (or fever history) and at least one other flu symptom.

If someone has flu symptoms what should they do?

The government have now launched a National Pandemic Flu Service. This comprises of a dedicated website:  https://www.pandemicflu.direct.gov.uk  and phoneline 0800 1 513 100 or text phone 0800 1 513 200.  This allows people to check their symptoms and get a unique number which will give them access to antivirals if necessary. Those who have swine flu symptoms will be given a unique access number and told where their nearest antiviral collection point is. They should then ask a flu friend - a friend or relative who doesn't have swine flu - to go and pick up their 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.

Anyone who suspects they have swine flu must not go to their GP or Accident and Emergency.  They should however contact their doctor by telephone rather than using the National Pandemic Flu Service if:

• they have a serious underlying illness,
• they are pregnant,
• they have a sick child under one year old,
• their condition suddenly gets much worse, or
• if their condition is still getting worse after 7 days (5 for a child)

People are advised NOT to go to their GP but to stay indoors and get a ‘Flu Friend’ to do the running around for them.

What do antivirals do?

Testing has shown that the effect of the human influenza H1N1 can be modified with antiviral medication.  There are two types of antiviral medicines available: Tamiflu and Relenza. Tamiflu is a course of capsules taken by mouth twice a day for 5 days. (it also comes in suspension form for children) Relenza is inhaled via a diskhaler.   Antivirals should be started within 48 hours of the onset of symptoms. The antivirals help to reduce the severity of symptoms and they can also lessen the time that people feel unwell by approximately 1 day.  Antivirals can also be taken as a prophylaxis however as we are now in the treatment  phase as opposed to the containment stage of the pandemic, it is only give as prophylaxis to those who have serious underlying health problems and have been in close contact with someone with swine flu.   For most people swine flu is a relatively mild disease, even without antiviral medicines and a full recovery is made within 7 days.

What measures can I take to protect against infection?

Advice is given in the leaflet distributed to all households (wc 11 May 2009). General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including the human swine influenza. This includes:

1. Covering your nose and mouth when coughing or sneezing, using a tissue when possible
2. Disposing of dirty tissues promptly and carefully
3. Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people
4. Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product
5. Making sure your children follow this advice

What is the difference between seasonal influenza, avian influenza, swine influenza and an influenza pandemic?

Influenza viruses are commonly circulating in the human and animal environment. Different strains can cause illness in humans, bird and pigs.

Seasonal influenza is caused by influenza viruses that are adapted to spread between humans (human influenza). Humans have some natural immunity to the strains that are in common circulation, and this immunity can be boosted by immunisation with a seasonal influenza vaccine.

Avian influenza is caused by influenza viruses adapted for infection in birds. Similarly, swine influenza is caused by influenza viruses adapted for infection in pigs.  These illnesses all elicit the same respiratory symptoms in their hosts. Sometimes, humans and animals can pass strains of influenza back and forth to one another, such as when humans become ill with avian or swine influenza, usually from direct contact with animals who are ill.

Mixing of human and animal influenza viruses can lead to the development of changed viruses with the ability to cause infection and spread in the human population. There may be little or no immunity in the human population to these new viruses.

An influenza pandemic is defined as a new or novel influenza virus that spreads easily between humans. When new influenza viruses are introduced into the environment, humans don’t have any natural immunity to protect against them. Therefore, there is a risk that that new influenza viruses could develop into a pandemic if the newly adapted virus starts to pass easily from human to human.

Can I catch Swine Flu from pork products?

People will not get swine flu from eating pork or pork products

It is important to stress that swine influenza viruses are not transmitted by food. There is no risk of catching the illness from eating properly handled and cooked pork or pork products.

Can I do anything to prepare?

Sensible personal steps might include thinking about;

• Emergency contact numbers for medical services
• Ordering repeat prescriptions if you have a pre-existing medical condition
• Ensuring that you have medicines at home that you would usually take to  treat colds and flu such as ibrobrufen.
• Avoiding large public gatherings
• Thinking about what strain on national infrastructure might mean for you and your family
• Increased hygiene measures and infection prevention measures at home and at work.

When did Nuffield Health start mobilising for a pandemic?

Nuffield Health has prepared fully for this event over the past 3 years through our clinical and occupational health teams to ensure we have prudent business plans in place for pandemic flu which fits into our Group approach to crisis management.

What is Nuffield Health doing currently?

We are prepared as a business.  In essence, we are following the HPA guidance and working closely with local PCTs.

A pandemic influenza team is leading our business continuity plans with regular meetings and communication to our hospitals and centres as the situation develops. The team is being led by the Group Medical Director supported by an external consultant microbiologist. Nuffield Health holds good stocks of antiviral and antibacterial medication and infection prevention equipment, our staff have been highly trained in infection prevention procedures. We are in regular contact with local and national public organisations coordinating influenza planning.

At what point will Nuffield Health start treating people for swine flu?

When they meet the criteria as outlined by the HPA for treatment (includes actual & prophylactic treatment).

What has and is happening to us, our patients and customers?

At present, services to patients and customers have not been directly affected although information is exchanged on a daily basis with our 200 business units and we have recommended to our staff and customers that now is the right opportunity to familiarise themselves with national procedures and policies.  Patients who are due to come into one of our hospitals or clinics are asked to telephone if they have symptoms of swine flu so that an assessment of their health can be made. Tests or operations will be rescheduled for when they are fully recovered.  Clients are asked not to attend our Hospitals or Wellbeing centres if they have symptoms of flu.

Is Nuffield Health in communication with the HPA / DH? If so, to what level?

Yes, via our Group Consultant Microbiologist & Group Medical Director who both do work for and have contact with the Department. Our Occupational Health manager has been part of the DH pandemic flu planning committee.

Is Nuffield Health helping local PCTs deal with swine flu? If so, how?

All hospitals are involved in their local emergency planning teams that are PCT co-ordinated.

If the pandemic escalates, all healthcare facilities will work together to assist with public health and business continuity,  The HPA  do have the power to commandeer our hospitals and staff for whatever purpose they see fit.

Is the organization less or more nervous than before?

Nuffield Health is well prepared for any escalation in the present situation but overall we are probably not as nervous as at the outset although we are aware that things may change in the Autumn.  It is possible that there will be a second wave in the Autumn that will be more virulent (stronger and more likely to kill).

How well do you think the Government / authorities have performed?

As well as can be expected and rapidly in response to developments – this is new to all of us worldwide but internationally it is very joined up and efficient.

When will a vaccine against swine flu be available?

The government hope to have a vaccine available by the autumn. They have ordered 60 million doses, enough for the whole of the UK.  In the first instance the vaccine will be given to those considered most at risk e.g. those with chronic underlying health problems, but it will then be rolled out across the UK.  The vaccine regime will comprise of a course of two injections separated by an interval of three weeks.   Nuffield Health will work with the Department of Health to assist with the national vaccination campaign.

Does seasonal flu vaccine give any protection against swine flu?

No, seasonal flu does not provide protection against swine flu. It is however still recommended that those who usually receive seasonal flu vaccine continue to do so.

Further Information

The internet is a good source of information;

For lay professionals (or your families) please refer to the NHS direct site.

For health professionals please refer to the HPA website.

The main principles of flu planning are;

• To isolate cases and anyone with symptoms should be encouraged to remain at home and call NHS direct in the first instance on 0800 1 513 100. 
• To review anyone who has come into contact with a proven case for antiviral protection.
• For health professionals to liaise and report to health protection services.

A national information line has been established for anyone who wants more information on 0800 1513 513.

If you are planning to travel abroad, check the Foreign and Commonwealth Office website or call 0845 850 2829 for information.

Dr Andrew Jones
Nuffield Health Group Medical Director