The study, led by the Centers for Disease Control and Prevention (CDC), tracked 63 Southern California health care workers who had contact with six of the first eight laboratory-confirmed 2009 H1N1 cases in the U.S. Because these contacts happened before the 2009 H1N1 outbreak had been widely reported, the cases shed light on how well health care workers protect themselves before a direct epidemiological threat becomes evident.

The investigation found that 9 of the health care workers tracked became infected with the 2009 H1N1 virus, likely from contact with infected patients. Twenty of the 63 health care workers reported that they had worn a mask or respirator at least once when in contact with patients, and no one from that group became infected with 2009 H1N1. Meanwhile, 43 workers reported never using a mask around patients, and all 9 infections occurred in workers from this group.

Overall, mask and respirator use was disappointingly low, the researchers report. Only 19 percent reported using a mask during every patient encounter. Use was especially low among outpatient workers, who also made up the majority of those who became infected with 2009 H1N1.

“The findings highlight the challenge of getting health care personnel to routinely wear Personal Protective Equipment,” Jenifer Jaeger, MD, MPH, Associate Pediatrician, Massachusetts General Hospital, said. “The study also suggests that greater attention to infection control and preparedness, particularly among outpatient workers, is needed.”

WASHINGTON, Nov. 2, 2009 – The Defense Department has started receiving H1N1 vaccines and will begin distributing doses in the coming weeks.

The Health and Human Services Department is distributing the vaccines, manufactured by four producers, to the department. Because rates of production vary among the manufacturers, supplies are expected to be limited initially, but to increase over time, said Ellen P. Embrey, acting assistant secretary of defense for health affairs.

The department “is working closely with HHS to receive its full allocation of vaccine as soon as possible,” Embrey said. Vaccinations are mandatory for military members, and as the quantity of doses on hand grows, officials anticipate Defense Department facilities will receive sufficient numbers to make the vaccine available to all of the department’s employees and beneficiaries, she said.

Meanwhile, Defense Department officials have implemented a plan to maintain mission readiness while ensuring those at greatest risk get vaccinated as soon as possible. Vaccines first will be made available to deployed personnel, bases that receive new military accessions, such as basic training installations and the service academies, and all health-care workers assigned to military medical treatment facilities.

Department providers should balance mission requirements with guidelines laid out by the Centers for Disease Control in determining who should receive vaccine when supplies are limited, Embrey said.

The arrival of the vaccines comes as CDC officials underscore the importance of remaining vigilant amid the rising incidence of flu nationwide.

“I would reiterate that we have more virus, more vaccine, and we have more treatment,” CDC Director Thomas Frieden told reporters at an Oct. 30 news conference in Atlanta. “We encourage the prompt treatment of people who have underlying conditions.”

CDC officials have identified groups they consider at a high risk of developing severe illness if they contract the flu: pregnant women, household contacts and caregivers for children younger than 6 months, health-care and emergency medical services personnel, people between 6 months and 24 years of age, then those between 25 and 64.

President Barack Obama is “deeply concerned” about H1N1, Frieden said.

“He’s directly involved, he’s briefed regularly, he asks a series of important and relevant questions, and he wants to make sure that we are doing absolutely everything we possibly can to respond effectively as we can,” he said.

In determining how to distribute supplies, Embrey said, military commanders, in collaboration with their medical authorities, will determine the best method to allocate the vaccine when demand exceeds supply. As more vaccine is received, it will be made available to all active-duty servicemembers, civilian employees, members of military reserve components and National Guard personnel.

Immunization for both seasonal flu and H1N1 is mandatory for all military personnel and is highly recommended for beneficiaries. When the first cases of H1N1 were diagnosed in April, a defense official said, the department bought 2.7 million doses of the vaccine for mission-assurance purposes.

HHS later provided 1 million doses to the Defense Department, raising the number to 3.7 million, according to Dr. Robert Morrow, the preventive medicine programs and policy officer for the Bureau of Navy Medicine and Surgery’s force health protection function.

In addition to vaccines being received for operational personnel, Defense Department medical treatment facilities are receiving vaccine for family members based upon a separate allocation to each of the 50 states and the District of Columbia. Officials also have completed an agreement with HHS to provide vaccine for family members living outside the United States.

Vaccine for family members, like that for the active-duty and civilian work force, will arrive at military medical treatment facilities incrementally, Embrey said.

A pregnant woman who gets any type of flu has a greater chance for serious health problems. Compared with people in general who get 2009 H1N1 flu, pregnant women with 2009 H1N1 flu are more likely to be admitted to hospitals. Pregnant women are also more likely to have serious illness and can die from 2009 H1N1 flu. To protect yourself and your baby, make sure to get both the 2009 H1N1 flu shot and the seasonal flu shot.

If you are pregnant and have flu symptoms, call your doctor right away. Treatment should begin as soon as possible. Treatment works best when started early (within 48 hours after symptoms start).

Read more about the 2009 H1N1 Influenza and Pregnant Women

• What Should Pregnant Women Know About 2009 H1N1 Flu (Swine Flu)?
• 2009 H1N1 Influenza Shots and Pregnant Women: Questions and Answers for Patients
• Protect Yourself and Others
• What to do if You Have Symptoms of 2009 H1N1 Influenza
• Treatment during Pregnancy
• Feeding Your New Baby
• Pregnant Women at Higher Risk of Flu at Work

Flu Shots and Pregnant Women

Pregnant women should get both the 2009 H1N1 flu shot and the seasonal flu shot because they can get seriously ill from any type of flu. Pregnant women should get the “flu shot”—a vaccine made with killed flu virus. This one is given with a needle, usually in the arm. Both 2009 H1N1 and seasonal flu shots are “killed” vaccines, so you cannot catch the flu from getting these shots. The other type of flu vaccine—a nasal spray—is not approved for pregnant women.

There is no evidence that thimerosal (a mercury preservative in vaccine that comes in multi-dose vials) is harmful to a pregnant woman or a fetus. However, because some women are concerned about thimerosal during pregnancy, vaccine companies are making preservative-free seasonal flu vaccine and 2009 H1N1 flu vaccine in single dose syringes for pregnant women and small children. CDC advises pregnant women to get flu shots either with or without thimerosal.

• Learn more about the 2009 H1N1 flu vaccine and pregnant women

Protect Yourself and Others

Take these everyday steps to protect your health

• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, call your doctor. Stay home for at least 24 hours after your fever is gone (without using a fever-reducing medicine like Tylenol®) except to get medical care or for other critical needs. Keep away from others as much as possible to keep from making them sick.
• Read more about What Should Pregnant Women Know About 2009 H1N1 Flu (Swine Flu)?

*Read information on hand sanitizers

What to do if you have Symptoms of Flu

If a pregnant woman thinks she has flu, she should call her doctor right away. If needed, he or she will prescribe an antiviral medicine that treats the flu. The medicine is most helpful if it is started soon (within the first 48 hours) after the pregnant woman becomes sick. If lab testing for flu was done, treatment should not wait for test results to come back. Start treatment right away.

Talk with your doctor about how to reach him or her quickly by telephone if you think you have the flu.

Call your doctor immediately if you think you have any of these symptoms.

• fever **
• cough
• sore throat
• runny or stuffy nose
• body aches
• headache
• chills
• fatigue
• sometimes diarrhea and vomiting

**Not everyone with flu will have a fever.

• Learn how flu spreads and how to care for your family
• Read general information about 2009 H1N1 Flu and how other family members can protect themselves

Treatment during Pregnancy

Oseltamivir (Tamiflu®) or zanamivir (Relenza®) can be used to treat 2009 H1N1 flu. To get these medicines, a doctor needs to write a prescription. These medicines fight against the flu by keeping flu viruses from making more viruses in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness. At this time, Tamiflu® is the best medicine to treat pregnant women who have 2009 H1N1 flu.

Fever should be treated right away. It can cause problems for the pregnant woman and her unborn child.  Acetaminophen (Tylenol®) is best for a pregnant woman to use to lower a fever.

Is it safe for me to take antiviral medicines for flu while I am pregnant?

The flu can cause severe illness and even death in pregnant women. Taking antiviral medicines can help prevent these severe outcomes. At this time, there are no studies suggesting harm to a pregnant woman or her unborn baby if she takes antiviral medicines. Being pregnant should not stop women from using antiviral medicines if their doctor advises them to take the medicine. Antiviral medicines can be taken at any stage during pregnancy. Take the medicine your doctor prescribes.

• Questions and Answers for Pregnant Women on Antiviral Recommendations

Feeding Your New Baby

If you can, breastfeed. Breast milk is the perfect food for your baby. There are many ways that breastfeeding and breast milk protect your baby’s health. Babies who are breastfed get sick from infections like the flu less often and less severely than babies who are not breastfed. Flu can be very serious in young babies. You do not have to stop breastfeeding if you have the flu.
If you are sick with the flu, certain precautions can be taken to protect your baby.

• Learn more about feeding your baby while you are sick

Pregnant Women who work in Schools, Child Care or Health Care

Pregnant women who work in schools, child care and health care are at higher risk for being exposed to the flu. Certain precautions can be taken to reduce this risk.

• Information for pregnant women more likely to be exposed at work

Protect Yourself, Protect Your Baby

• Get your flu shots — pregnant women will need both the 2009 H1N1 flu shot and the seasonal flu shot.

• Take everyday precautions.

• If you have been exposed to someone who likely had the flu, call your doctor.

• If you start to feel sick, call your doctor right away. Take the medicines your doctor prescribes.

• Plan to breastfeed as soon as your baby is born.

Within the past two weeks, FDA has

• urged caution regarding promotions and Internet sites offering products for sale that claim to diagnose, prevent, mitigate, treat or cure the H1N1 flu virus
• enhanced efforts to warn about potentially deceptive H1N1 products, and encourage reporting of suspected criminal activity, with the release of an H1N1 flu fraud widget. This portable application is embedded in an agency Web page (www.fda.gov/NewsEvents/PublicHealthFocus/ucm186340.htm) and can be copied onto any other Web site or blog.
• with the Federal Trade Commission (FTC), issued a warning letter to a Web site marketing fraudulent supplements that claim to help prevent the spread of the H1N1 virus. The letter advises the site’s owners to discontinue marketing the products or face legal action

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Previous Actions

These new measures follow FDA actions earlier this year to protect consumers against Web sites offering unapproved products. These actions included enforcing laws that protect consumers against these sites, and warnings posted through media outreach and a “Fraudulent Products List” posted on FDA’s Web site at www.accessdata.fda.gov/scripts/h1n1flu/.

Since May 2009, FDA has warned more than 75 Web sites to stop the sale of more than 135 products with fraudulent H1N1 influenza virus claims.

“Products that are offered for sale with claims to diagnose, prevent, mitigate, treat or cure the 2009 H1N1 influenza virus must be carefully evaluated,” says Commissioner of Food and Drugs Margaret A. Hamburg, M.D. “Unless these products and the claims they make are proven to be safe and effective, they will not prevent the transmission of the virus or offer effective remedies against infection. Furthermore, they can make matters worse by providing consumers with a false sense of protection.”

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Buy Only FDA-Approved Products

Consumers are urged to only purchase FDA-approved products from licensed pharmacies located in the United States, and should contact their health professional if they have any questions or concerns about medical products or personal protective equipment.

Tamiflu (oseltamivir phosphate) and Relenza (zanamivir) are the only two FDA-approved antiviral drugs for treatment and prophylaxis of the 2009 H1N1 influenza virus. In addition to their approved labeling, these drugs have been issued Emergency Use Authorizations by FDA that describe specific authorized uses during the H1N1 public health emergency.

Patients who buy prescription drugs from Web sites operating outside the law are at increased risk of suffering life-threatening adverse events such as side effects from inappropriately using prescription medications, dangerous drug interactions, contaminated drugs, and impure or unknown ingredients found in unapproved drugs.

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An Assortment of Targeted Products

FDA actively monitors the Internet and, where appropriate, purchases and analyzes drug products. In October 2009, it announced what it found when it purchased and analyzed several products represented online as Tamiflu.

One of these online orders resulted in delivery to FDA of an unmarked envelope postmarked from India. Inside were unlabeled, white tablets taped between two pieces of paper that were found to contain talc and acetaminophen, an active ingredient found in many medicines to help relieve pain and reduce fever. Not found was oseltamivir, the active ingredient of Tamiflu.

The Web site selling this product disappeared shortly after FDA placed the order.

The agency also bought four other products purported to diagnose, prevent, treat or cure the H1N1 influenza virus from other Web sites. These products contained various levels of oseltamivir but were not approved for use in the United States. Several did not require a prescription from a health professional.

In actions it announced in June 2009, FDA issued warning letters and advised operators of offending sites to immediately ensure that they weren’t marketing products intended to act against the H1N1 flu virus that have not been cleared, approved, or authorized by the agency.

• Among the unapproved, uncleared, or unauthorized H1N1 flu products it targeted at that time were
• a shampoo said to protect against the H1N1 flu virus
• a dietary supplement said to protect infants and young children from contracting the virus
• a “new” supplement said to cure H1N1 flu infection within four to eight hours
• a spray that claims to leave a layer of ionic silver on one’s hands that kills the flu virus
• several diagnostic tests that have not been approved to detect the H1N1 flu virus
• an electronic instrument whose sellers claim uses “photobiotic energy” and “deeply penetrating mega-frequency life-force energy waves” to strengthen the immune system and prevent symptoms associated with H1N1 viral infection

Work by FDA and the FTC to identify, investigate, and take regulatory action against individuals or businesses that wrongfully promote purported 2009 H1N1 influenza products will continue. These efforts can include additional legal actions including seizure of products, injunction, or criminal prosecution.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

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Date Posted: October 23, 2009

About the Flu

Flu refers to illnesses caused by a number of different influenza viruses. Flu can cause a range of symptoms and effects, from mild to lethal.

Two strains of flu, seasonal flu and the H1N1 (Swine) flu, are currently circulating in the United States. A third, highly lethal H5N1 (Bird) flu is being closely tracked overseas.

Most healthy people recover from the flu without problems, but certain people are at high risk for serious complications.

Extensive efforts are underway to track and monitor the spread of all flu viruses. In the U.S., epidemiologists at the Centers for Disease Control (CDC) are working with states to collect, compile and analyze reports of flu outbreaks. More on the current situation.

Flu symptoms may include fever, coughing, sore throat, runny or stuffy nose, headaches, body aches, chills and fatigue. In H1N1 (Swine) flu infection, vomiting and diarrhea may also occur.

Annual outbreaks of the seasonal flu usually occur during the late fall through early spring. Most people have natural immunity, and a seasonal flu vaccine is available. In a typical year, approximately 5 to 20 percent of the population gets the seasonal flu and approximately 36,000 flu-related deaths are reported.

This year, the H1N1 (Swine) flu virus may cause a more dangerous flu season with a lot more people getting sick, being hospitalized and dying than during a regular flu season. H1N1 (Swine Flu) is a new virus first seen in the United States. It is contagious and spreads from person to person. Like seasonal flu, illness in people with H1N1 can vary from mild to severe.

A flu pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population; the virus causes serious illness and spreads easily from person-to-person worldwide. On June 11, 2009, the World Health Organization (WHO) declared that a global pandemic of H1N1 (Swine) flu is underway.

H5N1 (Bird) flu is an influenza A virus subtype that is highly contagious among birds. Rare human infections with the H5N1 (Bird) flu virus have occurred. The majority of confirmed cases have occurred in Asia, Africa, the Pacific, Europe and the Near East. Currently, the United States has no confirmed human H5N1 (Bird) flu infections, but H5N1 (Bird) flu remains a serious concern with the potential to cause a deadly pandemic.

The U.S. Food and Drug Administration (FDA) has approved four vaccines for use against the 2009 H1N1 influenza virus.

The vaccines—made by CSL Limited, MedImmune LLC, Novartis Vaccines and Diagnostics Limited, and sanofi pasteur Inc.—will be distributed nationally after the initial lots become available. This is expected to occur within the next four weeks.

Commissioner of Food and Drugs Margaret A. Hamburg, M.D., says the approval is good news for the nation’s response to the 2009 H1N1 influenza virus. “The vaccine will help protect individuals from serious illness and death from influenza,” she says.

Vaccines against three seasonal virus strains are already available and should be used. However, they do not protect against the 2009 H1N1 virus.

What have studies of the H1N1 vaccines shown?
Based on preliminary data, the approved vaccines induce a robust immune response in most healthy adults eight to 10 days after a single dose, as occurs with the seasonal influenza vaccine.

Clinical studies under way will provide more information about the optimal dose in children. Recommendations for dosing will be updated if indicated by findings from those studies. The findings are expected in the near future.

What are the warnings and potential side effects?
In the ongoing clinical studies, the 2009 H1N1 vaccines have been well tolerated. However, consumers need to be aware of the following:

• People with severe or life-threatening allergies to chicken eggs, or to any other substance in the vaccine, should not be vaccinated.

• Potential side effects of the H1N1 vaccines are expected to be similar to those of seasonal flu vaccines. For the injected vaccine, the most common side effect is soreness at the injection site. Other side effects may include mild fever, body aches, and fatigue for a few days after the inoculation. For the nasal spray vaccine, the most common side effects include runny nose or nasal congestion for all ages, sore throats in adults, and—in children 2 to 6 years old—fever. (Also see seasonal flu information in the “For More Information” section below.)

• As with any medical product, unexpected or rare serious adverse events may occur.

FDA is working closely with other agencies to enhance adverse-event monitoring, information sharing, and analysis during and after the 2009 H1N1 vaccination program. In the U.S. Department of Health and Human Services, these agencies include the Centers for Disease Control and Prevention (CDC).

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Date Posted: September 16, 2009

What are the signs and symptoms of this virus in people?

How severe is illness associated with 2009 H1N1 flu virus?
Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.

In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.

One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.

How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.

When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu.  However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.

How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

Why is 2009 H1N1 virus sometimes called “swine flu”?
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. Scientists call this a “quadruple reassortant” virus.

2009 H1N1 Flu in Humans

Are there human infections with 2009 H1N1 virus in the U.S.?
Yes. Human infections with the new  H1N1 virus are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.
CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.

Is 2009 H1N1 virus contagious?
CDC has determined that 2009 H1N1 virus is contagious and is spreading from human to human.

How does 2009 H1N1 virus spread?
Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.

What are the signs and symptoms of this virus in people?
The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Severe illnesses and death has occurred as a result of illness associated with this virus.

How severe is illness associated with 2009 H1N1 flu virus?
Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.

In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.

One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.

How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.

When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu.  However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.

How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

Prevention & Treatment

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against 2009 H1N1 virus.  However, a 2009 H1N1 vaccine is currently in production and may be ready for the public in the fall. As always, a vaccine will be available to protect against seasonal influenza
There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

Take these 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* are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, CDC recommends that you stay 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.) Keep away from others as much as possible to keep from making others sick.

Other important actions that you can take are:

• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs,* tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick with flu-like illness, CDC recommends that you stay 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.)
Keep away from others as much as possible. 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.

If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners are also effective.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner*. CDC recommends that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where people have been identified with 2009 H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay 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.) Stay away from others as much as possible to keep from making others sick.Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.

If you become ill and experience any of the following warning signs, seek emergency medical care.

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

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

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
• Flu-like symptoms improve but then return with fever and worse cough

Are there medicines to treat 2009 H1N1 infection?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with 2009 H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.

What is CDC’s recommendation regarding “swine flu parties”?
“Swine flu parties” are gatherings during which people have close contact with a person who has 2009 H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity 2009 H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend “swine flu parties” as a way to protect against 2009 H1N1 flu in the future. While the disease seen in the current 2009 H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with 2009 H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay 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.) Stay away from others as much as possible to keep from making others sick.

Contamination & Cleaning

How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.

What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

*What if soap and water are not available and alcohol-based products are not allowed in my facility?
Though the scientific evidence is not as extensive as that on hand washing and alcohol-based sanitizers, other hand sanitizers that do not contain alcohol may be useful for killing flu germs on hands.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.

What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.

Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Exposures Not Thought to Spread 2009 H1N1 Flu

Can I get infected with 2009 H1N1 virus from eating or preparing pork?
No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.

Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.

Can 2009 H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.

Can 2009 H1N1 influenza virus be spread at recreational water venues outside of the water?

Yes, recreational water venues are no different than any other group setting. The spread of this 2009 H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.