Questions and Answers for the Public

This page is updated as the situation changes, so please recheck this advice.

24 Hour HSE Flu Information Line Freephone 1800 94 11 00

This website has a HEALTH ATLAS service, where you can find your nearest GP on a map, along with contact details. Check out the HEALTH ATLAS HERE.

What is influenza A(H1N1)?
Influenza A(H1N1) is a new flu virus which has been circulating worldwide since April, and we have seen over 144 cases in Irelandso far.  The World Health Organisation has declared this to be pandemic – a flu epidemic that spreads around the world.

Does this flu spread easily?
The new flu virus appears to be highly contagious and can spread quickly from person to person through tiny drops in coughs and sneezes. If you are close to a person with flu you can breathe them in and become infected.  Droplets can also be passed from surfaces like door handles and hand rails.

What are the symptoms of influenza A(H1N1)?
The symptoms are like those of normal seasonal flu and include: fever that begins very suddenly, severe fatigue, a cough, a sore throat, a runny nose, headache and muscle aches.  Some people have vomiting and diarrhoea.  While it is usually a mild disease some people may develop complications such as pneumonia.

Why have we changed our approach to managing the Influenza outbreak?

The Influenza A(H1N1) virus has spread around the world faster than any previous pandemic.  During the initial phase, we focused on slowing the spread of the virus – placing people with flu in isolation at home and asking their close contacts to self-isolate and take anti-viral medicine as a preventative measure.  Given the numbers of cases that have now been seen, and the fact that the flu is being passed from person to person within Ireland, we are moving to change how we manage cases of this flu.  From July 16th, like the USA, UK and other EU countries, we have shifted our focus to treatment rather than containment.  We are using our resources to ensure that those people who contract the flu can easily access the correct advice to take care of themselves, to stop the flu from spreading to others, and to access medicine or healthcare if they need it. We have moved to a treatment phase.

What does the treatment phase involve?

Given that this flu causes mostly mild to moderate illness, we now know that most people who get it can recover at home without needing anti-viral medicine.  Our clinical advice is that services and treatment can be concentrated mainly on those people with severe symptoms or who are considered at higher risk – like those with long term chronic illness. 

What has changed from July 16^th?

Instead of lab testing all cases, GPs will diagnose people based on their symptoms.  We no longer conduct routine contact tracing and giving those contacts preventative anti-viral medicine.  We are recommending to GPs that only people with severe symptoms or in high risk groups need to be prescribed antiviral medicine.

Who will receive anti-viral treatment and where is it available?

·        Patients who appear to have severe symptoms

·        Patients who are in defined high risk groups

·        All suspected cases who have a household contact in a very high risk group

Should a GP prescribe anti-viral treatment the prescription can be filled at any pharmacy. Anti-viral medicines for this flu are free of charge to all.

Who are those considered to be in a high risk group and needing treatment?
People who have: chronic lung, heart, kidney, liver, or neurological disease; people whose immune system is reduced by disease or medications; people with diabetes mellitus; people aged 65 years and older; children under 5 (children under 2 are at particular risk of influenza); people on medication for asthma, severely obese people (body mass index more than 40) and pregnant women.

Who are the contacts of cases who will require treatment even though they do not have the illness?

·        Pregnant women

·        Those on treatment for asthma

·        Those who are very obese (Body Mass Index >40)

Personal actions

What should I do if I get sick?
If you get sick with a flu-like illness phone the Flu Information Line on Freephone 1800 94 11 00, available 24 hrs a day.

Listen to the symptoms of flu and the advice on home care. Most people with flu will be able to recover at home within a few days without needing anti-viral medicine or medical care.

If you have severe symptoms, or are in a high risk group, contact your GP/family doctor by telephone. They will decide if you need testing or treatment

If you do need to be tested or treated the GP may arrange for you to be seen at their surgery or may arrange a home visit. You should stay at home for 7 days while ill unless needing further care.

How do I care for myself or someone else at home?
Stay at home for up to 7 days or until you fully recover

·        Discourage any visitors

·        Take medicines such as paracetamol or ibuprofen to reduce the symptoms

·        Drink plenty of fluids

·        Most people with flu will recover within a few days.

Visit www.hse.ie or call the Flu Information Line 1800 94 11 00 to get more advice on home care.

How will I know if I need medical care?

IF YOU AREAN ADULT

If you have taken the basic care steps outlined above and you start to feel worse, or if after a few days you are not feeling better, you may need more advice from your doctor.

Contact you doctor by phone if you notice:

• Shortness of breath at rest or while doing very little

• Painful or difficult breathing

• Coughing up bloody sputum

• Drowsiness, disorientation or confusion

• Fever for 4-5 days and not starting to get better (or getting worse)

• Starting to feel better then developing high fever and feeling unwell again.

IF YOU ARECARING FOR A CHILD

You should contact your doctor by phone if you have taken the steps above and are still concerned that the child shows any of the following symptoms:

• Fast breathing or trouble breathing

• Bluish skin colour

• Not drinking enough fluids

• 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

• Fever with a rash.

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.

How easily does this flu spread?

It appears that after a person becomes infected, it takes less than two days for symptoms to start and this is when people are most infectious.  Influenza spreads quickly in closed communities such as schools or residential homes.

Do the public need to wear masks if the flu starts to spread widely?

If a caregiver must have close contact with the sick person (for example, to hold a sick infant), spend the least amount of time possible in close contact and wear a facemask when entering the sick room. Avoid being face-to-face with the sick person. When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face. All persons in the household should clean their hands with soap and water or an alcohol-based hand rub (minimum 60% alcohol) frequently.

Are antiviral drugs effective?

Yes, antiviral drugs are effective in the treatment of influenza A(H1N1). If taken shortly after getting sick (within 2 days) they can reduce flu symptoms, shorten the length of the illness and potentially reduce the serious complications of the disease.  Irelandhas a stockpile of oseltamivir (Tamiflu) and of zanamivir (Relenza) - enough to treat 55% of the population. The focus of treatment will now be on those who have severe illness and those with Influenza who are at risk of severe illness.

I am pregnant – what if I get the flu?

Women who are pregnant and develop influenza symptoms should contact their GP and arrange to receive antiviral medication.

I am breastfeeding – what if I get the flu?
Breastfeeding allows important protection and antibodies to be passed from mother to child.  Infants who are not breastfeeding are particularly vulnerable to infection and hospitalisation for severe respiratory illness.

Women who are breastfeeding and who get the flu should continue to breastfeed as much as they can to protect their baby.  It is safe to breastfeed while taking anti-viral medicine.  In as far as is possible, breastfeeding babies should be fed on demand to allow as much protection pass to the baby as possible.

If a mother becomes too ill to feed then expressing milk may still be possible. If the baby becomes too ill to breastfeed, expressed milk should be used. The risk for influenza A(H1N1) transmission through breast milk is unknown as yet, but it is rare for normal flu to be be transmitted through breast milk from mother to baby.

If a mother is too ill to breastfeed or to express milk, infants should be kept well hydrated and fed with formula.

Pandemics

What is an Influenza Pandemic?
An influenza pandemic is a worldwide flu epidemic.  A pandemic can cause serious illness and death and can give rise to enormous social and economic disruption worldwide.

What does it mean that the pandemic level is at phase 6?
This is been declared because there is sustained human to human community transmission of the virus in more than one region. These are the conditions required to declare a pandemic

How serious is the current Pandemic?

At this time, the World Health Organisation considers the pandemic to be moderate. This is based on the clinical information available and reflects that:

1. Most people recover from infection without the need for hospitalisation or medical care.
2. Overall, national levels of clinically severe or fatal cases of respiratory illness appear similar to normal seasonal flu, although in some local areas and institutions, high levels of disease have occurred. 
3. Overall, hospitals and health care systems in most countries generally have been able to cope with the numbers of people seeking care - although in some localities, some facilities and systems have been stressed.

There is a concern that the current patterns of serious cases and fatalities are occurring mostly among younger people, including the previously healthy and those with pre-existing medical conditions or pregnancy.

Close monitoring during the pandemic period is essential for the WHO to make changes in future severity assessments if needed.

What preparations have been made for an outbreak of Influenza A(H1N1) in Ireland?
A national plan for pandemic influenza was put in place in January 2007, describing the health system’s response to a possible worldwide pandemic.  This detailed plan allowed the Department and HSE to make detailed preparation over the last few years for a pandemic. Stocks of anti-viral medicine and equipment were prepared, and the responses of health services were planned.  Ireland is well prepared to respond to a pandemic.

What is being done currently to deal with the outbreak in this country?
The Department of Health and Children and the HSE have been working together since April to manage our response to this outbreak.  We also link closely with the European Centres for Disease Control, public health officials in other European Member Statesand the WHO.

The National Public Health Emergency Team (NPHET) has been meeting since the outbreak was first confirmed. This team managed and directs the Department of Health and Children and the HSE responses to a public health emergency.  NPHET is chaired by the Secretary General of the Department of Health and Children.

The Government Interdepartmental Committee has been meeting to deal with health emergency planning involving transport, foreign affairs, education, security, etc. 

What specific measures have been taken?

• The HSE in association with the Department of Health and Children has finalised advance purchase agreements with two manufacturers for the procurement of 7.7 million doses of pandemic vaccine
• An information leaflet about Influenza A(H1N1) has been distributed to households
• Posters and leaflets have been placed in air and sea ports
• We have accumulated anti-viral medication stockpiles to treat 55% of the Irish population
• Anti-viral medication has been distributed to all community pharmacies to treat people with severe symptoms and those in high risk groups
• Advertising will be placed on TV and other media
• Information is being updated daily onHSE and Department of Health and Children websites
• Health Professionals have received communications outlining their role in managing cases of influenza.

Are there any plans to close schools or universities?
If a student is suspected of having a virus that might be Influenza A(H1N1) they must be assessed by their GP/family doctor before returning to school or college. If their GP/family doctor diagnoses the child to have probable or confirmed Influenza A(H1N1), the local Department of Public Health will be contacted.  The educational institution/school should take advice from the Department of Public Health, but in general the advice will be to continue normal school operations.

Unless the Department of Public Health advise the management to close as a precautionary measure, the educational institution/school should not do so. To date there has been one case that led to a single primary school class staying at home for a week.

Actions at ports
Specific information in the form of posters and leaflets has been distributed to all major air and sea ports.

Influenza A(H1N1) vaccination

Is there a vaccine available against the new influenza A(H1N1) virus?
Not yet, but work is underway to develop a vaccine that will be used here and internationally.  Ireland has advance orders in place for enough of this vaccine (7.7 million doses) for the Irish population.  This will deliver 2 separate doses to each member of the population.  Those who have been infected with the virus will not receive the vaccine.

When will influenza A(H1N1) vaccines be available?

The vaccine should become available to Ireland and other countries in the later part of this year.  We are still awaiting precise delivery dates, but vaccine is expected to begin arriving from September/October 2009.  It will be delivered in stages, so we will offer vaccine to high risk people first, along with healthcare staff and other essential workers.  The HSE will carry out a major public information campaign when the vaccination programme is ready to begin.

Will the influenza A(H1N1) vaccine be safe?

Licensed vaccines are held to a very high standard of safety. All possible precautions will be taken to ensure safety of new influenza A(H1N1) vaccines.

Travel advice

Are there restrictions on travel to any country because of the Pandemic?
No.  The WHO says that travel restrictions are not useful in limiting the spread of the virus.

We recommend that travellers at risk of complications from any form of flu such as those with chronic conditions (for example diabetes, lung disease, heart disease), elderly, pregnant women or children under 2 years of age, discuss the risk of travel with their health care provider before deciding on travel.

What precautions should I take when travelling?

·        Familiarise yourself with sources of health advice in the country of travel, and pay attention to local government and public health announcements including any movement restrictions and prevention recommendations.

·        Avoid close contact with people who have fever, sneezing or cough.

·        General advice includes frequent and thorough hand washing with soap and water, or alcohol based hand cleaners.

·        Clean surfaces regularly to get rid of germs

·        If you are sick, avoid close contact with others, stay at home or in your hotel room. 

·        If you have a mild flu-like illness seek medical advice over the phone if practical. 

·        Seek medical care if severely ill. 

·        Do not travel or fly home if you are ill.

·        If you become ill during a flight you should inform the cabin crew.

·        Cover your nose and mouth with a tissue when coughing, sneezing or wiping and dispose of tissues into a bin immediately.

·        If you are caring for someone who is ill, try to ensure they are not in close contact with others. Wearing a mask may be protective for those who are caring for someone with influenza.

For daily situation updates:

http://www.hpsc.ie/hpsc/News/MainBody,3602,en.html

Further information:
http://www.hpsc.ie/

http://www.hse.ie/eng/
http://www.who.int/csr/disease/swineflu/en/index.html
http://www.cdc.gov/swineflu/
http://ecdc.europa.eu/en/

Information and medical advice about influenza A(H1N1) for pregnant women and women who are breastfeeding

Version 1.0 : 26.5.09

What is influenza A(H1N1)?
Influenza A(H1N1) is different from the ordinary or seasonal flu that occurs every winter.
• It has spread rapidly in the Americas.
• It could be highly infectious
• It may affect large numbers of people
• It may cause more severe illness than ordinary flu
• It may cause more deaths than ordinary flu
• It may occur in two or more waves several months apart – with each wave possibly lasting weeks or months
Are there people at higher risk of complications?
Some people are at higher risk of complications from flu. They may require additional treatment or monitoring.
This group includes people with chronic heart or lung disease, diabetes, liver and kidney disease, people receiving cancer treatment and whose immune system is impaired due to disease or treatment (immunocompromised). It also includes children under 3 years and pregnant women.
What can people do to protect themselves from influenza A(H1N1)?
Preventing the spread of germs is the single most effective way to slow the spread of influenza.
1. Wash your hands often with soap and water, and especially after coughing and sneezing and before eating. Alcohol-based hand cleaners (minimum 60% alcohol) are also effective
2.Avoid unnecessary close contact with people who have influenza
3.Avoid touching your eyes, nose or mouth with your hands – germs spread this way
4.Cover your mouth and nose with a tissue when you cough or sneeze and put your used tissue in a wastebasket.

How will I know if I have got influenza A(H1N1)?
You will have the same symptoms as if you had ordinary flu but they will probably be sudden, and may be severe. They may include:
• Temperature over 38ºC/100.4ºF and some of the following:
• Dry cough • Sore throat
• Headache • Runny nose
• Severe weakness and fatigue • Vomiting / diarrhoea
• Aching muscles and joints
These can lead to complications some of which may be severe.

What should a pregnant woman do if she thinks she may have influenza A(H1N1)?
Anyone who is pregnant needs to have an urgent assessment by their doctor.
•Contact your GP by phone and follow his or her instructions.
•Discourage any visitors
•Take medicines such as paracetamol to reduce the symptoms
•Drink plenty of fluids
•Most people with flu will recover within a few days.
•Stay at home for up to 7 days or until you fully recover (whichever is the longer)
•If you need to go to a doctor’s office or to an emergency room, please telephone before you go and tell them that you think you might have influenza A(H1N1). When you are there cover your mouth and nose with a facemask or a cloth; make yourself known to staff. Do not sit in the waiting area with other patients.
When should a pregnant woman get emergency medical care?

If you have any of these signs, contact your doctor right away:
•Shortness of breath at rest or while doing very little
•Painful or difficult breathing
•Coughing up bloody sputum
•Drowsiness, disorientation or confusion
•Sudden dizziness
•Severe or persistent vomiting
•Decreased or no movement of your baby
•Fever for 4-5 days and not starting to get better (or getting worse)
•Starting to feel better then developing high fever and feeling unwell again

Is there a vaccine against influenza A(H1N1)?
No. There is currently no vaccine for influenza A(H1N1). The vaccine given for seasonal flu does not protect against influenza A(H1N1).

Is there treatment against influenza A(H1N1)?
Yes. The influenza A(H1N1) virus is sensitive to antiviral drugs. These medicines may reduce the severity of the illness. Treatment is most effective if started within 48 hours of symptom onset, but may also be given to very sick or high risk people (like pregnant women) even after 48 hours.

How else should pregnant women prepare for the possibility of spread of the influenza A(H1N1) virus?
Certain pregnant women are at higher risk of complications from flu – these include women with chronic heart disease, chronic lung disease, diabetes, liver and kidney disease, receiving cancer treatment and whose immune system is impaired due to disease or treatment (immunocompromised).
If you are one of these women you should consult your doctor and make sure all your vaccinations are up-to-date. Seasonal influenza vaccine should be used as advised and when available.The seasonal influenza vaccine is considered very safe in pregnancy.

What if I get this new virus and I am pregnant?
We do know that pregnant women are more likely to get sick than others and have more serious problems with seasonal flu. These problems may include early labour or severe pneumonia. We don’t know if this virus will do the same, but it should be taken very seriously.

Can I take antivirals if I am pregnant?
Your doctor will decide if you need antiviral drugs. There is little information about the effect of antiviral drugs in pregnant women or their babies, but no serious side effects have been reported.

Is it ok to breastfeed my baby if I am sick with this virus?
•A mother’s milk is made to fight diseases in her baby. This is really important in young babies when their immune system is still growing.
•Do not stop breastfeeding if you are ill. Breastfeed early and often. This will help protect your baby from infection.
•Be careful not to cough or sneeze in the baby’s face.
•Wash your hands often with soap and water.
•Your doctor might ask you to wear a mask to keep from spreading this new virus to your baby.
•If you are too sick to breastfeed, pump if possible and have someone give the expressed milk to your baby.
Is it OK to take antivirals while breastfeeding?
There is little information about the effect of antiviral drugs on breastfed babies, but no serious side effects have been reported. Your doctor will decide whether antivirals are right for you.
Telephone
Further Information is available from the HSE Flu Information Line.
The Flu Information Line is available 24 hours a day and is your primary source of information on influenza A(H1N1).
Freephone 1800 94 11 00
Websites
The HSE’s Website will be kept updated every day with latest information and advice. Check it often.
Health Service Executive
www.hse.ie
Department of Health and Children
www.dohc.ie
Information for Health Professionals will be on
www.hpsc.ie