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Influenza A (H1N1) update

What is the latest influenza A (H1N1) information?

In July 2009 the national pandemic flu service went live in England. It is a telephone and online service that uses a checklist of symptoms to diagnose influenza A (H1N1). More information on the national pandemic flu service can be found here.

Experts think there may be a second, more serious wave of influenza A (H1N1) during the winter, when flu spreads more easily. For this reason it's important to stay vigilant and follow the recommendations to reduce your risk of infection.

If you live outside the UK, check with your government's health authority for more information and advice.

The best advice for everyone to reduce the risk and spread of infection is still:

  • cover your nose and mouth when coughing or sneezing, and use a tissue when possible
  • dispose of dirty tissues promptly and carefully
  • maintain good basic hygiene, for example, washing hands frequently with soap and water to reduce the spread of the virus from your hands to your face or other people
  • clean hard surfaces (eg door handles) frequently using a normal cleaning product
  • make sure your children follow this advice
  • if you have symptoms of the flu: stay at home, don't go to work, don't visit your GP but call him or her, or NHS Direct for advice

View the Bupa video on how to wash your hands effectively. Although this video says it's for people visiting hospital, its guidance will be useful for everyone.

What is a pandemic?

A pandemic is a global outbreak of a disease that affects numerous populations or countries. A flu pandemic happens when a new version of the flu virus emerges and spreads easily and quickly across the world.

A flu pandemic can be caused by a dramatic change to the flu virus, or a change to the virus that occurs when strains of flu from different species combine. This mix of genes can make a new virus to which most people will have little or no immunity.

In June 2009, the Director-General of the World Health Organization (WHO), Dr Margaret Chan, announced that the influenza pandemic alert status was being raised from level five to six. This means a pandemic of influenza A (H1N1) (colloquially known as swine flu) was declared.

The WHO stressed that the rise in alert level indicated an increase in the number of people with the disease and how quickly it was spreading - it was not a sign that the virus had become more severe. The majority of people with the disease have had mild flu symptoms and have responded positively to antiviral treatment. Many infected people have recovered without the need for hospital treatment or even medicines.

What is swine flu?

Swine flu is a contagious respiratory disease found in pigs that is caused by type A influenza viruses. The virus often causes outbreaks in pigs, and many countries regularly vaccinate their pigs against the virus.

It's not normal for swine influenza to affect people, although there have been a small number of cases in the past. These cases were mostly in people who had been in direct contact with infected pigs.

How is influenza A (H1N1) different from normal swine flu?

The new influenza virus that has been seen in humans is very different to what normally circulates in pigs. It combines genes from humans, pigs and birds.

What is the difference between bird flu and swine flu?

Different strains of the flu virus cause the disease in different animals because they have adapted to infect that species. In the same way, human flu viruses have adapted to infect humans. Sometimes, strains of the virus can be passed between humans and animals. When this happens, the viruses may combine to make new viruses that can infect humans. Most people will have little or no immunity to this strain.

Can it spread between people?

Yes. It appears that the A (H1N1) virus is contagious and that it can spread from person to person. The virus is thought to be transferred in the same way as normal influenza, through coughing, sneezing, or close contact. You can't get influenza A (H1N1) from pork or pork products as long as they are properly prepared and cooked.

How long is someone infectious for?

It can take up to seven days for symptoms to start after someone is infected with influenza A (H1N1), but it is more likely to be between two and five days. If you have influenza A (H1N1), you will be infectious when you have symptoms. This is most likely to be for up to five days, although this may be longer in children.

In the UK, healthy close contacts of someone with influenza A (H1N1) will no longer be given antiviral medicines unless their GP decides they are at a higher risk of complications from the virus.

If you live outside the UK, check with your government's health authority for more information and advice.

Who is most at risk of complications?

Those who are more at risk of complications from influenza A (H1N1) include people with:

  • chronic lung, heart, kidney or liver disease
  • a chronic neurological disease
  • a weakened immune system, such as those who have HIV/AIDS, or those who are taking medicines to suppress the immune system
  • diabetes
  • asthma

Women who are pregnant and people over 65 years old or children under five years old are also more at risk of complications.

What are the symptoms of influenza A (H1N1)?

The symptoms of influenza A (H1N1) influenza are similar to ordinary influenza. People with influenza A (H1N1) usually have a fever or high temperature (38°C/100.4°F) and two or more of the following symptoms:

  • tiredness
  • headache
  • runny nose
  • sore throat
  • shortness of breath or a cough
  • loss of appetite
  • aching muscles
  • sickness or diarrhoea

Who is most at risk of getting influenza A (H1N1)?

Influenza A (H1N1) can affect anyone, even if they are fit and healthy. People who have other medical conditions and pregnant women appear to be at greater risk of complications.

How is influenza A (H1N1) diagnosed?

Influenza A (H1N1) is no longer diagnosed with tests in the UK, but from patients' symptoms. If you have flu-like symptoms, stay at home and contact your GP by telephone or NHS Direct.

If you're in England, you can contact the national pandemic flu service for advice. If appropriate, they will organise a voucher for antiviral medicine. If you are given a voucher number, a healthy family member or friend should collect the medicine for you. They will need to provide ID for themselves and for you. The UK Government has stressed that if you have flu-like symptoms and are at an increased risk of complications, then you should contact your GP, not the national pandemic flu line.

If you live outside the UK, check with your government's health authority for more information and advice.

Should I be taking antiviral medicines?

In the UK, antiviral medicines are offered to everyone who has influenza A (H1N1) confirmed by either the national pandemic flu service or by their GP. Antiviral medicines can't cure the flu but they help to reduce the length of time you are ill by about a day, relieve some of the symptoms and reduce your risk of serious complications such as pneumonia.

It's particularly important for people who are at risk of complications to start taking antiviral medicines as soon as possible after symptoms start. If you do have flu-like symptoms and are in one of the risk groups, contact your GP as soon as possible.

The two antiviral medicines available are oseltamavir (Tamiflu) and zanamivir (Relenza). Oseltamavir is taken as a tablet and zanamivir is taken through an inhaler. Zanamivir is more suitable for pregnant women.

Is there a vaccine to prevent it?

Yes, there are currently two vaccines awaiting approval for use in the UK. The Department of Health is expecting the first batch of vaccines to be delivered to the NHS shortly.

One of the influenza A (H1N1) vaccines, Pandemrix, has been recommended by the European Medicines Agency and is currently awaiting approval from the European Commission. Trials of this vaccine are underway across the UK to determine the exact dose needed and to check the safety of the vaccine. The European Medicines Agency has recommended that the vaccine is given in two doses, three weeks apart, for healthy adults and children aged six months and over. However, this dose may change as more clinical studies are carried out.

The second vaccine is still awaiting approval from the European Medicines Agency. When this vaccine is approved, there will be enough vaccines to cover the UK population.

At the moment, it's likely that the vaccine will only be available through the NHS, and will initially be delivered to primary care trusts. Priority will be given to the people who are at an increased risk of complications from influenza A (H1N1). At the moment, these are (in order of priority):

  • people aged between six months and 65 years who are usually at risk of complications from seasonal flu
  • pregnant women, depending on the drug licence
  • people with weakened immune systems, such as those who have HIV/AIDS, or those who are taking medicines to suppress the immune system
  • people aged 65 or over who are at risk of complications

Whether or not the vaccine is given to everyone in the UK will depend on what happens during the pandemic.

If you live outside the UK, check with your government's health authority for more information and advice.

Can I take have the seasonal flu vaccine at the same time as the influenza A (H1N1) vaccine?

Yes, the vaccine for influenza A (H1N1) can be given at the same time as other vaccines, such as the seasonal flu vaccine or childhood vaccines. It isn't compulsory but the Government has recommended that anyone between six months and 65 years who is in the seasonal flu at risk group should have the vaccine.

The seasonal flu at risk group includes people who have chronic respiratory, heart, kidney, liver or neurological disease, type 1 diabetes or a weakened immune system.

What can people do to reduce their risk of catching or spreading it?

If you do have flu-like symptoms, you should stay off work or school and minimise contact with other people.

The best advice for everyone to reduce the risk of infection is:

  • stay at home if you have symptoms of the flu
  • cover your nose and mouth when coughing or sneezing, and use a tissue when possible
  • dispose of dirty tissues promptly and carefully
  • maintain 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
  • clean hard surfaces (eg door handles) frequently using a normal cleaning product
  • make sure your children follow this advice

You do not need to alter your diet. Influenza A (H1N1) can't be transferred through pork or pork products as long as they are properly prepared and cooked to over 70°C throughout.

Will schools be closed?

In the UK, schools and other institutions will now only close if there are a significant number of cases in both students and teachers, or if the students are particularly vulnerable, for example special schools.

If you live outside the UK, check with your government's health authority for more information and advice.

What should I do if I think I have symptoms of influenza A (H1N1)?

A swine flu information line has been set up by the Department of Health on 0800 1 513 513. You can phone this number to hear the latest advice.

If you think you have flu-like, phone your GP for advice or contact NHS Direct on 0845 4647 in England (or NHS 24 in Scotland on 08454 24 24 24 and on 0800 0514 142 in Northern Ireland).

In England, the national pandemic flu service is available online at www.pandemicflu.direct.gov.uk and over the phone on 0800 1 513 100. This service is only suitable if you are not at an increased risk of complications.

You shouldn't go to your GP surgery or A&E department unless you are seriously ill or advised to do so, as you may spread the illness to others. Antiviral medicines can help to relieve symptoms, reduce the length of time you are ill and reduce the potential for serious complications. However, most previously reported cases of influenza A (H1N1) have recovered from the illness without the need for antiviral medicines. Your doctor will advise you if you need antiviral medicines.

There are a number of things you can do at home to help your symptoms.

  • Drink enough fluids to prevent dehydration.
  • Stay at home and rest.
  • Take over-the-counter medicines such as paracetamol, aspirin or ibuprofen to help with symptoms.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Children under 16 years old should not be given aspirin or any medicines containing aspirin.

Do I need to wear a face mask?

There's no evidence that wearing a face mask will protect you against the flu virus. However, because the virus can be spread through coughing and sneezing, if you have become infected, wearing a mask may prevent you from infecting other people.

What is the current travel advice?

The WHO does not recommend any travel restrictions based on the current outbreak of influenza A (H1N1). The UK Foreign and Commonwealth Office has lifted all previous restrictions on travel. Visit the Foreign and Commonwealth Office website for the latest country-specific advice.

As a Bupa customer, am I covered?

Bupa does provide cover for influenza A (H1N1). The details of the cover will depend on your scheme and is subject to the standard terms of your scheme. Bupa schemes do not cover preventive medicine. At the moment, Bupa doesn't recommend evacuation from any affected areas abroad.

Bupa customers who have any concerns about the influenza A (H1N1) health alert should call Bupa's dedicated health information service, Healthline, and speak to one of our fully-qualified nurses. Healthline is available 24 hours a day, 365 days a year on 0845 607 7777.

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