QUESTIONS AND ANSWERS

H1N1 influenza 09, also called Pandemic (H1N1) 2009, human swine influenza and swine flu, is a new influenza A virus that has been circulating around the world since April 2009. The virus causes a mild respiratory illness in most, but can be severe in some.

The ‘incubation period’, or the amount of time that someone can be infected with influenza before symptoms develop, is usually between one and four days after exposure, although it can be up to seven days.

People can be contagious from approximately one day prior to symptoms developing until seven days after symptom onset. If someone takes anti-influenza medication he is generally no longer infectious after three full days of medication.

• are pregnant (particularly in the second and third trimester)
• have chronic lung disease (including asthma)
• are very obese
• have chronic heart conditions
• have chronic kidney disease
• have chronic liver disease
• have blood disorders (including sickle cell disease)
• have neurological disorders
• have metabolic disorders (such as diabetes)
• have weakened or suppressed immune systems (which may be caused by cancers, medications or HIV/AIDS)
• are of Aboriginal of Torres Strait Islander background (of any age)

If you are in one of the above categories, you should visit your general practitioner or Aboriginal Medical Service as soon as possible after developing influenza-like illness.

A factsheet with additional information for people at increased risk of severe illness from influenza is available.

• fast breathing or difficulty breathing
• bluish skin colour
• not drinking enough fluids
• excessive drowsiness or significantly reduced activity level
• being so irritable that the child does not want to be held
• influenza-like symptoms improve but then return with fever and worse cough
• development of a rash
• persistent vomiting

• difficulty breathing or shortness of breath
• bluish skin colour
• pain or pressure in the chest or abdomen
• sudden dizziness
• confusion
• development of a rash
• persistent vomiting

Masks are worn most widely in hospitals. Outside of hospitals you may wish to wear a mask if you have an influenza-like illness and cannot avoid close contact with other people.

It is important to note that there is also a certain level of risk associated with wearing masks, as people who do not often wear masks tend to touch their face regularly to adjust the mask, and may transfer virus to their eyes and mouth by doing so.

Well people do not need to wear masks in the community.

As long as your child is symptom free, you do not need to do anything except watch for the development of symptoms. If your child starts to develop symptoms, he should stay at home and not attend school or other settings where he would normally mix with other people. Manage mild illness as you normally would. If your child is at increased risk of severe illness or is already moderately or severely unwell, speak with your general practitioner, or in an emergency, call triple zero (000) or go to an emergency department.

It is important that your child stays at home until his symptoms are gone. There is no need for children to provide a ‘clearance certificate’ indicating they are not infectious with influenza to be able to return to school.

Children do not need to stay home if they have a family member sick with influenza but are not sick themselves.

It is important that children who are unwell do not attend school. If you have specific concerns, it may help to speak with your child’s principal.

If you think your child has been exposed to someone with influenza, watch closely for the development of influenza-like symptoms. There is no need to present your child for testing or seeking any treatment if he does not have symptoms of influenza-like illness.

People unwell with influenza-like illness should not go to work until they are better. If an unwell person does attend work briefly, their work space and common areas (eg tea rooms) should be cleaned using normal detergent products.

Employers should ensure that soap is available in toilets and may wish to consider providing alcohol-based hand cleanser for their employees. Posters showing the appropriate handwashing techniques are available from this website on the right hand navigation bar.

If you are very sick, call triple zero (000) or go to an emergency department. If you have moderate illness, or are at higher risk of severe illness, you should visit your general practitioner as soon as you develop symptoms.

If you are mildly unwell and not at increased risk of severe illness, stay home until you are better. Cover your nose and mouth with a tissue when you cough and sneeze. Put used tissues in the bin. Wash your hands with soap and running water for 10 seconds after coughing, sneezing or blowing your nose and before touching other people or shared objects.

If you are breastfeeding, you can continue to breastfeed. A factsheet with additional information about breastfeeding and influenza is available.

Anti-influenza medications (also called antiviral medications) keep viruses from reproducing in the body. Anti-influenza medications are used to reduce the severity of influenza symptoms, shorten the length of illness, reduce the risk of getting influenza and make infected people less contagious. Oseltamivir (Tamiflu®) and zanimivir (Relenza®) are anti-influenza medications used for the treatment and prevention of influenza, and are effective against H1N1 influenza 09.

Anti-influenza medication works best if given within 48 hours of symptom onset (when you start to show signs of being sick). It is important to see your doctor as soon as symptoms develop if you are at increased risk of severe illness from influenza.

A factsheet with additional information about antiviral medications for you and your family is available.

The Australian Government has released anti-influenza medication from the National Medical Stockpile for the treatment of people with moderate or severe influenza or for those at increased risk of severe illness from influenza. Most general practitioners and Aboriginal Medical Services and all hospitals can provide anti-influenza medication free of charge, if it is recommended for the clinical management of an unwell person. Your doctor can recommend anti-influenza medication based on your illness and risk factors.

People who do not qualify for free anti-influenza medication can still buy it with a doctor’s prescription.

If you are pregnant you should always take care to avoid close contact with people who are unwell with influenza. Practicing effective hand and respiratory hygiene is another good way to avoid infection. We have developed an information sheet especially for pregnant women.

A vaccine against Pandemic influenza A (H1N1) 2009 has been developed and is recommended for pregnant women. The vaccine is expected to be available from 30 September. Further information on vaccination is available here.

If you are pregnant and start to develop influenza-like symptoms you should see your general practitioner as soon as possible. Anti-influenza medication is available free of charge for pregnant women, and is most effective if started within 48 hours of symptom onset. Your doctor will be able to discuss the risks and benefits to you and your baby of taking anti-influenza medications.

During the PROTECT phase, pathology testing of all potential cases is not required or desirable. This is because confirmation is no longer required to inform clinical decisions about quarantine or use of antivirals; most cases are mild and do not require treatment. The treatment is the same for all strains of influenza, so doctors generally do not need to know what strain of influenza you have to treat you.

Limited testing will be done for outbreaks in 'closed' environments (eg special schools, cruise ships, military facilities) to identify the cause of the outbreak.

PROTECT is the most appropriate national response, given what we have learned about the disease to date. PROTECT recognises that the infection caused by H1N1 influenza 09 is not as severe as originally envisaged - the disease is mild in most cases, severe in some and moderate overall. The overwhelming majority of patients are making a rapid and full recovery. PROTECT is a measured, reasonable and proportionate health response to the risk that the virus poses to the Australian community.

The decision was made by the Australian Government on the advice of the Australian Chief Medical Officer, Professor Jim Bishop, and the Australian Health Protection Committee which includes all State and Territory Chief Health Officers.

• Identifying and treating early infection in people at increased risk of severe illness from influenza including those who:
• are pregnant (particularly in the second and third trimester)
• have chronic lung disease (including asthma)
• are very obese
• have chronic heart conditions
• have chronic kidney disease
• have chronic liver disease
• have blood disorders (including sickle cell disease)
• have neurological disorders
• have metabolic disorders (such as diabetes)
• have weakened or suppressed immune systems (which may be caused by cancers, medications or HIV/AIDS)
• are of Aboriginal of Torres Strait Islander background (of any age).
• Controlling outbreaks, including diagnostic testing, in high-risk institutional settings, such as boarding schools or special schools.
• Voluntary home isolation for those who have mild illness. Contacts will not be placed into quarantine.
• Clear public messages that unwell people should not attend school or work.
• More sharply focused monitoring of outcomes such as hospitalisations, surveillance of institutions, outbreaks and people with moderate or severe disease.

Technically, isolation refers to confirmed cases of a disease staying away from others while they are infectious, while quarantine refers to contacts of confirmed causes staying away from others for a defined period until it is certain they have not become infected. Often, these terms are used interchangeably.

It is important that people with influenza-like illness stay at home and avoid close contact (within 1 metre) with others until their symptoms are gone, or until after three days of taking anti-influenza medication. Although it is important, this form of quarantine is voluntary.

As H1N1 influenza 09 is widespread in NSW, it is not necessary for well family members or close contacts of people with influenza to stay at home, as long as they remain well.

Community transmission means that people become unwell with influenza but don’t know where or from whom they got the infection.

When a person acquires the illness from a family member or a close contact, the link to another case of the disease is clear. When this link is not clear, for more than a minority of cases, the disease is described as having community transmission. People can become unwell from spread in the community, perhaps from surfaces contaminated with the virus or from people coughing close to them in the community.

Every winter influenza is spread by community transmission in NSW.

The World Health Organization has a range of information about the current influenza response around the world.

NSW Health monitors the level of presentations to emergency departments for influenza-like illness and respiratory illness. Weekly statistics are compiled into a report, available under case numbers and statistics on the front page of this website.

The report provides information on influenza activity in eight regions of NSW. Data are not published for individual towns or small areas as insufficient information is supplied to provide reliable statistics.

General H1N1 influenza 09 inquiries
Australian Government’s H1N1 influenza 09 hotline: 180 2007 (free)

Expert health advice about influenza symptoms or other health concerns
healthdirect 1800 022 222 (free)

Questions about medications during pregnancy and breastfeeding
Mothersafe 02 9382 6539 (Sydney) or 1800 647 848 (NSW country)

To access a phone interpreter for languages other than English
Translating and Interpreting Service (TIS) – 13 14 50 (free)

General information about influenza and specific information for pregnant women are available in a range of languages from our website.

People who don’t speak English can still use healthdirect – a free clinical advice line (1800 022 222). To access a phone interpreter, call the Translating and Interpreting Service (TIS) and 13 14 50. Tell the operator what language you speak and then ask to phone healthdirect.