Swine Influenza (Flu)
Human cases of swine influenza A (H1N1) virus infection have been identified in the United States. Human cases of swine influenza A (H1N1) virus infection also have been identified international y. The current U.S. case count is provided below.
# of laboratory confirmed cases
officials in states where human cases of swine influenza A (H1N1)
and the World Health Organization. This includes deploying staff
International Human Cases of Swine Flu Infection
CDC activated its Emergency Operations Center to coordinate the agency's response to this emerging health threat and yesterday the Secretary of the Department Homeland Security, Janet Napolitano, declared a public health emergency in the United States. This wil al ow funds to be released to support the public health response. CDC's goals during this public health emergency are to reduce transmission and il ness severity, and provide information to assist health care providers, public health officials and the public in addressing the chal enges posed by this newly identified influenza virus. To this end, CDC has issued a number of interim guidance documents in the past 24 hours. In addition, CDC's Division of the Strategic National Stockpile (SNS) is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak. Laboratory testing has found the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir. This is a rapidly evolving situation and CDC wil provide updated guidance and new information as it becomes available.
Key Facts about Swine Influenza (Swine Flu) What is Swine Influenza? Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of il ness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fal and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930. How many swine flu viruses are there? Like al influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as wel as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses. Swine Flu in Humans Can humans catch swine flu? Swine flu viruses do not normal y infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient. How common is swine flu infection in humans? In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported. What are the symptoms of swine flu in humans? The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea. Can people catch swine flu from eating pork? No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kil s the swine flu virus as it does other bacteria and viruses. How does swine flu spread? Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose. What do we know about human-to-human spread of swine flu? In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like il ness among the swine.
In fol ow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious il nesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like il nesses with antibody evidence of swine flu infection.
How can human infections with swine influenza be diagnosed? To diagnose swine influenza A infection, a respiratory specimen would general y need to be col ected within the first 4 to 5 days of il ness (when an infected person is most likely to be shedding virus). However, some persons, especial y children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing. What medications are available to treat swine flu infections in humans? There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to al four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses. What other examples of swine flu outbreaks are there? Probably the most wel known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; al of these patients had previously been healthy. The virus
was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus col ected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).
Is the H1N1 swine flu virus the same as human H1N1 viruses? No. The H1N1 swine flu viruses are antigenical y very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses. Swine Flu in Pigs How does swine flu spread among pigs? Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection. What are signs of swine flu in pigs? Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed. How common is swine flu among pigs? H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normal y occur in colder weather months (late fal and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifical y, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza. While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initial y were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses. Is there a vaccine for swine flu? Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine wil likely help provide partial protection against swine H3N2, but not swine H1N1 viruses. What You Can Do to Stay Healthy There are everyday actions people can take to stay healthy.
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, especial y after you cough or sneeze. Alcohol-based hands cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread that way.
Try to avoid close contact with sick people.
Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Preventing the Flu: Good Health Habits Can Help Stop Germs
The single best way to prevent seasonal flu is to get vaccinated each year, but good health habits like covering your cough and washing your hands often can help stop the spread of germs and prevent respiratory il nesses like the flu. There also are flu antiviral drugs that can be used to treat and prevent the flu.
1. Avoid close contact. Avoid close contact with people who are sick. When you are
sick, keep your distance from others to protect them from getting sick too.
2. Stay home when you are sick. If possible, stay home from work, school, and
errands when you are sick. You wil help prevent others from catching your il ness.
3. Cover your mouth and nose. Cover your mouth and nose with a tissue when
coughing or sneezing. It may prevent those around you from getting sick.
4. Clean your hands. Washing your hands often wil help protect you from germs.
5. Avoid touching your eyes, nose or mouth. Germs are often spread when a
person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
6. Practice other good health habits. Get plenty of sleep, be physical y active,
manage your stress, drink plenty of fluids, and eat nutritious food.
Stopping Germs at Home, Work and School How Germs Spread
The main way that il nesses like colds and flu are spread is from person to person in respiratory droplets of coughs and sneezes. This is cal ed "droplet spread." This can happen when droplets from a cough or sneeze of an infected person move through the air and are deposited on the mouth or nose of people nearby. Sometimes germs also can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches his or her own eyes, mouth or nose before washing their hands. We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks.
How to Stop the Spread of Germs
• Cover your mouth and nose • Clean your hands often • Remind your children to practice healthy habits, too
Cover your mouth and nose when coughing or sneezing. Cough or sneeze into a tissue and then throw it away. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.
The "Happy Birthday" song helps keep your hands clean? Not exactly. Yet we recommend that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. That's about the same time it takes to sing the “Happy Birthday” song twice!
Alcohol-based hand wipes and gel sanitizers work too. 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 kil s the germs on your hands.*
Good Health Habits
Remind children to practice healthy habits too, because germs spread, especial y at school.
Avoid close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too. Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You wil help prevent others from catching your il ness. Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
Cover Your Cough Stop the Spread of Germs that makes you and others sick.
Clean your hands. Washing your hands often wil help protect you from germs.
Clean Hands Saves Lives! Tips on hand washing and using alcohol-based hand sanitizers
Wash Your Hands Often Fact sheet and video clip from "An Ounce of Prevention Keeps the Germs Away"
Take Action Clean Hands Campaign Facts and survey results, educational materials From American Society for Microbiology
Consumer Advice: Clean: Handwashing Links to lots of educational materials, including those for schoolchildren. From www.foodsafety.gov
It's a SNAP Toolkit: Handwashing Handwashing materials. Part of It's A SNAP program aimed at preventing school absenteeism. From the School Network for Absenteeism Prevention, a col aborative project of the CDC, the U.S. Department of Health and Human Services and the Soap and Detergent Association
Handwashing Brief facts and quiz questions. From "Food Safety A to Z Reference Guide" part of middle school food safety science program produced by the FDA and the National Science Teachers Association
Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Seasonal Flu Information for Schools & Childcare Providers
Educators and staff can help slow the spread of colds and flu. On this page, you wil find more information on preventing the flu, as wel as, materials and tools for schools.
Approximately 1/5 of the U.S. population attends or works in schools. (U.S. Dept of
Some viruses and bacteria can live from 20 minutes up to 2 hours or more on
surfaces like cafeteria tables, doorknobs, and desks. (Ansari, 1988; Scott and Bloomfield, 1989)
Nearly 22 mil ion school days are lost annual y due to the common cold alone.
Addressing the spread of germs in schools is essential to the health of our youth,
Students need to get plenty of sleep and physical activity, drink water, and eat
good food to help them stay healthy in the winter and al year.
Cover their nose and mouth with a tissue when they cough or sneeze—have them throw the tissue away after they use it. Wash their hands often with soap and water, especial y after they cough or sneeze. If water is not near, use an alcohol-based hand cleaner. Remind them to not to touch their eyes, nose, or mouth. Germs often spread this way. Questions and Answers: Information for Schools
The Centers for Disease Control and Prevention (CDC) recognizes that school administrators, teachers, staff, and parents are concerned about the flu, particularly its effects on children. Schools are instrumental in keeping their communities healthy by taking actions such as posting information about hand hygiene in restrooms, providing flu prevention messages in daily announcements, and being vigilant about cleaning and disinfecting classroom materials.
The fol owing are some answers to questions commonly asked by school administrators, teachers, staff, and parents:
What is influenza (flu)?
The flu is a contagious respiratory il ness caused by influenza viruses. It can cause mild to severe il ness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccination each year.
Every year in the United States, on average:
5% to 20% of the population gets the flu;
more than 200,000 people are hospitalized from flu complications;
20,000 of those hospitalized are children younger than 5 years of age; and
Some people, such as older people, young children, and people with certain health conditions (such as asthma, diabetes, or heart disease), are at high risk for serious flu complications.
How does the flu spread?
Flu viruses 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. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. What are the symptoms of the flu?
Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults
Although the term "stomach flu" is sometimes used to describe vomiting, nausea, or diarrhea, these il nesses are caused by certain other viruses, bacteria, or possibly parasites, and are rarely related to influenza.
How long is a person with flu virus contagious?
The period when an infected person is contagious depends on the age and health of the person. Studies show that most healthy adults may be able to infect others from 1 day prior to becoming sick and for 5 days after they first develop symptoms. Some young children with weakened immune systems may be contagious for longer than a week.
What is the difference between a cold and the flu?
The flu and the common cold are both respiratory il nesses but they are caused by different viruses. Because these two types of il nesses have similar flu-like symptoms, it can be difficult to tel the difference between them based on symptoms alone. In
general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. Colds are usual y milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds general y do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.
How can you tell the difference between a cold and the flu?
Because colds and flu share many symptoms, it can be difficult (or even impossible) to tel the difference between them based on symptoms alone. Special tests that usual y must be done within the first few days of il ness can be carried out, when needed to tel if a person has the flu.
For more information about “Flu: The Disease” visit, http://www.cdc.gov/flu/about/disease/index.htm
Preventing and Treating the Flu What can I do to protect myself against the flu?
CDC recommends a yearly flu vaccine as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the flu vaccine protects against the three main flu strains that research indicates wil cause the most il ness during the flu season. The vaccine can protect you from getting sick from these three viruses or it can make your il ness milder if you get a different flu virus.
If you do get the flu, antiviral drugs are an important treatment option. Antiviral drugs are prescription medicines (pil s, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. Antiviral drugs can make your il ness milder and make you feel better faster. They may also prevent serious flu complications. This could be especial y important for people at high risk. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).
In addition, you can take everyday preventive steps like frequent hand washing to decrease your chances of getting the flu. If you are sick with flu, reduce your contact with others and cover your cough to help keep germs from spreading.
What kind of flu vaccines are there?
There are two types of vaccines that protect against the flu. The "flu shot" is an inactivated vaccine (containing kil ed virus) that is given with a needle, usual y in the arm. The flu shot is approved for use among people 6 months of age or older, including healthy people and those with chronic medical conditions (such as asthma,
diabetes, or heart disease). A different kind of vaccine, cal ed the nasal-spray flu vaccine (sometimes referred to as LAIV for Live Attenuated Influenza Vaccine or FluMist®), was approved in 2003. The nasal-spray flu vaccine contains attenuated (weakened) live viruses, and is administered by nasal sprayer. It is approved for use only among healthy* people 2-49 years of age who are not pregnant.
Each of the two types of vaccine contains three influenza viruses, which are chosen based on information about recently circulating strains. Each of the three vaccine strains in both vaccines – one A (H3N2) virus, one A (H1N1) virus, and one B virus – are representative of the influenza vaccine strains recommended for that year. Viruses for both vaccines are grown in eggs.
* "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.
How do flu vaccines work?
Both flu vaccines (the flu shot and the nasal-spray flu vaccine (LAIV)) cause antibodies to develop in the body. These antibodies provide protection against influenza virus infection.
At what age should a child be vaccinated?
CDC recommends that al children aged 6 months up to their 19th birthday get a flu vaccine. CDC also recommends that people in contact with certain groups of children get a flu vaccine in order to protect the child (or children) in their lives from the flu.
The fol owing contacts of children are recommended for influenza vaccination by CDC:
Close contacts of children younger than 5 years old (people who live with them) should get a flu vaccine.
Out-of-home caregivers (nannies, daycare providers, etc.) of children younger than 5 years old should get a flu vaccine.
People who live with or have other close contact with a child or children of any age with a chronic health problem (asthma, diabetes, etc.) should get a flu vaccine.
In addition, CDC recommends that al health care workers be vaccinated each year to keep from spreading the flu to their patients.
Children 6 months up to 9 years of age getting a flu vaccine for the first time wil need two doses of vaccine the first year they are vaccinated. If possible, the first dose should be given in September or as soon as vaccine becomes available. The second dose should be given 28 or more days after the first dose. The first dose "primes" the immune system; the second dose provides immune protection. Children who only get one dose but who need two doses can have reduced or no protection from a single dose of flu vaccine. Two doses are necessary to protect these children.
What are influenza antiviral drugs?
Influenza antiviral drugs are prescription medicines (pil s, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. Antiviral drugs can make your il ness milder and make you feel better faster. They may also prevent serious flu complications. This could be especial y important for people at high risk.
How are antiviral medications used for flu?
While getting a flu vaccine each year is the best way to protect you from the flu, antiviral drugs can be used as a second line of defense to treat the flu or to prevent flu infection. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms). When used this way, these drugs can reduce the severity of flu symptoms and shorten the time you are sick by 1 or 2 days. They also may make you less contagious to other people.
Flu Resources for Schools Where can I get more information about the flu?
For more information and updates about the flu, cal CDC's hotline or visit CDC's Web site. You can cal the CDC Flu Information Hotline (English and Spanish) at:
800-CDC-INFO (800-232-4636) 888-232-6348 (TTY)
You can visit CDC's flu Web site where you can access the fol owing:
Information about preventing the spread of flu in schools;
"Be a Germ Stopper" and "Cover Your Cough" posters formatted for printing;
"It's a SNAP" toolkit (leaves CDC's website), which includes activities that school administrators, teachers; and students and others can do to help stop the spread of germs in schools.
To find contact information for your state or local health department, go to http://www.cdc.gov/other.htm.
For "Key Facts about Seasonal Flu," a fact sheet including information about flu symptoms, how flu spreads, and how to prevent flu, go to http://www.cdc.gov/flu/keyfacts.htm.
For “The Flu: A Guide for Parents,” a flyer answering questions about the flu, how to protect your child, treatment, and more, go to http://www.cdc.gov/flu/school/index.htm.
For more information about both the flu shot and the nasal spray vaccine, go to http://www.cdc.gov/flu/about/qa/fluvaccine.htm.
For more information about treating flu and flu symptoms, including information about why children or teenagers with flu-like symptoms should NOT take aspirin, go to http://www.cdc.gov/flu/whattodo.htm
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