Nurse speaks to patient about Swine Flu
Questions & Answers – Script for Florida Flu Line
H1N1 Swine Flu
Last Update: May 6, 2009
GENERAL QUESTIONS
Is there swine flu in Florida?
Yes – as of May 6, at noon, there are five confirmed cases in Florida: 2 in Lee County, 1 each in Broward, Orange and Pinellas.
Why did Florida’s Surgeon General declare a public health emergency?
The declaration of a public health emergency provides the Florida Surgeon General with the powers necessary to bring antiviral drugs into the state of Florida quickly to better meet the needs of communities responding to swine flu.
I understand that there aren’t as many cases being identified?
Although select media outlets have reported a decrease in reported cases, it is still important for everyone to continue practicing prevention measures. SEE PREVENTION AND PROTECTION
SYMPTOMS/TREATMENT
My child has a fever (or is sick), what do I do?
If your child has become ill with flu-like symptoms, including fever, sore throat or cough, you may want to contact your health care provider, particularly if you are worried about your symptoms. Some have reported nausea, vomiting or diarrhea. Your health care provider will determine whether flu testing or treatment is needed. If your child is sick, do not send them to school.
IF your child is ill and experiences 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 skin color
• 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
I’m sick, what do I do?
If you become ill with flu-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact your health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether flu testing or treatment is needed. If you are sick, you should stay home and avoid contact with other people as and avoid social gatherings much as possible to keep from spreading your illness to others.
Precaution while dealing with the Swine Flu
If you become ill and experience any of the following warning signs, seek emergency medical care. In adults, some 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
How long do I stay home if I’m sick? When can my child go back to school?
People with a swine flu virus infection should be considered potentially contagious as long as they have symptoms and possible for up to seven days following illness onset. Children, especially younger children, are potentially contagious for longer periods. Contact your regular physician if you are unsure when to return to work or send your child back school.
Are there medicines to treat swine flu?
Yes. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) 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. For treatment, antiviral drugs work best if started soon after getting sick (within two days of symptoms). Contact your doctor to see if you should receive antivirals. If you are prescribed antivirals it is important that you take all the medication as prescribed.
How serious is swine flu infection?
Like seasonal flu, swine flu in humans can vary in severity – from mild to severe.
What is Florida doing to protect me from swine flu?
We have epidemiologists or “disease detectives” at the County Health Departments and in Tallahassee. There is a detailed plan in place to respond to flu outbreaks. Florida has a strong system to identify potential flu cases.
• Our state laboratories have the equipment and trained staff to analyze flu samples.
• We have 100 physicians who report flu activity to us on a weekly basis.
• We have access to a database that tracks over the counter medications to provide us with early warning of potential flu activity.
• We also track 106 emergency departments throughout the state to analyze trends in the types of illnesses that they are seeing.
The Department’s mission is to promote, protect and improve the health of Floridians. Department staff has been working around the clock to make sure Florida residents and visitors are protected and cared for during this challenging public health situation.
Why is the State Health Office not recommending everyone wear mask?
The current situation does not merit everyone wearing a mask. If you are in an area with confirmed cases,
1. Avoid close contact with people who might be ill, and avoid crowded settings.
2. Continue other general prevention efforts.
I can’t afford Antivirals. What do I do?
Local health departments have supplies of antivirals. Contact your county health department for more information. Visit www.floridashealth.com to find your local health department.
Do I need a prescription for these medicines?
Yes, you need a prescription. Contact your regular physician on how to get the antivirals. Your local health department will also have antivirals. Visit www.floridashealth.com to find your local health department.
My next door neighbor is from [insert any Hispanic country]. Will I catch this from him/her?
Anyone can catch the Swine Flu.
I heard that Florida has grounded airplanes?
Not at this time. If you are scheduled for a flight, please contact your air carrier or your local airport.
I’m allergic to hand gels. What should I do?
Use soap and water.
CONTAGIOUS/CONTAMINATION
Is this swine flu virus contagious?
Swine flu is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.
How can I keep from infecting others if I am sick?
If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Do not attend social gatherings such sporting events and religious ceremonies. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Don’t cough or sneeze into your hand. Instead, cough or sneeze into your sleeve or elbow. It may prevent those around you from getting sick.
What are the signs and symptoms of swine flu in people?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.
What is H1N1 Swine Flu?
H1N1 Swine Flu, initially referred to as “swine flu” is a new influenza virus causing illness in people. This new virus was first detected in people in April 2009 in the United States. Other countries, including Mexico and Canada, have reported people sick with this new virus as well. This virus is suspected to spread from person-to-person, in the same way regular seasonal influenza viruses spread.
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 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 avian genes and human genes. Scientists call this a “quadruple reassortant” virus.
How does swine flu spread?
Spread of this swine flu A (H1N1) virus 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 flu. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.
What is the incubation period?
According to information from the Centers for Disease Control and Prevention (CDC), the estimated incubation period for H1N1 Swine Flu is currently unknown, but could range anywhere from one to seven days, and more likely lasts one to four days.
According to the CDC, adult bodies shed, or reproduce, human influenza virus beginning the day before symptoms begin and continuing 5-10 day after illness onset. This shedding period can last even longer in young children and those with weakened immune systems.
Uncomplicated human influenza illness typically resolves after three to seven days, although cough and malaise can persist for more than two weeks. Human influenza virus infections can cause primary influenza viral pneumonia; worsen underlying medical conditions, such as pulmonary or cardiac disease; lead to secondary bacterial pneumonia or sinusitis; or cause co-infections with other viral or bacterial pathogens.
Can I get swine flu from eating or preparing pork?
No. Swine flu viruses are not spread by food. You cannot get swine flu from eating pork or pork products. It is safe to eat properly handled and cooked pork products. Cooking pork to an internal temperature of 160°F kills bacteria and viruses.
Can H1N1 Swine Flu re-infection occur?
The human body produces antibodies that offer a level of protection from being re-infected from viruses; however, studies are ongoing about how this particular virus is transmitted and the likelihood of being re-infected.
Some tips to prevent infection include,
• Those who experience illness should take time to fully recover.
• Frequent hand washing cuts down exposure and re-exposure to contagious diseases.
• Use of germicide gels that kill germs on contact is suggested.
• Using Lysol or other spray disinfectants keeps surfaces clean.
• Stay home from work or school if illness is suspected to cut down on exposure.
How long can an infected person spread swine flu to others?
People with swine flu should be considered potentially contagious as long as they are symptomatic and possible for up to seven days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.
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 and then touches their own eyes, mouth or nose before washing their hands.
How long can viruses live outside the body?
We know that some viruses and bacteria can live two hours or longer on surfaces like tables, doorknobs, and desks. Frequent hand washing will help you reduce the chance of getting contamination from these common surfaces.
What other examples of swine flu outbreaks are there?
Probably the most well 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 four soldiers and one death; all 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 flu A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).
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 flu: amantadine, rimantadine, oseltamivir and zanamivir. While most swine flu viruses have been susceptible to all four drugs, the most recent swine flu 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 flu viruses.
Is the H1N1 swine flu virus the same as human H1N1 viruses?
No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.
How can human infections with swine flu be diagnosed?
To diagnose swine flu, a respiratory specimen would generally need to be collected within the first four to five days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may spread virus for 10 days or longer. Identification at this time swine flu requires sending the specimen to CDC for laboratory testing.
What should be done if health care providers run-out of viral test kits?
If viral test kits are unavailable, physicians should begin treatment to patients who present all the symptoms. The use of bacterial testing kits is not recommended. The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. There are four different antiviral drugs that are licensed for use in the US for the treatment of flu: amantadine, rimantadine, oseltamivir and zanamivir. While most swine flu viruses have been susceptible to all four drugs, the most recent swine flu 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 flu viruses.
My doctor says I have swine flu, but he won’t test me.
Your doctor is the expert on diagnosing illnesses and determining what tests should be ordered for you. The Department of Health cannot and should not tell a doctor how to practice. As a matter of fact, unnecessary tests can cause backlogs and delays in the state laboratory system. You and your doctor are partners in your care. Ask questions, follow your doctor’s instructions, and be sure you keep your doctor informed of any changes in your condition.
What information is being distributed to professionals, i.e. message therapists?
The Florida Department of Health offers the following general tips for Florida’s business:
• Sick people should stay home unless they need to seek medical care.
• Keep commonly touched surfaces such as stairway railings, elevator buttons and door handles clean by wiping them down with detergent-based cleaners or EPA registered disinfectants. These products should be used according to directions on the product label. Additional, extensive cleaning by wiping down floors and walls prior to reopening is not necessary as it is unknown whether this would be helpful in decrease the spread of influenza.
• Encourage hand washing and covering your cough or sneezes. Do not cough or sneeze into your hand but in a tissue or your sleeve. Keep soap dispensers stocked and consider having hand sanitizers available in break rooms and near office equipment.
• If your business is equipped to have employees work effectively from home, consider encouraging employees to do so.
Swine Flu Prevention
PREVENTION AND PROTECTION
What should I do to keep from getting the flu?
First and most important: avoid sick people and participating in social gatherings. Wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick. If you do get sick, stay home. If you have been in close contact with someone who has had the flu, stay home or return home if you begin to feel ill.
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. It is recommended 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 can I do to protect myself from getting sick?
There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like flu. Take these everyday steps to protect your health:
• Avoid close contact with sick people.
• 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.
• If you get sick with flu, DOH recommends that you stay home from work or school and limit contact with others to keep from infecting them.
What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick, stay home and limit your contact with other people as much as possible. Do not go to work or school if ill. Avoid social gatherings such as graduations, sporting events, or religious ceremonies. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. 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.
How long can H1N1 Swine Flu survive in a dead body?
Studies are ongoing about how this particular virus is transmitted and how long the virus can survive in a deceased body. The transmission of infectious agents from the deceased to a living person may still be possible.
Those in close contact with the deceased, such as public safety workers – emergency medical personnel, firefighters and police officers, funeral workers, volunteers and healthcare professionals should exercise caution when handling the deceased to prevent the possible spread of infection.
Simple precautions such as good hygiene practice, hand-washing and the use and proper disposal of gloves can reduce the risk of exposure to diseases from dead bodies.
To avoid cross-contamination, personal items should not be handled while wearing soiled gloves and a new pair is recommended after each body or group of bodies is handled. Other personal protective equipment, such as eyewear, gowns and masks may be necessary. Hands should be washed thoroughly after handling cadavers and before eating. All equipment, including clothes, stretchers and vehicles used for transportation should be washed carefully with a disinfectant. Use of body bags and proper training in handling the deceased also help prevent the spread of disease.
SCHOOL INFORMATION
Will they close my child’s school?
You need to call your local school district or the school’s principal. The decision to close schools will be made by your local school district, and will depend on the situation in your local area. Florida Department of Health only provides recommendations and guidance to schools on whether they should close or take certain steps to ensure the safety and welfare of the students and staff, which are based on guidance from the Centers for Disease Control and Prevention. Local school boards and other local officials make decisions whether to close or open schools.
Who makes the decision about whether schools should close?
Local school districts will make the decision of whether to close schools. They will consult with state and local emergency management officials to make that decision.
The Florida Department of Health only provides recommendations and guidance to school districts on whether they should close or take certain steps to ensure the safety and welfare of the students and staff. These recommendations are based on guidance from the Centers for Disease Control and Prevention which can be found at (April 28, 2009, http://www.cdc.gov/h1n1flu/mitigation.htm).
Will students have to make up any missed school days?
It is too early to make a decision about missed days. The Commissioner of Education has some flexibility in granting a waiver and will be working closely with school districts to determine the best course of action. Parents should check with their child’s school or school district to see whether missed days must be made up.
What will be done to make my child’s school safe?
School districts will determine what measures to take to ensure a safe school environment. They will consult with state and local emergency management officials to make that decision.
What about private schools?
Parents of children in private schools should check with their school for information on school closures. Private schools do not fall under the jurisdiction of the Department of Education.
Will colleges and universities hold graduation ceremonies?
Contact the college or university for this information. The institution will make the decision about holding the graduation ceremony.
Should I attend social gatherings?
If you are sick, you should limit your contact with other people as much as possible and avoid attending or participating in graduation ceremonies.
In all situations, both children and adults should follow basic health and hygiene practices. These practices include regular hand washing, covering your nose and mouth with a tissue when you cough or sneeze and throwing the tissue into the trash, and avoiding touching your eyes, nose and mouth.
MISCELLANEOUS
Swine Flu in Pets
Can my pet get swine flu?
There are no known dog/cat to human (or vice-versa) influenza transmissions.
Swine Flu in Pigs
How does swine flu spread among pigs?
Swine flu viruses are thought to 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 typically found among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall 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 specifically, 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 flu.
While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 flu viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.
If you receive other questions, please write them down here and an SME will assist you. This information will also help us update this document after each shift.
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What to Do If You Get a Call from a Health Care Provider
If you get a call from a health care provider (doctor, nurse, someone else at a clinic, hospital etc..), raise your hand and ask for the assistance of one of the Subject Matter Experts who will be available at each shift.
Specimen Collection:
• Collect throat or nasopharyngeal swab specimens from those patients with flu-like illness (ILI). Definition of ILI: Fever >37.8°C (100°F) and a cough and/or sore throat
• Please collect up to 2 swabs from each patient with ILI
• Preferred specimen is an oropharyngeal swab or nasopharyngeal swab; most other routine respiratory specimens are also acceptable.
o nasopharyngeal swabs (NOT nose swabs) (must have an adequate volume of sample or the test will not be valid)
o nasopharyngeal aspirates
o bronchial wash
o sputum (NOT saliva)
• Specimen should be collected within 3 days of onset of illness and no later than 5 days after onset of symptoms.
• If the patient is hospitalized with pneumonia, specimens from the lower respiratory tract (e.g., tracheal aspirate, bronchoalveolar lavage) should also be obtained.
• When flu is detected in a clinical laboratory by RAPID TESTING methods, please send an aliquot (1-2 ml) of the original suspension (not exposed to test kit reagents) in viral transport media or sterile diluent; or if an additional original specimen is available, that is preferable.
• If flu is detected in a clinical laboratory by VIRAL CULTURE, please send the actively growing viral culture tube with 2 ml of viral maintenance media
Specimen shipping:
• Ship to Bureau of Laboratories -Tampa or -Jacksonville (whichever is your servicing Laboratory)
• Keep specimens refrigerated at 4ºC and sent on cold packs
• Ship on gel ice no later that 48 hours post collection. They must be refrigerated at all times after collection.
Participation in Centers for Disease Control and other national conference calls will continue.