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Novel influenza A (H1N1) is a new flu virus that was first detected in April 2009. The virus has sparked a growing and expanding outbreak of illness throughout the United States and worldwide.  On June 11, 2009, the World Health Organization (WHO) signaled that a global pandemic of novel influenza A (H1N1) was underway by raising the worldwide pandemic alert level to Phase 6. This action was a reflection of the spread of the new H1N1 virus, not the severity of illness caused by the virus.

Since the WHO declaration of a pandemic, the virus has continued to spread, with the number of cases of novel H1N1 continuing to increase worldwide with approximately 400,000 confirmed cases and over 4,700 deaths reported to WHO.  (However, as many countries have stopped counting individual cases, including the U.S., particularly of milder illness; therefore, the case count is significantly lower than the actually number of cases.) The United States continues to report the largest number of novel H1N1 cases of any country worldwide with forty-one (41) states reporting widespread influenza activity (as of the week ending on October 10). Any reports of widespread influenza activity in the U.S. in September are very unusual.

Both the H1N1 Flu virus and the regular seasonal influenza viruses are circulating this fall and winter. Based on global experience to date, the H1N1 Flu viruses likely will be the most common influenza viruses among those circulating in the 2009 – 2010 flu season.  However, circulation of seasonal influenza viruses during the 2009 - 2010 flu season is also expected.  Therefore, with this combination, this year's annual flu season poses the potential to cause significant illness with increased flu-related employee absenteeism, as well as increased numbers of hospitalizations and deaths from both the seasonal flu as well as the H1N1 Flu.

Because of the ongoing nature of this event, and the evolving knowledge about the H1N1 Flu, public health guidance is continually updated as this pandemic progresses.  The best source of information and guidance on the H1N1 Flu, and the best way to keep up-to-date on current guidance, can be found on the DOI H1N1 Flu website. For the current status, go to the Centers for Disease Control and Prevention’s H1N1 Flu Situation Update webpage.

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The H1N1 Flu virus is spread the same way that seasonal flu spreads. Flu viruses are mainly spread from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby.  Influenza viruses are also spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose before washing their hands.
* For related topics, see Questions 8 - 11.

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Currently, the H1N1 Flu appears to be similar to the seasonal flu in severity.  The seasonal flu usually causes mild to severe illness, and at times can lead to death. Each year in the United States, approximately 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Over 90% of deaths and about 60% of hospitalization occur in people older than 65.

One thing that appears to be different with the H1N1 Flu from seasonal influenza is that adults older than 64 years do not appear to be at increased risk of becoming infected with H1N1 Flu. The CDC has found in laboratory studies that no children and very few adults younger than 60 have existing antibodies to the H1N1 Flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much protection/immunity may be afforded against novel H1N1 Flu by these existing antibodies.

It is important to note that with both the seasonal flu and H1N1 Flu certain people are at high risk of serious complications. About 70% of people who have been hospitalized with this novel H1N1 virus have had one or more medical conditions previously recognized as placing people at high risk of serious seasonal flu-related complications.
* For a related topic, see Question 7.

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Given ongoing H1N1 Flu activity to date, the CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this pandemic in the United States this fall and winter. The novel H1N1 virus, in conjunction with regular seasonal influenza viruses, poses the potential to cause significant illness with associated hospitalizations and deaths during the U.S. influenza season.

Whether it will cause more illness than it has been causing to date, whether it will dominate among the seasonal flu viruses or whether it will really disappear is not predictable right now.  However, the H1N1 Flu was the dominant flu strain in the Southern Hemisphere during its annual flu season (which occurred during our summer months).

We are mindful of the past that pandemics of influenza have sometimes come in waves and the very severe 1918 pandemic had a moderate or mild herald wave in the spring and a much more severe second wave in the fall. We are now focusing on being prepared for the possibility that it will become more serious.

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The symptoms of the H1N1 Flu are similar to that of the seasonal flu, and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Severe illnesses and death has occurred as a result of illness associated with this virus.
* For related topics, see Questions 7, 13, 14 & 15.

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Because the symptoms between the two are so similar, it will be very hard to tell if someone who is sick has the H1N1 Flu or seasonal flu. Anyone who has the symptoms of flu-like illness should stay home and not go to work.
* For related topics, see Questions 13 & 14.

With the current situation of H1N1 Flu in the United States, a suspected case of influenza-like illness will not be tested for H1N1 Flu. More than 99% of circulating influenza viruses identified around the U.S. is the 2009 H1N1 Flu. Therefore, the CDC is recommending that healthcare providers diagnose patients with the flu based on symptoms and their clinical judgment without doing further laboratory testing to determine it is the H1N1 Flu. In most cases, if a healthcare provider suspects the flu, laboratory test results will not change their treatment decisions. However, CDC recommends laboratory testing for those who become seriously ill (hospitalized patients) and for those patients are at high risk for complications (such as persons with chronic conditions) because the test results will likely impact treatment decisions.

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Some population groups are at higher risk for complications from both the seasonal flu and the H1N1 Flu. These include children younger than 5 years of age, pregnant women, people with compromised immune systems and chronic health conditions (such as asthma, diabetes, cancer or heart disease), and people 65 and older.
* For related topics, see Questions 3, 17, 19, 20, 21 & 26.

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Students can get sick with flu and schools may act as a point of spread, where students can easily spread flu to other students and their families. The largest number of cases of H1N1 Flu has been in the age range of 5 – 24. The workplace also serves as a point of spread where coworkers infect each other with the flu, and then these employees bring the germs home to their families.
* For related topics, see Questions 9 - 11.

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The new guidance applies to any flu virus circulating during the 2009 - 2010 school year, not only the H1N1 Flu. The new guidance recognizes the need to balance the risks of illness among students and staff with the benefits of keeping students in school. It offers specific steps for school staff, parents and students to take given the current flu conditions as well as for more severe flu conditions. The new guidance also provides information for making decisions at the community level about when to use these strategies aimed at schools.

In addition, this guidance recommends that, based on current flu conditions, students and staff with flu-like illness stay home until at least 24 hours after they no longer have a fever or signs of a fever. This is a shorter time period from the previous guidance.

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There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

• Take these everyday steps to protect your health:
  • Maintain good health habits.
  • Eat a well-balanced diet and drink 6 – 8 glasses of water daily.
  • Exercise regularly.
  • 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.
  • Try to avoid close contact with sick people.
• Other important actions that you can take are:
  • Get both the H1N1 Flu and seasonal flu vaccines. * For related topics, see Questions 16 - 24.
  • Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
  • Make sure your family members all practice the healthy habits and infection control measures described in the bullet above.
  • Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs, tissues and other related items might could be useful.
    * For a related topic, see Question 13.  

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• Educate your employees about H1N1 Flu, and steps they can take to help prevent themselves from getting ill and spreading the infection around the workplace. * For related topics, see Questions 8, 10, 13, 14.
  • The DOI H1N1 Flu website is the Department’s one-stop shop for information and materials that you can provide your employees.
• Encourage respiratory/cough etiquette and proper handwashing.
• Provide hand-sanitizer, tissues and disposable wipes around the facility/office.
• Routinely clean surfaces and items (such as hand rails, elevator buttons, phones, computers, conference tables, chairs, and desks) that are more likely to have frequent hand contact. Additional disinfection beyond routine cleaning is not recommended.
• Provide disposable wipes so commonly used surfaces can be wiped prior to each use.
• Post infection control awareness signs/notices/posters around your office/facility.
• Encourage all employees to get vaccinated for both the seasonal flu and H1N1 Flu.
  * For related topics, see Questions 16 - 24.
• Separate employees who become sick at work from other staff and ask them to go home.
  * For related topics, see Questions 8, 13, 14 & 15.
• Advise all employees with flu-like symptoms to stay home if they are sick until at least 24 hours after they no longer have a fever or signs of a fever.
  * For related topics, see Questions 5, 6, 8, 13, 14 & 15.
• Encourage sick employees at higher risk of complications from flu to contact their health care provider as soon as possible.
  * For a related topic, see Question 7.

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Employees who are well but who have an ill family member at home with the H1N1 Flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze.  If they become ill, they should notify their supervisor and stay home.
* For a related topic, see Question 11.

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If you become ill with influenza-like symptoms (including fever, body aches, runny or stuffy nose, sore throat, nausea, vomiting and diarrhea), you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. Stay away from others as much as possible to keep from making others sick.

If you have severe illness or you are at high risk for complications from influenza, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.  
* For related topics, see Questions 6, 7 & 26.

In addition, contact your supervisor and inform him/her that you have a suspected/confirmed case of H1N1 Flu.
* For a related topic, see Question 15.

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First, separate the employee from the rest of the staff, and encourage the employee to go home and consult with their primary care provider.  In addition, refer to the Office of Personnel Management (OPM) “What a Supervisor Should Do if an Employee Appears Ill During a Declared Pandemic Influenza or Has Been Exposed to Pandemic Influenza”.

If the employee can not leave the workplace immediately, have the symptomatic individual wear a surgical mask (or a filtering facepiece respirator) to reduce the spread of infection.

If questions about types of leave that can be used in this situation, or other human resources questions arise, contact your human resources officer for advice.

Report the employee as a suspected case of H1N1 Flu in the DOI Safety Management Information System (SMIS).
* For a related topic, see Question 15.

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The Office of Occupational Health and Safety has created a H1N1 Flu reporting system on the Department’s Safety Management Information System (SMIS)to track and record DOI employees with suspected and confirmed cases of H1N1 Flu. This special SMIS H1N1 Flu reporting feature is embedded in the accident reporting portion of SMIS and is highlighted in red at the bottom of the screen.

Bureaus and offices are requested to implement this H1N1 Flu case reporting on SMIS though their supervisors and managers.  In entering and updating case information, supervisors and managers are reporting the status of the H1N1 Flu case as being suspected, confirmed or not H1N1, as well as reporting when the employee returned to work. * For a related topic, see Question 6.

This information provides a picture of the impact of H1N1 Flu on the Department as a whole, as well as by bureau/office and by geographic location. Pandemics travel in waves, and not every community/region will be impacted the same time. Therefore, having SMIS H1N1 Flu data will help us better target response measures and communications more effectively to those areas that are being the most impacted.

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The H1N1 Flu vaccine is different from the seasonal flu vaccine. Therefore, this year, the CDC is encouraging everyone to get both the seasonal flu and 2009 H1N1 Flu vaccines to be fully protected.  The seasonal flu vaccine is available now, and available to everyone.
* For related topics, see Questions 1, 17, 18, 21 & 22.

A.

Seasonal flu vaccines are highly effective in preventing the flu, and the 2009 H1N1 Flu vaccine works in a similar fashion to the seasonal flu vaccines.  Therefore, the benefits of vaccination with the 2009 H1N1 influenza vaccine will far outweigh the risks.  In general, anyone who wants to reduce their chances of getting the flu should get vaccinated. People who are at high risk of having serious flu-related complications or people who live with or care for those at high risk for serious flu-related complications are highly encouraged to get their flu vaccine. Getting vaccinated is the single best way to protect yourself against influenza illness.
* For related topics, see Questions 1, 20 & 21.

The 2009 H1N1 Flu vaccine has a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given. The CDC and the Food and Drug Administration (FDA) will be closely monitoring for any signs that the vaccine is causing unexpected adverse events and we will work with State and local health officials to investigate any unusual events.

The CDC and the FDA encourage you to ask your healthcare provider any questions you may have about the 2009 H1N1 influenza vaccine and the seasonal influenza vaccines that will be available during the 2009-2010 influenza season. Your healthcare provider is an excellent source for information on the benefits and risks of vaccination for protection against 2009 H1N1 influenza for you, your children, and other family members.
* For related topics, see Questions 1, 3, 16, 19 & 20.

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The 2009 H1N1 vaccine will be available through the same channels as the seasonal flu vaccine.  Employees are encouraged to get vaccinated for H1N1 by their healthcare provider or local healthcare system that they normally use to get their seasonal flu vaccine.  Additional options may be available through your workplace.

• Metro DC Area - Those DOI employees who work in the DC Metro area will be able to get both their seasonal and 2009 H1N1 vaccine through the DOI Health Unit in the Main Interior Building.  Once the H1N1 Flu vaccine is available, additional information will be sent out to DC Area employees providing details on dates/times they can get the 2009 H1N1 vaccine in accordance with the prioritization scheme.
  * For a related topic, see Question 19.
• Outside of the Metro DC Area – If your workplace normally provides the seasonal flu vaccine, you will be able to get your 2009 H1N1 vaccine there also.  (If you are unsure, check with your office’s management.)  Federal employees in health care and emergency services occupational categories can also obtain the 2009 H1N1 vaccine through the Department of Veterans Affairs (VA) and their healthcare facilities around the nation.

A.

The 2009 H1N1 vaccine will be available in limited quantities for the first 2 or 3 weeks. As a result, specific target groups and high-risk sub-groups (outlined below) will receive the first available doses.

The prioritization scheme of the 2009 H1N1 vaccine is based on health risk and -- except for health care workers, emergency medical personnel, and daycare providers – does not target specific occupational groups, nor will they provide preferential treatment for Federal workers. After the initial weeks, the 2009 H1N1 vaccine will available to all.

The CDC, in coordination with the Advisory Committee on Immunization Practices, recommends the H1N1 vaccine to the following groups first because they are at highest risk for disease or complications from this flu:

• Pregnant women
• Persons who live with or provide care for infants less than 6 months old
• Health care and emergency medical services personnel. (Initially, this will be limited to those with direct patient contact.)
• Persons aged 6 months - 24 years, and persons aged 25 - 64 years who have medical conditions that put them at higher risk for influenza-related complications.  (Initially, this will be limited to persons 6 months - 4 years, and persons aged 5-18 years with medical conditions that put then a higher risk for influenza-related complications.

* For related topics, see Questions 7 & 20 .

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For most pregnant women, as with most of the population, the H1N1 Flu is a mild illness.  However, pregnant women with H1N1 Flu are more likely to experience serious illness, hospitalization and death from the flu. Therefore, a pregnant woman who thinks she might have the flu needs to call her doctor right away. 
* For related topics, see Questions 3 & 7.

In addition, for this reason, it is extra important for a pregnant woman to receive both the H1N1 Flu and the seasonal flu vaccine (any time during pregnancy).  When a pregnant woman gets the flu vaccine, not only does she protect herself, studies/research has shown that it can also protect both her baby.

The seasonal flu vaccine has been given to millions of pregnant women over many years. Flu vaccines have not been shown to cause harm to pregnant women or their babies. The 2009 H1N1 Flu vaccine is being made in the same way and at the same places where the seasonal flu vaccine is made.

A.

There are two kinds of 2009 H1N1 vaccines being produced:

• 2009 H1N1 Flu shot — an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm.
• Everyone who can get the seasonal flu shot can get the 2009 H1N1 Flu shot.
• 2009 H1N1 Flu nasal spray vaccine — a vaccine made with live, weakened viruses (sometimes called LAIV for "live attenuated influenza vaccine").
• Those who can get the seasonal nasal spray can also get the 2009 H1N1 Flu nasal spray vaccine; however, the following groups should not get the nasal spray vaccine:
• People younger than 2 years of age
• Pregnant women
• People 50 years of age and older
• People with a medical condition that places them at higher risk for complications from influenza, including those with chronic heart or lung disease, such as asthma or reactive airways disease; people with medical conditions such as diabetes or kidney failure; or people with illnesses that weaken the immune system, or who take medications that can weaken the immune system
• Children younger than 5 years old with a history of recurrent wheezing
• Children or adolescents receiving aspirin therapy

* For a related topic, see Question 22.

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Both the seasonal and 2009 H1N1 Flu shot can be given on the same day, but should be given at different sites (e.g. one shot in the left arm and the other shot in the right arm). 

In addition,

• the 2009 H1N1 Flu nasal spray vaccine can be given at the same time as the seasonal flu shot OR
• the seasonal flu shot can be given at the same time as the 2009 H1N1 Flu nasal spray vaccine.

However, the seasonal nasal spray vaccine and the 2009 H1N1 Flu nasal spray vaccine should NOT be given at the same time. This is because the nasal spray vaccines might not be as effective if given together.

* For a related topic, see Question 21

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The side effects from the 2009 H1N1 Flu vaccine are similar to those from the seasonal flu vaccine.  Some people might have headache, muscle aches, fever, nausea or feel tired.  If these problems happen, they usually begin soon after getting the vaccine, and may last as long as 1 - 2 days.  For those who get the flu vaccine in the form of a shot, the most common side effects are mild, such as being sore and tender, red and swollen where the shot was given.

Sometimes, the flu vaccine, like any vaccine, can cause serious problems and severe allergic reactions.  However, these severe reactions to vaccines are very rare. Anyone with severe allergies to eggs, or to any other component/ingredient in the flu vaccine, should not get this vaccine.

In 1976, a different type of swine flu vaccine was associated with cases of a severe paralytic illness called Guillain-Barre Syndrome (GBS).  This occurred at a rate of approximately 1 case of GBS per 100,000 persons vaccinated with this earlier version of the swine flu vaccine. Some studies done since 1976 have shown a small risk of GBS in persons who received the seasonal influenza vaccine. This risk is estimated to be no more than 1 case of GBS per 1 million persons vaccinated. Pregnant women should tell the person giving the flu vaccines if they have ever had GBS.

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Unlike the flu shot, the nasal spray flu vaccine does contain live viruses. However, the viruses are attenuated (weakened) and cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures than found within the human body. The viruses cannot infect the lungs or other areas where warmer temperatures exist.
Some children and young adults 2 - 17 years of age have reported experiencing mild reactions after receiving seasonal nasal spray flu vaccine, including runny nose, nasal congestion or cough, chills, tiredness/weakness, sore throat and headache. Some adults 18 - 49 years of age have reported runny nose or nasal congestion, cough, chills, tiredness/weakness, sore throat and headache. These side effects are mild and short-lasting, especially when compared to symptoms of influenza infection.

Available data indicates that both children and adults vaccinated with the nasal spray can shed flu viruses for less than or equal to 2 days after being vaccinated.  However, virus shedding should not be equated with person-to-person transmission of the flu from the vaccine.  The risk of getting infected with vaccine virus after close contact with a person vaccinated with the nasal-spray flu vaccine is very low.

A.

While the CDC recommends both the H1N1 Flu and seasonal flu vaccines as the first and most important step in preventing flu this 2009 – 2010 flu season, antiviral drugs are a second line of defense against the flu. Antiviral drugs are not sold over-the-counter and are different from antibiotics. You can only get them if you have a prescription from your doctor or health care provider.
* For a related topic, see Question 16.

There are two antiviral drugs recommended by the CDC for H1N1 Flu and the 2009 – 2010 flu season: oseltamivir (Tamiflu) and zanamivir (Relenza). Tamiflu is available as a pill or liquid and Relenza is a powder that is inhaled.

A.

Most healthy persons who become sick with the flu, or persons who are recovering from influenza, do not need antiviral medications for treatment or prophylaxis. However, as CDC’s guidance states, persons with more severe cases of influenza and flu-related complications should receive antiviral therapy, regardless of previous health or age. In addition, all persons with suspected or confirmed influenza requiring hospitalization or are at high risk for complications/severe cases of the flu also should receive antivirals.
* For related topics, see Questions 3 & 7.

At this time, there have been no reports to show that pregnant women taking antivirals cause harm to the pregnant woman or her unborn baby.  Since pregnant women with H1N1 Flu are more likely to experience serious illness, hospitalization and death from the flu, taking antiviral medicine can help prevent these severe outcomes.

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When used for treatment, antivirals can shorten the time you are sick and also prevent serious flu complications. Antivirals have been shown to reduce the duration of symptoms by 1 - 1 ½ days when the treatment is started within the first 48 hours becoming ill.