Q&A: Advice about swine flu fro BBC

Swine flu has spread across the world since emerging in Mexico and is now officially the first flu pandemic for 40 years. Experts fear millions of people will be infected.

What is swine flu and what are the symptoms?

Symptoms:
1. High temperature, tiredness and lowered immunity
2. Headache, runny nose and sneezing
3. Sore throat
4. Shortness of breath
5. Loss of appetite, vomiting and diarrhoea
6. Aching muscles, limb and joint pain


Swine flu is a respiratory disease, caused by a strain of the influenza type A virus known as H1N1.

H1N1 is the same strain which causes seasonal outbreaks of flu in humans on a regular basis.

But this latest version of H1N1 is different: it contains genetic material that is typically found in strains of the virus that affect humans, birds and swine.

Although the strain may have originated in pigs, it is now a wholly human disease.

It can be spread from person to person by coughing and sneezing.

Symptoms of swine flu in humans appear to be similar to those produced by standard, seasonal flu.

A fever - which is a temperature of 38ºC (100.4ºF) - is the key symptom, combined with other complaints which may include a cough, sore throat, body aches, chills and aching limbs. Some people with the virus have also reported nausea and diarrhoea.

As with normal flu, the severity of symptoms will depend on treatment and the individual. Many people have only suffered mildly and have begun to recover within a week.

People are most infectious soon after they develop symptoms, but they cease to be a risk once those symptoms have disappeared. The incubation period may be as little as two days.

Apparently healthy people are dying from the virus. Does that means it is getting worse?

Experts say this does not change anything, and that if anything it is surprising that it has taken this long in the UK for someone without underlying health problems to die.
Apparently healthy people can die of any flu-related virus if it causes complications such as pneumonia so these latest deaths do not give any extra cause for concern.

Indeed, so far, many people who have developed symptoms of infection have not needed drugs to make a full recovery, according to the WHO.

Flu expert Professor Peter Openshaw, of Imperial College London, says about one in every three people who become infected will not realise they have had swine flu because they will have had no or only very few symptoms.

"About 98% of people who get infected will recover fully without any hospital treatment so I think the public needs to be reassured."

The real fear is that the strain will mutate and become more virulent which would pose a greater threat. This has been the feature of previous flu pandemics.

But this has not yet happened - and in any event it is worth remembering that seasonal flu often poses a serious threat to public health - each year it kills 250,000 - 500,000 around the world.

What should I do if I think I have it?

Anyone with flu-like symptoms who suspects they might have the swine flu virus are being advised to stay at home and use the "swine flu symptom checker" on the NHS Direct website, or phone NHS Direct - NHS 24 in Scotland.

If swine flu is suspected, your GP should be contacted - and he or she will issue a voucher for anti-flu drugs.

The infected person would then be expected to arrange for a friend or family member to pick up the anti-viral treatment for them from a collection point, most probably a pharmacy.

In the initial phase of the outbreak, lab testing was done to diagnose the flu but this is no longer happening routinely.

How is it treated?

Two drugs commonly used to treat flu, Tamiflu and Relenza, are effective at treating infection.

However, the drugs must be administered at an early stage to be effective.

Use of these drugs may also make it less likely that infected people will pass the virus on to others.

The UK government already has a stockpile of Tamiflu, ordered as a precaution against a pandemic.

However, there is concern that if too many people start taking anti-virals as a precaution, it could raise the risk of the virus developing resistance, reducing the drugs' effectiveness. There is however no evidence at present that this is happening.

In any event there is little point taking these drugs as a precaution as each tablet only provides a day's worth of cover. Given that the virus may be with us for many months - or indeed years - taking a regular pill is ill-advised as the long-term side effects are not known.

What measures then can I take to prevent infection?

As yet there is no vaccine, but manufacturers are trying to develop one. Good progress is being made and the first doses may be available in the UK by August. However the NHS says it may be next year before everyone can be immunised.

Older people and those under 16 - as well as health workers and those with existing clinical conditions - will be given priority.

It is hoped that even if the virus mutates in coming months, the vaccine would still confer a high degree of protection against related strains.

In the meantime, avoid close contact with people who appear unwell and who have fever and cough.

General infection control practices and good hygiene can help to reduce transmission of all viruses, including the human swine influenza.

This includes covering your nose and mouth when coughing or sneezing, using a tissue when possible and disposing of it promptly.

It is also important to wash your hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people, and cleaning hard surfaces like door handles frequently using a normal cleaning product.

In Mexico masks have been handed out to the general public, but experts are sceptical about how useful this is.

Some suggest it may even be counterproductive.

What is the advice for pregnant women?

The Department of Health has clarified its advice on how expectant mothers should protect themselves following a series of apparently mixed messages.

Concerns were heightened after a woman with swine flu died last week shortly after giving birth prematurely.

Pregnant women are among the groups at increased risk from swine flu. It is important that they follow the advice about hand hygiene.

They may also want to avoid very crowded places and unnecessary travel, but experts stressed people should use their own judgement and should carry on with their daily lives.

Where can I get further advice?

Further information and advice on swine flu can be found at websites of leading health and research organisations around the world. The World Health Organisation gives background information on the virus.

The UK's government services website is carrying regularly updated health and travel information. The Health Protection Agency advises the public about what to do if returning from an affected area. NHS Choices outlines how swine flu is different from other flu.

The European Centre for Disease Prevention and Control is another good source of information.

The US government's Centers for Disease Control and Prevention is counting the number of cases in the US.

You can also track spread of swine flu reports using unofficial sources. Google is mapping search term data as an indicator of flu activity both across the US down to state level and in Mexico. Healthmaps maps viruses using news reports. Social media guide Mashable lists a range of ways to track the virus .

Information and links to useful websites are being shared on Twitter, the micro-blogging service, while social networking website Facebook is tracking swine flu discussion amongst users.

For more information read this article

Pregnant women and young children most at risk as swine flu cases hit 100,000

Under-fives and pregnant women are emerging as key swine flu risk groups, according to hospital figures and the age profiles of those who have already died.

The Health Protection Agency (HPA) altered its advice this week to include the youngest age range – the under-fives – in the category of those "predominantly affected" while the Royal College of Midwives gave fresh advice todayon giving expectant women anti-viral drugs.

The shift in emphasis by health officials is a reminder that even if the final death rates from the pandemic are the same as normal seasonal flu, the social impact will be significantly different, with the disease apparently targeting the young more than elderly people. In normal seasonal flu it is the elderly who usually succumb through developing pneumonia.

Altogether, 29 people have died from swine flu in the UK. A patient from Swindon and a female tourist who died in Scotland after being admitted to hospital three weeks ago are among recent deaths. Figures from the West Midlands show that at one stage this month 23 of the 79 patients receiving treatment in hospital for swine flu were less than five years old.

On Thursday the chief medical officer, Sir Liam Donaldson, produced statistics showing that under-fives were three times more likely to need inpatient care than those in other age groups.

At least five of those who died are known to have been young children or babies. The NHS in London today confirmed that a baby less than six months old was among the fatalities. Some, like nine-year-old Asmaa Hussain, from Dewsbury, who suffered from epilepsy, had other prior conditions.

The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists issued joint advice on prescribing anti-virals, suggesting that pregnant women with flu symptoms be given a course of Relenza, using an inhaler.

"It is recommended for pregnant women because it easily reaches the throat and lungs, where it is needed, and does not reach significant levels in the blood or placenta," the advice said. "This has the theoretical advantage of not affecting the pregnancy or the growing baby." It added: "A few cases of severe illnesses among pregnant women and infants have been reported in the UK and from other countries. These have mostly affected women with pre-existing health problems. In previous pandemics, and in reports from some countries in this pandemic, there is evidence that pregnancy can increase the risk for influenza complications for the mother and the foetus."

As many as 100,000 people may now have contracted swine flu in the UK, according to estimates by the Health Protection Agency.

Fears that meningitis could be confused with swine flu were raised today after news that Gemma Drury, 17, of Brimington, Chesterfield, was first diagnosed with swine flu but then rushed to hospital with meningitis days later.

The Department for Children, Schools and Families said today that some schools and nurseries might not open as usual at the start of the autumn term.

The Department of Health dismissed fears that the threat of high death rates could endanger the international supply of vaccines. The UK has ordered 132m doses of vaccine, sufficient for all the UK population. The first doses could be ready as early as August.

Italy yesterday advised its citizens to take extra precautions when travelling to Britain. Italy's health ministry said travellers should first visit their doctor to see if they have any conditions that put them at risk, and should avoid crowded places.

Swine flu may keep some schools shut in September

Some schools in England could remain closed in September if the swine flu pandemic escalates over the summer, the government has admitted.

The Department for Children, Schools and Families (DCSF) said that, while it was expected schools and nurseries would open as usual at the start of the academic year, it could not be "certain what the situation will be" in the autumn.

Decisions on closures would be taken shortly before the start of the autumn term, a message to schools across the country from the department said.

The DCSF guidance, issued as many schools broke up for the summer today, said it was monitoring the spread of the H1N1 virus on a day-by-day basis. A message will be sent to schools in the last week of August telling them what to do at the start of term, it added.

The DCSF said: "As the summer term is drawing to an end, it is important to ensure that everyone will be in a position to know what will happen at the start of the autumn term.

"We expect that schools and early-years and childcare settings will reopen as usual but at this time we cannot be certain what the situation will be then; we will need to monitor developments over the summer, and take decisions based on the best advice available shortly before the start of term."

About 1,000 schools have already recorded cases of swine flu, although most have remained open, according to the DCSF.

The message to schools follows a warning from the government's chief medical officer, Sir Liam Donaldson, that up to 65,000 people could die from swine flu in the UK in a worst-case scenario.

A planning document published by the Department of Health yesterday suggested that if the current growth in cases was sustained, the number of cases could peak in early September, with up to 30% of the population suffering illness.

There are also suggestions the spread of the virus could begin to slow over July and August before a resurgence in the autumn when schools reopen.

Margaret Morrissey, of the lobby group Parents Outloud, said ministers should have closed schools across the country early for the summer.

"I do think the government has had a major event of mismanagement here. They should have shut down schools and public places, not for ever, but to stop the virus spreading," she said.

In swine flu hotspots, schools should remain closed until children had been vaccinated, Morrissey suggested. "We might have to, in some schools, keep them closed until the vaccine is in place," she said.

The campaigner also called for the government to hand money to employers so that their staff can stay at home with their children if they are affected by swine flu.

"We helped the banks out, how about helping parents?" she said.

"There could be a decision that schools have got to say to parents, 'If your finances can be supported, do you agree with having the school closed until the children are vaccinated?'"

But she added that if it was possible to open schools in September then that should happen.

At the start of the outbreak, affected schools were closed, but the Health Protection Agency is no longer recommending that approach because swine flu is now widespread within communities.

HPA guidance says: "People are likely to be repeatedly exposed to the virus in their everyday lives. Closing a school will no longer be effective in slowing the spread of the virus as people could still be exposed outside the school.

"In some special circumstances – for example, a school with children who are particularly vulnerable to infection – then school closures might still be recommended."

Parents expressed concern yesterday about the now rapid spread of the virus, and some admitted they were scared and unsure how to respond to the situation.

Gloria Newell, 49, a housing officer, who was picking up her nine-year-old daughter, Natasha, from St Mary's Church of England school in Islington, north London, said: "I am just astonished. The figures are quite shocking. There seems to be nothing really in place to cope with this. We have heard about a national vaccination scheme but we do not know when it might be in place."

In north London, another mother, Amal Khaireddine, 30, was concerned about her sons Joseph, five, Shamus, six, and Ryan, eight, all pupils at Hugh Myddelton school in Islington, where there had been several cases of swine flu. "They had sore throats and temperatures and I did what you should do and called the GP. They said … not to worry. But I think they should have been tested, some swabs should have been taken … all you are told is check the NHS website, but that is not 100% safe."

In nearby Culpepper Gardens, Richard O'Connell, 63, said he had taken his two-year-old grandson, Alfie, to the doctor because of a high temperature and had been told not to worry. "But you do worry because you don't know what to do … it's all very well telling people to look at the NHS website but what of those of us who do not have a computer?"

Anne Alexander, 62, a retired playschool worker from Highbury, north London, believed the publicity was causing "mass panic". Collecting her nine-year-old granddaughter, Niamh Stepto, from school, she said: "The reality is that it may only be as serious as normal seasonal flu."

Paola Domizio, a pathologist and mother of year-old twins Aron and Susha, said : "I'm undecided whether to panic or not. Certainly it is alarming that so many young children may be susceptible. But what can you do? Even if you keep them in all day there are no guarantees. If a vaccine is developed I suppose children will be vaccinated, but until then all you can do is follow the guidelines. So I can't say that I'm particularly panicking, although the figures do sound alarming."

Don't panic – even if you do catch swine flu

In the past few days, swine flu has turned from a topic of relatively light-hearted conversation into a serious anxiety. The figure of 65,000 deaths quoted by Sir Liam Donaldson, the Chief Medical Officer, has worked its way into the popular imagination. The fact that this is an upper limit tends to be overlooked, as does the even more important detail that it assumes an overall fatality rate of just 0.35 per cent of those infected. Fewer than one in 200 people who catch swine flu will die, according to these projections.

Even so, it is hard not to be worried, following a week in which 55,000 new cases emerged. Swine flu has not become more dangerous, but it is spreading faster than the medical authorities anticipated: since the beginning of July, the number of people consulting GPs with flu-like symptoms has increased from 15 to 40 per 100,000 per day. Hence the urgency of the Government's advice to pregnant women (whose immune systems are naturally suppressed) to avoid unnecessary travel on public transport and to parents to keep their babies away from crowds.
It is becoming clear that swine flu, while not yet more dangerous than ordinary flu, can inflict some nasty symptoms on Britain's society and economy. Holiday plans are being ruined as major airlines and tour operators refuse to transport passengers with suspected flu. This is fair enough – but, annoyingly, it is difficult to claim travel insurance for cancelled holidays because it involves doing just what the Government does not want people to do: visiting the GP. Meanwhile, dozens of British schoolchildren and teachers visiting Beijing were placed in quarantine at the weekend because three children were running high temperatures. And Italy's health ministry has advised its citizens to take extra precautions while visiting this country.

Britain is acquiring a reputation as the swine flu capital of Europe – and the figures explain why. After Mexico and the United States, we have the highest incidence of the disease in the world. Why? Perhaps this was only to be expected, given the unsettling degree to which Britain has become an international crossroads. But we also need to ask whether there should have been tighter screening at airports at the start of the Mexican epidemic.

There were claims yesterday that a clash between Whitehall departments delayed the launch of a swine flu hot line. So far, however, the Government's advice has been sensible and struck the right balance. A challenge lies ahead: to prevent infection and – almost equally important – to prevent unnecessary anxiety. Don't panic, even (or especially) if you are unlucky enough to catch swine flu.

Important information about swine flu

Swine flu is the common name that has been given to a new strain of influenza. It is called swine flu because it is thought to have originated in pigs, but this is not known for certain.

The most common symptoms are fever, sore throat, diarrhoea, headache, feeling generally unwell and a dry cough – in other words, symptoms very similar to seasonal influenza. Most people recover within a week, even without special treatment.

Pandemic
The virus was first identified in Mexico in April and has since become a pandemic, which means it has spread around the globe. It has spread quickly because it is a new type of influenza virus that few, if any, people have full resistance to.

Flu pandemics are a natural event that occur from time to time. Last century, there were flu pandemics in 1918, 1957 and 1968, when millions of people died across the world.

So far the new virus is known to have infected 77,000 people in over 100 countries around the world. However, this figure is almost certainly a large underestimate because it reflects only those cases which have been confirmed by laboratory tests.

In the majority of cases the virus has proved relatively mild. However, more than 300 people have died globally and its 'risk profile' is still not fully understood. For this reason, and because all viruses can mutate to become more potent, scientists are advising caution.

The situation in the UK
There have been nearly 10,000 cases confirmed in the UK since the outbreak started here on 27 April. Of these, over 100 have involved hospitalisation, and 15 people have died.

The UK formally moved from a 'containment' to a 'treatment' phase for swine flu on 2 July. This meant that intensive efforts to contain swine flu, via automatic school closures, for example, ended in order to free up capacity to treat the increasing numbers of people who are contracting swine flu daily.

As in other countries, the majority of cases reported so far in the UK have been mild. Only a small number have led to serious illness, and these have frequently been where patients have had underlying health problems.

There has been an argument put forward that government should restrict antivirals to those groups who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, then the NHS should let the virus run its course, treating it with paracetamol and bed rest as you would normal flu.

However, the government's Scientific Advisory Group on Emergencies (SAGE) believes that there is still some doubt about the risk profile of the virus. For instance, there are reports of some cases in Argentina where young, healthy adults have apparently become extremely ill from swine flu.

While there is still this doubt, the government has decided to continue offering the antiviral medicines Tamiflu or Relenza to everyone with swine flu at their doctor’s discretion.

High-risk groups
Some people are more at risk of serious illness if they catch swine flu, and will need to start taking antivirals as soon as they are confirmed with the illness. On occasion, doctors may advise some high-risk patients to take antivirals before they have symptoms if someone close to them has swine flu.

The risk profile of the virus is still being studied but it is already known that the following people are particularly vulnerable:

people with:
- chronic lung disease,
- chronic heart disease,
- chronic kidney disease,
- chronic liver disease,
- chronic neurological disease,
- immunosuppression (whether caused
by disease or treatment), and
- diabetes mellitus,
patients who have had drug treatment for asthma in the past three years,
pregnant women,
people aged 65 years and older, and
children under five years old.
Swine flu vaccine
A vaccine to protect against swine flu is being developed but it is not available yet.

The first batches of vaccine are expected to arrive in late August, and 30 million double doses – enough for half the population – are expected to be available by the end of the year.

The government has ordered enough vaccine for the whole population and, when it becomes available, will focus on those at the greatest risk first.

Catch it, bin it, kill it
Although the UK has moved to a treatment phase for swine flu, it is important that people continue to do everything they can to stop the virus from spreading.

The key is to practise good respiratory and hand hygiene. In other words, remember to Catch it, Bin It, Kill It. Catch your sneeze in a tissue, place it quickly in a bin and wash your hands and surfaces regularly to kill the virus.

UK moves from swine flu 'containment' to 'treatment'

The UK has moved from the 'containment' to the 'treatment' phase of swine flu as the number of people catching swine flu continues to rise.

'Containment' to 'treatment'
As Swine Flu spreads and more people start to catch it in their communities, the government has moved from efforts to contain the virus to treating the increasing number of people who have the disease.

The move from containment to treatment will apply in all four nations of the UK- England, Scotland, Wales and Northern Ireland.

This means that:

GPs will be able to diagnose swine flu on the basis of symptoms rather than waiting for laboratory testing

all tracing of people who have been in contact with a sufferer will stop

people who may have been exposed to the virus will not be given anti-viral drugs

anyone who is diagnosed with swine flu will continue to be offered anti-virals until further notice
Local primary care trusts will also begin to establish anti-viral collection points in their local communities. These could be at a designated pharmacy or a community centre, depending on local need.

Health Secretary Andy Burnham said:"Most cases of swine flu have not been severe and we are in a strong position to deal with this pandemic.

"But we must not become complacent and, while doubt remains about the way the virus attacks different groups, today's decision on the move to the treatment phase reflects our caution."