Swine flu will be covered under all mediclaim policies

Mumbai: Existing comprehensive health insurance policies will also cover hospitalisation expenses of patients affected by swine flu, insurance company officials said.
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Some insurers have already received claims for hospital expenses, though the number is not very large. However, given the fact more people are being hospitalised, insurance companies expect the number of claims to go up in the future.

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"Hospitalisation expenses of swine flu patients will be covered under the existing comprehensive health insurance policies of the insurance companies. There is no upper limit on the expenses. The customers can avail themselves of the amount commensurate to the sum assured," said an Oriental Insurance company official.

The hospitalisation charges will be borne by the insurance company subject to the cap on the room rent charges, a New India Assurance Company official said.

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Few claims so far

Swine flu will be covered under all the health insurance and travel insurance policies offered. A few claims have been received but the number is not large, said Sanjay Datta, Head Health Vertical, ICICI Lombard General Insurance Company.

Insurance companies are also expecting claims in the health segment to go up, but not by much.

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The claims in this segment will go up as the number of instances of hospitalisation increases. However, the outbreak is in the initial stages and the number of people who have taken a health insurance policy is also very low. Also, a very small proportion of people who have been diagnosed with the flu have to be hospitalised, Datta said.

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"At this point in time, the incidences of swine flu have not reached any threshold to have a significant impact on the number of claims logged. However, we have robust IT infrastructure and comprehensive network of providers to counter any exigencies that may arise in the near future," said the spokesperson of Apollo DKV, a standalone health insurance company.

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Most of the general insurance companies are operating through Third Party Administrators to settle claims.

Currently, more people are getting themselves tested for the flu rather than being hospitalised. Since the Government is bearing all the costs for the detection tests, the insurance companies are not burdened with that cost. Also, very few insurers offer policies covering OPD expenses, said a TPA official.

Some of the insurers such as ICICI Lombard and Apollo DKV also offer health insurance policies that cover the OPD expenses.

Six mysteries about swine flu

Government officials, public health experts and business leaders have faced a lot of questions about swine flu this week, and three words keep popping up in their answers: "We don't know."

The flu outbreak has spawned many mysteries - 2014 about origin, scope and impact, just for starters - 2014 and some of the most fundamental questions remain unanswered, or unanswerable.

Here's some of what we don't know.

1. How many people have had the virus?

A lot of numbers have bubbled up-2014 more than 100 lab-confirmed cases in the United States, at least 300 in Mexico, and dozens more in a few other countries. And then there are the suspected cases - 2014 thousands in Mexico alone.

But the real number of infections around the world is impossible to know, since many people may contract swine flu and simply get better without ever seeing a doctor. Even among the lab-confirmed cases of swine flu, many people have had only mild symptoms, similar to a run-of-the-mill case of seasonal flu.

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2. How big will this get?

This is the million-dollar question, and we probably won't know the answer until scientists figure out how easily the virus spreads and how often it kills. Then, they might be able to project more accurately what damage the outbreak might cause.

An influenza outbreak can spread rapidly and unpredictably, requiring only a cough or sneeze to jump from one person to another. The swine flu has taken hold in densely populated areas like Mexico City, home to 20 million people, where it can spread at an alarming rate. And the disease has popped up in many parts of the world, thanks to easy travel between one continent and another.

Even the public health experts most plugged into swine flu don't want to speculate about the ultimate scope of the outbreak.

There have been some clues about the outbreak's future, though: On Thursday, Mexico's top health official said the number of new swine flu cases is stabilizing, at least in that country. Though WHO's flu chief, reacting to similar comments from other Mexican officials, said WHO hadn't seen evidence of leveling off and cautioned that case numbers often go up and down, particularly in the early stages of an outbreak.

3. When and where did it start?

The virus may have mutated into its current form months or even a year ago, and it happened, well, somewhere in the world.

The first symptoms started to show up in early March in the Mexican state of Veracruz, an area with a number of pig farms. The earliest confirmed case was a 5-year-old boy, one of hundreds of people in the town of La Gloria whose flu symptoms left them struggling to breathe.

People from La Gloria kept going to jobs in Mexico City despite their illnesses, and could have infected people there.

Still, there's no guarantee the virus came into existence in Veracruz. It spreads so easily, it could have made its way to Mexico from just about anywhere.

Some Mexican officials have offered some other suggestions of places where the virus may have begun, such as China, Pakistan or Bangladesh. But the fact is that the flu's origin remains a mystery.

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Fortunately, it also doesn't really matter - 2014 the outbreak has made its way around the world, and nothing can be done now at the point of origin to slow it down.

4. Why have so many people died in Mexico, but virtually nobody anywhere else?

OK, this is the REAL million-dollar question, and a swarm of public health experts - 2014 including several from the US Centers for Disease Control and Prevention - 2014 have descended upon Mexico in search of an answer. This is especially a head-scratcher because experts have found no difference in samples of the virus collected in Mexico and the United States.

One theory is that many more people have had the virus in Mexico than health officials realize, and the number of cases there could well eclipse the number anywhere else in the world. If so, that country's death toll %u2014 at least a dozen confirmed deaths and many more suspected ones - 2014 would make sense.

Other theories have been floated %u2014 and ruled out - 2014 for the number of deaths in Mexico:

Lab tests of Mexican patients found no sign of complications from a second infection.
CDC investigators have not seen any obvious problem with low-quality health care.
The CDC found no evidence of an over-the-counter medicine or folk remedy compounding the problem.
Complications from Mexico City's altitude or air pollution are unlikely because severe cases have been reported in parts of Mexico at low altitude and with cleaner air.
5. Who are the victims in Mexico?

The Mexican government has revealed little about the victims, citing privacy reasons. The government has even been a bit haphazard about providing information that would not violate privacy rules, such as ages and hometowns.

After prodding by journalists, Health Secretary Jose Angel Cordova revealed Thursday that 5 of the 12 confirmed dead were between the ages of 20 and 40 and that they had an overactive immune system %u2014 possibly explaining why they did not survive.

On Wednesday, when there were 99 confirmed cases, he said 83 of them were from Mexico City. But when the number jumped Thursday, no information about hometowns was offered.

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Also, Mexico's chief epidemiologist, Miguel Angel Lezana, told reporters Wednesday that one of those confirmed dead was a Bangladeshi who had been in Mexico for six months, and whose brother, also apparently sick, had recently visited from Bangladesh or Pakistan.

And on Thursday, Mexico City government officials announced that preliminary investigations showed most of the people suspected to have died of swine flu in the capital lived in poor neighborhoods.

6. Will changes in the WHO alert level help stem the outbreak?

That's the idea, but it's unclear what concrete actions are actually taken by WHO and countries with a change in the alert level, which was bumped up on Wednesday to phase 5, one step away from the highest level, which indicates a global outbreak.

The alert levels mainly signify WHO's assessment of the pandemic situation, but they do come with actions and responsibilities. At the higher alert levels, WHO is essentially warning countries to prepare for a pandemic.

WHO monitors the outbreak situation at every level, but surveillance increases at higher levels for unusual outbreaks, the disease's spread, and the virus' possible drug resistance. WHO may also issue guidance about travel advisories, border closures, closings of schools and offices, and suspension of mass gatherings such as sporting events.

The alert system, however, is largely untested. Monday was the first time it had ever been raised above phase 3, which signifies only occasional cases or small clusters of a new flu virus.

Also, it's ultimately up to individual governments to activate pandemic response plans and to take such steps as closing schools or workplaces where a disease might spread. WHO cannot force countries to comply with recommendations.

At phases 5 and 6, WHO will also consider asking vaccine producers to switch from making seasonal flu vaccine to pandemic vaccine. It will also oversee distribution of its emergency stockpile of 5 million antiviral treatments to countries in need and help negotiate with vaccine makers for a proportion of the vaccine to go to developing countries.

How much does all this help? Until an outbreak has come and gone, the truth is: We don't know.

Available treatments for Swine flu

Swine flu is being treated with antiviral drugs such as Tamiflu and Relenza. Antiviral drugs work by preventing the flu virus from reproducing - to be effective you need to take them within 48 hours of the symptoms beginning. This can reduce the risk of complications and possibly shorten the illness by a day.

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Adverse reactions to Tamiflu

In some cases, antiviral medicine can cause side effects, such as:

* nausea
* vomiting
* diarrhoea
* stomach ache
* headache

Even if you do feel these symptoms it is important that those prescribed antiviral medicine complete the course, even if symptoms of swine flu clear and you start to feel better quickly.

Swine flu - some dos and don'ts

Do not shake hands or hug in greeting and avoid crowded places, the World Health Organisation (WHO) said Thursday as it raised the alert for swine flu to Phase 5 - the second highest level - for the infection which has left over 150 people dead in the western world The health organisation also said it is safe to eat well-cooked pork

No suspected case of swine flu in India: Govt

WHO appealed to the people across the world to follow a few precautions

DOs

Wash your hands

Avoid crowded places

Stay more than one arm's length distance from persons sick with flu

Get plenty of sleep

Drink plenty of water and eat nutritious food

DO NOTs

Shake hands or hug in greeting

Spit in public

Take medicines without consulting a physician

If you are sick, PLEASE

Stay home and limit contact with others as much as possible

Rest and take plenty of liquids

Cover your mouth and nose when you cough or sneeze

Seek medical advice if needed

WHO said it is safe to eat well-cooked pork

Influenza H1N1 List of State Nodal Officers and contact details of Control Room

Influenza H1N1
List of State Nodal Officers and contact details of Control Room

STATE CONTROL ROOM (ADD. & CONTACT) NODAL OFFICER
ANDHRA PRADESH Office of The Addl. Director (Health Services), Hyderabad.
040-24656852(T) [24x7] Dr Ramswarup
[09989923781]
ARUNACHAL PRADESH SSU IDSP, Directorate of Health Services, Naharlagun, Arunachal Pradesh.
Tel: 0360-2245460
Telefax:: 0360-2244271
(During office hours) Dr.L.Jampa
[09436055743]
[24x7]
ASSAM Office of the Director (Health Services), Guwahati.
0361-2235577
0361-2261630
0361-2261089
[24x7] Dr Doley
0361-2642008
09854066560
BIHAR Office of the Executive Director,
State Health Society, Sheikhpura, Patna.
0612-2280562
0612-2281232
0612-2290322(F)
[24x7] Mr. Santosh Mathew (IAS)
Dr D K Gupta (Addl.Nodal officer)- 09430057795
Control Room In-charge (Dr BK Singh: 9470003023)
CHHATISHGARH State Surveillance Unit (IDSP),
Directorate Health services,
Old Nurses Hostel, DKS Mantralya
Campus,Raipur
0771-2220011
[24x7] Dr T K Agarwal (Deputy Director, Epidemic)-Nodal officer: 09926624162
Dr S N M Murti (Addl.N.O)
09425564418
GUJARAT Office of Dy.Director (Epid)
Commisionerate of Health Services Block No:5, Dr.Jivaraj Mehta Bhawan, Old Sachivalaya , Ahmedabad, Gujarat
Tel: 079-23253334
Fax: 079-23250818
[24X7] Dr.S.J.Gandhi
[09825342899]

GOA Call Centre: 0832- 2458458
[24X7] Dr.Tamba (09822123801)
HIMACHAL PRADESH IDSP Cell, Directorate of Health Services, Kasumti, Shimla-9
Tel/Fax: 0177-2628046
[ during office hours] Dr.Vinod Mehta(09418163500)
[24x7]
HARYANA Office of the Director (Health Services),Sector-6, Panchkula
0172-2587346
[During office hours] Dr.Aparajita Sondh (Nodal Officer)
09417931024
[24x7]
JAMMU-KASHMIR Office of DHS, Srinagar, J& K
Tel/Fax. No (0194) 2452697 (main)
2452052,2454706,2430141
(24x7)
Dr.M.Ahmed (09419012355)
Dr.Bashir Ahmed Dar (Addl.N.O) (09419017716)

JHARKHAND RIMS, RANCHI
Chamber of Dr. A. K. Mathur (HOD Medicine)
(09431176496)
(RIMS acting as Control Room) Dr C.B Sharma (094311740820
Dr.Pradeep Baski
(09431102461)
KERALA Office of Addl.DHS (Public Health),
Near Govt. General Hospital Trivandrum
TF:(0471) 2466828
[24X7]
Dr. Amar
09447451846
DR. SHAUKAT ALI (Joint Director,NICD)-09447702444
Dr K K Mohammad-09447327569
KARNATAKA Office of the Director (Health and Family Welfare),Anand Rao Circle, Bangalore-9
Phone no: 080-1056
[24X7] Dr.Chelluraj
09901060584
Dr.Vasudev Murthi
09880024329

MAHARASHTRA
Mumbai Room no.137,First Floor,
Swasthaya Bhawan,Mumbai.
022-22029070
022-22025830
[24X7] Dr. Gawande
(09420711426)
Dr Awate-09423337556
Pune Office of the Joint Director (Health Services), Central Building , Pune
020-26124299
[24X7]
Dr. Desai-09822429266
Dr. Suresh Bohatre
09881364656

MEGHALAYA Office of DHS, Medical Institutions
Nokrek Bldg. 3rd Secretariat,
Shillong, Meghalaya TF:(0364)2506498
[Office hour only]

Control room no 0364-2505842
Civil hospital
Shilling
[24x7]
Dr.R.R.Lanong,
(09436102763)

MANIPUR Medical Directorate, Office of DHS, Manipur
Room no-23
Lamphelpat
Manipur-795004
0385-2411668
(9am-6pm) Dr Bhubon Chandra
[09436021607]
MADHYA PRADESH State Surveillance Unit, Directorate Health Services, Satpura Bhavan, Bhopal
0755-4094192(TF)
[Office hours only] Dr. B N Chauhan
09826282249
MIZORAM Civil hospital
Aizwal
0389-2322318
102 Dr Sangawalar
0389-2313721
NAGALAND SSU IDSP, Directorate of Health Services& FW, T.R .Hill, KOHIMA-797001.
Tel:(0370)2245016
[Office hours only] Dr.Kebichusa
(09436000463)
[24x7]
ORISSA State Surveillance Unit, Director of Health Services, Heads of the Department Buildings, Bhubaneshwar.
0674-2390466 (TF)
[24x7] Dr. V. Patnaik
0674-2390466
PUNJAB Pariwar Kalyan Bhawan,
Sector-34A, Chandigarh.
Tel:(0172) 2621506
Dr. Deepak Bhatia
09814302403 [24x7]
0172-2621506(0)/0172-2620234(Fax)
RAJASTHAN Office of the Director (Public Health), Swasthaya Bhawan, Jaipur.
0141-2225624
0141-2224831(F)
[ Mr. R K Meena ,IAS, Principal Sect.(Health)- Nodal Officer

Dr. O P Gupta(Addl.Nodal Officer)-0141-2229858 09829333936
SIKKIM SSU IDSP, Health & F.W.
Govt. of Sikkim
03592-204199
[Office hours only] Dr.Y.D.Chingappa
(09832079576)
Tel:(03592)204199
TRIPURA DHS building
PN Building
Gurkha Basti
Agartala
Tel/Fax:(0381) 2215879 Dr P Chatterjee (09436120711)
Dr.R.K. Dhar
(09436137652)

TAMILNADU Office of the Director (Public Health &Preventive Medicine),
Central Malaria Laboratory,
359,Annasalai,Chennai-6

044-24321569 (TF)
[24X7] DR. Elango, DHS,
(09940610123)
UTTARAKHAND Office of DHS, IDSP,
107,Chander Nagar, Dehradun
TF: 0135-2721792
0135-2729897
[Office Hours only] Dr.Pankaj Jain(09412969502)
[24x7]
UTTAR PRADESH Swasthaya Bhawan,Luknow
Control Room No-Tel:(0522)2616482
Fax:(0522)2622819
[24X7]
Dr Pyaremohan Srivastava
0522-2629106(TF)
(09415181629)
WEST BENGAL Chamber of Joint Director (Health Services), Swasthaya Bhawan,
Sector-5,GN Block, Kolkata-91
(033)-23571192
[ 10 am to 7 pm on working days]
[11 am to 4:30 pm on Saturday and Holidays] Dr.Bhaskar Bhattacharya,
Jt.DHS
033-23330180
(09831187818)
ANDAMAN AND NICOBAR G.B.Pant Hospital, Port Blair
Tel:03192-230622,233473 Dr.Abhijit Roy,Dy.Director (H) (09474269315)
T/F: (03192-232797)
CHANDIGARH Govt. Multispecialty Hospital,
Sector-16, Chandigarh.
Call Centre:102
Tel:(0172) 2700255 Mr. H.C. Gera
(09988212139)
(0172)-2740408
DADRA AND NAGAR HAVELI Office of DHS, Silvassa.
T/F (0260)2642061,2641759

CONTROL ROOM NO- 0260-2642120 Dr.L.M.Patra DHS
(09426117593)
DAMAN AND DIU CHC, Daman.
Tel:(0260)2230080
Fax:(0260)2230570
[24x7] Dr.B.Hansraj (Daman)
(09825142600)
Dr.Das (Silvassa)
Tel:0260-2642961,26422120
DELHI DHS Office
Tel:22307145
(24X7) Dr.R.P.Vashist
(09212222456)/22305657(O),23646049(O),23646173(F)
LAKSHADWEEP Office of DHS,
Tel:(04896)262316
[Office hours only]

Dr.K P Hamza Koya (DHS)-Nodal officer(09496429027,04896-262113)
04896-262089,04896-262209(F)
Dr K. Attakoya (Addl.Nodal officer)-04896-262109,262317
PUDUCHERRY Call Centre:(24X7)
Tel: (0413)1070
(0413)1077 Dr.G.S.Naidu (09443729783)

Tel:(0413)2249357

List of Influenza A H1N1 affected countries as on 16.6.2009

S.No Name of the Country
1. Argentina
2. Australia
3. Austria
4. Bahamas
5. Bahrain
6. Barbados
7. Belgium
8. Bolivia
9. Brazil
10. Bulgaria
11. Canada
12. Cayman Islands, UKOT
13. Chile
14. China
15. Colombia
16. Costa Rica
17. Cuba
18. Cyprus
19. Czech Republic
20. Denmark
21. Dominica
22. Dominican Republic
23. Ecuador
24. Egypt
25. El Salvador
26. Estonia
27. Finland
28. France
29. Germany
30. Greece
31. Guatemala
32. Honduras
33. Hungary
34. Iceland
35. India
36. Ireland
37. Israel
38. Italy
39. Jamaica
40. Japan
41. Korea, Republic of
42. Kuwait
43. Lebanon
44. Luxembourg
45. Malaysia
46. Mexico
47. Netherlands
48. New Zealand
49. Nicaragua
50. Norway
51. Panama
52. Paraguay
53. Peru
54. Philippines
55. Poland
56. Portugal
57. Romania
58. Russia
59. Saudi Arabia
60. Singapore
61. Slovakia
62. Spain
63. Sweden
64. Switzerland
65. Thailand
66. Trinidad and Tobago
67. Turkey
68. Ukraine
69. United Arab Emirates
70. United Kingdom
71. United States of America
72. Uruguay
73. Venezuela
74. Viet Nam
75. West Bank and Gaza Strip

GUIDELINES FOR SCHOOLS/COLLEGES/INSTITUTIONS ON INFLUENZA A/H1N1

There have been some cases of Influenza A H1N1 virus among students and staff in certain schools, primarily in Delhi and Maharashtra. There has been considerable speculation over the need for closure of schools to control the outbreak. This matter has been considered by the Joint Monitoring Group in the Ministry of Health and Family Welfare. All schools and colleges are advised to observe the following guidelines for managing cases of infection of Influenza AH1N1.

(i) Any student or staff member showing flu like symptoms such as fever, cough, running nose and difficulty in breathing should be allowed to stay at home for a period of 7 to 10 days.

(ii) Educational institutions should not insist on production of medical certificate by the student/staff.

(iii) Educational institutions should monitor the health status of such students/staff who might have come in contact with a suspected case of Influenza AH1N1 to see whether they develop flu like symptoms. In case they do so, they should be allowed to stay home, as outlined at (i) above

(iv) In case of students staying in Hostels, the educational institutions would not only monitor the health status of the students, but also that of care providers. It has to be ensured that the care providers wear face mask and wash hands regularly. It might not be advisable to send the boarders back to home, as it would spread infection further.

(v) Educational institutions are further encouraged to report such cases to local health officers for further monitoring.

(vi) Given the current magnitude of the spread of AH1N1 infection and the fact that the current virus is fairly mild, closure of educational institutions on account of any student/staff member falling ill with flu like symptoms is not recommended.

(vii) In the first place, the schools should discourage the excursions of the students to the affected countries.

(viii) In case if the students had proceeded to affected countries on unavoidable tours, then on their return, if some students show flu like symptoms of fever, sore- throat , cough , body ache, running nose, difficulty breathing etc. they should be advised to abstain from attending school and be allowed to stay at home for a period of 7 to 10 days.

Guidelines for testing, Home isolation and treatment

Revised Guidelines for testing of persons with flu like symptoms reporting at hospitals notified for influenza H1N1

So far, the present guidelines stipulate that a person suspected of influenza A H1N1 need to be referred to an identified govt. health facility. He/she needs to be kept in an isolation facility in that hospital and if found positive, is treated accordingly.

In order to make the testing facility for H1N1 more accessible at large and due to the onset of the Influenza season in the country, it has been decided to revise the existing guidelines.

Under the new guidelines, any person with flu like symptoms such as fever, cough, sore throat, cold, running nose etc. should go to a designated Government facility for giving his/her sample for testing for the H1N1 virus. After clinical assessment, the designated medical officer would decide on the need for testing. Except for cases that are severe, the patient would be allowed to go home (This was not allowed under the existing guidelines).

The sample of the suspect case would be collected and sent to the notified laboratory for testing. If tested as positive for H1N1 and in case the symptoms are mild, the patient would be informed and given the option of admission into the hospital or isolation and treatment at his own home.

In case the patient opts for home isolation and treatment, he/she would be provided with detailed guidelines / safety measures to be strictly adhered to by the entire household of the patient. He/ she would have to provide full contact details of his entire household. The house hold and social contacts would be provided with the preventive treatment.

Notwithstanding the above guidelines, the decision of the doctor of the notified hospital about admitting the patient would be final.

In case the test is negative, the patient will accordingly be informed.

These guidelines have been issued by the Government in public interest and shall be reviewed from time to time depending on the spread of the pandemic and its severity in the country. These guidelines would however not apply to passengers who are identified through screening at the points of entry. The existing policy of isolating passengers with flu like symptoms would continue.

List of govt hospitals authorised to treat swine flu In India

In the wake of threat posed by the A (HINI) influenza, the government has authorised a number of hospitals across the country to test and treat cases of swine flu:

All India Institute of Medical Sciences -- Ansari Nagar, Aurobindo Marg Ring Road, New Delhi [ Images ] - 29

Phone: (011) 26594404, 26861698 Professor R C Deka – 9868397464.

National Institute for Communicable Diseases, 22, Sham Nath Marg, New Delhi - 54

Phone: (011) 23971272/060/344/524/449/326.

Dr Ram Manohar Lohia Hospital, Kharak Singh Marg, New Delhi - 01

Phone: (011) 23741640, 23741649, 23741639, Dr N K Chaturvedi – 9811101704.

Vallabhai Patel Chest Institute University, Enclave, New Delhi- 07

Phone: (011) 27667102, 27667441, 27667667, 27666182

Kasturba Gandhi [ Images ] Hospital, Arthur Road, N M Joshi Marg, Jacob Circle, Mumbai [ Images ] - 11

Phone: (022) 23083901, 23092458, 23004512

Sir J J Hospital, J J Marg, Byculla, Mumbai - 08

Phone: (022) 23735555, 23739031, 23760943, 23768400 / 23731144 / 5555 / 23701393 / 1366

Haffkine Institute, Acharya Donde Marg, Parel, Mumbai - 12

Phone: (022) 24160947, 24160961, 24160962

ID Hospital, 57,Beliaghata, Beliaghata Road, Kolkata [ Images ] - 10

Phone: (033) 23701252

Victoria Hospital, K R Market, Kalasipalayam, Bangalore - 02

Phone: (080) 26703294 Dr. Gangadhar - 94480-49863

SDS Tuberculosis & Rajiv Gandhi [ Images ] Institute of Chest Diseases, Hosur Road, Hombegowda Nagar, Bangalore - 29

Phone: (080) 26631923 Dr. Shivaraj - 99801-48780.

Chennai King Institute of Preventive Medicine (24/7 Service) Guindy, Chennai – 32

Phone: (044) 22501520, 22501521 & 22501522

Communicable Diseases Hospital Thondiarpet, Chennai

Phone: (044) 25912686/87/88, 9444459543

Government General Hospital, Opp Central Railway Station, Chennai – 03

Phone: (044) 25305000, 25305723, 25305721, 25330300

Hospital Nr Le''Meridian, Raja Bahadur Mill, GPO, Pune - 01

Phone: (020) 26058243

National Institute of Virology, 20A Ambedkar Road, Pune - 11

Phone: (020) 26006290

Government Medical College, Gandhi Nagar P O, Kottayam - 08

Phone: (0481) 2597311,2597312

Government Medical College, Vandanam P O, Allapuzha - 05

Phone: (0477) 2282015

Taluk Hospital, Railway Station Road, Alwaye, Ernakulam

Phone: (0484) 2624040 Sathyajit – 09847840051,

Taluk Hospital, Perumbavoor PO, Ernakulam 542

Phone: (0484) 2523138, Vipin - 09447305200

Government General Hospital, near Railway Station, Trichy Road, Coimbatore - 18

Phone: (0422) 2301393, 2301394, 2301395, 2301396

Govt General and Chest Diseases Hospital, Erragadda, Hyderabad

Phone: (040) 23814939

13 swine flu deaths take India's toll to 277

Thirteen swine flu deaths, including five in Andhra Pradesh, took the toll in the country Thursday due to Influenza A (H1N1) to 277, health officials said here.

Meanwhile, as many as 283 fresh swine flu cases were recorded in the country, taking the total number of positive cases to 8,979.

Four deaths were reported from Maharashtra - Pune, Nashik, Mumbai and Nagpur -- while three deaths occurred in Karnataka - two in Bangalore and one in Updupi.

Two deaths were reported from Hyderabad Thursday. Three deaths had occurred earlier in Andhra Pradesh, but the laboratory reports came in Thursday. One death took place in Uttarakhand, taking the state's toll to two.

So far, 28 people have died in Andhra Pradesh since the outbreak of the flu in the country in May 16.

In Maharashtra, which tops the chart for the maximum number of deaths and cases in the country, as many as 112 people have succumbed to the contagious virus and 2,574 have been affected.

Karnataka's toll has reached 85 - the second highest in the country.

The senior wing of Delhi Public School (DPS) at Indirapuram, Ghaziabad, was closed Thursday after two students tested positive for the influenza.

Two days back, the school had closed its junior wing following two children being detected with the virus.

The school will remain closed till Sep 28.

'Four students have been reported infected. We have closed down as a precautionary measure. All infected students are from the primary section. All these students are under treatment and belong to Mayur Vihar, Preet Vihar, Vikas Marg and Vishwas Nagar area of Shahdara,' school principal Meeta Rai said.

'We have undertaken every possible measure to deal with the situation,' she added. The school has around 5,300 students from Delhi, Noida and Ghaziabad.

The national capital Thursday reported 113 fresh cases of swine flu with the majority of them being children, Delhi Health Minister Kiran Walia said.

'Of the 113 swine flu cases, 65 are children and all of them have been quarantined,' she said.

Walia said that till Thursday, 2,275 cases were admitted and treated in designated government hospitals and of these 90 percent have been discharged. Delhi has so far reported nine swine flu deaths.

'The situation is under control and the government is doing its best in providing treatment to H1N1 patients. I advise people to visit the doctor at the earliest if any symptom of swine flu appears,' she said.

As the H1N1 virus continued to spread, Delhi Mayor Kanwar Sain said the Municipal Corporation of Delhi (MCD) would evaluate its response to checking the swine flu outbreak in the capital.

'Swine flu, other than causing loss of human lives, should give us reason to sit down and evaluate the efficacy and style of our responses,' Sain said as he addressed a convention organised by Health Essayists and Authors League (HEAL) here.

Fresh cases were also reported from Andhra Pradesh (43), Karnataka (22), Tamil Nadu (34), Maharashtra (35), Haryana (25) and Gujarat (2).

Student dies of swine flu in AP, state toll rises to 15

Hyderabad, Sept 16 (PTI) A 15-year-old boy died of swine flu in Warangal today, taking the death toll due to the virus in the state to 15, Andhra Pradesh Major Irrigation Minister Ponnala Lakshmaiah said.

Sai Krishna, a class 10th student, died due to the H1N1 virus here last night.

The death toll due to the viral disease today rose to 203 from 201 last night as two more persons succumbed to the infection today in Andhra Pradesh and Maharashtra each.

Three other persons tested positive for H1N1 influenza in the district and are being treated in various hospitals, Lakshmaiah told reporters after a meeting with the district health authorities.

The minister said special arrangements were being made in the MGM hospital in Warangal for treating swine flu affected patients and 7,200 doses of Tamiflu tablets are available.

Swine Flu Self Test

Self screening

Individuals are asked to perform H1N1 Flu illness self screening following exposure to a confirmed or suspected case.

To conduct self screening, please perform the following steps:

Step One: Check whether you have symptoms of illness including fever and cough, sore throat or body aches.

Step Two: Check your temperature using a standard, good quality thermometer following the manufacturer’s instructions.

Step Three: If you have symptoms as described in Step One or you have a temperature greater than 100.4o F or 38o C, you must not go into the workplace.

Guide Lines To Test People On Swine Flu

Government of India Revised Guidelines for testing people with flu-like symptoms, reporting to hospitals

Due to the onset of the influenza season in the country and to make the testing facility for H1N1 more accessible, Government of India has revised the existing guidelines.

Under the new guidelines, any person with flu like symptoms such as fever, cough, sore throat, cold, running nose etc. should go to a designated government facility for giving his/her sample for H1N1 testing. After clinical assessment, the designated medical officer will decide on the need for further clinical tests. Except for cases that are severe, the patient will be allowed to go home (this was not allowed under the existing guidelines).

Samples will be collected from suspected cases and sent to the notified laboratory for testing. If tested positive for H1N1 and in case the symptoms are mild, the patient will be notified and given the option of admission into the hospital or isolation and treatment at his/her own home.

In case the patient opts for home isolation and treatment, he/she would be provided with detailed guidelines/safety measures to be strictly adhered to by the entire household of the patient. He/ she is required to provide full contact details of all household members and social contacts so that they may be provided with preventive treatment.

The decision of the doctor from the notified hospital regarding admitting the patient will be final. In case the test results are negative, the patient will be informed, accordingly.

How to prevent the spread of H1N1 Flu

How to prevent the spread of H1N1 Flu?

Wash Your Hands:
Before eating or preparing food
After coughing, sneezing, or blowing your nose
After using the washroom

Hand washing technique:
Wash your hands with soap and water for 20 seconds. Rinse well, with hands held downward. Dry with a paper towel, then use the towel to turn off the faucet
If soap and water are not available, use an alcohol-based hand cleanser. Alcohol-based hand cleansers significantly reduce the number of germs

Spread of germs:
Avoid touching your eyes, nose or mouth. Germs often spread when a person touches something contaminated and then touches their eyes, nose or mouth

Avoid close contact with people who are sick
Attempt to keep at least three (3) feet or one (1) meter away from ill individuals
When sick, keep your distance from others to protect them from getting sick
Practice respiratory etiquette. Cover your mouth and nose when coughing or sneezing, use tissues and dispose them properly. Wash your hands afterwards

Swine Flu Preventive Steps At Work Place

Workplace instructions if you become ill or exposed

If you have been diagnosed with H1N1 Flu or have symptoms of this illness including fever and cough, sore throat or body aches you are requested to refrain from coming into any IBM work environment (including customers).

Individuals providing direct care for someone with H1N1 Flu or symptoms of the illness are requested to refrain from coming into any IBM work environment (including customers).

This restriction applies for seven (7) calendar days from the last date of exposure to the ill person. During this time period, the exposed
individual should conduct self screening tests daily for identifying symptoms of illness.

Self screening
Individuals are asked to perform H1N1 Flu illness self screening, following exposure to a confirmed or suspected case. The following steps are to be conducted for self screening:

Step One: Check whether you have symptoms of illness including fever, cough, sore throat or body ache.

Step Two: Check your temperature using a standard, good quality thermometer following the manufacturer’s instructions.

Step Three: If you have symptoms as described in Step One or have a temperature greater than 100.4 deg F or 38 deg C, you are asked to refrain from coming into any IBM work environment. You must:

Notify your manager that you are unable to report to work
Contact designated government facilities for further health instructions
Refer to the guidance in Workplace Instructions in the link below

How To Prevent Swine Flu While Travelling

Travel advisory from WHO

Is it safe to travel?

Yes. WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Today, global travel is commonplace and large numbers of people move around the world for business and leisure. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.

Influenza A(H1N1) has already been confirmed in many parts of the world. The global response now focuses on minimizing the impact of the virus through the rapid identification of cases, and providing patients with appropriate medical care, rather than on stopping its spread internationally.

Although identifying signs and symptoms of influenza in travellers can help track the path of the outbreak, it will not reduce the spread of influenza, as the virus can be transmitted from person to person before the onset of symptoms. Scientific research based on mathematical modelling shows that restricting travel would be of limited or no benefit in stopping the spread of disease. Historical records of previous influenza pandemics, as well as experience with SARS, validate this.


Does WHO recommend screenings at country entry and exit points to detect if ill people are travelling?

No. We do not believe entry and exit screenings would work to reduce the spread of this disease. However country-level measures to respond to a public health risk are the decision of national authorities, under the International Health Regulations 2005

Countries that adopt measures that significantly interfere with international traffic (e.g. delaying an airplane passenger for more than 24 hours, or refusing country entry or departure to a traveller) must provide WHO with the public health reasoning and evidence for their actions. WHO will follow up with all of its Member countries on such matters. Travellers should always be treated with dignity and respect for their human rights.


How can I protect myself from influenza A(H1N1) when I am travelling?

People who are ill should delay travel plans. Returning travellers who become ill should contact their health care provider. Travellers can protect themselves and others by following simple prevention practices that apply while travelling and in daily life.

Swine Flu Preventive Medicines And Steps

Steps to Lessen the Spread of Flu in the Home

When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to:


· keep the sick person away from other people as much as possible (see “placement of the sick person”)
· remind the sick person to cover their coughs, and clean their hands with soap and water or an alcohol-based hand rub often, especially after coughing and/or sneezing.
· have everyone in the household clean their hands often, using soap and water or an alcohol-based hand rub


Placement of the sick person:


· Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed.
· Unless necessary for medical care, persons with the flu should not leave the home when they have a fever or during the time that they are most likely to spread their infection to others
· If persons with the flu need to leave the home (for example, for medical care), they should cover their nose and mouth when coughing or sneezing and wear a loose-fitting (surgical) mask if available.
· Have the sick person wear a surgical mask if they need to be in a common area of the house near other persons.
· If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant


Protect other persons in the home:


· The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
· If possible, have only one adult in the home take care of the sick person.
· Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of influenza-related complications and immunity can be suppressed during pregnancy).
· All persons in the household should clean their hands with soap and water or an alcohol-based hand rub frequently, including after every contact with the sick person or the person’s room or bathroom.
· Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
· If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).


If you are the caregiver:


· Avoid being face-to-face with the sick person. · When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face. · Clean your hands with soap and water or use an alcohol-based hand rub after you touch the sick person or handle used tissues, or laundry. · Talk to your Doctor about taking antiviral medication to prevent the caregiver from getting the flu. · Monitor yourself and household members for flu symptoms and the local H1N1 Command Center if the symptoms occur.


Household Cleaning, Laundry, and Waste Disposal:


· Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste. · Keep surfaces (especially bedside tables, surfaces in the bathroom, and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. · Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid “hugging” laundry prior to washing it to prevent contaminating yourself.

Clean your hands with soap and water or alcohol-based hand rub right after handling dirty laundry. · Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Symptoms of Swine Flu In Children and Adults

Symptoms In children, emergency warning signs that need urgent medical attention include:

· Fast breathing or trouble breathing
· Bluish or gray skin color
· Not drinking enough fluids
· Severe or persistent vomiting
· 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


In adults, 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
· Flu-like symptoms improve but then return with fever and worse cough

Important Information for Swine Flu Treatment in Hyderabad

The Union Government has identified the Govt. General and Chest Diseases Hospital, Erragadda as the facility in Hyderabad for testing, isolation and critical care of suspected/confirmed swine flu patients. The Hyderabad Airport Limited has set up a screening facility at the Hyderabad International Airport for all the inbound passengers flying into the country to prevent the spread of H1N1. Doctors from the Hospital are round the clock screening the passengers at the Airport.

Govt. General and Chest Diseases Hospital, Erragadda , Hyderabad
Hospital Helpline Number - 040-23814939

Swine Flu To Aishwarya Rai

Swine Flu Victim Aishwarya Rai, Swine Flu Symptoms

Bollywood Heroine Aishwarya Rai Bachchan seems to be the latest victim of Swine Flu. Amitabh Bachchan yesterday wrote about Aishwarya’s illness in his Personal Blog.

“Aishwarya has taken ill and is down with chest infection and flu like symptoms. Had a high fever yesterday but is settling down today,”

Aishwarya was shooting for the film “Raavan“.

We wish Aishwarya Rai a Speedy recovery.

Swine Flu Testing Centres In Hyderabad and Secunderabad

Swine Flu Testing / Screening Labs In Hyderabad and Secunderabad

Osmaniya General Hospital, Gandhi Hospital King Koti, Vanasthali Puram, Kondapur, RTC, Railway and ESI Hospitals OP section will work specially for the Swine Flu patients. Hospitals OP will work from 9am to 12pm specially for Swine Flu Testing.

Swine Flu Prevention Steps For Overseas Travellers

AVOID PIGS - The swine flu is prevalent among pigs during fall and winter. Avoid farms, petting zoos and county fairs that have livestock.

If you are exposed to farm animals, wash your hands thoroughly after contact and especially before touching your nose or mouth. The swine flu is passed from pigs to humans and humans to humans usually by touching something with the flu virus on it and then touching your nose or mouth.

2.WASH YOUR HANDS REGULARLY - Wash your hands regularly, especially before eating, before touching your face and after using the bathroom. 3.BEWARE - You should use caution when you have contact with someone that has recently (last two weeks) come into this country.

Washing your hands periodically during the day and washing your face at night before you go to bed will keep many germs away. You can protect yourself from getting the swine flu it is very rare in humans.



To prevent flu from spreading further one must undestand two points regarding the transmission of virus, first:

1. Respiratory droplets while sneezing and coughing

2. Via fomites - that is particulate matter on hands on which virus ges deposited when you put your hands on mouth when coughing and sneezing; following which one may shake hands or touch furniture/items like computer keyboards etc thus leading the fomite to other persons hand.

Now this uninfected person touches his face/nose/lips and infect oneself beacuse of virus sitting there. So do no handshake/hug/kiss and if you do wash hands and stay away from crowds and 2 arm length from infected people

59 Swine Flu Found Cases So Far In India

Three more persons, including a couple who travelled to India from the US, tested positive for swine flu on Sunday taking the total number of cases in the country to 59

While two cases were reported from Chennai, the third one was reported from the national capital where a 15-year-old boy tested positive for the disease.

A 29-year-old man and his 25-year-old wife, who travelled from North Carolina to Chennai on June 13, had reported symptoms for swine flu five days later. "They were tested positive today," a Health Ministry official said.

The case from Delhi was that of the teenager who reached the city on June 17 from New York.

Of the total 59 cases, 32 have been discharged while the rest are admitted to various hospitals across the country.

"So far samples of 421 persons have been tested out of which 59 have been tested positive for novel Influenza A [H1N1]. Of these, six are indigenous cases who got the infection from people who travelled from abroad," the official said.

Swine Flu Cases In Andhra Pradesh, Hyderabad, India

So far Hyderabad, Andhra Pradesh, India team found Swine Flu Cased nearly about 40+ cases @ Shashabad International Airport.

Doctors are suggesting to check all the passengers in the Flight, just not only feeling not good.

This is really a bad situation where the Swine Flu affected Andhra Pradesh which is upcoming / growing State in India.


Here goes some tips how to stop the Swine Flu -

Swine Flu Symptoms and Prevention Tips

What are the symptoms of swine flu?

The symptoms of swine flu in people are similar to the symptoms of a regular flu:

Fever
Cough
Sore throat
Body aches
Headache
Chills
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.

How does swine flu spread?

Spread of this swine influenza 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 influenza.

Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How can someone with the flu infect someone else?

Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more 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 should I do to keep from getting the flu?

First and most important:

Wash your hands frequently
Try to stay in good general health
Get plenty of sleep
Be physically active
Manage your stress
Drink plenty of fluids
Eat nutritious food
Try not touch surfaces that may be contaminated with the flu virus
Avoid close contact with people who are sick.

What else can I do to protect myself from getting sick?

There is no vaccine available right now to protect against swine flu.

But 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:

Cover your nose and mouth with a tissue when you cough or sneeze.
Throw away nasal 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.

If you get sick with influenza, recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Antiviral Drugs and H1N1 Flu (Swine Flu)

Antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including swine influenza viruses. Antiviral drugs can be used to treat swine flu or to prevent infection with swine flu viruses. These medications must be prescribed by a health care professional. Influenza antiviral drugs only work against influenza viruses -- they will not help treat or prevent symptoms caused by infection from other viruses that can cause symptoms similar to the flu.

There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir, amantadine and rimantadine). The swine influenza A (H1N1) viruses that have been detected in humans in the United States and Mexico are resistant to amantadine and rimantadine so these drugs will not work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1) viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir. MRSA Latest Update


Benefits of Antiviral Drugs
Treatment: If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. Influenza antiviral drugs work best when started soon after illness onset (within two [2] days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.

Prevention: Influenza antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with swine influenza. When used to prevent the flu, antiviral drugs are about 70% to 90% effective. When used for prevention, the number of days that they should be used will vary depending on a person’s particular situation.


CDC Recommendation
CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent influenza A and B virus infection in people one year of age and older.

Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older.

Recommendations for using antiviral drugs for treatment or prevention of swine influenza will change as we learn more about this new virus.

Clinicians should consider treating any person with confirmed or suspected swine influenza with an antiviral drug.

Stpes To Take Care Of Swine Flu Sick Person

Taking Care of a Sick Person in Your Home

Swine influenza A virus infection (swine flu) can cause a wide range of symptoms, including 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 in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with swine flu infection. Certain groups might be more likely to develop a severe illness from swine flu infection, such as persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.

The following information can help you provide safer care at home for sick persons during a flu pandemic.

How Flu Spreads
The main way that influenza viruses are thought to spread is 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 may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

People with swine flu who are cared for at home should:

check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema check with their health care provider about whether they should take antiviral medications

stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer get plenty of rest drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands.

Avoid close contact with others – do not go to work or school while ill
be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention

SWINE FLU BREAKING NEWS 2: Global case update, eyeing phase 6, probable cases, southern hemisphere viruses, WHO gathers clinical experts

The World Health Organization (WHO) reported 1,085 confirmed cases of influenza A/H1N1 (swine flu) and 26 deaths in 21 countries as of 18:00 GMT (noon US EST) today, up from 985 cases in 20 countries reported earlier in the day. Mexico has reported 590 confirmed cases and 25 deaths. The WHO's latest total reflects today's updated US numbers from the Centers for Disease Control and Prevention (CDC), which stand at 286 cases and 1 death. [WHO update 14]

At a WHO media briefing today, Keiji Fukuda, MD, the WHO's assistant director-general for health security, emphasized that the rationale for any future move to pandemic alert phase 6 wouldn't be based on disease severity, but rather on sustained outbreaks in more than one WHO region. On Apr 29 the WHO raised the pandemic alert to its current level, phase 5, which signifies sustained community outbreaks in two or more countries within one WHO region.

The CDC will begin reporting "probable" cases of flu in addition to confirmed cases to give a better sense of the size of the US epidemic, acting director Dr. Richard Besser said Monday. In addition to the 286 confirmed cases, there are more than 700 probable cases in the United States.

The CDC will work with international health authorities to monitor the southern hemisphere's flu season, beginning shortly, to see how the novel H1N1 strain behaves in competition with other flu viruses. "That will tell us a lot about whether the virus is changing and what measures we might want to take in the fall," Besser said.

Tomorrow the WHO will host its second scientific teleconference to address clinical issues surrounding patients who have influenza A/H1N1 (swine flu) infections, the WHO's Fukuda said today at a media briefing. The conference will allow scientists to share information on crucial topics such as disease severity. The topic of the first teleconference, held on Apr 29, was the influenza situation in Mexico.

Flu virus's likely human-to-swine jump triggers concern

The tentative detection of the novel swine influenza H1N1 virus in an Alberta swine herd over the weekend shook Canada's pork industry and raised concern about the potential for new hybrid viruses to emerge.

Canadian authorities said on May 2 that preliminary testing detected the virus in an Alberta herd and that it probably came from a Canadian carpenter who works on the farm and had a flu-like illness when he returned from a visit to Mexico in mid-April

Dr. Brian Evans of the Canadian Food inspection Agency (CFIA) said the worker had contact with the pigs on Apr 14 and that about 220 pigs in the herd of 2,200 began showing signs of sickness on Apr 24, according to a Canadian Press report.

The carpenter has recovered and the pigs were recovering, the CFIA said. The farm has been quarantined.

A US Department of Agriculture (USDA) statement said the worker's family also had a flu-like illness but were recovering. The agency said it would take anywhere from 5 days to 2 weeks to get the final test results on the Canadian herd.

Pigs are often infected with flu viruses, including strains from humans and birds. They are described as a mixing vessel where different viruses can trade genes (reassort) and produce new variants. The novel H1N1 virus itself has been said to contain genetic material from swine, avian, and human flu viruses.

"Reassortment is a concern that people express because pigs have their own influenza virus, so if they get infected with this [human] one, do you have to worry about other reassortant viruses coming out? Yes, it seems that would be a risk," said David A. Halvorson, PhD, a veterinarian and avian influenza expert at the University of Minnesota in St. Paul.

Global animal and human health officials said the Canadian finding is not a big surprise.

"The human-to-animal transmission that occurred in Canada does not come as a surprise as influenza viruses are capable of transmitting from humans to animals," said Joseph Domenech, chief veterinary officer of the United Nations Food and Agriculture Organization (FAO) said in a statement today.

At a news briefing yesterday, Peter Ben Embarek of the World Health Organization (WHO) said the virus isolated from the swine does not appear to differ from the virus spreading among humans. "There is no sign that it has changed at all. But this could of course happen like with any other flu viruses," he said. He added that it's important to increase surveillance in humans and animals so as to detect any mutations.

Despite repeated official assurances that proper cooking destroys any flu viruses in pork, ten countries have banned Canadian pork products since the Alberta finding, CBC News reported today. China specifically banned pork from Alberta.

Canada's trade minister, Stockwell Day, called China's action "disappointing and unwarranted," the CBC reported.

The Canadian finding added to fears in some quarters about the safety of pork, given that the illness caused by the new virus infecting people in 21 countries is unofficially called swine flu.

The US Department of Agriculture (USDA) said pork and pork products remain safe and the finding would not affect US trade with Canada.

Humans occasionally pick up influenza viruses from pigs. Reports of human-to-pig transmission are apparently rare, but such cases are assumed to happen.

"We really don't know how common that might be; there's no way of knowing that," said Halvorson. "We do know that pigs have been harboring a virus that has genes form human viruses in it. Those genes had to come from someplace, and presumably they came from a human flu virus getting into pigs." He said the virus, an influenza A/H3N2 subtype, has been found in pigs in many parts of the United States.

The FAO advised that when swine show signs of respiratory illness, operators should use strict biosecurity measures, including restricting the movement of pigs, goods, and people.

Also, people who work with pigs should not go to work if they have any signs of respiratory disease, fever, or any flu-like illness, the FAO said. At the same time, the agency said there is "absolutely no need to slaughter animals" to prevent the spread of the novel H1N1 virus.

Meanwhile, the USDA said it is "actively working to develop an H1N1 vaccine for swine, just as the CDC is doing for humans."

At the WHO briefing, Ben Embarek said at least two laboratories are experimentally exposing pigs to the new virus to see how it affects them. Also, the World Organization for Animal Health (OIE) said today it is awaiting the results of experiments to determine the susceptibility of various animals to the H1N1 virus.

CDC, states weigh usefulness of school closures

The Centers for Disease Control and Prevention (CDC) signaled today that it will change its current recommendation—which is to close schools for at least 2 weeks when a confirmed case of novel H1N1 swine flu is found among students—as health officials in the Seattle area and Minnesota scaled back their guidance to reflect more of a seasonal influenza approach.

Acting CDC director Dr. Richard Besser said in a press briefing that the virus is so widespread in the United States that "closing the schools as a means of not letting [the novel flu] spread through the community is not very effective."

"I would expect that as we get more information we will be looking to revise that guidance," he said.

The CDC's advice to close schools for 2 weeks has been "very aggressive—you may only get one chance to get out in front of a new infectious disease," Besser said. But the rapid spread of the virus across the country, plus information from multiple locations that the spectrum of disease is about as severe as average seasonal flu, has caused the agency to reconsider.

Therefore, he said, the CDC is considering changing its advice from automatically closing schools to asking schools and parents to weed out sick children and individually send them home for at least a week.

That procedure is already followed in Canada and in Seattle, which "asks people to really push hard on personal responsibility," Besser said, and today Minnesota followed suit. Health and education officials in that state released updated school closure guidance that asks parents and teachers to identify and isolate children who have a fever and a recent onset of flu like symptoms.

Besser said that, in those areas, parents are asked to check their children in the morning, and, if they are sick or are starting to feel a little sick, to keep them home for a full 7 days, even if they start to feel better before that period is up. In addition, schools and individual teachers are asked to take a close look at children as they arrive in the morning, and to send them home if the school believes they are developing illness—for 7 days or until they are proven not to have flu.

Public Health Seattle and King County, in its revised school closure guidance posted yesterday, said its policy change is an enhanced version of the approach it uses for seasonal influenza and is based on what is known about the new influenza virus and its spread. The guidance notes that the new strain, already spread widely, will continue for some time and that illness severity doesn't appear to be greater than typical seasonal influenza.

"Individualized school closure based on reports of diagnosed cases is less effective, in addition to being impractical, as a control measure," the Seattle-King County health department said. However, officials added that, consistent with seasonal influenza policy, some schools might be closed if large numbers of students or faculty become ill.

As the outbreak progresses, laboratory diagnosis will identify a shrinking proportion of cases, as testing demand exceeds capacity and many people who have mild infections won't see their doctors. "Closing schools where cases happen to be diagnosed while leaving most schools with undiagnosed cases open does not make sense as an ongoing influenza control strategy in our community," the department said.

Public Health Seattle and King County has several tools for schools and parents on its Web site, including a guide for parents on when to keep a child home from school, a flu symptom checklist, and advice on how to care for someone who has influenza.

Minnesota officials today unveiled similar guidance aimed at keeping students and staff with influenza symptoms out of schools, rather than routinely closing schools. They said in a statement that it's not possible to identify every case of novel influenza, because the symptoms mimic those of other respiratory diseases. "We also know that we have other acute viral respiratory infections circulating in Minnesota," they said in the statement.

"The fact that the novel influenza is currently behaving like regular flu does not mean we can relax,” said Sanne Magnan, MD, Minnesota commissioner of health, in a press release today. "Seasonal flu is a major health concern in its own right. It's one of our leading causes of death, year in and year out."

Schools that have a confirmed novel influenza case have three options: remain open with the individual isolated at home, close schools based on public health and community assessment, or close schools for a set number of days based on CDC guidance, which could change.

Minnesota officials also said they are developing enhanced school-based surveillance for influenza-like illnesses.

Swine Flu Affected In Hyderabad India

A Hyderabadi student, pursuing his higher education in engineering in Texas, returned to the city three days ago with symptoms of flu and voluntarily approached the doctors at Institute of Preventive Medicine, who suspected it to be a case of Swine Flu.

The identity and other particulars of the student were kept secret by the doctors, on the request of his parents, in order to avoid panic reaction among their relatives, friends and other people of Hyderabad. Later, he was referred to the Government Chest Hospital, where he was quarantined and is now undergoing symptomatic treatment.

State medical and health minister K Rosaiah, who on Thursday confirmed that tests had been conducted on the boy, said, “We keep confidential the details of this boy of marriageable age”.

He said the doctors had conducted tests on him as a part of the special screening for foreigners and NRIs, who arrived in city in the last 10 days. And the student was found to have symptoms of Swine Flu.

Swine Flu - India On High Alert

India has increased surveillance at international airports and ports as part of global measures to check the spread of swine flu.

Passengers arriving on flights from the US, Canada and Mexico are being checked for the virus, health officials say.

In Goa, officials are trying to track down British tourists who arrived there after the deadly outbreak.

The virus is thought to have killed nearly 160 people in Mexico, where it was first found.

The number of swine flu cases globally is rising and the US has confirmed that the death of a 23-month-old child there is the first fatality outside Mexico.

Swine flu is usually found in pigs and contracted only by people in contact with the animals.

It can also spread from person to person - probably through coughing and sneezing.

As a potential pandemic edges closer, governments around the world have been stepping up precautions against its spread.

Officials in India have also decided to increase the country's reserves of the antiviral drug Tamiflu.

Swine Flu Infected Countires All Over So Far

Within a day, the swine flu death toll in Mexico climbed to 152, prompting the World Health Organization (WHO) to raise its global pandemic flu alert level to phase four. Confirmed cases in other parts of the world — 50 in the US, six in Canada, two in the UK and one in Spain — have been linked to travel to Mexico.

Brazil, Australia, Israel and New Zealand have suspected swine flu cases, but three of the four people tested for the virus tested negative in France. While the WHO has not advised restriction of international travel, it has asked people with symptoms following international travel to get tested and treated. Swine flu symptoms include fever, lethargy, lack of appetite, cough, runny nose, sore throat, nausea, vomiting and/or diarrhoea. There is no risk of infection from eating well-cooked pork and pork products, says the WHO.

How prepared is India to tackle swine flu? Not as much as the Health Ministry would have us believe. A reality check of the government’s contingency plan to stop swine flu from entering India showed that nothing is in place at Delhi and Mumbai airports that get the most flights from the affected countries.

On Monday afternoon, the health ministry informed the media that it has issued an advisory asking travellers to India from affected countries to report flu symptoms to the airport health authority or call 1075 or 011-23921401.

Ministry officials, however, were still to inform airport authorities, who had got no information till late Tuesday evening. “We have yet to get a notification from the health ministry telling us about what steps need to be taken, but we are planning to add more counters to screen passengers for symptoms of cough, cold and fever,” said a spokesman of the Delhi International Airports Limited. “Usually travel advisories are issued by the WHO, but we have not heard from them or the Indian government,” the Air India spokesperson told HT.

The anti-flu drug oseltamivir (brandname Tamiflu) is very effective against the H1N1 virus that causes swine flu and India has stockpiled 1 million doses, with plans to add another 1 million for an emergency.

Oseltamivir is manufactured in India by several companies, including Cipla and Hetero Drugs. “W are in talks with Mexico, Israel and Latin American countries for oseltamivir and can manufacture 1.5 million doses within four to six weeks. We, however, don’t supply to the Indian government, which I beleive has already stockpiled it,” Cipla’s chief executive Amar Lulla told HT.

Is Swine Flu Infection Causing deaths?

Swine flu spreads, India falters

Within 24 hours, the swine flu death toll in Mexico climbed to 152, putting Indian holiday plans in jeopardy and forcing many frequent fliers to choose conference calls over business travel.

While the World Health Organization (WHO) has not advised restrictions on food (eating pork) or international travel, it has asked all people with flu symptoms travelling through affected countries (see box) to get tested and treated.

Swine flu symptoms include fever, lack of appetite, cough, runny nose, sore throat, nausea, vomiting and/or diarrhoea.

The advisories are expected to affect outbound travel to Europe and US.

“Governments have started issuing advisories and travellers are being asked to take adequate precautions. There could be an estimated 20 per cent fall in overseas travel if infection spreads across continents,” said H.K. Singh, general secretary, Travel Agents Association of India.

Though an advisory has been issued in India, a reality check of the government’s contingency plan showed that nothing is in place at Delhi and Mumbai airports that get the maximum flights from affected countries.

On Monday afternoon, the health ministry announced its travel advisory.

Airport authorities in Delhi were asked to put up health counters late on Tuesday evening. "We haven't got a notification from the health ministry on steps to be taken. We did get a call asking us to set up eight special counters to screen passengers on flights from Mexico, US and Canada from Tuesday midnight," said a Delhi International Airports Limited spokesman.

The health ministry had announced they would assign 32 health officials to Delhi airport and a similar number to Mumbai, who would work in four shifts in groups of eight.

Airlines, however, have still not been informed. "Usually travel advisories are issued by the WHO, but we have not heard from them or the Indian government," the Air India spokesperson told HT.

The situation is no better at Chhattrapati Shivaji International Airport, with the Mumbai International Airport Limited (MIAL) being asked to provide only three counters at the country's busiest airport. "We have been asked to provide facilities by Wednesday noon. They may start screening in the afternoon," said an MIAL spokesperson.

Checking every passenger for symptoms could result in delays and long queues at immigration, fear airport officials. "These counters are located before the immigration counters. It could cause chaos," said an airport official requesting anonymity, as he is not authorised to speak to the media.

Swine Flu Update In India

Santa Clara County Public Health Department
Swine Flu Update: April 27, 2009

Local Situation
At this time there are no reported cases in Santa Clara County. But since it is the role of the Santa Clara County Public Health Department to inform the public, medical community and other local agencies about a potential health emergency, and the current outbreak of swine flu poses a potential risk to the residents of this community, the Public Health Department has taken the following actions:

Activated the Public Health Department Medical/Health Emergency Operations Center, with the Health Officer and at least one Deputy Health Officer on-call at all times.
Has the Public Health Laboratory on alert over the weekend, making resources available to take specimens from local hospitals and physicians.
Participating in regular updates and conference calls with the CDC and the California Department of Public Health.
Conducting interviews with the news media to provide updated information to the general public.
Sent a Health Alert to Santa Clara County Hospitals, Emergency Departments and community physicians providing instructions for surveillance, collecting lab samples and procedures for sending in their samples.
Continues to monitor the situation locally, state-wide, nationally and internationally.

We know people are concerned about swine flu situation and we share that concern. At this early stage of this outbreak, there is a lot of uncertainty and the situation remains very fluid.

National Situation
The Centers for Disease Control and Prevention (CDC) today provided the following update on the 20 confirmed cases of swine flu in the United States:
California: seven (7) confirmed cases
Kansas two (2) confirmed cases
New York City, eight (8) confirmed cases
Ohio, one (1) confirmed case
Texas, two (2) confirmed cases

At this time, the cases in the United State have had mild symptoms, with the exception of one case that was hospitalized. All of these people have or are recovering.

Also today, the US Department of Health declared a Public Health Emergency in the United States. This means they have the ability to release resources, including the national stockpile of Tamiflu for treatment of confirmed swine flu cases. The US Department of Health emphasized that this declaration should be viewed as an early preparedness alert so that local jurisdictions and states can review their plans and put early preparedness efforts in place.

Currently, there are no travel restrictions to or from Mexico but it is anticipated that within the next 24 hour this will change and travel to and from Mexico will be restricted.

California Situation
The seven (7) California cases are located in Southern California:
Five (5) in San Diego County
Two (2 ) in Imperial County

All local California Public Health Departments are conducting active surveillance and continue to remain in communication with each other and the California Department of Public Health. Because of the release of the national stockpile of Tamiflu, California will be receiving 25% of our 5 million courses of treatment, which means 1.25 million courses.

International Situation
The international situation remains fluid. Currently, three nations have confirmed cases of swine flu: Mexico, Canada and the United States. Nations from New Zealand to Spain have also reported suspected cases. The numbers being reported for the situation in Mexico range from 943 to 1,300 swine flu cases, with anywhere from 20 possible deaths due to swine flu to 71 possible deaths.

Next Steps
With the growing concern about this situation, the Public Health Department is planning on taking the following actions this week.

Increase Active Surveillance by placing Public Health Department nurses at all SCC hospitals to assist the infection control staff and report findings quickly to the Public Health Department. We will also develop recommendations and guidance for SCC school districts and the San Jose International Airport specifically, and work with the Mexican Consulate to provide information to the farm worker community and others that may particularly at-risk.

Additionally, the Public Health Laboratory will continue to accept specimens and conduct preliminary tests on these specimens.

In the area of Public Information, we will continue to provide information to members of the news media. Key messages will include:
There is not any specific swine flu action people need to take
What you should do if you have flu symptoms
The importance of limiting the spread of disease and germs and what you should do (wash hands, cover cough, go to sccphd.org or ready.gov for more preparedness information).

Background
These cases of swine flu in humans raises concerns since it is a new flu virus for which people have little or no immunity. Since this is a new flu virus there is no vaccine. Swine flu virus regularly causes outbreaks in pigs but rarely affects humans. Occasionally there have been human infections of swine flu and there have been documented cases of a person spreading swine flu to others.

The symptoms of swine flu are very similar to regular seasonal flu symptoms. These symptoms include fever, coughing, runny nose, sore throat, head and body aches, lack of appetite and lethargy. With swine flu there may be additional gastrointestinal symptoms such as of nausea, vomiting and diarrhea.

For more information about swine flu see the attached flyer or , visit www.cdc.gov/flu/swine

For information in Spanish, visit http://www.cdc.gov/flu/swine/espanol/swine_espanol.htm

Swine Flu Latest News Worldwide

Cases of swine flu have been reported in several U.S. states, Mexico, and a growing number of other countries. While the U.S. government has declared this a “public health emergency,” Homeland Security Secretary Janet Napolitano emphasized that this signifies a “declaration of emergency preparedness,” meaning that national, state, and local health organizations are closely monitoring new cases and taking steps to contain the spread of the virus.

On April 27, 2009, the U.S. Centers for Disease Control and Prevention (CDC) issued a travel advisory recommending that people avoid “non-essential travel to Mexico” (e.g., that they postpone Mexican vacations or other non-necessary trips to the country). For up-to-date CDC travel warnings, advisories, and other notices for Mexico and other destinations, visit the CDC’s travelers’ health page.

Members of the MIT community are urged to follow the same strategies they would ordinarily use to protect themselves and others during a normal cold and flu season:

Wash your hands frequently and thoroughly with soap and warm water or use an alcohol-based hand sanitizer

Cover coughs and sneezes

Avoid touching your eyes, nose, and mouth

Stay home if you are feeling sick

MIT Medical and the Massachusetts Department of Public Health continue to monitor the situation closely. The most up-to-date national and local information is available from the CDC and the state's public health blog.

Statement by WHO Director-General, Dr Margaret Chan

Swine influenza
Ladies and gentlemen,

Based on assessment of all available information, and following several expert consultations, I have decided to raise the current level of influenza pandemic alert from phase 4 to phase 5.

Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world.

Related links


Watch the video [wmv, 7min 13 sec]

Listen to the audio [mp3 57 Mb]

Swine influenza - full coverage

Current WHO phase of pandemic alert

International Health Regulations (IHR)



On the positive side, the world is better prepared for an influenza pandemic than at any time in history.

Preparedness measures undertaken because of the threat from H5N1 avian influenza were an investment, and we are now benefitting from this investment.

For the first time in history, we can track the evolution of a pandemic in real-time.

I thank countries who are making the results of their investigations publicly available. This helps us understand the disease.

I am impressed by the work being done by affected countries as they deal with the current outbreaks.

I also want to thank the governments of the USA and Canada for their support to WHO, and to Mexico.

Let me remind you. New diseases are, by definition, poorly understood. Influenza viruses are notorious for their rapid mutation and unpredictable behaviour.

WHO and health authorities in affected countries will not have all the answers immediately, but we will get them.

WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels.

The results of these ongoing assessments will be issued as public health advice, and made publicly available.

All countries should immediately activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.

At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace.

I have reached out to donor countries, to UNITAID, to the GAVI Alliance, the World Bank and others to mobilize resources.

I have reached out to companies manufacturing antiviral drugs to assess capacity and all options for ramping up production.

I have also reached out to influenza vaccine manufacturers that can contribute to the production of a pandemic vaccine.

The biggest question, right now, is this: how severe will the pandemic be, especially now at the start?

It is possible that the full clinical spectrum of this disease goes from mild illness to severe disease. We need to continue to monitor the evolution of the situation to get the specific information and data we need to answer this question.

From past experience, we also know that influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries.

No matter what the situation is, the international community should treat this as a window of opportunity to ramp up preparedness and response.

Above all, this is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic.

As I have said, we do not have all the answers right now, but we will get them.

Thank you.

courtesy:WHO website

Swine influenza Latest Update News

29 April 2009 -- The situation continues to evolve rapidly. As of 18:00 GMT, 29 April 2009, nine countries have officially reported 148 cases of swine influenza A/H1N1 infection. The United States Government has reported 91 laboratory confirmed human cases, with one death. Mexico has reported 26 confirmed human cases of infection including seven deaths.

The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (13), Germany (3), Israel (2), New Zealand (3), Spain (4) and the United Kingdom (5).

Further information on the situation will be available on the WHO website on a regular basis.

WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.

There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

source:WHO

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 internationally. The current U.S. case count is provided below.

An investigation and response effort surrounding the outbreak of swine flu is ongoing.




CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization. This includes deploying staff domestically and internationally to provide guidance and technical support.

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 will allow funds to be released to support the public health response.

CDC's goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist health care providers, public health officials and the public in addressing the challenges 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 will provide updated guidance and new information as it becomes available.

Risk of Swine Flu Associated with Travel to Affected Areas

Public health officials within the United States and throughout the world are investigating outbreaks of swine influenza (swine flu).

Swine flu is a respiratory disease of pigs caused by a type A influenza virus that regularly causes outbreaks of influenza among pigs. Swine flu viruses do not normally infect humans; however, human infections with swine flu do occur. Public health officials have determined that this strain of swine flu virus spreads from human to human and can cause illness.

The outbreak is ongoing and additional cases are expected. For more information concerning swine flu infection, please see the Centers for Disease Control and Prevention (CDC) website: http://www.cdc.gov/swineflu/. For specific information on travel precautions and an update on the affected areas, please visit: www.cdc.gov/travel.

The symptoms of swine flu in people are similar to the symptoms of seasonal flu in humans and may include:

Fever (greater than 100°F or 37.8°C)
Sore throat
Cough
Stuffy nose
Chills
Headache and body aches
Fatigue

Some people have reported diarrhea and vomiting associated with swine flu. Severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

People entering the United States who are experiencing symptoms consistent with swine flu and have traveled to an affected area (see http://www.cdc.gov/swineflu/investigation.htm for affected areas), or have been exposed to someone possibly infected with swine flu, during the last 7 days should report their illnesses to their health care provider immediately and inform them of their recent travel.

People traveling from the United States to affected areas should be aware of the risk of illness with swine flu and take precautions.

To prevent the spread of swine flu:

Avoid contact with ill persons.

When you cough or sneeze, cover your nose and mouth with a tissue or your sleeve (if you do not have a tissue). Throw used tissues in a trash can.
After you cough or sneeze, wash your hands with soap and water, or use an alcohol-based hand gel.

If you think you are ill with flu, avoid close contact with others as much as possible. Stay at home or in your hotel room. Seek medical care if you are severely ill (such as having trouble breathing). There are antiviral medications for prevention and treatment of swine flu that a doctor can prescribe. Do not go to work, school, or travel while ill.