PANDEMIC INFLUENZA. Be Informed... Be Prepared. A Community Information Booklet MORE INFORMATION - For more information or advice, contact:

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1 MORE INFORMATION - For more information or advice, contact: Department of Human Services Victoria - Communicable Disease Control Unit on CALL THE SWINE INFLUENZA HOTLINE on PANDEMIC INFLUENZA Be Informed... Be Prepared Department of Human Services: community.htm Australian Government Department of Health and Ageing: publishing.nsf Department of Foreign Affairs and Trade: World Health Organization: index.html Centres for Disease Control and Prevention (USA): Please note: The containment strategies listed in this booklet are a guide only and may change depending on State/Commonwealth discussions and best available evidence at the time of an influenza pandemic It will 24 be important to listen for public announcements on TV, radio and other media about the pandemic. A Community Information Booklet Department of Human Services

2 ABOUT THIS BOOK Reading this booklet may save your life! This Booklet is designed to be used by the general public to provide basic information about what to do in the event of an influenza pandemic. Detailed information about pandemic influenza and the management of an influenza pandemic is contained in the following official publications: Victorian Health Management Plan for Pandemic Influenza Australian Management Plan for Pandemic Influenza Acknowledgement is made of use of the above publications in the development of this booklet. Acknowledgment is also made of use of the booklet Pandemic Preparedness, Look after yourself. How to care for yourself and the people you care about - Vancouver Coastal Health & British Columbia 2007, in the preparation of this booklet. This booklet is part of the Little Yellow Infection Control Booklet series produced by Bruce Fowkes and Mary Smith for the Grampians Region Infection Control Group. For other infection control resources visit : Resources/index.aspx DISCLAIMER: Care has been taken to confirm the accuracy of the information presented in this guide, however, the authors and publisher are not responsible for errors or omissions or for any consequences from application of the information in the guide and make no warranty, express or implied, with respect to the contents of the publication. Every effort has been made to ensure the information provided is in accordance with current recommendations and practice. However, in view of ongoing research, changes in government 2 regulations and the flow of other information, the information is provided on the basis that all persons undertake responsibility for assessing the relevance and accuracy of its content. Emergency Kit for all sorts of emergencies not just flu: 23 First aid kit Extra supplies of paracetamol or ibuprofen - for aches, pains and fever Torch, spare batteries Radio, spare batteries Can opener (manual) Gas BBQ - don t forget the gas bottle. Emergency food and water enough for 7 days Ready to eat canned and dried food Dried and long life milk Snack food Supplies for babies and small children 3 litres of water per person per day Toilet rolls Soap Detergent/disinfectant and cleaning equipment Stock up on prescription medications. Personal protective equipment If a pandemic becomes widespread in the community, authorities may encourage people who are not sick to wear a mask or other covering for the nose and mouth to help protect them from catching the virus. It is particularly important for people who are sneezing or coughing to also wear a mask if possible to prevent the spread of infection to others. Surgical face masks Tissues and plastic bags for disposal of used tissues Handwashing soap or alcoholbased hand rub. Listen for public announcements on TV, radio and other media about the influenza pandemic.

3 CONTENTS Be prepared to stay at home for several days/weeks... If you have been in contact with an infected person or have just returned from a pandemic influenza affected area you may be asked to stay at home for 7 to 10 days. Work and school may be closed for prolonged periods. Depending on the severity of the pandemic and the number of people affected, it is possible that there will be intermittent disruption to: Food supply Medical supplies Water Fuel/transport Electricity Telephone system Internet. Plan ahead have an emergency supply of food and essentials stored in your pantry. Have items at home to occupy you and your family if you have to stay at home for a couple of weeks. Think about activities that do not involve using electricity as basic supplies may be disrupted in the event of an influenza pandemic. DON T PANIC BUT BE PREPARED Page What is seasonal influenza? 4 Is it a cold or influenza? 5 How is influenza spread? 6-7 How is influenza diagnosed? 8 What treatment is available? 9 How serious is influenza? 9 Cover your cough 10 How do you protect yourself against flu? 11 Annual influenza vaccine 11 What is swine influenza? 12 Why are authorities worried? 12 What is an influenza pandemic? 13 What if there is a flu pandemic? 14 Pandemic influenza vaccine 14 What can you do to stay healthy? What if you come in contact with the flu? 18 Recording your temperature and symptoms 19 What to do if you become ill with the flu 20 Looking after others 21 Be prepared to stay at home 22 Emergency kit 23 More information

4 What is seasonal influenza? Seasonal influenza is an acute respiratory infection caused by either type A or type B influenza virus. The influenza virus mainly attaches to the nose, throat and lungs and causes mild to severe illness depending on: Type of virus Age of affected person General health of affected person. Symptoms of influenza include: Fever (>38 o C) Headache Muscle aches Sore throat Runny nose Dry cough Shivers Tiredness and weakness Loss of appetite Diarrhoea and vomiting - in children and the elderly. It can take from 1 up to 7 days for you to become ill after you are exposed to the virus. You are able to pass on the virus to others from onset of illness until 7 days after the fever has resolved (12 years or over). Children less than 12 years can spread the virus for up to 21 days after onset of illness. Looking after others During a pandemic you can help your family, friends and neighbours stay healthy. Check up on family, friends and neighbours, especially those who live alone Offer to get groceries and run errands for those who are at higher risk of getting influenza or serious complications from influenza, such as seniors or people with chronic medical conditions Keep emergency phone numbers and self-care instructions in a place where everyone in the household can find them Schools and community centres may be closed: keep books and games at home for children to play with Arrange for childcare that reduces your children s exposure to crowds Make arrangements for school work to be done from home. Most symptoms resolve within two to seven days although the cough may persist longer. Complications of influenza include middle ear infections, secondary bacterial pneumonia and exacerbation of underlying 4 21 chronic health conditions.

5 Is it a Cold or Influenza? If you become sick: Stay home from work, school or shopping when you are sick at least 7 days after your symptoms start Ask for help if you live alone, are a single parent with small children or have trouble looking after yourself or others Do not get too close to uninfected relatives and friends - try to keep a distance of greater than one metre Stay in your room as much as possible, if more than one person in the home is ill, they can share a room Keep your personal items separate from those of the rest of the household Do not share towels Do not share eating utensils or drinks with anyone Clean frequently touched surfaces frequently taps, doorknobs, telephones, benches, railings There is no need for special handling of laundry or linen, launder as usual, wash hands after handling laundry items There is no need for special handling of garbage generated by a person who has influenza, wash hands after handling waste. Influenza (Influenza Virus) Common Cold (Rhino Virus) Onset Abrupt Less abrupt Symptoms Fever C, chills, headache (can be severe), muscle aches, cough, extreme fatigue and weakness, chest discomfort Duration Approximately 7 days very unwell Sore throat, runny nose, nasal congestion 3-7 days - usually 1-2 days Fatalities Well recognised Not reported 20 5

6 How is influenza spread? Transmission of respiratory viruses Influenza is mainly spread by coughing and sneezing moist particles which travel up to one metre. Hands which are used to hold handkerchiefs and tissues and cover coughs also spread virus particles. Surfaces and objects handled by infected persons with unwashed hands provide reservoirs of virus particles which are picked up by other persons hands. The mouth, nose and eyes of un-infected persons are danger zones for the absorption of virus particles. 6 Recording temperature and symptoms Do not take your temperature for 30 minutes after having a hot or cold drink, having a hot shower or bath, exercising or smoking Take your temperature before you take any medication that lowers your temperature (e.g. aspirin, paracetamol, ibuprofen If you have taken any of these medications, wait for 6 hours before taking your temperature. Day Date Time Temp. Symptoms, if any If you develop a fever of 38 o C or higher or develop any symptoms of influenza you should: Seek medical attention immediately phone ahead, tell the receptionist about your symptoms so you can be seated away from others, you may even be asked to wear a mask Doctors Phone Number:..... Try and stay away from other people Make sure all other household members practice 19 very good hygiene practices. For more information:

7 What if you have been exposed to the influenza virus? You may be quarantined you may be asked to stay at home for 7 10 days after contact with an infected person or if you have returned from a pandemic influenza infected area. Especially easy to spread in crowds: Work, school, church.. Is there any risk to my family and friends? The risk of spread of infection from infected people is quite high. If you have been exposed and become unwell, people who have been in close contact with you will be assessed, monitored and, if necessary, given antiviral medication. Antiviral medication may reduce the risk of becoming unwell, especially if taken very soon after exposure. Precautions to take if you have been exposed. Check your temperature daily for seven days after your last exposure to pandemic influenza If you have been advised to take anti-viral medication, take the medication daily for seven days after your last exposure to pandemic influenza Stay at home even if you are free of symptoms. Symptoms: Fever > 38 o C, Shivers Headache, Muscle aches Cough Runny nose, Sore throat Tiredness, Weakness Diarrhoea, Vomiting (children, elderly) Direct contact is important, as the virus will survive some hours in dried mucus, particularly in cold and dry environments. Infectious virus can be transferred to hands from nonporous surfaced for at least 2-8 hours Virus transfer from porous materials to the hands is much less efficient - up to 15 minutes

8 How is influenza diagnosed? A clinical diagnosis can be confirmed by culture or antigen testing of appropriate respiratory specimens such as nasopharyngeal aspirate or nose and throat swabs, taken within five days of onset. The more time you spend in contact with others during a pandemic, the more likely you are to be in contact with someone who is carrying the influenza virus! Or it can be confirmed by serology performed on blood specimens taken during the acute and convalescent stages. A sample of nose or throat mucous is collected using a swab The sample is sent to Pathology for testing 8 17

9 Avoid Crowds Limit visitors to your home Shop at smaller stores with shorter line-ups Shop at off peak hours at stores that stay open late or are open 24 hours If possible, phone your grocery order in for quick pickup or delivery Pay your bills at an ATM, online or over the phone Cancel or postpone family outings or gatherings. What treatment is available? Have someone around to care for a person who has influenza Stay at home, away from work/school and avoid contact with others while the infection is contagious (7 days or up to 21 days for children) Ensure adequate fluids and bed rest Take medications to help with fever and pain, such as aspirin (not in children) and paracetamol Antiviral treatment give within hours of onset of illness, it is important to seek medical attention early so that antiviral medication can be commenced immediately Stay healthy at work or school Wash your hands often with soap and water or use a hand sanitizer Work from home or arrange to work flexible hours, if possible Clean objects, such as phones and hard surfaces that are handled by many people, with a disinfectant Keep your office door closed Use stairs instead of crowded elevators If you must meet people, stay 1 metre apart Avoid shaking hands, kissing or hugging people Cancel unnecessary meetings, use teleconferencing or video conferencing, telephone, s, or fax Travel on public transport at off peak hours, drive your car, walk or ride your bike to school or work 16 Take your lunch and eat it at your desk or away from others, avoid crowded cafeterias and restaurants. 9 Antibiotics are not effective because the flu is caused be a virus and antibiotics fight bacteria. How serious is influenza? Those people at greater risk include: The very young The elderly Pregnant women People with long term illness People with decreased immunity.

10 What can you do to stay healthy in an influenza pandemic? Short of a vaccine, there are many simple ways you can substantially reduce your risk of being infected by or spreading the influenza virus and improve your chances of a speedy recovery. Good hygiene such as washing your hands regularly, helps reduce your risk of infection Cover your nose and mouth with a tissue when coughing or sneezing or cough and sneeze into your sleeve Maintain general good health, eat nutritious food, including plenty of fruit and vegetables Get plenty of sleep Exercise in moderation Get your annual flu shot Don t smoke and don t allow others to smoke in the house or car It is a good idea, as much as possible, to avoid contact with people who are sick Stay at home if you are sick or feel unwell, rest and drink plenty of fluids

11 What if there is a flu pandemic... WHAT MIGHT HAPPEN? Some workplaces and schools might close Normal health and other services may not be available for several weeks You might need to care for yourself and others at home There will be public announcements on TV, radio and other media about the pandemic. Can pandemic influenza kill people? Yes, however, there are treatments available in the form of antiviral medication and ways to prevent infection from occurring in the first place. Government and health authorities have strategies in place to reduce the spread and impact of the pandemic in the population. The availability of antibiotics should reduce the number of deaths from associated bacterial pneumonia. Pandemic influenza vaccine This will be a new strain of the flu virus so the seasonal flu vaccine will not work. Once the strain of influenza that causes the pandemic is identified, it may take several months to develop a vaccine. There may be no vaccine available during the first wave of a pandemic. When a vaccine is available it will be in short supply. Governments and medical experts have identified highrisk groups who will received the vaccine first. 14 How do you protect yourself against seasonal flu? Yearly influenza vaccination 2. Attention to personal hygiene 3. Do not share eating utensils or drinks 4. Don t visit people who have the flu unless absolutely necessary 5. Avoid large crowds or gatherings in the flu season. Annual influenza vaccine Free annual influenza vaccine is provided and recommended for the following groups in Victoria: All people aged 65 years and older All Aboriginal and Torres Strait Islanders aged 50 years and older, and those aged years who are at high risk for the complications of influenza including those with: chronic disease such as diabetes, heart, lung, kidney or liver disease decreased immunity living in chronic care facilities All public hospital staff in both outpatient and ward settings who provide direct care to patients, to protect themselves and their patients Annual influenza vaccination is also recommended for staff working in nursing homes and other chronic care facilities to protect themselves and their patients.

12 What is Swine Influenza? Swine influenza (swine flu) is a respiratory disease of pigs caused by Type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Outbreaks and sporadic human infection with swine influenza have been occasionally reported. Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death. Recently increased cases of human infection with swine influenza A (H1N1) virus have been reported in Mexico and cases have spread to the USA and internationally as well. What are the symptoms of swine flu in humans? - The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhoea. Current Treatment The swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir (brand name Tamiflu ) and zanamivir (brand name Relenza ). What is an influenza pandemic? Pandemic influenza is a human disease caused by a completely new virus. The virus is different to the seasonal influenza virus that normally affects humans, and may cause infection in many people because almost no one will be immune to it. An influenza (flu) pandemic is a flu outbreak that occurs worldwide when: 1. A new strain of flu virus emerges, to which noone is immune 2. The virus causes disease in humans 3. The virus is easily spread between humans. A new influenza strain can spread rapidly across the globe with high numbers of cases and deaths and this appears to be what is happening in the case of the swine influenza virus. It is over 35 years since the last flu pandemic (history shows they occur every years) so the world is overdue for an influenza pandemic. The symptoms of pandemic influenza are the same as seasonal flu and it is spread in the same way via close contact with an infected person while they are talking, coughing or sneezing. Touching contaminated surfaces then putting your fingers in your eyes, nose or mouth may also place you at risk. The Centre for Disease Control (CDC) and the World Health Organisation (WHO) have determined that this strain of swine influenza virus is contagious and is spreading human to human. The authorities have declared that there is a high chance that this outbreak of swine influenza will lead to an influenza pandemic.