Swine flu - information prescription Introduction Swine flu is a relatively new strain of influenza (flu) that was responsible for a flu pandemic during 2009-2010. It is sometimes known as H1N1 influenza because it is the H1N1 strain of virus. On 10 August 2010, the World Health Organization (WHO) declared that the swine flu pandemic was officially over. However, this does not mean that swine flu can be ignored. The swine flu virus will be one of the main viruses circulating this winter. It has therefore been included in the 2012-13 seasonal flu vaccine. Vaccination It is recommended that people in high-risk groups be vaccinated against swine flu. This includes all pregnant women, at any stage of pregnancy. Pregnant women in high-risk groups and those not in high-risk groups are advised to take the seasonal flu jab, which protects against swine flu. This is because there is good evidence that all pregnant women are at increased risk from complications if they catch swine flu. For more information, see swine flu advice for pregnant women. For general information about flu, see seasonal flu and seasonal flu jab. What to do if you have swine flu People with swine flu typically have a fever or high temperature (over 38C or 100.4F) and may also have aching muscles, sore throat or a dry cough (see symptoms of swine flu). The symptoms are very similar to other types of seasonal flu. Most people recover within a week, even without special treatment.
Contact your GP if you think you have swine flu and you are worried. They will decide the most appropriate action to take. The National Pandemic Flu Service no longer operates. High-risk groups Some people are more at risk of complications if they catch flu. People are particularly vulnerable if they have: chronic (long-term) lung disease chronic heart disease chronic kidney disease chronic liver disease chronic neurological disease (neurological disorders include motor neurone disease, multiple sclerosis and Parkinson's disease) immunosuppression (whether caused by disease or treatment) diabetes mellitus Also at risk are: patients who have had drug treatment for asthma in the past three years pregnant women people who are 65 years of age or over See preventing swine flu for a full list of people advised to have this year's flu jab. Preventing the spread of swine flu The most important way to stop flu spreading is to have good respiratory and hand hygiene. This means sneezing into a tissue and quickly putting it in a bin. Wash your hands and work surfaces regularly and thoroughly to kill the virus. Anyone who is concerned about flu symptoms should contact their GP, who will determine the most appropriate action to take. For more information about how the H1N1 virus spreads, see causes of swine flu. Swine flu is the H1N1 strain of the virus that caused a pandemic in 2009
The swine flu pandemic In 2009, swine flu spread quickly around the world, before dying down in the spring of 2010. This type of global outbreak is known as a pandemic. The virus was first identified in Mexico in April 2009. It spread rapidly from country to country because it was a new type of flu virus that few people had full resistance to. Flu pandemics are a natural event that occur from time to time. In the last century, there were flu pandemics in 1918, 1957 and 1968, when millions of people died across the world. The 2009 swine flu virus proved to be relatively mild and the pandemic was not as serious as originally predicted. As in other countries, most cases reported in the UK were mild. There were a small number of cases that resulted in serious illness and death. These were mostly in people with pre-existing health conditions, such as cancer, that had already weakened their immune systems. Symptoms of swine flu The symptoms of swine flu are similar to those of other types of seasonal flu. The effects of the illness are often mild, but some people (see below) are more at risk of serious illness. If you or a member of your family has a fever or high temperature (over 38C/100.4F) and two or more of the following symptoms, you may have swine flu:
unusual tiredness headache runny nose sore throat shortness of breath or cough loss of appetite aching muscles diarrhoea or vomiting It makes sense to have a working thermometer at home, as an increase in temperature is one of the main symptoms. If you are unsure how to use a thermometer, read about how to take someone's temperature. What to do If you have flu-like symptoms, stay at home, get plenty of rest and use over-the-counter painkillers to relieve symptoms. If you are concerned, contact your GP. They will determine the most appropriate action to take. High-risk groups For most people, swine flu is a mild illness. Some people get better by staying in bed, drinking plenty of water and taking over-the-counter flu medication. However, some groups of people are more at risk of serious illness if they catch flu. It is already known that you are particularly at risk if you have: chronic (long-term) lung disease chronic heart disease chronic kidney disease chronic liver disease chronic neurological disease (neurological disorders include chronic fatigue syndrome, multiple sclerosis and Parkinson's disease) immunosuppression (whether caused by disease or treatment) diabetes mellitus Also at risk are:
patients who have had drug treatment for asthma within the past three years pregnant women people who are 65 years of age or over Outlook For most people, the illness appears to be mild. For a minority of people, the virus can cause severe illness. In many of these cases, other factors contribute to the severity of the illness. When complications occur, they are usually caused by the virus affecting the lungs. Infections such as pneumonia can develop. How swine flu spreads The swine flu virus is spread in exactly the same way as the common cold and other flu viruses. The virus is contained in the millions of tiny droplets that come out of the nose and mouth when someone coughs or sneezes. These droplets typically spread about 1 metre (3 feet). They hang suspended in the air for a while, but then land on surfaces, where the virus can survive for up to 24 hours. Anyone who touches these surfaces can spread the virus by touching anything else. Everyday items at home and in public places may have traces of the virus. These include food, door handles, remote controls, hand rails and computer keyboards. People usually become infected by picking up the virus on their hands from contaminated objects and then placing their hands near their mouth or nose. It is also possible to breathe in the virus if it is suspended in airborne droplets. Good hygiene
Preventing the spread of germs is the most effective way to slow the spread of diseases such as swine flu: Ensure everyone washes their hands regularly with soap and water. Clean surfaces regularly to get rid of germs. Use tissues to cover your mouth and nose when you cough or sneeze. Put used tissues in a bin as soon as possible. Read more about preventing swine flu. The rapid spread of flu Evidence from previous pandemics suggests that one person will infect about two others, and that flu spreads particularly rapidly in closed communities such as schools or residential homes. People are most infectious soon after they develop symptoms, although they can spread the virus for up to five days after the start of symptoms (for children this is seven days). Treating swine flu Swine flu is treated in a similar way to ordinary flu. Antiviral and antibiotic medications are also available if further treatment is needed or complications develop. As with ordinary flu, people who have swine flu should get lots of rest and use standard paracetamol-based cold remedies to reduce their temperature and help relieve symptoms.
Some over-the-counter treatments used by adults can be given to children for the relief of the symptoms. Follow the instructions that come with each medicine. However, children under 16 must not be given aspirin or ready-made flu remedies containing aspirin. Always read the label or check with the pharmacist that a medicine is suitable for children. Antivirals The antiviral medications oseltamivir (Tamiflu) and zanamivir (Relenza) may be used to treat some people with swine flu. Your GP will decide if these are necessary. Antivirals are not a cure for swine flu, but will help: reduce the length of time you are ill by around one day relieve some of the symptoms reduce the potential for serious complications such as pneumonia Tamiflu and Relenza are both medicines of the same type, but Relenza comes as an inhaler (rather than a pill) and is recommended for use in pregnancy. If you are prescribed antivirals, you will need to pay a prescription charge (unless your prescriptions are normally free of charge). Antibiotics Antibiotics are used to treat swine flu patients who develop complications. They help combat bacterial infections such as pneumonia. In hospitals, antibiotics will be used to treat the most ill patients and may reduce the length of hospitalisation.
Swine flu medicines To learn about the medicines that are used to treat swine flu, including the benefits and side effects, see the flu medicine guide. Swine flu advice for pregnant women Pregnant women are at greater risk from swine flu because their immune system is suppressed during pregnancy. This means that pregnant women are more likely to catch flu and, if they do, they are at greater risk of developing complications (see below). However, during pregnancy, the immune system still functions and the risk of complications is very small. Most pregnant women will only have mild symptoms. Symptoms and risks If you are pregnant and you catch swine flu, the symptoms are likely to be similar to those of normal flu. You will usually have a fever (a high temperature of or above 38C/100.4F), plus two or more of the following symptoms: unusual tiredness headache runny nose sore throat shortness of breath or cough
loss of appetite aching muscles diarrhoea or vomiting Most pregnant women will have only mild symptoms and recover within a week. However, there is evidence from previous flu pandemics that pregnant women are more likely to develop complications. Possible complications include: pneumonia (an infection of the lungs) difficulty breathing dehydration In pregnant women, these are more likely to happen in the second and third trimester. If a pregnant woman develops a complication of swine flu, such as pneumonia, there is a small chance this will lead to premature labour or miscarriage. There is not yet enough information to know precisely how likely these birth risks are. It is therefore important to be well prepared and to take precautions against swine flu. Vaccination and pregnancy Pregnant women are advised to take the seasonal flu jab, whatever the stage of pregnancy. This includes pregnant women not in high-risk groups. This year's seasonal flu jab offers protection against the swine flu virus, as well as other strains of flu virus. There is no evidence that inactivated vaccines, such as the seasonal flu vaccine, will cause any harm to pregnant women or their unborn baby. Every year, the seasonal flu vaccine is given to pregnant women who are at risk of flu. The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency has given a clear recommendation that the GlaxoSmithKline vaccine Pandemrix can be given safely to all pregnant women. Special precautions If you are pregnant, you can reduce your risk of infection by avoiding unnecessary travel and avoiding crowds
where possible. Pregnant women should also follow general measures to prevent swine flu, as described below. Good hygiene is essential. You can reduce, but not eliminate, the risk of catching or spreading swine flu by: always covering your nose and mouth with a tissue when coughing or sneezing throwing away dirty tissues promptly and carefully maintaining good basic hygiene, for example washing hands frequently with soap and warm water to reduce the spread of the virus from your hands to your face, or to other people cleaning hard surfaces, such as door handles, frequently using a normal cleaning product If you think you may have swine flu, call your doctor for an assessment. Your doctor will advise you what to do if they think you have flu. Unless you have swine flu symptoms, carry on attending your antenatal appointments to monitor the progress of your pregnancy. Antivirals If you are pregnant and diagnosed with swine flu, you may be given a course of antiviral medication. If you have an uncomplicated illness due to influenza and do not have an underlying disease, you can take either Relenza or Tamiflu. Relenza is recommended as a first choice. Relenza is inhaled using a disk-shaped inhaler. It is recommended for pregnant women because it easily reaches the throat and lungs, where it is needed, and does not reach significant levels in the blood or placenta. Relenza should not affect your pregnancy or your growing baby. However, Tamiflu should be offered instead of Relenza if you: have a condition such as asthma or chronic obstructive pulmonary disease have difficulty taking an inhaled antiviral develop a severe or complicated disease due to influenza (where you will probably be treated in hospital) An expert group reviewed the risk of antiviral treatment in pregnancy. It is much smaller than the risk posed by the
symptoms of swine flu. Some people have had wheezing or serious breathing problems when they have used Relenza. Relenza is therefore not recommended for people with asthma or chronic obstructive pulmonary disease (COPD). Other possible side effects of Relenza include headaches, diarrhoea, nausea and vomiting. In a small number of cases, nausea is a side effect of Tamiflu. If you take an antiviral and have side effects, see your healthcare professional to check that you are OK. Painkillers You can also take paracetamol to reduce fever and other symptoms. This is safe to take in pregnancy. However, pregnant women should not take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Nurofen). Preventing swine flu The most effective way to prevent the spread of infections, such as flu, is to practise good hygiene. A seasonal flu jab is also available for people who are most at risk. You can protect yourself and your family by: ensuring everyone washes their hands regularly with soap and water cleaning surfaces regularly
You can prevent a virus spreading to others by: always carrying tissues using tissues to cover your mouth and nose when you cough and sneeze binning the tissues as soon as possible washing your hands regularly The phrase 'catch it, bin it, kill it' is a simple way to remember this. Seasonal flu jab This winter, the swine flu virus has been included in this year's seasonal flu jab. It means that the vaccine will protect you from swine flu, as well as other strains. Vaccination is given free of charge to the following at-risk people, to protect them from flu: people with a serious medical condition (see paragraph below) people aged 65 or over pregnant women people living in a residential or nursing home the main carers for an elderly or disabled person whose welfare may be at risk if the carer becomes ill healthcare or social care professionals directly involved in patient care those who work in close contact with poultry, such as chickens For more information about flu immunisation, including background information on the vaccine and how you can get the jab, see seasonal flu jab. Conditions that increase your risk The seasonal flu jab is offered free of charge to anyone over the age of six months with the following medical conditions, as they are at higher risk of catching flu: chronic (long-term) respiratory disease, such as severe asthma, COPD or bronchitis chronic heart disease, such as heart failure chronic kidney disease chronic liver disease chronic neurological disease, such as Parkinson's disease or motor neurone disease
diabetes a weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment) Antiviral medication The National Institute for Health and Clinical Excellence (NICE) recommends the antiviral medicines oseltamivir and zanamivir to prevent flu if all of the following apply: The amount of flu virus circulating is sufficient to mean that if someone has a flu-like illness, it is likely to have been caused by this flu virus. The person has a certain medical condition (see above) or is over 65 years of age. The person has been in contact with someone with a flu-like illness and can start treatment within 36 hours (zanamivir) or within 48 hours (oseltamivir). The person has not been effectively protected by vaccination (see below). People who are not effectively protected by vaccination include: Those who have not been vaccinated since the previous winter. Those who cannot be vaccinated, or who have been vaccinated but it has not taken effect yet. Those who have been vaccinated for a different form of flu virus. If there is an outbreak of seasonal flu in a residential or nursing home, oseltamivir and zanamivir may be offered to people if they have been in contact with someone with confirmed flu. This is because these homes are closed places in which flu can spread quickly. For more information, see the NICE guidelines on antivirals to prevent influenza.