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Health Department - H1N1 Flu Information

Frequently Asked Questions About H1N1 Flu

• General Information
  • What is 2009 H1N1?
  • Why is this new H1N1 virus sometimes called “swine flu”?
• Cases in Virginia
  • What are the latest numbers regarding confirmed cases of H1N1 A virus in Virginia?
• Exposure
  • What is the incubation period after exposure?
• How does it spread?
  • How does H1N1 flu spread?
  • How long can an infected person spread this virus to others?
  • What surfaces are most likely to be sources of contamination?
  • How long can influenza virus remain viable on objects (such as books and doorknobs)?
• Food
  • Can people catch this flu from eating pork?
  • Should I be concerned about eating at Mexican restaurants?
• Prevention
  • What can people do to prevent being infected by the H1N1 virus?
  • How can people decrease the spread of H1N1?
  • What is the best technique for washing my hands to avoid getting the flu?
• Masks
  • Should masks be used?
  • Facemasks/Respirators
• Signs & Symptoms
  • What are the flu symptoms?
  • What should I do if I get sick?
• Diagnosis/Testing
  • Is there a test to know for sure if I have 2009 H1N1 flu?
  • Is there a rapid test available at my doctor's office or public health clinic for flu?
• Vaccines and medicines
  • Are there medicines to treat H1N1 flu?
  • What is the availability of antiviral medication, are there sufficient quantities?
  • How can I get antivirals?
  • Is a previous swine flu vaccination still effective?
  • When will the vaccine be ready?
  • Should I be getting the vaccine?
  • Is the seasonal vaccine and the H1N1 vaccine the same thing?
  • Can both seasonal and H1N1 vaccine be taken at the same time?
  • How and where will I get the vaccine?
• Severe Illness
  • When should I call 911?
• Travel
  • Should I cancel my travel plans?
  • Should I travel to Mexico?
• Babies/Children
  • What can I do to protect my baby?
  • Does breastfeeding protect babies from this new flu virus?
  • Should I stop breastfeeding my baby if I think I have come in contact with the flu?
  • Is it ok to breastfeed my baby if I am sick?
  • If my baby is sick, is it okay to breastfeed?
  • Is it okay to take medicine to treat or prevent novel H1N1 flu while breastfeeding?
• Schools
  • What is VDH telling schools to do?
• Government Preparedness
  • What is Virginia doing?
  • Why has a public health emergency been declared in Virginia?
• Health Care Providers
  • I am a health care provider. What do I need to know about testing patients?
  • I am a health care provider. How do I get testing kits?
• Immigrants
  • Should I be concerned about seeking medical assistance if my immigration status is in question?
• Pregnant Women
  • What if I get this new virus and I am pregnant?
  • If I’m pregnant and work in schools/childcare or healthcare, what precautions should I take?
• Water
  • Is there a risk from drinking water?
  • Can the novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
• Cleaning
  • What household cleaning should be done to prevent the spread of influenza virus?
  • How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
• Miscellaneous
  • What other examples of swine flu outbreaks are there?
  • Are the cases of swine flu in the U.S. connected to the cases in Mexico?
  • If I get this flu, can I get it again?
  • Is seasonal flu more deadly than H1N1?
  • When would you advise having an emergency kit in case of quarantine?

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General Information

What is 2009 H1N1?

This is a new strain of the influenza A (H1N1) virus that has not previously been seen in humans. It causes fever and respiratory illness. The new strain combines strains from viruses that affect humans, birds and pigs.

Why is this new H1N1 virus sometimes called “swine flu”?

This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian genes and human genes. Scientists call this a “quadruple reassortant” virus.

Cases in Virginia

What are the latest numbers regarding cases of 2009 H1N1 virus in Virginia?

The Virginia Department of Health (VDH) monitors the level of activity of influenza like illnesses (ILI) each week. VDH uses a number of different data sources to determine the level of flu activity that is occurring each week during flu season. The main data sources that are used to make the weekly flu activity level determination are, laboratory reports, outbreak reports, and data on visits to hospital emergency departments and urgent care centers for flu-like illness.

Flu surveillance is not designed to count every person who has the disease. That would be nearly impossible because not all people with the disease are diagnosed by a physician and even fewer have their illness confirmed by a laboratory test. Instead, VDH monitors changes in flu activity from week to week in each of the five regions to look for increases compared to a baseline period.

For information about current influenza activity please visit the VDH website.

Exposure

What is the incubation period after exposure?

The estimated incubation period is not confirmed and could range from 1-7 days. However, it is more likely to only be 1-4 days.

How does it spread?

Is this virus contagious?

CDC has determined that 2009 H1N1 virus is contagious and is spreading from human to human.

How does H1N1 flu spread?

Spread of this influenza 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 long can an infected person spread this virus to others?

People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface.

Food

Can people catch this flu from eating pork?

No. The virus is not transmitted by food. You cannot get infected by eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills bacteria and viruses.

Should I be concerned about eating at Mexican restaurants?

No. Restaurants in Virginia are inspected on a regular basis. The reports are posted on our the VDH Web site at VDH.Virginia.gov

Prevention

What can people do to prevent being infected by the H1N1 virus?

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

• Covering coughs (Cough into your sleeve. If you cover your nose and mouth with a tissue when you cough or sneeze throw the tissue in the trash after you use it and wash your hands with soap and water or alcohol-based hand sanitizer.)
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are effective, too.
• Try to avoid close contact with sick people.
• If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
• Avoid touching your eyes, nose or mouth. Germs spread that way.

How can people decrease the spread of Influenza A (H1N1)?

Taking the following steps can decrease the spread of flu:

• Frequent hand washing
• Covering coughs (Cough into your sleeve. If you cover your nose and mouth with a tissue when you cough or sneeze throw the tissue in the trash after you use it and wash your hands with soap and water or alcohol-based hand sanitizer.)
• Having ill persons stay home, except to seek medical care
• Minimizing contact with others
• Eat healthy foods, get enough rest and exercise regularly.
• Use the disposable wipes available at grocery/retail stores to wipe handles of shopping carts.
• Having household members of cases minimize contact in the community, to the extent possible
• Reducing unnecessary social contacts
• Avoiding crowded settings, when possible.

What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. We recommend that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

Masks

Should masks be used?

In community and home settings, the use of facemasks and respirators generally are not recommended. 

Some individuals choose to wear masks when they are in crowded settings. These masks may look more effective than they are.

• Where Influenza A (H1N1) has been confirmed, people should avoid close contact with ill persons and avoid being in crowded settings rather than relying on the use of facemasks or respirators.
• A facemask or respirator may be considered, specifically for persons at increased risk of severe illness from influenza, please see the more detailed guidelines on respiratory and mask use.

Signs & Symptoms

What are the symptoms in humans?

Symptoms in people are similar to the symptoms of regular human flu: fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported vomiting and diarrhea.

What should I do if I get sick?

If you become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick. Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.

However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are:

• Children younger than 5, but especially children younger than 2 years old
• People 65 and older
• Pregnant women
• People who have:
  • Cancer
  • Blood disorders (including sickle cell disease)
  • Chronic lung disease [including asthma or chronic obstructive pulmonary disease (COPD)]
  • Diabetes
  • Heart disease
  • Kidney disorders
  • Liver disorders
  • Neurological disorders (including nervous system, brain or spinal cord)
  • Neuromuscular disorders (including muscular dystrophy and multiple sclerosis)
  • Weakened immune systems (including people with AIDS)

Also, if you have severe illness contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.

If you do become ill and experience any of the following warning signs, seek emergency medical care.

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• 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
• Fever with a rash

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

Diagnosis/Testing

Is there a test to know for sure if I have 2009 H1N1 flu?

Some health care providers will do a rapid test (one that gives results the same day) to see if a patient has flu.  The rapid test looks for several flu viruses, not just for 2009 H1N1 flu virus.  These tests are not perfect -- even when a person has 2009 H1N1 flu, the test might be negative.

There is a specific test that will look just for 2009 H1N1 flu.  However, this test is only done in very specific cases and is not a regular diagnostic test that is performed on individuals who present with flu-like symptoms.

Is there a rapid test available at my doctor's office or public health clinic for flu?

Rapid influenza (flu) diagnostic tests detect seasonal flu A and B antigens, which are cells that make the body produce infection-fighting cells. The 2009 H1N1 flu virus is an influenza A virus. The rapid flu diagnostic tests can be used for patients with 2009 H1N1 virus infection. However, CDC has received reports of high levels of false negative results using the rapid tests. A doctor may or may not use a rapid diagnostic test as part of the evaluation, but results should be interpreted with caution. Confirmation of H1N1 flu infection can only be made with:

• Reverse-transcription polymerase chain reaction (RT-PCR); or
• Viral culture (growing cells).

Vaccines and medicines

Are there medicines to treat H1N1 flu?

Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with 2009 H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.

What is the availability of antiviral medication, are there sufficient quantities?

Based upon conversations we are having on a regular basis with distributors that supply major pharmacy chains and independent pharmacies throughout the state, there is no shortage of antiviral medication in the private sector.

As part of our pandemic flu plan, we have 860,000 courses in our warehouse and we have begun to receive another 280,000 courses from the federal government. These would only be provided if and when there is a supply shortage identified in the private sector. We also are prepared to support priority needs among uninsured indigent individuals in collaboration with free clinics and federally qualified health centers.

There is no cost to patients for antiviral medication supplied by VDH.

How can I get antivirals?

You must have a prescription from a physician. Most people ill with the flu will recover without complications.

Some people are at increased risk of flu complications and doctors will prioritize the treatment with flu antiviral drugs this season. The people who may most need antiviral treatment include:

• People with more severe illness, such as those hospitalized with suspected or confirmed influenza
• People with suspected or confirmed influenza who are at higher risk for complications
  • Children younger than 2 years old
  • Adults 65 years and older
  • Pregnant women
  • People with certain chronic medical or immunosuppressive conditions
• People younger than 19 years of age who are receiving long-term aspirin therapy

Children 2 years to 4 years old are more likely to require hospitalization or urgent medical evaluation for influenza compared with older children, although the risk is much lower than for children younger than 2 years old.  Children aged 2 years to 4 years without high risk conditions and who are not severely ill do not necessarily require antiviral treatment.

Children and adults presenting with suspected influenza who have symptoms of lower respiratory tract illness or clinical deterioration should also receive prompt empiric antiviral therapy, regardless of previous health or age.

Physicians may also decide not to treat some people in these groups and/or treat people who are not in these groups based on their clinical judgment.

Is a previous swine flu vaccination still effective?

This is a new virus that has never been seen before in humans or animals and there is no vaccine available.

When will the vaccine be ready?

The vaccines will be distributed nationally to the states after initial lots become available in early-to-mid October.

Should I be getting the vaccine?

The groups recommended to receive the 2009 H1N1 influenza vaccine include:

• Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
• Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants younger than 6 months old might help protect infants by “cocooning” them from the virus;
• Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;
• All people from 6 months through 24 years of age
  • Children from 6 months through 18 years of age because cases of 2009 H1N1 influenza have been seen in children who are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
  • Young adults 19 through 24 years of age because many cases of 2009 H1N1 influenza have been seen in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
• Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

No shortage of 2009 H1N1 vaccine is expected, but vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities.  So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities. For more information see the CDC press release

Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Once vaccine demand among younger age groups has been met people 65 or older should be vaccinated.

Is the seasonal vaccine and the H1N1 vaccine the same thing?

No, the seasonal flu shot will not protect you against H1N1. The seasonal vaccine is not expected to protect against the H1N1 (Swine) flu and the H1N1 (Swine) flu vaccine is not intended to replace the seasonal flu vaccine.  You will need to get both the seasonal flu vaccine and the H1N1 vaccine to be fully protected against the flu this year.

Can both seasonal and H1N1 vaccine be taken at the same time?

Yes, when both flu vaccines are available, inactivated seasonal flu and 2009 H1N1 vaccines may be administered on the same day, but in different places on your body.

Providers can administer seasonal and 2009 H1N1 inactivated vaccines, seasonal inactivated vaccine and 2009 H1N1 LAIV, or seasonal LAIV and inactivated 2009 H1N1 at the same visit, or at any time before or after each other. Live attenuated seasonal and live 2009 H1N1 vaccines should NOT be administered at the same visit until further studies are done. If a person is eligible and prefers the LAIV formulation of seasonal and 2009 H1N1 vaccine, these vaccines should be separated by a minimum of four weeks.

Where will I get the H1N1 vaccine?

Once the vaccine becomes available the Chesapeake Health Department and VDH will provide access to the vaccine in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices registered as a vaccine administration site, schools, and other private settings, such as pharmacies and workplaces.

Novel H1N1 vaccine will be purchased by the federal government and made available at no cost. However, a provider is allowed to charge a small administration fee. This fee cannot exceed the regional Medicare vaccine administration fee.

Will I need two H1N1 Vaccine dosages?

The U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10 years of age and older.

FDA has approved two doses for children 6 months through 9 years of age.

Severe Illness

When should I call 911?

During times of health crisis it is essential that people reserve the use of 911 and emergency rooms to true life threatening or serious emergencies. If ambulances become overwhelmed with calls, they will not be available for those who truly need them. If you are ill and suspect it is Influenza A 9H1N1), call your doctor first to seek guidance and alert them that you are coming.

You should call 911 if the person:

• has difficulty breathing or chest pain
• has purple or blue discoloration of the lips
• is vomiting and unable to keep liquids down
• has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
• has seizures (for example, uncontrolled convulsions)
• is less responsive than normal or becomes confused

Travel

Should I cancel my travel plans?

CDC has NOT recommended that people avoid domestic travel. If you are planning travel to affected areas monitor the outbreak situation in that area by going to the CDC website or contact the officials in the area where you are traveling. Also be sure you are up-to-date with all your routine vaccinations, including seasonal influenza vaccine if available. Identify the health-care resources in the area(s) you will be visiting.

Should I travel to Mexico?

At this time, CDC has removed its recommendation that U.S. travelers avoid travel to Mexico.

Babies/Children

What can I do to protect my baby?

Take everyday precautions. In addition, take extra care to wash your hands often with soap and not to cough or sneeze in the baby’s face while feeding your baby, or any other time you and your baby are close.

Does breastfeeding protect babies from this new flu virus?

There are many ways that breastfeeding and breast milk protect babies’ health.  Flu can be very serious in young babies.  Babies who are not breastfed get sick from infections like the flu more often and more severely than babies who are breastfed.

Since this is a new virus, we don’t know yet about specific protection against it. Mothers pass on protective antibodies to their baby during breastfeeding.  Antibodies are a type of protein made by the immune system in the body.  Antibodies help fight off infection.

If you are sick with flu and are breastfeeding, someone who is not sick can give your baby your expressed milk.

Should I stop breastfeeding my baby if I think I have come in contact with the flu?

No, because mothers make antibodies to fight diseases they come in contact with, their milk is custom-made to fight the diseases their babies are exposed to as well.  This is really important in young babies when their immune system is still developing.

It is OK to take medicines to prevent the flu while you are breastfeeding.  You should make sure you wash your hands often and take everyday precautions.

However, if you develop symptoms of the flu such as fever, cough, or sore throat, you should ask someone who is not sick to care for your baby.  If you become sick, someone who is not sick can give your baby your expressed milk.

If my baby is sick, is it okay to breastfeed?

Yes, one of the best things you can do for your sick baby is to keep breastfeeding.

• Do not stop breastfeeding if your baby is sick. Give your baby many chances to breastfeed throughout the illness.  Babies who are sick need more fluids than when they are well.  The fluid babies get from breast milk is better than anything else, even better than water, juice, or Pedialyte® because it also helps protect your baby’s immune system.
• If your baby is too sick to breastfeed, he or she can drink your milk from a cup, bottle, syringe, or eye-dropper.

Is it okay to take medicine to treat or prevent novel H1N1 flu while breastfeeding?

Yes, mothers who are breastfeeding and taking medicine to treat flu because they are sick should express their breast milk for bottle feedings, which can be given to your baby by someone who is not sick.  Mothers who are breastfeeding and are taking medicines to prevent the flu because they have been exposed to the virus should continue to feed their baby at the breast as long as they do not have symptoms of the flu such as fever, cough, or sore throat.

Schools

What is VDH telling schools to do?

Local governments make decisions about school closings, not the state. Each locality in Virginia has an emergency plan. Contact your local government or school district to find out about their plan.

Government Preparedness

What is Virginia doing?

The Virginia Department of Health routinely monitors influenza like activity (ILI). With recent national occurrences of this illness, we have asked health care providers to be alert to symptoms and are requesting ongoing testing of ILI by sentinel physicians.

Why has a public health emergency been declared in Virginia?

A declaration of a public health emergency enables the state health commissioner to communicate more efficiently and effectively with health care providers by accessing a data base of licensed health care professionals maintained by the Virginia Department of Health Professions. This declaration does not mean that the situation in Virginia has become more severe.

Does Virginia have a plan?

The state pandemic flu response plan has been activated including an Incident Command Structure and Emergency Coordination Center at VDH. The plan has been tested and exercised six times since August 2006. Local health districts are activating their local response plans and coordinating with local and regional governments.

Health Care Providers

I am a health care provider. What do I need to know about testing patients?

• The focus is on testing in the same manner which occurs during the regular flu season. This is done through the use of our Sentinel Surveillance by pre-designated providers only.
• The health department would also like to test those who appear to be associated with a cluster of acute febrile respiratory illness in a group setting (e.g., school, college, daycare, or long term care facility).

It is important for health care providers to contact their local health department and to stay up to date with current CDC and VDH recommendations.

Immigrants

Should I be concerned about seeking medical assistance if my immigration status is in question?

The Virginia Department of Health will not ask about your citizenship or immigration status. You are not required to share your social security number to receive service.

Pregnant Women

I am pregnant.

For most pregnant women, 2009 H1N1 flu has been a mild illness.  However, some pregnant women have become very sick.  These women needed to be admitted to the hospital.  Some pregnant women have died.  For this reason, a pregnant woman who thinks she might have the flu needs to call her doctor right away. She is also recommended to get her seasonal flu and H1N1 flu vaccine.

If I’m pregnant and work in schools/childcare or healthcare, what precautions should I take?

Pregnant women working in or attending schools should follow the same guidance as the general public about staying home when sick, hand hygiene, respiratory etiquette, and routine cleaning.  Pregnant women are at higher risk of complications from flu and should speak with their doctor as soon as possible if they develop a flu-like illness to find out whether they should take antiviral flu medicines. Any person at high risk for flu complications should do the same. Pregnant women in a healthcare setting who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage.

Early treatment with antiviral flu medicines is recommended for pregnant women who have the flu. Pregnant women and their doctors should know that they are part of the first priority group to receive the 2009 H1N1 flu vaccine.

Water

Is there a risk from drinking water?

Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.

Can the novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?

Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels do not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.

Cleaning

What household cleaning should be done to prevent the spread of influenza virus?

To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label

How should linens, eating utensils and dishes of persons infected with influenza virus be handled?

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.

Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid "hugging" laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.

Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Miscellaneous

If I get this flu, can I get it again?

The H1N1 virus is new and research is being conducted to better understand its characteristics. In addition, although data on H1N1 are scarce and this illness is still being studied, it is also important to know that flu viruses undergo frequent changes during an outbreak.

In general, exposure to a particular strain of flu virus will protect you against that strain in the future. However, it will not protect you from infection by other flu virus strains.

Please also note that it is possible for a person to be infected with the seasonal influenza (flu) virus more than one time in a season, because several strains of flu virus circulate each year.

Is seasonal flu more deadly than H1N1?

With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.

When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu.  However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.

When would you advise having an emergency kit in case of quarantine?

At this point there is no need for quarantine. Families should have a plan in place in case of any emergency—not just influenza, but for severe weather as well. Lists of what to have in kits are available at such resources as ReadyVirginia.gov.

Guidelines and advice for the public may change as the CDC learns more about this virus.

City of Chesapeake, Virginia