What is Pandemic Influenza?
	HOW IS INFLUENZA SPREAD?
	WHAT TO DO IF YOU GET INFLUENZA
	INFLUENZA MEDICATION
	PREPARE YOUR HOME AND WORKPLACE FOR A PANDEMIC

Pandemic Influenza

Most people with influenza will recover after a few days illness Most sick people can be cared for at home Hospital is only for serious complications Stay home from work or school and avoid social contact if sick Simple personal health measures will help to keep you, and everyone else safe Good hand washing and drying will help to reduce the spread of influenza Avoid crowded places and stay away from unwell people Practice good cough etiquette. Don't cough and sneeze over people Make a family plan and stock up on home emergency supplies now

Pandemic influenza and its symptoms

An Influenza Pandemic occurs when a new strain of influenza that can infect humans emerges, spreads around the world and infects many people. It is a virus that people have no natural immunity to, can easily spread from person to person and is capable of causing severe disease.

Currently there is no pandemic influenza.

Avian Influenza, H5N1, (bird flu) outbreaks affect mainly poultry; however, it can be contracted by humans (Highly Pathogenic Avian Influenza-HP H5N1) through direct contact with birds. There have been 208 confirmed cases (as at 12/06/2006) of HP avian influenza in humans with 115 deaths.

In the 20th century there were three pandemics in, 1918, 1957 and 1968. The 1957 and 1968 pandemics were caused by viruses containing both human and avian influenza genes.

The World Health Organisation is worried that avian influenza (H5N1) and human influenza might mix, or avian influenza might mutate causing a new human influenza that could easily be passed from person to person.

The Nelson Marlborough District Health Board is working with Civil Defence, local authorities and others to plan for pandemic influenza.

Symptoms of influenza

Fever, cough and fatigue are the most common symptoms of influenza.; A fuller range of influenza features includes:

Bronchitis, pneumonia and ear infections may follow influenza. Influenza infection may also aggravate pre-existing health problems, like heart disease or asthma.

In newborn babies and children under 2 years, fever may be the only symptom or there may be non-specific features such as pallor, floppiness or poor feeding.  Children under 2 years are more likely to present with diarrhoea and vomiting than older children.

Children and youth between 5 and 17 years of age most frequently present with fever, cough, runny nose, headache, rigors (chills), muscle aches and sore throat.

Elderly people aged 65 years and older, especially those who are frail or living in residential facilities, and persons who are immunosuppressed (chronic medical conditions such as renal failure, those taking medication such as steroids or chemotherapy) are more likely to have severe, complicated or atypical influenza infections.  For example, the patient may not have a fever and may take longer to recover.

HOW IS INFLUENZA SPREAD?

The influenza virus can be found in the nose, throat and phlegm of infected patients.  It has also been found in the faeces of infected patients with diarrhoea.  Human-to-human spread of influenza is mainly by droplets that come out of the mouth of infected persons when sneezing, coughing or talking.  These droplets can travel about 1 metre from an infected person and will spread the infection if they land in the mouth, nose or eyes of another person. 

The influenza virus can spread via kissing or via hand-to-hand if that person then touches his or her mouth, nose or eyes.  The virus may get onto surfaces around an infected person, such as cups, cigarettes, pens, door knobs, keyboards etc. and can survive for up to 48 hours on hard surfaces.  From a surface, the virus can spread if that item comes into contact with your hand, mouth, nose or eyes. 

Persons who are infected with influenza can spread the virus from 6 to 12 hours before their symptoms start until 7 days after their symptoms start (adults).  This infectious period may be up to 14 days in school children and 21 days in children under 5 years old.  The risk of spread is highest when the person has symptoms.

How to avoid catching influenza

Consider a yearly influenza vaccine

• Ask your doctor for an influenza vaccination each year.  The usual yearly flu jabs will not protect you against a new pandemic virus but they will help stop you getting ill with other influenza viruses.  Because these viruses change all the time, you need to get vaccinated each year
• Vaccination is free for people aged 65 years and over and adults and children with certain long-term (chronic) conditions.

Get the pandemic influenza vaccine when it becomes available

• A specific vaccine against the pandemic influenza virus will take several months to be developed once the pandemic virus is identified.  When available to the New Zealand public, you will be notified about when and how to get it.

Social distancing

• When influenza is widespread in the community, avoiding gatherings of people and public places (e.g., public transport) may reduce your chances of catching the virus
• Try to stay a metre away from sick people (if you are caring for someone with influenza, see advice below – link).

Hygiene

• Washing and drying your hands properly is one of the best ways of protecting yourself against the spread of germs such as influenza.  Wash hands for at least 20 seconds with soap and water (then dry hands well) or apply an alcohol-based rub.
• Wash and dry your hands:
• before preparing food and eating
• after coughing or sneezing, blowing noses, wiping children's noses, visiting the toilet or looking after sick people
• Keep your coughs and sneezes covered.  Put tissues straight into a covered, lined rubbish bin or a plastic bag and wash your hands

What to do if you get influenza

1. Most people with influenza will recover after a few days illness and can be cared for at home
2. During a pandemic if you think you might have influenza:
   •  Go to the NMDHB influenza self-assessment page [link] to find out    whether you have influenza or not and whether you need to go to a    community-based assessment centre, or
   •  Phone the free NMDHB Pandemic Influenza Care Centre on 0800 FLU INFO, or
   •  Phone the Ministry of Health Pandemic Influenza information service on    0800 HEALTHLINE
3. If you have symptoms of influenza and need help, go to your nearest community-based assessment centre. Do not go to your GP or to the hospital – you are likely to be turned away and sent to a community-based assessment centre
4. If you are unable to get to the community-based assessment centre, ask the staff member at the NMDHB Pandemic Influenza Care Centre (0800 FLU INFO) about transport options.

Simple personal health measures

• Take paracetamol, Nurofen® (or another anti-inflammatory pain reliever) to treat fever or aching muscles or joints – NOTE avoid giving children asprin).
• Drink plenty of fluids (adults - at least 2 litres per day)
• Get plenty of bed rest but make sure you have a walk each day
• Avoid exposure to tobacco smoke
• Older persons, pregnant women and those with chronic illnesses are at increased risk of complications from influenza.  In addition to the guidelines above, ensure supervision from family or friends and/or arrange reassessment  by phone or visit to a community influenza clinic after 48 hours
• Take anti-influenza medication (e.g. Tamiflu) and/or antibiotics and other medications if prescribed.

When and how to seek further help

• Seek further help if you are not improving, are not coping at home or are worried about your health (e.g., increasing shortness of breath, chest pain, worsening cough, vomiting)
• Call the NMDHB Pandemic Influenza Care Centre (0800 FLU INFO).

Preventing the spread of influenza at home

Sick persons should:

• Stay in their own room or stay at least 1 metre from others
• Keep the room well ventilated (e.g., keep the windows and doors of the room open if possible)
• Use disposable tissues for nose wiping
• Cover nose and mouth with a disposable tissue when sneezing and coughing
• Wash or cleanse hands after coughing, sneezing or using tissues
• Avoid sharing utensils with others.

Caregivers

• Gloves are not routinely necessary as long as hands are washed or cleansed (plain soap is fine for this) before and after contact with a sick person
• Wear gloves if contact will be made with the sick person’s blood, bodily secretions, mucous membranes, wounds or broken areas of skin
• Single-use disposable medical gloves should not be washed or reused; dishwashing gloves may be washed and dried between use; plastic bags can also be used as gloves
• When providing care avoid touching your eyes or mouth with your hands
• Wear a mask if you are likely to be splashed with sprays of blood or bodily secretions (e.g., person coughing in your face)
• Monitor your own temperature twice daily and watch for influenza symptoms.

Cleaning, laundry and rubbish

• Surfaces and objects that have been touched by the sick person should be cleaned daily with a regular household cleaning agent. Products labeled antibacterial are not necessary but may be used
• Special handling of laundry is not necessary: regular washing detergent, normal machine wash and dry or hanging linens on a clothes line is effective

INFLUENZA MEDICATION

Antiviral medication for influenza

Oseltamivir (Tamiflu®) is a commercially available antiviral that can be used to treat acute influenza when started within 48 hours of the onset of symptoms.  Tamiflu has been stockpiled by the New Zealand Government for use during a pandemic.  This will be allocated in accordance with nationally determined priorities.

Tamiflu® does not take away the symptoms of influenza immediately but it shortens the duration of influenza illness, reduces complications and reduces the need for antibiotics for secondary bacterial infections. 

Between 5% and 15% of persons taking Tamiflu® suffer nausea and vomiting but this is generally mild and lasts less than a day.  The risk of nausea and vomiting is less if the Tamiflu® is taken with food.  There are no other important side-effects. 

Influenza vaccination

From the onset of an influenza pandemic, a new vaccine may take up to six months to develop.  The Ministry of Health is exploring options for getting access as quickly as possible to pandemic vaccine supply, once a vaccine is developed and available.

PREPARE YOUR HOME AND WORKPLACE FOR A PANDEMIC

Here are a few simple things you can do now to prepare for a pandemic.

Have a plan
During a pandemic, you or your family may be so sick that you need to stay home for several weeks. Make a plan with family and friends that includes:

• Who could help with food and supplies if you and your household are ill
• If you have prescription medicines (eg, for blood pressure), renew your prescription well before you run out
• The telephone numbers of people who live near you, as well as your doctor's phone number (keep this in a place that is easy to see, eg; on the fridge door)
• An emergency supplies kit - see the 'Emergency Survival Items' list on the inside back cover of the Yellow Pages or check the Ministry of Civil Defence and Emergency Management website on www.civildefence.govt.nz - select 'Be Prepared' then select 'What to do.'

Build up your emergency supplies kit

• Have a supply of food and drinks to last for at least a week.  Choose long-lasting foods in cans and packets and dried foods
• Paracetamol and ibuprofen are good for bringing down a fever and reducing aches and pains.  Do not use anything else for children unless you talk to your doctor or pharmacist first
• Masks worn by sick people can help stop the spread of germs.  You can buy masks from a pharmacy or hardware store.  If there is a pandemic, people will be told how and when to use their masks.  A mask can be worn only for a short time and needs changing when wet from sneezing and coughing
• Have tissues (or toilet paper) and plastic bags – supermarket bags are good – to put the used tissues into
• Think about things to do if you and your family have to stay home for a couple of weeks (eg, books, games and videos).

Follow this link to an Emergency Supplies Kit list: http://www.moh.govt.nz/moh.nsf/pagesmh/5196/$File/emergency-supplies-kit.pdf

If you work from home or run your own business

• You need to think about how to keep your business running.  You will find some ideas in the Business Planning Guide at www.med.govt.nz - select from the list 'Influenza Pandemic Planning Information for Business Continuity' then select '1.Business Continuity Planning Guide'
• You may want to talk to your insurance provider about your cover.

More information on influenza and planning for an influenza pandemic is available on this website www.moh.govt.nz.