Influenza A Vaccine
Vaccines against swine influenza are available for preventing in pigs. There is no vaccine to prevent it in humans. Vaccine formulation is under research by CDC at present. Vaccine for seasonal influenza may protect against H3N2 partially, but not H1N1viruses. Hence, WHO needs access to maximum viruses to select the most appropriate candidate vaccine virus. 22,1
It is expected that vaccine will be available late in September or October. 23 The U.S. is estimating to receive 45 million vaccine doses against H1N1 virus by October and by December it is anticipated to receive 195 million vaccine doses. 24
The CDC's Advisory Committee on Immunization Practices (ACIP) is planning to target with H1N1 flu vaccine after its availability. The target groups it is planning to vaccinate include: pregnant women; household member in close contact with infants below 6 months of age; healthcare and emergency-services workers; young people between 6 months - 24 years of age; non elderly adults with other risk conditions, such as diabetes and chronic lung disease. They are considering elderly people above 65 years of age as the lowest priority. 25 However, health experts are not recommending vaccination for children except those in risk groups because most of the children recover completely. 23
Caring a Sick Person
Sick persons suffering from Flu A should follow certain minimum things. They must:
- Consult a doctor especially if they are pregnant or having any disease/disorder like diabetes, heart disease, asthma, or emphysema for special care or to know of they require any antiviral medications.
- Keep away from others and stop going to work / school during the illness to prevent it spreading to others. They must stay at home after fever for minimum 24 hours unless they need medical care or other necessities. Younger children particularly have the potential for being contagious for longer durations.
- Drink plenty of water and clear fluids (like broth, sports drinks, electrolyte beverages) to prevent dehydration.
- Cover mouth while coughing or sneezing and should not forget to wash their hands with soap and water or an alcohol-based hand wash after coughing or sneezing and after using tissues.
- Wear a facemask if they are sharing common spaces with other family members to prevent spread of virus if available and tolerable especially if other members are at high risk of influenza complications.
- The sick persons has to accommodate in a separate bedroom with attached bathroom, which has to be cleaned with a disinfectant daily 26 and other than common areas of the house, the room doors must be closed.
Prevention of Spread of Flu A
The following points must be taken care of by the ill person to prevent its spread in the community.
- Keep distance of minimum 6 feet from people having influenza-like illness (ILI) especially when sneezing or coughing. One must keep interactions as brief as possible with the ill person. Those who are sick must not take care of infants.
- Cover your nose and mouth with a single use tissue while coughing or sneezing, and dispose the tissue in trash after use or facemask/ N95 respirator can be worn if possible and available.
- Wash your hands with soap and water or alcohol-based hand cleaners frequently after coughing or sneezing and when you take off face cover. Household members must remind children of this frequently and help cleaning their hands.
- Avoid touching your eyes, nose or mouth to prevent spreading of germs.
- Avoid close contacts like- touching/hand shake/kissing/hugging with a sick person.
- Avoid traveling when you are sick, for minimum 7 days after you fall sick. Stay home from work or school if you are sick.
- Temporary reassignment of those at increased risk of severe illness or care takers is required to avoid exposure from H1N1 or ILI.
- Separate well ventilated space should be provided for sick people in home. Try to be away from the patient at least by 1 meter distance. Caretakers should be assigned for the sick person.
- Consult your health care provider if you are in contacts with sick person to enquire about any need for antiviral medications for prevention especially pregnant women or those having chronic disorders. 26
Preventive Measures for Health Care Personnel
Controlling measures to stop the spread of H1N1 influenza in health care settings recommended by CDC for patients with suspected or confirmed H1N1 influenza include:
- Patients must be placed in a single-patient room with the door kept closed. An airborne-infection isolation room with negative-pressure air handling is used, if available. Air exhaustion should be done directly outside or can be recirculated by a high efficiency particulate air (HEPA) filter.
- Suctioning, bronchoscopy, or intubation should be performed in a procedure room with negative-pressure air handling.
- Patients should wear a surgical mask outside their room. Personnel involved in aerosol-generating activities (eg: collection of clinical specimens, bronchoscopy, endotracheal intubation, nebulizer treatment) or cardiac pulmonary resuscitation or resuscitation involving emergency intubation should wear a fit-tested disposable N95 respirator.
- Health care personnel should wash their hands with soap and water or use hand sanitizer immediately after removing gloves and other equipment and after contact with respiratory secretions. Encourage patients to wash their hands frequently and follow respiratory hygiene practices. Cups and other utensils used by the sick person should be washed with soap and water before use by other persons.
- Cleaning and disinfection strategies commonly used during influenza seasons can be followed. Standard, droplet, and contact precautions should be used for all patient care activities and continued for 7 days after illness onset or until symptoms have resolved.
- Health care personnel or personnel collecting clinical specimens from patients should wear disposable non-sterile gloves, gowns, and eye protection like goggles to prevent conjunctival exposure.
Physician’s Instructions to the Patient
Physician must instruct their patients to take medications as prescribed:
- All the antiviral medications must be taken as directed.
- Contact the doctor in case of any side effects like nausea, vomiting, rash, or unusual behaviour.
- Medications for symptomatic relief of fever and pain must be taken which include acetaminophen or any cough medicine until symptoms improve.
- Children younger than 18 years should not be given aspirin (acetylsalicylic acid) or products that contain aspirin. Those younger than 4 years should not be administered over-the-counter cold medications without prescription from your doctor. 27
Home Care Recommendations
Household cleaning, laundry, and waste disposal:
- Visitors except that caretaker should not be allowed for the sick. One adult is sufficient as care giver of the sick person.
- People who are at greater risk of severe illness or complications from flu should not be the caretaker of sick person, especially pregnant women.
- It is safe to use paper towels for wiping hands after washing hands and separate cloth towels must be used by each person at home like different coloured towels for each person.
- It is better to maintain good ventilation in household areas like keeping windows open in restrooms, kitchen or washrooms. 27
- If you are the caregiver:
- Do not maintain face-to-face contact with the sick person.
- Sick infants/children must be carried with their chin placed on your shoulder to avoid them coughing in your face.
- Clean your hands properly after touching sick persons or handling laundry or any used tissues.
- You must constantly monitor yourself for any flu symptoms and consult your physician to check if you might require antiviral medication to prevent flu infection.
- Eyes, nose and mouth must not be touched because germs spread this way. 28
- Tissues and other items used by the sick person must be carefully disposed in the trash and hands should be washed after disposal.
- Surfaces must be wiped with a household disinfectant especially bedside tables, bathroom surfaces, and children toys.
- Bed linens, utensils, and dishes used by the sick do not require separate cleaning, but they should not be shared without proper washing.
- Eating utensils/dishes should be washed either in a dishwasher or by hand with hot soapy water.
- Bed sheets and towels must be washed using laundry soap and tumble dry under hot setting. 26
Facemasks and Respirators
: It refers to disposable facemasks approved by the U.S.FDA as medical devices. These are labelled as surgical, dental, medical procedure, isolation, or laser masks available in several designs. It is flat/pleated or duck-billed in shape. It can be fixed to the head with two ties, covering the face with flexible adjustment for nose bridge. Some are pre-moulded for adhering to the head with a single elastic band, and flexible adjustment for the nose bridge. Another type of mask is flat / pleated and fixed to the head with ear loops. They avoid the spread of droplets, splashes or sprays from reaching the mouth and nose among person to person. However, they do not protect from very small particle aerosols that might contain viruses.
It refers to an N95 or higher filtering face piece respirator approved by CDC or National Institute for Occupational Safety and Health (NIOSH). It protects against inhalation of very small particle aerosols containing viruses from an infected person. It fits snugly on the face but it is harder to breathe through it for long duration compared to a facemask. Respirators require fit testing, training and medical clearance for proper usage to maximize its effectiveness. Research has limited evidence to conclude that use of a respirator without fit-testing provides better protection compared to facemask against small particle inhalation.
There significant difference between facemasks and respirators is that they do not seal tightly to the face and are used against only large droplets. But, N95 respirators seal tightly the wearer’s face and protect against small particles. However, there is limited data on both of their effectiveness in preventing Influenza A transmission.
Facemask or respirator can be beneficial if used correctly and consistently. They are available at any pharmacy or hardware store. If you are giving respiratory treatment to a sick person using a nebulizer or inhaler, then you must wear an N95 respirator. Facemasks or N95 respirators must be disposed in regular trash after using so they don’t contaminate other things. They should not be re-used. A fabric facemask can be re-used after laundry with normal detergent and tumble-dried in a hot dryer. Hands must be washed with soap and water or an alcohol-based hand sanitizer after removing facemask or N95 respirator.
Recommendation for use:
The use of facemasks or respirators depends up on exposure to H1N1 in a group at higher risk of severe illness.
- The use of facemasks and respirators is not recommended for house hold persons except for persons at increased risk of severe influenza illness (children less than 5 years of age; aged people above 65 years; children and adolescents less than 18 years receiving long-term aspirin therapy, reye syndrome after influenza; pregnant women; pulmonary, cardiovascular, hematological, hepatic, neuromuscular, neurologic, metabolic disorders, or immunosuppression by medications / HIV; and nursing homes residents)
- For specific work activities where close contact with persons with ILI can not be avoided, one must wear a facemask or N95 respirator on a voluntary basis.
- Respirators or facemasks are recommended in occupational healthcare setting but not for non-healthcare workers.
- For children or persons having facial hair, respirators are not recommended.
- Mandatory use of respirators is required in occupational settings involving exposure to large amounts of aerosols. 29
Traveling with FLU A
If you want advice on how Flu A can affect your travel plans, you need to consult your physician for travel medical advice. For further guidance and clarifications you need to check with the Foreign Office travel for advice before travelling. Many airlines are not allowing people flu to travel. If you are refused to board a flight for returning back home from abroad you can seek consular advice from your nearest Diplomatic mission.
Claiming on your travel Insurance:
Travel insurers in few countries will require a unique ID number generated by the National Flu Service, with the label on your anti-flu drugs as proof of diagnosis to validate a travel insurance cancellation claim. You need to ensure that all the original documentations are carried along with you for validation by insurers to receive medications. 30