Pandemic H1N1 influenza virus – Common questions

Q&A topic sections

1. About the virus
2. Prevention and treatment
3. Pandemic H1N1 influenza vaccine
4. How to care for yourself and others
5. Pandemic H1N1 influenza virus in Alberta, Canada and worldwide

1. About the virus

1. What is pandemic H1N1 influenza virus?

• It is a new strain of the influenza A virus (2009). The World Health Organization (WHO) has declared it a pandemic virus.
• It contains a combination of genes from pigs (swine), bird (avian) and human influenza viruses that have never previously been detected in humans and swine.
• Most people have no immunity to protect them from getting sick with this new virus.
• This virus is being detected in humans in many countries around the world and is spreading from person to person in communities.

Compare pandemic H1N1 influenza and seasonal influenza

2. Is the second wave of pandemic H1N1 influenza over?

The second wave of the pandemic appears to be declining as shown by a decrease in H1N1 influenza activity in the community and H1N1-related hospital admissions. However, the virus will continue to circulate in our communities throughout the winter.

Alberta Health and Wellness and Alberta Health Services encourage all Albertans to get the H1N1 vaccine to lessen the impact of the current wave and of any further waves of activity. Immunization is our best line of defence against the H1N1 influenza virus and is effective in reducing severe illness and deaths.

Mass immunization clinics are scheduled until late December. Alberta Health Services will be working over the coming weeks to make vaccine available through other providers, including family physicians, pharmacies and post secondary and employer clinics.

• Influenza immunization clinic information

3. Can we expect a third wave of the pandemic?

Yes, there is a possibility that there will be a third wave. Even after a large second wave, many people will not have been infected and they will remain susceptible to infection unless they are immunized.

Historically, there have been more than two waves of influenza activity in past pandemics. The disease typically infects one group of people first, infections appear to decrease and then infections increase in a different part of the population.

• In the Asian flu pandemic, the age group most affected in the first wave that peaked October 1957 were school age children. A second wave of infections followed in January and February 1958 among the elderly.

4. Why is the pandemic H1N1 influenza virus sometimes called swine flu?

It was originally called “swine flu” as laboratory testing demonstrated that some of the genes in this new virus were similar to influenza viruses that normally circulate in pigs (swine).

5. How does the severity of illness caused by pandemic H1N1 influenza virus compare to seasonal influenza?

The severity of illness has been similar to seasonal influenza, causing mostly mild illness. However, there have been some cases of severe disease requiring hospitalization and a few deaths.

6. Who is most at risk for complications of pandemic H1N1 influenza?

The number of individuals with complications as a result of pandemic H1N1 influenza has been low in Canada. However, based on current information about the virus, the groups at higher risk of complications or more likely to require hospitalization include:

• Pregnant women (especially in the second and third trimesters);
  • Read H1N1 fact sheet
• Children under five years (especially those under two years of age);
• Adults and children with chronic health conditions such as heart disease, asthma and chronic lung disease, diabetes, weakened immune systems, neurological disorders, liver disease, blood disorders, and severe obesity; and
• Aboriginal people and persons who reside in a remote or isolated area.

Consult with your health-care provider if you are at risk for complications and if you have even mild influenza symptoms.

7. How does pandemic H1N1 influenza virus spread?

• It spreads the same way as seasonal influenza – from person to person through “droplets” that are released through the air when an infected person coughs and sneezes. The droplets can then be breathed in by others.
• The virus can also be contracted through:
  • Shaking hands that are contaminated with the virus; and
  • Touching a hard surface, such as a counter or door handle that has been contaminated with the virus.
• A person then becomes infected by then touching their eyes, nose or mouth.
• The virus is considered infectious for up to eight hours on hard surfaces and only a few minutes on soft surfaces.

8. How is pandemic H1N1 influenza diagnosed?

• People with mild symptoms generally do not require testing.
• If your health care provider feels your symptoms require further investigation, a nose swab may be taken and sent to the lab for confirmation. Other tests, such as bloodwork, may also be ordered.

9. What is the incubation period for pandemic H1N1 influenza virus?

• The incubation period is the time from when people become infected until they develop symptoms.
• It appears to have a somewhat longer incubation period than seasonal influenza, usually 3–4 days but can it be up to seven days.

10. How long is a person contagious if they develop pandemic H1N1 influenza?

• Usually persons are contagious from one day before, up to seven days after symptoms begin.
• Children, especially younger children, immunocompromised individuals and those with severe illness may be contagious for a longer period, i.e. up to 10 days
• If you are sick with influenza-like illness, stay home from work or school for seven days from the start of your symptoms or until you are able to resume normal activities, whichever is shorter.
• Avoid close contact with others as much as possible. This is to keep you from infecting others and spreading the virus further.

11. What are the symptoms of pandemic H1N1 influenza virus?

The symptoms of pandemic H1N1 influenza virus in Canada have been generally mild, but illness can be severe for some individuals. The symptoms are similar to seasonal influenza and may include:

Almost always:

• Cough and fever (over 38 C)

Common:

• Fatigue;
• Muscle aches;
• Sore throat;
• Headache;
• Decreased appetite;
• Runny nose.

Sometimes:

• Nausea;
• Vomiting;
• Diarrhea.

12. How can an influenza virus spread from pigs to people?

• Different strains of influenza regularly circulate in our environment, including strains that can cause illness in humans, birds and pigs.
• Swine influenza viruses do not normally infect humans. Humans and animals can sometimes pass strains of influenza back and forth to one another through direct close contact, such as in pig production barns and livestock exhibits at fairs.
• When swine influenza does infect a human, there is also a risk that the animal influenza can mutate and then spread directly between humans. The new pandemic H1N1 influenza virus originated in this way.

13. Can I catch pandemic H1N1 influenza virus from eating pork?

No. Pandemic H1N1 influenza virus is not spread through eating properly handled and prepared pork or pork byproducts. It does not pose a food safety concern.

14. What is being done to test the pandemic H1N1 influenza virus to know if it is changing?

• Alberta’s Provincial Laboratory for Public Health provides samples to the National Microbiology Laboratory, which tests both human and animal virus samples.
• Information on test results is added to an international database used by experts to look for changes in viruses.

Prevention and treatment

15. What can Albertans do to protect themselves and others from pandemic H1N1 influenza virus?

Albertans can take simple measures to minimize the risk of being infected or infecting others.

1. If ill, stay home from work, school and avoid public places until symptoms resolve and you are feeling well enough to fully participate in normal day-to-day activities. A dry cough may persist.
2. Help prevent infection with pandemic H1N1 influenza by getting the vaccine.
3. Clean hands frequently, especially after coughing, sneezing or blowing your nose. Wash your hands with soap and water, or use an alcohol-based hand sanitizer. When done correctly, this is the single most effective way to reduce the spread of infections.
   • Read how to clean your hands properly to reduce the spread of influenza.
4. Cough and sneeze into your arm, not your hand.
5. Do not touch your eyes, nose or mouth after shaking hands or touching hard surfaces like counters and door handles or other surfaces that may harbour influenza and other viruses. Keep common surfaces clean and disinfected.
6. Stay at least two metres (six feet) away from people who are experiencing influenza-like symptoms. This is called social distancing and includes staying away from crowds when influenza is circulating in the community.
7. Other steps to keep yourself healthy include:
   • Healthy eating;
   • Maintaining an active lifestyle;
   • Getting enough rest and sleep; and
   • Don't smoke and avoid second hand smoke.
8. Read more about influenza self-care
9. Read H1N1 fact sheet for pregnant and postpartum women

16. Should Albertans wear masks to prevent catching pandemic H1N1 influenza virus while out in the community?

No. Evidence shows that wearing masks is not effective in preventing the spread of influenza in the general public.

17. Should people be avoiding exposure to pigs?

• The pandemic H1N1 influenza virus is spreading between humans. There is no risk from close contact with healthy pigs.
• Individuals with influenza symptoms should avoid close contact with pigs to reduce the possibility of introducing a new influenza virus into domestic swine populations.
• For people in close contact with pigs, the recommendations to avoid infection are the same as for regular seasonal influenza – frequent hand cleaning, getting a yearly influenza shot, covering coughs and sneezes, and staying home when ill.

18. Can I get antiviral medication if I have symptoms of influenza?

Antivirals are recommended for treatment of influenza for individuals at higher risk for influenza-related complications, including:

• Pregnant women (especially in the second and third trimesters, up to and including four weeks postpartum);
• Children under two years of age;
• Persons 65 years of age and older;
• Adults and children with chronic health conditions such as heart disease, asthma and chronic lung disease, diabetes and other metabolic disorders, weakened immune systems, neurological disorders, liver disease, blood disorders and severe obesity;
• Aboriginal people and persons who reside in a remote or isolated area; and
• Other disadvantaged populations (e.g. homeless).

Use of antiviral medications is also strongly recommended in hospitalized and/or severely ill individuals with influenza-like illness.

• Antivirals are most effective if given within 48 hours from the start of symptoms.

Antivirals are NOT recommended for prophylaxis (preventive treatment) against influenza because of the risk of resistance (i.e. it is no longer effective in treating the illness caused by the virus). They are also usually not recommended for the treatment of mild cases in otherwise healthy individuals.

Pandemic H1N1 influenza vaccine

19. Is there a vaccine for pandemic H1N1 influenza virus?

Yes. Clinics began immunizing all Albertans six months of age and older against H1N1 on October 26 with recommendations to immunize those at highest risk first. In the first six days of the campaign, Alberta immunized 10 per cent of the population, a very positive response.

Given a positive resolution to the national vaccine shortage, and good uptake of vaccine among the highest-risk groups previously announced, Alberta’s H1N1 immunization program expanded to include all Albertans six months of age and older on Monday, November 23.

For the convenience of the public, several clinic locations are provided in larger urban centres. Clinic dates may vary in smaller communities, so check the website before you go.

• H1N1 influenza immunization clinic information
• Read common questions about pandemic H1N1 influenza vaccine

Alberta Health Services is working to enable those pharmacists and doctors who wish to participate and post-secondary institutions with on-site health centres to provide H1N1 immunization in the weeks ahead. H1N1 immunization will continue to be available at immunization clinics throughout the province.

The seasonal influenza vaccine being used in Canada this year is not effective against this new strain of influenza, but is an important step to prevent infection with seasonal influenza.

• Find out more about influenza vaccine

How to care for yourself and others

20. What should you do if you are concerned that you have symptoms of pandemic H1N1 influenza virus?

• Refer to the pandemic H1N1 influenza home page
• Read H1N1 fact sheet for pregnant and postpartum women

21. What should I do if I have been in contact with someone who is sick with pandemic H1N1 influenza virus?

• If you are well, no further action is needed. Monitor yourself for symptoms of influenza illness for four days.
  • The incubation period for the virus is the time from when people become infected until they develop symptoms.
• If you have symptoms of a respiratory infection with a sudden fever and cough, refer to the home page.

Pandemic H1N1 influenza virus in Alberta, Canada and worldwide

22. Are both seasonal and pandemic H1N1 influenza currently circulating in Alberta?

The second wave of the pandemic is underway in Alberta and there has been a significant increase in the number of cases compared to the spring and summer months. Seasonal influenza has also been reported, but in much smaller numbers. It is expected that the vast majority of cases this influenza season will continue to be pandemic H1N1 influenza.

23. What is being done to contain the spread of pandemic H1N1 influenza virus in Alberta?

• Surveillance has been increased and Alberta health care providers are on alert and are looking for cases of influenza-like illness.
• The health care system in Alberta is on alert and continues to respond to the pandemic as the situation evolves.
• Health care workers have been provided with detailed advice on how to manage possible and/or confirmed cases.
• Communication to Albertans has been increased to ensure they are well-informed as to how to best protect themselves and their families.

24. Is Alberta's pandemic plan in place?

Yes, Alberta has a pandemic influenza plan in place.

• Alberta’s Plan for Pandemic Influenza will direct activities of the Government of Alberta, Alberta Health Services and other key groups in response to pandemic influenza, to provide a coordinated and phased-in response.
  • Read the Alberta Pandemic Plan
• Alberta’s plan is being updated as the current pandemic situation changes.

25. What is the government of Canada doing to protect Canadians and control the spread of pandemic H1N1 influenza?

1. The Public Health Agency of Canada (PHAC) is working with international partners to learn more about how the pandemic H1N1 influenza virus spreads to best control and slow the spread of disease.
2. An overall implementation for the health sector of The Canadian Pandemic Influenza Plan is underway.
3. There is close collaboration with provinces and territories to optimize the response to the pandemic alert including monitoring essential health-related resources and supplies.
4. The National Emergency Stockpile System (NESS) which contains hospital supplies, equipment and other pharmaceuticals (including a stockpile of antiviral medications) is being managed.
5. There is ongoing involvement with the vaccine manufacturer for pandemic vaccine development, testing and production.
6. Communicating to Canadians through the Citizen Readiness Campaign to ensure they are well-informed as to how to protect themselves and their families.

26. How does the World Health Organization (WHO) determine what level of pandemic alert is required?

A six-phased pandemic alert is used to determine the approach to activating plans that prepare for and respond to a new influenza virus capable of causing a worldwide epidemic.

• More information is on the WHO website.

27. What does WHO raising the pandemic level to Phase 6 mean for Albertans?

The Phase 6 designation is a measure of where and how widespread the new virus is around the world.

• It is not indicative of how severe the disease is. The risk level to the general public remains low.
• Alberta has a pandemic plan that has been unfolding in response to the levels of pandemic alert.

28. Are there any precautions for travellers going to countries affected by pandemic H1N1 influenza?

Travellers should take the same precautionary measures as with seasonal influenza. These include receiving immunizations, washing your hands often, covering coughs and sneezes, and staying home when ill.

Prior to travelling, individuals should familiarize themselves with the situation in the country of destination. Some governments have implemented screening measures at airports for influenza symptoms. Consult the Public Health Agency of Canada’s Travel Reports to verify if the country you are travelling to/from has established screening procedures. You may also seek advice from that country's diplomatic mission in Canada.

More information

• Visit the Alberta Health Services website

Updated: December 21, 2009