Swine Flu,Questions & Answers

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  • What is swine flu?

    Swine influenza is a disease that pigs get. The virus currently spreading among people is now generally referred to as swine flu, although the origin of the disease is still under investigation. There is no evidence of this strain of the disease circulating in pigs in the UK.

    There are regular outbreaks of swine flu in pigs worldwide. It does not normally infect humans, although this does sometimes happen, usually in people who have had close contact with pigs.

    Swine flu viruses are usually of the H1N1 sub-type. The swine flu that has spread to humans is a version of this virus.

    Why is swine flu affecting humans?

    Because the swine flu virus has mutated (changed) and is now able to infect humans and transmit between them.

    How is the swine flu infection diagnosed?

    There is now a new self-care service, called the National Pandemic Flu Service, which allows people to check their condition online or over the telephone (0800 151 3100 or textphone 0800 151 3200) and obtain antiviral medication if swine flu is confirmed.

    The following people should call their GP directly for an assessment of their symptoms and a diagnosis:

    * those with a serious existing illness, such as cancer
    * pregnant women,
    * those who have a sick child under one,
    * those with a condition that suddenly gets much worse, or
    * those with a condition that is still getting worse after seven days (five for a child).

    Which people are most vulnerable from swine flu?

    Those who are more at risk from becoming seriously ill with swine flu are people with:

    * chronic (long-term) lung disease, including people who have had drug treatment for their asthma within the past three years,
    * chronic heart disease,
    * chronic kidney disease,
    * chronic liver disease,
    * chronic neurological disease (neurological disorders include motor neurone disease, Parkinson’s disease and multiple sclerosis),
    * suppressed immune systems (whether caused by disease or treatment),
    * diabetes,
    * pregnant women,
    * people aged 65 or older, and
    * young children under five.

    Is the new swine flu virus contagious?

    Swine flu spreads in the same way as ordinary colds and flu. The virus is spread through the droplets that come out of the nose or mouth when someone coughs or sneezes.

    If someone coughs or sneezes and does not cover it, those droplets can spread about one metre (3ft). If you are very close to them you might breathe these in.

    If someone coughs or sneezes into their hand, those droplets and the virus within them are easily transferred to surfaces that the person touches, such as door handles, hand rails, phones and keyboards. If you touch these surfaces and touch your face, the virus can enter your system and you can become infected.

    How long does the virus live on surfaces?

    The flu virus can live on a hard surface for up to 24 hours, and a soft surface for around 20 minutes.

    What is the incubation period for swine flu?

    According to the Health Protection Agency, the incubation period for swine flu (the time between infection and appearance of symptoms) can be up to seven days, but it is most likely to be between two and five days. But it is currently too early to be able to provide details on virus characteristics, including incubation period, with total certainty.

    When are people most infectious?

    People are most infectious soon after they develop symptoms. They can continue to shed (spread) the virus (for example, in coughs and sneezes) for up to five days (seven days in children). People become less infectious as their symptoms subside, and once their symptoms are gone they are no longer considered infectious to others.

    Should I avoid contact with people suspected of having swine flu?

    People with suspected swine flu will have been asked to stay at home and restrict their contact with people. Most people should continue their normal life, including going to school or work. This includes children who attend a school with a confirmed case of swine flu.

    There is no need to avoid contact with people who might simply have come into contact with those with the illness, such as the parents of children at schools with a confirmed case but who are not themselves ill.

    How dangerous is it?

    It is difficult to judge this at the moment. There have been deaths, but for most infected people the symptoms have not been severe.

    It appears that early doses of antiviral medicines such as Tamiflu are effective in helping people to recover. In the UK we have enough antivirals to treat half the population if they were to become ill. Also, orders of Tamiflu have been placed to increase UK supplies to 50 million doses, enough to treat 80% of the population.

    Will I die from swine flu?

    For most people, the illness has been mild and self-limiting. The virus has caused severe illness in a minority of people, most of whom had an existing serious condition. NHS staff are well trained in treating people who are in hospital with swine flu. They can provide effective treatment for any secondary bacterial infections, such as pneumonia.

    What are the complications of swine flu?

    One of the most common complications of any type of flu is a secondary bacterial chest infection, such as bronchitis (infection of the airways).

    This can become serious and develop into pneumonia. A course of antibiotics will usually cure this, but the infection sometimes becomes life-threatening.

    Other rare complications include:

    * tonsillitis,
    * otitis media (a build-up of fluid in the ear),
    * septic shock (infection of the blood that causes a severe drop in blood pressure),
    * meningitis (infection in the brain and spinal cord), and
    * encephalitis (inflammation of the brain).

    What are the symptoms of swine flu?

    The symptoms of swine flu are expected to be similar to the symptoms of regular seasonal flu. People with swine flu typically have a fever or high temperature (over 38°C/100.4°F) and 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.

    For more information, see Symptoms.

    How long are symptoms expected to last?

    As with any sort of flu, how bad the symptoms are and how long they last will vary depending on treatment and individual circumstances. Most cases reported in the UK to date have been relatively mild, with affected people starting to recover within a week.

    What if I don’t recover within a week?

    If your symptoms don’t improve after seven days (or five days if you are under 16), contact your Primary Health care

    How does swine flu cause death?

    Like any other type of flu, people can die from swine flu if they develop complications, such as pneumonia.

    Has the swine flu virus developed resistance to Tamiflu?

    The first case of resistance of the swine flu virus to the antiviral drug oseltamivir (Tamiflu) has now been reported in England.

    The resistant virus was identified in a patient with a weakened immune system. Although the virus was resistant to Tamiflu, it was susceptible to the antiviral zanamivir (Relenza) and, following treatment, the patient recovered from their illness.

    Should we expect a more severe second wave of the pandemic in the winter?

    The history of previous flu pandemics suggests that the current viral strain will spread more widely in the autumn or winter, causing more illness and death. It is possible that the virus will mutate (change) into a stronger strain.

    Should I go to work or school if I have been in contact with someone who I know has swine flu?

    Yes, as long as you do not have flu-like symptoms. If you are feeling well, you should continue your normal activities, including going to school or work.

    It can take up to seven days (normally two to five days) after infection for swine flu symptoms to develop. If you develop symptoms, stay at home and follow the general advice (see What should I do if I think I’m infected?).

    Is it possible to catch swine flu twice?

    Yes, because the virus can mutate (change). If you become infected with the swine flu virus, your body produces antibodies against it, which will recognise and fight off the virus if the body ever meets it again. However, if the virus mutates, your immune system may not recognise this different strain and you may become ill again, although you may have some protection from having had a similar virus previously.

    Should I have a swine flu party or try to catch swine flu now, so I will be immune to more serious strains that may emerge later?

    No. Don’t try to catch the virus as you may help it spread. Also, as everything about the virus is not yet known, it is too soon to assume it is only a mild infection. Catching swine flu will not necessarily protect you from strains that may emerge later (see Is it possible to catch swine flu twice?).

    Can my pet catch swine flu?

    There is currently no evidence that pets could get this new strain of flu. The swine flu virus appears to be passing only from person to person or from human to swine. In general, flu viruses commonly infect just one species; for example, dogs and cats do not get seasonal flu from their owners.

    What is the National Pandemic Flu Service and how does it work?

    The National Pandemic Flu Service is a new self-care service that will give people with swine flu symptoms fast access to information and antivirals.

    It is a dedicated website and a phoneline (0800 151 3100 or textphone 0800 151 3200) where you can get information, check your symptoms and get a unique number that will give you access to antivirals if necessary.

    When you are given your unique access number, you will be told where your nearest antiviral collection point is. Ask a flu friend (a healthy friend or relative) to go and pick up the antiviral medication.

    If you think you have swine flu, do not go to your GP surgery or A&E. Stay at home to avoid spreading the virus.

    Will the Flu Service be able to distinguish between swine and other flu?

    The staff are trained to identify cases of swine flu. However, the symptoms of seasonal flu are very similar and therefore there is likely to be some overlap with other circulating flu cases. As swine flu becomes more common, a higher proportion of flu-like illnesses will be swine flu.

    How will the government stop people fraudulently getting Tamiflu?

    The government is relying on the public to use the system responsibly. There is no need to jump the queue, because there is more than enough Tamiflu for everyone likely to catch the virus in the months ahead. Nor is there any need to buy Tamiflu from someone who has obtained it under false pretences. Anyone who needs it will be supplied free of charge.

    How much contact should I have with family and friends?

    If you have swine flu, avoid unnecessary contact with family and friends while you are infectious, which is usually until five days after your symptoms started (seven days in children). Once your symptoms have gone, you are no longer infectious.

    Keep one metre or more away from people’s faces to avoid droplets from your throat affecting others. Where possible, you can avoid exposing your partner to infection by sleeping in the spare room.

    What if I need someone to care for me? Will they catch my swine flu?

    If you are unable to look after yourself at home, ask a friend or relative to collect medicines and groceries for you, order any repeat prescriptions, help with basic household tasks, such as cooking, and generally care for you.

    If your friend or relative keeps their distance from you wherever possible and you both have good hygiene (sneezing into a tissue and washing your hands thoroughly), there is a good chance that they will not catch the infection.

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    I’ve lost my appetite. What should I do?

    Losing your appetite is a common symptom of flu and will usually return as you begin to feel better. Try to eat light, nutritious foods, such as soup, toast, baked beans and scrambled eggs (these are also easy to prepare). It may be easier for you to eat little and often.

    Should I go out?

    The National Pandemic Flu Service is a new online service that gives you self-care advice and antiviral medication if you need it without going to your GP.

    If you feel up to it, you may want to get some fresh air. Do not go on public transport, stay in crowded places or visit your GP or hospital when you have swine flu symptoms, as you may infect other people with the virus.

    If you suddenly get much worse, seek medical advice immediately.

    When should I go back to school or work?

    You can go back to school or work when you are feeling well and are no longer infectious. Adults are most infectious soon after they develop symptoms and remain infectious while their symptoms continue, which is usually for up to five days. They can normally return to work within seven days. In children, symptoms continue for up to seven days and they can normally return to school within 10 days.

    What should I do if I’m off work with swine flu for more than seven days?

    Phone your employer and explain why you can’t go back to work yet. They will probably ask you to provide evidence that you can’t work.

    If you’ve already been assessed as having swine flu by the National Pandemic Flu Service or your GP, they will have advised you to stay at home while you’re ill. If your symptoms are not improving by day seven, you should seek further medical advice by phone. You should not go to your GP practice.

    What can I do?

    You can reduce, but not get rid of, the risk of catching or spreading swine flu by:

    * Always covering your nose and mouth with a tissue when coughing or sneezing.
    * Disposing of dirty tissues promptly and carefully.
    * Maintaining good basic hygiene, for example washing your hands often with soap and warm water to reduce the spread of the virus from your hands to face, or to other people.
    * Cleaning hard surfaces, such as door handles, often and thoroughly using a normal cleaning product.

    You can also make the following preparations now:

    * Confirm a network of flu friends (friends and relatives) who could help you if you fall ill. They could collect medicines and other supplies for you so you do not have to leave home and possibly spread the virus.
    * Know your NHS Number and those of other family members. Keep them in a safe place. It is not essential to have your NHS Number in order to receive treatment, but it can help NHS staff to find your health records. You will be able to find your NHS Number on your medical card or other items such as prescribed medication, a letter from your GP or hospital appointment card/letter.
    * Have a thermometer and enough cold and cough remedies in your medicine cupboard, in case you or your family get swine flu.

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    Are alcohol handrubs better than soap and water?

    Both alcohol handrubs and washing with soap and water are important to minimise the risk of spreading swine flu, as they both deactivate the flu virus. Alcohol handrub can only be used on visibly clean hands. If hands are dirty, soap and water should be used. Handrubs are useful when there is no easy access to a place to wash and dry your hands.

    Who should be wearing a facemask?

    The Health Protection Agency (HPA) recommends that healthcare workers wear a facemask if they come into close contact with a person with symptoms (within one metre), to reduce their risk of catching the virus from patients.

    However, the HPA does not recommend that healthy people wear facemasks in their everyday life.

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    Why shouldn’t the general public wear facemasks?

    There is no evidence to suggest that this is a useful preventative measure.

    The virus is spread by people touching infected surfaces, or by someone coughing or sneezing at very close range. So unless you are standing very close to someone with the virus, wearing a facemask will not make a difference.

    There are concerns about the risks of not using facemasks correctly. They must be changed regularly as they don’t work as well when dampened by a person’s breath. People may infect themselves if they touch the outside of their mask, or may infect others by not throwing away old masks safely.

    Finally, wearing a facemask may encourage complacency. It is more important to keep your hands clean, stay at home if you feel unwell and cover your mouth when they cough or sneeze.

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    So why do people in other countries wear facemasks?

    This is an issue which each government has considered separately. France is encouraging the public to buy their own masks for use as a precaution, but it is not stocking masks centrally from government funds. Neither is the US.

    In other countries, people already wear facemasks either to avoid spreading illness or to protect themselves from pollution. This is not the case in the UK.

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    What should I do if I think I’m infected?

    If you have flu-like symptoms and are concerned that you may have swine flu, stay at home, read about swine flu symptoms and check your condition using the National Pandemic Flu Service.

    Phone your GP if:

    * you have a serious existing illness,
    * you are pregnant,
    * you have a sick child under one,
    * your condition suddenly gets much worse,
    or
    * your condition is still getting worse after seven days (five for a child).

    The National Pandemic Flu Service is a new online service that will assess your symptoms and, if required, provide an authorisation number that can be used to collect antiviral medication from a local collection point. For people who do not have internet access, the service can be accessed on:

    * Telephone: 0800 151 3100
    * Minicom: 0800 151 3200

    For more information, go to the Flu service: Q&A.

    If it is confirmed that you have swine flu, ask a healthy relative or friend to pick up your antiviral medication for you.

    In the meantime, take paracetamol-based cold remedies to reduce fever and other symptoms, drink plenty of fluids and get lots of rest.

    Don’t go into your GP surgery or to a hospital, as you may spread the disease to others.

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    If I have been in close contact with an infected person, do I need treatment?

    You only need antiviral treatment if you have been diagnosed with swine flu or if a doctor decides that you are at serious risk of developing severe illness. See Will antivirals be given to people without flu symptoms?.

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    Can swine flu be treated?

    Testing has shown that the swine flu can be treated with the antiviral medicines oseltamavir (Tamiflu) and zanamivir (Relenza). However, the drugs must be taken at or near the start of the illness to be effective. See Treatment for more information.

    The UK already has enough antivirals to treat half the population. Orders of Tamiflu have been placed to increase UK supplies to 50 million doses, enough to treat 80% of the population.

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    What do antivirals do?

    Antivirals are not a cure, but they help you to recover by:

    * relieving some of the symptoms,
    * reducing the length of time you are ill by around one day, and
    * reducing the potential for serious complications, such as pneumonia.

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    How does Relenza work?

    To reproduce and spread, a virus has to enter your body, take over healthy cells and force them to make copies of itself. Relenza stops the release of new copies of the virus from infected cells in the lungs. This slows the spread of the virus, reduces the symptoms and length of time that you feel unwell for and makes it harder for the virus to spread to other people.

    Relenza should first be taken within 48 hours of symptoms appearing in adults (36 hours in children). It works better the earlier you start taking it.

    How does Tamiflu work?

    To reproduce and spread, a virus has to enter your body, take over healthy cells and force them to make copies of itself. Tamiflu stops the flu virus entering your cells and blocks the release of new copies of the virus. This slows the spread through your body, reduces the symptoms and the length of time that you feel unwell for and makes it harder for the virus to spread to other people.

    Tamiflu should first be taken within 12 to 48 hours of symptoms appearing. It works better the earlier you start taking it.

    How effective are Relenza and Tamiflu?

    Relenza reduces the duration of flu symptoms by one-and-a-half days on average. Tamiflu reduces the duration of symptoms by up to two days.

    What if I forget to take a dose?

    Even if you forget a dose of Relenza or Tamiflu, you must not double the next dose. Take the forgotten dose as soon as you remember, as long as the next one is not due for a few hours. If the next dose is due within a few hours, just carry on as you are supposed to. Don’t take a catch-up dose.

    What happens if I take Tamiflu but then have similar flu-like symptoms at a later stage?

    If you re-call the Flu Service with the same details as before, you will be advised that you have already had an antiviral and cannot access another one through the service.

    You should therefore contact your GP to explain that you have received a treatment course of antivirals but are now ill again. Your GP will assess your symptoms and determine the appropriate treatment, which might include another course of antivirals.

    Does the UK have enough antivirals?

    The government has 23 million Tamiflu treatments Tamiflu and 10.5 million treatments of Relenza. Orders of Tamiflu have been placed to increase UK supplies to 50 million doses, enough to treat 80% of the population.

    Is one of the antivirals more appropriate for pregnant women and people with certain kidney conditions?

    Relenza is an inhaled drug that will be used for pregnant women and people with certain kidney conditions who are unable to take Tamiflu. See Pregnancy and children.

    I’m allergic to penicillin. Can I take antivirals?

    Yes, it is safe for you to take antivirals if you have a penicillin allergy.

    I am on warfarin. Can I take antivirals?

    Yes, you should be able to take antivirals if you are on warfarin, but contact your GP for advice first.

    Are there any interactions between Tamiflu and other drugs?

    Tamiflu is not expected to alter the effect of any other medicines. If you are taking other medicines and have any questions or concerns, you should speak to your GP or pharmacist. Tamiflu can be taken with paracetamol, ibuprofen or acetylsalicylic acid (Aspirin).

    As a precaution, the MHRA has set up a web portal for people to report any side-effects from antivirals prescribed for swine flu.

    Will antivirals be given to people without flu symptoms?

    In most cases, no. Antivirals will generally only be given to people who have been diagnosed with swine flu.

    Doctors should not offer antiviral medication as prophylaxis (prevention) to people close to patients unless they have serious existing health problems, such as cancer, or there are other special circumstances.

    Will my child have nausea if they take Tamiflu?

    As with many medicines, nausea is a known side effect of Tamiflu in a small number of cases. Symptoms may improve over the course of the treatment. It may help to take Tamiflu either with or immediately after food, and drinking some water may also lessen any feelings of nausea.

    How are those with confirmed swine flu getting access to antivirals?

    If antivirals are required, the National Pandemic Flu Service will provide you with an authorisation number, which can be used to collect antiviral medication from a local collection point (see How is swine flu infection diagnosed?). Alternatively, if you are in a high-risk group, your GP will advise you over the phone on how to collect your antivirals.

    A healthy friend or relative can then pick up the antivirals for you from your local collection centre, usually a pharmacy or community centre.

    Should people be buying their own antivirals?

    No. The government has enough antivirals to treat half the population, and will increase this to cover 80% as an extra precaution. Therefore, antivirals should be available for everyone who gets ill in the pandemic and there is no need for people to buy their own.

    Does Tamiflu go out of date?

    Yes. There will be an expiry date on the packet. The government has a programme to replace any expired doses under a rolling stock system.

    If I take an antiviral and have side effects, who should I tell?

    First, see your doctor to check that you are OK. Then report your reaction to the Medicines and Healthcare products Regulatory Agency (MHRA) through its new online system (links to external site).

    This new web-page, based on the Yellow Card Scheme (a website where you can report side effects to other medicines), helps the MHRA to monitor the safety of Tamiflu and Relenza.

    Anyone who does not have access to the internet can ask their GP to send a report on their behalf.

    How do we know if the vaccine works?

    The GlaxoSmithKline vaccine (Pandemrix) has shown a strong immune response in clinical trials. Further details can be found in the special product characteristics.

    Who will be a priority for vaccination with the H1N1 swine flu vaccine?

    People who are most at risk from swine flu need to be vaccinated first. These groups are, in order of priority:

    * People aged between six months and 65 years in the seasonal flu vaccine at-risk groups.
    * All pregnant women.
    * People who live with those whose immune systems are compromised, such as cancer patients or people with HIV/AIDS.
    * People aged 65 and over in the seasonal flu vaccine at-risk groups.

    Frontline health and social care workers will also be offered the vaccine at the same time as the first clinical at-risk groups. Health and social care workers are both at an increased risk of catching swine flu and of spreading it to other at-risk patients.

    What are the seasonal flu vaccine at-risk groups?

    These are people with:

    * chronic respiratory disease, such as chronic obstructive pulmonary disease (COPD),
    * chronic heart disease, such as heart failure,
    * chronic kidney disease, such as kidney failure,
    * chronic liver disease, such as chronic hepatitis,
    * chronic neurological disease, such as Parkinson’s disease,
    * diabetes requiring insulin or oral hypoglycaemic drugs, and
    * immunosuppression (a suppressed immune system), due to disease or treatment.

    Why are healthy people over 65 and children not a priority for the swine flu vaccine?

    Healthy people aged over 65 appear to have some natural immunity to the swine flu virus. And while children are disproportionately affected by swine flu, the vast majority make a full recovery – therefore the experts do not advise that children (other than those in at-risk groups) should be vaccinated initially.

    If I am in a priority group, is it compulsory to be vaccinated?

    No, the swine flu vaccine is voluntary. However, the government strongly encourages everyone in an at-risk group to have it.

    Ultimately, it is down to the individual to decide whether they, or any children in their care, have a vaccine or not.

    How do I know if I am in a priority group?

    If you are in a high-risk group, your GP will write to you about getting a vaccine.

    When will everyone else who isn’t in a priority group receive the vaccine?

    The Joint Committee on Vaccination and Immunisation (JCVI) has advised that the use of the vaccine in the wider healthy population should depend on how the pandemic evolves and on emerging clinical data on the use of the vaccine. This will be kept under review. The government will not announce further groups until they have further advice from the JCVI on this issue.

    What are the names of the swine flu vaccines?

    The swine flu vaccine manufactured by GlaxoSmithKline is called Pandemrix and the vaccine manufactured by Baxter is called Celvapan.

    What dosage will be given for each vaccine?

    The following vaccination schedule is recommended in the UK:

    Pandemrix:

    * For all children aged from six months to nine years:
    – two half doses (0.25ml each) given with a
    minimum of three weeks between doses.
    * For individuals aged 10-59:
    – one dose (0.5ml) given.
    * For individuals aged 60 years and over:
    – one dose given (this advice will be reviewed
    when more data become available).
    * For individuals aged 10 years and over with weakened immune systems:
    – two doses (0.5ml each) given with a
    minimum of three weeks between doses.

    Celvapan:

    * For children aged from six months and adults:
    – two doses (0.5ml each) given with a
    minimum of three weeks between doses.

    This dosage schedule is based on advice given by the Joint Committee on Vaccination and Immunisation, following consideration of clinical data available on the vaccines. The dosage and recommendations will be kept under review as more clinical data become available.

    Is the vaccine safe?

    Vaccines would not be licensed if they were considered unsafe. Both swine flu vaccines have been licensed.

    How will vaccine safety be monitored?

    As with any new vaccine, rare and very rare side effects cannot be identified or excluded until the vaccines are used in much larger numbers of people in the general population. Therefore, effective safety monitoring systems for all medicines, including vaccines, are in place to detect and evaluate previously unobserved adverse reactions.

    Why can’t babies under six months be vaccinated?

    The swine flu vaccine (as with seasonal flu) does not produce enough of an immune response in children under six months to provide protection.

    Will the vaccine give me swine flu?

    No. The vaccine does not carry a ‘live’ virus, so it cannot give you swine flu. Some people may experience mild fever up to 48 hours after immunisation as their immune system responds to the vaccine, but this is not flu.

    Is there a link between Guillain-Barre syndrome and swine flu vaccines?

    Guillain Barre Syndrome (GBS), a rare neurological disorder, was an identified risk with swine flu vaccines used in the United States in 1976 – it is thought that one extra case of GBS occurred with every 100,000 doses of vaccine. The reason why the 1976 vaccine increased the risk of GBS remains unknown.

    Many studies have looked at whether other flu vaccines used since 1976 carry a risk of GBS and no robust evidence of a causal link has been found. No cases of GBS have been found in the clinical trials of H5N1 vaccines.

    Does the vaccine contain any porcine (pork) product?

    Some porcine products are used in the manufacturing process of Celvapan, although there are no detectable traces of these products in the vaccine itself.

    Pandemrix does not contain porcine products.

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    Is the vaccine safe for people with an egg allergy?

    The GlaxoSmithKline vaccine (Pandemrix) is not suitable for people who have an anaphylactic reaction (allergic reaction) to egg.

    The Baxter vaccine (Celvapan) does not use eggs in its production and so would be suitable for people who have a confirmed anaphylactic reaction to egg products.

    What are the ingredients in the vaccine?

    The full list of ingredients of Pandemrix can be found by going to the Pandemrix summary of product characteristics.

    The full list of ingredients for the Baxter vaccine can be found here.

    Can the swine flu vaccine be given at the same time as other vaccines?

    Yes. The swine flu vaccine can be given at the same time as other vaccines, including the seasonal flu jab.

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    I’ve already had swine flu – do I still need to be vaccinated?

    You can only be certain that you have had swine flu if it was confirmed by a laboratory test. Otherwise, you may have had normal flu or something else. Unless you know for sure that you have had swine flu, and are in one of the high-risk groups, you should have the vaccination.

    Will the vaccine still provide people with protection if the swine flu virus mutates?

    At this stage, it is impossible to predict if or how the H1N1 swine flu virus will mutate (change). However, experiences with the H5N1 bird flu vaccine would suggest that an H1N1 vaccine would also provide a high level of immunity against closely related strains. The level of cross-protection is expected to be greatest for more closely related strains.

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    Does the NHS have enough syringes to administer the swine flu vaccine?

    Yes, sufficient needles and syringes to mix and administer the vaccine will be provided to primary care trusts (PCTs) free of charge. Stocks will be delivered to PCTs, for onward distribution to GPs, in advance of the vaccine deliveries.

    Why do you need antibiotics in a pandemic?

    While antivirals may reduce complications, they are still likely to occur in the pandemic. Some of the most common include bacterial infections in the respiratory tract and lungs, such as pneumonia. Antibiotics are needed to treat these.

    Antibiotics will be used to treat people in the community if they develop complications. In hospitals, antibiotics will be used to treat the most ill patients and may reduce the length of hospitalisation.

    Are pregnant women more likely to catch swine flu?

    Yes. Pregnant women are more susceptible to all infections, because their immune system is naturally suppressed in pregnancy. They are especially vulnerable to swine flu, as this virus is affecting younger age groups in particular.

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    Are pregnant women with swine flu more at risk of complications?

    Most pregnant women with swine flu will only have mild symptoms, the same as most other people with swine flu. However, pregnant women have an increased risk of complications from any type of flu, because their immune system is naturally supressed in pregnancy. Possible complications are pneumonia (an infection of the lungs), difficulty breathing and dehydration, which are more likely to happen in the second and third trimester.

    There is a small chance that these complications will lead to premature labour or miscarriage. There is not yet enough information to know precisely how likely these birth risks are.

    What precautions can pregnant women take?

    If you are pregnant, you can reduce your risk of infection by avoiding unnecessary travel and avoiding crowds where possible, and following the general hygiene advice (see What can I do?).

    If a family member or someone else in close contact with you has swine flu, your doctor may prescribe antiviral medication (usually Relenza) as a preventative (prophylactic) measure. Relenza is taken through an inhaler rather than a tablet. This means it builds up in your throat and lungs but not in your blood or placenta, so it is unlikely to affect your baby.

    If you think that you may have swine flu, call your doctor for an assessment immediately. If your doctor confirms swine flu over the phone, antiviral medication will be prescribed, to be taken as soon as possible.

    Unless you have swine flu symptoms, carry on attending your antenatal appointments so that you can monitor the progress of your pregnancy.

    Can I take antiviral drugs if I am pregnant?

    Yes, on the advice of a doctor. The Department of Health has bought Relenza, an inhaled antiviral drug that treats flu and minimises any potential effect on the developing foetus. It is unlikely that Relenza will affect your pregnancy or your growing baby.

    However, if your doctor or midwife thinks that a different medicine is needed (for instance, if you have unusually severe flu), you will be given Tamiflu instead.

    The risk of antiviral treatment during pregnancy has been reviewed and proven to be extremely small. It is much smaller than the risk posed by the symptoms of swine flu.

    What are the possible side effects of Relenza?

    Some people have had wheezing or serious breathing problems when they have used Relenza. It is therefore not recommended for people with asthma or COPD. Other possible side effects include headaches, diarrhoea, nausea and vomiting.

    If you take an antiviral and have side effects, see your GP to check that you are OK. Then report your reaction to the Medicines and Healthcare products Regulatory Agency (MHRA) through its new new online system.

    Can I take painkillers if I am pregnant?

    You can take paracetamol to reduce fever and other symptoms. This is safe to take in pregnancy.

    Pregnant women must not take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Nurofen).

    Will pregnant women get preference for a swine flu vaccine?

    Pregnant women are second priority for the swine flu vaccine. See Who will be a priority for vaccination with the H1N1 swine flu vaccine?

    Swine flu,Question & Answer 2

    Is the vaccine safe for pregnant women?

    Yes. The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency has given a clear recommendation that the GlaxoSmithKline vaccine can be given safely to pregnant women. This has now been ratified by the European Commission in the marketing authorisation given to the GSK vaccine.

    Will breastfeeding protect my baby from swine flu?

    Breastfeeding does not appear to reduce the likelihood of babies getting cold or flu. However, it should help reduce the risk of associated complications, such as pneumonia and chest infections. For more information, go to Health A-Z: breastfeeding recommendations

    What should I do if my baby gets flu?

    Your doctor may recommend antiviral medication for your baby, and will advise you on the dose and how to give it to them. If you are breastfeeding, you should continue this: breast milk is easily digestible and your baby will find it comforting.

    Should I stop breastfeeding if I need to take antiviral drugs?

    Women who are breastfeeding can continue to do so while receiving antiviral treatment. If a mother is ill, she should continue breastfeeding and increase feeding frequency. If she becomes too ill to feed, expressing milk may still be possible. Antiviral drugs are excreted into breast milk in very small (insignificant) amounts, which are unlikely to have any side effects on your baby. For more information, go to Health A-Z: breastfeeding recommendations

    How can I tell if my child has swine flu?

    Call your GP immediately if your child has any of the following symptoms and a temperature of 38°C or above or feels hot:

    * tiredness
    * headache,
    * runny nose and sneezing,
    * sore throat,
    * shortness of breath,
    * loss of appetite,
    * vomiting,
    * diarrhoea, or
    * aching muscles, limb and joint pain.

    If you are worried about your child, always call your GP for advice.

    One thing you can do right now is to make sure you have a digital thermometer to take your child’s temperature with.

    If my child has swine flu, what should I do?

    If your GP confirms that your child has swine flu, keep them at home and treat their symptoms like any other cold or flu. Make sure they drink plenty of liquids, get lots of rest and take over-the-counter cold and flu remedies to help control their temperature. However, children under 16 must not be given aspirin or ready-made flu remedies containing aspirin.

    Your GP will tell you whether your child should also take antiviral drugs. Antivirals such as Tamiflu shorten the symptoms by about a day and can reduce the risk of complications. Antivirals are only effective if taken within 48 hours of symptoms starting. If you are worried about your child, call your GP immediately.

    However, antivirals can also have side effects. If your child’s swine flu symptoms are mild, you may not wish to give them antivirals. Your GP can advise you on this.

    Can children take antivirals?

    Yes, on the advice of a doctor. Tamiflu is safe for infants at a reduced dose. It was recently licensed for use in children aged under one during a pandemic outbreak.

    Relenza (an inhaler) can be used by children aged five and older under the supervision of an adult.

    A study published in the BMJ says that antivirals are of ‘small benefit’ for treating children with seasonal flu. So why are children with swine flu being prescribed Tamiflu?

    The BMJ review is based on seasonal flu and not swine flu. As the authors note, the extent to which the findings can be applied to the current pandemic is questionable. Swine flu behaves differently to seasonal flu, and past pandemics have hit younger people hardest.

    While there is uncertainty about how swine flu affects children, the government believes that offering antivirals to everyone remains a sensible and responsible way forward. However, this policy will be kept under review as more is learnt about the virus and its effects.

    The BMJ research is correct to say that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them.

    But for those who experience severe symptoms, the best scientific advice indicates that Tamiflu should still be taken as soon as possible: to suggest otherwise is potentially dangerous. If people are in any doubt about whether to take Tamiflu, they should contact their GP.

    Can babies under the age of one take antivirals?

    Yes, Tamiflu was recently licensed for use in babies aged under one during a pandemic outbreak. The European Medicines Agency has given the following advice:

    * The appropriate dosage to treat children aged under one is 2-3mg/kg twice daily for five days.
    * It is preferable to treat children under medical supervision.
    * The capsule content can be diluted to prepare the correct dose.

    Can my baby take Tamiflu as a preventative measure?

    Whether babies without flu symptoms can take Tamiflu should be decided by an expert in the care of young children. The recommended dose for prevention in the under-ones is 2mg/kg once a day for 10 days (but must not exceed 10 days).

    The best way to protect babies aged under one is by using tissues and throwing them away, washing your hands and the baby’s hands thoroughly, and frequently and thoroughly cleaning surfaces, toys and equipment.

    How can I get antiviral drugs for my child?

    Your GP will tell you over the phone how you can pick up the antiviral medication. Ask a flu friend (a friend or relative who does not have swine flu) to collect this for you.

    I’m on immunosuppressants. Am I more at risk of catching swine flu?

    Yes. If you take immunosuppressants you have a greater risk of becoming infected with any virus, including swine flu, and will be less able to fight it off once you have it.

    Will my dose of immunosuppressants be altered in the event of an outbreak?

    Your doctor may advise that your dose of immunosuppressants needs to change. The appropriate dose will vary from patient to patient.

    Can I take antivirals if I’m on immunosuppressants?

    Yes, if your doctor agrees it is safe for you to take Tamiflu or Relenza.

    Am I more at risk of catching swine flu if I have HIV?

    Probably not. Although HIV infects CD4 cells and reduces their number and function, there are other parts of the immune system that are able to fight flu. For more information, visit the Terrence Higgins Trust website (links to external site).

    Am I more likely to suffer complications if I have HIV and catch swine flu?

    If you have a low CD4 count (under 200), you may be more likely to suffer complications like pneumonia from any type of flu, including swine flu.

    Can I take antivirals if I have mild to moderate kidney disease?

    Yes. If you have stage one to three kidney disease, or your glomerular filtration rate (GFR) is above 30, you will be treated as any other person would be. This means you can take Relenza or Tamiflu, if necessary.


    Can I take antivirals if I have severe kidney disease?

    You can take some but not necessarily all antivirals. If you have stage four or five kidney disease, or your glomerular filtration rate (GFR) is below 30, you will probably be under the care of a kidney specialist. Relenza (an inhaler) is safe to take. If you find this tricky to use, your doctor may give you a reduced dose of Tamiflu tablets instead.

    Are people with asthma or chronic obstructive pulmonary disease (COPD) more at risk of catching swine flu?

    You are no more likely to catch swine flu than anyone else. However, if you do catch a respiratory infection, including swine flu, it may add to any breathing difficulties you have.

    What advice is there for people with asthma or COPD?

    Your condition places you at greater risk if you catch the disease. It is therefore all the more important that you follow good hygiene practices (see What can I do) and react quickly if you develop flu-like symptoms (see What should I do if I think I’m infected).

    Can I take antivirals if I have asthma or COPD?

    Yes, Tamiflu is safe to take. However, Relenza (an inhaler) is usually not given to people with asthma as on rare occasions it can cause breathing complications.

    I have diabetes. Am I at more at risk of catching swine flu?

    You are no more likely to catch swine flu than anyone else. However, if you do catch it, your blood glucose may increase and your diabetes treatment may need to be adjusted accordingly.


    What should I do if my blood glucose increases?

    If your blood glucose has increased, or you become thirsty and are urinating more, call your GP. If you are on insulin and testing your own blood glucose, you may be advised to do this more often so you can adjust your dose according to the results. If you start to vomit or become increasingly unwell, call your GP as soon as possible.

    Is there any advice for people with liver disease?

    If you have liver disease you are no more likely to catch swine flu than anyone else. If you do catch it, antivirals are safe to take. There is no interaction between these and other antivirals you may already be taking.

    Is there any advice for people who need regular replacement hydrocortisone therapy (such as those with Addison’s disease)?

    You can read the swine flu information sheet for patients taking hydrocortisone, produced by the Society for Endocrinology.

    Can I take antivirals if I am on epilepsy treatment?

    Yes. It is thought that antiviral treatments will not affect medicines taken to control epilepsy.

    I look after someone who is very ill or disabled. What if I become too ill to care for them?

    As a carer, it makes sense to begin planning for a caring emergency as soon as possible. The best way to get help with planning for a caring emergency is to arrange to have a carer’s assessment done by your local authority.

    If you have time you may be able to arrange for formal respite care, but you may want to talk to friends, neighbours and relatives about forming a network of flu friends who can help out and look after you if you are ill.

    Are older people more likely to catch swine flu?

    It is not yet known, but most cases so far in the UK have been in people younger than 60. Some older people may have partial resistance to the swine flu virus, due to being exposed to a similar flu virus in a previous pandemic.

    Are older people more at risk of complications if they do catch it?

    Older and frail people are more likely to develop complications from any type of flu, and are generally less able to fight it off.

    What is the advice for travellers?

    Before travelling, check the Foreign & Commonwealth Office (FCO) website for information specific to the country you are visiting. People who do not have internet access can call the FCO’s 24-hour advice line on 0845 850 2829.

    What advice are you giving to people with flu who want to travel by plane?

    The Health Protection Agency is advising anyone in the UK with flu symptoms not to travel until they are no longer infectious. Similarly, any British nationals abroad with flu who want to fly home should only travel when they are no longer infectious.

    What if British nationals abroad ignore this advice and try to travel anyway? Will they be putting other passengers at risk?

    It is the discretion of the airline whether to carry a person with signs or symptoms of infectious disease. Any British national prevented from boarding flights when trying to return home from abroad can get advice from their nearest diplomatic mission.

    Will people be screened when they arrive at their destination?

    The FCO website states that medical screening for the swine flu virus has been introduced at several airports for passengers arriving on international flights, including China. In the section on China, the guidance states: “The Chinese government continues to place great emphasis on screening and surveillance, rapid detection, quarantine and treatment.”

    What should I do if I become ill on holiday or on the flight home?

    Find out in advance where you can get medical advice if you or your family feel unwell on holiday. Have over-the-counter medication for flu with you, such as paracetamol or ibuprofen. Remember that children should not take aspirin.

    If you have flu-like symptoms, keep away from public places to avoid spreading it. Then contact a doctor or other health professional and tell them your symptoms.

    If you become ill on your flight home, alert the cabin crew to your symptoms. There are procedures in place for dealing with passengers who become unwell on flights, and the airline will advise port health officials on the ground that a passenger requires a health assessment and may need treatment.

    Will GPs have to certify people as having swine flu for travel insurance purposes?

    The Association of British Insurers (ABI) has confirmed that swine flu will be treated no differently from any other illness by travel insurers. People diagnosed with swine flu before they are due to travel abroad, and any immediate family members (spouse, parents and children, with some policies covering other relatives) due to travel with them, will be covered for the cost of holiday cancellation by their travel insurance.

    Insurers usually require a doctor’s certificate to confirm that the patient was unable to travel. The government welcomes the comments from the ABI that they would expect insurers to be flexible on the time it takes to obtain such a certificate and that they are considering what other forms of evidence might be acceptable.

    Do I need extra medical insurance?

    No. You should always have insurance when you travel abroad. You do not need extra insurance for swine flu.

    Is it safe to use public transport now we are in a pandemic?

    Yes. Public transport has not been closed during previous pandemics, and while there is a slightly higher risk to the public, this is no more than using other public places.

    Anyone who has the flu or feels unwell should stay at home and not travel.

    Will the government restrict travel within the UK?

    The government is not planning to restrict travel within the UK unless it becomes necessary for public health reasons. Scientific modelling shows that internal travel restrictions would have little impact on the total number of people infected by flu. However, the public is advised to avoid non-essential travel, and anyone who has the flu or feels unwell should stay at home and not travel.

    What happens to visitors to the UK if they are confirmed with swine flu during their stay?

    Foreign nationals should not be treated any differently from UK nationals with regard to self-isolation or other recommended measures. People with symptoms of swine flu, including foreign nationals, are advised not to travel. Overseas visitors will not be charged for NHS hospital treatment for swine flu, including antivirals.

    What does WHO Phase 6 mean?

    The technical definition of Phase 6 is human-to-human spread of the virus into at least two countries in one World Health Organization (WHO) region, with community level outbreaks in at least one other country in a different WHO region.

    Is swine flu a mild infection and therefore no cause for concern?

    It is too soon to assume it will be a mild infection. Not everything about the virus is known, and each case that comes up is being closely monitored.

    The flu virus changes very rapidly. It can pick up and swap genetic material, which dramatically changes it, increasing the severity of symptoms. The virus could change in the autumn, and so this has to be prepared for.

    Will hospital capacity be adequate?

    Most flu sufferers can be cared for appropriately at home. The UK has well-developed methods in place for managing extra demand on the healthcare system during the pandemic. For more information, see the Department of Health guidelines on Managing demand and capacity in healthcare organisations.

    Is it safe to eat pig meat?

    Yes. The WHO says there is no evidence that swine flu can be spread through eating meat from infected animals. However, it is essential to cook meat properly. A temperature of 70°C (158°F) would be sure to kill the virus. Pig meat includes pork, bacon, ham and pork products, such as pork sausages and bacon.

    Are the reports that 65,000 people are going to die true?

    It is wrong to suggest there will be a particular number of deaths each day. Scientific and clinical experts can use sophisticated modelling techniques to help us understand how the virus may behave, but that is all they can do: guide, not predict.

    What happens if someone doesn’t have a flu friend?

    The government has been working with organisations such as the Red Cross to meet the needs of people who may be isolated or otherwise find it difficult to identify a flu friend.

    I’m observing Ramadan. What should I do if I get swine flu?

    Islamic law excuses sick people from fasting. Therefore if you become infected with swine flu during Ramadan, it is sensible to break the fast and take the necessary medication for flu, including antivirals.

    Antivirals are not a cure, but they help you to recover by:

    * relieving some of the symptoms,
    * reducing the length of time you are ill by around one day, and
    * reducing the potential for serious complications, such as pneumonia

    Should I undertake the Hajj this year?

    The World Health Organization and the Saudi government advise that the elderly, pregnant women, people with chronic diseases and children should postpone the Hajj and Umrah pilgrimages this year for their own safety.

    It is highly likely that swine flu will be transmitted in the course of the pilgrimage.

    The Saudi Government has advised that pilgrims planning to attend the Hajj must be vaccinated against seasonal flu at least two weeks before applying for a visa. You will need to provide proof of vaccination when you apply for your visa

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