Swine Flu Advice

Our Clinical Director, Dr. David Lalloo, offers the following advise regarding the current Swine Flu situation:

It is becoming clear that the outbreak is spreading to a number of different countries throughout the world and all overseas travellers or contacts of infected individuals in the UK need to be aware of the problem. The list of affected countries will be updated regularly on the NaTHNaC website (LSTM is one of the two clinical centres for NaTHNaC)

As ever, common sense should prevail. At the moment, UK advice is to avoid travel to Mexico only: if this changes, staff will be notified. The information below summarises current UK advice on what to do if you have been potentially exposed and are symptomatic. One of the key issues is to try to avoid spread: so if you are symptomatic you should not come to work or attend hospital (unless extremely unwell): cases will be diagnosed and managed in the community. Please remember that symptoms of flu and malaria can be similar: if you have travelled to malaria endemic areas in the past six months, please contact the clinic staff or doctor on call (07909 910 899) for advice.

We will continue to monitor the situation and update staff if the situation changes

Transmission and clinical illness

Influenza viruses are usually transmitted person to person by respiratory droplets when an infected person coughs in close proximity (less than one to two meters) to others. Contact with contaminated surfaces may also be a mode of transmission. The incubation period and time of infectivity are not entirely known for swine influenza. They are expected to be similar to those of seasonal influenza which has an incubation period of one to four days and an infectivity time form the day before the onset of symptoms to seven days after development of illness. Children may be contagious for longer periods.

Symptoms of swine influenza are similar to typical influenza and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some report diarrhoea and vomiting. Infection has ranged from asymptomatic and mild to severe with pneumonia and death. Those at higher risk for complications are expected to be the same groups as for seasonal influenza: infants, the elderly, immunocompromised, HIV infected, and those with chronic medical conditions, such as diabetes or renal failure.

Swine influenza isolates in samples from infected persons have been killed by the anti-viral drugs oseltamivir and zanamivir, but not amantadine or rimantadine.
A case definition used for the surveillance of respiratory illness to aid in the detection of human swine influenza is: fever ³38°C or history of fever, plus two or more of the following symptoms: cough, sore throat, runny nose, muscle aches or pains, headache.

Advice for travellers

The Foreign and Commonwealth Office has advised travellers to defer non-essential travel to Mexico. There are no other travel restrictions at present, and the WHO has recommended not closing international borders.
Influenza is transmitted via the respiratory route and travellers should exercise sensible precautions:

• it is prudent that if you are ill with a respiratory illness to delay travel
• follow public health guidance at your destination
• avoid crowding or mass gatherings
• avoid close contact (within 2 meters) with persons who are ill with an influenza like illness
• wash hands with soap and water; use alcohol-based hand gels when soap and water is not available
• avoid touching your nose, mouth or eyes, to prevent the spread of germs
• cover your nose and mouth with a tissue when you cough or sneeze and dispose of the tissue promptly
• keep hard surfaces (e.g. door handles, countertops) clean using a normal cleaning solution
• assure that children follow similar advice
• swine influenza is not passed through properly handled or prepared pork; the virus is killed by cooking to temperatures of 70°C
• there is little evidence of the effectiveness of wearing masks at a mass level, however, properly fitted, special grade masks can be worn in situations such as healthcare settings
• receive appropriate vaccines for your destination, including seasonal influenza vaccine if you come under the recommended risk groups (see NaTHNaC Health Information Sheet on Influenza)

Travellers who have visited affected areas should monitor their health for seven days after the visit. If you develop a febrile illness with cough, sore throat, headache and muscle aches, you should:

• check your symptoms on NHS Direct (www.nhsdirect.nhs.uk) or NHS Choices (www.nhs.uk), and if you remain concerned, contact your GP or NHS Direct (0845 4647) and inform them of your travel history
• limit contact with other people
• cover your nose and mouth with a tissue when you cough or sneeze and dispose of the tissue promptly
• wash hands with soap and water
• keep hard surfaces (e.g. door handles, countertops) clean using a normal cleaning solution
• think whether malaria could be a possibility