The World Health Organization says the current swine flu outbreak is the fastest-moving pandemic in history. The number of cases reported in Ireland has recently seen a substantial increase, as have hospitalisations and, unfortunately, deaths.
The vaccine programme against swine flu has now begun for the initially identified at-risk group. These are - people under six months and under 65 years old with chronic illnesses, women over 14 weeks pregnant and those who are severely obese. It is now moving on to the next selected at-risk groups - under fives, over 65s and healthcare workers.
Here, we update you on what you need to know about swine flu.
What is swine flu?
Swine flu is a respiratory disease, caused by a strain of the influenza type A virus known as H1N1. Swine flu has been circulating worldwide since April of this year.
The new flu virus can be highly contagious and can spread quickly from person to person through tiny drops in coughs and sneezes. If you are close to a person with flu you can breathe them in and become infected. Droplets can also be passed from surfaces like door handles and hand rails, which can carry bacteria for up to 24 hours.
What are the signs and symptoms of swine flu?
The symptoms of swine flu are similar to the symptoms of seasonal flu and include fever, cough, sore throat, pains in the muscles or joints, headache, chills, fatigue and runny nose. Some people have reported diarrhoea and vomiting. A high fever, which is a temperature of over 38º Celsius (100.4º Fahrenheit), is the key symptom. The vast majority of patients have both a fever and cough. Most swine flu patients have reported a sudden onset of symptoms.
Certain symptoms may require emergency medical attention. In children, signs of respiratory distress such as blue lips and skin, dehydration, rapid breathing, excessive sleeping and significant irritability that includes a lack of desire to be held may indicate the need for emergency medical care. In adults, shortness of breath, painful or difficult breathing, sudden dizziness or confusion, or coughing up bloody sputum may indicate the need for emergency care. In both children and adults, persistent vomiting or symptoms improving but then returning may require medical attention.
What should I do if I think I have swine flu?
Anyone with a flu-like illness is advised to contact their doctor by telephone. They will decide if you need testing or treatment. People are advised not to go to doctors’ surgeries.
If you have symptoms of flu, you should cover your nose and mouth with disposable tissues when sneezing, coughing, wiping and blowing your nose and dispose of used tissues in the nearest waste bin. Wash your hands frequently and thoroughly with soap and water, especially after coughing and sneezing. Alcohol-based hand cleaners are also effective. Clean hard surfaces such as door handles frequently, and try to avoid close contact with sick people.
If you are sick with swine flu, stay at home for up to seven days or until you fully recover to avoid spreading infection to others and avoid touching your eyes, nose or mouth. Discourage any visitors and take paracetamol or ibuprofen to reduce the symptoms. Drink plenty of fluids.
Most people with flu will recover within a few days, but are advised to contact their GP if they don’t improve.
Who is at higher risk of developing complications from swine flu?
Some people are at higher risk of complications from flu and may require additional treatment or monitoring. This group includes people with chronic conditions such as diabetes, asthma, lung disease, heart failure, liver or kidney disease; people whose immune system is impaired due to illness or disease; people who are severely obese with a BMI over 40; pregnant women, children under the age of five and people over the age of 65.
Just over 40% of people in Ireland who have been hospitalised with swine flu have had underlying health conditions. A US study by the CDC has indicated that among those who have been hospitalised for swine flu, 32% have asthma or chronic lung disease, 16% have diabetes, 10% are current smokers, and 7% are pregnant.
An analysis of 99 US residents who died of swine flu revealed that 11% had asthma, 24% had other lung diseases, 13% had diabetes, 11% were morbidly obese, and 34% were obese.
Is swine flu treatable?
Testing has shown that the swine flu can be treated with the anti-viral medicines oseltamavir (brand name Tamiflu) and zanamivir (Relenza). However, the drugs must be administered at an early stage to be effective. Anti-virals are not a cure but they help patients 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.
To date these drugs have been generally reserved for serious cases and at-risk patient groups.
What medication will I receive if I have swine flu?
Most people with swine flu will not be given any anti-virals if their illness is mild, as it is now known that most people who get it can recover at home without needing anti-viral medicine. They can, however, take ibuprofen or paracetamol to relieve their symptoms. If a patient’s symptoms are severe or if they are in the higher risk groups, their doctor may give them a prescription for anti-viral drugs, which are available free of charge. Very high risk household contacts of swine flu patients will also receive anti-virals. Those deemed ‘very high risk’ are pregnant women, those on medication for asthma and those who are very obese. Ireland has stockpiled enough anti-virals to treat 55% of the population.
How bad is the outbreak predicted to be in Ireland?
The Department of Health has warned that one million people in Ireland, or one quarter of the population, could eventually get swine flu. In recent weeks, as we move into winter, the rate of swine flu (H1N1) infection has been increasing rapidly and its incidence has exceeded the rate of 'normal' seasonal flu. This increase was expected and upsurges like the current one are common in pandemics. The increased incidence is beginning to have an effect on hospital services and some hospitals have had to cancel some elective admissions. A pregnant woman with no underlying medical condition recently died of swine flu.
The virus has spread around the world more rapidly than any previous flu pandemics in spite of containment efforts. Only six weeks elapsed between the initial cases being identified in Mexico and the declaration of a global pandemic. Previous viruses have taken six months to spread to the same extent.
Is it true that mostly young people are catching swine flu?
Yes. The vast majority of people in Europe who have contracted the virus have been under the age of 30. Some 77% of cases were reported in children and young adults under 30, a feature which distinguishes it from seasonal flu. However, in developed countries, 98 to 99% of cases have been mild, have not required admission to hospital and have made a full recovery. Recent data shows that just over half of those who have died so far in Ireland from swine flu were over 45 years old - two of the deaths have been in over 65s. It is believed that those over 65 have certain levels of immunity to the swine flu virus.
Do the public need to wear masks if the flu starts to spread widely?
There is no conclusive evidence that facemasks will protect healthy people in their day-to-day lives, and there are concerns about the risks posed by not using facemasks correctly.
Facemasks must be changed regularly as they are less effective when dampened by a person’s breath. People may infect themselves if they touch the outer surface of their mask, or may infect others by not disposing of old masks safely.
It is, however, recommended that healthcare workers wear masks if they come into close contact with a person with symptoms to reduce their risk of catching the virus from patients.
What is happening with vaccinations?
Vaccination is the most effective way to prevent individuals getting swine flu and its spread in the community. The vaccination programme began offically on November 2, with the first priority group of patients being people under the age of 65 with chronic illnesses, pregnant women over 14 weeks and those who are severely obese. These are being targeted first on the basis of medical need and in accordance with the availability of vaccine supplies. View the full list of eligible people in the initial at risk group here
Around 500,000 vaccine doses are being made available to this group. It is then planned that under-fives, healthcare workers and the elderly will be targeted for vaccine. As the uptake among the initial at-risk groups becomes clearer and as more vaccine supplies are made available, the vaccine programme is expected to be extended to the entire population by around the end of the year or early into the new year
Eventually, enough vaccine will be supplied to to give everyone in the country two doses, although it has not yet been confirmed which groups of the population will need two doses. Those who have already been infected with the virus will not receive the vaccine. The HSE says some initial 'glitches' with supplies to GPs will be sorted out and extra supplies can be given to GPs who run out of vaccine.
The vaccine is being made available to everyone in the country free of charge.
Where can you get the vaccine?
The vaccine is available (to the initial at-risk groups first) from GPs, and around 2,300, or most of the GPs in the country, have signed up to deliver the first stage of the vaccination programme. The vaccine is also available in special HSE clinics. Those who want to get the vaccine at their GP's surgery are asked to contact the surgery first. People are also advised to book attendance at the clinics for the vaccine, although people who turn up without an appointment at clinics will still be vaccinated.
However, it should be stressed that GPs will only be delivering the vaccine to the initial at-risk group - those under 65 with chronic illnesses and pregnant women. The vaccine for the remainder of the population will be administered in HSE clinics.
You can view a list of HSE clinics (also available from info phonelines below) and can book an appointment on-line here
How safe is the vaccine?
The health authorities say the vast majority of the adverse events seen to date with the H1N1 vaccine will be mild in nature and of short duration. There are sometimes local skin reactions at the injection site, which are mild and transient. People can also have generalised symptoms after the vaccine such as aches and fever, which are mild and usually pass after two days. The vaccine does not give you the flu. There may be severe allergic reactions to the vaccine but these are very rare, according to the health authorities.
Is the vaccine safe for pregnant women?
Women more than 14 weeks pregnant are included in the first at-risk cohort being given the vaccine. The health authorities here say the vaccine is safe for pregnant women. The Irish Institute of Obstetricians and Gynaecologists , the HSE and the Department of Health have stressed that the potential complications with swine flu in pregnancy far outweigh any possible slight risks associated with vaccination in pregnancy. Pregnant women are four times more likely to develop serious complications from swine flu or to be hospitalised from swine flu than non-pregnant women. Possible pregnancy complications with swine flu include early labour and severe pneumonia. Switzerland has not approved Pandemrix for use in pregnant women, although this appears to be the only European country where this has happened. Already, one pregnant woman has unfortunately died from swine flu.
Does the vaccine contain mercury?
There are two vaccines available in Ireland. For packaging and storage reasons, Pandemrix is being supplied to GP surgeries, while the other vaccine, Celvapan, is being made available in the HSE clinics. The health authorities here say both vaccines are safe. Pandemrix contains a small amount of thiomersal, a compound containing mercury that is used as a preservative and allows for a longer period for use of the multi-dose vials, but there is no evidence that this is harmful, according to the health authorities.
According to the Irish Medicines Board, a European study previously concluded that there is no evidence of harm from thiomersal in vaccines, other than the possibility of an allergic reaction in a very small number of cases. The authorities say thiomersal has been used in medical products for many years without reports of adverse effects. However, anyone worried about receiving the vaccine with thiomersal would have the option of going to a HSE clinic to get the other vaccine instead.
I am pregnant – what if I get the flu?
Women who are pregnant and develop influenza symptoms should contact their GP and arrange to receive anti-viral medication, which is safe to take in pregnancy. You can also take paracetamol-based cold remedies to reduce fever and other symptoms. Paracetamol is safe to take in pregnancy, but ibuprofen is not. Pregnant women are being advised to avoid contact with people who have flu symptoms.
I am breastfeeding – what if I get the flu?
Breastfeeding allows important protection and antibodies to be passed from mother to child. Infants who are not breastfeeding are particularly vulnerable to infection and hospitalisation for severe respiratory illness.
Women who are breastfeeding and who get the flu should continue to breastfeed as much as they can to protect their baby. It is safe to breastfeed while taking anti-viral medicine. In as far as is possible, breastfeeding babies should be fed on demand to allow as much protection pass to the baby as possible.
If a mother becomes too ill to feed then expressing milk may still be possible. If the baby becomes too ill to breastfeed, expressed milk should be used. The risk for swine flu transmission through breast milk is unknown as yet, but it is rare for normal flu to be be transmitted through breast milk from mother to baby.
If a mother is too ill to breastfeed or to express milk, infants should be kept well hydrated and fed with formula.
Are there any restrictions on travel or schools?
No. According to the WHO, travel restrictions are not useful in limiting the spread of the virus. The HSE has recommended that travellers at risk of complications (see above) should discuss the risk of travel with their doctor before deciding whether or not to go. Travellers are advised to familiarise themselves with sources of health advice in their country of travel and pay attention to local government and public health announcements, including any movement restrictions and prevention recommendations.
Is there a chance the virus will mutate?
At this stage, it is impossible to predict if or how the swine flu virus will mutate. However, if it does mutate, it is believed that the vaccine would still provide a high level of immunity against closely related strains, as occurred with the bird flu vaccine.
Are there any plans to close schools, universities or other places where public gatherings might take place?
The issue of school closures has been considered by the National Public Health Emergency Team on the basis of advice provided to it by the Pandemic Influenza Expert Group and there are no plans at present to close all schools. The matter is being constantly reviewed in an evolving situation.
At present, if a student is suspected of having swine flu they must be assessed by their GP before returning to school or college. If their GP diagnoses the child to have probable or confirmed swine flu, the local Department of Public Health will be contacted. The educational institution/school should take advice from the Department of Public Health, but in general the advice will be to continue normal school operations.
Unless the Department of Public Health advise the management to close as a precautionary measure, the educational institution/school should not do so. To date there has been one school closure. No public places have been closed and no public gatherings have been cancelled thus far.
The HSE's automated swine flu information line is freephone 1800 94 11 00
The HSE's information helpline is 1850 24 1850
View a wide range of swine flu advice and information from the HSE here
Information is also available online through a mobile website - m.swineflu.ie. This can be accessed through mobile phones with internet browsers, PDAs, iPhones etc., either directly or by texting FLU to 51444.
See also 'Swine flu - a lesson from history' here
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