Clinical Updates
28 April 2009
Swine influenza in humans: Update 1. Changes to the pandemic alert level and travel recommendations for Mexico
The World Health Organization (WHO) has reviewed the level of the influenza pandemic alert, and has raised the level from phase 3 to phase 4 [1]. This upgrading recognizes that there has been verified human-to-human transmission of the swine influenza virus and that there is the risk of community level outbreaks [2]. This indicates that the likelihood of a pandemic is increased, but is not inevitable. A pandemic occurs when there is worldwide, sustained transmission of a new type of influenza virus.
The Foreign and Commonwealth Office now advises against all non-essential travel to Mexico [3].
Current status of the outbreak
Cases of human swine influenza A (H1N1) have been identified in countries throughout the world including the United Kingdom. The WHO does not consider containment of the outbreak as a feasible goal, and has focused on mitigation of the consequences of the outbreak [1]. Countries reporting cases include Mexico (1,840 suspected cases of which 26 are confirmed), the United States (40 confirmed cases), New Zealand (3 confirmed and 7 suspected cases), Canada (6 confirmed cases), the United Kingdom (2 confirmed cases), and Spain (1 confirmed case) [4-10]. Several other countries are investigating possible cases. There have been no deaths due to human swine influenza outside of Mexico.
There is continued mobilisation of resources and expertise by public health bodies throughout the world to improve surveillance, detection and management of cases.
Advice for travellers
Travellers are advised to defer non-essential travel to Mexico. There are no other travel restrictions at present. The WHO has recommended not closing international borders [1].
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
- wash hands with soap and water; use waterless 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
- there is little evidence of the effectiveness of wearing masks at a mass level, however, properly fitted masks can be worn in special 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:
- 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
Further information is available at the following sources:
NaTHNaC Clinical Update: Swine influenza in humans: United States, Mexico and Canada. 27 April 2008. Available at: http://www.nathnac.org/pro/clinical_updates/swineinfluenza_27
Health Protection Agency, Swine Influenza: http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListN
ame/Page/1240732817665?p=1240732817665
WHO, Swine Influenza: http://www.who.int/csr/disease/swineflu/en/index.html
Centers for Disease Control and Prevention, Swine Influenza (flu): http://www.cdc.gov/swineflu/
NaTHNaC Country Information pages: http://www.nathnac.org/ds/map_world.aspx
References
1. World Health Organization. Swine influenza. 27 April 2009. [Accessed 28 April 2009]. Available at: http://www.who.int/mediacentre/news/statements/2009/h1n1_2
2. World Health Organization. Current WHO phase of pandemic alert. 27 April 2009. [Accessed 28 April 2009]. Available at: http://www.who.int/csr/disease/avian_influenza/phase/en/index.
3. Foreign and Commonwealth Office. Mexico. 27 April 2009. [Accessed 28 April 2009]. Available at: http://www.fco.gov.uk/en/travelling-and-living-overseas/travel-advice-by-country/north-central-america/mexico?ta=all
4. Centers for Disease Control and Prevention, US. Swine influenza (flu). 27 April 2009. [Accessed 28 April 2009]. Available at: http://www.cdc.gov/swineflu/
5. Public Health Agency of Canada. Government of Canada provides update to provinces and territories and international partners regarding swine flu. 27 April 2009. [Accessed 28 April 2009]. Available at: http://www.phac-aspc.gc.ca/media/nr-rp/2009/2009_0427_swine-eng.php
6. Pan American Health Organization. Influenza cases by a new subtype, update for the Americas. 27 April 2009. [Accessed 28 April 2009]. Available at: http://new.paho.org/hq/index.php?option=com_content&task=vie
7. Ministerio de Sanidad y Política Social, Spain. ÚLTIMO COMUNICADO: sobre el brote humano de gripe de origen porcino. Reunión extraordinaria del CISNS. 27 April 2009. [Accessed 28 April 2009]. Available at: http://www.msc.es/gabinetePrensa/notaPrensa/desarrolloNota
8. Health Protection Agency. Suspected Cases in Scotland Test Positive for Swine Influenza. 27 April 2009. [Accessed 28 April 2009]. Available at: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAwe
b_C/1240812259242?p=1231252394302
9. World Health Organization. Swine influenza – update 3. 27 April 2009. [Accessed 28 April 2009]. Available at: http://www.who.int/csr/don/2009_04_27/en/index.html
10. New Zealand Ministry of Health. Results of H1N1 (Swine flu) testing. 28 April 2009. [Accessed 28 April 2009]. Available at: http://www.moh.govt.nz/moh.nsf/indexmh/results-of-h1n1-swine-flu-testing-280409
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