Travellers

News

5 May 2009

Swine influenza in humans: Update 6

Current status of the outbreak

Cases of human swine influenza A (H1N1) have been identified in 21 countries [1]. Outside of North America, there appears to be little onward transmission from imported cases, and the only confirmed deaths have been in Mexico and the United States.

The WHO continues to focus on mitigation of the consequences of the outbreak. They do not recommend closure of borders, nor do they recommend travel restrictions in an effort to prevent disruption to the global community [2].

The current pandemic influenza alert level remains at level 5, indicating that there is human-to-human transmission of swine influenza occurring in at least two countries of a WHO region, in this case, North America.

A table detailing laboratory-confirmed cases of swine influenza can be found here:

WHO has published a global map of cases.

Advice for travellers

The Foreign and Commonwealth Office advises against all non-essential travel to Mexico. There are no other travel restrictions.

Travellers should consider the necessity of going to swine influenza affected areas, the risk of acquiring swine influenza at the destination, and the level of medical care including access to anti-viral medications in the event of an influenza-like illness (ILI).

Influenza is transmitted via the respiratory route and travellers should exercise sensible precautions:

  • if you are ill with a respiratory illness you should 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 ILI
  • 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
  • swine influenza is not passed through properly handled and 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 [3]
  • 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 or muscle aches, within seven days 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

There is guidance for health professionals who evaluate persons with suspected swine influenza on the Health Protection Agency website, listed below.

Further information is available at the following sources:

Health Protection Agency, Swine Influenza: http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListN

ame/Page/1240732817665?p=1240732817665

Health Protection Agency: Algorithm for the management of suspected cases (returning travellers and visitors from countries affected by swine influenza A/H1N1 or contacts). S5. 2 May 2009. Accessed 3 May 2009. Available at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/124073281

9361 

WHO, Influenza A (H1N1): http://www.who.int/csr/disease/swineflu/en/index.html

European Centre for Disease Prevention and Control: http://ecdc.europa.eu/

Centers for Disease Control and Prevention, H1N1 Flu (Swine flu): http://www.cdc.gov/h1n1flu/

Centers for Disease Control and Prevention. Interim novel influenza A (H1N1) guidance for cruise ships. 2 May 2009. Available at: http://www.cdc.gov/h1n1flu/guidance/cruiseships.htm 

NaTHNaC Country Information pages: http://www.nathnac.org/ds/map_world.aspx

NHS Choices: http://www.nhs.uk/Pages/HomePage.aspx 

References

1. World Health Organization. Influenza A (H1N1) – update 15. 5 May 2009. [Accessed 5 May 2009]. Available at:

http://www.who.int/csr/don/2009_05_05/en/index.html

2. World Health Organization. No rationale for travel restrictions. 1 May 2009 [Accessed 3 May 2009]. Available at: http://www.who.int/csr/disease/swineflu/guidance/public_health

/travel_advice/en/index.html

3. World Health Organization. Advice on the use of masks in the community setting in influenza A (H1N1) outbreaks. Interim guidance. 3 May 2009. [Accessed 5 May 2009]. Available at: http://www.who.int/csr/resources/publications/swineflu/masks_

community/en/index.html