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Guide

The guide has been created due to great care and appreciation towards our clients visiting MMC’s website, who are interested in medicine and health related matters. We would like to offer you a series of straightforward articles, containing a bunch of useful information about the most common diseases and their treatment methods. We draw your attention especially to main symptoms, which should be a subject to immediate medical consultation. In this section you may also read about Maternity and Infant Care Scheme, which presents a great deal of information on this pregnancy supporting medical program. Our guide main aim is to make staying in good health easier by promoting health prevention and increasing medical issues awareness.

We hope you will find it useful and will have a pleasurable reading!

Information and Advice on the Flu

Are you worried about the flu?

In this section of the site, you will find medical information and advice about flu and this pandemic.

Do you have Flu? Symptoms and Advice

Flu is an acute respiratory illness, which usually causes high fever, severe weakness and fatigue. It makes you feel very sick, more than a normal cold. A common cold is a milder, though uncomfortable illness. The symptoms of colds and flu are compared below:

Flu Symptoms Include:

• Sudden Onset of Symptoms
• High Fever - Temperature over 38ºC/100.4ºF
• Severe weakness and fatigue
• Dry cough
• Aching muscles and joints
• Sore throat
• Headache
• Runny nose
• Vomiting / diarrhoea

Common Cold Symptoms Include:

• Sneezing
• a blocked nose, or a runny nose
• pain when swallowing
• mild fever - temperature between 37 and 38.3°C or 98.6 and 101.0°F
• mild earache
• tiredness
• headache
• coughing

What are the symptoms of Influenza A(H1N1)?

The symptoms are like those of regular seasonal flu and include: fever that starts suddenly, cough, sore throat, runny nose, headache and muscle aches. Some people have vomiting and diarrhoea.

What should I do if I get sick?

If you get sick with a flu-like illness, phone the Flu Information Line on Freephone 1800 94 11 00. This is availalbe 24 hours a day, and has detailed advice on symptoms and how to care for yourself or someone else at home. Most people with flu are able to recover at home within a few days without needing anti-viral medicine or medical care. If you have severe flu symptoms, or if you have a chronic illness, are pregnant, or are aged under 5 or over 65, Contact your GP/family doctor by telephone. They will decide if you need testing or treatment. This website has a HEALTH ATLAS service, where you can find your nearest GP on a map, along with contact details. Check out the HEALTH ATLAS HERE. Don't go to the doctor's surgery or to a Hospital emergency department, unless it is an emergency. If you go to the doctor's office, and you have the flu, you are likely to spread it to other people there.

If you have symptoms of flu:

• Cover your Cough: Cover your nose and mouth with disposable tissues when sneezing, coughing, wiping and blowing your nose
• Bin your Tissues: Dispose of used tissues in the nearest waste bin
• Wash your Hands: Wash your hands often with soap and water, and especially after coughing and sneezing. Alcohol-based hand cleaners are also effective.
• Keep the house clean: Clean hard surfaces (e.g door handles) frequently using a normal cleaning product
• Avoid contact with Flu: Flu: Try to avoid close contact with sick people
• Home is the best Hospital: If you are sick with flu, stay at home to avoid spreading infection to others. Avoid touching your eyes, nose or mouth

WHAT SHOULD I DO IF I HAVE A COLD?

A common cold will clear up in a few days and does not usually require time off work or school. Take it easy and drink plenty of fluids. You can take over-the-counter cold medicines, containing paracetamol or ibuprofen, to reduce pain and mild fever. Other remedies are available from your pharmacist for coughs or sore throats.

WHAT SHOULD I DO IF I THINK I MAY HAVE THE FLU?

• Phone the Freephone Flu Information Line 1800 94 11 00. Listen to the information on symptoms and home care.
• If you feel you have flu symptoms and need medical advice, you can phone your GP for advice
• Your GP will decide if you need anti-viral treatment or testing
• Most People do not need treatment with anti-virals and are able to recover at home
• Stay at home for up to 7 days or until you fully recover
• Discourage any visitors
• Take medicines such as paracetamol or ibuprofen to reduce the symptoms
• Drink plenty of fluids

Most people with flu will recover within a few days. Contact your GP if you don’t improve. This website has a HEALTH ATLAS service, where you can find your nearest GP on a map, along with contact details. Check out the HEALTH ATLAS HERE.

HIGHER RISK GROUPS

Some people are at higher risk of complications from flu. They may require additional treatment or monitoring. Age in itself is not a risk factor but this group includes

• people with chronic diseases like heart failure, lung disease, diabetes, liver or kidney disease
• people whose immune system is impaired due to illness or disease
• children under 5 years and pregnant women
• people who are severly obese, BMI over 40

These people should contact their GP by phone as soon as they develop symptoms of flu.

IF YOU ARE AN ADULT

If you have taken the basic care steps outlined above and you start to feel worse, or if after a few days you are not feeling better, you may need more advice from your doctor. Contact you doctor if you notice:

• Shortness of breath at rest or while doing very little
• Painful or difficult breathing
• Coughing up bloody sputum
• Drowsiness, disorientation or confusion
• Fever for 4-5 days and not starting to get better (or getting worse)
• Starting to feel better then developing high fever and feeling unwell again

IF YOU ARE CARING FOR A CHILD

You should contact your doctor by phone if you have taken the steps above and are still concerned that the child shows any of the following symptoms:

• Fast breathing or trouble breathing
• Bluish skin colour
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash.

Remember, if your symptoms change, you should contact your GP if you are worried. Call the HSE 24 hour Flu Information Line for up to date recorded information on the A(H1N1) Flu 24 hours a day - Freephone 1800 94 11 00 Call the HSE Information Line to speak to a HSE staff member and get information and contact details for all HSE Hospital and Community Services Monday – Saturday, 8am to 8pm - Callsave 1850 24 1850 This website has a HEALTH ATLAS service, where you can find your nearest GP on a map, along with contact details. Check out the HEALTH ATLAS HERE.

What is Pandemic (H1N1) 2009?

Pandemic (H1N1) 2009 is a new flu virus which has been circulating worldwide since April. The World Health Organisation has declared this to be pandemic – a flu epidemic that spreads around the world. Pandemic (H1N1) 2009 is a type of influenza virus. It causes respiratory disease in humans, pigs and birds. The type causing the current pandemic is caused by a new and previously unseen type.

Who will receive anti-viral treatment?

As most cases of Pandemic (H1N1) 2009 will be mild, anti-viral treatment will only be necessary in a small proportion of cases. Doctors will assess each case but the following groups are the ones most likely to require treatment with anti-virals:

• Patients who appear to have severe symptoms
• Patients who are in defined high risk groups

Should a GP prescribe anti-viral treatment the prescription can be filled at any pharmacy. Anti-viral medicines for this flu are free of charge to all.

Who are those considered to be in a high risk group and needing treatment?

People who have: chronic lung, heart, kidney, liver, or neurological disease; people whose immune system is reduced by disease or medications; people with diabetes mellitus; people aged 65 years and older; children under 5 (children under 2 are at particular risk of influenza); people on medication for asthma, severely obese people (body mass index more than 40), pregnant women and people with haemoglobinopathies.

Will any contacts of cases require preventative anti-viral therapy?

In general preventative therapy is not recommended for contacts. However, under exceptional circumstances doctors may decide to prescribe preventative anti-viral therapy.

Does this flu spread easily?

The new flu virus appears to 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.

What numbers of cases of Pandemic (H1N1) 2009 are occurring now?

There has been a steady increase in the number of countries reporting cases around the world. Ireland has been affected as well and we are seeing a steady increase in the number of our cases.

Why is this situation of concern?

The virus that has now been found in the Pandemic (H1N1) 2009 cases contains genes in a combination that has not been observed before in the world. In addition, the virus appears to spread easily from person to person. A small proportion of patients have become very ill and there have been small numbers of deaths. These have largely, but not entirely, been among people with pre-existing serious underlying illness. However most people have a typical flu-like illness and recover fully with simple measures such a drinking plenty of fluids and taking paracetamol for the fever and aches and pains seen with influenza.

What has changed from July 16th?

Instead of lab testing all cases, GPs will diagnose people based on their symptoms. We no longer conduct routine contact tracing and giving those contacts preventative anti-viral medicine. We are recommending to GPs that only people with severe symptoms or in high risk groups need to be prescribed antiviral medicine.

Why have we changed our approach to managing the influenza outbreak?

This spread of influenza around the world has been more rapid than in previous pandemics. Only six weeks elapsed between the initial cases being identified and the declaration of a global pandemic, despite the containment strategy of limiting the entrance and spread within a country which was adopted in many countries around the world, including Ireland . Ireland ’s National Public Health Emergency Team (NPHET) which manages Ireland ’s response to this infection has decided thatIreland ’s policy would move from one of containment to one of mitigation, or minimising the impact of the flu virus as its circulation increases.

The rate at which new cases are appearing in Irelandand other countries strongly suggests we in Irelandwill see a major increase in cases of Pandemic (H1N1) 2009 infection. Mitigation is aimed at treating increasing numbers of cases and preparing for mass immunisation with the pandemic vaccine. This change will have greater impact that continuing a policy of prevention and containment of this illness.

From now on doctors will diagnose Pandemic (H1N1) 2009 following examination rather than relying on laboratory testing.

Why did the World Health Organisation declare an influenza pandemic?

An influenza pandemic occurs when a new influenza virus becomes able to spread easily between people leading to outbreaks that extend across the world. When new influenza viruses are introduced into the population, people have little natural immunity to them. On11/6/09 , the WHO raised the level of the pandemic phase to Phase 6 (for an explanation of these phases please see here). The raising of the pandemic level to phase 6 by WHO is in response to the widespread geographical distribution of cases and not in relation to the severity. At this stage, the WHO is characterising this pandemic as moderate in severity (further information on what this level of severity means can be found on the Department of Health and Children's website).

What does the treatment phase involve?

Given that this flu causes mostly mild to moderate illness, we now know that most people who get it can recover at home without needing anti-viral medicine. Our clinical advice is that services and treatment can be concentrated mainly on those people with severe symptoms or who are considered at higher risk – like those with long term chronic illness.

What are the symptoms of Pandemic (H1N1) 2009?

The symptoms are like those of regular seasonal flu and include: fever of sudden onset, cough, sore throat, runny nose, headache and muscle aches. Some people have vomiting and diarrhoea. In severe cases, pneumonia and respiratory failure may develop and occasionally death can occur. Most cases, however, are mild and patients recover without hospitalisation.

Stay Healthy: stop the spread of infection by:

• Avoiding close contact with people who appear unwell and have fever and cough
• Always carrying tissues
• Always covering your nose and mouth with clean tissues, when coughing or sneezing
• Always disposing of used tissues into a bin immediately
• Washing your hands thoroughly with soap and water or alcohol based hand cleaners regularly
• Cleaning surfaces regularly to get rid of germs

Personal actions

What should I do if I get sick?

If you get sick with a flu-like illness phone the Flu Information Line on Freephone 1800 94 11 00, available 24 hrs a day.

Listen to the symptoms of flu and the advice on home care. Most people with flu will be able to recover at home within a few days without needing anti-viral medicine or medical care.

If you have severe symptoms, or are in a high risk group, contact your GP/family doctor by telephone. They will decide if you need testing or treatment

If you do need to be tested or treated the GP may arrange for you to be seen at their surgery or may arrange a home visit. You should stay at home for 7 days while ill unless needing further care.

How do I care for myself or someone else at home?

Stay at home for up to 7 days or until you fully recover

• Discourage any visitors
• Take medicines such as paracetamol or ibuprofen to reduce the symptoms
• Drink plenty of fluids
• Most people with flu will recover within a few days.

Visit www.hse.ie or call the Flu Information Line 1800 94 11 00 to get more advice on home care

How will I know if I need medical care?

IF YOU ARE AN ADULT

If you have taken the basic care steps outlined above and you start to feel worse, or if after a few days you are not feeling better, you may need more advice from your doctor.

Contact you doctor by phone if you notice:

• Shortness of breath at rest or while doing very little
• Painful or difficult breathing
• Coughing up bloody sputum
• Drowsiness, disorientation or confusion
• Fever for 4-5 days and not starting to get better (or getting worse)
• Starting to feel better then developing high fever and feeling unwell again.

IF YOU ARE CARING FOR A CHILD

You should contact your doctor by phone if you have taken the steps above and are still concerned that the child shows any of the following symptoms:

• Fast breathing or trouble breathing
• Bluish skin colour
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash.

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.

How easily does this flu spread?

It appears that after a person becomes infected, it takes less than two days for symptoms to start and this is when people are most infectious. Influenza spreads quickly in closed communities such as schools or residential homes.

Do the public need to wear masks if the flu starts to spread widely?

If a caregiver must have close contact with the sick person (for example, to hold a sick infant), spend the least amount of time possible in close contact and wear a facemask when entering the sick room. Avoid being face-to-face with the sick person. When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face. All persons in the household should clean their hands with soap and water or an alcohol-based hand rub (minimum 60% alcohol) frequently.

Are antiviral drugs effective?

Yes, antiviral drugs are effective in the treatment of Pandemic (H1N1) 2009. If taken shortly after getting sick (within 2 days) they can reduce flu symptoms, shorten the length of the illness and potentially reduce the serious complications of the disease. Irelandhas a stockpile of oseltamivir (Tamiflu) and of zanamivir (Relenza) - enough to treat 55% of the population. The focus of treatment will now be on those who have severe illness and those with Influenza who are at risk of severe illness.

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 antiviral medication.

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 Pandemic (H1N1) 2009 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.

What is an Influenza Pandemic?

An influenza pandemic is a worldwide flu epidemic. A pandemic can cause serious illness and death and can give rise to enormous social and economic disruption worldwide.

What does it mean that the pandemic level is at phase 6?

This is been declared because there is sustained human to human community transmission of the virus in more than one region. These are the conditions required to declare a pandemic

How serious is the current Pandemic?

At this time, the World Health Organisation considers the pandemic to be moderate. This is based on the clinical information available and reflects that:

1. Most people recover from infection without the need for hospitalisation or medical care.
2. Overall, national levels of clinically severe or fatal cases of respiratory illness appear similar to normal seasonal flu, although in some local areas and institutions, high levels of disease have occurred.
3. Overall, hospitals and health care systems in most countries generally have been able to cope with the numbers of people seeking care - although in some localities, some facilities and systems have been stressed.

There is a concern that the current patterns of serious cases and fatalities are occurring mostly among younger people, including the previously healthy and those with pre-existing medical conditions or pregnancy.

Close monitoring during the pandemic period is essential for the WHO to make changes in future severity assessments if needed.

What preparations have been made for an outbreak of Pandemic (H1N1) 2009 in Ireland?

A national plan for pandemic influenza was put in place in January 2007, describing the health system’s response to a possible worldwide pandemic. This detailed plan allowed the Department and HSE to make detailed preparation over the last few years for a pandemic. Stocks of anti-viral medicine and equipment were prepared, and the responses of health services were planned. Ireland is well prepared to respond to a pandemic.

What is being done currently to deal with the outbreak in this country?

The Department of Health and Children and the HSE have been working together since April to manage our response to this outbreak. We also link closely with the European Centres for Disease Control, public health officials in other European Member Statesand the WHO.

The National Public Health Emergency Team (NPHET) has been meeting since the outbreak was first confirmed. This team managed and directs the Department of Health and Children and the HSE responses to a public health emergency. NPHET is chaired by the Secretary General of the Department of Health and Children.

The Government Interdepartmental Committee has been meeting to deal with health emergency planning involving transport, foreign affairs, education, security, etc.

What specific measures have been taken?

• The HSE in association with the Department of Health and Children has finalised advance purchase agreements with two manufacturers for the procurement of 7.7 million doses of pandemic vaccine
• An information leaflet about Pandemic (H1N1) 2009 has been distributed to households
• Posters and leaflets have been placed in air and sea ports
• We have accumulated anti-viral medication stockpiles to treat 55% of the Irish population
• Anti-viral medication has been distributed to all community pharmacies to treat people with severe symptoms and those in high risk groups
• Advertising will be placed on TV and other media
• Information is being updated daily onHSE and Department of Health and Children websites
• Health Professionals have received communications outlining their role in managing cases of influenza.

Are there any plans to close schools or universities?

If a student is suspected of having a virus that might be Pandemic (H1N1) 2009 they must be assessed by their GP/family doctor before returning to school or college. If their GP/family doctor diagnoses the child to have probable or confirmed Pandemic (H1N1) 2009, 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 case that led to a single primary school class staying at home for a week.

Travel precautions going to an affected area:

• Familiarise yourself with sources of health advice in the country of travel, and pay attention to local government and public health announcements including any movement restrictions and prevention recommendations.
• Avoid close contact with people who have fever, sneezing or cough.
• General advice includes frequent and thorough hand washing with soap and water, or alcohol based hand cleaners, particularly after sneezing or coughing.
• If you are sick, avoid close contact with others, stay at home or in your hotel room.
• If you have a mild flu-like illness seek medical advice over the phone if practical.
• Seek medical care if severely ill or in a risk group. Antiviral medications can be prescribed for the treatment of influenza.
• Do not travel or fly home if you are ill.
• Cover your nose and mouth with a tissue when coughing, sneezing or wiping and dispose of tissues into a bin immediately.
• If you are caring for someone who is ill, try to ensure they are not in close contact with others. Wearing a mask may be protective, for those who are caring for someone with influenza

Actions if someone develops a flu-like illness in an affected area:

If you get sick with a flu-like illness as described above, and are travelling in an affected area you should make contact with the local health services by telephone. They will decide if you need testing or treatment.

Precautions for travellers upon return from affected areas:

Travellers returning from affected areas should observe their personal health and if, within 7 days after return, they experience an illness like that described above they should stay at home and immediately contact their GP/family doctor. If you become ill during a flight you should inform the cabin crew.

What precautions should I take when travelling?

• Familiarise yourself with sources of health advice in the country of travel, and pay attention to local government and public health announcements including any movement restrictions and prevention recommendations.
• Avoid close contact with people who have fever, sneezing or cough.
• General advice includes frequent and thorough hand washing with soap and water, or alcohol based hand cleaners.
• Clean surfaces regularly to get rid of germs
• If you are sick, avoid close contact with others, stay at home or in your hotel room.
• If you have a mild flu-like illness seek medical advice over the phone if practical.
• Seek medical care if severely ill.
• Do not travel or fly home if you are ill.
• If you become ill during a flight you should inform the cabin crew.
• Cover your nose and mouth with a tissue when coughing, sneezing or wiping and dispose of tissues into a bin immediately.
• If you are caring for someone who is ill, try to ensure they are not in close contact with others. Wearing a mask may be protective for those who are caring for someone with influenza.

For daily situation updates:

http://www.hpsc.ie/hpsc/News/MainBody,3602,en.html

Further information:

http://www.hpsc.ie/

http://www.hse.ie/eng/

http://www.who.int/csr/disease/swineflu/en/index.html

http://www.cdc.gov/swineflu/

http://ecdc.europa.eu/en/