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ECDC HEALTH INFORMATION
Q1. What is the influenza virus A(H1N1)?
The present epidemic influenza virus A(H1N1) is a new virus subtype of influenza affecting humans, which
contains genes from pig, bird and human influenza viruses, in a combination that has never been observed before
anywhere in the world. This virus is transmitting from human to human and has spread to many countries in the
world. While most cases have been mild, the resulting illness has been severe in a substantial number of cases
especially in Mexico.
Q2. What is the difference between the new influenza
A(H1N1) and swine influenza?
The typical swine influenza (swine flu) is an acute viral infection of the respiratory tract in pigs, caused by type A
influenza virus. The mortality rate is low in pigs and recovery usually occurs within 7–10 days. Swine-origin
influenza infections also occur in wild birds, poultry, horses and humans, but transmission between species is
considered a rare event. So far three influenza type A virus subtypes have been found in pigs: H1N1, H1N2 and
H3N2.
Human infections with swine influenza have been detected occasionally since the late 1950s, usually in persons with direct exposure to pigs (e.g. people working on pig farms, etc.). In Europe, since 1958 a total of 17 cases have been reported. In the US in 1976, an outbreak of swine influenza virus infections in humans was detected among recruits in a military camp in Fort Dix, New Jersey. A link to pigs was presumed but never established. Instead there was extensive human-to-human transmission, with over 200 infections resulting in 12 hospitalisations and one death. In contrast to the typical swine influenza virus, the new influenza virus A(H1N1) contains genes from pig, bird and human influenza viruses. It transmits from humans to humans, and pigs are not a part of the present spread of the virus. European Centre for Disease Prevention and Control, 2009. Reproduction is authorised, provided the source is acknowledged.
EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL
Influenza virus A(H1N1)
Q3. What are the symptoms of influenza A(H1N1)?
Symptoms of influenza A(H1N1) in humans are usually similar to regular human seasonal influenza symptoms:
Respiratory symptoms such as cough or runny nose Vomiting or diarrhoea (not typical for influenza but reported by some of the recent cases of the new influenza) In some cases, severe complications could occur even in normally healthy persons who become infected with the virus. Q4. How do people become infected with influenza virus
A(H1N1)?
People become infected with influenza virus A(H1N1) in the same way as for normal seasonal influenza. It spreads
from person to person via droplets from an infected person who is coughing or sneezing; indirectly when droplets
or secretions from the nose and throat settle on hands and other surfaces which then are touched by other people
who touch their own mouth or nose.
Q5. Can this influenza virus be transmitted to humans by
eating pork and pork products?
No. The influenza virus is not transmitted by eating properly handled and cooked pork and pork products. It has
not been isolated from animals to date and there is no indication that the virus is currently in the pork production
chain. The European Food Safety Authority (EFSA) and ECDC are not aware of any scientific evidence to suggest
that influenza viruses can be transmitted to humans through the consumption of meat such as pork and pork
products.
Regardless of the present epidemic, longstanding food safety advice is to avoid eating raw meat in order to prevent possible risk of food-borne illness. It is always recommended to follow proper food hygiene practices in kitchens and to wash hands and all surfaces and equipment with soap after handling raw meat. Cooking pork thoroughly (to an internal temperature of 70°C) kills viruses and bacteria. Q6. Is there a vaccine against the influenza virus A(H1N1)?
Although there is a vaccine available for pigs against swine influenza, there is no vaccine to protect humans from
influenza virus A(H1N1) (see also Q7).
Q7. Is the human seasonal influenza vaccine effective
against this influenza virus A(H1N1)?
There are certain similarities between the usual H1N1 human influenza viruses (covered by the seasonal vaccine)
and the novel influenza virus A(H1N1) so one cannot rule out some level of cross-protection, but this is likely to be
only partial. Investigations need to be undertaken to determine whether this is the case. Those investigations are
under way, but are likely to take some time before any results are available.

EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL
Influenza virus A(H1N1)
Q8. Can influenza virus A(H1N1) be treated?
Most swine influenza viruses have been susceptible to antiviral medications such as neuraminidase inhibitors
(oseltamivir and zanamivir) and older antiviral drugs (amantadanes). Current evidence suggests that the influenza
virus A(H1N1) is susceptible to neuraminidase inhibitors but resistant to amantadanes.
Q9. What is the situation across Europe?
The situation is constantly evolving, therefore for latest information please consult the ECDC home page. More
detailed updates can be found at:
http://www.ecdc.europa.eu/en/Health_topics/novel_influenza_virus/2009_Outbreak/
Q10. What is being done about the situation?
In the European Union, ECDC is following the epidemiological situation and assessing the risks, while the European
Commission is working closely with the EU Member States on all risk management issues within the Early Warning
and Response System (EWRS). The Health Security Committee is also meeting to discuss the situation and the
Global Health Security Initiative is exchanging information on the current status of the situation and counter-
measures. EU Health Ministers held an extraordinary meeting to discuss the situation on 30 April 2009, where they
reinforced the need for the EU to work together and join forces.
The US Centers for Disease Control and Prevention (CDC) in Atlanta ECDC, the European Commission together with its Member States and the WHO Regional Office for Europe are monitoring and assessing the situation closely. The health authorities in Mexico are undertaking a number of measures for control and management of the outbreak such as closure of schools, advising avoidance of mass gatherings and distribution of face masks and antivirals. Furthermore, they have issued advice on hygiene measures to avoid the spread of flu. The US public health authorities have implemented their emergency response and are sending antiviral drugs, personal protective equipment, and respiratory protection devices to all States and US territories to help them respond to the outbreak. Q11. Are we facing a new influenza pandemic?
The World Health Organization has raised the influenza pandemic phase from 4 to 5. This is a signal that a
pandemic may evolve, and that countries should act to finalise the organisation and implementation of their
planned measures.
Phase 5 is characterised by human-to-human spread of the virus within at least two countries in one WHO region: in this case in Mexico and the United States. The succeeding phase 6, characterised by community-level outbreaks in at least one other country in a different WHO region, will be certainly reached but it is not possible to know for certain when this will happen. An influenza pandemic is characterised as an ongoing worldwide epidemic caused by a that infects a large proportion of the human population lacking immunity to that virus. In the 20th century there have been three influenza pandemics: in 1918, 1957 and 1968. In Europe in recent years there have been considerable efforts in pandemic preparedness planning and all EU Members States have a national influenza pandemic preparedness plan. Q12. The development of a pandemic: how does flu spread?
One of the components of the definition of a pandemic virus is that it is a novel influenza virus; therefore many
people, if not most people, have little immunity to it – less than to ordinary seasonal virus. We do not yet know
what proportions of people will be in this situation.
Because many people are infected during a pandemic some will have no symptoms at all (asymptomatic infections) and many will have mild symptoms. However, a small proportion will have more severe symptoms and will benefit from hospitalisation and a very small proportion of the group will die prematurely, usually from complications of the influenza infection. The best way of estimating these proportions is to look back to the experience of previous pandemics: those of 1918, 1957 and 1968. These three pandemics differed in many of their characteristics, especially in their severity.
EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL
Influenza virus A(H1N1)

Figure 1. Examples of clinical attack rates from previous pandemics
r 25%
tack
Source. We are grateful to the UK Department of Health and the Health Protection Agency for this presentation. These are the examples of clinical attack rates, i.e. people who actually had symptoms. The percentages are of the whole population. It is important to note that a 50% attack rate would mean an infection rate of much higher (about 85%) because of the asymptomatic infections (people who show no symptoms). So a reasonable range of a clinical attack rate is 25% to 35%, which means an infection rate of about 50% because of the asymptomatic infections. Q13. Is it safe to travel to Mexico?
As of now, Mexico is the country that has been worst hit by the new influenza A(H1N1) epidemic, including
infection to travellers from other countries. The present ECDC advice is therefore that persons should defer any
unnecessary travel to this country, until further notice.
Q14. What should I do if I want to travel to areas with
reported cases?
In a statement on 27 April 2009, the Director-General of WHO recommended not to restrict international travel,
though it is considered prudent for people who are ill to delay international travel. Anyone who develops
symptoms following international travel should seek medical attention.
Persons who intend to travel to areas with reported cases of influenza virus A(H1N1) are advised to consult the WHO website and websites of their ministries of foreign affairs or national public health institutes. All travellers are advised to follow some general hygiene measures, such as: Avoiding close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too. Staying home from work, school, and avoid running errands when you are sick. This will help prevent others from catching your illness. Covering your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Throw the tissue in the bin after you use it. Washing your hands will help protect you from germs. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners may also be effective. Avoid touching your eyes, nose or mouth because germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL
Influenza virus A(H1N1)

Q15. What precautions are needed for travellers returning
from areas with reported cases
Travellers returning from areas with reported cases should observe their personal health and should immediately
contact a physician if, within seven days of return, they experience:
and one or more of the following symptoms Respiratory symptoms such as cough or runny nose Vomiting or diarrhoea (not typical for influenza but reported by some of the recent cases of swine influenza infection) Q16. What should I do to keep from getting the flu?
First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically
active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not to touch surfaces that may be
contaminated with the flu virus. Avoid close contact with people who are sick.
Q17. What surfaces are most likely to be sources of
contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or
her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs
can be spread when a person touches respiratory droplets from another person on a surface like a desk, for
example, and then touches their own eyes, mouth or nose before washing their hands.
Q18. What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against this new H1N1 virus. There are everyday actions that
can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to
protect your health:
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the bin after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Avoid touching your eyes, nose or mouth: germs spread this way. Try to avoid close contact with sick people. Stay home if you are sick for seven days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further. Q19. What is the best way to keep from spreading the virus
through coughing or sneezing?
If you are sick, limit your contact with other people as much as possible. Do not go to work or school if il for
seven days or until your symptoms go away (whichever is longer). Cover your mouth and nose with a tissue when
coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste
basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you
cough or sneeze.

EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL
Influenza virus A(H1N1)

Q20. What is the best technique for washing my hands to
avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-
based hand cleaner. We recommend that when you wash your hands – with soap and warm water – that you
wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel
sanitisers may be used. You can find them in most supermarkets and pharmacies. If using gel, rub your hands
until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.
For more information on Influenza A(H1N1) please visit our website at

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