Swine influenza - Health Protection Agency update

The first confirmed cases of swine influenza have been seen in Europe – one case in Spain and two in Scotland. The Health Protection Agency is continuing to monitor events and work closely alongside the UK government, to review the ongoing events and assess any threat they pose to UK public health.

The appearance of confirmed cases in the UK and Europe is not unexpected. In addition to the Mexican cases there have been cases reported in various parts of the US, Canada and New Zealand so the likelihood that it would come here was always high.

Outside of Mexico the majority of cases have been mild and cases have responded positively to antiviral treatment. Although there has been a high number of a deaths associated with the Mexican outbreak there have not so far been any deaths reported elsewhere.

Individuals returning from affected areas who become unwell within seven days of their return should stay at home and contact their GP or NHS Direct. They will be assessed and, if necessary, testing and treatment will be provided.

Clinicians have been asked to consider swine influenza A (H1N1) virus infection when assessing returning travellers and visitors to the UK who present with flu-like symptoms AND have a history of travel to affected areas in the 7 days preceding illness onset.

The World Health Organization (WHO) has requested that all countries strengthen their flu surveillance to provide more information on this infection.

There are currently very low levels of flu activity in the UK but the Agency and the NHS have ongoing surveillance systems in place, which will alert public health authorities of any unusual strain circulating in the UK.

Guidance for health professionals
As part of its preparations the Agency has produced and distributed guidance for the NHS (a WHO Pandemic Alert Phase 3 algorithm) on the management of returning travellers and visitors from countries affected by swine influenza A/H1N1 who present with febrile respiratory illness.

This guidance will support health professionals in their recognition, investigation and initial management of patients who have travelled to affected areas and may be at risk.

The UK's detection capability for this virus is already excellent, using the Health Protection Agency's regional laboratory network and the Centre for Infections Virus Reference Department.

Advice for returning travellers
If you have recently visited one of the countries or areas where human cases of influenza have been identified, it is important for you to monitor your health closely for seven days after your visit to the affected area. There is no need for you to isolate yourself from other people as long as you remain well.

If during this period you develop a feverish illness accompanied by one or more of cough, sore throat, headache and muscle aches, you should stay at home and contact your GP by phone or seek advice from NHS Direct (084...). You should make sure that you tell those from whom you are seeking advice about your recent travel to an area affected. Depending on your symptoms you may be advised that further investigations may be necessary.

General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including the human swine influenza. This includes:

• Covering your nose and mouth when coughing or sneezing, using a tissue when possible
• Disposing of dirty tissues promptly and carefully
• Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people
• Cleaning hard surfaces (eg door handles) frequently using a normal cleaning product
• Making sure your children follow this advice

Travel health
There are currently no UK travel restrictions on those who are planning to visit affected areas. However, it is always good practice to follow good respiratory and hand hygiene.

Any passengers arriving in the UK with symptoms of illness are being offered health information and advice by port health representatives.

There are well established guidelines about what happens with people who become unwell in transit and these are governed by international air travel regulations to which the UK is a signatory.

Airlines are required to carry out informal pre-departure screening at the check-in desk for many factors as well as communicable disease. Check-in staff have guidance on the types of health problems that may present travellers with in-flight or other travel problems and are encouraged to use them to screen passengers.

If someone becomes unwell during a flight then cabin crew have to follow the International Air Travel Association (IATA) guidelines. The pilot has a duty to notify the port health staff so that the passenger can be assessed upon arrival.

Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe.

There has at present been no change to the WHO pandemic alert level which is currently at WHO Phase 3, although WHO is keeping the situation under constant review.