Sunday, May 24, 2009

Swine Flu Quarantined English teachers in South Korea -- Do you know what you need to about H1N1 prevention?

I've been emailing back and forth a bit with one of the American English teachers in quarantine. I just sent them some info I found on the WHO website about H1N1.

I get the impression that there have been no instructions given by the medical staff in the quarantine center about proper use of the N95 masks that the teachers have been told, "wear the mask 24/7" . . . that's all they're hearing.

But here's the problem,

Using a mask incorrectly however, may actually increase the risk of transmission, rather than reduce it. If masks are to be used, this measure should be combined with other general measures to help prevent the human-to-human transmission of influenza, training on the correct use of masks and consideration of cultural and personal values.

(from the WHO website)


And more specifically,


The following information on correct use of masks derives from the practices in

health-care settings4:

place mask carefully to cover mouth and nose and tie securely to minimize any gaps

between the face and the mask

while in use, avoid touching the mask

whenever you touch a used mask, for example when removing or washing, clean

hands by washing with soap and water or using an alcohol-based handrub

replace masks with a new clean, dry mask as soon as they become damp/humid

do not re-use single-use masks

discard single-use masks after each use and dispose of them immediately upon

removing.

(from the WHO website)


If the medical staff are not giving the detained teachers the correct information about how to use their masks, and reviewing the specific hand washing procedure the WHO says is critical to make mask use effective . . . do they themselves even know about the procedures?


The following info (below) is from the WHO website. Misinformation is going to be one of the other major problems foreign teachers are going to face as this virus increases its presence in Korea.


The information below is from the WHO website. There's a lot of info on the H1N1 related pages, so I've put some of the more relevant info here (take this with a grain of salt as I am NOT a doctor) in order to save people time if they're too busy to read through all the stuff at the site itself.


I'm hoping we all hear some positive news from the quarantined teachers soon. They've been told they're not allowed to smoke, and are supposed to stay indoors at all times . . . needless to say the smokers are not having a good time, and . . . the indoor thing has been . . . 'taken under advisement,' lol.


J


Here's the latest update on the WHO site,


Influenza A(H1N1) - update 37

23 May 2009 -- As of 06:00 GMT, 23 May 2009, 43 countries have officially reported 12 022 cases of influenza A(H1N1) infection, including 86 deaths.

The breakdown of the number of laboratory-confirmed cases by country is given in the following table and map.

Map of the spread of Influenza A(H1N1): number of laboratory confirmed cases and deaths [jpg 492kb]
As of 08:00 GMT, 23 May 2009

Laboratory-confirmed cases of new influenza A(H1N1) as officially reported to WHO by States Parties to the International Health Regulations (2005)



About the disease

1 May 2009

How do people become infected with influenza A(H1N1)?

Outbreaks in humans are now occurring from human-to-human transmission. When infected people cough or sneeze, infected droplets get on their hands, drop onto surfaces, or are dispersed into the air. Another person can breathe in contaminated air, or touch infected hands or surfaces, and be exposed. To prevent spread, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.

What are the signs and symptoms of infection?

Early signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting or diarrhoea.

Regarding study of the first outbreak, have you received any feedback from the WHO team sent to Mexico to investigate the outbreak?

Teams are already sending epidemiological evidence but we will know more over the next few days.

Is there any confirmation of transmission between pigs and humans at this point?

No.

Is there any information on the economic impact of the outbreak so far?

No.

Why are we so worried about this pandemic possibility when thousands die every year from seasonal epidemics?

Seasonal epidemics occur every year and we are able to treat the virus with seasonal vaccines. A pandemic is a worldwide epidemic. It is a new virus and one to which the populations will have no immunity.

Related link

Influenza (seasonal) fact sheet


Advice on the use of masks1 in the community setting in

Influenza A (H1N1) outbreaks

Interim guidance

3 May 2009

This document provides interim guidance on the use of masks in communities that have

reported community-level outbreaks caused by the new Influenza A(H1N1) virus. It will be

revised as more data become available.

Background

At present, evidence suggests that the main route of human-to-human transmission of the new

Influenza A (H1N1) virus is via respiratory droplets, which are expelled by speaking, sneezing or

coughing.

Any person who is in close contact (approximately 1 metre) with someone who has influenza-like

symptoms (fever, sneezing, coughing, running nose, chills, muscle ache etc) is at risk of being

exposed to potentially infective respiratory droplets.

In health-care settings, studies evaluating measures to reduce the spread of respiratory viruses

suggest that the use of masks could reduce the transmission of influenza.2 Advice on the use of

masks in health-care settings is accompanied by information on additional measures that may

have impact on its effectiveness, such as training on correct use, regular supplies and proper

disposal facilities. In the community, however, the benefits of wearing masks has not been

established, especially in open areas, as opposed to enclosed spaces while in close contact with

a person with influenza-like symptoms.

Nonetheless, many individuals may wish to wear masks in the home or community setting,

particularly if they are in close contact with a person with influenza-like symptoms, for example

while providing care to family members. Furthermore, using a mask can enable an individual

with influenza-like symptoms to cover their mouth and nose to help contain respiratory droplets,

a measure that is part of cough etiquette.

Using a mask incorrectly however, may actually increase the risk of transmission, rather

than reduce it. If masks are to be used, this measure should be combined with other

general measures to help prevent the human-to-human transmission of influenza, training

on the correct use of masks and consideration of cultural and personal values.

1 The term “mask” is used here to include home-made or improvised masks, dust masks and surgical masks (sometimes called

“medical masks”). Masks have several designs. They are often single use and labelled as either surgical, dental, medical procedure,

isolation, dust or laser masks. Masks frequently used outside health-care settings may also be made out of cloth, or paper or similar

material. Masks, names and standards differ among countries.

2 Jefferson T, Foxlee R, Del Mar C et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic

review. BMJ 2008; 336;77-80.

2

General advice

It is important to remember that in the community setting the following general measures

may be more important than wearing a mask in preventing the spread of influenza.

For individuals who are well:

Maintain distance of at least 1 metre from any individual with influenza-like symptoms, and:

refrain from touching mouth and nose;

perform hand hygiene frequently, by washing with soap and water or using an alcoholbased

handrub 3 , especially if touching the mouth and nose and surfaces that are

potentially contaminated;

reduce as much as possible the time spent in close contact with people who might be ill;

reduce as much as possible the time spent in crowded settings;

improve airflow in your living space by opening windows as much as possible.

For individuals with influenza-like symptoms:

stay at home if you feel unwell and follow the local public health recommendations;

keep distance from well individuals as much as possible (at least 1 metre);

cover your mouth and nose when coughing or sneezing, with tissues or other suitable

materials, to contain respiratory secretions. Dispose of the material immediately after use

or wash it. Clean hands immediately after contact with respiratory secretions!

improve airflow in your living space by opening windows as much as possible.

If masks are worn, proper use and disposal is essential to ensure they are potentially

effective and to avoid any increase in risk of transmission associated with the incorrect

use of masks. The following information on correct use of masks derives from the practices in

health-care settings4:

place mask carefully to cover mouth and nose and tie securely to minimise any gaps

between the face and the mask

while in use, avoid touching the mask

whenever you touch a used mask, for example when removing or washing, clean

hands by washing with soap and water or using an alcohol-based handrub

replace masks with a new clean, dry mask as soon as they become damp/humid

do not re-use single-use masks

discard single-use masks after each use and dispose of them immediately upon

removing.

Although some alternative barriers to standard medical masks are frequently used (e.g. cloth

mask, scarf, paper masks, rags tied over the nose and mouth), there is insufficient information

available on their effectiveness. If such alternative barriers are used, they should only be used

once or, in the case of cloth masks, should be cleaned thoroughly between each use (i.e. wash

with normal household detergent at normal temperature). They should be removed immediately

after caring for the ill. Hands should be washed immediately after removal of the mask.

3 In settings where alcohol-based hand rubs are available and the safety concerns (such as fire hazards and accidental ingestion)

are adequately addressed, their proper use (rubbing hands for 20–30 seconds) could be promoted as a means of disinfection.

4 Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care WHO Interim

Guidelines (Jul 2007) available at http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html


http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf


What can I do?

6 May 2009 (updating content posted 1 May 2009)

What can I do to protect myself from catching influenza A(H1N1)?

The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:

  • avoid touching your mouth and nose;
  • clean hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated);
  • avoid close contact with people who might be ill;
  • reduce the time spent in crowded settings if possible;
  • improve airflow in your living space by opening windows;
  • practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.

What about using a mask? What does WHO recommend?

If you are not sick you do not have to wear a mask.

If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards.

When and how to use a mask?

If you are sick and must travel or be around others, cover your mouth and nose.

Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.

How do I know if I have influenza A(H1N1)?

You will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A(H1N1).

What should I do if I think I have the illness?

If you feel unwell, have high fever, cough or sore throat:

  • stay at home and keep away from work, school or crowds;
  • rest and take plenty of fluids;
  • cover your nose and mouth when coughing and sneezing and, if using tissues, make sure you dispose of them carefully. Clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub;
  • if you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;
  • use a mask to help you contain the spread of droplets when you are around others, but be sure to do so correctly;
  • inform family and friends about your illness and try to avoid contact with other people;
  • If possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.

What should I do if I need medical attention?

  • If possible, contact your health care provider before traveling to a health facility, and report your symptoms. Explain why you think you have influenza A (H1N1) (e.g. if you have recently traveled to a country where there is an outbreak in people). Follow the advice given to you.
  • If you cannot contact your health care provider before traveling to a health facility, tell a health care worker of your suspicion of infection immediately after arrival at the clinic or hospital.
  • Cover your nose and mouth during travel.

Should I go to work if I have the flu but am feeling OK?

No. Whether you have influenza A(H1N1) or a seasonal influenza, you should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your work colleagues and others.

Can I travel?

If you are feeling unwell or have symptoms of influenza, you should not travel. If you have any doubts about your health, you should check with your health care provider.

More on WHO travel recommendations


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For more information, call the special media telephone line: +41 22 791 2222

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REGIONAL INFORMATION ON INFLUENZA A(H1N1)

WHO African Region

WHO Region of the Americas

WHO Eastern Mediterranean Region

WHO European Region

WHO South-East Asia Region

WHO Western Pacific Region


MORE INFORMATION

Related links

Pandemic influenza prevention and mitigation in low

resource communities

This summary guidance is derived from the WHO document Pandemic influenza preparedness and

mitigation in refugee and displaced populations: WHO guidelines for humanitarian agencies, Second

edition, 2008

Key principles

1. Public health measures taken by individuals and communities, such as social distancing,

respiratory etiquette, hand hygiene, and household ventilation, are at present the most

feasible measures available to reduce or delay disease (morbidity) caused by pandemic

influenza.

2. In the case of mild illness, patients should be provided with supportive care at home by a

designated caregiver and only referred to health care facilities if they deteriorate or

develop danger signs. Separation of sick from well individuals, with rigorous respiratory

etiquette and hygiene measures should be practised.

3. In health-care settings, a system of triage, patient separation, prioritization of use of

antiviral medicines and personal protective equipment (PPE) according to risk of

exposure, and patient management should be in place to focus efforts on the most

effective interventions to reduce mortality and any further morbidity.

1. Key prevention measures for individuals and communities

Social distancing (keeping at least an arm's length distance from others, minimizing gatherings),

respiratory etiquette (covering coughs and sneezes), hand hygiene, and household ventilation,

are likely to be the most effective public health measures and are highly recommended.

Once cases of pandemic influenza in a community are widespread, evidence and experience

suggest that interventions to isolate patients and quarantine contacts would probably be ineffective,

not a good use of limited health resources, and socially disruptive.

Ill people should as far as possible be cared for at home by a designated caregiver (with appropriate

home-care instructions communicated in advance) and advised not to attend health-care facilities

unless they deteriorate or develop danger signs so as not to overwhelm health facilities (see

guidance note below). Supportive care entails bed rest, fluids, medication for fever, antibiotics if

prescribed, and good nutrition.

WHO recommends that mask use should be based on risk, including frequency of exposure and

closeness of contact with potentially infectious people. Recommendations for mask use by health

and other essential staff, and for home care are described in parts 2 and 3 below. Routine mask use

in public places should be permitted but is not expected to have an impact on disease prevention.

2. Management of patients

The objectives of patient management are to provide supportive health care to decrease

mortality and to minimize disease transmission.

2

Given limited resources, it will be necessary to triage patients for treatment during a

pandemic to maximize the impact of available treatment capacity.

Essential medical services should be continued, while elective and non-essential medical

services should be temporarily suspended.

Patients are most likely to be managed in two distinct settings: in the health-care facility

and at home.

Patient management in the health-care facility

_ Admission criteria may change depending on bed availability, but should be reserved for

severe cases most likely to benefit from treatment.

_ For milder cases presenting to the outpatients department, a caregiver, preferably an

available family member, should be identified if possible to manage care of the ill patient

in the home if the patient is being discharged.

_ Health facilities should anticipate a very high demand for treatment with supportive care,

and should plan accordingly. Based on current estimates, agencies should anticipate that

up to 10% of those who fall ill may require inpatient treatment. In a population of 10 000,

this could mean 500–600 persons requiring inpatient care for influenza alone over a

period of 2–3 months, or approximately 6–10 patients per day. These figures are an

average to assist calculations. Note that the number of patients affected per week may

not be constant over the pandemic period: it is likely that there will be increasing numbers

affected per week, reaching a peak in the middle of the pandemic (weeks 4–8) with

decreasing numbers thereafter.

Ensure:

_ separation of patients with respiratory symptoms from those presenting with other

symptoms at both the outpatient and inpatient level;

_ availability of admission and discharge criteria (these may change depending on

treatment capacity);

_ availability of case-management protocols;

_ referral protocol, if feasible (with appropriate infection control during the transfer);

_ confinement in a separate respiratory ward for patients admitted with suspected

pandemic influenza;

_ maximum separation of beds and head-to-toe positioning of patients in inpatient wards if

space is limited;

_ good ventilation of outpatient and inpatient areas;

_ adherence to Standard and Droplet Precautions;

_ use of PPE according to risk of exposure.

Inpatient treatment in low resource settings should include:

_ treatment of dehydration with IV or oral rehydration fluids;

_ supplemental oxygen therapy (if available) by face mask rather than nasal prongs;

_ antibiotics (oral or parenteral) for secondary bacterial infections;

_ non-aspirin antipyretics for pain and fever;

_ nutritional supplementation as needed.

3

Note: in HIV-infected individuals, a distinction between opportunistic pneumonia and secondary

pneumonia from pandemic influenza may be difficult.

Antiviral medicines decrease the duration of virus excretion and the severity of illness when

used for treatment of ill patients, and may also prevent illness when used for prophylaxis. If

only limited quantities are available, prioritization of use should be in place according to

national protocol.

In general, the order of priority for antiviral use should be:

_ treatment of sick health-care and other essential staff;

_ treatment of sick individuals from the community;

_ post-exposure prophylaxis for essential staff with unprotected, high-risk exposure;

_ pre-exposure prophylaxis for critical staff with anticipated high-risk exposure.

.

Patient management at home

_ During a pandemic, very high numbers of patients presenting to the health-care facility

will necessitate home treatment. Trusted community leaders should be identified in

advance for crowd control at the health-care facility and to address concerns among

health-seekers and their caregivers.

_ Ill people not exhibiting severe symptoms and signs of influenza should be encouraged

(through health messaging) to stay at home, institute respiratory etiquette (cover coughs

and sneezes or cough/sneeze into sleeve) and hand hygiene, and restrict close contact

(within approximately 1m) with others as much as possible.

_ Home confinement of ill people in crowded settings may not be practicable. However,

restricting contact with others should be encouraged as much as possible.

_ Adequate supervision within the household of the ill person should be ensured with

preferably only one caregiver to limit potential exposure.

_ Patients and caregivers should be trained to wear and dispose of masks during the

infectious period of the patient, if supplies are available. Where supplies are limited, it is

more important in the home that the patient wears the mask than the caregiver. The mask

need not be worn all day and only when close contact (within approximately 1m) with the

caregiver or others is anticipated. Masks should be disposed of safely if wet with

secretions. Tightly-fitting scarves or a reusable mask made of cloth covering the mouth

and nose could be used if masks are unavailable. They should be changed if wet and

washed with soap and water.

_ If enough masks are available, caregivers should also use them to cover their mouth and

nose when in close contact with ill persons.

_ The caregiver should always wash hands after patient contact.

_ General support and advice should be given to caregivers on the use of antipyretics

(acetylsalicylic acid should be avoided in children), oral fluids, nutrition and bed rest.

_ Instructions must be provided on the use of antibiotics (if necessary) for bacterial

complications of influenza when prescribed.

_ Instructions for further care in case of deterioration (if capacity exists) should be given (i.e.

when there are symptoms of severe illness or dehydration – see guidance note below).

_ Those who have recovered are no longer infectious and can be considered immune

(usually 2–3 weeks after the onset of illness).

_ Proper respiratory etiquette and hand hygiene must be promoted for all household

members.

4

_ Keep windows open and allow ventilation of the room/tent.

_ Household surfaces should be cleaned regularly with soap and water or disinfectant.

GUIDANCE NOTE

Referral to health-care facilities

_ The majority of influenza cases may be cared for at home with the simple

supportive care outlined above.

_ However, if there is deterioration or severe symptoms, then patients may

need to access a health-care facility.

_ These symptoms may include: weakness/not able to stand, lethargy,

unconsciousness, convulsions, very difficult/obstructed breathing or

shortness of breath, inability to drink fluids and dehydration, high fever.

_ It is important that specific instructions are provided according to the local

context.

3. Protection of staff

Rigorous attention to Standard Precautions (basic measures to minimize direct unprotected exposure

to blood and body fluids) and Droplet Precautions (medical masks when close to patients with

respiratory symptoms) is required to reduce the opportunities for transmission in the health-care

setting. Mechanisms for procuring (and/or stockpiling) antibiotics, PPE, antiviral medicines and

vaccines (when/if available) should be considered, with protocols and prioritization for their use.

Priority recipients will include those involved in direct clinical contact with patients, and

those staff required to maintain essential functions who anticipate close contact with

potentially ill people.

Source control (i.e. of the ill person) is crucial, as this can prevent opportunities for

transmission; the patient must be encouraged at all times to cough/sneeze into a

tissue/cloth or into their sleeve and to practice frequent hand hygiene.

Masks

Use of masks should be prioritized to ensure that those at highest risk of exposure have access to

available protection. Masks do not have to be worn at all times as they may become uncomfortable,

particularly in hot climates. They should be worn as a priority by health-care workers and caregivers,

and other essential staff when in close contact (within approximately 1m) with sick patients.

Antibiotics and antivirals

Antibiotics. Consideration should be given to stockpiling quantities of antibiotics sufficient to treat

secondary bacterial pneumonia in at least 5–10% of total staff and dependents.

Antivirals. If feasible and where quantities are available, agencies should stockpile sufficient

oseltamivir to provide treatment of ill staff and post-exposure prophylaxis of essential staff.

Self-monitoring

Health staff should monitor their temperatures twice daily. Fevers should be reported and the staff

member should confine themselves at home. If a staff member becomes unwell, treatment with

antivirals as well as supportive care as for other patients should be provided at home by a caregiver

2 comments:

breehill said...

I just found this video on You Tube that really shows how germs and viruses spread. It is so cool. It's meant for kids but I even learned a lot!

http://www.youtube.com/watch?v=56mq1t1BqfY

breehill said...

I just found this video on You Tube that really shows how germs and viruses spread. It is so cool. It's meant for kids but I even learned a lot!

http://www.youtube.com/watch?v=56mq1t1BqfY