The number of confirmed cases of Swine Flu (H1N1) across the world continues to grow. On 11 June the World Health Organisation raised the pandemic alert to Phase 6. This is characterised by human-to-human spread of the virus in more than one WHO region. The alert phase refers to the geographical spread of the pandemic, not its severity.

At this point the World Health Organisation has assessed the severity of the pandemic flu to be moderate. This means that most people recover from infection without the need for hospitalization or medical care. Overall, national levels of severe illness from influenza A (H1N1) appear similar to levels seen during local seasonal influenza periods.

The World Health Organization does not recommend any travel restrictions. Influenza A (H1N1) has already been confirmed in many parts of the world. “The global response now focuses on minimizing the impact of the virus through the rapid identification of cases, and providing patients with appropriate medical care, rather than on stopping its spread internationally. “

Definitions of cases

Confirmed case: Any person with laboratory confirmation of influenza A(H1N1)

Probable case: Any person meeting the clinical features and epidemiological risk factors (defined below) and with a positive test for Influenza A

Possible case: Any person meeting the clinical features and epidemiological risk factors OR severe community acquired pneumonia in a patient <60 years AND in hospital or requiring hospitalisation (anywhere in Scotland)

Definition of clinical features and epidemiological risk factors:

Clinical features:

Pyrexia of >38C (OR fever) in the last 7 days AND EITHER flu like illness (two or more of the following symptoms: cough, sore throat, rhinorrhea, limb/joint pain, headache, vomiting, diarrhoea OR CAP OR severe/life threatening illness suggestive of an infective process in a patient aged <60 years

AND

Epidemiological risk factors:

(a) date of onset of symptoms within 7 days of being in a country in which sustained person to person transmission is occurring (currently Mexico and USA) OR

(b) contact of a confirmed or probable case of influenza A(H1N1) OR

(c) being in a geographical area within Scotland where sporadic cases of influenza A(H1N1) have occurred in the last 7 days.

Incubation Period

This is the time taken between contact with the virus and the onset of symptoms. The range is from 1 – 4 days.

Infectious Period

People are most infectious when they start to develop symptoms. The infectious period is generally around 5 days (7 days in children). People become less infectious when their symptoms start to decline, and when symptoms have gone altogether they are no longer infectious.

Transmission

It spreads by large droplets (particles >5 μm in diameter) that are generated when infected persons cough or sneeze

Risk of exposure to the virus exists from:

• large droplet spread (distance to the droplet source range approximately 1 metre);
• direct contact between an infected person and a susceptible individual
• indirect contact via contaminated surfaces.

Individual contribution to prevention

As individuals we all have a part to play in reducing the transmission of pandemic flu. Everyone should follow these simple guidelines:

• Use a tissue to cover the nose and mouth when coughing or sneezing, dispose of the tissue promptly and then wash your hands.
• Do not use cloth handkerchiefs or reuse tissues as this can lead to recontamination.
• Clean hands frequently with soap and water, especially after coughing, sneezing and using tissues.
• Avoid touching the mouth, eyes and/or nose, unless you have recently cleaned your hands.
• Normal household detergent and water should be used to clean surfaces frequently touched by hands.
• Individuals should wash their hands as soon as they get to work and when they arrive home.

Guidelines for Mobilising Offshore

1. Any person with flu symptoms and/ or temperature of 38oC should not mobilise offshore, regardless of travel / geographical history. They should see their GP.
2. Any person who has had contact with a confirmed case of swine flu should not mobilise offshore until 7 days have passed since last contact.
3. If and person has returned from the USA or Mexico within the past 7 days and have been symptom free throughout, they may mobilise offshore.
4. If a person has recently been in any of the areas in the UK where sporadic cases have been occurring (south of Glasgow, Paisley and Argyll & Bute) in the last 7 days and have been symptom free, they may mobilise offshore.