Swine Flu Update (updated 4/29 @ 7:00 a.m.)

Good morning.   The CDC has confirmed 64 cases of swine flu in humans in the U.S.  There have been no cases identified yet in Massachusetts, however, like other states we are increasing our surveillance activities to see if cases develop in the Commonwealth.  We are working very closely with the CDC and our partners at the state and local level.  All of the newly reported cases are in the same five state where previous cases have been confirmed.

DPH STATEMENT ON CASE ANNOUNCEMENTS:

Consistent with CDC guidelines, it is the policy of the Massachusetts Department of Public Health to comment only on confirmed cases of swine influenza.  There are several important reasons for not commenting on specific "suspect cases".  First, many of these cases will rule out for swine influenza, and commenting on them raises undue concern for families and communities.  During a time of enhanced alertness for cases, DPH and local public health authorities will get many reports from health care providers about cases of flu-like illness.  We will always follow up on reports consistent with CDC guidance and good public health practice; just because we are not commenting on unconfirmed cases, doesn't mean we're not working on those cases.  Second, there have been a number of media reports on suspect cases that have included information that could be used to identify a specific person's health information, which in turn could violate that person's health privacy.  Third, our goal throughout this outbreak is to provide the public with the most accurate and useful information.  That goal is always challenging when the situation is fluid and changing frequently.  Our guidance to the general public about how to stay healthy is the same whether or not there is a case we are following in their community.  On the other hand, some of that guidance may change if we find a confirmed case.  When we know about a confirmed case in Massachusetts, the public will know about that case. 

MASS211 ACTIVATED TO HELP PROVIDE THE PUBLIC WITH INFORMATION:

Massachusetts residents can now call (2-1-1) for basic information about swine flu.

NEW MATERIALS ON DPH WEB SITE

We are adding new materials to our web site on a regular basis including our swine flu fact sheet, and an advisory that provides information for schools and childcare settings.  

Swine Flu Factsheet in Spanish, Chinese, Khmer and Portuguese.

INFORMATION ABOUT SWINE FLU AND PREVENTION STEPS TO HELP YOU STAY HEALTHY:

Swine flu is a respiratory infection caused by influenza type A virus that regularly cause outbreaks of influenza in pigs.  People do not normally get swine flu, but human infections can occur.  Human cases typically involve people who have had direct contact with pigs, but person-to-person transmission is suspected among recent confirmed cases.  

It is still early in the public health investigation of this outbreak, and we are working hard to gather as much information as possible about the situation nationally and here in our state.  Some of the cases in Mexico have been very serious, but most of the confirmed cases from California, Texas, Kansas, Ohio and New York City have been reported to be mild.  We don't know yet why the cases in Mexico and the U.S. seem to be different in severity, but answering that question will be part of the larger public health investigation.  Also, the severity of the illness in the U.S. could change and become more serious.

Even though there have been no cases identified in our state up to now, there are steps that everyone can take to help prevent getting or spreading any type of influenza:

• Wash your hands often with soap and water, especially after you cough or sneeze.  Alcohol-based hand cleaners are also effective.
• Practice good "cough etiquette" by coughing or sneezing into a tissue, or into your elbow instead of into your hands.
• Try to avoid close contact with sick people.
• If you get sick, stay home from work or school and limit contact with others to avoid infecting them.

For more information on swine flu, visit the CDC's new web site at www.cdc.gov/swineflu.  We also have some very good information on how to care for someone at home who has the flu on our DPH web site.

We will update this blog regularly with new information when it becomes available.  As with every public health investigation, the situation will likely change many times, and we will do our best to keep the residents of Massachusetts updated as the situation evolves.  Thanks in advance for your patience and please check back for updates.

Comments

[Tracey Thompson]

I work at a college in food services. Today I witnessed a student leaving the infirmary with a mask and proceeded to enter our dining hall. The student was questioned and she said she had the bad flu. Upon further investigation, we have found out a student is in the process of being tested for the swine flu. My concern would be, is it safe to have someone in our cafeteria who may have this flu? It seemed awfully careless that she was in the general public, mask or not. I realize this is her home but doesn't the college have a responsibility to prevent the disease from spreading if someone is under suspicion? I feel fine but I really don't feel comfortable going back to work not knowing who else this person could have been in contact with. What should I do?

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Dr. Lauren Smith responds: I know it can be disconcerting to see someone walking around with a mask on, but actually, the infirmary did the right thing by asking the student to wear a mask. This helps prevent her from spreading germs by coughing or sneezing.

Whether the student has H1N1 or not, there are likely other students in your school that have the virus that aren't wearing masks. You would probably more easily catch it from those students. The bottom line is, you should assume H1N1 is at the school at which you work, and in the community in which you live.

That's way it's so very important to remember to wash your hands regularly with soap and water, or use a hand sanitizer. Also, try to keep your hands away from your face. That's how germs enter your body.

[Irina]

I regularly visit CDC site and DPH MA site for information.
Please, provide information about logistics of distributing
antiviral medication to sick population, if more people will get sick? Doctors, telephone lines, emergency rooms are very slow in response in normal environment. What are new regulations for our overwhelmed as it is health system?
Thank you,
Irene

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Thanks for your question Irene. MDPH has been working with hospitals for the last several years on a plan to distribute antiviral medications to people sick with the flu if and when the need arises. The Strategic National Stockpile has already arrived in MA, and will be available for distribution according to those plans if and when the need arises. Suzanne Crowther, DPH

[Jeannie]

I work with physically disabled children, and young children. Your safe coughing guide says to use a tissue or cough into your elbow. If you are constantly lifting or holding children, what are the chances of transferring germs from your clothing? Would it be safer to use your hands, and immediately wash them?

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Thanks for your question. The "cover the cough" guidance is geared at preventing the flu or cold germs from travelling through respiratory droplets. The best thing you could do to protect yourself from any germs is to cover your and the childrens' coughs / sneezes with a tissue and given your line of work, wash your hands more often, avoiding contact with your eyes, nose or mouth. Kristin Golden, DPH

[Patricia Cutone]

I work in an elementary school setting; parents are known to administer fever reducing meds such as Tylenol or Motrin and send the child to school. I would love to see huge emphasis placed on this issue. Also, I know the seasonal flu usually has sudden onset of symptoms vs. gradual illness. Is this also the trend your seeing with Swine flu? Are there other symptomatic factors which distinguish it as likely flu vs. run of the mill virus?
Thank you

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The symptoms of swine flu in people are similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea. Kristin Golden DPH

[irene]

I have read your four steps to be observed in trying to prevent swine flu infection. Shouldn't people also abstain from hugging and kissing when greeting each other, perhaps even shaking hands?
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Hello Irene: As with any flu virus, we should be avoiding close contact -- such as hugging, kissing or shaking hands -- with people who are showing signs of illness, like coughing, sneezing, or showing other symptoms of flu.
John Jacob, DPH

[Bobbie Orsi]

Hi, my daughter is pregnant and we have a relative coming to visit us this week the day after she returns from San Diego. Would it be safest to wait a few days to be sure that this relative has no symptoms? Are there special concerns for pregnant women?

Thank you.
Bobbie

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Tom Lyons Responds: Hi Bobbie, thank you for your question. According to the CDC, pregnant women are at higher risk for complications from seasonal (regular) flu, so it is reasonable to assume that they'd also be at higher risk for complications from swine flu. As of April 28, there were 5 cases of confirmed swine flu in all of San Diego County. The population of San Diego County is just over 3 million people. The risk that your relative was exposed to someone who was infected with swine flu would seem very low. However, since a person infected with the flu may be able to infect others beginning 1 day before symptoms develop, a very conservative approach might be for you to wait a day or so and see how your relative is feeling after their long trip east. You could also ask your relative if she/he has been in close contact recently with anyone who experienced flu-like illness.

While the risk is low if your relative is not ill, or has not been in close contact with people who are ill, your daughter and you should make the decision that will give you peace of mind and help you to enjoy the visit from your relative.

[maria]

My son has been contracted by a Mexican company-He has resigned his actual job in Baires and has plain tickets to travel on May 6 to MEXICO DF-I am very worried. He really wants to accept the position wich is a very well paid one.
What must I do?
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Tom Lyons Responds: Maria, thanks for your question. The best thing is for your son to know the facts about the situation and how to keep himself healthy. Look at the materials on our site www.mass.gov/dph, or the CDC's web site at www.cdc.gov/swineflu. The CDC has a current travel advisory advising against non-essential travel to Mexico at this time. If people must travel to Mexico, the CDC site also provide guidance for travelers, including following the directions of local health authorities

[Celeste]

My husband was in Az about 2 wks ago drove back to MA. Strarted feeling sick on his way home and has been sick ever since. Runnie nose, a fever, cough, tired and no real appatite. He is a man and very stuburn, he would not go to the doctor. I finaly got him to call the doctor and he is going today. What do you think?
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Tom Lyons Responds: Celeste, good job. You did the right thing, and so did your husband. It was particularly good that he called first so that the doctor's office could be prepared for his arrival. That's important when people have flu-like symptoms.

[Virginia Rehm]

Are there any current guidelines for long term care residents?

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Virginia, let me check on that. The CDC is producing many guidance documents and a very fast clip. You should also check the CDC site at www.cdc.gov/swineflu.

If I find something I will post a link.

[Alexis Berthier]

The French Consulate in Boston offers the latest information and resources on the local swine flu situation to French citizens living in Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont. They can visit our website: www.consulfrance-boston.org

Also, on April 25, liaising closely with the interministerial crisis unit at the French Health Ministry, the French Foreign and European Ministry’s crisis centre has set up a telephone number for the public to call for information about the situation in Mexico (tel. 011 33 1 45 50 34 60).

French people, including French citizens living in Massachusetts, wishing to travel to Mexico are advised to consult the Foreign Ministry’s Travel Advisory site at http://www.diplomatie.gouv.fr/fr/conseils-aux-voyageurs_909/pays_12191/mexique_12292/index.html

[Jill]

My boyfriend got back from Cancun last night and has no symptons as of it. Should I avoid contact with him? Do you know the incubation period?

Thank you,
Jill

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Tom Lyons Responds: Hi Jill, I am happy to hear that your boyfriend is well. Chances are he will not have any problems whatsoever, but it makes sense given the situation that he pays close attention to how he is feeling over the next couple of days. If he starts to not feel well and exhibits flu-like symptoms, he should call his health care provider to report his condition and get advice on evaluation and treatment. Calling first is always the best thing to do when you have the flu (regular flu as well) rather than just going to doctors office. This way the doctor's office can expect your arrival and make arrangement to treat you and lessen the chance of exposing other patients waiting to the flu.

As far as contact, if he is not exhibiting symptoms there shouldn't be any problems. However, we should all be practicing those basic prevention steps that I mention in the blog post.

Thanks for your question.

[LINDA]

What about workers at DTA and Mass Health who are in direct contact with the population all day. At Mass Health in Spfld sometimes workers see 153 "walk-in"s every day...they are often sick..You advise avoiding sick people. How do we do that? Refuse to see them if they are sick..we can't do that/ We have no masks to wear..what about issuing or funishing Mass Health offices masks to wear when seeing sick clients as just a minimal precaution for workers.....we are exposed to everything every day, but yet we have received no specific instructions regarding OUR healh as we go about serving the public...
Linda

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Hi Linda, thanks for your question. Please see our fact sheet on swine flu, which is linked in this post. We also are translating the fact sheet in multiple languages. The instructions that we give the public are the same instructions that we would give to State employees. People sometimes get tired of us talking about hand washing, using alcohol rubs, practicing good coughing techniques, etc. However we do so because those strategies work in helping to prevent spread of illness. We also have materials on handwashing and good cough practices that you can download and share with your co-workers. You can find them here:

http://www.mass.gov/dph/swineflu

Thanks for your comment.

[Tammy]

I live and work in an elementary school in Massachusetts and we have a group of children returning from a week-long visit in Mexico City on an emergency flight tonight. They were told to stay home from school for 48 hours but all siblings, etc will still be returning to school tomorrow. What can be done to ensure these children are not bringing this flu home with them to their family and friends? Shouldnt they have some sort of quarentine?
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Tom Lyons Responds: Hi Tammy, thanks for your question. At this time, exclusion is not recommended for school or childcare participants who have recently traveled to an area where swine flu cases have been confirmed, and who do not have symptoms. School or childcare participants with acute febrile respiratory illness, regardless of travel history, should be sent home according to facilities-established procedures with instructions to stay at home for least 7 days after the onset of illness or until 24 hours after their symptoms resolve, whichever is longer. Earlier today we released an advisory for schools and childcare settings that was developed to help schools answer questions just like this. I linked to the advisory in the blog post above.

[Margaret]

Is there any reason to be concerned about food products emanating from Mexico? How about pork products?

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Tom Lyons Responds: Hi Margaret, thanks for your question. No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

[Linda]

My son and I were both sick with symptoms similar to those described for swine flu. My son lst got it around 3/17, with sore throat, bad cough, fever as high as 104, and significant fatigue lasting a couple weeks. I got the symptoms about a week later, and the fatigue also lasted a couple weeks for me. I know other people who had similar symptoms. Could it be that swine flu is already here, but health care practitioners haven't been identifying it. We were sent for strep and mono tests..

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Tom Lyons Responds: Hi Linda, thank you for your comment. First, I'm sorry that you and your son have been ill and I hope both of you are feeling better. It is unlikely that you or your son had swine flu, but it's understandible why you might think that. The signs and symptoms of swine flu look a lot like seasonal influenza. You note that your illnesses both took place in March. We were certainly still seeing seasonal flu activity in Massachusetts during that time, and if fact are seeing a limited amount of seasonal flu cases now (although it has as expected trailed off as significantly).

It is also not likely that the current strain of swine flu has been present in the United States for long. There are many millions of diagnostic flu tests performed by health care providers in the U.S. every year, however we have not seen this strain of flu before. (We have had other swine flu outbreaks in the past) Because it is a strain that we haven't seen before we must take if very seriously. And because public health agencies around the world are on the lookout for cases, we are likely to see more confirmed cases in the future. At this point most of the cases appear to be mild, but it is important to point out that flu of any kind is a serious illness and we should do all that we can to prevent it.

Thanks again for visiting our blog.

[Michelle]

Great article. I have a friend in MA who might have just had the swine flu. She had all the symptoms and went to her doctor's last week before all the news became available. Where could she be tested in MA?

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Tom Lyons Responds: Hi Michelle, thanks for your question. I'm sorry your friend was sick, but if she's well now there is no need for her to be tested. It's not likely that swine flu was the cause of your friend's illness, but it could have been seasonal flu since the symptoms are quite similar.