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H1N1 — Swine Flu Virus


Frequently Asked Questions


Background


What is 2009 H1N1 influenza?

One of the names given to the new strain of influenza virus that has spread around the world, 2009 H1N1 Influenza A is also known as swine flu, Novel Influenza A H1N1 or simply H1N1. Originating as an infection in pigs, recent genetic changes have allowed it to infect and be transmitted among humans. In June 2009, the World Health Organization declared it to be pandemic – a worldwide epidemic. Most of those infected have experienced symptoms similar to those of common, seasonal influenza, but experts are concerned because millions appear to be susceptible. Most infections have been experienced among persons 5-24 years of age and although hospitalization and death rates are not high, they are most common in persons of this age group. Adults older than 65 appear less likely to develop the illness. The rapid spread, uncharacteristic pattern of infection and the potential for further mutation have lead to an extraordinary campaign to educate and vaccinate the public.

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How does 2009 H1N1 Influenza spread?

The virus is spread mainly through coughing and/or sneezing. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

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Who is at risk for 2009 H1N1 Influenza?

Anyone who has close contact with an infected person may become infected; however, persons born since 1975 appear to be most susceptible. There are, however, people at higher risk for influenza-related complications.

  • Children younger than 5 years of ageAdults 65 years and older
  • Pregnant women
  • People with certain chronic medical or immunosuppressive conditions including asthma and other chronic lung diseases, chronic cardiovascular diseases (excluding hypertension), chronic kidney and liver disease, cancer and those immunosuppressed by diseases or medications
  • People younger than 19 years of age who are receiving long-term aspirin therapy

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The Illness

What are the symptoms of 2009 H1N1 Influenza?

2009 H1N1 Influenza symptoms appear similar to those of regular human influenza and include fever, cough, sore throat, body aches, lethargy, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 flu. Symptoms often begin suddenly. Fever typically will last a few days and cough and fatigue the better part of one week. Symptoms may persist longer than one week and a small number of people experience complications such as sinus infection, bronchitis and pneumonia. 

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What should I do if I get sick?

We ask that students call the University Health Service at 607-777-2221 and report if they develop a fever or are concerned whether they are ill with 2009 H1N1 Influenza. We have enhanced our abilities to receive phone calls related to flu concerns. This initial remote access to care connects callers to a nurse who will provide up-to-date information about 2009 H1N1 Influenza. The nurse will also review symptoms and guide students on self-care. Appointments will be arranged for students as needed. Special attention will be given to those who are ill and are identified as being at higher risk of influenza-related complications (see above). These higher risk people will be considered for treatment with the antiviral drugs of Tamiflu or Relenza. It is necessary for these medications to be started within the first 48 hours of the illness to be effective. The University Health Service does not stock these medications but prescriptions can be called to off-campus pharmacies and deliveries can be arranged. Those who are not at risk of influenza-related complications and who do not have symptoms that need emergency medical attention (see below) are advised to rest, hydrate with liquids, take fever reducing medications (see below), cover the cough, wash hands frequently and self isolate. The University Health Service will continue contact by phone with ill students until symptoms have improved.

In addition, if a student is ill and is self-isolating him or herself, he or she can complete the permission slip on the Sodexo website to allow friends to pick up and deliver food to the ill student.

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What are influenza antiviral drugs?

Influenza antiviral drugs are prescription drugs (pills, liquid or inhaler) that decrease the ability of flu viruses to reproduce. They are used to both treat influenza and, occasionally, to prevent the development of influenza in those who have been exposed. While getting the flu vaccine is the more important step in preventing the flu, antiviral drugs are a second line of defense in the prevention (Chemoprophylaxis). Currently, Tamiflu (oseltamivir) and Relenza (zanamivir) are recommended for 2009 H1N1 Influenza. Antiviral drugs must be started within 48 hours of initial symptoms in order to be effective in treatment.

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What are the treatment benefits of influenza antiviral drugs?

For treatment, antiviral drugs should be started within 48 hours after becoming sick. When used this way, these drugs can reduce the severity of flu symptoms and shorten the time you are sick by 1 or 2 days. They may also prevent serious flu complications. Antiviral drugs may be especially important for people who are very sick (hospitalized) or people who are sick with the flu and who are at increased risk of serious flu complications (see above).

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How effective are antiviral drugs at preventing the flu?

When used to prevent the flu, antiviral drugs are about 70 to 90 percent effective against susceptible viruses (i.e., viruses that are not resistant to the antiviral medication). It is important to remember that flu antiviral drugs are not a substitute for getting a flu vaccine.

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What is Chemoprophylaxis?

Chemoprophylaxis is the treatment of people with medications to prevent the development of disease. The same antiviral medication used to treat the illness of influenza can be taken by people to reduce the possibility of developing influenza. This type of therapy is only considered when a person at higher risk of influenza-related complications has been exposed to someone already sick with the illness. 

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Why wouldn’t you want to treat all influenza cases with antiviral drugs?

The reasons we do not treat everyone include the following:

  • The vast majority of people recover quickly and completely using self-care measures.
  • Antiviral medications are generally well tolerated but may cause side effects which include nausea, vomiting and, rarely, confusion (http://www.cdc.gov/flu/protect/antiviral/sideeffects.htm).
  • Antiviral medications are expensive.
  • Influenza viruses can become resistant to antiviral medications and caution must be used to keep these medications available and effective for those who need them most.

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I am a person who is at higher risk for influenza-related complications (see above).  What should I do to protect myself from 2009 H1N1 Influenza?

  • Eat nutritious foods, exercise and allow adequate rest at night.
  • Avoid immunity-reducing behaviors including the use of alcohol and other drugs. You should not smoke cigarettes.
  • Follow the specific prevention behaviors designed at reducing your risks for 2009 H1N1 Influenza (see below).
  • Know the symptoms of influenza so you can seek prompt medical care.
  • Speak with your healthcare provider about:
    • your current care and prescriptions,
    • whether you should receive the annual, seasonal influenza vaccine and the 2009 H1N1 Influenza vaccine and
    • whether he/she recommends the use of antiviral medications for treatment or prophylaxis in regard to 2009 H1N1 Influenza.

When should I call for emergency treatment and/or transportation?

While the current 2009 H1N1 Influenza cases have been mild so far, infected individuals should still monitor for severe symptoms. If you become ill and experience any of the following warning signs, seek emergency medical care. Symptoms that need emergency medical attention include:
  • difficulty breathing or shortness of breath
  • pain or pressure in the chest or abdomen
  • sudden dizziness
  • confusion
  • severe or persistent vomiting
    • Anyone suffering from symptoms that require emergency medical attention should call 911 on a campus land line or 607-777-3333 if using a cell phone for Harpur’s Ferry Student Volunteer Ambulance Service response.

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What fever-reducing medications can people take when sick?

Fever-reducing medications contain acetaminophen (such as Tylenol) or ibuprofen (such as Motrin). These medicines can be given to people who are sick with flu to help bring their fever down and relieve their pain. Do not give aspirin (acetylsalicylic acid)  to anyone younger than 19 years of age who has flu; this can cause a rare but serious illness called Reye’s Syndrome.

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What should I do if I become ill when the University Health Service is closed?

The University Health Service is open from 8 a.m.4:45 p.m. Monday through Friday and your health fee covers your care on campus. If you become ill during the night or on a weekend, you could visit an area walk-in clinic. (The University Health Service website has information on these clinics, as well as on the three local hospital emergency rooms at http://www2.binghamton.edu/health/faq/walk-in-clinics.html.) If you go to a walk-in clinic or emergency room, it is important to carry your health insurance information with you.

However, students should anticipate illness; Own a thermometer and have a supply of either acetaminophen or ibuprofen to use as necessary for fever, headache or other discomforts. Check your temperature and determine whether any of the above warning signs are present. If they are, call for emergency services by dialing 911 on a campus land line or 607-777-3333 if using a cell phone. If an emergency does not exist, call a family member or friend for advice. If you are a person at higher risk for influenza-related complications, call your medical provider. General care advice includes rest, hydration with clear liquids such as water, soda or clear fruit juice, and possibly taking a dose of acetaminophen or ibuprofen if you have an elevated temperature (100 degrees Fahrenheit or 38 degrees Celsius).

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Should I be tested for the H1N1 virus?

Unfortunately, screening tests for H1N1 are often inaccurate and very few labs in the U.S. are approved to run the test that is needed to confirm the illness. The New York State Health Department Wadsworth Lab is no longer providing the confirmational test for clinical use. It had previously limited this test to those hospitalized for influenza and has now shifted its focus to surveillance and special circumstances where there is question of antiviral resistance. Binghamton University Health Service is one of a few Influenza Sentinels for the CDC and will continue to send specimens for surveillance purposes to Wadsworth for confirmation, but, like other medical practices, this will not affect the clinical management of any individual case.

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If I experience flu symptoms, do I need medication?

As noted above, the antiviral medicines Tamiflu (oseltamivir) and Relenza (zanamivir) can help alleviate 2009 H1N1 Infuenza symptoms, but experts warn not to overuse them for fear of developing viral resistance. However, these drugs are particularly important for people with severe illness or with risk factors for complications from flu (see the list of risk factors above). Flu patients who belong to these risk groups should seek treatment. Treatment may also be appropriate for household members or roommates with these same risk factors to help prevent the infection.

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How do I avoid spreading the disease?

  • Stay home or in your room (self-isolate) away from other people until at least 24 hours after you no longer have a fever (100 degrees Fahrenheit or 38 degrees Celsius) or signs of a fever (chills, feel very warm, flushed appearance or sweating). This should be determined without the use of fever-reducing medications (any medicine that contains ibuprofen or acetaminophen, or, for adults 19 years of age or older, aspirin).
  • If possible, return to your family’s home.
  • If unable to return home, remain in your room except to leave for medical care. Look for friends or “flu buddies” for assistance with care and meals.
  • Wear surgical masks to reduce the likelihood of spreading the illness to a roommate. 
  • Remain in daily contact with friends and check in by phone with the University Health Service until recovered.

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What should I do if someone I live with has confirmed 2009 H1N1 Influenza?

Follow the same precautions you would to avoid the common seasonal flu:

  • Limit your contact with the affected person. Avoid close contact such as kissing and do not share towels, glasses or toothbrushes.
  • Avoid having visitors. If visitors must enter the room or apartment, they should avoid close contact with the affected person.
  • Wash your hands with soap and water or with an alcohol-based hand cleanser.
  • Consider using a facemask or an N95 respirator. These can be purchased at a pharmacy or hardware-type store. Your hands may become contaminated as you touch the outside of the mask. Wash your hands and avoid touching your face and nose.
  • Wash dirty dishes and eating utensils in a dishwasher or by hand with warm water and soap. You do not need to separate eating utensils for use by a patient with influenza.
  • Do laundry in a standard washing machine with warm or cold water and detergent. It is not necessary to separate the patient’s laundry.
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Can household cleaning help prevent transmission of 2009 H1N1 Infleunza in the room or apartment of an infected person?

Yes. To help prevent transmission, all hard surfaces such as doorknobs, refrigerator door handles, telephones and bathroom surfaces should be washed with soap or detergent, rinsed with water and then disinfected and rinsed. Disinfectants are those with “registered disinfectant” on the label. If disinfectants are not available, use a chlorine bleach solution made by adding 1 tablespoon of bleach to a quart (4 cups) of water. Use a cloth to apply this to surfaces and then rinse them with water. Dispose of the used bleach solution and mix a fresh solution when repeating the cleaning process. Use sanitizer cloths to wipe electronic items (phones, computers, remote controls) that are touched often.

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Why aren’t students being isolated at the University Health Service or being grouped into special areas in the residence halls? 

Housing capacity is at 100 percent and the anticipated number of ill students makes an isolation strategy impossible. In addition, the University Health Service has only two resting beds for use during the hours of 8 a.m.-5 p.m. Monday through Friday.

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Prevention

How can I protect myself and others from 2009 H1N1 Influenza?

Here are the best ways to avoid getting or spreading influenza:

  • Practice good hand hygiene by washing your hands with soap and water, especially after coughing or sneezing. Alcohol-based hand cleaners also are effective.
  • Practice respiratory etiquette by covering your mouth and nose with a tissue when you cough or sneeze. If you don’t have a tissue, cough or sneeze into your elbow or shoulder, not into your hands. Avoid touching your eyes, nose or mouth.
  • Know the signs and symptoms of the flu. A fever is a temperature taken with a thermometer that is equal to or greater than 100 degrees Fahrenheit or 38 degrees Celsius. Look for possible signs of fever: if the person feels very warm, has a flushed appearance, or is sweating or shivering.
  • Stay home if you have flu or flu-like illness for at least 24 hours after you no longer have a fever (100 degrees Fahrenheit or 38 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medications (any medicine that contains ibuprofen or acetaminophen). Don’t go to class or work.
  • Talk with your health care providers about whether you should be vaccinated for seasonal flu. Also if you are at higher risk for flu complications from the flu (see above), you should consider receiving the 2009 H1N1 Influenza vaccine when it becomes available.
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What vaccinations should I consider?

There are three vaccinations that persons should consider to protect themselves from influenza and its complications. These are all “killed” vaccine products and are unable to infect the person. The vaccines carry proteins (antigens) from these viruses. This exposure stimulates us to produce protective antibodies against these infectious organisms.

  1. Seasonal Influenza Vaccine. This is the annual vaccine that is adjusted each year for the common strains of influenza viruses expected to be circulating in the fall and winter. This vaccine actually covers three different influenza strains: two Influenza A viruses and one Influenza B virus. The 2009 seasonal influenza vaccine components are A/Brisbane/59/2007 (H1N1), A/Brisbane/10/2007 (H3N2) and B/Brisbane/60/2007. The A/Brisbane/59/2007 (H1N1) should not be confused with the Novel Influenza A (H1N1).
  2. Pneumococcal Polysaccharide Vaccine (PPV). This vaccine has been available for several years and previously has been approved for use in adults over 65 years of age and other persons who are at risk of complicated infection such as chronic heart and lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, cancer or who deal with immunosuppression. It has recently received approval for use in adults who have asthma or who are cigarette smokers. It protects against pneumococcal bacterial infections which are a common complicating infection of those who have been ill with influenza.
  3. The 2009 H1N1 Influenza vaccine which has been designed to provide immunity against this new pandemic influenza virus. Binghamton University has ordered both injectable and nasal mist forms of the vaccine, but vaccine production is behind schedule and only partial orders are being received each week. Vaccine is being administered during vaccine clinics set up in the University Union Mandela Room. Announcements of the dates and times of these vaccine clinics are posted on the face page of the University website as they are schedule.

The first batches of this vaccine are being given preferentially to certain targeted groups which include:

  • pregnant women, including for up to two weeks postpartum or post-pregnancy loss,
  • persons who live with or provide care for infants 6 months of age or younger,
  • healthcare and emergency service personnel,
  • children and young adults age 6 months through 24 years, and
  • persons age 25 through 64 years who have medical conditions that put them at higher risk for influenza-related complications.

 There is no charge for this vaccine.

What is the difference between the injectable and nasal mist 2009 H1N1 Influenza vaccines?

The injectable form is a “killed” vaccine made of protein particles from the virus which are injected into the deltoid (shoulder) muscle. These particles encourage the production of antibodies against the illness. This vaccine is the more versatile of the two forms and can be used in both children and adults. It can also be used in women who are pregnant and in those who have asthma, diabetes or other chronic illness. See the Vaccine Information Sheet (VIS) posted on the University website for more information.

The nasal mist form is a live vaccine that causes a mild nasal infection after it is sprayed into the nostrils. This low-grade infection encourages the production of antibodies against the illness. The nasal mist option for influenza vaccine has been available for several years. Like the injectable form, it is safe and effective. It, however, has not been approved for women who are pregnant, for those older than 49 years or for those with asthma, diabetes or other long-term health problems. See the Vaccine Information Sheet (VIS) posted on the University website for more information.

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What actions should pregnant students, faculty or staff take to protect themselves from the flu?

Pregnant women should follow the same guidance as the general public related to staying home when sick, hand hygiene, respiratory etiquette and routine cleaning. Pregnant women are at higher risk of complications from flu and should speak with their health-care provider as soon as possible if they develop flu-like symptoms. Early treatment with antiviral flu medicines is recommended for pregnant women who have the flu; these medicines, as mentioned above, are most effective when started within the first 48 hours of feeling sick. Pregnant women are in the first priority group to receive the 2009 H1N1 Influenza vaccine when it becomes available.  Seasonal flu vaccine is also recommended for pregnant women and can be given at any time during pregnancy.

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Academic Absences

How should students handle classes if they become ill with the flu?

A note from a doctor or nurse practitioner will not be required to confirm an illness or recovery. Faculty have been asked to alter policies on missed classes and examinations and to create alternative ways to handle class attendance, laboratories, papers, presentations and any other course requirements in the event a student falls ill. They have been asked to include this information in their syllabi, to post it on the course Blackboard site and to review it with students in handouts as necessary.

These written contingency plans will assure students that faculty will make accommodations, especially in the event of a major outbreak on campus. Students are asked to work closely with their faculty to complete course requirements.

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How should faculty handle classes if they become ill with the flu?

The University Health Service is unable to provide letters or notes for confirmation of illness or recovery. The New York State Health Department neither recommends nor makes available the lab test that confirms 2009 H1N1 Influenza. Also, many students will be guided by phone consultation and never be seen at the Health Service. Students and instructors alike have been asked to self-isolate and not reenter the classroom until their oral temperature is less than 100 degrees Fahrenheit for at least 24 hours (without the use of any fever reducing medication like Tylenol or Advil). Faculty members have received a memo from Provost Mary Ann Swain which has asked that they alter practices for attendance and coursework as appropriate for this pandemic.

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University Response

What are the University and the Health Service doing about the H1N1 flu?

The University has activated its Incident Management Team, which met twice daily in the spring during the initial H1N1 influenza outbreak and implemented sections of its plan, which is available at http://emergency.binghamton.edu/. The team has, and continues to:

  • Work closely with the county and state health departments monitoring both the spread of the H1N1 flu and the various updates and following the guidelines provided by the New York State Health Department and the Centers for Disease Control,
  • Stock appropriate medical and support supplies,
  • Refine policies and procedures for sanitizing rooms, relocating possible suspect influenza cases to alternative housing and responding to the need for after-hours and weekend assessment of possible suspect cases,
  • Institute an educational campaign to encourage good health practices, and
  • Develop public health plans for large events on campus.

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    For updates and additional information on the Novel Influenza A (H1N1) virus, visit the University update page.

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    Last Updated: 11/5/09