H1N1 is now spreading within the local communities of Singapore. Most patients do recover from the infection with only basic symptomatic treatment and rest. The estimated case fatality rate is around 0.16 to 0.3% ie out of 1000 thousand infected only about 1-3 people will die from complications. The Ministry of Health has identified several groups of patients that are considered high risk for developing complications when infected with H1N1. These are :

• Persons >= 65 yrs old
• Children <= 5 yrs old
• History of chronic lung disease such as chronic obstructive lung disease or chronic asthma
• History of heart disease

Anyone with regular follow-up in the last one year on :

• Chronic metabolic diseases such as diabetes
• Kidney impairment
• Haemoglobinopathies such as Thalassaemic patients
• Immunosuppression from medication or infection such as HIV infection

• Children and teenagers 6 months to 18 years who are on long term aspirin treatment
• Pregnant women

Ministry of Health has advised the public that anyone who has come down with influenza-like-illness should excuse themselves from work or school and present themselves to a doctor at the Pandemic Preparedness Clinics (PPC) or polyclinics or to see their own family doctors. Ministry of Health has defined influenza-like-illness (ILI) as anyone coming down with fever (>38) + two out of any of these symptoms (sore throat, cough, body aching, running nose). Patients with ILI will be assessed by the doctors regarding their risk of developing influenza complications according to the list given above. Patients who fit into the list will be treated with Tamiflu. Adult patients with ILI will be given 7 days of medical leave from onset of symptoms and for children, 10 days of medical leave. The medical leave is given so that the patients can be isolated at home and avoid further spread to the people around them.

Patients with ILI should be socially responsible by :

1. Avoiding crowed places
2. Avoid taking public transport
3. Isolation at home especially if there are young children, elderly or patients with chronic diseases
4. Avoiding visitation
5. Avoid going to work places
6. Wearing a mask if there is a chance of contact with other people in close proximity

With the presence of local spread, patients should also highlight to the doctors if they develop flu symptoms that do not fit into the ILI definitions, when they have been to the local clusters. This is because some patients with H1N1 will not present with typical ILI symptoms.

Due to the high risk of influenza related complications, it is advisable for patients to seek consultation with their specialist if they are pregnant, on kidney dialysis, on chemotherapy, or if age <1 year old.

How to Avoid Getting Swine Flu
*Cover your nose and mouth with tissue when you cough or sneeze. Throw the tissues in the trash after you use them.
*Wash your hands frequently with soap and water, especially after coughing or sneezing. Alcohol-based hands cleaners are also helpful.
*Try to avoid close contact with sick people.
*Wear an approved RESPIRATOR or SURGICAL MASK
*If you are sick, stay home from work or school and limit contact with others to keep from infecting them.
*Avoid touching your eyes, nose, or mouth, as germs are spread that way.
*See a doctor if you have swine flu symptoms.

Swine Flu Symptoms
The Swine Flu is well known to scientists and is not a new illness but the newest strain, A H1N1 could reach pandemic levels and is easily spread by humans, which is a new development. Newer versions of Swine Flu are seen annually and are sometimes combined with Bird Flu, but the latest version A/H1N1 also contains a strain of a human flu virus.

Swine Flu symptoms include typical flu symptoms: Aches, pain, sinus problems and fever. A H1N1 spreads quickly and strikes fast; A H1N1 is also a killer flu.

If you feel sick and have been to Mexico, Texas or California or have come in contact with someone who has, be watchful for these Swine Flu symptoms:

*High fever (as high as 105 or more)
*Nausea and vomiting
*Headaches and muscle and/or joint pain.
*Respiratory problems
*Sinus problems
*Diarrhoea and/or dehydration

If you have most or all of these these Swine Flu symptoms, see a doctor or go to hospital and inform friends, family and anyone else you may have daily or close contact with so that they can be tested immediately.

The A H1N1 Swine Flu virus is treatable (so far) with existing anti-viral medications: Tamiflu and Relenza.

Remember, visiting the doctor if you feel unwell will definitely help in preventing the spread of swine flu.

Wear a Facemask or a Respirator
Wearing facemasks and respirators will help control the spread of pandemic flu.

Wear a facemask if:

*You are sick with the flu and think you might have close contact with other people.
* You live with someone who has the flu (you therefore might be in the early stages of infection) and need to be in a crowded place. Limit the amount of time you spend in these crowded places and wear a facemask while you are there.
* You are well and do not expect to be in close contact with a sick person but need to be in a crowded place. Limit the amount of time you spend in these crowded places and wear a facemask while you are there.

Wear a respirator if:

* You are well and you expect to be in close contact with people who are known or thought to be sick with pandemic flu. Limit the amount of time you are in close contact with these people and wear a respirator during this time. These recommendations apply if you must take care of a sick person at home.

What is a facemask?

Facemasks are loose-fitting, disposable masks that cover the nose and mouth. These include products labeled as surgical, dental, medical procedure, isolation, and laser masks.

Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing the flu facemask. They are not designed to protect you against breathing in very small particles. Facemasks should be used once and then thrown away in the trash.

What is a respirator?

A flu respirator (for example, an N95 or higher filtering facepiece respirator) is designed to protect you from breathing in very small particles, which might contain viruses. These types of respirators fit tightly to the face so that most air is inhaled through the filter material. To work the best way, N95 respirators must be specially fitted for each person who wears one (this is called “fit-testing” and is usually done in a workplace where respirators are used). Most of the time, N95 flu respirators are used in construction and other jobs that involve dust and small particles. Some healthcare workers, such as nurses and doctors, use these types of respirators when taking care of patients with diseases that can be spread through the air.

If you have a heart or lung disease or other health condition, you may have trouble breathing through respirators and you should talk with your doctor before using a respirator.

Like surgical masks, N95 respirators should be worn only once and then thrown away in the trash.

Additional Information

Neither flu facemasks nor a respirator will give complete protection from the flu. That is why it is important to wash your hands often, cover your coughs and sneezes with a handkerchief or your arm, and avoid crowds and gatherings during a pandemic. To learn more about these and other issues relating to pandemic influenza.

To Parents
Please do not send your children to school should they feel unwell. Thank you.

Advice from MOH

Singaporeans are reminded to maintain high standards of personal hygiene. This means covering your nose and mouth with a tissue when you sneeze or cough, and washing your hand frequently with soap and water, especially after contact with respiratory secretions (e.g., after sneezing and coughing). We also need the cooperation of everyone to be socially responsible. This means staying home and avoiding crowded places (including trains, buses, offices), putting on a surgical mask and seeing a doctor if you have flu symptoms. MOH advises those who travelled to affected areas to closely monitor their health and seek treatment as soon as possible should they develop symptoms.

Members of the public are advised to exercise caution over travel to affected areas. In the event that travel is unavoidable, the public is advised to take precautionary measures such as avoiding crowded areas and maintaining high standards of personal hygiene at all times. However, iff you are unwell with fever and cough but have no travel history to affected areas, please see a doctor and stay at home.

MOH is monitoring the situation closely and will update the public should there be any new developments. For more information on Influenza A (H1N1-2009), please access MOH’s website at www.moh.gov.sg, call our hotline at 1800-333 9999, or visit www.flu.gov.sg.

MINISTRY OF HEALTH
27 May 2009

Preventing the Flu
What should I do to keep from getting the flu?
What is the best way to keep from spreading the virus through coughing or sneezing?
What is the best technique for washing my hands to avoid getting the flu?
What kills influenza virus? What household cleaners kill the virus?

Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.
How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry. Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Should I begin taking antiviral medications such as Tamiflu® if I'm planning a visit to another country known to have any type of flu?

No, the Centers for Disease Control and Prevention (CDC) specifically states that at this time persons traveling to countries where there are cases of avian or H1N1 (swine) influenza in birds, poultry, swine, or humans do not need to take Tamiflu ® to prevent illness. If you become ill in any way while in the country, you should seek medical advice immediately. If you plan to travel to any country that has reported cases of flu among birds, swine, or humans, you should consider scheduling an appointment with your health care provider before traveling to discuss risks for potential exposure to diseases. Only you and your health care provider can determine that risk and what the most appropriate precautions are for you.