Information in Lithuanian
Information about Influenza:
World Health Organization
European Commission information
Health–EU portal information
Health Map. Global Disease Alert Map
European Centre for Disease Prevention and Control (ECDC)
Press Releases and Reccomendation
2011
Influenza progresses in Europe: there is still time to take preventive measures against it (2011 01 25)
2010
WHO/Europe interim reccommendations on influenza vaccination during the 2010/2011 winter season (2010 09 28)
Frequently Asked Questions for the WHO web site
Audience: Public
What is post-pandemic?
1. What does post-pandemic mean? How do we know that the pandemic is over?
The H1N1 pandemic was characterized by the emergence of a new influenza virus to which many people had no pre-existing immunity. It caused unusual and extensive outbreaks of disease in the summer months in many countries and very high levels of disease in winter months. It was also characterized by an almost complete dominance of the pandemic virus over other seasonal influenza viruses, and by unusual clinical patterns where the most severe cases occurred most often in younger age groups.
We are now moving into a situation where the virus has spread to all countries, when many people in all age groups in many countries have some immunity to the new virus, and where no large and unusual summer outbreaks have occurred in either Northern or Southern Hemispheres, and where seasonal influenza A (H3N2) and influenza B viruses are being reported in many countries. Based on this overall picture, the evidence is strong that the recent influenza pandemic patterns have been replaced by seasonal patterns of influenza. However, it is important to realize that the new H1N1 virus can be expected to remain for many years and that individual influenza seasons themselves can be highly variable. In some years, the impact can be mild while in other years it can be quite severe.
In the post pandemic period, cases and outbreaks due to the H1N1 virus are expected to continue to occur. In addition, it is most likely that for some period of time, younger age groups, including pregnant women, will continue to be affected disproportionately by severe disease from H1N1, including viral pneumonia. It is impossible to predict if younger people will remain at higher risk over the long term for severe disease or whether and when this will change. Given this picture, it will remain important for people to continue to take prudent steps to protect themselves. Actions to generally reduce risks of influenza infection, such as use of vaccines and hand and respiratory hygiene, will also reduce the risks from H1N1 infection.
Related link:
Pandemic Influenza Preparedness and Response Guidelines
http://www.who.int/csr/disease/influenza/pipguidance2009/en/index.html
2. Does the end of the influenza pandemic mean that fewer people will become sick and die of the H1N1 virus?
The future health impact of the H1N1 virus is not possible to predict. On the one hand, the H1N1 virus is expected to continue to circulate as a seasonal influenza strain for the foreseeable future and because of this, more people will develop immunity to this virus. On the other hand, the virus is also expected to change over time as a result of antigenic drift and these changes may mean that the immunity that has developed to this version of the virus may become less protective against future versions of this virus. In addition, many people were not infected by the H1N1 virus during the pandemic, and therefore there may well be areas of some countries that were less severely affected during the pandemic but that could experience more severe disease later.
3. Why did WHO take so long to declare the end of the pandemic?
WHO has been monitoring epidemiological and virological evidence from all parts of the world, including both Northern and Southern Hemispheres, to determine when the pandemic is over. In particular, WHO has waited until the picture in the Southern Hemisphere and tropical countries has become clearer.
4. What does the end of the pandemic mean for individuals?
For most individuals, there will not be much impact on their daily lives. Regardless of whether the world is in a pandemic situation or not, influenza viruses pose a risk of disease to many individuals and therefore, individuals should take prudent steps to reduce their risk of infection. Such steps include the use of influenza vaccine when available and especially if they are in a group at high risk for severe illness. Most individuals who become ill can be treated safely at home but caretakers and family members should be aware that if an individual develops symptoms suggesting more severe disease, such as prolonged high fever, trouble breathing, or confusion, then professional medical care should be sought.
5. Will the H1N1 flu virus continue to cause severe illness among the same higher risk groups?
Based on available evidence, the H1N1 virus currently continues to pose a higher risk for severe illness in some groups, including young children, pregnant women and those with respiratory or chronic health conditions.
Related links:
Who is more at risk to severe illness? What about other risks?
http://www.who.int/csr/disease/swineflu/frequently_asked_questions/risk/en/index.html
6. What can individuals do to protect themselves from the H1N1 flu virus?
Individuals can continue to protect themselves and others from the H1N1 virus, and other influenza viruses, through preventive measures such as practicing good hand hygiene and respiratory etiquette, including covering their mouth when they sneeze or cough. WHO also continues to recommend vaccination against the virus through a monovalent (single virus) pandemic vaccine, or a trivalent seasonal influenza vaccine (which includes the pandemic H1N1 strain, as well as other seasonal strains H3 and B), depending on whichever is available.
Related link:
What can I do? http://www.who.int/csr/disease/swineflu/frequently_asked_questions/what/en/index.html
7. What major public health measures are recommended to countries now?
Even as we move out of the pandemic period, it is important for countries to remain vigilant and alert for infections and outbreaks and to continue to take steps to protect their populations against influenza.
WHO recommends that countries:
• Maintain monitoring for influenza, through routine respiratory disease surveillance and reporting as well as mmonitoring and investigating unusual disease patterns suggestive of potential changes in the severity, and monitoring of the H1N1 virus for important changes.
• .
• Continue prevention and control efforts to reduce the impact of influenza, including vaccination against influenza. The pandemic monovalent H1N1 vaccine and the seasonal influenza vaccines both now cover the H1N1 virus, either may be used depending on which is available and according to national guidelines.
The H1N1 pandemic provided a significant challenge to all countries and WHO encourages countries to assess their experience and identify lessons that can be applied to strengthen their preparedness and response to future pandemics.
8. Does WHO still recommend oseltamivir use now that the pandemic is over?
WHO's guidelines for use of antiviral medicines cover both seasonal and pandemic influenza and should continue to be followed. Although we are now post-pandemic, the H1N1 virus is still circulating as one of the seasonal flu strains. It is likely that we will still see severe illness in higher risk individuals as well as otherwise healthy persons. Early recognition and appropriate treatment remain important.
Related link:
WHO guidelines for use of antiviral medicines
http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/index.html
9. Why should people continue to vaccinate against the H1N1 influenza virus?
When it is available, WHO strongly recommends the use of influenza vaccine to protect people as a safe and effective countermeasure to reduce the chances of developing severe illness. This H1N1 influenza virus is expected to continue to circulate worldwide for many years, and many people are still susceptible to infection. WHO particularly recommends vaccination for health care workers and groups at high-risk for severe disease.
Related links:
Vaccines for pandemic (H1N1) 2009
http://www.who.int/csr/disease/swineflu/frequently_asked_questions/vaccine_preparedness/en/index.html
10. Does pandemic H1N1 vaccine protect individuals against seasonal flu?
The pandemic H1N1 2009 virus is expected to continue to circulate as one of the seasonal flu strains for some time to come. The current seasonal trivalent vaccine includes the pandemic H1N1 strain, as well as other seasonal strains (H3, B), and will therefore protect against all the expected seasonal influenza viruses. The monovalent (single virus) pandemic vaccine will only protect against the H1N1 virus.
Pandemic H1N1 virus caused most of its severe or fatal disease in younger people, both those with chronic conditions as well as healthy persons, and caused many more cases of viral pneumonia than is normally seen with seasonal influenza.
Since no one can accurately predict which or how many of the circulating influenza viruses will infect them, the trivalent seasonal influenza vaccine will provide the broadest protection. However, in some places the trivalent vaccine is not available and it is still prudent to be vaccinated against the H1N1 virus to prevent severe illness.
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Archive
Travellers notice!
Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home
For your attention – Influenza A(H1N1) Infection Situation Report, provided be the European Centre for Disease Prevention and Control (5 May, 2009)
ECDC frequently asked questions for human swine influenza A(H1N1)
Swine influenza frequently asked questions
25 April 2009
What is swine influenza?
What are the implications for human health?
Where have human cases occurred?
How do people become infected?
Is it safe to eat pork meet and products?
What about the pandemic risk?
Is there a human vaccine to protect swine influenza?
What drugs are available for treatment?
What is swine influenza?
Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses. Morbidity tends to be high and mortality low (1-4%). The virus is spread among pigs by aerosols and direct and indirect contact, and asymptomatic carrier pigs exist. Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones. Many countries routinely vaccinate swine populations against swine influenza.
Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, H3N2). Pigs can also be infected with avian influenza viruses and human seasonal influenza viruses as well as swine influenza viruses. The H3N2 swine virus was thought to have been originally introduced into pigs by humans. Sometimes pigs can be infected with more than one virus type at a time, which can allow the genes from these viruses to mix. This can result in an influenza virus containing genes from a number of sources, called a "reassortant" virus. Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans.
What are the implications for human health?
Outbreaks and sporadic human infection with swine influenza have been occasionally reported. Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death. Since typical clinical presentation of swine influenza infection in humans resembles seasonal influenza and other acute upper respiratory tract infections, most of the cases have been detected by chance through seasonal influenza surveillance. Mild or asymptomatic cases may have escaped from recognition, therefore the true extent of this disease among humans is unknown.
Where have human cases occurred?
Since the implementation of IHR(2005)1 in 2007, WHO has been notified of swine influenza cases from the United States and Spain.
How do people become infected?
People usually get swine influenza from infected pigs, however, some human cases lack contact history with pigs or environments where pigs have been located. Human-to-human transmission has occurred in some instances but was limited to close contacts and closed groups of people.
Is it safe to eat pork and pork products?
Yes. Swine influenza has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The swine influenza virus is killed by cooking temperatures of 160F/70C, corresponding to the general guidance for the preparation of pork and other meat.
Which countries have been affected by outbreaks in pigs?
Swine influenza is not notifiable to international animal health authorities (OIE, www.oie.int), therefore its international distribution in animals is not well known. The disease is considered endemic in the United States. Outbreaks in pigs are also known to have occurred in North and South America, Europe (including the UK, Sweden, and Italy), Africa (Kenya), and in parts of eastern Asia including China and Japan.
What about the pandemic risk?
It is likely that most of people, especially those who do not have regular contact with pigs, do not have immunity to swine influenza viruses that can prevent the virus infection. If a swine virus established efficient human-to human transmission, it can cause an influenza pandemic. The impact of a pandemic caused by such a virus is difficult to predict: it depends on virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection and host factors. Swine influenza viruses can give a rise to a hybrid virus by mixing with a human influenza virus and can cause pandemic.
Is there a human vaccine to protect from swine influenza?
No. Influenza viruses change very quickly and the match between the vaccine and the circulating virus is very important to give adequate protective immunity to vaccinated people. This is why WHO needs to select vaccine viruses twice a year for seasonal influenza protection, once for the northern hemisphere winter and another for the southern hemisphere. Current seasonal influenza vaccine produced based on WHO recommendation does not contain swine influenza virus. It is unknown whether the seasonal vaccines can provide any cross protection to ongoing swine influenza virus infection in the United States and Mexico. WHO is working closely with its partner institutions for further advise on the use of seasonal influenza vaccine in preventing the swine influenza infection. This section will be updated as more information becomes available.
What drugs are available for treatment?
1 International Health Regulation (2005) http://www.who.int/ihr/about/en/
Antiviral drugs for seasonal influenza are available in some countries and effectively prevent and treat the illness. There are two classes of such medicines, 1) adamantanes (amantadine and remantadine),
and 2) inhibitors of influenza neuraminidase (oseltamivir and zanamivir).
Most of the previously reported swine influenza cases recovered fully from the disease without requiring medical attention and without antiviral medicines. Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of chemoprophylaxis and treatment. The viruses obtained from the recent human cases with swine influenza in the United States were sensitive to oselatmivir and zanamivir but resistant to amantadine and remantadine. Information is insufficient to make recommendation on the use of the antivirals in prevention and treatment of swine influenza virus infection. Clinicians have to make decisions based on the clinical and epidemiological assessment and harms and benefit of the prophylaxis/treatment of the patient2. For the ongoing outbreak of the swine influenza infection in the United States and Mexico, the national and the local authorities are recommending to use oseltamivir or zanamivir for treatment and prevention of the disease based on the virus’s susceptibility profile.
2 For benefits and harms of influenza-specific antivirals, see http://www.who.int/csr/disease/avian_influenza/guidelines/
pharmamanagement/en/index.html
Where to get more information:
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Ministry of Health of the Republic of Lithuania
Public Health Department
Tel. +370 5 266 14 66, + 370 5 266 14 64
Free hotline + 370 800 66 004
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State Public Health Service
Tel. +370 5 277 80 36
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Commucable Disease Prevention and Control Centre
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Tel. +370 5 277 90 51
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Health Emergency Situations Center
Hotline all day and night +370 5 261 98 88
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The Key Facts about Avian Influenza
Influenza Pandemic Preparedness Planning
Background WHO documents
Avian influenza: assessing the pandemic threat
Responding to the avian influenza pandemic threat
Recommended strategic actions
WHO checklist for influenza pandemic preparedness planning
WHO global influenza preparedness plan
Vaccines for pandemic influenza
Informal consultation on influenza pandemic preparedness in countries with limited resources
Influenza pandemic. Preparadness Planning. Euro situation (Dr. Bernardus Ganter, regional Advisor, CSR)
Communication and information
Questions?
bga@who.dk
www.euro.who.int
www.who.int/csr/gip
www.ecdc.eu.int
The links to ECDC’s influenza web addresses are:
1. Weekly update – latest epidemiology including EISS, news and scientific and public health developments with ECDC commentaries. Updated every Thursday http://www.ecdc.eu.int/influenza/update_influenza.php - worth checking each week and using the content
2. Influenza Index (closest thing to an Influenza web-site) http://www.ecdc.eu.int/influenza/index.php
3. Avian Influenza Index (the Bird Flu ‘web-site’) http://www.ecdc.eu.int/avian_influenza/index.php
4. Avian Infuenza Portfolio of Technical Information http://www.ecdc.eu.int/avian_influenza/Scientific_Technical_Guidance.php
5. Influenza Questions and Answers – Ordinary Influenza http://www.ecdc.eu.int/Influenza/Influenza_QA_2.php
6. Avian Influenza and Pandemic Influenza http://www.ecdc.eu.int/influenza/influenza_QA.php Note these are going through a review at present
7. EU Pandemic Plans http://www.ecdc.eu.int/Influenza/National_Influenza_Pandemic_Plans.php
8. EC-ECDC-Euro Assessment Tool http://www.ecdc.eu.int/Influenza/Assessment_Tool.php
There are in addition frequent articles in Eurosurveillance Weekly www.eurosurveillance.org
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