• Swine Flu Level 6 Pandemic FAQ

    Swine Flu Pandemic FAQ

    What the swine flu pandemic means to you.

    Swine flu Level 6 is pandemic, the World Health Organization (WHO) has declared.

    A pandemic sounds scary. But what does it really mean? Here are answers to your questions.

    What is a pandemic?

    A pandemic is a new infectious disease that spreads around the world.

    The best recent example of a pandemic is AIDS, caused by a virus new to humans: HIV.

    Seasonal flu viruses spread around the globe and cause 250,000 to 500,000 deaths each year -- including some 36,000 annual deaths in the U.S. But seasonal flu isn't considered a pandemic, even though the viruses that cause them change a little from season to season.

    One of the seasonal flu viruses is a type A H1N1 (Swineflu) virus. But the type H1N1 swine flu virus that appeared in 2009 is an entirely different virus. It carries genes from swine flu viruses from North America and Eurasia as well as genes from human and bird flu viruses.

    Humans have never before been infected with this virus. That means that nobody is immune, although some people born before 1957 may have been exposed to an ancestor virus that could possibly give them a small degree of protection.

    Because the vast majority of people are vulnerable to the 2009 H1N1 swine flu virus, because it spreads easily from person to person, and because the virus is spreading in communities in different parts of the world, the current swine flu has reached pandemic proportions.

    Flu pandemics occur regularly. That's because there are many kinds of flu viruses in animals (mostly birds), but so far only a few have evolved the ability to infect humans.

    What does the WHO pandemic alert mean?

    The World Health Organization has declared the 2009 H1N1 swine flu to be a pandemic.

    That does NOT mean that swine flu is more dangerous than it was before. The declaration means only that the WHO officially recognizes that swine flu is spreading globally -- and that countries that have not yet put their flu-pandemic plans into action should do so now.

    Swine flu already has been spreading in the U.S., so the WHO declaration makes very little difference. U.S. health officials already have been working furiously to prepare for the fall 2009-2010 flu season.

    Why has WHO declared a pandemic now?

    WHO's technical criteria for declaring a pandemic is that the infection must be spreading locally in at least two distinct regions of the world. That actually went on for some time before the official declaration.. But the WHO was worried that governments might overreact to a pandemic declaration.

    They had good reason to think so. Early in the pandemic, some countries stopped importing pork and even slaughtered local pig herds -- even though the so-called swine flu is spread from person to person and cannot be spread by eating pork. And other nations established unreasonable travel restrictions or unnecessarily quarantined healthy people from countries where the flu was spreading.

    These unnecessary actions had serious economic and social impacts. And since most public health experts feared that the next flu pandemic would be the vastly more deadly H5N1 bird flu, most pandemic preparedness plans contained steps far more drastic than steps needed to fight swine flu, which is only moderate in severity.

    The six-stage WHO pandemic alert system does not take disease severity into account; it's based on the geographic spread of a virus.

    The CDC does have a pandemic severity scale, which has five categories. The scale is based on the percentage of infected people who die -- the case-fatality ratio.

    It's too soon to know the case-fatality ratio for H1N1 swine flu. But the CDC's best estimate so far is that it is 0.1%. That puts it on the borderline between Category 1 (the lowest category) and Category 2. The 1918 swine flu was a Category 5 pandemic, with a case-fatality rate of over 2%.

    Even a Category 1 pandemic is serious. The CDC estimates that a pandemic with a 0.1% case-fatality ratio would result in some 90,000 U.S. deaths if no vaccine becomes available.

    Has H1N1 swine flu become more dangerous?

    No. So far, the H1N1 swine flu virus that is spreading around the globe is very similar to the swine flu viruses first seen in North America.

    Experts say the disease is moderate in severity. That is because most cases -- and most hospitalizations -- have been in young people 5 to 24 years old. A small proportion of these young people have died.

    Even though most people who get swine flu recover fully, these troubling deaths in otherwise healthy young people make experts hesitate to call the disease "mild."

    Flu viruses do, of course, mutate. They may become less dangerous. But they may become more deadly, possibly picking up virulence factors from other flu bugs circulating at the same time. The nightmare scenario is that the H1N1 swine flu would combine with the H5N1 bird flu to create a fast-spreading, lethal virus. But the chance of this happening is small.

    And pandemics come in waves. They tend to appear, wane, and reappear over two or three years. Sometimes there may be a mild first wave, followed by far more serious waves. That's what happened in 1918 and 1919 -- and that's what keeps public health officials awake at night.

    Am I less safe now that swine flu is pandemic?

    aNo. In fact, the world likely is more safe now that all nations will be taking appropriate actions to limit the impact of the H1N1 swine flu pandemic.

    What should I do now that a pandemic has been declared?

    aThe pandemic alert is a good time to check your family and community preparedness plan.

    If you don't know your community plan, check with local heath officials. Let them know if you think you might be able to volunteer in case your help is needed. Even a mild flu could disrupt local services if a large number of people fall ill.

    And if you don't have a family checklist, it's time to make one. The CDC offers guidance at its pandemicflu.gov web site.

    When will the pandemic end?

    Most pandemics end when enough people become immune to the disease -- either because they've survived infection or because they've been vaccinated.

    Past pandemics have lasted two or three years. This time, the pandemic may be shorter.

    That's because the world has steadily been building up its ability to make flu vaccines -- and because the new H1N1 swine flu virus was discovered and isolated in record time.

    It's possible that a successful vaccination campaign could significantly shorten the pandemic. Whether this will happen remains to be seen.

    Interestingly, pandemic flu viruses don't go away when the pandemic ends. Often they stick around to become a new seasonal flu bug, replacing one of the seasonal viruses.

    What is the government doing about the pandemic?

    There's been a strong response by the U.S. federal government to the swine flu epidemic. State and local responses have been vigorous, but in many areas have been -- and will be -- hampered by budget cuts to health departments.

    The federal Department of Health and Human Services and Department of Homeland Security are working extremely hard. These efforts have focused on preparing to assist state and local responses and on developing a swine flu vaccine.

    The vaccine effort is very complicated. Early steps have gone well. The CDC has isolated and given to vaccine manufacturers a "seed virus" that can be used to make a vaccine. Now manufacturers are working to make an actual vaccine.

    Once there's a first lot of vaccine, the National Institutes of Health will test it on human volunteers to see if it seems to work -- and if it seems to be safe.

    Meanwhile, the U.S. government has purchased bulk materials for commercial-scale vaccine manufacture. Purchase of needles and syringes will follow. But the big questions -- whether to go ahead with full-scale vaccine manufacture, who should be vaccinated first, and how the vaccine will be distributed -- remain to be answered.


    A Pandemic Is Declared (Swine Flu Level 6)

    On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert to level 6 in response to the ongoing global spread of the novel influenza A H1N1 Flu virus. A Swine Flu Level 6 designation indicates that a global pandemic is underway.

    More than 70 countries are now reporting cases of human infection with novel H1N1 flu. This number has been increasing over the past few weeks, but many of the cases reportedly had links to travel or were localized outbreaks without community spread. The WHO designation of a pandemic alert Phase 6 reflects the fact that there are now ongoing community level outbreaks in multiple parts of world.

    WHO’s decision to raise the pandemic alert to Swine flu level 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus. It’s uncertain at this time how serious or severe this novel H1N1 level 6 (Swine flu level 6) pandemic will be in terms of how many people infected will develop serious complications or die from novel H1N1 infection. Experience with this virus so far is limited and influenza is unpredictable. However, because novel H1N1 is a new virus, many people may have little or no immunity against it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against novel H1N1 virus.

    In the United States, most people who have become ill with the newly declared pandemic virus have recovered without requiring medical treatment, however, CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this pandemic in the coming days and weeks. In addition, this virus could cause significant illness with associated hospitalizations and deaths in the fall and winter during the U.S. influenza season.

  • A New Influenza Virus (Swine Flu)

    Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in April, 2009. The virus is infecting people and is spreading from person-to-person, sparking a growing outbreak of illness in the United States. An increasing number of cases are being reported internationally as well.

    It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the coughs and sneezes of people who are sick with the virus.

    It’s uncertain at this time how severe this novel H1N1 outbreak will be in terms of illness and death compared with other influenza viruses. Because this is a new virus, most people will not have immunity to it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against this novel H1N1 virus. CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks.

    Novel influenza A (H1N1) activity is now being detected through CDC’s routine influenza surveillance systems and reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories. The fact that novel H1N1 activity can now be monitored through seasonal surveillance systems is an indication that there are higher levels of influenza-like illness in the United States than is normal for this time of year. About half of all influenza viruses being detected are novel H1N1 viruses.

    CDC Response

    CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.

    CDC is issuing updated interim guidance daily in response to the rapidly evolving situation.

    Clinician Guidance

    CDC has issued interim guidance for clinicians on identifying and caring for patients with novel H1N1, in addition to providing interim guidance on the use of antiviral drugs. Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including novel influenza H1N1 viruses. The priority use for influenza antiviral drugs during this outbreak is to treat severe influenza illness, including people who are hospitalized or sick people who are considered at high risk of serious influenza-related complications.

    Public Guidance

    In addition, CDC has provided guidance for the public on what to do if they become sick with flu-like symptoms, including infection with novel H1N1. CDC also has issued instructions on taking care of a sick person at home. Novel H1N1 infection has been reported to cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, a significant number of people also have reported nausea, vomiting or diarrhea. Everyone should take everyday preventive actions to stop the spread of germs, including frequent hand washing and people who are sick should stay home and avoid contact with others in order to limit further spread of the disease.


    CDC has developed a PCR diagnostic test kit to detect this novel H1N1 virus and has now distributed test kits to all states in the U.S. and the District of Columbia and Puerto Rico. The test kits are being shipped internationally as well. This will allow states and other countries to test for this new virus. This increase in testing will likely result in an increase in the number of confirmed cases of illness reported. This, combined with ongoing monitoring through Flu View should provide a fuller picture of the burden of disease in the United States over time.

  • Antiviral Drugs A H1N1 Flu (Swine Flu) - Tamiflu

    Antiviral Drugs

    Antiviral drugs are medicines (pills, liquid or an inhaler) with activity against influenza viruses, including swine influenza viruses. Antiviral drugs can be used to treat swine flu or to prevent infection with swine flu viruses. Influenza antiviral drugs only work against influenza viruses -- they will not help treat or prevent symptoms caused by infection from other viruses that can cause symptoms similar to the flu.

    There are four influenza antiviral drugs approved for use in

    the United States (Tamiflu, zanamivir, amantadine and rimantadine). The swine influenza A (H1N1) (Swine Flu) viruses that have been detected in humans in the United States and Mexico are resistant to amantadine and rimantadine so these drugs will not work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1) (Swine Flu) viruses so far indicate that they are susceptible (sensitive) to Tamiflu and zanamivir.

    Benefits of Antiviral Drugs

    Treatment: If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. Influenza antiviral drugs work best when started soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.

    Prevention: Influenza antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with swine influenza. When used to prevent the flu, antiviral drugs are about 70% to 90% effective. When used for prevention, the number of days that they should be used will vary depending on a person’s particular situation.

    CDC Recommendation

    CDC recommends the use of Tamiflu (oseltamivir) or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

    · Tamiflu (Oseltamivir) is approved to both treat and prevent influenza A and B virus infection in people one year of age and older.

    · Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older.

    Recommendations for using antiviral drugs for treatment or prevention of swine influenza will change as we learn more about this new virus.

  • World and U.S. Human Cases of H1N1 Flu Infection (Swine flu)

    Novel Influenza A (H1N1) Cases.

    19 May 2009, 40 countries have officially reported 9830 cases of influenza A (H1N1) infection (Swine flu), including 79 deaths.

    Mexico has reported 3648 laboratory confirmed human cases of infection, including 72 deaths. The United States has reported 5469 laboratory confirmed human cases, including 6 deaths.

    The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Belgium (5), Brazil (8), Canada (496), Chile (4), China, Hong Kong Special Administrative Region (7), Colombia (11), Costa Rica (9), Cuba (3), Denmark (1), Ecuador (1), El Salvador (6), Finland (2), France (14), Germany (14), Guatemala (3), India (1), Ireland (1), Israel (7), Italy (9), Japan (159), Korea (3), Malaysia (2), Netherlands (3), New Zealand (9), Norway (2), Panama (59), Peru (2), Poland (1), Portugal (1), Spain (103), Sweden (3), Switzerland (1), Thailand (2), Turkey (2) and the United Kingdom (102).

    The ongoing outbreak of novel influenza A (H1N1) continues to expand in the United States. CDC expects that more cases, more hospitalizations and more deaths from this outbreak will occur over the coming days and weeks.

    5469 Confirmed Cases of H1N1 Flu (Swine Flu) in 48 States (U.S.)

    U.S. Human Cases of A H1N1 Flu Infection (Swine flu)
    (As of May 19, 2009,)


    Confirmed Cases

























































    New Hampshire


    New Jersey


    New Mexico


    New York


    North Carolina


    North Dakota










    Rhode Island


    South Carolina


    South Dakota
















    Washington, D.C.





    5,469 cases

    6 deaths