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ABOUT PANDEMIC INFLUENZA A (H1N1) AUGUST 2009 cough or sneeze, and throw the tissue in a rubbish bin immediately after you have used it. Alternatively, cough and sneeze into your sleeve. Avoid touching your eyes, nose or mouth, as you could infect yourself that way. Limit close (1 to 2 m) contact with people who are sick with flu. If you get sick, stay at home and limit contact with others to keep from infecting them. 1. What is pandemic H1N1 influenza virus? The pandemic A (H1N1) influenza (flu) virus (germ) is a new member of the influenza virus family. Different influenza viruses cause the annual seasonal (winter) flu and, every few decades, a global pandemic. Influenza viruses infect birds and mammals and are usually species specific. Occasionally viruses cross over from one species to another. The pandemic A (H1N1) virus seems to have originated in pigs; however, it is not spreading in pigs or from pigs to humans but only between human beings. Seasonal human influenza results in 6 000 to 10 000 deaths every winter in South Africa and between 250 000 - 500 000 deaths globally, mostly in people over 65 and those with certain chronic medical conditions. In contrast, during pandemic influenza many of the deaths occur in younger and apparently healthy individuals. The number of deaths during an influenza pandemic varies greatly, depending mostly on the virulence of the virus, but also on factors like crowding, individual health, access to health care, and preventive measures. For the 1918 flu pandemic estimates of 25 to 40 million deaths worldwide are often quoted. The estimates for excess deaths worldwide in the 1957 and 1968 pandemics are between one and two million. 2. How does the flu virus spread? Influenza viruses are very infectious. It is almost impossible to stop influenza viruses, whether seasonal or pandemic, from spreading from person to person mainly through coughing or sneezing by infected people. Touching surfaces such as counters and doorknobs with influenza viruses on them can also infect people and afterwards their mouth, nose or eyes. This is why handwashing helps. However, influenza viruses are very infectious and all precautions can only decrease, but not eliminate, risk. 3. How can the spread be limited? You can reduce the risk of getting or spreading influenza by taking standard precautions: •	 Wash your hands or clean them with alcohol-based hand rubs frequently, especially after you cough or sneeze and before you eat. •	 Cover your nose and mouth with a clean tissue when you

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4. Symptoms of an influenza like illness These are the same for pandemic and seasonal influenza. Typical symptoms include a sudden onset of high fever, cough, runny or stuffy nose, sore throat, headache, body aches, chills, tiredness, and lack of appetite. Some of those affected have reported nausea, vomiting, and diarrhea. 5. What to do if you or your child have symptoms? •	 Children and adults who are sick should stay at home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. •	 Drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated. •	 Dishes etc. can be cleaned with hot soapy water. •	 Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste. •	 Have everyone in the household wash hands often with soap and water, especially after coughing or sneezing. Alcoholbased hand cleaners are also effective. •	 Avoid touching your eyes, nose and mouth. Germs spread this way. •	 A person who is sick should recover in his or her own room as far as possible. •	 If someone in your home is sick, as far as possible keep the person away from those who are not sick •	 If a household member needs to come into the room keep at least an arms length away (1 to 2 m) and do not sit on the bed.

6. Take medication as prescribed •	 Take medicine for symptom relief as needed for fever and pain such as paracetamol or ibuprofen. •	 These medicines do not need to be taken regularly if your symptoms improve. •	 Do not give aspirin (acetylsalicylic acid) or products that contain aspirin to children or teenagers 18 years old or younger. •	 Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider. •	 Should you be prescribed antiviral medication take it as directed. •	 Continue to cover your cough and wash your hands often (even when taking antiviral medications), to prevent spreading influenza to others. •	 Call the clinic/GP if you (or your child) experience any side effects; i.e. nausea, vomiting, rash, or unusual behaviour. 7. Seek emergency care if you or your child experiences any of the following •	 Fast breathing or trouble breathing •	 Bluish or grey skin colour •	 Not drinking enough fluids •	 Severe or persistent vomiting •	 Not waking up or not interacting •	 Being so irritable that the child does not want to be held •	 Flu-like symptoms improve but then return with fever and worse cough •	 •	 •	 •	 •	 •	 •	 In adults, emergency warning signs that need urgent medical attention include: Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Flu-like symptoms improve but then return with fever and worse cough

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severe acute respiratory illness. Clusters of cases where a diagnosis of the cause of the outbreak is needed. Someone who has died where pandemic influenza A (H1N1) is suspected as the cause of death.

9. What medication is available to treat H1N1 flu virus infections? •	 The antiviral drugs oseltamivir or zanamivir are only recommended for those at risk of complications: see below. 10. Who is at risk of complications •	 Persons (adults or children) with underlying medical conditions and who are receiving regular medical care for chronic pulmonary disease (including asthma) and cardiac disease (excluding hypertension), chronic renal and hepatic diseases, diabetes mellitus and similar metabolic disorders. •	 Individuals who are immunosuppressed (HIV-infected, on immunosuppressive therapy, etc.). •	 Adults and children who have any condition (e.g. difficulty in understanding, spinal cord injuries, seizure or other neuromuscular disorders) which make it difficult to cough and are at risk of inhaling respiratory secretions. •	 Children and adolescents on aspirin therapy and at risk of Reye’s syndrome if contracting any kind of flu. •	 Residents of nursing homes, and other chronic-care facilities. •	 Pregnant women. Outbreaks in institutions Should a significant number of learners or students or residents of an institution be affected by the spread of influenza, an outbreak investigation may be indicated to quantify the size of the impact and assess the trends to inform decision making (useful site www. ). Contacts who do not have flu symptoms should continue with their regular daily activities, including going to work or school, whether or not they have or been in contact with someone who is reported to have the sickness.

8. Who should be tested? Laboratory testing of people with a flu-like illness is NOT generally recommended, as it is expensive and does not affect the treatment. Laboratory testing is only recommended for the patients with the abovementioned symptoms and a clinical picture of severe respiratory disease where a positive test will affect patient management. •	 Patients with co-morbid disease and at risk for serious complications (see below) and who have the symptoms and signs of

Distributed by Medi-Clinic Southern Africa in the interest of public health This leaflet is based on the Revised Health Workers Handbook on Pandemic Influenza A (H1N1) 2009 “Swine Flu” by the National Institute for Communicable Diseases, updated on 22 July 2009, by the Centre for Infectious Diseases, Faculty of Health Sciences, University of Stellenbosch

OOR PANDEMIESE GRIEP A (H1N1) AUGUSTUS 2009 1. Wat is die pandemiese H1N1 griepvirus? Die pandemiese A (H1N1) griepvirus (kiem) is ’n nuwe lid van die griepvirusfamilie. Verskillende virusse veroorsaak jaarliks seisoenale (winter-) griep en elke paar dekades ’n wêreldwye pandemie. Griepvirusse infekteer voëls en soogdiere en is gewoonlik spesiespesifiek. Soms kruis virusse oor van een spesies na ’n ander. Dit wil voorkom of die pandemiese A (H1N1) virus in varke ontspring het; dit versprei egter nie onder varke of van varke na mense nie, maar net onder mense. Seisoenale menslike griep veroorsaak 6 000 tot 10 000 sterftes elke winter in Suid-Afrika en van 250 000 tot 500 000 sterftes wêreldwyd, meestal mense oor 65 en dié met sekere chroniese mediese toestande. In teenstelling hiermee kom talle sterftes tydens pandemiese griep voor in jonger en op die oog af gesonde mense. Die getal sterftes tydens ’n griep-pandemie wissel taamlik, afhangend van die aggressiwiteit van die virus, maar ook van faktore soos oorbevolking, persoonlike gesondheid, toegang tot gesondheidsorg en voorkomende maatreëls. Beraamde sterftes van 25 tot 40 miljoen sterftes wêreldwyd word dikwels aangehaal vir die 1918 griep-pandemie. Vir die 1957 en 1968 pandemies word getalle van tussen een en twee miljoen wêreldwyd genoem. 2. Hoe versprei die griep-virus? Griepvirusse is uiters aansteeklik. Dis amper onmoontlik om te keer dat griepvirusse, seisoenaal of pandemies, van mens tot mens versprei deur geïnfekteerde mense wat hoes of nies. Mense kan ook aansteek deur aan oppervlakke soos toonbanke en deurknoppe met griepvirusse te raak, en daarna aan hul mond, neus of oë. Dis hoekom handewas help. Griepvirusse is egter uiters aansteeklik en enige voorkomingsmaatreëls kan die risiko slegs verminder, nie uitskakel nie. 3. Hoe kan die verspreiding beperk word? Jy kan die risiko om griep aan te steek of te versprei beperk deur standaard voorsorgmaatreëls toe te pas: •	 Was jou hande of maak hulle dikwels met alkohol-lappies skoon, veral nadat jy gehoes of genies het en voor jy eet. •	 Hou ‘n skoon snesie voor jou neus en mond wanneer jy hoes of nies en gooi dit dadelik in ’n asblik weg. •	 •	 •	 •	 Jy kan ook in jou mou hoes of nies. Moenie aan jou oë, neus of mond raak nie aangesien jy jouself só kan infekteer. Bly 1 m tot 2 m weg van mense wat griep het. As jy siek word, bly tuis en bly weg van ander mense sodat jy hulle nie aansteek nie.

4. Simptome van ’n griep-agtige siekte Pandemiese en seisoensgriep het dieselfde simptome. Tipiese simptome is ’n skielike hoë koors, hoes, loop- of toe neus, seer keel, hoofpyn, lyfseer, kouekoors, moegheid en gebrek aan eetlus. Party mense toon ook naarheid, braking en diarree. 5. Wat om te doen as jy of jou kind simptome toon •	 Kinders en volwassenes wat siek is behoort vir sewe dae nadat die imptome begin het, tuis te bly, of totdat jy vir 24 uur simptoom-vry is, wat ook al langer is. •	 Drink helder vloeistof (soos water, helder sop, sportdrankies, elektrolietdrankies vir babas) om ontwatering te voorkom. •	 Skottelgoed kan met warm seepwater gewas word. •	 Gooi snesies en ander weggooi-items wat die siek persoon gebruik het, in die asblik weg. Was jou hande nadat jy snesies en soortgelyke rommel hanteer het. •	 Die hele huishouding moet hul hande dikwels met seep en water was, veral nadat hulle gehoes of -nies het. Alkohol handontsmettingsmiddel is ook baie doeltreffend. •	 Probeer om nie aan jou oë, neus en mond te raak nie. Kieme versprei só. •	 Sover moontlik moet die sieke in sy of haar eie kamer bly. •	 As iemand in jou huis siek is, hou die persoon sover moontlik weg van dié wat nie siek is nie. •	 As iemand in die siekekamer moet kom, bly ten minste ‘n armlengte (1 tot 2 m) weg en moenie op die bed sit nie. 6. Neem medisyne soos voorgeskryf •	 Neem medisyne vir die verligting van simptome (parasetamol of ibuprofen) soos nodig vir koors en pyn. •	 Wanneer die simptome verbeter hoef dié medisyne nie meer gereeld geneem te word nie.

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Moenie aspirien (asetielsalisielsuur) of produkte wat dit bevat aan kinders of tieners van 18 jaar of jonger gee tensy dit deur ’n geneesheer voorgeskryf is nie. Moenie verkouemedisyne wat oor die toonbank gekoop kan word gee aan kinders van vier jaar of jonger voordat jy met ‘n gesondheidsorg-diensverskaffer gepraat het nie. As antivirale medikasie voorgeskryf word, neem dit soos aangedui. Bedek jou mond en neus wanneer jy hoes of nies en was jou hande dikwels (selfs wanneer antivirale middels geneem word) om die verspreiding van griep te voorkom. Skakel die kliniek/huisdokter as jy of jou kind enige neweeffekte soos naarheid, braking, uitslag of buitengewone gedrag toon.

9. Watter medikasie is beskikbaar vir die behandeling van H1N1 griepvirusinfeksies? •	 Die antivirale middels oseltamivir of zanamivir word slegs aanbeveel vir persone met die risiko vir komplikasies. 10. Wie loop die risiko vir komplikasies? •	 Mense (volwassenes of kinders) met onderliggende mediese toestande en wat gereelde mediese sorg ontvang vir chroniese longsiektes (insluitende asma) en hartsiekte (uitsluitende hoë bloeddruk), chroniese nier- en lewersiektes, diabetes Mellitus en soortgelyke metaboliese toestande. •	 Mense wat immuun-onderdruk is (MIV-infeksie, op immuunonderdrukkende terapie, ens). •	 Volwassenes en kinders met enige toestand (bv ruggraatbeserings, toevalle of ander neuro-muskulêre toestande) wat dit moeilik maak om te hoes en wat die gevaar loop om respiratoriese sekresies in te asem. •	 Kinders en adolessente op aspirienterapie en met die risiko van Reye-sindroom te ontwikkel. •	 Inwoners van verpleeginrigtings en ander chroniesesorgfasiliteite. •	 Swanger vroue. Uitbreke in inrigtings Sou ’n noemenswaardige getal leerders of studente of inwoners van ’n inrigting deur die verspreiding van griep geraak word, sal ’n uitbraak-ondersoek dalk noodsaaklik wees om die omvang van die uitbraak te bepaal. (Nuttige webwerf ) Kontakte van nie griepagtige simptome het nie moet voortgaan met hul gewone daaglikse aktiwiteite, soos werk of skool toe te gaan, of hulle in kontak was al dan nie met iemand wat na berig die siekte het.

7. Kry noodsorg indien jy of jou kind enige van die volgende ervaar •	 Vinnige asemhaling of asemhalingsprobleme •	 Blouerige of grys velkleur •	 Nie genoeg vloeistof drink nie •	 Ernstige of aanhoudende braking •	 Nie wakker word nie of nie reageer nie •	 So geïrriteerd is dat hy of sy nie vasgehou wil word nie •	 Griepagtige simptome verbeter, maar keer terug met koors en erge hoes •	 •	 •	 •	 •	 •	 In volwassenes, asemhalingsprobleme of kortasemrigheid Pyn of druk in die bors of buik Skielike lighoofdigheid Verwarring Ernstige of aanhoudende braking Griepagtige simptome verbeter, maar keer terug met koors en erge hoes

8. Wie moet getoets word? Laboratoriumtoetse van mense met ’n griepagtige siekte word NIE algemeen aanbeveel nie aangesien dit duur is en nie die behandeling beïnvloed nie. Laboratoriumtoetse word slegs aanbeveel vir pasiënte met bogenoemde simptome en ’n kliniese beeld van ernstige respiratoriese siekte waar ’n positiewe toets die behandeling van die pasiënt sal beïnvloed. •	 Pasiënte met onderliggende siektes met die risiko van ernstige komplikasies, en wat die tekens en simptome van ernstige akute respiratoriese siekte toon. •	 Groepe gevalle waar ’n diagnose van die oorsaak van die uitbraak benodig word. •	 Iemand wat gesterf het waar pandemiese griep A (H1N1) vermoed word as die oorsaak van dood.

Versprei deur Medi-Clinic Suider-Afrika in belang van publieke gesondheid Hierdie blaadjie is gebaseer op die Revised Health Workers Handbook on Pandemic Influenza A (H1N1) 2009 “Swine Flu” deur die Nasionale Instituut vir Oordraagbare Siektes, soos opgedateer op 22 Julie 2009, deur die Sentrum vir Oordraagbare Siektes, Fakulteit Gesondheidswetenskappe, Universiteit van Stellenbosch

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