Pandemic Flu

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					Pandemic Flu
Public Health Information

The World Health Organisation (WHO) predicts that a new pandemic flu will occur. No one knows when it will
happen - however, we must be prepared.

This brochure explains what pandemic flu is, how it differs from the seasonal flu that occurs each winter and
what the Norwegian authorities are doing in preparation for influenza pandemic.

What is pandemic flu?
Pandemic flu is an illness that is brought about by a completely new type of influenza virus. Few people will
be immune to it, and it spreads easily from person to person. The illness will spread rapidly throughout the
world and this is called a pandemic. Pandemic flu occurs every few decades but it is impossible to predict
when it will reoccur. During the last century there were three pandemics: `Spanish flu` (1918-19), `Asian flu`
(1957-58) and `Hong Kong flu` (1969-70).

How does a pandemic start?
Flu viruses are in constant change. In most cases the changes are minor. This is the reason why we have to
re-formulate flu vaccines prior to the onset of each winter season. However, a new virus occasionally
emerges. This can happen should the human flu virus get mixed with the animal flu virus, or the avian flu
virus changes with time. If this new virus differs considerably from previous flu viruses and spreads easily
amongst humans, it could be the source of the next pandemic. Avian flu was the predecessor of all the
pandemics of the previous century.

If a pandemic should arise, Norway will be affected sooner or later. When the pandemic reaches to Norway it
is likely that it will spread to all parts of the country within a few weeks.

How dangerous is pandemic flu?
It is not yet possible to say how serious a new pandemic will be. It depends on the characteristics of the new

It is highly probable that a greater number of people will be affected by a pandemic flu than by the usual
seasonal flu. During the winter approximately 5-10 per cent of the population becomes ill because of the
seasonal flu. With a pandemic flu the authorities expect – as a worst-case scenario – that half the population
will contract it, and that 25 per cent will become ill and confined to their beds. One must expect more deaths
than with seasonal flu, and thus pressure on the health service will increase proportionally.

Not everyone will become ill at the same time. The illness is likely to appear in waves over a period of few
months. Each wave will last a few weeks, but each individual will, more often than not, be ill for a week or so.

Who will be at risk?
Because the majority of people will have no immunity to the new virus, the likelihood of becoming ill is
greater than with seasonal flu. With seasonal flu some groups are more vulnerable to complications and
becoming seriously ill. There is reason to believe that this will also happen with pandemic flu. However, until
the characteristics of the flu are known it is difficult to predict which groups will be more vulnerable. Previous
flu pandemics have affected different age groups in different ways.

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Pandemics in the Previous Century

Spanish flu
Year: 1918-1919
Virus: H1N1
20-40 million deaths worldwide (approximately 15 000 in Norway)
Source: Bird
Most affected: Healthy, young adults 20-40 years, in addition to the young and old.
Severity: Approximately 15-20 times that of the usual seasonal flu.

Asian flu
Year: 1957-58
Virus: H2N2
1 million deaths worldwide (approximately 2 000 in Norway)
Source: A combination of H1N1 from humans and H2N2 from birds.
Most affected: The very young and the very old.
Severity: Approximately 3 times that of the usual seasonal flu.

Hong Kong flu
Year: 1968-69
Virus: H3N2
1-4 million deaths worldwide (approximately 3 000 in Norway)
Source: A combination of H2N2 from humans and the H3 virus from birds.
Most affected: The very old and people with underlying diseases.
Severity: Approximately 3 times that of the usual seasonal flu.

How can I protect others and myself?
Flu is transmitted from person to person through droplets in the air, often generated by coughing and
sneezing. Here is some simple advice to limit the risk of infection:

       Do not put your hand over your mouth when coughing or sneezing. Cough into the corner of your
        elbow (inner elbow joint).

       Use paper tissues and discard them after use.

       Wash hands frequently with soap and running water.

Is there a vaccine against pandemic flu?
Development and production of vaccines take time and it cannot start until we know about the virus causing
the illness. Therefore, we have to be prepared for the fact that no vaccine will exist when the first pandemic
wave hits us.

The development of a vaccine will begin as soon as the virus is known. Norway has an agreement with a
vaccine producer to buy 4 million doses of the first vaccine that is produced.

Is there any medication to treat pandemic flu?
Pandemic flu can be treated with modern medicines. Treatment can reduce the symptoms of flu and aid a
quicker recovery. They can also contribute to reducing the spread of infection among people.

Norway has a stockpile of 1.4 million treatment units of the medicine Tamiflu®. This medicine is primarily
intended for treatment of people who become ill. It is, therefore, unnecessary for people to buy their own
supplies of Tamiflu® in order to be prepared for a pandemic.

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Medicines used in treating influenza
Tamiflu® or Relenza® can be used in the treatment of pandemic flu
    For the treatment to be effective it should start as soon as possible and within 48
       hours of the first flu symptoms appearing.
    Treatment reduces symptoms and shortens the duration of the illness
    The Norwegian stockpile of Tamflu® is dimensioned in proportion to the population
       and everyone who contracts pandemic flu can expect treatment.
    Plans are being prepared to ensure that people in need of medicines will receive
       them in time.

How is Norway prepared?
WHO is keeping the situation under surveillance, receiving reports from all over the world about possible
signs of a pandemic. Norway is part of this and other surveillance systems. The Norwegian health authorities
have prepared an emergency plan, which deals with the challenges that the population and the Health
Authorities will have to face. The purpose of the pandemic flu plan is to:
     Reduce illness and deaths.
     Ensure sufficient capacity to deal with large-scale illness and dying patients.
     Maintain the necessary services of society.
     Provide continuous, necessary information to the public.

The authorities will advise people what they should do if a pandemic threatens Norway.

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What are the differences between the 3 types of flu?
                         Seasonal Flu                  Pandemic Flu                Avian Flu
Illness                                                This is a totally new flu   This is a bird illness
                                                       virus, which will spread    that is spread amongst
                                                       all over the world and      birds.
                                                       is likely to give a more
                         This is the usual flu         severe illness.             Humans are rarely
                         that comes around             Pandemics appear            infected and only in
                         each winter.                  every few decades.          cases of close contact
                                                       The last one was the        with infected birds or,
                                                       `Hong Kong flu` in          possibly, people that
                                                       1968-70. The most           are sick from avian flu.
                                                       known is the `Spanish       Can give severe
                                                       flu` in 1918. We do not     illness.
                                                       know when the next
                                                       pandemic will occur.
Infection                Directly by droplets          The same as seasonal  Humans are not
                         from coughing and                                   normally infected.
                                                       flu but spreads quicker
                         sneezing and indirectly       because more people   Stools and body fluids
                         by hands and objects.         are vulnerable to it. from birds can,
                                                                             although very rarely,
                                                                             infect humans.
Virus                    A flu virus that changes                            The majority of flu
                         slightly from year to      A type of flu virus that viruses are found in
                         year. Since the change is so different from         birds. A new
                         is so slight many          other flu viruses that   aggressive form of bird
                         people will have built     virtually nobody is      virus is the subtype
                         up a certain level of      immune to it             A(H5N1), which is
                         immunity to the virus.                              currently spreading
                                                                             among birds.
Treatment                The three types of flu affecting humans can be treated with modern
                         medicines (Tamiflu® and Relenza® among others)
Vaccine                  New ones are made          Will be produced as
                         each year and are          soon as the pandemic     A vaccine exists for
                         recommended for            virus is identified.     birds. There is no
                         people above 65 years Norway will receive           vaccine commercially
                         of age, people with        vaccine for the whole    available for humans.
                         heart conditions, lung     of its population.
                         conditions, diabetes,
                         and immunological
What should I do?        Take the vaccine if you Take the vaccine when Avoid contact with sick
                         belong to the group at     it is offered. Wash      or dead birds. Follow
                         risk. Wash hands           hands often. Follow the the advice from the
                         often.                     advice from the Health   Health and Food
                                                    Authorities.             Control Authorities.

More information
Should you require more information please visit the following websites:
Directorate for Health and Social Affairs:
Norwegian Institute of Public Health:
Norwegian Food Safety Authority:
Should a pandemic arise a public telephone service will be established and continuous
information will be given.

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