Influenza A (H1N1) Swine Flu - Update Seventy-nine

New Zealand remains in the containment phase but planning is underway to move to a “manage it” phase when required. Although the number of cases of Influenza A (H1N1) infection is increasing in New Zealand, there are still relatively few cases and isolated instances of community transmission. Most people recover from infection without the need for hospitalisation or medical care.

Containment involves both border management (keep it out) and cluster control (stamp it out). But as more cases are confirmed in the community, the focus will need to shift to boosting the way care is provided in the community. The decision on where best to direct the efforts of health professionals is reviewed daily.

Preventing, delaying and minimising the arrival of further cases of infection into New Zealand and the community spread of infection remain the current objectives.

Planning for the next phase is to enable community-based health services to manage large numbers of people with influenza as well as maintain services for patients with other illnesses. An important part of this approach includes individuals being prepared to look after themselves at home in the same way they would with seasonal flu.

The Ministry of Health is not advising people to cancel social gatherings, sports events and travel. However, there are practical steps that individuals and communities can take to reduce the community spread of the virus. These steps include practising good hand hygiene and covering coughs and sneezes. If you are sick, stay home until you have fully recovered as you can easily spread the germs to others.

Information for the public is being constantly revised and improved to ensure people have easy access to comprehensive advice about the new Influenza A (H1N1) virus.

General information on the signs and symptoms of the new influenza, and advice on limiting the spread of infection and how to care for yourself at home are available on the Ministry of Health website: (http://www.moh.govt.nz). The Influenza A (H1N1) webpages have been upgraded to make it easier for people to find information.

Information and health advice can be accessed through Healthline 0800 611 116. The Ministry of Health is boosting the capacity of the Healthline call centre to try to reduce waiting times and the Ministry apologises for delays experienced by some people. Callers to Healthline seeking flu information who do not have symptoms should take the “Press 1” option. They will hear the recorded information about Influenza A (H1N1) but can also opt to speak to an operator at anytime. Those with flu symptoms should “Press 2” to speak to a registered nurse.

A national GP support line for all flu pandemic queries is currently being set up to help GPs better manage the rise in swine flu cases. The new telephone advice service will be established jointly by the Ministry of Health, the Royal New Zealand College of General Practitioners and ProCare Health.

Latest numbers
The cumulative total of confirmed cases in New Zealand is 153, up 26 from 127 yesterday. The number of probable cases is 19, down from 20 yesterday.
The 26 new confirmed cases are:
Auckland – 1 case
an 8-year-old male

Canterbury – 12 cases
a 32-year-old (sex unknown)
an 8-year-old female
a 22-year-old male
a 9-year-old female
an 11-year-old male
a 22-year-old female
a 4-year-old male
a 14-year-old female
a 16-year-old female
an 8-year-old male
an 11-year-old female
a 7-year-old male

Hawke’s Bay – 1 case
a 2-year-old male

Wellington – 12 cases
a 28-year-old male
an 18-year-old male
a 24-year-old female
an 11-year-old male
a 42-year-old male
a 19-year-old female
a 50-year-old female
a 44-year-old female
a 13-year-old male
a 24-year-old (sex unknown)
a 13-year-old (sex unknown)
a case (age and sex unknown)

The cumulative total of confirmed cases by region are:
Northland (0); Auckland (46); Waikato (4); Bay of Plenty/Lakes (4); Gisborne (0); Hawkes Bay (2); Taranaki (0); Wanganui/Palmerston North (1); Wellington (44); Nelson/Marlborough (1); Canterbury (51) and Otago/Southland (0).

Seasonal Influenza Vaccination Programme
As part of the management of the Influenza A (H1N1) outbreak, the Ministry of Health has purchased an extra 125,000 doses of the seasonal influenza vaccine, which is available for immediate use.

The fewer people who contract seasonal influenza, the fewer hospitalisations will occur. The people most at risk of complications are those who are in the group eligible for the free programme. If more of this group are vaccinated, it means there will be a better chance of being able to deal with the increasing numbers of people likely to be hospitalized with complications from Influenza A (H1N1).

The Ministry of Health is strongly encouraging frontline health workers to be vaccinated for seasonal influenza. This means hospitals and other frontline health services will be better able to cope with the increased demand over the winter months.

Travellers
The Ministry has refined the advice to international travellers arriving in New Zealand. Better information about the incubation period of the disease means that only people with flu-like symptoms within four days of overseas travel are now considered to be at risk of having influenza A (H1N1) infection.

Public health professionals are present at the border and information is being provided to travellers.

Advice for workplaces
It is business as usual for most workplaces. Staff should stay home only if they have flu-like symptoms or if they have received medical advice to stay home. Generally, if a staff member is suspected of having influenza A (H1N1), public health staff will assess them and advise on appropriate action.
How to protect yourself and others
Signs and symptoms of influenza include fever, cough, sore throat, stuffy nose, body aches, headaches, chills and fatigue. Some people also experience diarrhoea and vomiting.
Try to avoid contact with sick people and reduce time spent in crowded settings.
Sick people should stay home until they are well, rather than going to school or work.
If you become sick, stay home for seven days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep you from infecting others. Most people will be able to safely recover at home.
You should seek medical advice if necessary (by phone first), for example if you have a serious underlying health condition or your condition worsens. This is particularly important for people with underlying medical conditions, who are at greater risk of developing complications from influenza. If you need medical advice, please phone Healthline 0800 611 116 in the first instance, or your GP. Do not turn up at a hospital or medical centre before doing this as you can spread germs to other people.
If you are caring for someone with flu, watch for signs that they may need further medical attention, including: shortness of breath, chest pain, blueness around the lips, inability to keep fluids down, becoming less alert or lightheadedness. More information can be found on the websites of the Department of Human Services of the State Government of Victoria in Australia (http://humanswineflu.health.vic.gov.au/public/what_to_expect.htm) and the Centers for Disease Control in the US
(http://www.cdc.gov/h1n1flu/qa.htm).

Be prepared – at home and in the workplace

Be prepared - This is the time for people to make sure they’re prepared to be self-sufficient for a week, should they need to. This means you should have enough food water and basic medical supplies including paracetamol or ibuprofen as well as regular medications, nappies for babies, cleaning products, tissues and bathroom supplies for at least a week.
Hand hygiene is still the single most effective measure in protecting yourself. Wash your hands with soap and water and dry them thoroughly.
Alcohol-based cleaners are also effective. Avoid touching your eyes, nose or mouth as germs spread this way.
Practise good cough and sneeze etiquette. This means covering your nose and mouth with a tissue when you cough or sneeze and disposing of the tissue in a lined rubbish bin with a lid or plastic bag
Checklists and advice on how individuals and families can prepare for a pandemic are available on the Ministry of Health's website: http://www.moh.govt.nz/moh.nsf/indexmh/pandemicinfluenza-resources-factsheets

International Update from the World Health Organization
On 11 June 2009, the WHO raised the level of influenza pandemic alert from phase 5 to phase 6 on the basis of available evidence and expert assessments of that evidence. At this time, WHO considers the overall severity of the influenza pandemic to be moderate. The assessment reflects the fact that most people recover from infection without the need for hospitalisation or medical care.

As of 17:00 GMT, 15 June 2009, 76 countries have officially reported 35, 928 cases of influenza A(H1N1) infection, including 163 deaths.

The breakdown of the number of laboratory-confirmed cases by country is given in the following table (http://www.who.int/csr/don/2009_06_15/en/index.html).

As at 5am AEST on 18 June, Australia has reported 2118 confirmed cases of Influenza A (H1N1) influenza, including 1230 cases in Victoria.

Regular updates on the Influenza A (H1N1) pandemic are available on the WHO website (http://www.who.int).

Unless otherwise specified, this information can be attributed to Dr Darren Hunt, Deputy Director of Public Health.