ECDC HEALTH INFORMATION

Frequently asked questions on

novel influenza virus A(H1N1)
Updated 29 April 2009

Q1. What is novel influenza virus?

The novel influenza virus A(H1N1) that has recently been found is a new virus subtype of influenza affecting
humans, which contains genes from pig, bird and human influenza viruses, in a combination that has never been
observed before anywhere in the world. In addition there is every indication that this virus has been transmitting
from human to human and the resulting illnesses have been severe in a substantial number of cases in Mexico.

Q2. What is swine influenza?

Swine influenza (swine flu) is an acute viral infection of the respiratory tract in pigs, caused by type A influenza
virus. The mortality rate is low in pigs and recovery usually occurs within 7–10 days. Swine-origin influenza
infections also occur in wild birds, poultry, horses and humans, but interspecies transmission is considered a rare
event. So far three influenza type A virus subtypes have been found in pigs: H1N1, H1N2 and H3N2.

Q3. Can swine influenza infect humans?

Yes. Human infections with swine influenza have been detected occasionally since the late 1950s usually in
persons with direct exposure to pigs (e.g. people working in pig farms, etc.). In Europe, since 1958 a total of 17
cases have been reported. In the US in 1976, an outbreak of swine influenza virus infections in humans was
detected among recruits in a military camp in Fort Dix, New Jersey. A link to pigs was presumed but never
established. Instead there was extensive human-to-human transmission, with over 200 infections resulting in 12
hospitalisations and one death.

Q4. What is the difference between swine influenza and

novel influenza virus?
In contrast to the typical swine influenza virus, the novel influenza virus A(H1N1) contains genes from pig, bird
and human influenza viruses, in a combination that has never been observed before anywhere in the world.
Moreover, swine influenza is commonly transmitted through direct contact or close proximity with pigs. Secondary
cases following human-to-human transmission have been reported in the past but they have been very rare.

Stockholm, April 2009

© European Centre for Disease Prevention and Control, 2009. Reproduction is authorised, provided the source is acknowledged.
EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL Novel influenza virus A(H1N1)

However, the novel influenza virus has been transmitting from human to human and the resulting illnesses have
been severe in a substantial number of cases in Mexico.

Q5. What are the symptoms of novel influenza A(H1N1)?

Symptoms of novel influenza A(H1N1) in humans are usually similar to regular human seasonal influenza
symptoms:
• Fever
• Respiratory symptoms such as cough or runny nose
• Sore throat
• Possibly other symptoms such as
• Body aches (particularly muscle pain)
• Headache
• Chills
• Fatigue
• Vomiting or diarrhoea (not typical for influenza but reported by some of the recent cases of novel
influenza)
In some cases, severe complications could occur even in normally healthy persons who become infected with the
virus.

Q6. How do people become infected with novel influenza

virus A(H1N1)?
People become infected with novel influenza virus A(H1N1) in the same way as for normal seasonal influenza. It
spreads from person to person via droplets from an infected person who is coughing or sneezing; indirectly when
droplets or secretions from the nose and throat settle on hands and other surfaces which then are touched by
other people who touch their own mouth or nose.

Q7. Can this novel influenza virus be transmitted to humans

by eating pork and pork products?

No. The novel influenza virus is not transmitted by eating properly handled and cooked pork and pork products.
This new influenza virus has not been isolated from animals to date and there is no indication that the virus is
currently in the pork production chain. The European Food Safety Authority (EFSA) and ECDC are not aware of
any scientific evidence to suggest that influenza viruses can be transmitted to humans through the consumption of
meat such as pork and pork products. In the event that pigs were exposed to this novel virus and it were to be
found in meat, cooking pork thoroughly (to an internal temperature of 70°C) would kill the virus as it does for
other viruses and bacteria. However, whilst some consumers may enjoy eating raw meat, longstanding food safety
advice is to avoid eating raw meat in order to prevent possible risk of food-borne illness. It is always
recommended to follow proper food hygiene practices in kitchens and to wash hands and all surfaces and
equipment with soap after handling raw meat.

Q8. Is there a vaccine against novel influenza virus

A(H1N1)?
Although there is a vaccine available for pigs against swine influenza, there is no vaccine to protect humans from
novel influenza virus A(H1N1) (but see Q9, below).
EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL Novel influenza virus A(H1N1)

Q9. Is the human seasonal influenza vaccine effective

against novel influenza virus A(H1N1)?
There are certain similarities between the usual H1N1 human influenza viruses (covered by the seasonal vaccine)
and the novel influenza virus A(H1N1) so one cannot rule out some level of cross-protection, but this is likely to be
only partial. In any case, investigations need to be undertaken to determine whether this is the case. Those
investigations are under way, but will take quite some time.

Q10. Can novel influenza virus A(H1N1) be treated?

Most swine influenza viruses have been susceptible to antiviral medications such as neuraminidase inhibitors
(oseltamivir and zanamivir) and older antiviral drugs (amantadanes). The novel influenza virus is susceptible to
neuraminidase inhibitors but resistant to amantadanes.

Q11. What is the situation across Europe?

The situation is evolving rapidly, therefore for latest information please consult the ECDC home page.

Q12. What is being done about the situation?

In the European Union, ECDC is following the epidemiological situation and assessing the risks, and the European
Commission is working closely with the EU Member States on all risk management issues within the Early Warning
and Response System (EWRS). The Health Security Committee is also meeting to discuss the situation and the
Global Health Security Initiative is exchanging information on the current status of the situation and counter-
measures.
The US Centers for Disease Control and Prevention (CDC) in Atlanta, the European Centre for Disease Prevention
and Control (ECDC), the European Commission together with its Member States and the WHO Regional Office for
Europe are monitoring and assessing the situation closely. The health authorities in Mexico are undertaking a
number of measures for control and management of the outbreak such as closure of schools, advising avoidance
of mass gatherings and distribution of face masks and antivirals. Furthermore, they have issued advice on hygiene
measures to avoid the spread of flu. The US public health authorities have also issued advice on hygiene measures
in the affected regions and have intensified the surveillance.

Q13. Are we facing a new influenza pandemic?

The World Health Organization has raised the influenza pandemic phase from 3 to 4. This means that there has
been an increase in the risk of a pandemic but does not necessarily mean that a pandemic is inevitable.
It is too early to know for certain whether the current situation will develop into a pandemic. An influenza
pandemic is characterised as an ongoing worldwide epidemic caused by a novel influenza virus that infects a large
proportion of the human population lacking immunity to that virus. In the 20th century there have been three
influenza pandemics: in 1918, 1957 and 1968.
In Europe in recent years there have been considerable efforts in pandemic preparedness planning and all
European Members States have a national influenza pandemic preparedness plan.

Q14. Is it safe to travel to Mexico1?

In a statement on 27 April the Director-General of WHO recommended not to restrict international travel, though it
is considered prudent for people who are ill to delay international travel. Anyone who develops symptoms
following international travel should seek medical attention.
Persons who intend to travel to affected areas are advised to consult the WHO website and websites of their
ministries of foreign affairs or national public health institutes. All travellers are advised to follow some general
hygiene measures (see Q15).
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Q15. What can I do to protect myself if I want to travel to

Mexico1?
Travellers should follow standard precautions regarding respiratory infection if they travel to areas where human
infections with novel influenza have been reported. All travellers to Mexico 1 should respect general hygiene
measures such as:
• Avoiding close contact with people who are sick. When you are sick, keep your distance from others to
protect them from getting sick too.
• Staying home from work, school, and avoid running errands when you are sick. This will help prevent
others from catching your illness.
• Avoiding crowding or mass gatherings.
• Covering your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you
from getting sick. Throw the tissue in the bin after you use it.
• Washing your hands will help protect you from germs. Wash your hands often with soap and water,
especially after you cough or sneeze. Alcohol-based hand cleaners may also be effective. Avoid touching
your eyes, nose or mouth because germs are often spread when a person touches something that is
contaminated with germs and then touches his or her eyes, nose, or mouth.

Q16. What precautions are needed for travellers returning

from Mexico1?
Travellers returning from Mexico1 should observe their personal health and should immediately contact a physician
if, within seven days of return, they experience:
• Fever
and one or more of the following symptoms
• Respiratory symptoms such as cough or runny nose
• Sore throat
• Possibly other symptoms such as
• Body aches (particularly muscle pain)
• Headache
• Chills
• Fatigue
• Vomiting or diarrhoea (not typical for influenza but reported by some of the recent cases of swine
influenza infection)

1
So far, sustained human-to-human transmission of the novel influenza virus has only been documented in
Mexico.