Questions and answers about the new influenza A Decalogue of organizational suggestions 
On New Influenza A: origin, evolution
Is it true that the new influenza virus A is created in a lab?
historic times, always that any new disease has emerged there have been many ways of explaining it (scientific theories, magical theories, political theories). Currently there is no evidence for the proposition that the flu virus has been created in a laboratory. The most accepted hypothesis is that this virus belongs to a variety of viruses formed by triple recombination 'virus' genetic material of pigs, poultry and humans, which was first detected in the 90's, and affected pig populations in the United States (who also suffered infections from human or avian flu). In this decade, cases appeared sporadic transmission of some viruses such a man. It seems that the current pandemic virus is one of these viruses, which acquired the ability to pass easily between humans.
Why is also called H1N1?
Currently, WHO refers to the new infection, such as pandemic influenza (H1N1) 2009. The influenza virus H1N1 is a subtype of influenza virus, called Influenza A virus (there are three types of influenza viruses, A, B and C). The pandemic flu virus this year is a different strain of H1N1 virus. This name comes from two of the proteins that form, neuraminidase (NA) and hemagglutinin (HA), the structure may change resulting in new virus subtypes A.
I can " developing seasonal and novel influenza A?
If you can have two flues to be two different viruses. What has happened in most countries in the southern hemisphere (where he spent the winter), is a shift in seasonal influenza viruses for the new influenza A. This situation is also observed in the northern hemisphere, so it is possible that most cases of influenza virus infection than the new influenza A. Anyway both have flu-like symptoms and very low risk of complications.
Why the new flu affects young adults?
The observed age distribution among those affected by the flu shows that over 65 years represent a very small percentage of patients (Less than flu season in other years). Some studies have shown that older people can maintain immunological memory to some other infection with H1N1 virus-like structure, which might be prevailing between 1918 (arises H1N1 virus strain that causes a pandemic) and 1957 (when arises virus strain H2N2 that moved to the H1N1 virus, causing a second pandemic).
What is the mortality rate of new influenza A?
According to the currently available data from Southern Hemisphere countries where the winter is past, the new influenza mortality is lower than the seasonal flu (that of all the years). In Spain, September 17, we had 1.8 deaths per 10,000 cases of disease.
Why mostly young people die?
Since most of the population suffering the novel A young, although the likelihood of complications is lower, the total number of deaths in that age can approach the older population (with fewer patients). While it is important to note that mortality from this flu is less than the seasonal flu in other years, and in Spain from 0.18 per thousand patients.
If flu patient, I have immunity for good?
has been observed that patients born before 1957 may have partial immunity to the new influenza A. This is because between 1918 and 1957 (from the 1918 pandemic until 1957, by a virus H2N2) predominated as seasonal influenza virus strains of subtype H1N1, which could have a similar structure to the actual pandemic virus. It would be possible to get the new influenza A, have partial immunity for decades, but only to H1N1 viruses that have a similar structure.
What we suffer a flu pandemic?
means that there is a new variant of influenza virus A (in the present case the H1N1 virus 2009) that is easily transmitted and spread in a short time by many countries.
Is flu more serious than seasonal flu?
No, the data from the Southern Hemisphere, where winter just ended, they show less severity of the new influenza A. The evolution in the northern hemisphere countries do not show changes suggest a different situation in the winter.
The new influenza A (H1N1) that has appeared this year, will have to experience again next year?
is likely, as the virus continues to circulate in both susceptible population continues to exist (not yet passed it) or is displaced by another strain of influenza virus.
What does the virus spread in waves? According
other information contained in previous flu pandemics has been observed several peaks of incidence are substantial increases in the number of cases after several weeks with a progressive decline. Usually not as strong as the first peak. These phases have been called long waves. In the case of the flu pandemic which could also be the situation, but it is difficult to predict.
exposure and contagion
What is the route of infection of the flu?
flu viruses that affect humans are spread primarily through droplets expelled by coughing, sneezing and to a lesser degree, to speak. These droplets are deposited on the surface of the mucosa of the upper respiratory tract (nose, mouth) of people who are within walking distance (1-2 meters). It can also spread through contact with objects contaminated with these droplets, and then touching your nose or mouth. The cutlery, glasses, etc. can be shared after their normal wash.
Why is so infectious new virus flu?
This H1N1 virus is a virus with a different structure from that of H1N1 viruses in recent decades, so much of the population (especially young people) has had no contact with him and, therefore, is not immune. The reason for this difference is that, by a mechanism called "triple recombination, has in its structure with genes from avian influenza virus, human influenza and avian flu. This did not occur with seasonal viruses in other years.
A person with flu, how long can contagious?
People infected with the H1N1 influenza virus can infect others when symptoms and possibly up to 5-7 days after onset of illness, based on the behavior of seasonal influenza viruses. Children, especially younger ones, can infect others for longer periods (approximately 10 days).
"virus Influenza A is transmitted through sexual contact or blood?
No. The flu virus is not transmitted during sexual intercourse or through contact with blood from another person. The influenza virus is spread from person to person when someone with the virus coughs or sneezes near you. You can also become infected by touching a surface with the virus and then touching their mouth or nose. So the importance of basic hygiene rules: use of tissue, cover them when sneezing or coughing and then throwing them away, wash hands, etc.
Can you pass the flu to receive mail packages from other countries?
is virtually impossible. The influenza virus can survive for varying lengths of time depending on temperature and humidity, and the possibility of infection also depends on the amount of virus in an area. Virus deposited on nonporous surfaces (plastics, metal) may be capable of infecting up to 24 hours, and transmission is possible from clothes in just the first 15 minutes. In the hands of influenza viruses only survive, maximum of 5 minutes. In fact, the virus survives longer, but lost ability to infect humans.
Is it true that the virus is transmitted by water?
The rules for drinking water treatment offer a high degree of protection against viruses and, although no specific research on the new flu virus, it is known that levels of chlorine commonly used in drinking water treatment are appropriate to clear the bird flu. Therefore, and given that there are documented cases of pandemic influenza in humans caused by exposure to water can be considered a secure medium.
If I have a wound on the body "out there can get the virus and infected?
No. The virus binds only in the cells lining the airways and digestive tract.
Is it safe to eat pork?
Yes, the spread of the H1N1 virus does not occur through food, including pork and products derived from this animal. Eating pork is cooked and properly handled safely.
I have pets at home (a dog and a cat) and I'm sick with flu, do you I can spread the disease? And they to me?
transmission of influenza virus to humans has been documented in pigs and poultry. It is likely that the new flu virus can be transmitted between pigs and humans, but not to other species.
Can you spread the flu to attend places like swimming pools, spas or water parks?
is unlikely, because chlorine levels recommended for aquatic facilities are sufficient to eliminate influenza virus similar to the new influenza A.
¿Me pueden contagiar esta gripe por asistir a la iglesia, el cine o el teatro?
En cualquier lugar cerrado y donde se reúnen muchas personas se pueden contagiar infecciones por transmisión aérea (las gotas con virus lanzadas al toser pueden llegar a 2-3 metros de distancia) o por el contacto con superficies contaminados con estas gotitas, y tocarse después la nariz o la boca. Esto no es algo nuevo relacionado con esta gripe, ni debería have a special fear it. Mild respiratory infections are frequent, and should not stop doing things you enjoy for fear of them (including the new influenza A, which is benign). In addition, you can never reduce risk to zero.
"I can travel to countries where there are patients suffering from flu?
At this time, the new influenza A can be present anywhere in the world. But it is an uncomplicated influenza in most cases, such as the flu each year. Therefore, you can travel, always follow the usual recommendations for travel abroad.
Symptoms
What are the symptoms of the new flu?
The data we have thousands of cases of novel influenza A show that is very similar to seasonal flu (that of all the years). It presents with classic flu symptoms: fever and cough (most common), sore throat, headache, nasal mucus or Aguilla and muscle aches. The only difference found so far in some studies is that the gastrointestinal symptoms (diarrhea or vomiting) are more common in the new flu pandemic, but never to complicate the course and always accompanied by the symptoms of the flu. Also, as with many viral diseases, there are many asymptomatic cases, probably in a proportion similar to flu (a third to half of all infections).
What symptoms of seasonal flu differ from the new flu? According to World Health Organization, the new influenza A (H1N1) has symptoms similar to flu, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhea. Several publications indicate that the new influenza can present with gastrointestinal symptoms more often, but accompanied by the classic symptoms of the flu. In summary, no differences in symptoms that are useful to distinguish seasonal influenza novel influenza A.
Tengo fiebre y tos, ¿voy directamente al hospital?
fever and cough are common symptoms of influenza and, in general, it is necessary to face assessment by a doctor unless they are accompanied by more serious or long lasting as possible complications is very low. You can take care of yourself at home and use antipyretics when fever is annoying. We do recommend seeking medical attention to those risk factors or who have severe discomfort, difficulty breathing, severe pain in the chest, impaired consciousness (feeling of lightheadedness or fainting), a sudden worsening or aggravation after 7 days of onset of symptoms. In the case of children under age 6 months, rapid breathing, or fever that lasts more than three days (72 hours) are also recommended a medical evaluation. In any case, it is only advisable to go to the hospital by the doctor or in a serious situation.
I have a fever and cough I call the doctor to come to my house? (I do not give it to anyone)
First symptoms such as fever (over 38 º C) and cough, which could correspond to the flu should seek medical attention those who have severe discomfort, difficulty breathing, severe pain in the chest , alterations of consciousness (feeling of lightheadedness or fainting), a sudden worsening or aggravation after 7 days from the onset of symptoms. In that case, you should contact by telephone with your doctor or nurse to decide the type of care. Do not forget that healthy people who present no data on influenza complications can perform self-care at home secured with the usual (good hydration, good nutrition and good hygiene).
Diagnosis
Is some analysis for diagnosis of novel influenza A? There
rapid tests for diagnosis of influenza in samples from the upper airways (nose and throat). These tests do not distinguish subtypes of influenza A (do not know if the new influenza A subtype or if different). For the diagnosis of new influenza A have low sensitivity (approximately 40%), that means 100 people with the new influenza A will detect only about 40. That is, although it gets a negative test, if you have flu-like symptoms could be caused by influenza A.
The test most commonly used as diagnostic confirmation is the RT-PCR, a technique complex only available in some laboratories. This test detects viral subtypes yes, but not a rapid test (takes several hours) and only performed in patients with complicated or to epidemiological surveillance.
Doubts on risk situations
Am risk group of new influenza A if I am pregnant?
So far there has been observed that pregnant women have more chance of getting a new flu than the rest of the population. However, there is some increased risk of complications, especially in the third quarter, although absolute risk is very low. This increased risk is also present in the seasonal flu. In any case, the vast majority of women who develop new influenza A have a mild and without complications.
I want to get pregnant, do I have to delay before the flu?
No. The flu virus has moved to the seasonal flu virus in most countries of the southern hemisphere, and it is reasonable to think that will happen the same in the northern hemisphere countries. In the next winter season could be the predominant virus, another strain to displace it. In addition, the increased risk of flu complications of the new (third quarter) is equivalent to the seasonal flu, so the vast majority of infected pregnant women presented a mild and smooth to the mother or the fetus. So no sense in delaying pregnancy.
If I am pregnant I have to take off work?
No. Pregnancy can not be considered a disease, it is not excluded, unless complications occur, on sick leave. Yes you should take into account the specific risk groups defined by the Ministry of Health, among workers who are pregnant or immunocompromised infants and young workers, and to evaluate the change of job within the company to minimize risk contagion.
Soy médico y me he contagiado de gripe, ¿se considera enfermedad profesional?
No. La gripe estacional nunca se ha considerado enfermedad profesional por lo que a la nueva gripe A se le dará la misma consideración. Los trabajadores que puedan haberse contagiado de la gripe producida por el nuevo virus A (H1N1) se considera incapacidad temporal derivada de enfermedad común.. Únicamente is considered an occupational disease in some cases health workers (eg, laboratory professionals analyzing contaminated samples).
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07/05/1909 resolution, the General Directorate of Social Security, for consideration as temporary disability resulting from common disease of the periods of administrative segregation experienced by workers as a result of Influenza A H1 N1; BOE 09/05/1909
Measures preventive I: vaccines and drugs
"What are risk groups to be vaccinated for influenza A in Spain?
According to the Ministry of Health and Social Policy in Spain (press release August 31) first defined risk groups for vaccination are pregnant women, chronically ill, from 6 months of age and health personnel. Subsequently other groups could be included as "recommendations by experts and international agencies, and consensus in the Inter-Territorial Council." This decision is the same as that of experts from 27 member countries of the European Union.
Do I have seasonal flu vaccine?
generally recommends the vaccine only to persons belonging to certain risk groups, the same as other years. While noting that the new influenza virus A is moving the seasonal flu virus, official recommendations for seasonal influenza vaccination (of each year) have not changed. It is preferable to do this ask your doctor or pediatrician, who can advise you in a personalized way.
If I seasonal flu vaccine, also I have to vaccinate the new flu?
seasonal flu vaccine does not protect against infection by new influenza virus A. Defined risk groups for both types of flu are similar, except the healthy population over 65 years, have not been included in the first groups defined for the new flu vaccine A.
If I seasonal flu vaccine, does take time to get vaccinated for the flu? In
principle, since this vaccine contains no live virus, it need not be necessary to keep any length of time between them. However, no data yet with these two vaccines that can corroborate this general principle, as is often recommended to spend between 2 and 4 weeks of each other. Another option would be to put the two vaccines on the same day, but that's not currently possible because they are not yet available for the new influenza vaccine A.
Is flu vaccine effective?
As has not yet begun the vaccination campaign and have clinical efficacy studies, we can not know the capacity of this vaccine to prevent infection. We expect to have the results of such studies, although we will not know the true effectiveness (in real terms), to evaluating the results of the vaccination campaign in different countries.
I have been told that the seasonal flu vaccine, a percentage is H1N1 virus. I shot every year from seasonal flu, am I then protected?
This H1N1 virus is a virus with a different structure from that of H1N1 viruses in recent decades, so has never been developed for seasonal influenza vaccine (the one every year) from it . Therefore, the seasonal flu vaccine, even when made from subtype H1N1 virus is not useful for pandemic flu H1N1. This fact has been observed in studies in Australia.
Does the flu vaccine has side effects?
Currently, this vaccine is still experimental and therefore not fully known side effects and their frequency. It is known that other flu vaccine side effects have occurred, but it seems prudent not to extrapolate these data to this vaccine.
Can it affect the baby with the flu vaccine?
can not tell yet whether the vaccine would affect the fetus or not. It is true that pregnant women are vaccinated for seasonal influenza without having reviewed the appearance of malformations associated with this. Anyway, as it is not advisable to extrapolate data, we should expect to make an assessment of this type.
"What has been the decision process of the risk groups for vaccination against the new flu?
The Inter-Territorial Council of the National Health defined Aug. 31, by agreement, the first risk groups against the new influenza A (H1N1), before vaccines are approved by the European Medicines Agency, by what still can be changes in the defined groups. The decision was based on "expert opinion and international organizations, as well as the agreement itself within the Inter-Territorial Council, which represents the regions.
Moreover, the reference institutions make decisions according to the agreement of a group of experts, taking into account the behavior of the disease, the groups most at risk of complications according to current trends, and how much vaccine will be available and on what date. However, the configuration of these risk groups has been controversial, with a vaccine that is currently being evaluated for efficacy and safety en la que las empresas farmacéuticas tienen puestas grandes expectativas, y con una difícil valoración del riesgo de ciertos grupos, como embarazadas y niños sanos.
My boss wants us to force us to vaccinate the new flu is this possible?
No. The patient has the right to decide their own treatment and any preventive measures, except in certain exceptional situations (not including vaccines) may be at risk where Public Health. In Spain vaccinations are always voluntary and both the Ministry of Health as the ministries of health, "recommend" that should be placed.
Are there any medications that I strengthen defenses against the new influenza A and prevent infection?
currently no medication to do this function. The information given some medication and some food products in this regard are not based on consistent scientific evidence and misleading advertising rub. Maintaining a proper diet rich in fruits and vegetables, adequate rest, good physical activity and mood are as positive as possible the elements which help to "strengthen our defenses."
Do I have to take antivirals as prevention if I will travel to a country where there have been cases of flu?
There are cases of influenza A in most people, so this measure provides no benefit and may expose side effects unnecessarily. In any case, the indication of antiviral prophylaxis (to prevent infection) is controversial, and only acceptable in patients at high risk of complications and close contact with flu patients.
Preventive II: non pharmacological
Is it advisable not to give kisses to my partner or my children?
The new flu is similar to other years, so they are not needed major changes in our behavior. The influenza virus is transmitted through droplets expelled saliva that reach the mucous membranes of the mouth and nose of another person, and also by contact via hands or objects in which the virus has recently deposited. In everyday life, just try to follow some basic rules of hygiene (hand washing, cough or sneeze with your mouth and nose covered with a handkerchief) and be more strict if there is a family member with a respiratory infection (cold or not ) at the time, or if you are sick.
How often do I have to wash your hands a day to be safe from the spread of new influenza A?
is unclear the number of daily hand washes are effective. Washing hands frequently and for long enough (at least 20 seconds) is a simple measure that reduces the risk of transmission of various infections (including those caused by respiratory viruses), but not guaranteed to be completely safe from them. Depending on their type of work, if you have direct contact with many people or live with someone who is infected at the time, would have to wash their hands more or less often.
Is it useful to alcohol gel from 70 ° to disinfect hands and prevent the spread of flu?
wipes, gels or solutions based disinfectants alcohol (60-95% alcohol) are effective, but is more accessible, cheaper, and is also effective, wash hands with soap and water. Therefore, these solutions can be used where there is no soap and water in place that hand washing is required.
What I can do to avoid getting a new flu?
At first it is necessary to take special measures to prevent the spread of new influenza A. The reaching masks has not been shown to prevent the spread of the disease. Being locked at home and social life ring is not a good option. We must apply common sense and follow the usual means of hygiene, knowing that it is a mild illness in most cases.
I'm sick of influenza A, what I can do to avoid spreading it to others?
Abide and hygienic measures usually recommended prevention (hand washing, tissues when coughing or sneezing), which are the same as for other respiratory diseases. It is advisable to clean and ventilate the rooms, and avoid sharing towels. Cooking utensils and clothes should be washed as usual. The use of surgical masks by the patient, when you share common areas, can reduce the transmission of the disease.
I'm sick of the new flu, I do not know where to throw the waste I produce "straight away?
waste generated at home related to any type of flu (scarves, etc..) Can be deposited in the regular trash.
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CDC. H1N1 influenza (swine flu) and you
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Ministry of Health and Social Policy. Recommendations for prevention of infection in health care in cases of infection with novel influenza virus A (H1N1) or seasonal flu. August 2009.
Do I have to mask to go outside?
is not necessary. If you are sick with the flu it is best to stay home to rest. If you have to go out, you must cover your mouth and nose coughing or sneezing, preferably with a tissue. Limit the extent possible social contacts in the first 5-7 days after onset of symptoms or until 24 hours of its decision.
live with a relative suffering from flu, what should I do to avoid infection?
Follow the advice on hygiene and prevention common in any type of flu: Wash your hands often, avoid face to face contact, not sharing eating utensils (washing serves in), housing ventilation, limit the time contact spaces, etc. This is recommended until 24 hours after defervescence.
Should I take my kids to school?
Like that has not stopped coming to school in time for seasonal flu, there is no recommendation not to take children to school in the new flu to prevent the flu. Most of the cases the symptoms are mild and the disease progression is good. On the other hand, there are many possible sites and social networking, in addition to the school, with which it is possible to get, so that the measure would be useful.
Are there any dietary supplement to increase my defenses and prevent the spread of new influenza A?
There is no dietary supplement has been shown in studies of sufficient quality, effectively increase (reduce the number of cases or severity) defenses against the flu.
I own a company, what steps should I implement safety and health of my workers?
A guide published by the Ministry of Health with the measures and plans to be developed by the companies. The most important thing is to spread hygiene and prevention measures (especially if your company is open to the public or it is a power sector company) and give clear and rational workers.
What should I do if my work is given a new case of the flu?
Follow the advice on hygiene and prevention usual, since, in general, not recommended any exceptional measure. Usually the sick worker will not be incorporated up to 24 hours after fever has subsided.
Treatment
Does the new flu treatment?
Being an infection that progresses with mild and heal without treatment in most cases, we need only treat the symptoms (antipyretics, usually) if they are bothersome. Although antiviral drugs (oseltamivir or zanamivir) have not been studied for the new influenza A, there is considerable agreement for use in cases of suspected flu complications (inpatients). It is also recommended in patients with higher risk of poor outcome, although in this case the evidence of its usefulness are of lesser quality. However, the decision to treat should be individualized, depending on the situation of the patient and the physician's clinical trial.
Does antiviral treatment of influenza A new side effects?
Any medical treatment can have side effects. A portion of the people who use them can have serious side effects and, more rarely, can cause severe reactions. If you refer to oseltamivir (Tamiflu ®) is not uncommon cause nausea, vomiting or abdominal pain, and know some cases of serious problems such as arrhythmias, angioedema and behavioral disorders. When a drug has been marketed for some time, we must be especially cautious, especially because of its beneficial effects are not clear.
I read that there is resistance to Tamiflu ®. Already a drug is not valid against the new flu?
There are some influenza viruses with resistance to oseltamivir (Tamiflu ®), although in the case of novel influenza virus A by now this resistance are exceptional. Anyway, even if there is resistance to this drug, its effectiveness remains limited.
If I am pregnant and I suffer from flu, "my child is at risk if I take antivirals?
The use of oseltamivir, in some studies with small numbers of patients, has not been associated with risks to the fetus. However, the limited quality of data required to weigh the potential risks and benefits of antivirals. In any case, oseltamivir (Tamiflu ®) would the drug of choice, and no zanamivir. The European network entis, monitoring of fetal malformations drug, maintains a close monitoring of pregnant women treated with oseltamivir for this flu outbreak.
Can influenza A, is treated with antibiotics?
No. The use of antibiotics is reserved for treating bacterial infections that may be associated with the flu, should they arise.
"should be treated with antiviral drugs to children with the new flu?
generally not given its limited effectiveness for the common cold and the lack of data regarding the new influenza A, in addition to the limited experience of its use in children of all its impossible to know perfil de seguridad. Debería reservarse para niños con cuadros graves, y quizás los pertenecientes a algunos grupos de riesgo, siempre considerando la relación entre el beneficio de administrarlo y los riesgos que conlleva.
Los niños que no pertenecen a grupos de riesgo, ¿deben ser tratados con antivirales?
En general, no. Both children and previously healthy adults who do not have a severe case should not be treated with antiviral drugs, with little effectiveness for influenza, the possibility of side effects and the absence of data regarding the new influenza A.
children belonging to risk groups, should be treated with antivirals?
These cases must be individualized and consulted with his pediatrician, because not all risk groups are equal, and all the diseases encompassed in a risk group has the same gravity.
Review and links updated 21/9/2009
More questions and answers places of interest:
http:// www.cdc.gov/h1n1flu/espanol/influenza-porcina-y-usted.htm (updated June 22)
http://www.informaciongripea.es/preguntas-y-respuestas -more-frecuentes.html (updated September 21)
This document, prepared by the group Influenza A: first of all very quiet , distributed under a license Creative Commons Attribution 3.0 Spain.
