Swine Flu - vacines, pregnancy, travel and more

Is there a vaccine?

No, not at the moment. Influenza viruses change very quickly. For a vaccine to provide adequate protection it needs to be adapted to the particular strain in circulation.

Scientists are making good progress in developing a new vaccine for swine flu and we are expecting the first batches of vaccines in August. Further stocks will arrive in the autumn, but it may well be next year before we can vaccinate everyone.

The government has ordered enough vaccines for the whole population, but to reduce the impact of swine flu, the NHS is focusing on those at the greatest risk first (see Who will be a priority for vaccination with the H1N1 swine flu vaccine?).

Why does it take several months to produce a swine flu vaccine?

The flu vaccine production process is long and complicated. Production technology is labour-intensive. The government's plans include two manufacturers, thus maximising chances of early development.

If other countries are also being given advance supply guarantees, will we get ours first?

The UK has a binding contractual agreement in place to ensure its supply.

Does the current seasonal flu vaccine work?

The current seasonal flu vaccine is designed to protect against H1N1, but it is unclear as yet whether this will offer any protection against the current strain of swine flu.

How many stocks are available of seasonal vaccine?

Flu vaccine is produced each year for the seasonal flu. Discussions are ongoing with manufacturers about how much may still be available. However, the government has determined that there are 430,000 doses of vaccine available in the UK.

Who will be a priority for vaccination with the H1N1 swine flu vaccine?

The Joint Committee on Vaccination and Immunisation has previously advised that the priority groups in relation to H5N1 (the bird flu vaccine) should be assumed to be:

frontline health and social care workers (to help ensure the NHS functions well),
older people and those in clinical risk groups (see Which people are most vulnerable from swine flu?), as flu can be more serious in these groups, and
under-16s, as protecting children can slow the spread of the virus in the population.

The priority groups would be reviewed in light of evidence on the virulence and severity of the new virus in different groups.

The government will still aim to achieve universal vaccination, but because the vaccine will have to be delivered over time, it is right that we start thinking now about groups to be prioritised.

Will the vaccine still provide people with protection if the swine flu virus mutates between now and the autumn?

At this stage, it is impossible to predict if or how the H1N1 swine flu virus will mutate (change). However, experiences with the H5N1 vaccine (bird flu vaccine) would suggest that an H1N1 vaccine (produced using the same processes) would also provide a high level of immunity against closely related strains. The level of cross-protection is expected to be greatest for more closely related strains.

Does the NHS have enough syringes to administer the swine flu vaccine?

Yes, orders have been placed to ensure there are enough syringes to administer the vaccine.

What extra antibiotics have been purchased?

Orders have been placed for 15.2m courses of antibiotics. They will play an important part in the response to the pandemic.

Why do you need antibiotics in a pandemic?

While antivirals may reduce the number of complications, there are still likely to be significant numbers of complications occurring in the pandemic. Some of the most common include bacterial infections in the respiratory tract and lungs, such as pneumonia. Antibiotics are needed to treat such complications.

Antibiotics will be used to treat people in the community if they develop complications. In hospitals, antibiotics will be used to treat the sickest patients and may reduce the length of hospitalisation.

Are pregnant women more likely to catch swine flu?

Yes. Pregnant women are more susceptible to all infections, because their immune system is naturally suppressed in pregnancy. They are especially vulnerable to swine flu, as this virus is affecting younger age groups in particular.

Does swine flu pose special risks in pregnant women?

Pregnant women have an increased risk of complications from any type of flu, because their immune system is naturally supressed in pregnancy. Possible complications are pneumonia (an infection of the lungs), difficulty breathing and dehydration, which are more likely to happen in the second and third trimester.

There is a small chance that these complications will lead to premature labour or miscarriage. There is not yet enough information to know precisely how likely these birth risks are.

It is important to note that most pregnant women will only have mild symptoms and recover within a week.

What special precautions can pregnant women take?

If you are pregnant, you can reduce your risk of infection by avoiding unnecessary travel and avoiding crowds where possible. Pregnant women should also follow the general hygiene advice (see What can I do?).

If a family member or other close contact has swine flu, your doctor may prescribe you antiviral medication (usually Relenza) as a preventative (prophylactic) measure.

If you think that you may have swine flu, check your symptoms online. If you are still concerned, call your doctor for an assessment immediately (see What should I do if I think I'm infected). If your doctor confirms swine flu over the phone, you will be prescribed antiviral medication to take as soon as possible.

Unless you have swine flu symptoms, carry on attending your antenatal appointments so you can monitor the progress of your pregnancy.

Can I take antiviral drugs if I am pregnant?

Yes, on the advice of a doctor. The Department of Health has purchased Relenza, an inhaled antiviral drug that treats flu without reaching the developing fetus. Relenza should not affect your pregnancy or your growing baby. However, if your doctor or midwifery specialist thinks that a different medicine is needed (for instance, if you have unusually severe flu), you will be given Tamiflu instead. An expert group reviewed the risk of antiviral treatment in pregnancy, which is extremely small - much smaller than the risk posed by the symptoms of swine flu.

What are the possible side effects of Relenza?

Some people have had wheezing or serious breathing problems when they have used Relenza. Relenza is therefore not recommended for people with asthma or COPD. Other possible side effects include headaches, diarrhoea, nausea and vomiting. If you take an antiviral and have side effects, see your healthcare professional to check that you are ok. Then report your suspected drug reaction to the Medicines and Healthcare products Regulatory Agency (MHRA) via their new new online system.

Can I take flu remedies or painkillers if I am pregnant?

You can take paracetamol-base cold remedies to reduce fever and other symptoms. Paracetamol is safe to take in pregnancy.

However, pregnant women should not take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Nurofen).

Will pregnant women get preference for a swine flu vaccine?

It will be the end of August before a swine flu vaccine becomes available. When it is available, there will be guidelines on which groups of people are a greater priority for vaccination. Go to Who will be a priority for vaccination with the H1N1 swine flu vaccine?

Should I stop breastfeeding if I need to take antiviral drugs?

Women who are breastfeeding should continue to do so while receiving antiviral treatment, as this is not contraindicated. If a mother is ill, she should continue breastfeeding and increase feeding frequency. If she becomes too ill to feed, then expressing milk may still be possible. Antiviral drugs are excreted into breast milk in very small (insignificant) amounts.

Can children take antivirals?

Yes, on the advice of a doctor. Tamiflu is safe for infants aged one and older, at a reduced dose. Relenza (an inhaler) can be used by children aged five and older under the supervision of an adult.

Can babies under the age of one take antivirals?

Tamiflu and Relenza are not licensed for use in babies under the age of one. However, after evaluating all the available evidence, the European Medicines Agency has advised that children under one may be treated with Tamiflu, considering that:

the appropriate dosage to treat children aged under one is 2-3mg/kg twice daily for five days,
children are preferably treated under medical supervision, and
dilution of the capsule content can be used to prepare the dose.

Can my baby take Tamiflu as a preventative measure?

The balance of benefit and risk for using Tamiflu for the prophylaxis (prevention) of swine flu in babies who are not suffering from flu symptoms is not clear. A decision on whether this is recommended should be taken by an expert in the care of young children. The recommended course for prevention in the under-ones is 2mg/kg once a day for 10 days (but should not exceed 10 days). The first line of protection for babies aged under one is respiratory and hand hygiene and frequent cleaning of surfaces, toys and equipment.

I'm on immunosuppressants. Am I more at risk from swine flu?

Yes. If you take immunosuppressants you have a greater risk of becoming infected with any virus, including swine flu, and will be less able to fight it off once you have it.

Will my dose of immunosuppressants be altered in the event of an outbreak?

Your doctor may advise that your dose of immunosuppressants needs to change. The appropriate dose will vary from patient to patient.

Can I take antivirals if I'm on immunosuppressants?

Yes, on the advice of a doctor it is safe for you to take Tamiflu or Relenza.

Am I more at risk of catching swine flu if I have HIV?

Probably not. Although HIV infects CD4 cells and reduces their number and function, there are other parts of the immune system that are able to fight flu. For more information, go to the Terrence Higgins Trust website

Am I more likely to suffer complications if I have HIV and catch swine flu?

If you have a low CD4 count (under 200), you may be more likely to suffer complications like pneumonia from any type of flu, including swine flu.

Can I take antivirals if I have mild to moderate kidney disease?

Yes. If you have stage 1 to 3 kidney disease, or your glomerular filtration rate (GFR) is above 30, you will be treated as any other person would be. This means you can take Relenza or Tamiflu, if necessary.

Can I take antivirals if I have severe kidney disease?

Yes. If you have stage 4 or 5 kidney disease, or your glomerular filtration rate (GFR) is below 30, you will probably be under the care of a kidney specialist. Relenza (an inhaler) is safe to take. If you find this tricky to use, your doctor may give you a reduced dose of Tamiflu tablets instead.

Will people with long-term conditions get preference for a swine flu vaccine?

It will be months before a swine flu vaccine becomes available. When it is available, there will be guidelines on which groups of people are a greater priority for vaccination.

What advice is there for people with asthma or COPD?

Your condition places you at greater risk if you catch the disease. It is therefore all the more important that you follow good hygiene practices (see 'What can I do') and react quickly if you develop flu-like symptoms

Can I take antivirals if I have asthma or COPD?

Yes - Tamiflu is safe to take. However, Relenza (an inhaler) is usually not given to people with asthma as on rare occasions it can cause breathing complications.

I have diabetes. Am I at more at risk from swine flu?

You are no more likely to catch swine flu than anyone else. However, if you do catch it, your blood glucose may increase and your diabetes treatment may need to be adjusted accordingly.

What should I do if my blood glucose increases?

If you find your blood glucose has increased, or you develop thirst and are urinating more, call your GP. If you are on insulin and testing your own blood glucose, you may be advised to do this more often so you can adjust your dose according to the results. If you start to vomit or become increasingly unwell, call your GP as soon as possible.

Is there any advice for people with liver disease?

If you have liver disease you are no more likely to catch swine flu than anyone else. If you do catch it, antivirals are safe to take - there is no interaction between these and antivirals you may already be taking to treat hepatitis.

Can I take antivirals if I am on epilepsy treatment?

Yes. It is thought that antiviral treatments will not affect medicines taken to control epilepsy.

I look after someone who is very ill/disabled. What if I become too ill to care for them?

As a carer, you should probably begin planning for an emergency caring situation as soon as possible. The best way to get help with planning for a caring emergency is to arrange a carer's assessment from your local authority. If you have time you may be able to arrange for formal respite care, but you may want to talk to friends, neighbours and relatives about forming a network of 'flu friends' who can help out and look after you if you are ill.

Are older people more likely to catch swine flu?

It is not yet known, but the vast majority of cases so far in the UK have been in those younger than 60. It is speculated that some older people may have partial resistance to the swine flu virus, due to being exposed to a similar flu virus in a previous pandemic.

Are older people more at risk of complications if they do catch it?

Older and frail people are more likely to develop complications from any type of flu, and are generally less able to fight it off.

What advice is being given out to travellers?

Before travelling, you should check the Foreign and Commonwealth Office (FCO) website for information specific to the country they are visiting (see Useful links). Those who do not have internet access can call the FCO's 24-hour advice line on 0845 850 2829.

What advice are you giving to people with flu who want to travel by plane?

The Health Protection Agency is advising anyone in the UK who is symptomatic not to travel until they are no longer infectious. Similarly, any British nationals abroad with flu who want to fly home should only travel when they are no longer infectious.

Is it safe to use public transport now we are in a pandemic?

Yes. Public transport has not been closed during previous pandemics, and while there is a small additional risk to the public, this is no greater than using other public places. Anyone who has the flu or feels unwell should stay at home and not travel.

What is the definition of WHO Phase 6?

The technical definition of Phase 6 is human-to-human spread of the virus into at least two countries in one World Health Organisation region, with community level outbreaks in at least one other country in a different WHO region. Because the virus has been spreading for some time in North America, the decision that 'community level outbreaks' were occurring in other regions means that the criteria for Phase 6 have been fulfilled.

I am about to go on holiday to a country affected by swine flu - what should I do?

Make sure you consult the overseas travel advice on the Foreign & Commonwealth Office website and take sensible precautions.

What should I do if I become ill on holiday or on the flight home?

If you experience flu-like symptoms during a stay in a country affected by swine flu, contact a health professional and tell them your symptoms.

If you become ill on your flight home, alert the cabin crew to your symptoms. There are procedures in place for dealing with passengers who become unwell on flights, and the airline will advise port health officials on the ground that a passenger requires a health assessment and may need treatment. To access the Department of Health Swine Flu Information line when abroad, call 00 44 207 928 1010.

Is it a mild infection and therefore no cause for concern?

Don't be complacent, as it is too soon to assume it will be a mild infection. We don't know the profile of the virus and are closely monitoring each case that comes up. Everyone who has been infected with the virus in this country has so far been diagnosed early and treated with antivirals, which reduce the severity of symptoms.

The flu virus changes character very rapidly. It can pick up and swap genetic material, which can dramatically change its character, increasing the severity of symptoms. The virus could change in the autumn, so we need to plan for this.

Is it safe to eat pig meat / pork?

Yes. The WHO says there is no evidence that swine flu can be transmitted through eating meat from infected animals. However, it is essential to cook meat properly. A temperature of 70°C (158°F) would be sure to kill the virus. Pig meat includes pork, bacon, ham and pork products.

What happens to visitors to the UK if they are confirmed with swine flu during their stay?

Foreign nationals should not be treated any differently from UK nationals with regard to self-isolation or other recommended measures for symptomatic people. People with symptoms of swine flu, including foreign nationals, are advised not to travel. Overseas visitors will not be charged for NHS hospital treatment for swine flu, including antivirals.

check your symptoms online.