VNAA - Visiting Nurse Associations of America

H1N1 Flu (Swine Flu) Updates

Recent Updates:

September 2010

CDC recommends a yearly flu vaccination as the first and most important step in protecting against the flu. The U.S. 2010-2011 seasonal influenza vaccine will protect against an H3N2 virus, an influenza B virus, and the 2009 H1N1 virus that emerged last year to cause the first global pandemic in more than 40 years and resulted in substantial illness, hospitalizations and deaths.

August 2010

On August 10, 2010, the World Health Organization (WHO) International Health Regulations (IHR) Emergency Committee declared an end to the 2009 H1N1 pandemic globally. For information about CDC's response to the 2009 H1N1 pandemic, visit The 2009 H1N1 Pandemic: Summary Highlights, April 2009-April 2010. Internationally, 2009 H1N1 viruses and seasonal influenza viruses are co-circulating in many parts of the world. It is likely that the 2009 H1N1 virus will continue to spread for years to come, like a regular seasonal influenza virus.

June 2010

The U.S. Public Health Emergency for 2009 H1N1 Influenza expired on June 23, 2010.

January 2010
Download National Influenza Vaccination Week (NIVW) materials focused on H1N1 influenza - NIVW Week 2010 Web page.

  • The 2009 H1N1 virus is still causing sickness and serious illness. Vaccination is your best protection. There is more vaccine available now, and many retail pharmacy stores have vaccine, so it's easier than ever to protect yourself from influenza. Check to find vaccine in your area.
  • The 2009 H1N1 influenza virus is a contagious disease that can cause mild to severe illness and can lead to hospitalization and even death. The virus spreads mainly when an infected person coughs or sneezes near others.
  • Studies have shown that pregnant women, healthcare and emergency medical service providers, children, young adults under the age of 25 and adults between the ages of 25 to 64 with an underlying chronic medical condition (such as heart of lung disease) are at increased risk of serious complications from H1N1 influenza virus.
  • Young adults aged 18-24 are recommended for vaccination against 2009 H1N1 as this group has been hit disproportionately hard by the virus.

October 2009
The VNAA has put together a 2009 VNAA H1N1 Influenza Guide to help assist you this flu season. The Guide includes a variety of materials that will be beneficial to not only the clinician but to your patients and general public too. Download the 2009 VNAA H1N1 Influenza Guide here!

August 10, 2009
On August 5, 2009, the CDC issued updated recommendations for the amount of time persons with influenza-like illness should be away from others. These updates impact the interim guidance for caring for a person with Novel H1N1 in the Home (A link for more information is listed at the end of the update.)

CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (1000 F [37.80C]), or signs of a fever without the use of fever-reducing medications.

This is a change from the previous recommendation that ill persons stay home for seven days after illness onset or until 24 hours after the resolution of symptoms, whichever was longer. The new recommendation applies to camps, schools, businesses, mass gatherings, and other community settings where the majority of people are not at increased risk for influenza complications. This guidance does not apply to healthcare settings where the exclusion period should be continued for 7 days from symptom onset or until the resolution of symptoms, whichever is longer; see for updates about the healthcare setting. This revision for the community setting is based on epidemiologic data about the overall risk of severe illness and death and attempts to balance the risks of severe illness from influenza and the potential benefits of decreasing transmission through the exclusion of ill persons with the goal of minimizing social disruption. This guidance will continue to be updated as more information becomes available.

Decisions about extending the exclusion period should be made at the community level, in conjunction with local and state health officials. More stringent guidelines and longer periods of exclusion - for example, until complete resolution of all symptoms - may be considered for people returning to a setting where high numbers of high-risk people may be exposed, such as a camp for children with asthma or a child care facility for children younger than 5 years old. High-risk groups for influenza complications include: children younger than 5 years old; persons aged 65 years or older; children and adolescents (younger than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection; pregnant women; adults and children who have asthma, other chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders such as diabetes; adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV); and residents of nursing homes and other chronic-care facilities.

Epidemiologic data collected during spring 2009 found that most people with the 2009 H1N1 influenza virus who were not hospitalized had a fever that lasted 2 to 4 days; this would require an exclusion period of 3 to 5 days in most cases. Those with more severe illness are likely to have a fever for longer periods of time. Although fever is a component of the case definition of influenza-like illness, the epidemiologic data collected during spring 2009 found that a minority of patients infected with the 2009 H1N1 influenza virus with respiratory symptoms did not have a fever.

Sick individuals should stay at home until the end of the exclusion period, to the extent possible, except when necessary to seek required medical care. Sick individuals should avoid contact with others. Keeping people with a fever at home may reduce the number of people who get infected, since elevated temperature is associated with increased shedding of influenza virus. CDC recommends this exclusion period regardless of whether or not antiviral medications are used. People on antiviral treatment may shed influenza viruses that are resistant to antiviral medications.

Many people with influenza illness will continue shedding influenza virus 24 hours after their fevers go away, but at lower levels than during their fever. Shedding of influenza virus, as detected by RT-PCR, can be detected for 10 days or more in some cases. Therefore, when people who have had influenza-like illness return to work, school, or other community settings they should continue to practice good respiratory etiquette and hand hygiene and avoid close contact with people they know to be at increased risk of influenza-related complications. Because some people may shed influenza virus before they feel ill, and because some people with influenza will not have a fever, it is important that all people cover their cough and wash hands often. To lessen the chance of spreading influenza viruses that are resistant to antiviral medications, adherence to good respiratory etiquette and hand hygiene is as important for people taking antiviral medications as it is for others.

Fever-reducing medications, that is, medications containing acetaminophen or ibuprofen, are appropriate for use in individuals with influenza-like illness. Aspirin (acetylsalicylic acid) should not be given to children or teenagers who have influenza; this can cause a rare but serious illness called Reye's syndrome. The determination of readiness to return to school, businesses, or other community settings should be made when at least 24 hours have passed since the ill person's temperature first remained normal without the use of these medications.

Visit: for more information on caring for sick persons in the home.

July 30, 2009
Below are key updates for both seasonal and novel H1N1 influenza.

Seasonal Influenza

  1. All four of VNAA preferred vendors for seasonal influenza vaccine have been awarded licenses for their product.
  2. You should be hearing from your manufacturer representatives in the next few weeks to schedule shipments which could begin as early as in mid-August.
  3. The July 24, issue of Morbidity and Mortality Weekly Report (MMWR) offers the ACIP guidance for seasonal influenza vaccine and recommends providers begin administering the seasonal influenza vaccine in "September or earlier" to reduce the potential overlap with novel H1N1 vaccination efforts.

Novel H1N1 Influenza

  1. Clinical trials for novel H1N1 influenza vaccine will begin in the United States in August.
  2. A decision has still not been made about administering the vaccine nor do we know how many doses will be required. More information will be available after the clinical trials are conducted.
  3. During the ACIP meeting in Atlanta July 29, the following priority groups were identified for H1N1 vaccination, should it be released for administration:
    • Pregnant women
    • Contacts of children aged younger than 6 months
    • Healthcare workers and emergency medical personnel
    • Children and young adults aged 6 months through 24 years
    • Non-elderly adults with underlying risk conditions or medical conditions that increase their risk of complications from influenza
  4. We continue to encourage all members to work with your state and local health departments to express your ability to help with H1N1 administration. You may have several options for working within your community such as contracting with your public health departments to offer community clinics or be designated as a community immunizer separate from public health. More information will be coming in the next few weeks.

July 3, 2009

  • Based on reports from the US Department of Health and Human Services (HHS), the federal government will purchase the H1N1 vaccine and likely use a centralized distribution channel, delivering vaccine directly to the states, at which point it will be the states' responsibility to administer it to the public.
  • We understand that the government will provide syringes, sharps containers, and alcohol swaps as well.
  • At this time, the major uncertainties include:
    • Groups recommended for vaccination
    • Amount and timing of availability of vaccine
    • Demand for vaccine
  • However, the Centers for Disease Control and Prevention (CDC) released its recommendations for state and local planning for a 2009 novel H1N1 influenza vaccination program, which includes planning assumptions and scenarios; visit
  • With that said, we encourage you to reach out to your state and local health officials to position yourself as a viable resource to assist in administering the H1N1 flu vaccine once final decisions have been made on the federal level.
  • In the meantime, the VNAA will continue to work with the CDC as well as The Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO) to ensure that you have the current information and the resources needed to help educate and provide for your communities.

June 11, 2009
On June 11, 2009, the World Health Organization (WHO) raised the influenza pandemic alert to Phase 6, indicating that a global pandemic is underway based on the current activity of the novel influenza A (H1N1) virus, also commonly referred to as the "H1N1 flu." Globally, nearly 30,000 cases of the H1N1 flu have been confirmed in 74 countries. In the U.S., all 50 states and the District of Columbia have reported H1N1 flu activity with a total of more than 13,000 confirmed cases. During a press briefing, the Centers for Disease Control and Prevention (CDC) assured the public that the decision by WHO to raise the pandemic alert level was not a reflection of the severity of the illness caused by the virus, but of the spread of the virus. Due to the uncertainty of the seriousness or severity of the H1N1 flu pandemic, the CDC called for continued unity among the government, healthcare providers, and public, commending the state and local level governments and communities for their continued responsiveness and preparedness since the outbreak occurred.

The VNAA recently learned that each of its immunization partners-VaxServe, a sanofi pasteur company; Novartis; MedImmune, Inc.; GlaxoSmithKline-received orders from the U.S. Department of Health and Human Services (HHS) to begin production of H1N1 flu vaccine components. The manufacturing process is in its earliest stages, but clinical trials and testing are expected to commence late summer or early fall. However, the government has not confirmed whether administering the vaccine, if successfully produced, will occur.

May 22, 2009
Here are a couple of key updates regarding the H1N1 flu:

  • The circulation of the virus continues; however, a decline in activity in some areas has been confirmed.
  • The states reporting the most activity include Arizona, California, Illinois, New York, Texas, Washington [state] and Wisconsin.
  • To date, there are 6,052 confirmed and probably cases of H1N1 flu in the US.
  • Of these cases, nine fatalities are reported as well as more than 300 hospitalizations.
  • The CDC is currently compiling "candidate vaccine viruses" necessary to initiate the process of manufacturing a new vaccine; it expects to provide vaccine manufacturers with these viruses by the end of May.

May 8, 2009
Few helpful links:

Attention Residents in California - Information from the California Department of Public Health's H1N1 (Swine Flu):

May 5, 2009
Today, there are 403 confirmed cases of H1N1 flu across 38 states. Additional statistics about the infected population include: Age Median = 16 years old Range = Three (3) months to 81 years old 62% are under 18 years old 35 hospitalizations One (1) death During a news brief yesterday, the CDC announced that it will begin reporting the total number of "probable" cases, which will be reported to the CDC by state health departments and occur in people who test positive for influenza A virus infection, but whose test samples have not had confirmatory testing for the novel H1N1 flu strain. However, it is important to note that 99% of "probable" cases sent to the CDC by state health departments to date have been laboratory confirmed as cases of novel H1N1 flu infection. Today, the number of probably cases reported was approximately 700. While it is still working closely with Mexican health officials to better understand the outbreak in Mexico, the CDC has also began working with the World Health Organization (WHO) to monitor the Southern Hemisphere for the potential onset of influenza A virus and H1N1 flu activity.

As you may have read in this wee's issue of VNAA Member Update, a recording of last Thursday's teleconference regarding H1N1 flu is now available (see below). As follow-up to the discussion about the role of VNAA "preferred vendors" in ensuring that member agencies have the prevention related supplies they need, please see the letter from McKesson Medical-Surgical president, Brian Tyler.

Again, the VNAA encourages you to contact your state and local heath departments to assist in the prevention and treatment of H1N1 flu as the number of cases increases. During last week's teleconference, representatives from The Association of State and Territorial Health Officials (ASTHO) and National Association of County and City Health Officials (NACCHO) attested to the ongoing need for volunteers and the important role that home healthcare agencies can fulfill.

May 4, 2009
As of May 4, the CEC has confirmed 286 U.S. cases of H1N1 Flu (swine flu) in a total of 36 states.

Thanks to all who joined us on the teleconference on Friday. In case you missed it download the teleconference now.
Download and listen to the teleconference. (members only) A new Web browser should open and then it will take a few minutes to download, please be patient. If you have any problems, contact [email protected].

Links of Interest:

April 30, 2009
Thanks to all VNAA members who joined us on a Conference call, April 30, 4:00 p.m.-5:00 p.m., EDT, to discuss H1N1 (swine flu) and pandemic preparedness. VNAA has confirmed guest speakers from the Association of State and Territorial Health Officials (ASHTO) and the National Association of County and City Health Officials (NACCHO). These two associations represent state and local health departments which are key channels in responding to situations like the one we are in now as well as pandemic outbreaks in general.

Few Helpful Links Mentioned on the Conference Call:

April 29, 2009
By the end of the day on April 29, the CDC confirmed a total of 91 cases of the H1N1 Flu, now referred to as Swine-origin Influenza A (H1N1) Virus (S-OIV). Aside from the five initial states (California, Kansas, New York, Ohio, Texas) five additional states have confirmed cases, including Arizona (1), Indiana (1), Massachusetts (2), Michigan (2), and Nevada (1). Unfortunately, one death has been reported in Texas. In addition, the World Health Organization (WHO) elevated the global pandemic threat level to Phase 5, which is characterized by human-to-human spread of the virus into at least two countries in one WHO region; other countries with laboratory reported cases include Austria, Canada, Germany, Israel, Mexico, New Zealand, Spain, and the United Kingdom.

According to the CDC Website, the agency has implemented its emergency response. "The agency's goals are to reduce transmission and illness severity, and provide information to help healthcare providers, public health officials and the public address the challenges posed by the new virus...the CDC's Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond to the outbreak."

Treatment options have been identified which include prescription Influenza antiviral medications which reduce the duration and intensity of the illness. Four antiviral medications have been tested against the swine-origin flu (H1N1) amantadine, rimantadine, oseltamivir and zanamivir. It has been identified that the swine-origin flu (H1N1) is only susceptible to oseltamivir and zanamivir. The government has included these two medications in the Strategic National Stockpile for Pandemic Preparedness.

Within your communities, it is important to continue to educate people about prevention by reinforcing healthful practices like covering your nose and mouth with a tissue when you cough or sneeze, washing your hands often with soap and water, avoiding close contact with sick people, etc.

April 28, 2009
As of today, the CDC has confirmed a total of 64 cases of H1N1 Flu in the US. The cases still remain in the initial five states; however increases in California, New York City, and Texas were reported. In addition, as of yesterday, the World Health Organization has raised the pandemic threat level to Phase 4, which is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause "community-level outbreaks" but does not necessarily mean that a pandemic is a forgone conclusion. At this time, there are no restrictions on travel, but the CDC has recommended that people avoid nonessential travel to Mexico.

April 27, 2009
Since Monday, April 27, 2009, the Center for Disease Control and Prevention's (CDC) has confirmed a total of 40 cases of H1N1 Flu in the US, including seven in California, two in Kansas, 28 in New York City, one in Ohio, and two in Texas. Based on the CDC news brief today as well as feedback that we received from VNAA members, below are key points that may be of interest to you as you continue to follow H1N1 Flu (swine flu) activity and communicate with patients and/or your community:

The CDC continues to work closely with state and local health departments to track the spread and offer guidance. 25% of the nation's stockpile, or 11 million courses of antiviral drugs, has been released and will be allocated to states, particularly the five that have confirmed cases. Although HHS has declared a Public Health Emergency, which essentially facilitates the ability to quickly prepare and mobilize for disasters and emergencies, the CDC continues to recommend to the public to follow the standard practices related to human flu. To date, there is no confirmation of cross protection from this year;s human flu vaccine; however, we encourage you to continue your current planning efforts for 2009 seasonal flu program activities, which will help to reduce future hospitalizations, etc., should H1N1 Flu activity continue to spread.

Important Information:


Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness.

If H1N1 Flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. (Taken from CDC Website)

What is H1N1 Flu (swine flu)?

Swine Influenza (H1N1) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get H1N1 Flu, but human infections can and do happen. H1N1 Flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe. (Taken from CDC Website)

What are the symptoms on H1N1 Flu (swine flu)?

The symptoms of H1N1 Flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 Flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with H1N1 Flu infection in people. Like seasonal flu, H1N1 Flu may cause a worsening of underlying chronic medical conditions.

How do I protect myself?

Currently, there is no vaccine available to protect against H1N1 Flu. However, there are everyday actions to reduce contracting or spreading H1N1 Flu. Cover your nose and mouth with a tissue when you cough or sneeze. Wash your hands with soap and water, especially after coughing or sneezing. Alcohol-based hand cleaners like hand sanitizer are also effective. Avoid touching your eyes, nose or mouth, especially when in public places. Avoid close contact with sick people. If you do get sick, the CDC recommends you stay home from work or school to limit contact with others.

Additional Resources:

Pandemic Influenza Preparation Guide - (members only)

The VNAA Pandemic Influenza Preparation Guide was first distributed via printed copy to members in 2007 in response to the avian influenza outbreak at that time. While the guide is no longer available in print, many of the guidelines are timeless pandemic preparedness recommendations applicable to the current H1N1 Flu (swine flu) activity. We anticipate the guide will provide fundamental policy and procedures templates for member agencies to further refine according to updated CDC and WHO information, organizational practices and community needs. Online access to the guide is for informational purposes only. When you access and/or download the guide, you agree to utilize the tool as such and accept full responsibility in updating the guide as needed to maintain compliance with local, state and federal regulatory entities as well as accreditation bodies. Duplication and distribution of the guide is prohibited.

 Download the Pandemic Influenza Preparation Guide - (members only)

Additional questions, please contact:

Clinical Education Director
Heather McKenzie, RN
[email protected]

Corporate Relations Manager
Meredith Davis
[email protected]

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