Frequently Asked Questions Compilation of the New Influenza Type A (H1N) Strain

The Bureau of Emerging Infectious Diseases, Department of Disease Control, Ministry of Public Health has compiled a collection of frequently asked questions (FAQs) regarding the new influenza A (H1N) strain, as of June 15, 2009 at 8:00 a.m. This collection includes questions about wearing a mask, taking antiviral drugs, prevention methods, and proper practices to prevent an epidemic. For more information, please read here.

Frequently Asked Questions Compilation of the New Influenza Type A (H1N) Strain

1.             What is the flu that is currently spreading in the news?

The 2009 new influenza outbreak began in Mexico and spread to travelers in many other countries. It is caused by a new strain of influenza virus type A H1N1 (A/H1N1) which contains the genetic material of human influenza, swine flu, and avian influenza. This strain has never been seen before in both swine and humans, and is believed to have originated from cross-breeding. No contact from pigs was found. When the World Health Organization announced the official name on April 29, the disease was changed to "New strains of influenza, type A, H1N1".

2.             Why was the term “Swine Flu” not used like the name used in the early stages of the epidemic?

The English term “Swine Flu” was used when reporting the influenza epidemic in Mexico. The results of genetic analysis revealed that it is a new strain found in humans and has never been found in pigs before. Swine flu is typically a respiratory disease that occurs in pigs, caused by several different influenza viruses, such as H1N1, H1N2, H3N1, and H3N2, each with different strains. Occasionally, pigs can be infected and become sick, which is rare. Infection is normally caused by humans inhaling droplets when pigs cough or sneeze, or come into contact with pigs or the environment in which the pigs live. However, no outbreaks of this disease in swine have been reported in either Mexico or the United States, and results of disease investigation have found no one to have contracted the disease from swine. Instead, it is believed to only spread the disease from person to person.

On April 29, 2009, the World Health Organization officially changed the name of the new strain of influenza, formerly known as Swine Flu, to "Influenza A H1N1". In response to this change, the Thai Ministry of Public Health has adopted the same name and changed the abbreviation from "2009 new influenza" to "New strains of influenza, type AH1N1" to ensure consistency and help convey a common understanding to the public. It is important to note that this strain of influenza is distinct from seasonal influenza A H1N1, which are caused by different influenza viruses.

3.             How is a person infected?

Most people acquire influenza by coming into contact with the respiratory droplets, coughs, sneezes, mucus, and saliva of infected individuals. Additionally, indirect transmission of the virus can occur when individuals touch contaminated surfaces such as handkerchiefs, doorknobs, telephones, eyeglasses, and other objects. There is no evidence to suggest that influenza is transmitted through the consumption of pork.

Most patients usually experience symptoms 1-3 days after being exposed to the virus. In rare cases, this period can extend up to 7 days. They may become infectious one day prior to the onset of illness, and the first 3 days are the most contagious. The infectious period typically lasts no longer than 7 days, although in young children, it may last up to 10 days.

4.             Can humans infect other animals?

The International Animal Disease Organization officially published a report on May 7, 2009, confirming a new strain of influenza type AH1N1 that has been found in both humans and swine in Canada, leading to an outbreak of the disease in swine.

5.             Will the consumption of pork or products made from pork result in infection with this new strain of virus?

Cooking pork and pork products at 70 degrees Celsius or higher will make them safe to consume. It is important to not use sick or dead pigs for cooking, as the heat from cooking will not destroy any new strains of influenza virus that may be present.

6.             What are the symptoms of H1N1 influenza?

Symptoms of the common flu, such as high fever, headache, muscle aches, cough, and sore throat, are similar to those seen in most cases of the virus. Nausea, vomiting, and diarrhea may also be present. Generally, 95 percent of patients experience mild symptoms and are able to recover without having to be hospitalized. However, people with chronic underlying diseases such as respiratory disease, asthma, cardiovascular disease, diabetes, the elderly, children under 5 years old, those with low immunity, obesity, and pregnant women are at risk of severe complications and even death.

7.             Can this disease be treated and how?

Most patients with mild symptoms, such as low-grade fever, can recover without hospitalization by taking symptomatic medications such as paracetamol to reduce fever (do not use aspirin). These patients can visit their doctor at the clinic or obtain medicines and advice from a pharmacist near home to maintain their condition at home. However, those with more severe symptoms such as difficulty breathing, panting, and vomiting a lot should see a doctor to consider the provision of antiretroviral drugs or to be admitted to the hospital.

8.             How do we protect ourselves from this disease?

In order to protect yourself from contracting this disease, it is important to avoid contact with people who have flu symptoms. If you must take care of a patient, make sure to wear a mask, as well as ensuring that the patient also wears a mask. Additionally, it is important to regularly wash your hands with either water and soap or alcohol gel, especially after coughing and sneezing. To further prevent the spread of germs, do not share glasses, drinking straws, food spoons, handkerchiefs, or towels with others. Finally, it is important to maintain good health by eating nutritious food, drinking clean water, getting enough sleep, exercising regularly, and avoiding smoking and alcohol.

Outbreak situation and severity of the disease

9.             What is the current influenza A (H1N1) situation?

Since mid-March 2009, Mexico has seen an abnormal increase in influenza and pneumonia cases. Subsequently, laboratory samples have been sent as of June 15, 2009, which revealed a confirmed case of influenza infection due to a new strain of type A (H1N1). As of this date, 29,669 cases have been reported in 74 countries, resulting in 145 deaths, accounting for a morbidity rate of about 0.49%. A list of countries where cases were found and daily disease situation reports can be found on the Ministry of Public Health website www.moph.go.th.

10.          Has this new Influenza strain of influenza been discovered in Thailand?

Since April 28, 2009, Thailand has seen 201 confirmed cases of influenza A (H1N1) infection, of which 30 were imported cases and 171 were domestically infected. Currently, there is an outbreak of the disease in Bangkok, Chon Buri, and Pathum Thani, which has caused the closure of schools and entertainment venues both in Thai and foreign tourist attractions. All patients reported mild symptoms and there have been no fatalities. In order to prevent the spread of the virus, health officials have been closely monitoring people who have had close contact with infected individuals. Those who have been affected have been treated, but their symptoms have not been severe.

11.          What is the trend of the outbreak?

The World Health Organization has declared that the opportunity to contain the H1N1 flu epidemic to the country of origin has passed and that the outbreak is likely to continue to spread across the globe, creating a pandemic. The virus may undergo mutations, leading to either more or less severe outbreaks, the severity of which is still unpredictable. However, from the experience of past pandemics, there are usually subsequent outbreaks that tend to be more severe than the first wave.

12.          How does the Ministry of Public Health predict outbreak trends in Thailand?

The outbreak of the disease within and outside the country can be divided into three distinct phases, taking into account the nature of the disease, its environment, and the potential it has in the country. The phases should be considered in order to identify the current epidemic situation in the country.

Situation A involves a patient who has been infected from outside the country and has come into the country.

Situation B involves a localized spread of the infection within the country's borders.

Situation C involves a widespread distribution of the infection within the country.

From late April to early June 2009, Thailand has been screening international travelers (Scenario A) and sustained domestic transmission for more than 6 weeks. Recent data suggests that Thailand has started to experience new influenza infections within the country (Scenario B) and the domestic outbreak may continue to spread (Scenario C), similar to the outbreaks in other countries such as the United States and Japan. To successfully combat the crisis, the public, government, and other stakeholders must cooperate and take strong preventive measures. If successful, the impact on health, economy, and society can be kept to a minimum.

13.          What is the impact of a widespread outbreak?

The spread of the disease in the past can have a significant impact on the health of the people in Thailand, with an estimated 10-40% of the population (6.5-26 million people) potentially becoming infected. This could lead to many deaths, and would also have major economic and social implications such as reduced tourism, businesses suffering, and disruption to people's daily lives.

14.          What information is the Ministry of Public Health concealing or distorting about the outbreak, if any?

The Ministry of Public Health has a policy of providing information to the public with transparency, so that people have accurate knowledge and understanding and can participate in the prevention and control of the disease. Official information may take some time to verify for accuracy, or may require consultation with experts and all parties involved for use in consideration and decision-making. This is done for the greatest benefit to the country and with the least amount of errors. However, some information should not be publicly disclosed, as it may cause more harm than good, such as personal details of patients which are not needed for the prevention and control of the disease. These details must be kept confidential in order to protect the rights of the patient.

15.          What is the reason for the discrepancy between the number of Thai cases reported by the World Health Organization and the number of cases announced by the Ministry of Public Health?

In order to accurately report official cases to the World Health Organization, individual report forms must be filled out with detailed information. This includes information that must be gathered over time, such as the patient's treatment results, which may not be known until after the patient has recovered or finished their medication. Recently, the number of cases has risen rapidly in clusters, which could lead to the World Health Organization reporting a lower number of cases than what is initially announced by the Ministry of Health.

Outbreak Warning Level

16.          What is the Outbreak Warning Level?

In 2005, the World Health Organization set the pandemic alert level for influenza in order to reflect the stages of an outbreak, starting with the discovery of a new strain of the virus in animals and ending with a global epidemic. It was estimated that the virus causing the pandemic influenza was the H5N1 bird flu virus, but when the outbreak occurred in 2009, it was the new H1N1 influenza virus. In response, the World Health Organization revised their definitions for each outbreak level to make it easier to direct disease prevention and control measures and to have a common understanding around the world.

17.          How many outbreak warning levels are there and what do they mean?

The World Health Organization (WHO) has revised its 2009 Warning Level for new influenza outbreaks, setting it at six levels.

Level 1 is triggered when a new strain of influenza virus is found in animals.

Level 2 indicates infection has occurred in humans.

Level 3 is when patients are found in small groups and human-to-human contact is limited.

Level 4 is an outbreak at the community level.

Level 5 is when human-to-human transmission is occurring in at least two countries in the same WHO region.

Level 6 is an outbreak in more than one WHO region.

18.          What is our current warning level for the outbreak?

On June 12, 2009, Dr. Margaret Chan, Director-General of the World Health Organization, announced that the pandemic alert level had been raised from Level 5 to Level 6, indicating that the new influenza A (H1N1) virus had begun to spread worldwide with human-to-human transmission occurring at that time. By that date, the virus had been confirmed in more than 30,000 cases across 74 countries.

19.          What is the 6th outbreak level like?

The World Health Organization recommends that countries prepare for an ever-increasing number of patients in the near future. For countries with widespread disease outbreaks, a particular emphasis should be placed on preparing for a second wave of disease outbreaks, as well as ensuring proper nursing care for patients. Laboratory investigations and disease investigations in areas with widespread outbreaks should be deemphasized, as the benefits may not be worth the resources that have to be invested into it.

The World Health Organization is now working closely with vaccine manufacturers to maximize the availability of the new strain of flu vaccine within the next few months. In the meantime, the WHO recommends that public health and community measures, such as promoting personal hygiene and restriction of gatherings, should be implemented to prevent the spread of infection. Travel restrictions or borders should not be closed.

Antiviral Drug

20.          Is there any kind of medicine that can treat this disease ?

If a patient is suffering from influenza, oseltamivir is a highly effective oral medication that can be used to treat it. However, if the viral examination results show that the virus is resistant to the antiviral drugs amantadine and rimantadine, zanamivir may be used as an inhaler. For the best results, it is recommended that the medication be taken within two days of the onset of fever.

21.          Is there enough Oseltamivir in Thailand?

The Thai Ministry of Public Health and the Department of Disease Control have taken steps to ensure that sufficient medication is available for the current situation, as 95% of COVID-19 patients have mild symptoms and can recover without hospitalization or antiretroviral therapy. To this end, 420,000 sets of ready-to-use drugs have been reserved nationwide, and raw materials for the production of an additional 100,000 sets have been reserved by the Government Pharmaceutical Organization. Aspirin should not be used, and instead paracetamol can be taken to reduce fever.

22.          Is it necessary for both state enterprises and private sector organizations to reserve antiviral drugs, and if so, why?

The Ministry of Public Health has a policy to promote private sector participation in the antiretroviral stockpile in order to expand the country's reserves and prepare for a potential pandemic of influenza. Oseltamivir (Tamiflu) is currently being used for both therapeutic and prophylactic purposes in accordance with medical indications.

The drug is classified as a controlled substance, and its use is restricted to hospitals with overnight patient beds. Doctors must prescribe the medication, and establishments can acquire or donate it through private hospitals approved by the Ministry of Public Health. The importer must inform the Drug Control Division of the Food and Drug Administration and provide evidence of importation.