Written By: Colin McCrann
To learn more visit:
http://www.mesorc.com/blog/

Mike Dubron, founder of the Firefighter Cancer Support Network, recently answered some questions concerning the job of a firefighter and connections to cancer. Dubron, himself a cancer survivor, said the experience opened his eyes to the ways in which firefighters are vulnerable to certain carcinogens in the workplace including hazardous chemicals and building materials. His exploration led him to numerous studies, including Grace Lemasters’ report from the University of Cincinnati, showing a direct correlation between different types of cancer and firefighting.

Firefighters are constantly at risk during the course of a day, even during downtime at the station. Fire engines run on diesel fuel and benzene exposure from the exhaust is very common. Structural fire fighting in its various forms brings the added danger of emissions from both known and unknown dangerous materials. One concern within the industry is the potential for asbestos exposure while fighting fire in older buildings. Exposure to asbestos, a hazardous mineral common in construction products, can lead to mesothelioma, lung cancer, and other health problems. Mesothelioma is a cancer caused almost always by asbestos exposure and is usually fatal within two years of a diagnosis. Mesothelioma law has become major industry because many asbestos manufacturers continued to supply their products despite knowledge of its harmful effects on the lung.

Now that there is evidence firefighters have an increased risk of cancer, it is important to determine the best safety measures. Wearing a breathing apparatus at all times and continually maintaining the proper equipment are recommendations from Dubron. Other suggestions from him include diesel exhaust removal systems and annual wellness exams for firefighters. For additional information on Firefighter safety training, check out FullyInvolvedFire.com.

Reprinted Thanks to:
Lisa Wimberger
Trance Personnel Consulting Group
TPCG specializes in training individuals and organizations to understand, identify and retrain stress patterns that un
Learn more at: www.tpconsultinggroup.com

I had the pleasure of gaining more insight into a firefighter’s world recently during an interview with Bryan, a Firefighter/EMT/HazMat professional from Texas. It seems painfully obvious to me that first responders, no matter what the nature of their stress, need preventative wellness programs to keep them productive and in a rewarding long-term career.

Bryan, like many firefighters, deals with survival threats on a scale most people don’t consider. Each time a call comes in he prepares as though it is a critical incident. And while it’s true that the occurrence of critical incidents is small, there is no way to predict that as he suits up. At the onset of a call comes a flood of adrenaline, which increases his reaction time. Bryan arrives on scene pumped on self-made chemicals. If the situation warrants, he responds as a superhero—saving homes, memories and lives. If the incident is benign, the adrenaline has no where to go; and he leaves the scene pumped but unable to use his skill set. In either scenario the adrenaline must return to a normal, sustainable level for him to come back to physical, emotional and mental equilibrium. This looks cut and dry, but the stress reaction is cumulative which adds a complexity to the healing process. Adrenaline levels don’t always return to normal, thus creating a need to spike higher the next time. If Bryan doesn’t reach equilibrium for any reason then his nervous system holds the stress and builds on it the next time. It might be years down the road when a seemingly small incident sets him off into a depression cycle—or worse.

For Bryan to have done a good job and get validation of his professional worth, someone has to suffer or be in harm’s way. Firefighters use gallows humor as a coping mechanism most people don’t understand. The lay person may think it callous that Bryan jokes about the uneventful call, or the disappointment he feels responding to “just a smoking toaster oven”. But many lay people don’t need others to suffer mortal threats in order to have done a good job at work that day.

Bryan’s stress is compounded by the different responsibilities he has as an EMT. Being bound by medical protocol means his options in a crisis are limited. It is his ability to follow these protocols, think quickly and creatively, and respond calmly under pressure that decides if a person lives or dies. Bryan deals with loss that sometimes has no justification or closure.

Firefighters and EMTs are heroes whose need to appear strong and in control still dominates the profession, making it difficult to openly ask for help. And while the buddy system works very well for one’s overall mental well-being, it is not a foolproof plan for wellness. Bryan maintains a dire need for preventative stress management and emotional survival training. He sees burnout first hand, and clearly identifies gaps in his own stress management methods. It’s Bryan’s description of his profession that highlights parallels to the law enforcement world. Although the nature of the stressors differ logistically, the result of unmitigated stress is the same: avoidance, repetition compulsion, depression, damaged family relationships, harmful coping habits, and sometimes suicide.

I am deeply grateful that Bryan took the time to share his experience with me, so that I may continue to expand my understanding of first responders and their unique situations. TPCG is committed to providing preventative stress management and emotional survival trainings to those individuals who sacrifice their lives to save others.

Reprinted courtesy of:
www.tpconsultinggroup.com

For Immediate Release
Office of the Press Secretary
Contact: 202-282-8010

Department of Homeland Security (DHS) Secretary Janet Napolitano today officially launched Virtual USA, an innovative information-sharing initiative—developed in collaboration with the emergency response community and state and local governments across the nation—that helps federal, state, local and tribal first responders communicate during emergencies.

“Our first responders need interoperable tools to make accurate and timely decisions during emergencies,” said Secretary Napolitano. “Virtual USA makes it possible for new and existing technologies to work together seamlessly during disaster response and recovery and gives the public an opportunity to contribute information in real-time to support the efforts of police officers, firefighters and other emergency management officials.”

The announcement came as part of the White House Open Government Initiative and reflects President Obama and Secretary Napolitano’s shared commitment to making government more efficient and fostering a culture of transparency, participation and collaboration.

Virtual USA links disparate tools and technologies in order to share the location and status of critical assets and information—such as power and water lines, flood detectors, helicopter-capable landing sites, emergency vehicle and ambulance locations, weather and traffic conditions, evacuation routes, and school and government building floor plans—across federal, state, local and tribal governments.

Virtual USA:
• Integrates Existing Frameworks and Investments: Virtual USA utilizes current information-sharing platforms to permit new and existing technologies to seamlessly exchange information with one another.
• Draws on Local Input: Virtual USA is based on the needs of local and state first responders to manage data access within their own jurisdictions and to share information with relevant jurisdictions across the nation.
• Employs a Comprehensive Approach: Virtual USA is not limited to information exchanges between two agencies; instead, the initiative fosters dynamic information sharing among all federal, state, local and tribal practitioners.
• Provides a Flexible, Accessible Platform: Because Virtual USA uses open data standards and open source software, more states and localities can join this information exchange project.
• Involves Everyone: Virtual USA allows Americans in their own communities to contribute information—in real-time—to support the efforts of police, fire and emergency management officials during disasters and recovery efforts.

Developed by the DHS Science and Technology Directorate (S&T), Virtual USA currently operates as a pilot in eight states—Alabama, Georgia, Florida, Louisiana, Mississippi, Texas, Virginia and Tennessee—with plans to incorporate additional states underway. In Virginia alone, Virtual USA has reduced response times to incidents involving hazardous materials by 70 percent.

For more information, visit www.dhs.gov.

###

While CDC expands its public health response to the devastating earthquake in Haiti, we are ever mindful of the extraordinary loss of life and the pain and suffering of an entire nation.

CDC activated its Emergency Response Center immediately following the earthquake to help assess public health needs, outline health risks, and offer disease and injury prevention recommendations. CDC is working to support surveillance and help address specific issues such as food and water safety and the prevention and treatment of infectious diseases.

CDC’s current response activities include supporting the United States Agency for International Development (USAID), the World Health Organization (WHO) and Pan American Health Organization (PAHO) in the public health effort. CDC also is coordinating closely with international and national governmental organizations and non-governmental organizations (e.g., International Red Cross, World Food Program, UNICEF, CARE).

CDC Haiti Deployments
CDC staff deployed for the earthquake response includes specialists in epidemiology, veterinary medicine, environmental health, and infectious diseases who include physicians, public health advisors, sanitarians, and nurses.

Moving Forward
The Haiti earthquake response is an urgent priority. CDC will continue to support the people of Haiti and others affected by this tragedy.

CDC public health information on earthquakes and updated information about our response to the Haiti earthquake are posted at http://emergency.cdc.gov/disasters/earthquakes/.

Exhaustion on the fire ground is real. It must be addressed!

We have all read the LODD’s as they come out. Our goals are to not allow history to repeat itself. You have to wonder how many deaths could be avoided or at least problems discovered before it is too late. The goal of this column is to talk about the importance of incident rehabilitation.

I know being assigned to rehab is not for the cool kids and every firefighter reading this wants to be in the fire saving the baby from the clutches of the fire like on TV, but here is an opportunity to truly help our own.

So the question begs, when do we implement rehab? According the NFPA 1584, “procedures shall be in place to ensure that rehabilitation operations commence whenever emergency operations pose the risk of members exceeding a safe level of physical or mental endurance”. Although there are no set rules as to when to establish rehab the NFPA does offer the following guideline:

• Members shall undergo rehabilitation following the use of a second 30-minute self-contained breathing apparatus (SCBA) cylinder, a single 45-minute or 60-minute SCBA cylinder, or 40 minutes of intense work without SCBA. A supervisor shall be permitted to adjust the time frames depending upon work or environmental conditions (NFPA, 2008).

Obviously weather plays a big part of rehab, so it is important that this is taken into account.

It is important to note that as your incident grows in size, it is imperative that your rehab sector is able to accommodate the influx of additional units. As the incident commander, you should locate your rehab based on 3 factors;
1. In the cold zone, uphill, up wind from hazard area
2. Reasonable distance from work area
3. Weather appropriate
Now, we will talk about what is required at rehab. Again if we reference the NFPA 1584, we learn that there are minimum abilities that need to be available;
1. Medical evaluation and treatment
2. Food and Fluid Replenishment
3. Relief from climatic conditions
4. Rest and recovery
5. Member Accountability

Of course things change depending where you are at, so be sure to be aware of your department’s policies and procedures. Over the next few columns we will address each of these abilities in detail. Please join us next time as we delve into medical evaluation and treatment.

Works Cited
NFPA. (2008). NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. Quincy: NFPA.
USFA. (2008). Emergency Incident Rehabilitation. FEMA.

More than 70 countries are now reporting cases of human infection with novel H1N1 flu. This number has been increasing over the past few weeks, but many of the cases reportedly had links to travel or were localized outbreaks without community spread. The WHO designation of a pandemic alert Phase 6 reflects the fact that there are now ongoing community level outbreaks in multiple parts of world.

WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus. It’s uncertain at this time how serious or severe this novel H1N1 pandemic will be in terms of how many people infected will develop serious complications or die from novel H1N1 infection. Experience with this virus so far is limited and influenza is unpredictable. However, because novel H1N1 is a new virus, many people may have little or no immunity against it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against novel H1N1 virus.

In the United States, most people who have become ill with the newly declared pandemic virus have recovered without requiring medical treatment, however, CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this pandemic in the coming days and weeks. In addition, this virus could cause significant illness with associated hospitalizations and deaths in the fall and winter during the U.S. influenza season.

Background
Novel influenza A (H1N1) is a new flu virus of swine origin that first caused illness in Mexico and the United States in March and April, 2009. It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects and then touching your nose or mouth. Novel H1N1 infection has been reported to cause a wide range of flu-like symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, many people also have reported nausea, vomiting and/or diarrhea.

The first novel H1N1 patient in the United States was confirmed by laboratory testing at CDC on April 15, 2009. The second patient was confirmed on April 17, 2009. It was quickly determined that the virus was spreading from person-to-person. On April 22, CDC activated its Emergency Operations Center to better coordinate the public health response. On April 26, 2009, the United States Government declared a public health emergency and has been actively and aggressively implementing the nation’s pandemic response plan.

Since the outbreak was first detected, an increasing number of U.S. states have reported cases of novel H1N1 influenza with associated hospitalizations and deaths. By June 3, 2009, all 50 states in the United States and the District of Columbia and Puerto Rico were reporting cases of novel H1N1 infection. While nationwide U.S. influenza surveillance systems indicate that overall influenza activity is decreasing in the country at this time, novel H1N1 outbreaks are ongoing in parts of the U.S., in some cases with intense activity.
CDC is continuing to watch the situation carefully, to support the public health response and to gather information about this virus and its characteristics. The Southern Hemisphere is just beginning its influenza season and the experience there may provide valuable clues about what may occur in the Northern Hemisphere this fall and winter.

CDC Response
CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.

CDC is issuing updated interim guidance in response to the rapidly evolving situation.

Clinician Guidance
CDC has issued interim guidance for clinicians on identifying and caring for patients with novel H1N1, in addition to providing interim guidance on the use of antiviral drugs. Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) with activity against influenza viruses, including novel influenza H1N1 viruses. The priority use for influenza antiviral drugs during this outbreak is to treat people hospitalized with influenza illness, and to treat people at increased risk of severe illness, including pregnant women, young children, and people with chronic health conditions like asthma, diabetes and other metabolic diseases, heart or lung disease, kidney disease, weakened immune systems, and persons with neurologic or neuromuscular disease.

Public Guidance
CDC has provided guidance for the public on what to do if they become sick with flu-like symptoms, including infection with novel H1N1. CDC also has issued instructions on taking care of a sick person at home and the use of facemasks and respirators to reduce novel influenza A (H1n1) transmission. Everyone should take everyday preventive actions to stop the spread of germs, including frequent hand washing and people who are sick should stay home and avoid contact with others in order to limit further spread of the disease.

Testing
CDC has developed a PCR diagnostic test kit to detect this novel H1N1 virus and has now distributed test kits to all states in the U.S. and the District of Columbia and Puerto Rico. The test kits are being shipped internationally as well. This will allow states and other countries to test for this new virus.

Vaccine
Vaccines are a very important part of a response to pandemic influenza and the U.S. Government is aggressively taking early steps in the process to manufacture a novel H1N1 vaccine, working closely with manufacturers. CDC has isolated the new H1N1 virus, made a candidate vaccine virus that can be used to create vaccine, and has provided this virus to industry so they can begin scaling up for production of a vaccine, if necessary. Making vaccine is a long multi-step process requiring several months to complete.

Stockpile Deployment
CDC has deployed 25 percent of the supplies in the Strategic National Stockpile (SNS) to all states in the continental United States and U.S. territories. This included antiviral drugs, personal protective equipment, and respiratory protection devices. The influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. These supplies and medicines will help states and U.S. territories respond to novel H1N1 virus.

Surveillance
Novel influenza A (H1N1) activity is now being detected through CDC’s routine influenza surveillance systems and reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories. While our influenza surveillance systems indicate that overall influenza activity is decreasing in the United States, novel H1N1 outbreaks are ongoing in different parts of the U.S., in some cases with intense influenza-like activity. Most of the influenza viruses being detected now are novel H1N1 viruses.

Shared Responsibility
Individuals have an important role in protecting themselves and their families.

~Stay informed. Health officials will provide additional information as it becomes available.

~Everyone should take these everyday steps to protect your health and lessen the spread of this new virus:

~Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

~Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

~Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.

~If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

~Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.

Forums Post:
www.FullyInvolvedFire.com
To start this topic off, I would like to see how other departments use Rehab. What are the benchmarks that is needed to be met to establish a rehab sector per your agency? Do you have a SOP/SOG that covers this or is it done on the fly? Which units perform this function? Do you have specialized units that perform this function or do you have any available box respond for this duty? Most importantly, what are the benchmarks that your agency uses for being set free from rehab? Everyone is encouraged to reply whether you are metro career or rural volunteer. The goal is to learn from each other, and build a better mouse trap.

JUST IN – WORLD HEALTH ORGANIZATION RAISES ALERT FROM PHASE 4 TO PHASE 5
Announcement Transcript: http://www.who.int/mediacentre/news/statements/2009/h1n1_20090429/en/index.html
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. For more information click: http://www.who.int/csr/disease/avian_influenza/phase/en/index.htmlPRIVATE SECTOR CONFERENCE CALL TOMORROW AT NOON
There will be a Private Sector Conference Call giving an update on the H1N1 Flu to the business community. The call is scheduled for 30 Apr from 12:00 PM – 1:00 PM EST
The dial-in telephone number is: 800-779-3136, Pass code: 7457424
There will be an opportunity for “question and answer” period at the end of the call.
KEY INFORMATION LINKS
U.S. Information: http://www.cdc.gov/swineflu/?s_cid=swineFlu_outbreak_001
Things you can do: http://www.cdc.gov/flu/protect/habits.htm?s_cid=swineFlu_outbreak_003
Plan and Prepare: http://www.pandemicflu.gov/
International Information: http://www.who.int/csr/disease/swineflu/en/index.html
Key Web Sites
www.cdc.gov
www.hhs.gov
www.pandemicflu.govPREPAREDNESS AND PREVENTION
Workplace Questions: http://www.pandemicflu.gov/faq/workplace_questions/
Pandemic Preparedness in the Workplace: http://www.pandemicflu.gov/plan/workplaceplanning/index.html
Critical Infrastructure Guide: http://www.pandemicflu.gov/plan/pdf/cikrpandemicinfluenzaguide.pdf
Travel Industry Pandemic Flu Checklist: http://www.pandemicflu.gov/plan/workplaceplanning/travelchecklist.html
Health and Safety Information: http://www.pandemicflu.gov/health/index.html TRAVELERS GUIDANCE
CDC Travelers Health Alert: http://wwwn.cdc.gov/travel/
U.S. Department of State Travel Alert for Mexico: http://travel.state.gov/travel/cis_pa_tw/pa/pa_3028.html
Travel Questions: http://www.pandemicflu.gov/faq/travel/index.htmlFEDERAL INTERAGENCY UPDATES AND INFORMATION

Join Secretary Sebelius & Secretary Napolitano tomorrow for a Webcast on H1N1 Flu

HHS Secretary Sebelius and DHS Secretary Napolitano will host a Webcast to answer questions from the American people regarding the H1N1 flu on Thursday at 1:00 PM EDT. They will be joined by Acting Director of CDC, Dr. Besser. The Webcast can be viewed at www.hhs.gov and www.cdc.gov. Submit questions for the webcast by emailing hhsstudio@hhs.gov.

U.S. Department of Homeland Security
(4/29) Testimony of Secretary Janet Napolitano before Senate Homeland Security and Governmental Affairs Committee, ” H1N1 Virus”
http://www.dhs.gov/ynews/testimony/testimony_1241017177339.shtm(4/28) Remarks by Secretary Napolitano at the Media Briefing on the H1N1 Flu Outbreak
http://www.dhs.gov/ynews/releases/pr_1240965057737.shtm(4/29) Customs and Border Protection (CBP) Monitors H1N1 Flu Outbreak; All Ports Operating Routinely
http://www.cbp.gov/xp/cgov/newsroom/alerts/flu/
Post the H1N1 Flu Web Widget and Public Service Advertisements
Help us get the message out to the public, post the H1N1 Flu Outbreak Web Widget (both English and in Spanish) to your web site: http://www.hhs.gov/
(4/28) CDC Public Service Announcements on H1N1 Flu: http://www.cdc.gov/swineflu/psa/Center for Disease Control and Prevention
Main CDC H1N1 Flu Outbreak Page: http://www.cdc.gov/swineflu/

(4/26) Travelers Health: http://wwwn.cdc.gov/travel/contentSwineFluTravel.aspx
(4/26) Travelers Health (Spanish): http://wwwn.cdc.gov/travel/contentSwineFluTravelSpanish.aspx
Key Facts on H1N1 Flu: http://www.cdc.gov/swineflu/key_facts.htm
(Updated 4/29) Antiviral Drugs and Swine Influenza Guidance: http://www.cdc.gov/swineflu/antiviral_swine.htm
CDC Caretaking Guidance: http://www.cdc.gov/swineflu/guidance/
Information for Airline Passengers Exposed to H1N1 Flu: http://wwwn.cdc.gov/travel/contentSwineFluPassengers.aspx
Good Health Habits Guidance: http://www.cdc.gov/flu/protect/habits.htm
(Updated 4/29) H1N1 Flu (Swine) Flu and Youhttp://www.cdc.gov/swineflu/swineflu_you.htm
U.S. Department of Health and Human Services: PandemicFlu.gov
· (4/26) HHS Declares Public Health Emergency for H1N1 (Swine) Flu Outbreak http://www.hhs.gov/news/press/2009pres/04/20090426a.html
· Frequently Asked Questions on H1N1 Flu Outbreak: http://pandemicflu.gov/faq/swineflu/
· Guidance for individuals and families preparing for pandemic: http://www.pandemicflu.gov/plan/individual/index.html.
· Planning information for community organizations: http://www.pandemicflu.gov/plan/community/index.html

U.S. Food and Drug Administration
· (4/27) FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans
http://www.fda.gov/bbs/topics/NEWS/2009/NEW02002.html

U.S. Department of Agriculture
· (4/28) Updated Statement by Agriculture Secretary Vilsack Regarding USDA Efforts Regarding H1N1 Flu Outbreak http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?contentidonly=true&contentid=2009/04/0137.xml
· Frequently Asked Questions: http://www.usda.gov/wps/portal/?contentidonly=true&contentid=2009/04/0131.xml

Office of Personal and Management
Director Barry’s Memo – Flexibilities for Agencies: http://www.chcoc.gov/Transmittals/TransmittalDetails.aspx?TransmittalID=2227
Pandemic Influenza Information: http://www.opm.gov/pandemic/index.aspU.S. Department of Labor/Office of Safety and Health Administration
Preparing Workplaces for an Influenza Pandemic http://www.osha.gov/Publications/influenza_pandemic.html
Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers: www.osha.gov/Publications/OSHA_pandemic_health.pdf
Proposed Guidance on Stockpiling of Respirators and Facemasks in Occupational Settings: http://www.osha.gov/dsg/guidance/stockpiling-facemasks-respirators.html

U.S. Department of Homeland Security
Private Sector Office
Contact: private.sector@dhs.gov
(202) 282-8484

April 27, 2009 011:00AM ET

This document provides interim guidance and will be updated as needed.

Detailed background information and recommendations regarding the use of masks and respirators in non-occupational community settings can be found on PandemicFlu.gov in the document Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic.

Information on the effectiveness of facemasks¹ and respirators² for the control of influenza in community settings is extremely limited. Thus, it is difficult to assess their potential effectiveness in controlling swine influenza A (H1N1) virus transmission in these settings. In the absence of clear scientific data, the interim recommendations below have been developed on the basis of public health judgment and the historical use of facemasks and respirators in other settings.

In areas with confirmed human cases of swine influenza A (H1N1) virus infection, the risk for infection can be reduced through a combination of actions. No single action will provide complete protection, but an approach combining the following steps can help decrease the likelihood of transmission. These actions include frequent handwashing, covering coughs, and having ill persons stay home, except to seek medical care, and minimize contact with others in the household.Additional measures that can limit transmission of a new influenza strain include voluntary home quarantine of members of households with confirmed or probable swine influenza cases, reduction of unnecessary social contacts, and avoidance whenever possible of crowded settings.

When it is absolutely necessary to enter a crowded setting or to have close contact³ with persons who might be ill, the time spent in that setting should be as short as possible. If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time. More information on facemasks and respirators can be found at www.cdc.gov/swineflu.

When crowded settings or close contact with others cannot be avoided, the use of facemasks¹ or respirators² in areas where transmission of swine influenza A (H1N1) virus has been confirmed should be considered as follows:

1. Whenever possible, rather than relying on the use of facemasks or respirators, close contact with people who might be ill and being in crowded settings should be avoided.
2. Facemasks¹ should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people’s coughs and to reduce the wearers’ likelihood of coughing on others; the time spent in crowded settings should be as short as possible.
3. Respirators² should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (e.g., family member with a respiratory infection) at home.

These interim recommendations will be revised as new information about the use of facemasks and respirators in the current setting becomes available.

For more information about human infection with swine influenza virus, visit the CDC Swine Flu website.

1 Unless otherwise specified, the term “facemasks” refers to disposable masks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks. Such facemasks have several designs. One type is affixed to the head with two ties, conforms to the face with the aid of a flexible adjustment for the nose bridge, and may be flat/pleated or duck-billed in shape. Another type of facemask is pre-molded, adheres to the head with a single elastic band, and has a flexible adjustment for the nose bridge. A third type is flat/pleated and affixes to the head with ear loops. Facemasks cleared by the FDA for use as medical devices have been determined to have specific levels of protection from penetration of blood and body fluids.

2 Unless otherwise specified, “respirator” refers to an N95 or higher filtering facepiece respirator certified by the U.S. National Institute for Occupational Safety and Health (NIOSH).

3 Three feet has often been used by infection control professionals to define close contact and is based on studies of respiratory infections; however, for practical purposes, this distance may range up to 6 feet. The World Health Organization uses “approximately 1 meter”; the U.S. Occupational Safety and Health Administration uses “within 6 feet.” For consistency with these estimates, this document defines close contact as a distance of up to 6 feet.

Swine Flu
What is Swine Influenza?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

How many swine flu viruses are there?
Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Swine Flu in Humans
Can humans catch swine flu?
Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

How common is swine flu infection in humans?
In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.
What are the symptoms of swine flu in humans?
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can people catch swine flu from eating pork?
No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.

How does swine flu spread?
Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What do we know about human-to-human spread of swine flu?
In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.

In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.

How can human infections with swine influenza be diagnosed?
To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.
What medications are available to treat swine flu infections in humans?
There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

What other examples of swine flu outbreaks are there?
Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).

Is the H1N1 swine flu virus the same as human H1N1 viruses?
No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

Swine Flu in Pigs
How does swine flu spread among pigs?
Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.

What are signs of swine flu in pigs?
Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.

How common is swine flu among pigs?
H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.

While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.

Is there a vaccine for swine flu?
Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.