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

Swine influenza A virus infection (swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with swine flu infection. Certain groups might be more likely to develop a severe illness from swine flu infection, such as persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.

The following information can help you provide safer care at home for sick persons during a flu pandemic.
How Flu Spreads

The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

People with swine flu who are cared for at home should:

• check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
• check with their health care provider about whether they should take antiviral medications
• stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer
• get plenty of rest
• drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
• cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands.
• avoid close contact with others – do not go to work or school while ill
• be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention

Steps to Lessen the Spread of Flu in the Home

When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to:

• keep the sick person away from other people as much as possible (see “placement of the sick person”)
• remind the sick person to cover their coughs, and clean their hands with soap and water or an alcohol-based hand rub often, especially after coughing and/or sneezing.
• have everyone in the household clean their hands often, using soap and water or an alcohol-based hand rub
• ask your healthcare provider if household contacts of the sick person—particularly those contacts who may have chronic health conditions—should take antiviral medications such as oseltamivir (Tamiflu®) or zanamivir (Relenza®) to prevent the flu

Placement of the sick person

• Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed.
• Unless necessary for medical care, persons with the flu should not leave the home when they have a fever or during the time that they are most likely to spread their infection to others (at the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods).
• If persons with the flu need to leave the home (for example, for medical care), they should cover their nose and mouth when coughing or sneezing and wear a loose-fitting (surgical) mask if available.
• Have the sick person wear a surgical mask if they need to be in a common area of the house near other persons.
• If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant (see below).

Protect other persons in the home

• The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
• If possible, have only one adult in the home take care of the sick person.
• Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of influenza-related complications and immunity can be suppressed during pregnancy).
• All persons in the household should clean their hands with soap and water or an alcohol-based hand rub frequently, including after every contact with the sick person or the person’s room or bathroom.
• Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
• If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
• Antivirals can be used to prevent the flu, so check with your healthcare provider to see if some persons in the home should use antiviral medications.

If you are the caregiver

• Avoid being face-to-face with the sick person.
• When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
• Clean your hands with soap and water or use an alcohol-based hand rub after you touch the sick person or handle used tissues, or laundry.
• Talk to your health care provider about taking antiviral medication to prevent the caregiver from getting the flu.
• Monitor yourself and household members for flu symptoms and contact a telephone hotline or health care provider if symptoms occur.

Using Facemasks or Respirators

• Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
• If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask) or N95 disposable respirator.
• An N95 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 an N95 mask for long periods of time. More information on facemasks and respirators can be found at H1N1 Flu (Swine Flu) website.
• Facemasks and respirators may be purchased at a pharmacy, building supply or hardware store.
• Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor. Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
• Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they don’t touch anything else.
• Avoid re-using disposable facemasks and N95 respirators if possible. If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
• After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.

Household Cleaning, Laundry, and Waste Disposal

• Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste.
• Keep surfaces (especially bedside tables, surfaces in the bathroom, and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
• Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
• Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid “hugging” laundry prior to washing it to prevent contaminating yourself. Clean your hands with soap and water or alcohol-based hand rub right after handling dirty laundry.
• Eating utensils should be washed either in a dishwasher or by hand with water and soap.

for more information http://www.cdc.gov/h1n1flu/guidance_homecare.htm

As a Dallas-based physician, there has been a recent flurry of panic about the H1N1 (swine influenza). School districts closed down. Intramural sports statewide were cancelled. Some even suggested closing the border with Mexico, where approximately three quarters of a million people routinely cross back and forth every day. The panic certainly was fueled by the media reports. Likewise, the media can serve to educate the public about health issues.

For that reason, I have created this column to respond to frequently asked questions about H1N1 and reassure the public that pork is safe and will continue to be safe to consume.

What is H1N1 (swine flu)?

H1N1 (previously referred to as “swine flu”) is a respiratory illness. This new virus was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

Why was the H1N1 virus originally called “swine flu”?

This virus was originally referred to as “swine flu” because laboratory testing showed that some of the genes in this new virus were similar to influenza viruses that have occurred in pigs. But further study has shown that this H1N1 virus is very different from what normally circulates in North American pigs. In fact, this strain is unique and was not previously recognized in either people or pigs.

How is H1N1 spread?

Flu viruses generally spread from person to person, often through the moisture in coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of another individual. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own or another’s mouth or nose. You cannot get H1N1 from handling raw pork or eating cooked pork.

Is the H1N1 virus spread through animals?

It appears that the virus is spreading from humans to humans. No evidence indicates that any of the human illnesses resulted from contact with pigs or other animals.

Isn’t it better to be cautious?

According to the most reputable health organizations, including the World Health Organization, U.S. Centers for Disease Control and Prevention, U.S. Departments of Agriculture and U.S. Health and Human Services, the H1N1 flu strain cannot be transmitted by eating pork; it is not a food safety issue. To be cautious, you need to take measures to avoid coming into contact with the virus, such as frequent hand washing.

It doesn’t seem clear to me

The facts are clear. The Centers for Disease Control (CDC) has not found any evidence to indicate that any of the illnesses resulted from contact with pigs. The CDC web site states, “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.”

When should I seek medical care?

Signs that you should seek immediate attention include: difficulty in breathing or chest pain, discoloration of the lips, vomiting and inability to keep liquids down, dizziness, absence of urination or seizures.

Can pork be part of a healthy diet?

Absolutely. Lean cuts such as tenderloin and pork chops rival chicken as an ideal protein source. Pork provides many under-consumed nutrients such as potassium, phosphorous and vitamin B12, a vitamin found only in animal foods.

Source: National Pork Board

Bowing to pressure, the World Health Organization announced Friday that it would rewrite its rules for alerting the world to new diseases, meaning the swine flu circling the globe will probably never be declared a full-fledged pandemic.

Dr. Keiji Fukuda, the deputy director general making the W.H.O. announcement, said that he could not predict exactly what the new rules would be but that criteria would include a “substantial risk of harm to people,” not just the geographic spread of a relatively benign virus.

The six-point system was created in 2005 when the threat was H5N1 avian flu, which has a fatality rate of about 60 percent. But the system does not take into account a virus’s lethality, and in the current outbreak, some countries have complained that the warning system created panic and pressure for border closings, even though the strain was less deadly.

Asked if the W.H.O. could damage its credibility by changing the rules in mid-outbreak, Dr. Fukuda said: “There’s nothing like reality for telling you whether something is working or not. Rigidly adhering to something that is not working would not be very helpful.”

Speaking in Geneva, Dr. Fukuda added, “We’re trying to walk a fine line between not raising panic and not being complacent.”

The W.H.O., starting in April, quickly raised its alert level to 4 and then 5 as the virus spread in North America. But even as the virus infected people in Britain, Spain and Japan, the agency did not go to Level 6, which signifies spread to a new continent. Dr. Fukuda argued that there was still no proof of “community spread,” meaning beyond travelers, schools and contacts. Some experts were skeptical.

While acquiescing, he noted that experts hashed out these issues in 2005. Geographic spread is easy to detect, but severity is highly subjective. Death rates are impossible to calculate before many people are infected; if they turn out to be high, precious time has been lost. Viruses can mutate, becoming more lethal, and even a less lethal strain can kill many people in poor nations with young, malnourished and AIDS-infected populations.

Separately, federal health officials said a study of flu genes released Friday showed that the virus could have been circulating undetected in pigs for years, and called for better surveillance.

The study, published online by Science magazine, was a collaboration between virologists from the Centers for Disease Control and Prevention and the W.H.O., along with others from Mexico, Britain, the Netherlands and the health departments of several American states and New York City.

After sequencing virus genes from 76 Americans and Mexicans and comparing them to known human and pig sequences, the study found no identical matches but concluded that the virus could be in pigs anywhere in the world, said Dr. Nancy Cox, chief of the federal agency’s flu division.

The closest match, surprisingly, was found in Thailand in 2005 — a pig with both North American and Eurasian flu genes.

Since the outbreak began, virologists have wondered how Eurasian genes got into a North American pig. Live pigs are moved through the Americas fairly easily, but rarely are legally moved across oceans, because they carry diseases. Even a single breeding boar must be tested and quarantined.

Now that the mixed genes have been found in Asia, it is possible that they came from a North American pig that was taken there. There is little flu surveillance of pigs in much of the world, and even in the United States it is “not very systematic,” Dr. Cox said.

Canadian pig farmers are required to report flu; Americans are not. Early this month, the United States Agriculture Department’s chief veterinarian said it sequenced only 500 samples a year from 100 million pigs.

In 2006, facing the avian flu threat, the United States chicken industry began voluntarily testing 1.6 million chickens a year.

Dr. Paul Sundberg, head of science for the National Pork Board, said it was planning more tests, especially on pigs in contact with people at fairs or livestock exhibits.

Henry L. Niman, who runs a Web site tracking flu mutations, complained that many swine sequences are posted by American universities and in Mexico only on private databases. “Those sequences would be very useful for figuring out how the H1N1 emerged,” he said.

The flu could also be in an intermediate host, said Dr. Cox, as the 2002 SARS virus passed from bats to humans through palm civets. But she said scientists “don’t have a hypothesis for alternative hosts.” Not enough is known about how many species carry flu, Dr. Cox said. For example, virologists were surprised to learn in 2004 that bird flu could kill zoo tigers and house cats.

Dr. Fukuda also said the new virus has been confirmed in 42 countries and had killed 86 people. About half of those hospitalized are young and healthy with no underlying conditions, he said. In the United States, such conditions are more common among the 300 now hospitalized.

take from http://www.nytimes.com/2009/05/23/health/policy/23who.html

Background:
Conserved two-component system ColRS of Pseudomonas genus has been implicated in several unrelated phenotypes. For instance, deficiency of P. putida ColRS system results in lowered phenol tolerance, hindrance of transposition of Tn4652 and lysis of a subpopulation of glucose-grown bacteria. In order to discover molecular mechanisms behind these phenotypes, we focused here on identification of downstream components of ColRS signal transduction pathway.
Results:
First, highly similar ColR binding sites were mapped upstream of outer membrane protein-encoding oprQ and a putative methyltransferase-encoding PP0903. These two ColR binding sequences were used as an input in computational genome-wide screening for new potential ColR recognition boxes upstream of different genes in P. putida. Biological relevance of a set of in silico predicted ColR-binding sites was analysed in vivo by studying the effect of ColR on transcription from promoters carrying these sites. This analysis disclosed seven novel genes of which six were positively and one negatively regulated by ColR. Interestingly, all promoters tested responded more significantly to the over-expression than to the absence of ColR suggesting that either ColR is limiting or ColS-activating signal is low under the conditions applied. The binding sites of ColR in the promoters analysed were validated by gel mobility shift and/or DNase I footprinting assays. ColR binding consensus was defined according to seven ColR binding motifs mapped by DNase I protection assay and this consensus was used to predict minimal regulon of ColRS system.
Conclusions:
Combined usage of experimental and computational approach enabled us to define the binding consensus for response regulator ColR and to discover several new ColR-regulated genes. For instance, genes of outer membrane lipid A 3-O-deacylase PagL and cytoplasmic membrane diacylglycerol kinase DgkA are the members of ColR regulon. Furthermore, over 40 genes were predicted to be putatively controlled by ColRS two-component system in P. putida. It is notable that many of ColR-regulated genes encode membrane-related products thus confirming the previously proposed role of ColRS system in regulation of membrane functionality.

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