Advice on Exclusion from Schools and Workplaces

Following the closure of some schools as a precautionary measure, where probable or confirmed cases of swine flu have occurred, the Health Protection Agency would like to provide the following advice for the public. This advice relates to the current situation, while our knowledge of the virus is limited and our strategy is to delay and reduce onward transmission of the illness. Such advice may change as our understanding of the virus improves.

• The only people who need to refrain from their normal activities (such as going to school or work) are:
  • those who have been confirmed as having swine flu;
  • those who are being investigated as a possible* or probable** case of swine flu (also see second main bullet point below); or
  • those who have been attending a school where a case is found to have been present and have symptoms of the illness (a possible case).
• Anyone who is being investigated as a possible case of swine flu (which means they meet the epidemiological criteria and have symptoms) will be given antiviral medicine and will be asked to stay at home and limit their contact with other people until the test results are available.
• Close contacts of probable or confirmed cases (family, friends or otherwise) will be started on antiviral medicine as a precautionary measure but can continue their normal lives so long as they do not have any clinical symptoms.
• Children and adults who have no symptoms but have had contact with probable or confirmed cases in social community settings do not need to be excluded from either school or the workplace. They should continue their normal daily routines.

* Possible case: patient meets the epidemiological criteria and has symptoms
** Probable case: patient meets the epidemiological criteria, has symptoms, and results of initial testing suggest swine flu

It is important to remember that flu is usually spread from one person to another when an infected person has symptoms (i.e. coughing and sneezing).

General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including swine flu. This includes:

• Covering your nose and mouth when coughing or sneezing, using a tissue when possible.
• Disposing of dirty tissues promptly and carefully.
• Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people.
• Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product.
• Making sure your children follow this advice.

Swine flu: frequently asked questions

About swine flu

Treatment

Health protection advice

Pandemic and preparation

Swine flu and schools

About swine flu

What is swine flu?

Swine flu is a respiratory illness caused by a virus that usually infects pigs. People do not normally get swine flu but human infection can happen.

The latest outbreaks in countries around the world have been caused by a new version of the swine flu virus called influenza A/H1N1v.

Why is this virus such a threat?

People have some natural immunity to flu types (strains) that are in common circulation, but not to strains that circulate in other animals.

Sometimes, humans and animals can pass strains of flu back and forth to one another, such as when people become ill with bird or swine flu. This usually occurs after a human has direct and close contact with animals that are ill.

Mixing of human and animal flu viruses can lead to the development of new, changed viruses, such as the one that is currently circulating. Because they are new, people may have little or no immunity to them and they may have the ability to cause infection and spread quickly.

What are the symptoms of swine flu?

The symptoms of this swine flu in people are similar to the symptoms of regular human seasonal flu and include fever, fatigue, lack of appetite, coughing, sore throat, pain in muscles and joints, headache and chills. Some people with swine flu have also reported vomiting and diarrhoea.

Can I catch it?

The virus is contagious and can spread between people, although it is not known how easily. Transmission of this new flu virus is thought to occur in the same way as seasonal flu:

• From person to person by coughing or sneezing.
• From touching an object such as a door handle which has virus on it from someone infected with flu.

There is no risk of catching the illness from eating properly handled and cooked pork or pork products. Swine flu viruses are not transmitted by food.

General hygiene can help to reduce transmission of all viruses, including the swine flu virus. This includes:

• Covering your nose and mouth when coughing or sneezing, using a tissue when possible
• Disposing of dirty tissues promptly and carefully
• Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to your face or to other people
• Cleaning hard surfaces (such as door handles) frequently using a normal cleaning product.

I think I may have been exposed to the swine flu virus - what should I do?

If you have recently visited one of the countries or areas where human cases of swine flu have been identified, or been in close contact with someone who has confirmed or suspected swine flu, it is important for you to monitor your health closely for seven days after your visit or contact.

There is no need for you to isolate yourself from other people as long as you remain well.

If you develop flu-like symptoms, you should stay at home and phone your family doctor or NHS Direct (0845 4647). If a health professional decides that you need to have tests, you should avoid contact with other people as much as possible until you receive the results.

Also make sure you follow the basic hygiene precautions described above.

 

Treatment

What is the difference between a confirmed and probable case?

A confirmed case of swine flu is one where the person has tested positive for the swine flu virus.

A probable case is a person who is awaiting laboratory confirmation of infection with the swine flu virus.

What is a close contact?

Close contacts are people such as friends and family who have usually been in close and prolonged contact with an individual suffering from an infection. 

These people are thought to be more at risk of catching flu. As swine flu is a respiratory virus that can be spread by coughing and sneezing, close contacts may have been put at risk and are followed up and given antiviral medication as a precautionary measure. 

Can swine flu be treated?

The swine flu virus can be treated with antiviral medication called oseltamavir (Tamiflu) and zanamivir (Relenza), which reduce the development of the virus and lessen the symptoms.

Antiviral medication does not cure the infection, but reduces its impact and helps the body recover. It must either be used as a preventative measure or early in the development of an infection. It should be taken as soon as possible, ideally within 48 hours of the infection starting.

As a precaution, anyone who is being investigated as a possible case of swine flu will be given antiviral medication and will be asked to stay at home and limit their contact with other people until their test results are available.

When is antiviral medication given?

Antiviral medication is given to everyone being investigated as a possible swine flu case. If someone becomes a probable or confirmed cases then they will be advised to continue on to take the medication.

It is also offered as a precautionary measure for close contacts who were exposed to a probable or confirmed case of swine flu during the period when the person had symptoms AND the most recent exposure was no more than seven days ago.

Why do suspected cases need to take antiviral medication?

The preventative use of antiviral medication is being used at the moment in an effort to contain the outbreak of swine flu and prevent its spread to the wider population in the UK. 

Close contacts of probable or confirmed cases (such as family, friends) are started on antiviral mediciation as a precautionary measure but can continue their normal lives so long as they do not have any clinical symptoms.  If those contacts become ill, they should go home and stay at home and contact their GP by telephone or call NHS Direct.

How will I get antiviral medication if I need it?

People with symptoms and others at risk will be assessed by their GP. If antiviral medication is considered necessary, the GP will contact the HPA, which is coordinating the distribution of antivirals at this stage.

Is there a vaccine to protect against swine flu?

Not yet, because the virus that is circulating is a new strain. A vaccine is currently being developed to immunise people against swine flu but this will take several months to produce.

 

Health protection advice

What can I do to protect against infection?

General hygiene can help to reduce transmission of all viruses, including swine flu. This includes:

• Covering your nose and mouth when coughing or sneezing, using a tissue when possible
• Disposing of dirty tissues promptly and carefully
• Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people
• Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product
• Making sure your children follow this advice.

Do I need to wear a face mask? 

Face masks of the type worn by surgeons are normally used in healthcare settings such as hospitals and clinics. This is to reduce the risk of healthcare professionals passing viruses or bacteria to patients undergoing certain procedures, such as operations.

The wearing of face masks by healthy people, who are not involved in caring for people who are ill, is not recommended.

However, there are some circumstances when wearing a face mask may be beneficial, for instance for: 

• People with swine flu when they are in contact with other people (to reduce the risk of passing on infection)
• Healthy people when they are caring for a patient with swine flu (to reduce the risk of getting an infection)
• Face masks are also recommended for healthcare professionals when they are testing people for swine flu.

 

Pandemic and preparation

What is a pandemic?

A pandemic is a sudden outbreak of an infectious disease, such as flu, that spreads quickly affecting vast numbers of people in different countries across the world.

When new flu viruses are introduced into the environment, humans do not have any natural immunity to protect against them. Therefore, there is a risk that that new flu viruses could cause a pandemic if the virus passes easily from person to person.

What is happening elsewhere in the world?

A number of countries around the world have confirmed cases of swine flu. The World Health Organization (WHO) is coordinating the global response to the human infection, working with authorities in affected countries.

What does pandemic Phase 6 mean?

The World Health Organization (WHO) uses a series of six phases of pandemic alert to inform the world of the seriousness of the threat and the need to launch progressively more intense preparedness activities. WHO has raised its pandemic alert level from Phase 5 to 6.

Phase 5 was used to describe the situation where there is spread of the virus from person to person into at least two countries in one WHO region. While most countries will not necessarily have been affected at this stage, the declaration of Phase 5 was a strong signal that a pandemic was imminent and that the time to finalise the organisation, communication and implementation of the planned measures was short.

Phase 6 is used to describe a pandemic situation where there are outbreaks of infection in communities in at least one other country in a different WHO region in addition to that stated in Phase 5. The declaration of Phase 6 shows that a global pandemic is under way.

Does this mean the situation is more dangerous?

The move to Phase 6 should not be a cause for concern. WHO's decision to declare a pandemic is based on what is happening globally with swine flu and does not suggest a sudden shift in the UK situation.

Advice to the public and healthcare staff remains unchanged.

Around the world we are seeing an increase in cases and the same can be said for the UK. We may well see further rises but it remains difficult to predict what will happen over the next few weeks. Flu activity usually reduces at this time of year, and this normal seasonal pattern may take over at any time.

Is the infection becoming more severe?

The move to Phase 6 does not mean the infection is becoming more severe. It reflects the level of spread of the infection, not a change in its severity.

There is good evidence here in the UK that for most people so far the disease has been generally mild although it is proving severe in a small minority of cases.

The small number of cases that have been affected more severely is to be expected and acts as a reminder that even with seasonal flu people can become very unwell - even healthy people but particularly among those in at risk groups or with underlying medical conditions.

Is the disease spreading rapidly?

Generally across the UK we are not seeing widespread community transmission. Most of the cases being identified in the UK have become infected here in the UK but their source of infection can be traced back to travellers returning from affected areas or those individuals who have already been confirmed.

Some cases however, are being reported with no identifiable link to travel or previously confirmed cases. These so-called 'sporadic' cases are occurring as a result of chains of spread that cannot be identified.

Although this does not represent widespread community spread it is evidence that transmission is occurring and there are signs that this is growing in some areas of the country. This comes as no surprise and is something we have always expected to see.

Why are there so many cases in schools?

Much of the spread that we have seen so far has happened in schools. We know that children are especially vulnerable to infections and can receive greater exposure than adults due to a number of factors including their mixing patterns at school and lack of understanding about good infection control and the importance of respiratory and hand hygiene.

What is being done to protect the public?

The UK's approach so far has been to delay by all reasonable measures available, the spread of this infection for as long as possible, giving us time to strengthen preparations.

That approach has worked well and will continue. Any changes to the strategy to manage swine flu in the UK will come as a result of developments in the local situation and as our understanding of this disease grows/ changes.

The HPA's infection control measures such as isolation of people who are infected, tracing of their contacts and precautionary treatment with antiviral medicines have given scientists time to find out more about the virus, work on developing an effective vaccine and enable the UK health services to to adapt their responses to this new virus.

The HPA is continually reviewing its arrangements, as our understanding of the disease improves and as the situation in the UK develops.

How well prepared is the UK?

The UK government is well prepared to manage a pandemic - the UK is said to be one of the best prepared countries in the world.

Nevertheless everyone can play their part in preventing the spread of swine flu by practising good respiratory and hand hygiene.

What is the role of the Health Protection Agency?

The Health Protection Agency monitors flu strains closely and has systems in place with the NHS that will alert authorities of any unusual flu strain circulating in the UK.

When cases of swine flu are suspected, the HPA works with NHS colleagues and patients to collect samples from patients, carry out testing, and provide advice on giving antiviral medication and other public health activities.

The HPA also produces practical guidance for health professionals on swine flu. This guidance is continually updated on our website.

 

Swine flu and schools

Why does swine flu seem to be particularly affecting children and young adults?

Children are proving to be highly efficient carriers of the swine flu (H1N1) virus and schools provide the perfect environment for it to spread.

What's the role of the HPA in relation to schools?

The HPA provides advice to schools on whether they should close or stay open and also on measures schools can take to try to slow the spread of the disease. 

What is the HPA’s policy on school closures?

The decision to close a school is made by the school and the local authority. The HPA will provide detailed advice based on a thorough assessment of all the risks and will only recommend closure if this will help to contain and lessen the spread of the virus.

For example, where the virus has spread in a community and there is regular mixing with family and close friends outside of the school, closure
would not slow the spread of the virus.

There is a case in our school – why is it still open?

If there has been a confirmed case of swine flu at your school, the HPA will perform a thorough risk assessment. Every risk assessment is judged against the same principles but the HPA will also take into account the local circumstances before making a recommendation.

If your school is still open, it means that the confirmed case is not considered to have posed a risk of further spread to other pupils. Another reason for the school to remain open could be that if the virus is circulating within your community, closing the school would not help to slow the spread of the virus as people could still be exposed outside the school.

There are high absentee rates at my child’s school – surely this must be a swine flu outbreak?

Schools are closely monitoring absentee rates and are looking out for the symptoms of flu among pupils and staff. If there are high absentee rates the school should contact either the local authority or the HPA so that this can be followed up.

My child is in the same class as a confirmed case – why is s/he not receiving antiviral medication?

Antiviral medication will only be offered to confirmed cases, their household contacts and high-risk contacts such as pregnant women, people with underlying illnesses or low immune systems. This is because where the virus has spread widely in the community, extensive use of antiviral medication to prevent infection is no longer appropriate as people are likely to be repeatedly exposed to the disease.

Why isn’t antiviral medication given out to everybody?

In some instances where there are significant levels of local transmission of swine flu, children and adults are likely to be repeatedly exposed to the disease, making preventative medication ineffective.

Isn’t it better for my child to catch this now to develop some immunity in case this comes back more seriously?

This is good evidence that in the majority of swine flu patients the disease is generally mild, but it is also proving severe in a small minority of cases. It is preferable to avoid exposure to the virus if possible, which also helps to protect high-risk groups from unnecessary risk. However, children should not be kept off school if they are well and their school is open.

Our school is open again – what does this mean?

If your school has reopened, it means that any confirmed cases are not considered to pose a risk of further spread to other pupils, or that the virus is already circulating within your community and keeping the school closed would not help to slow the spread of the virus as people could still be exposed outside the school.

What can schools and parents do to slow the spread?

Our advice to people with flu-like symptoms remains the same. Anyone who has a fever and flu-like symptoms should stay at home and contact NHS Direct on 0845 4647 or their GP by phone for advice. They should not go to school or work, and should not attend health settings such as GP surgeries or hospital A&E departments. For more details call the swine flu information line on 0800 1513 513.

Everyone can play their part by practising good hygiene:
• Washing hands frequently with soap and water to reduce the spread of virus from your hands to face or to other people.
• Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product.
• Covering your nose and mouth when coughing or sneezing, using a tissue when possible.
• Disposing of dirty tissues promptly and carefully.
• Making sure children follow this advice.

Last reviewed: 19 June 2009

Additional Swine Flu Information

The Health Protection Agency has prepared advice for the public and for healthcare professionals on swine influenza. 
Further information.