As we head into the flu season, we wanted to share some frequent questions we have received.  We encourage the ongoing submission of questions and will continue to update this document and post it to our website.  Our team of medical directors answered these questions with guidance from the Centers for Disease Control (CDC).

General Questions about the Flu

What is the difference between the seasonal flu and the H1N1 flu? 
The seasonal flu occurs every year and typically appears between November and March.  Different strains of the seasonal flu virus circulate each year.  The H1N1 flu virus first appeared in the United States in 2009 and was originally referred to as the “swine flu”.  On June 11, 2009, the WHO declared that the H1N1 virus was at a pandemic level.  Unlike the seasonal flu, H1N1 is expected to appear year round.

The seasonal flu and the H1N1 virus present similar symptoms such as the rapid onset of a fever over 100?, cough and/or sore throat, headache, body aches, chill and/or fatigue.  Those with H1N1 have been reporting diarrhea, vomiting and shortness of breath more frequently than those with the seasonal flu.

How is the flu transmitted? 
Both the seasonal flu and the H1N1 flu are primarily spread from person to person through coughing or sneezing by people with the flu. Touching something that has the flu virus on it, such as a surface or an object, and then touching your nose or mouth is another possible way to get either flu virus.

What are the symptoms of the flu?
The symptoms of both flu viruses include:

• Rapid onset of fever over 100 degrees
• Cough and/or sore throat
• Headache, body aches, chills and/or fatigue
• Diarrhea, vomiting, shortness of breath have been reported more frequently with H1N1 than with seasonal flu

How is the flu treated? 
The primary recommended treatment for both viruses is rest, drinking plenty of fluids, and controlling the fever.  Anti-viral medicine may be recommended for those who are very young, very old or who may have other health issues or concerns.

What can I do to prevent myself from getting either the seasonal or the H1N1 flu? 
Vaccination is the most effective way to prevent the flu.  If you can’t get the vaccine, proper hygiene is the best next step.  This includes:

• Washing hands often with soap and water or using an alcohol-based hand sanitizer
• Staying home when you’re sick
• Covering your cough or sneeze with a tissue or your upper sleeve
• Not sharing drinks, food, utensils or anything that goes in or near the mouth with others

When should I seek emergency medical care for the flu? 
Get medical care right away if a person sick with the flu exhibits any of the following symptoms:

• Has difficulty breathing or chest pain
• Has purple or blue lip discoloration
• Is vomiting and unable to keep liquids down
• Has seizures (e.g., uncontrolled convulsions)
• Is less responsive than normal or becomes confused
• Has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry

If I’m sick (or my children are home sick), when is it okay to return to work or school? 
The CDC currently recommends that people with a flu-like illness stay at home until at least 24 hours after their fever has subsided.  These recommendations may change over time depending on how severe the outbreak becomes.  Additionally, some communities may extend this period for those that are returning to a site where high numbers of high-risk people may be exposed, such as schools or child care facilities.  Please check with your employer and your children’s schools for their specific policies and procedures for dealing with sick employees and students.

Should I stay home if one of my household members is sick? 
Employees who are well but have a sick family member at home can go to work as usual.  These employees should monitor their health every day and continue to practice good hygiene, such as washing hands frequently or using alcohol-based cleansers.  If an employee becomes ill, the CDC recommends informing the employer and going home.  Employees who are pregnant or have an underlying medical condition should contact their healthcare provider if they become ill.

Once you get the H1N1 flu, are you immune thereafter or can you get it again? 
Unless you catch a strain that is different from the one that made you sick, you won’t get the H1N1 flu again.  Once you have been infected, your body has produced antibodies for the first infection, which will protect you from getting the H1N1 flu again.

Will the fall-winter outbreak of the H1N1 virus be more severe than the outbreak during the spring of 2009? 
Perhaps the only predictable aspect of the H1N1 virus thus far has been its unpredictability.  It is possible that this virus will continue to circulate and cause more illness this fall or winter. Whether it will dominate the seasonal flu virus or disappear is not currently known.

The CDC and other public health agencies are mindful of the fact that pandemics sometimes come in waves.  There’s no way to predict whether this virus will cause a lot of disease, some disease or no disease in the Northern Hemisphere this fall or winter, but the CDC is preparing itself for the possibility that it will be serious.   The CDC does think that it is very likely this new influenza strain will be a problem in the fall, based on U.S. cases during the summer and cases from the Southern Hemisphere.  But a successful vaccination campaign could prevent a serious outbreak.  So at this point, there’s no way to tell how severe the H1N1 outbreak will be this fall or winter.

Vaccine Questions

Will the seasonal flu vaccine protect me against H1N1? 
No, the seasonal flu vaccine will not protect you against H1N1.  However, it is still recommended that you get the seasonal flu vaccine to protect you from the seasonal flu.

Will I need to get both the seasonal flu and the H1N1 vaccine? 
Yes, the seasonal flu vaccines and the H1N1 vaccines are different; you will need both to protect yourself from the seasonal flu and the H1N1 flu.  This means you’ll need two shots this flu season to fully protect yourself from both.  But getting both is the best way to protect yourself from both viruses.

When will the H1N1 vaccine become available? 
States are expected to start receiving their shipments of the H1N1 vaccine the week of October 5.  It is expected that the initial shipments will be prioritized for the priority groups such as healthcare workers, children, pregnant women, and people with existing conditions.  One dose is expected to suffice for most people (it was originally thought that two doses would be needed), although children between the ages of 6 months and nine years old may be given two doses.

Who should get the H1N1 vaccine? 
Everybody is recommended to get the H1N1 vaccine since this is a new strain of the H1N1 virus.  The target groups that are recommended to receive the vaccine first are:

• Pregnant women
• People between the ages of 6 months and 24 year olds
• Those in close contact with children less than 6 months old
• Individuals 25-64 with high risk conditions
• Healthcare and EMS personnel

Can someone who has had the vaccine still somehow "carry" the virus and spread it to others? 
No.  If you have received the H1N1 vaccine (or any vaccine for that matter), you can’t carry the virus and spread it to others.  The only way you can spread the virus to others is if you became sick with the H1N1 flu (which you are at risk for if you don’t get the vaccine) and transmit it by coughing or sneezing on somebody, or touching something that somebody who isn’t ill then touches.

Does the H1N1 or seasonal flu vaccine contain thimerosal? 
Yes, the majority of influenza vaccines distributed in the United States currently contain thimerosal as a preservative. However, some contain only trace amounts of thimerosal and are considered to be preservative free by the Food and Drug Administration (FDA).

The 2009 H1N1 influenza vaccine will be manufactured in several formulations. Some will come in multi-dose vials and will contain thimerosal as a preservative. Multi-dose vials of seasonal influenza vaccine also contain thimerosal to prevent potential contamination after the vial is opened.

Some vaccine manufacturers will be producing 2009 H1N1 influenza vaccine in single-dose units, which will not require the use of thimerosal as a preservative. In addition, the live-attenuated version of the vaccine, which is administered through the nose, is produced in single-units and will not contain thimerosal.

Workplace Policies and Procedures

What should employers do about maintaining productivity if 30% of the work force is home ill? 
This flu season may give employers a chance to exercise their pandemic preparedness plans.  Your preparedness plans should have guidelines on how to maintain business operations with a reduced staff. 

What happens when an employee has no sick time, but s/he is ill (or has an ill family member) and needs to go home? 
Each organization will need to develop their own policies and procedures about how to handle situations where an employee is ill but has no sick time.  During this flu season, the CDC is recommending that organizations allow and encourage sick workers to stay home without fear of losing their jobs.

What should I do if I have employees who have H1N1 or are suspected to have H1N1? 
Each organization will need to develop their own policies and procedures about how to address employees who are sick.  Due to similarities in symptoms, it may not be possible to determine if somebody is sick with the H1N1 virus or with the seasonal flu virus.  Regardless, the CDC recommends that you encourage sick workers to stay at home until at least 24 hours after their fever has subsided.  The CDC is recommending that organizations develop flexible policies that allow sick employees to stay at home.

If I feel sick, can I work from home and not use sick time? 
Each organization has different policies and procedures about working at home.  Please check with your Human Resources department for your company’s policies on working at home.  The CDC recommends that employers allow employees who don’t feel well to stay home.  Many employees who don’t feel well aren’t as productive as they are when they are healthy, so your employer may encourage you to take the sick time.

What happens if I get the flu and am out of sick time? 
Each organization has different policies and procedures about what to do about employees who are ill but out of sick time.  Please check with your Human Resources department for your organization’s policies on this situation.  It should be noted that the CDC is encouraging all organizations to develop flexible sick leave policies during this flu season, so your company may be willing to develop a plan with you on how to address this situation.

If I need to stay home to care for a family member, how will my time be charged? 
Please check with your Human Resources department as each organization has different policies and procedures about how to handle this situation.  Your company may agree to let you work from home while you stay home to take care of your family member.

Do I need to bring any documentation from my physician when I come back? 
Each organization has different policies and procedures about whether physician documentation is needed when you come back to work after any illness.  Please check with your Human Resources department about whether your organization requires documentation to return back to work.  Companies should be aware that doctor’s offices may be overrun this flu season, and may not be able to give notes to their patients clearing them for work.  The CDC is currently recommending that people are okay to return to work once their fever has subsided for at least 24 hours.

If one of my co-workers comes to work sick, what should I do? 
Many organizations are reviewing their policies and procedures about whether to send sick workers home during this flu season.  If you have a co-worker who comes to work sick and they are unable to go home, the CDC recommends the seasonal and H1N1 flu vaccines this fall season as the best means of protecting yourself from getting the flu.  If you are unable to get the vaccine, then practicing good hygiene is the next best method to protect yourself from getting sick.

Significa Benefits will continue to keep you updated on this situation at its website, www.significabenefits.com.  As experts in pandemic flu preparedness, Significa Benefits can assist you with any questions you have about preparing your organization for a pandemic.