General Information

H1N1 Flu Virus has been reported around the world, and the World Health Organization (WHO) has declared it a pandemic influenza virus.

Governments around the world and the World Health Organization are engaged to investigate and address this situation.

The Public Health Agency of Canada continues to work with federal, provincial and international governments to address this situation, and will share more information with Canadians as it becomes available.

H1N1 Flu Virus in Canada

Q1. How many people in Canada have been affected by H1N1 Flu Virus ?

Cases of H1N1 Flu Virus in Canada

Q2. How many suspect cases are currently being tested in Canada?

Specimens are currently being tested at provincial and territorial laboratories as well as at PHAC's National Microbiology Laboratory.  Canada is only reporting on confirmed cases of H1N1 flu virus.

Test results on specimens submitted to PHAC's National Microbiology Laboratory for testing will not be disclosed until the confirmed cases have been shared with the province and/or territory and/or international partner who submitted the specimens for testing.

Q3. Does the Government of Canada expect to see more cases of H1N1 Flu Virus in Canada?

Yes.  With continuing surveillance, we fully expect that new cases will be identified.  Fortunately, most of the cases continue to be mild.  We continue to work with our international partners to learn more about this virus and to monitor for additional waves of illness and/or changes to the nature of the virus.

Q4. I understand Canada has experienced deaths related to the H1N1 virus.  Does this mean the virus has grown in strength?

There is no evidence to suggest that the virus has become stronger.

It is not clear what role the H1N1 flu virus played in the deaths, however, the Government of Canada has noted since the outset of the outbreak that serious illness and death could be expected.

It is important to realize that different strains of influenza result in about 4,000 Canadian deaths a year. We must take all influenza – not just the current strain – seriously, and take measures to protect ourselves.

Government of Canada Actions

Q5. What is the Government of Canada doing to protect Canadians from the virus here in Canada?

Our primary goal is to protect the health of Canadians and their families. At this time, the most effective way to do this is to slow the spread of the disease.

A number of steps are involved in doing this:

• The Public Health Agency of Canada (PHAC) is distributing a Health Alert Notice that provides all travellers entering Canada at land border crossings and at airports with information and advice on the H1N1 flu virus, specifically, advice on what to do if they experience symptoms and tips on how to protect themselves from infection. 
• Canada Border Services Agency (CBSA) officers will distribute these notices.
• Heightened Surveillance will continue and frontline health care workers are actively looking for and reporting positive cases. 
• Health care workers have been provided with detailed advice on how to manage suspect and/or confirmed cases.
• Provincial and territorial laboratories are working cooperatively with Canada's National Microbiology Lab in Winnipeg
• If needed, antiviral medications from Canada's stockpile would be used both to treat active severe illness and to prevent onset of illness in people close to the affected patient and vulnerable to infection – this is called “prophylaxis”.
• Communications to Canadians will continue through the Citizen Readiness Campaign to ensure they are well-informed as to how best protect themselves and their families.  Additional outreach will take place if needed.

Q6. How well prepared is Canada now that the WHO has raised the pandemic alert level to Phase 6?

It’s important for Canadians to understand that the Canadian government has been implementing an aggressive approach to this particular virus for a number of weeks based on information sharing and technical assistance between Canada, US, Mexico and the WHO.

Canada is a global leader in pandemic planning and we continue to implement our overall pandemic plan for the health sector (Canadian Pandemic Influenza Plan).

Our advanced level of readiness is also due to close cooperation with provinces and territories and health professionals across the country.

With the escalation to Pandemic Phase 6, federal actions will be actively continued under the Canadian Pandemic Influenza Plan for the Health Sector, including:

• Ensuring that the National Antiviral Stockpile can be mobilized quickly so Canadians can receive the treatment they need;
• Reviewing the science and working with the vaccine manufacturer, GlaxoSmith Kline, to begin the process of developing and testing a pandemic vaccine in accordance our standing contract; and ongoing involvement in vaccine development, testing and production;
• Managing the National Emergency Stockpile System (NESS) which contains hospital supplies, equipment and other pharmaceuticals (including a stockpile of antiviral medication);
• Assessing implementation of community-based strategies aimed at mitigating potential impact on the healthcare system and society as whole;
• Working with national professional organizations and non-government organizations to optimize and monitor essential health-related resources such as: medical supplies, antivirals, vaccines, sanitizers and antibiotics; health care worker availability, hospital occupancy/availability, and use of alternative health facilities.

International Actions

Q7. The World Health Organization (WHO) has raised the pandemic alert level to Phase Six. What are these phases?

 WHO currently identifies six stages of Pandemic Preparedness and Response.

Phase 1: Influenza viruses are circulating in animals, especially birds. No reports of animal viruses infecting humans.

Phase 2: Human infection by an animal influenza virus. Potential pandemic threat.

Phase 3: An animal or animal-human influenza virus has caused limited disease in people. Isolated human to human transmission may occur – but not widespread.

Phase 4: Verified human to human transmission of an animal or human-animal virus causing widespread or “community-level” outbreaks. Risk of pandemic is considered much higher but not a foregone conclusion.

Phase 5: Human to human spread of the virus is confirmed in at least two countries in one WHO region. It is likely that a pandemic is imminent. Time to finalize organization, communication, and implementation of planned mitigation strategies is short.

Phase 6: The Pandemic Phase. Community outbreaks in at least one country from a second WHO region – indicating that a global pandemic is underway.

The Director-General of the WHO makes the decision about an elevation of pandemic phases based on reports from countries of the impact of disease.

Q8. Who decides when to raise the pandemic alert level  and what are the criteria for that decision?

The World Health Organization sets the pandemic alert level globally in consultation with member states, and has raised the pandemic level to Phase Six.

Phase 6 is declared when there is evidence of sustained community transmission in more than one WHO region-indicating that a global pandemic is under way.

The declaration is based on the spread of the virus, and not on the severity of the illness it causes.

Q9. The WHO has indicated that the overall level of severity of the pandemic to be moderate. What does this mean?

At this time, the WHO considers the overall severity of the pandemic to be moderate. This assessment is based on the clinical and epidemiological information available to WHO to date, as well as input from its Member States on the pandemic's impact on their health systems and more generally on their social and economic functioning. Essentially, this assessment reflects that:

• The overwhelming majority of patients experience mild symptoms and make a rapid and full recovery without the need for hospitalization or medical care.
• Overall, national levels of clinically severe or fatal cases of respiratory illness appear similar to levels seen during local seasonal influenza periods-- although in some local areas and institutions, high levels of disease have occurred.
• Overall, hospitals and health care systems in most countries generally have been able to cope with the numbers of people seeking care -- although in some localities, some facilities and systems have been stressed.

Q10. What other recommendations is the WHO making related to Phase Six?
      The WHO is also recommending:

• No border closure. It will not be possible to stop the virus at the border, at ports or at airports. There is no evidence that these measures stop the spread of the disease, and they may be very disruptive for international traffic and trade.
• No restriction of travel. People who are infected with the virus and are capable of infecting others, may not show symptoms when travelling, so they cannot be identified from others who are not infected.
• Greater emphasis on providing care with a decreased emphasis on stopping the spread of the virus. Now that a pandemic has been declared,all governments will need to focus its resources on caring for those who fall ill.

Q11. Are all pandemics severe?
No. An influenza pandemic may be mild, moderate or severe.  An influenza pandemic means the virus is spread easily between humans, and affects a wide geographic area. An influenza pandemic does not necessarily cause more severe illness than seasonal influenza.

Travel Advice and Information

Q12. Now that the WHO has increased the pandemic alert to Phase Six, what will be the impact on Canadian travellers? What measures should Canadians take before travel?

The WHO is recommending against border closures by international governments. There is no evidence that these measures will limit the spread of the pandemic.

As per normal procedures,  Canadian travellers may be subjected to quarantine measures while travelling abroad. These measures could include entry or exit health screening measures.

Canadians are advised to visit the Department of Foreign Affairs and International Trade website for country-based Travel Reports and Warnings, and for additional information pertaining to travel: http://www.voyage.gc.ca/countries_pays/menu-eng.asp

Each country has the right to determine who is allowed to enter its borders. It is the traveller’s responsibility to check with the destination country’s embassy and consulates for up-to-date information.

Canada will not close its borders during the pandemic. Canadian Quarantine measures, including entry health screening, will continue.

PHAC advises Canadians not to travel while ill.

Q13. Why is Canada no longer issuing specific advice to travellers going to and coming from Mexico?

There are several reasons for this decision:

• The number of H1N1 flu virus cases in Mexico has leveled off and the risk of contracting the virus has decreased
• There is no evidence of a resurgence of ‘second wave' of illness in Mexico, and no rapid escalation of illness in other parts of the world
• Nearly all cases of H1N1 flu virus infection in Canada that have been traced back to Mexico have been mild
• The H1N1 flu virus is circulating within Canada, so limiting travel to Mexico will no longer affect the international spread of the virus

Q14. What measures is Canada taking to inform travellers about the risk of H1N1 Flu Virus?

Health Alert Notices are being handed out to travellers at land border crossings and at airports with information and advice on the H1N1 flu virus , specifically, advice on what to do if they experience symptoms and tips on how to protect themselves from infection. Canadian Border Services Agency (CBSA) officers will distribute these notices.

Q15. How can I find a doctor while travelling abroad if I feel sick?
If you get sick when you are travelling, here's how to get help.

• If you need urgent care, the best option is often the nearest hospital.
• Most major tourist hotels have in-house doctors who can provide medical care.
• Hotels can also arrange appointments with local physicians.
• Find more information about influenza and travelling on www.fightflu.ca.

Q16. What should I do if I feel sick when I am supposed to fly or travel by train or bus?
If you have symptoms of illness, see a doctor before boarding an airplane or other forms of public transportation.  If you become sick while at the airport, consult airport officials before boarding the airplane.

Q17. If I live in or have travelled to regions with reports of H1N1 Flu Virus and I'm feeling sick, what should I do?

If you live in or have travelled to any of the affected areas and you become sick with flu-like symptoms - especially respiratory symptoms such as, fever and cough or difficulty breathing - see your doctor and tell him or her that you have recently travelled to those areas.

Q18. I recently travelled to an affected area and I have no symptoms of illness.  Should I stay home from work or school?

No. Recent travellers who are symptom-free are advised to return to daily activities.
While it may be possible for people to spread the illness up to one day before they are ill, at the time, the amount of virus people are carrying in their system is very low, so the risk of transmission is low.

However, once people begin to develop symptoms, the amount of virus in their body increases, and transmission is much easier. Once someone is exhibiting symptoms, they should stay home to prevent spreading the virus to others.

Q19. Should I avoid contact with people who have recently travelled to an affected area?

Returning travellers are being screened on arrival in Canada for early signs of illness.  Those who are symptom-free are being advised to return to regular daily activities.  Travellers who report symptoms associated with H1N1 flu virus will be assessed and isolated, if required.

How to protect yourself

Q20. What can I do to protect myself from infection?
The Public Health Agency advises Canadians to:

• Wash hands thoroughly with soap and warm water, or use hand sanitizer
• Cough and sneeze in your arm or sleeve
• Keep doing what you normally do, but stay home if sick
• Check www.fightflu.ca for more information
• Check www.voyage.gc.ca for travel notices and advisories
• Talk to a health professional if you experience severe flu-like symptoms

Treatment and Prevention Measures

Q21. Are there drugs that can treat H1N1 Flu Virus?

Yes. Early research indicates that there are two prescription antiviral drugs, oseltamivir (Tamiflu) and zanamivir (Relenza) that are effective in treating the H1N1 Flu Virus.

Q22. What are PHAC’s recommendations for the use of antivirals?
PHAC's recommendation is that antivirals be used to treat H1N1 Flu Virus when the illness is moderate to severe and the patient is at a great risk for complications.
PHAC is not recommending that antivirals be given for a mild disease or on a preventive basis at this time.
The reasons for this are:

• We do not have sufficient information to suggest that this influenza virus requires the use of antivirals. Most patients in Canada are recovering well on their own.
• There is a risk that the virus could be resistant to antiviral treatment if antivirals are overused to treat mild illness.
• The antiviral stockpile is a finite resource. We want to be sure not to run out before they are really needed.

Q23. How are antiviral medications made available if needed?

Antiviral medications are prescription drugs.  Initially, they may be obtained from a pharmacy with a regular prescription. 
There is a national stockpile of antiviral medication, and some provinces and territories also have their own stockpiles. Every province and territory has access to the national stockpile and antivirals have been distributed on a per-capita basis.

Q24. What is the difference between an antiviral and a vaccine?

Antivirals are drugs used for the prevention and early treatment of influenza. If taken shortly after getting sick (within 48 hours), they can reduce influenza symptoms, shorten the length of illness and potentially reduce the serious complications of influenza.

Antivirals work by reducing the ability of the virus to reproduce but do not provide immunity against the virus. The H1N1 Flu Virus can be treated with two different antivirals, oseltamivir (Tamiflu) and zanamivir (Relenza).

In order to provide the best protection, a vaccine must be tailored to fight off specific strains of influenza.

Q25. Will the Government of Canada ensure that Canadians will have access to an H1N1 flu vaccine?
Adequate vaccine supply will be available for all Canadians who wish to receive it. This is a key component of Canada’s comprehensive pandemic readiness plan that has been developed jointly with the provinces and territories.

Q26. Who determines when it is the right time to proceed with the development of an H1N1 vaccine?

Since an influenza pandemic is a global health emergency, the WHO plays many key roles in the pandemic vaccine process. These include coordinating the development of the seed stock for vaccine manufacture, recommending that manufacturers start making pandemic vaccine and providing advice for the use of pandemic vaccines. GlaxoSmithKline has been undertaking all necessary activities using existing seed strains to develop a vaccine in as short a time as possible to meet supply demands.

Q27. If a decision is taken to proceed with vaccine production and immunization, and all goes well with the vaccine manufacturing, how soon will it be before Canadians can access the H1N1 vaccine?

The best case scenario is that immunization could begin in November 2009, in advance of the winter flu season.

Q28. Will everyone have access to the H1N1 vaccine at the same time, or are there priority recipients?

The current plan is to produce sufficient quantities of vaccine for Canadians and ensure their timely distribution in all communities.

Q29. I got my flu shot this year. Will it protect me against H1N1 Flu Virus ?

It is unlikely that the seasonal flu shot will provide protection against H1N1 Flu Virus . The flu shot will protect against the seasonal flu, which is still circulating in Mexico.

Q30. Does the Government of Canada recommend the closing of schools, and other gathering places to limit the spread of the virus?

In Canada, decisions about school closures are made locally. PHAC does not recommend school closures to contain the spread of the virus.

PHAC recommends that people who are sick stay at home to reduce the risk of spreading infection. If this influenza virus spreads, people may want to avoid crowds to decrease the chance of exposure.

Q31. Should Canadians take any extra measures like wearing surgical masks to avoid catching H1N1 Flu Virus?

Canadians should continue to take normal precautions to protect themselves as they would from a regular flu. While we are investigating to learn more about how this virus spreads, our best advice is for Canadians to wash their hands frequently, cover coughs and sneezes, and stay home when ill.

The Public Health Agency of Canada does not recommend that members of the general public wear surgical masks to protect against contracting H1N1 Flu Virus . Evidence shows that this is not effective in preventing transmission of influenza in the general public. People often use masks incorrectly, or contaminate themselves when putting masks on and taking them off, which could actually increase the risk of infection.

The exception is people who are ill with H1N1 Flu Virus or people who are exhibiting flu-like symptoms. In order to protect those in close contact, like doctors, nurses, and caregivers at home, these people may be asked to wear a face mask.

Q32. What protection will the Government of Canada offer to healthcare workers to protect against H1N1 Flu Virus?

As per normal infection control practices, healthcare workers will need to practice frequent hand washing. When in close contact with affected patients, healthcare workers will use added safeguards such as wearing masks and eye protection.

For more information on protective measures for healthcare workers, visit the Health Professionals section.

About H1N1 Flu Virus

Q33. I have heard that people are becoming sick with swine influenza.  What is it?

H1N1 Flu Virus has been reported around the world, and the World Health Organization (WHO) has declared it a pandemic influenza virus.
Swine influenza (sometimes called swine flu) is a strain of the influenza virus that usually affects pigs, but which may also make people sick.

H1N1 Flu Virus is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu.  The symptoms include fever, fatigue, lack of appetite, coughing and sore throat.  Some people with H1N1 Flu Virus have also reported vomiting and diarrhea.

Q34. How can an influenza virus spread from pigs to people?

Different strains of influenza are commonly circulating in our environment, including strains that can cause illness in humans, birds and pigs. 

Sometimes, humans and animals can pass strains of flu back and forth to one another through direct close contact - such as in pig production barns and livestock exhibits at fairs. For people in close contact with pigs, the recommendations to avoid infection are the same as for regular seasonal influenza – frequent handwashing, getting an annual flu shot, covering coughs and sneezes, and staying home when ill.

When a swine influenza virus does affect a human, there is also a risk that the animal influenza can mutate and then spread directly between humans. 

Q35. Is H1N1 Flu Virus contagious? How does it spread between people? 

Yes, this virus is contagious. Since most of the people who have become ill have not been in direct contact with pigs, we know that the virus has spread from person to person.

More investigation is needed on how easily the virus spreads between people, but it is believed that it is spread the same way as regular seasonal influenza.

Influenza and other respiratory infections are transmitted from person to person when germs enter the nose and/or throat. Coughs and sneezes release germs into the air where they can be breathed in by others. Germs can also rest on hard surfaces like counters and doorknobs, where they can be picked up on hands and transmitted to the respiratory system when someone touches their mouth and/or nose.

Q36. Why are people concerned about this particular strain?

The strain of H1N1 Flu Virus is a new, or novel, influenza virus.

Since this is a new strain, people will likely have no natural immunity to protect against the virus. International experts are concerned that this strain could spread quickly.

Investigation is underway to learn more about the way the virus spreads. Governments around the world and the World Health Organization are engaged to investigate and address this situation.

Q37. Are all cases of H1N1 Flu Virus severe?

No. The majority of Canadian cases of H1N1 flu virus have experienced mild illness and have recovered at home. Overall, the WHO is describing this pandemic as moderate.

Q38. Should people be avoiding exposure to pigs?

Influenza viruses can be transmitted from pigs to people and vice versa via coughes and sneezes, but there are not many documented cases of this actually happening.  This H1N1 Flu Virus is spreading between humans – not directly from pigs to people.  As a result, there is no risk from proximity to healthy pigs.

Because humans can also spread the disease to pigs, individuals with influenza symptoms should avoid close contact with pigs to reduce the risk of introducing a new influenza virus into domestic swine populations.

Government officials are conducting investigations to find out more about how this particular strain of H1N1 Flu Virus spreads.

Q39. Can I catch swine influenza from eating pork?

No.  H1N1 Flu Virus is not transmitted through pork meat. Continue to follow proper handling and cooking procedures to reduce the risk of foodborne illnesses.

Q40. What is the incubation period for H1N1 Flu Virus (Human Swine Flu)?

This is a new virus and we continue to learn more about it and how it spreads. However, we expect the incubation period for human swine influenza to be two to seven days.

Q41.  If I get sick with H1N1 Flu Virus (Human Swine Flu) once, does that give me immunity or can I get infected with it again?

Typically, when a person is infected with an influenza virus and recovers, they develop antibodies that provide them with immunity to that particular virus.
However, this is a new virus, and we continue to work with international partners to learn more about how it affects people and how it spreads.

Q42.  How long does the virus live outside of the body?

The H1N1 flu virus can live outside the body on hard surfaces, such as stainless steel and plastic, for 24-48 hours and on soft surfaces, such as cloth, paper, and tissues for less than 8-12 hours; however, it can only infect a person for up to 2-8 hours after being deposited on hard surfaces, and for up to a few minutes after being deposited on soft surfaces.

Q43.  Can the H1N1 flu virus be transmitted from humans to other animals, other than pigs, such as farm animals and household pets?

Scientists are currently conducting a range of studies to learn more about the H1N1 flu virus. Part of this work is focusing on the susceptibility of various species.

Q44.  How high can the body temperature reach for an individual who has a fever who is infected with the H1N1 flu virus, and how long do symptoms last?

More investigation is needed on how long a person can be infectious (be able to spread the virus to others), but, it is believed that this period is for one day before the onset of symptoms and continues for approximately 7 days after symptoms have started.

What we are generally seeing in Canada with H1N1 is similar to typical influenza, whereby illness includes a sudden onset of respiratory illness with a fever (body temperature above 38ºC or 100.4ºF), cough, and potentially other symptoms such as sore throat, runny nose, muscle aches, and extreme fatigue. Most people with influenza recover completely in 1-2 weeks; however, some may have serious complications (particularly those with underlying conditions) since the severity of illness can vary. A person who is concerned about their health or wellbeing should contact a health care practitioner to discuss their personal circumstances.

SOURCE: http://www.phac-aspc.gc.ca/index-eng.php