• Visits to doctors for influenza-like illness (ILI) continued to increase in the United States, and overall, are higher than levels expected for this time of the year.

• Total influenza hospitalization rates for laboratory-confirmed influenza are higher than expected for this time of year for adults and children. And for children 5-17 and adults 18-49 years of age, hospitalization rates from April – October 2009 exceed average flu season rates (for October through April).

• The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and now exceeds what is normally expected at this time of year. In addition, 19 flu-related pediatric deaths were reported this week; 16 of these deaths were confirmed 2009 H1N1 and 3 were unsubtyped influenza A and likely to be 2009 H1N1. A total of 76 laboratory confirmed 2009 H1N1 pediatric deaths have been reported to CDC since April.

• Thirty-seven states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Texas, Tennessee, Virginia, Washington, and Wyoming. Any reports of widespread influenza activity in September and October are very unusual.

• Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

You may have the flu if you have some or all of these symptoms:

* fever
* cough
* sore throat
* runny or stuffy nose
* body aches
* headache
* chills
* fatigue
* sometimes diarrhea and vomiting

What should I do if I get sick?

If you get sick with flu-like symptoms this flu season, you should stay home and avoid contact with other people except to get medical care. Most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are:

* Children younger than 5, especially children younger than 2
* People 65 and older
* Pregnant women
* People who have:
o Cancer
o Blood disorders (including sickle cell disease)
o Chronic lung disease [including asthma or chronic obstructive pulmonary disease (COPD)]
o Diabetes
o Heart disease
o Kidney disorders
o Liver disorders
o Neurological disorders (including nervous system, brain or spinal cord)
o Neuromuscular disorders (including muscular dystrophy and multiple sclerosis)
o Weakened immune systems (including people with AIDS)

Also, it’s possible for healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care provider.

There are emergency warning signs. Anyone who has them should get medical care right away.
What are the emergency warning signs?

In children

* Fast breathing or trouble breathing
* Bluish skin color
* Not drinking enough fluids
* Not waking up or not interacting
* Being so irritable that the child does not want to be held
* Flu-like symptoms improve but then return with fever and worse cough
* Fever with a rash

In adults

* Difficulty breathing or shortness of breath
* Pain or pressure in the chest or abdomen
* Sudden dizziness
* Confusion
* Severe or persistent vomiting

Do I need to go the emergency room if I am only a little sick?

No. The emergency room should be used for people who are very sick. You should not go to the emergency room if you are only mildly ill.Photo of sick child If you have the emergency warning signs of flu sickness, you should go to the emergency room. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. If you go to the emergency room and you are not sick with the flu, you may catch it from people who do have it.

Are there medicines to treat 2009 H1N1?

Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

How long should I stay home if I’m sick?

CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other things you have to do and no one else can do for you. (Your fever should be gone without the use of a fever-reducing medicine, such as Tylenol®.) You should stay home from work, school, travel, shopping, social events, and public gatherings.

What should I do while I’m sick?

Stay away from others as much as possible to keep from making them sick. If you must leave home, for example to get medical care, wear a facemask if you have one, or cover coughs and sneezes with a tissue. And wash your hands often to keep from spreading flu to others.

Wearing facemasks and respirators will help control the spread of pandemic flu.

Wear a facemask if:

* You are sick with the flu and think you might have close contact with other people.
* You live with someone who has the flu (you therefore might be in the early stages of infection) and need to be in a crowded place. Limit the amount of time you spend in these crowded places and wear a facemask while you are there.
* You are well and do not expect to be in close contact with a sick person but need to be in a crowded place. Limit the amount of time you spend in these crowded places and wear a facemask while you are there.

Wear a respirator if:

* You are well and you expect to be in close contact with people who are known or thought to be sick with pandemic flu. Limit the amount of time you are in close contact with these people and wear a respirator during this time. These recommendations apply if you must take care of a sick person at home.

What is a facemask?

Facemasks are loose-fitting, disposable masks that cover the nose and mouth. These include products labeled as surgical, dental, medical procedure, isolation, and laser masks.

Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing the flu facemask. They are not designed to protect you against breathing in very small particles. Facemasks should be used once and then thrown away in the trash.

What is a respirator?

A flu respirator (for example, an N95 or higher filtering facepiece respirator) is designed to protect you from breathing in very small particles, which might contain viruses. These types of respirators fit tightly to the face so that most air is inhaled through the filter material. To work the best way, N95 respirators must be specially fitted for each person who wears one (this is called “fit-testing” and is usually done in a workplace where respirators are used). Most of the time, N95 flu respirators are used in construction and other jobs that involve dust and small particles. Some healthcare workers, such as nurses and doctors, use these types of respirators when taking care of patients with diseases that can be spread through the air.

If you have a heart or lung disease or other health condition, you may have trouble breathing through respirators and you should talk with your doctor before using a respirator.

Like surgical masks, N95 respirators should be worn only once and then thrown away in the trash.

Additional Information

Neither flu facemasks nor a respirator will give complete protection from the flu. That is why it is important to wash your hands often, cover your coughs and sneezes with a handkerchief or your arm, and avoid crowds and gatherings during a pandemic. To learn more about these and other issues relating to pandemic influenza.

• Cover your nose and mouth with tissue when you cough or sneeze. Throw the tissues in the trash after you use them.
• Wash your hands frequently with soap and water, especially after coughing or sneezing. Alcohol-based hands cleaners are also helpful.
• Try to avoid close contact with sick people.
• Wear an approved RESPIRATOR or SURGICAL MASK
• If you are sick, stay home from work or school and limit contact with others to keep from infecting them.
• Avoid touching your eyes, nose, or mouth, as germs are spread that way.

See a doctor if you have swine flu symptoms.

Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers
www2a.cdc.gov says: This guidance is for laboratory workers who may be processing or performing diagnostic testing on clinical specimens from patients with suspected swine influenza A (H1N1) virus infection, or performing viral isolation.
Human Swine Influenza Investigation

www2a.cdc.gov says: Human cases of swine influenza A (H1N1) virus infection have been identified in the U.S. in San Diego County and Imperial County, California as well as in San Antonio, Texas. Internationally, human cases of swine influenza A (H1N1) virus infection have been identified in Mexico.
Swine Flu Updates on CDC’s Twitter Feed
www2a.cdc.gov says: Follow CDC on Twitter to get real-time updates on the swine flu investigation
Swine Flu Video Podcast
www2a.cdc.gov says: Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu – its signs and symptoms, how it’s transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.
Daily Update – Human Swine Influenza Investigation

www2a.cdc.gov says: Investigations are ongoing to determine the source of the infection and whether additional people have been infected with similar swine influenza viruses. CDC is working very closely with state and local officials in California, Texas, as well as with health officials in Mexico, Canada and the World Health Organization.
CDC Health Advisory
www2a.cdc.gov says: Investigation and Interim Recommendations: Swine Influenza (H1N1)
Distributed via Health Alert Network
CDCHAN-000281-2009-04-25-ALT-N
Swine Flu and Safe Travel in the United States
www2a.cdc.gov says: CDC has NOT recommended that people avoid travel at this time. However, if you are planning travel, please follow recommendations to reduce your risk of infection and stay healthy.
Travel Health Precaution – Swine Influenza and Severe Cases of Respiratory Illness in Mexico

www2a.cdc.gov says: CDC has NOT recommended that people avoid travel to Mexico at this time. However, if you are planning travel to Mexico, follow recommendations to help you and your family stay safe and healthy.
Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home
www2a.cdc.gov says: Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home
Update: U.S. Human Cases of Swine Flu Infection
www2a.cdc.gov says: Human cases of swine influenza A (H1N1) virus infection have been identified in the U.S.
Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected
www2a.cdc.gov says: Information on the effectiveness of facemasks and respirators for the control of influenza in community settings is extremely limited. These interim recommendations have been developed on the basis of public health judgment and the historical use of facemasks and respirators in other settings.
Media Availability on CDC Investigation of Human Cases of Swine Influenza
www2a.cdc.gov says: Press briefing from April 25, 2009. CDC’s Dr. Anne Schuchat, Interim Director for Science and Public Health Programs and and Dr. Daniel Jernigan, Director of the Influenza Division.