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October 9, 2009 3:30 PM ET

Actions To Take This Flu Season

1. Get Your Seasonal Flu Shot
The best way to prevent seasonal flu is by getting a seasonal flu vaccination each year. As always, CDC recommends that people 65 and older get their regular, or “seasonal,” flu vaccine as soon as it is available. This year is no exception as seasonal flu viruses are expected to circulate along with 2009 H1N1 viruses this flu season. When the 2009 H1N1 vaccine becomes available for people 65 years and older, you should get that vaccine also.

2. Take Everyday Preventive Actions including covering coughs, washing hands often and avoiding people who are sick.

3. Seek medical advice quickly if you develop flu symptoms to see whether you might need medical evaluation or possibly treatment with antiviral medications. People 65 and older are prioritized to get antiviral drugs if they become sick with the flu according to CDC’s guidance. Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever.
People 65 Years and Older and Seasonal Flu

It has been recognized for many years that older people are at greater risk of serious complications from the flu compared with young, healthy adults. It’s estimated that 90 percent of seasonal flu-related deaths and more than 60 percent of seasonal flu-related hospitalizations in the United States each year occur in people 65 years and older. This is because human immune defenses become weaker with age. So influenza can be a very serious disease for people 65 and older.

People 65 Years and Older and 2009 H1N1 Flu

The new 2009 H1N1 virus does not seem to be affecting people 65 years and older in the same way that seasonal flu usually does. Most people who have gotten sick from this new virus have been younger. In fact, people 65 and older are the group that is least likely to get infected with this new virus. There have been relatively few infections and even fewer cases of serious illness and death with this new virus in people older than 65. Laboratory tests on blood samples indicate that older people likely have some pre-existing immunity to the 2009 H1N1 flu virus. But while people 65 and older are the least likely to be infected with 2009 H1N1 flu, those that do become infected are at greater risk of having serious complications from their illness.
Flu Vaccination

Seasonal Flu Vaccine

People 65 and older are recommended to get seasonal flu vaccine this year, as always.

2009 H1N1 Flu Vaccine

People 65 and older are not in a target group recommended to get the earliest doses of 2009 H1N1 vaccine. This is because people age 65 and older are least likely to get sick with the 2009 H1N1 virus. Because there will be limited amounts of vaccine available at first, the first doses are recommended for those who are most likely to get infected.

The U.S. government has purchased 250 million doses of 2009 H1N1 vaccine, so anyone who wants to get the vaccine will have the opportunity to do so. While people 65 and older are not included in the groups recommended to get the earliest doses of vaccine, they can get the 2009 H1N1 influenza vaccine as soon as the high risk and younger groups have had the opportunity to be vaccinated.
People Age 65 Years and Older and Antiviral Drugs

Influenza antiviral drugs are prescription drugs (pills, liquid, or inhaled powder) that decrease the ability of flu viruses to reproduce. While getting a flu vaccine each year is the first and most important step in protecting against flu, antiviral drugs are a second line of defense in the treatment of flu.

It’s very important that antiviral drugs be used early to treat flu illness in people 65 and older who are very sick (for example people who are in the hospital) and people who are sick with flu and who also have a greater chance of getting serious flu complications (see http://www.cdc.gov/h1n1flu/highrisk.htm).

Although they are the least likely group to be infected with 2009 H1N1 flu, people age 65 and older are at higher risk for influenza related complications. Therefore, they are prioritized for antiviral treatment if they get sick with either seasonal or 2009 H1N1 flu this season.

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This podcast helps businesses understand how novel H1N1 flu can affect their business and how to keep their workers and worksites safe.

This podcast helps businesses understand how novel H1N1 flu can affect their business and how to keep their workers and worksites safe. Created: 5/20/2009 by Centers for Disease Control and Prevention (CDC). Date Released: 5/20/2009.

[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.

CDC understands that businesses are concerned about the health and safety of their workers and worksites during this outbreak of novel H1N1 flu. This podcast answers many of the questions we’ve received from the business community and will provide your organization with information on resources and tools to effectively respond to the outbreak.

Novel H1N1 is a new influenza virus causing illness in people. The virus was first detected in people in the United States in April 2009; other countries have also reported people sick with the new virus. CDC expects that more cases, hospitalizations, and deaths from this outbreak will occur over the coming days and weeks.

Businesses are essential partners in protecting the public’s health and safety during this outbreak. The health of employees during an outbreak such as novel H1N1 influenza plays a critical role in the continued operations of a business. The workforce, like the public, needs clear, concise, consistent information.

H1N1 flu is a completely new disease that isn’t comparable to the seasonal flu we see each year. One of the differences is that H1N1 flu is attacking healthy teens and adults. With seasonal flu, the very young and the very old are at greatest risk because their immune systems are less effective than those of healthy adults.

It’s difficult to make accurate predictions on the length of time it may take for the novel H1N1 flu to run its course in the U.S. Past outbreaks have had different durations and affected different percentages of the population in different ways. Outbreaks of new influenza viruses usually last much longer than seasonal flu, and often come in waves. The health impact in terms of severity of each wave has also varied.

Here are some ways to protect employees and worksites:

Sick employees should stay home and not come to work. People who have the flu can spread it to others and the flu virus can spread easily when people are close together. If someone is sick with novel H1N1 flu, they’ll probably have symptoms similar to those of seasonal flu, including fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. A significant number of people have also reported diarrhea and vomiting.

Tell employees you don’t want them coming to work sick so they don’t worry about losing their job. Let them know their job is safe if they need to care for someone who is sick or are sick themselves. CDC recommends that people who are sick with novel H1N1 flu stay home for seven days after the onset of illness or at least 24 hours after symptoms have subsided, whichever is longer.

To stay healthy or to stop the spread of the virus, remind your employees to do these four things:

1. Cover their nose and mouth with a tissue when they cough or sneeze and then throw the tissue in the trash.

2. Wash their hands often with soap and water, especially after coughing or sneezing, or use an alcohol-based hand cleaner if soap and water aren’t available.

3. Avoid touching their eyes, nose, or mouth to prevent spreading germs.

4. Try to avoid close contact with sick people.

In order to ensure business continuity, develop a plan to protect your employees and maintain operations during this H1N1 flu outbreak. Companies that provide critical infrastructure services, such as power and telecommunications, have a special responsibility to plan for continued operation in a crisis, including consideration for significant absenteeism. Having a contingency plan is essential.

There are no special precautions for workers who handle or deliver packages, other than practicing good hand hygiene. If soap and water aren’t available to these employees, make sure they have a supply of alcohol-based hand cleaner. Instruct them to use it after each contact with customers, including after sharing a pen with customers.

Although the current H1N1 flu virus is new and scientists are still studying it, studies on other forms of flu viruses have shown that influenza virus can survive on environmental surfaces, such as books, countertops, door knobs, and money, and can infect a person for up to eight hours after being deposited on the surface. It’s important to note that in the transportation and shipping industry, banking institutions, and retail businesses – where money and goods move daily – workers have not shown an increase in infection rates during periods of seasonal influenza. To prevent the spread of the virus, it’s important to keep surfaces, especially commonly touched surfaces, such as work stations, countertops, and bathroom surfaces, clean by wiping them down with a household disinfectant, according to label directions.

Employees who need to travel for business can protect themselves by doing a few simple things. All travelers should wash their hands often with soap and water or use an alcohol-based hand cleaner. Travelers may also want to bring alcohol-based sanitizing wipes that can be used to clean hard surfaces near their seat on the airplane, such as seat arms, seatbelt, fold-down tray, and overhead bins.

For more information on how to stay healthy during travel and any updates on CDC travel notices, please visit CDC’s Travelers’ Health website at www.cdc.gov/travel.

For help in preparing your business for the novel H1N1 flu, visit www.cdc.gov/h1n1flu/business where you’ll find resources, tools, and information for businesses OR call 1-800-CDC-INFO, that’s 1-800-232-4636.

[Announcer] For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO, 24/7.

Page last modified Wednesday, May 20, 2009

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Safer, Healthier People
Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day – cdcinfo@cdc.gov
USA.gov: The U.S. Government’s Official Web PortalHHS.govDepartment of Health and Human Services

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How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.
What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time.
*What if soap and water are not available and alcohol-based products are not allowed in my facility? Updated on Sept 14
If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.
What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.
How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
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.

Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.Eating utensils should be washed either in a dishwasher or by hand with water and soap.
Exposures Not Thought to Spread 2009 H1N1 Flu
Can I get infected with 2009 H1N1 virus from eating or preparing pork?
No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.
Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.
Can 2009 H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.
Can 2009 H1N1 influenza virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of this 2009 H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.
Note: Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to 2009 H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available

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Prevention & Treatment of H1Ni ( & season flu)

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against 2009 H1N1 virus.  However, a 2009 H1N1 vaccine is currently in production and may be ready for the public in the fall. As always, a vaccine will be available to protect against seasonal influenza
There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

Take these everyday steps to protect your health:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.

Other important actions that you can take are:

• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs * (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public while you are sick and contagious.

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. If soap and water are not available, they should use an alcohol-based hand rub.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. CDC recommends that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used.* You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where people have been identified with 2009 H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children, emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• 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

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

Are there medicines to treat 2009 H1N1 infection?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with 2009 H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.

What is CDC’s recommendation regarding “swine flu parties”?
“Swine flu parties” are gatherings during which people have close contact with a person who has 2009 H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity 2009 H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend “swine flu parties” as a way to protect against 2009 H1N1 flu in the future. While the disease seen in the current 2009 H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with 2009 H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.

CDC.gov

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2009 H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.
Why is 2009 H1N1 virus sometimes called “swine flu”?
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. Scientists call this a “quadruple reassortant” virus.

2009 H1N1 Flu in Humans

Are there human infections with 2009 H1N1 virus in the U.S.?
Yes. Human infections with the new H1N1 virus are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.
CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.
Is 2009 H1N1 virus contagious?
CDC has determined that 2009 H1N1 virus is contagious and is spreading from human to human.
How does 2009 H1N1 virus spread?
Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
What are the signs and symptoms of this virus in people?
The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and death has occurred as a result of illness associated with this virus.
How severe is illness associated with 2009 H1N1 flu virus?
Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.
In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.
One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.
How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.
When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.
How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

CDC.gov

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Why do scientists warn it may take two doses of vaccine to protect against swine flu when one dose is the norm in a regular flu season? Blame your naive immune system.

It takes the immune system a while to ramp up to fight unique types of influenza. Since we’ve never been exposed to this brand-new virus, formally called the 2009 H1N1 strain, scientists assume our bodies will act like those of young children.

When children under age 9 get their first flu vaccine — the kind that protects against regular winter flu — one dose doesn’t spark as much immune protection as the doses they’ll get over the next years. So those first-timers are given two shots, a month apart, for good protection.

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By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer Sun Aug 30,

WASHINGTON – When is swine flu just miserable and when do you need a doctor?

If it’s hard to breathe, that’s an emergency. It’s the not-so-obvious cases that can have parents, or the sick of any age, fretting.

“There tends to be a lot of hysteria,” said Dr. Nathan Litman of the Children’s Hospital at Montefiore Medical Center in New York. “We should try to emphasize the prevention mode, and the rational approach to dealing with the illness rather than when the child has a runny nose running to the emergency room.”

Symptoms of any flu include fever of 100 degrees or more, cough, body chills and aches, congestion. Diarrhea and vomiting sometimes occur, particularly with the swine flu that doctors call the 2009 H1N1 flu.

Regardless of the strain, most people who otherwise are healthy need to stay home and rest, and get plenty of fluids, health officials agree.

But there’s a catch. Not everyone with swine flu gets a fever, making it hard to know if they’ve got that or a common cold.

That doesn’t happen too often, although there are no good statistics and no one knows if those people even are as contagious as the fevered, said Dr. Anne Schuchat, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases. But generally, people without a fever don’t get as sick.

Signs to seek emergency care include shortness of breath, chest pain or pressure, confusion or seizures, persistent vomiting or inability to hold down liquids, bluish lips.

Who’s at higher risk from any kind of flu?

Pregnant women; people of any age with heart disease, asthma, diabetes and other chronic illnesses; children under 2; people over 65.

While the over-65 tend not to catch swine flu, they are prime targets of the regular winter flu — and there’s no way for patients to tell the two apart.

Litman said doctors would rather get a call from or see a high-risk person “sooner rather than later” to decide if they need the anti-flu medications Tamiflu or Relenza. The drugs work best if taken within the first 48 hours of symptoms.

If fever goes away and then a new one sets in days later, seek medical care, Litman said. That can be a sign of bacterial infections that sometimes follow any type of flu.

For children, pediatricians advise watching activity levels. Being listless or lethargic can be a warning sign of worsening illness.

What if people without insurance can’t afford the $100 or so anti-flu drugs? The government has shipped millions of doses from a federal stockpile to the states, and in what’s being cited as a model program, Texas is using its stockpiled supply in part for those patients.

Doctors certify the person’s lack of insurance coverage when they write the prescription and direct the patient to certain pharmacies. The goal is to have at least one pharmacy in every county that then fills the prescription for free or a nominal fee, said the state’s health commissioner, David Lakey.

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On the Net:

Centers for Disease Control and Prevention background: http://www.cdc.gov/h1n1flu/h1n1flu

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