Fact Sheet: 2009-H1N1, Pandemic Influenza, and H5N1

This information is current as of today,

Current Situation – 2009-H1N1 Influenza A

2009-H1N1 influenza (sometimes referred to as novel H1N1 or “swine flu”) is a new virus causing illness in humans.  It was first detected in people in the United States in April 2009, and the symptoms  resemble those of seasonal flu.  The virus spreads from person to person.  Although it is sometimes referred to as "swine flu," people cannot catch 2009-H1N1 by eating pork products that have been properly prepared.

In June 2009, the World Health Organization (WHO) labeled the outbreak a pandemic to reflect its worldwide spread.  Even though the 2009-H1N1 virus is highly infectious, the pandemic was not considered to be “severe.”  In addition to efficient and wide-spread infectivity, a severe pandemic would also have a high mortality rate and the potential for exerting a strong impact on the social structure.  The pandemic caused by the 2009-H1N1 virus was, instead, labeled as "moderate" to reflect that most of those infected fully recover.  The WHO declaration caused some nations to initiate or to strengthen pre-existing screening and quarantine procedures for travelers.  

In August 2010, the WHO announced its determination that the post-pandemic period has begun.  The organization stated that the 2009-H1N1 virus is expected to circulate as a seasonal virus for several years, and many people are still susceptible to infection.  Vigilance remains important, since the behavior of the virus as a seasonal virus cannot be reliably predicted.  For more information about the WHO’s determination, visit the WHO website.  Further information about 2009-H1N1 influenza may be found on the Center for Disease Control (HHS/CDC) website, and country-specific information is at the U.S. Department of State website, and on individual Embassy and Consulate web pages.  You may also call the Office of Overseas Citizens Services in the United States for the latest travel information. The Office of Overseas Citizens Services can be reached from 8:00 a.m. until 8:00 p.m. Eastern Daylight Time, Monday through Friday, by calling 1-888-407-4747 from within the U.S. and Canada, or by calling (202) 501-4444 from other countries.

2009-H1N1 Vaccine:  HHS/CDC continues to recommend vaccination against influenza.  Its website notes that the 2010-2011 seasonal influenza vaccine includes protection against the 2009-H1N1 strain in addition to two other influenza strains currently circulating,

Antiviral Drugs for 2009-H1N1:  HHS/CDC recommends the use of oseltamivir and zanamivir (commonly known by their brand names of Tamiflu® and Relenza®) for the treatment of 2009-H1N1 influenza, and, in limited cases, for prevention of 2009-H1N1 influenza.  Guidance for using these antiviral drugs may change as researchers learn more about this virus.

Information on the U.S. Government's overall planning and response effort is available at the federal influenza website.

U.S. Government Pandemic Policy for U.S. Citizens Abroad

The U.S. Government remains concerned about the possibility of a severe influenza pandemic resulting from changes to existing viruses.  The ability of influenza viruses to mutate means there is potential for a highly-infectious but moderate influenza strain, like 2009-H1N1, to mutate to a more lethal strain, or for a highly-lethal strain to mutate to a more infectious strain.  The new strain could cause a severe pandemic threatening economic and social structures worldwide. This fact sheet offers information on measures U.S. citizens can take to prepare for and cope with a severe pandemic.  It also includes information on the U. S. Government’s efforts to plan for and respond to such a pandemic, should one happen.

Once health authorities confirm the start of a severe pandemic, the State Department will assess whether travel is possible and advisable by considering the availability of transport, the likelihood of infection during travel to the United States, issues surrounding departure or arrival screening, the ability of U.S. health institutions to provide care, and other factors. If travel is not inadvisable, the State Department will urge U.S. citizens to consider returning to the United States while commercial transportation is available. (U.S. citizens will be permitted to re-enter the United States, but the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention (HHS/CDC) may quarantine or isolate incoming travelers based on the traveler's health status, whether travel was from or through an area affected by pandemic influenza, or other public health concerns.)

Note that international transportation options may become very limited or unavailable by the time the outbreak moves beyond initially affected countries.  Therefore, the State Department continues its efforts to advise American citizens overseas to consider, well in advance of an outbreak, whether they will return to the United States once a severe pandemic has been officially confirmed, even if the outbreak is in another region.  Persons at high risk during a pandemic should carefully consider their options.  According to HHS/CDC, those at high risk may include:  pregnant women; adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological, or metabolic disorders (including diabetes mellitus); adults and children who have immunosuppression (including that caused by medications or by human immunodeficiency virus); and adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders or other neuromuscular disorders) that can compromise respiratory function.

Evacuations (including non-combatant evacuation operations (NEOs) supported by the Department of Defense) will be considered only if there is a breakdown in civil order that cannot be contained by local authorities and that further threatens the lives of Americans in a particular country.  Even then, such evacuation operations may not be possible or advisable based on other concerns.  Note that, if the U.S. Government does coordinate an evacuation operation, private U.S. citizens may be required to find their own transportation to the departure point.  Note also that private U.S. citizens are required to reimburse the USG for all costs of their evacuation.

Once commercial transportation options become unavailable, American citizens who are still overseas will likely need to remain there during at least the first wave of the pandemic.  U.S. citizens should prepare now for such an eventuality, since there is no reliable way to predict if, or how rapidly, commercial transportation would be disrupted.  Information on how to prepare is contained in the flyer “Options During a Pandemic,” which urges that U.S. citizens maintain adequate provisions (e.g., food, drinkable water, medications, etc.) for a pandemic wave or waves that could last from two to twelve weeks.

Due to legal restrictions, the U.S. Department of State cannot provide U.S. citizens with supplies, medications, or medical treatment.  Therefore, you should carefully weigh the risks of remaining in country versus the risks of traveling, keeping in mind the potential benefits of returning to the United States.  For example, returning to the United States could provide you with greater access to antiviral medications, respirators, face masks, and pandemic vaccine.  Traveling could also increase the potential for exposure to the virus and for being stranded in a third country if flights are diverted or cancelled.

If you remain abroad, U.S. Government assistance to you may be limited by conditions, but, if possible, will include communicating with family and friends on your behalf, monitoring quarantine/detention conditions as permitted by local health authorities, arranging for transfers of funds or granting temporary subsistence loans, and providing information regarding the availability of medical care (you will have to pay for this care yourself).  You should be aware that the U.S. Government cannot demand your immediate release if you are detained or quarantined abroad in accordance with public health and legal authorities.

Current Situation – Avian Influenza A (H5N1)

A different influenza than H1N1 novel influenza, the H5N1 avian influenza is still a cause for concern.  Countries continue to report outbreaks of avian influenza A (H5N1), commonly referred to as "bird flu," in their domestic bird populations.  The infection is now endemic in wild bird populations.  In addition, countries have reported, on a very limited basis, H5N1 infections in other wild and domestic animals.  A small number of confirmed cases of H5N1 among humans have been reported, and approximately 60% of these have resulted in death.  More information is available on the WHO website.  Please refer to that website for the most current information on countries affected by H5N1 and the number of confirmed human cases and deaths.

The vast majority of reported human infections have resulted from direct contact with avian influenza A (H5N1)-infected poultry.  Although there is evidence to suggest very limited human-to-human transmission, primarily in family groups involving close exposure to a critically ill member, there is no evidence to suggest the virus can be easily transmitted from human-to-human in a sustained manner at the present time.  However, HHS/CDC, the WHO, and the U.S. Department of State are concerned about the potential for this virus to adapt or mutate into a strain that could cause a severe, highly lethal influenza pandemic.

HHS/CDC advises, if you travel to or live in countries affected by H5N1 influenza, to avoid poultry farms, contact with animals in live food markets, contact with surfaces that appear to be contaminated with feces or fluids from poultry or other animals, and consumption of poultry and eggs that are not thoroughly cooked.  If you travel to or live in countries affected by H5N1 influenza, you should consider the potential risks of remaining abroad and should keep up to date on the latest medical guidance in the country you are in (or will travel to) so you can make appropriate plans.  Specific information relating to H5N1 influenza, including preventive measures, is available at the HHS/CDC website.  Additional information on H5N1 influenza is available at the WHO website.

Quarantines can quickly be established.  Some countries have restricted (and often prevented) movement into and out of areas where H5N1 outbreaks occurred in poultry within 24 hours.   If the virus evolves into a form that can be easily and repeatedly transmitted from human to human, governments may respond by imposing public health measures that restrict domestic and international movement.  This will limit the U.S. Government's ability to assist you in these countries.  During a pandemic, such measures may be implemented very quickly.

If you plan to travel to a country that has reported outbreaks of avian influenza A (H5N1), or are concerned about H5N1 influenza, you should monitor the HHS/CDC and WHO websites for up-to-date information.  Additional country-specific information can be obtained from the U.S. Department of State website, and from individual Embassy and Consulate web pages.  You may also call the Office of Overseas Citizens Services in the United States for the latest travel information.  The Office of Overseas Citizens Services can be reached from 8:00 a.m. until 8:00 p.m. Eastern Daylight Time, Monday through Friday, by calling 1-888-407-4747 from within the U.S. and Canada, or by calling (202) 501-4444 from other countries.

H5N1 Vaccine:  The Food and Drug Administration approved a vaccine for humans that effectively prevents infection with the H5N1 influenza virus, but is not yet commercially available.

Antiviral Drugs for H5N1:  HHS/CDC research shows that antiviral medications such as oseltamivir and zanamivir (commonly known by their brand names of Tamiflu® and Relenza®) may be effective in treating H5N1 if taken early in the infection, although their effectiveness will not be known with certainty until an H5N1 pandemic strain emerges and is analyzed.

Information on the U.S. Government's overall planning and response effort is available at the federal influenza website.

General Information About Antiviral Drugs

Two of the most common antiviral medications for the treatment of influenza are oseltamivir and zanamivir (also known by their brand names of Tamiflu® and Relenza®).

As with all prescription medications, side effects may occur, and rare-but-serious side effects have been reported with both oseltamivir and zanamivir.  You should consult with your healthcare provider and read the package insert approved by the U.S. Department of Health and Human Services/Food and Drug Administration (HHS/FDA) before taking these medications.  Expired medications should not be taken.

You can get oseltamivir and zanamivir antiviral medications by prescription from a healthcare provider in the United States.  If such medications or adequate medical treatment are not readily available at an overseas location or travel destination, you should discuss with your doctor how to get them before you travel overseas.  More information is available at the HHS/CDC Travelers’ Health website.

The U.S. Department of State has positioned supplies of antiviral medications at its Embassies and Consulates for eligible U.S. Government employees and their dependents.  However, due to legal restrictions and a lack of sufficient resources, the U.S. Department of State cannot provide private U.S. citizens with supplies, medications, or medical treatment in the event of a pandemic.

You should also be aware of the potential health risks posed by counterfeit drugs, including those represented as oseltamivir or zanamivir by scam artists who sell products on the internet or in countries with lax regulations governing the production and distribution of pharmaceutical products.  For more information on counterfeit drugs, please visit HHS/FDA’s website.

Prevention and Response –Taking Charge

Though antiviral medications are an important tool for the treatment and prevention of influenza, according to HHS/CDC, the spread of viral infection can also be reduced by washing hands frequently with soap and water (or an alcohol-based hand cleaner), covering coughs with a tissue, refraining from touching the eyes, nose or mouth, and avoiding close contact with sick individuals.

To reduce the spread of illness, HHS/CDC recommends that you avoid travel if you have flu-like symptoms or are sick with a disease easily spread from person o person.  If you have flu-like symptoms, you should follow the guidance of local health authorities for the isolation of sick persons and should not take public transportation for the duration of the infectious period unless medically cleared to do so.

If you remain in a country experiencing a pandemic, you should also limit exposure to the virus through such measures as avoiding mass transit and public gatherings, and you should take the hygienic precautions outlined above.  For more detailed information on steps you can take to stay healthy, please visit the HHS/CDC website and the U.S. Government’s federal influenza website.

Complete planning guidance on how you can prepare to remain in a foreign country during a pandemic, including advice on stocking food, water, and medical supplies, is available at the federal influenza website.


Embassy and Consulate Web Pages -  http://www.usembassy.gov/

Federal Influenza Website - http://www.flu.gov/

Health and Human Services / U.S. Food And Drug Administration - http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/CounterfeitMedicine/default.htm
The Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA 30333
Telephone: (800) 232-4636
TTY: (888) 232-6348
International: (404) 639-3311
E-Mail: cdcinfo@cdc.gov

The World Health Organization (WHO)
WHO Liaison Office
1889 F Street, NW, Suite 369
Washington, DC 20006
Telephone: (202) 974-3787

U.S. Department of State - http://www.travel.state.gov/travel/travel_1744.html

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