Prevent the Flu e-Workbook

Disease Prevention – Preventing Seasonal and Pandemic Flu

The importance of prevention:

It is best to think about the flu before you become sick and to practice means of prevention rather than waiting until you get sick to act. Adopting these simple prevention behaviours will not only be useful in preventing the flu, but can also help protect you and your family from other infectious diseases, including the common cold. Traditional medicine can also be effective in preventing and treating the flu, so you may want to speak to an Elder or healer about the traditional medicines and health products that could help you.

It is especially important to do these things because, during an influenza (flu) pandemic, there may be shortages of medical supplies and beds in hospitals, and access to health professionals in general may become limited.

The flu:

Influenza is an infection of the airways caused by a virus that is common in Canada, especially in the winter. The influenza virus can also cause bronchitis and pneumonia. It spreads through direct contact with an infected person, through virus particles in the air (from coughing and sneezing), and from direct contact with contaminated objects, such as doorknobs and toys. The virus can live on these inanimate objects for days. When a person touches a flu-contaminated object the virus enters the body from the hand to the mouth, nose, or eyes. People who are infected can spread the flu virus for up to two days before they have any symptoms. Influenza spreads quickly and easily and causes headache, fever, chills, cough, sore throat, muscle weakness, tiredness, and loss of appetite. It can also cause complications for people with other health conditions such as diabetes, heart disease, or cancer. Every year there are flu- related deaths in Canada and between 10% and 25% of Canadians get the flu.

Once flu symptoms begin, most adults can spread the virus for about five days. Children and people who have weakened immune systems can spread the virus for up to two weeks.

The influenza virus changes quickly and often resulting in many different strains of the virus. There are changes almost every year. The immune system treats each change as a new virus and as a result infection or immunization with one strain does not provide immune system protection against another strain. A person who has had the flu one year can still get the flu again, multiple times. The frequent changes of the virus make development of a vaccine difficult. In order to produce a vaccine in time for the annual flu season, scientists have to use formulas to try to predict which strain of the vaccine will be circulating among the population. The vaccine changes each year to provide protection to the strains that have been predicted to be the most common for the current year’s flu season. This means that some people who are vaccinated may still get the flu because they may catch a strain of the flu that was not included in the vaccine. The flu virus can also change in a way that makes it even more different. When this occurs, the new virus can cause a flu pandemic because it is totally new and almost all people are susceptible to it.

With the pandemic H1N1 flu (swine flu) that is currently circulating in First Nations communities and other communities across Canada, all people are at risk of developing flu symptoms. In Canada, from April to July 2009, about 26% of severe cases of pandemic H1N1 were in Aboriginal People and about 67% of hospitalized patients were women. The average age for hospital admission with pandemic H1N1 was 32 years. Young, healthy people have been getting sick with the flu. Pregnant women and people with other health conditions are at increased risk of developing complications. These people must take great care to ensure that they regularly wash their hands, and to use other flu prevention measures discussed in this workbook. Pregnant women in particular should know the symptoms of the flu and should speak to a health care provider if these symptoms develop, especially if they get worse.

There are treatments for influenza; however they must be given within 48 hours of the beginning of symptoms to be effective. A section on anti-viral flu treatments is included later in this e-workbook.

What is a flu pandemic?

A pandemic occurs when there is a worldwide outbreak of a disease at rates that are higher than normal.  A flu pandemic, as opposed to the regular, annual seasonal flu, occurs when there is a new flu virus in circulation to which people have not previously been exposed. However, the use of the term ‘pandemic’ does not necessarily mean that a severe illness is circulating worldwide. Pandemic illnesses can be mild or severe, and the degree of severity can change over the course of a pandemic.

Nevertheless, some flu pandemics in the past have been particularly infectious and caused a relatively high number of deaths. For example, the flu pandemic of 1918-1919 (commonly called the Spanish flu) caused between 40 and 50 million deaths and almost one-third of the world’s population got sick. While this seems very high, it should be remembered that 97% of people who got the Spanish flu survived, even without the use of antiviral medications or vaccines that had not yet been developed at the time.

As noted above, pandemic flu is different from the more common ‘seasonal flu’. Seasonal flu follows a predictable pattern and because there are usually more cases in the winter months, this time of year is referred to as the ‘flu season’. Seasonal flu is responsible for the deaths of between 4000 and 8000 Canadians from associated flu complications each year. Pandemic flu, on the other hand, does not follow the same pattern, although it also occurs in cycles. In the 20th century there were three flu pandemics: the previously mentioned 1918 Spanish flu, the 1957 Asian flu, and the 1968 Hong Kong flu. Since the seasonal flu occurs annually, it will continue to circulate even in times of pandemic flu.

Seasonal flu does not usually cause complications in healthy adults. The elderly, children and infants, and people with other health conditions are generally at greater risk.  Pandemic flu, however, may cause illness in otherwise apparently healthy people including young adults and adults

The health system can usually cope fairly well with seasonal flu outbreaks. However, in times of pandemic flu, it may become strained and therefore it may be harder to see a doctor when more people than usual could be sick at the same time. There may also be shortages of medical supplies and shortages of spaces and beds in hospitals. Every year even the seasonal flu causes people to miss days of work, but pandemic flu may cause many more people than usual to be sick at the same time. This may have impacts on daily activities since many of your co-workers might be sick at the same time. Even health care providers may have to stay home with the flu, as well as other vital professionals such as teachers, police officers, and firefighters. In fact, experts have predicted that there could be significant increases in work absentee rates in Canada. Many businesses and most public services have developed plans to cope with these potential losses.  Some examples of coping measures you might be able to adapt include allowing employees to work from home whenever possible, to reduce the amount of exposure an employee has with a potentially sick co-worker, and designating a co-worker to cover assignments and tasks in the event that you or your co-worker will need miss work. For coping measures with reduced medical and emergency personnel, please see the First Nations Centre’s Emergency Preparedness E-workbook.

It is important to realize that pandemic flu occurs in waves. The second wave generally follows between six and nine months after the first wave (although there can be several more waves as well). Because pandemic flu can last for months, it is important for you to follow the recommended practices in order to protect the health and safety of yourself and your loved ones. In other words, prevention measures need to become part of your daily habits to provide the most protection from the flu.

The World Health Organization considers the current H1N1 flu pandemic to be of moderate severity, which means that the vast majority of people who get sick will recover without the need for medical care.

The flu vaccine given for the annual flu season will not likely provide any protection against the H1N1 or Swine Flu. However, this shot may provide some protection against the annual flu that will be circulating at the same time as the pandemic flu strain. As mentioned above, the seasonal flu shot does not guarantee protection from seasonal flu. The Public Health Agency of Canada recommends the seasonal flu shot for everyone, especially people at high risk for flu complications. This includes the elderly, pregnant women, children, anyone with a chronic health condition, and health professionals. Some studies have found that the seasonal flu vaccine is not effective at preventing the flu for children under 2 years of age or for the elderly living in community and group homes. (Rivetti et al., 2009; Jefferson et al., 2009)New vaccines for the pandemic H1N1 flu (or Swine Flu) are being developed and tested and will be available in early November. You are not required to get the flu shot or the new pandemic H1N1 vaccine. Since vaccines are not risk free, you are free to make the decision regarding vaccination for yourself and your children.

Symptoms of the Flu:

The flu usually begins with sneezing and a runny nose. Other symptoms that are common in the beginning are sore throat, muscle aches, headache, and muscle weakness. Other flu symptoms include:

• Fever,
• Cough,
• Shortness of Breath,
• Nausea, Vomiting, and Diarrhea.

With the flu, because of fever, vomiting, and diarrhea, it is important to be able to recognize signs of dehydration. The signs of dehydration include mouth dryness, decreased saliva, low volume of urine (infrequent urination), darker urine, sunken eyes, low blood pressure (noticeable when sitting up from lying down or when standing from a sitting position), fast heart rate (especially when changing to standing or sitting from lying down).

How is the flu different from “the common cold”?

Flu symptoms can be different and are more severe than cold symptoms

• The flu causes a high fever but colds hardly ever cause fever.
• The flu can cause headaches and severe headaches. Colds rarely cause headaches.
• The flu causes general aches and pains, and fatigue and weakness that can be severe and may last for weeks. Colds can also cause these symptoms, however they are milder than with the flu.
• Extreme fatigue is common with the flu and can be severe. It is not often caused by colds.
• Chest discomfort and coughing with the flu can be severe. With colds these symptoms occur occasionally but are not as severe as with the flu.
• Common symptoms of colds, such as runny, stuffy nose; sneezing; and sore throat can also occur with the flu.

Complications from the flu can be much more severe. While complications from colds may include sinus congestion or earache, the flu can lead to pneumonia and, in rare cases, respiratory failure. The flu can make other respiratory conditions worse and can endanger a person’s life.

You can download a Ways You Can protect Yourself From the Flu e- workbook to write in your own answers to the questions below either by printing the  E- Workbook or by saving the file and typing in your answers.

Handwashing

Handwashing is one of the most important flu prevention technique. It is therefore crucial to wash your hands frequently, especially during a flu pandemic or even during the regular flu season. If you don’t have the flu, handwashing is an important way to avoid getting it and if you already have the flu, handwashing can protect your friends and family and anyone else you come in contact with.

Wash your hands after you have any contact with a sick person. You should also wash your hands before eating or preparing any food and after touching any objects that may have been in contact with a sick person. If you don’t have a chance to wash your hands right away, at least avoid touching your face, especially your nose, eyes, and mouth. If you already have the flu, be sure to wash your hands after coughing, sneezing, and blowing your nose to prevent spreading your flu germs.

Use the following handwashing technique:

• Put a small amount of liquid soap in the palm of one hand. (Liquid soap is more hygienic. If bar soap is the only option make sure it is stored on a rack so that the bar is not sitting in water. Bar soaps stay moist and germs can live on them.)
• Rub your hands together for 20 seconds to produce a lather. Scrub between your fingers, under your fingernails, and the backs of your hands.
• Rinse your hands well with running water for at least 10 seconds. Try not to touch the faucets once your hands are clean. Use a towel to turn off the water.
• Dry your hands using a towel. Change the hand towel every day. During a flu pandemic and during the regular cold and flu season you may want to give each sick family member his/her own hand towel.
• Model good handwashing technique to children and teach them the amount of time required to clean their hands properly.

Adapted from the Public Health Agency of Canada:http://www.phac-aspc.gc.ca/chn-rcs/handwash-eng.php

Remember to wash your hands after being in public places, like the grocery store (since the grocery cart handle is a great place to contact flu viruses) and public transportation (since the handrails are likely flu virus spots).

Despite popular belief to the contrary, you don’t need special soaps for handwashing. Regular soap will clean your hands. It is the combination of soap, rubbing your hands together, rinsing , and drying that helps remove germs from your hands. Correct handwashing technique includes friction (rubbing your soapy hands together), and washing between the fingers and under the fingernails. The back and outside area of the thumb is commonly missed. Ideally, you should wash your hands for at least 20 seconds. Teach children to sing “happy birthday”, “twinkle twinkle little star” or a similar song twice while washing their hands. It is important to dry your hands if there are clean hand towels or paper towels available. If you are using a public bathroom, you should use a paper towel to turn off the tap whenever possible, so that you can avoid recontamination of your hands. Try not to touch the doorknob on your way out of the bathroom by using the paper towel if possible.

Alcohol-based hand sanitizers are a good alternative to hand washing if there is no way to wash your hands with soap and water, although these sanitizers are less effective if your hands are visibly dirty. If no running water is available, you can wash your hands using 2 separate containers. One container will hold the water supply and the second is used to wash your hands. Moving soapy hands in a container of water can mimic running water. Be sure to throw away the water used to wash your hands once you’ve finished and clean and dry the container. If you usually have to boil your water before drinking it, you can still use this water, with soap, to wash your hands. Bring the water to a rolling boil and boil it for one minute.

Another option is to treat the water using emergency water treatment (1 drop or 0.05mL of liquid household bleach with 5% chlorine and 1 litre of water. Mix and let stand for 30 minutes before using).  If the wrong bleach or the wrong amount of bleach is used this method can pose health risks. Please follow your regional or provincial recommendations for treating water.  Once the water has been boiled or treated, wash your hands using the 2 container method from above for when running water is unavailable. Pre-moistened towlettes used for cleaning babies during diaper changes are not effective at cleaning hands and should not be used as a substitute for handwashing. Alcohol-free hand sanitizers may be an option however they are less effective than alcohol-based hand sanitizers and are less commonly available.  These products can actually support the growth of some bacteria if not stored properly and can cause allergic reactions for some people. At this time there are no alcohol-free hand sanitizers recommended by the World Health Organization or the Public Health Agency of Canada. The Public Health Agency of Canada has some handwashing tips on the following website: http://www.phac-aspc.gc.ca/alert-alerte/h1n1/public/handhygiene-eng.php

Your first choice for hand washing should be regular soap and water. If this option is not available you can use alcohol-based hand sanitizers. If access to either of these is not available then you should use alcohol-free hand sanitizer.

If there is an outbreak of the flu in your community, it is important to continue with your regular daily activities. Listen to public health or band council direction regarding school closures and public events. It may be wise to try to avoid any unnecessary trips to crowded public events. If you do go to public events, try to give yourself as much space as possible from other people, wash your hands as frequently as possible, and try not to touch your mouth, nose, or eyes until you’ve washed your hands. The use of alcohol based sanitizer may be an option in these situations. If possible avoid shaking hands or hugging the people you meet to avoid putting yourself at increased risk of contacting flu viruses. Because pregnant women in particular are at increased risks for complications from H1N1, they should take extra care to wash their hands and avoid contact with sick people.

It is a good idea for all people to avoid touching public doorknobs and door handles as much as possible. When possible use your arm or elbow instead of your hands to push open doors because this will keep your hands clean and help prevent you from transferring any flu viruses into your body.

Surgical masks can also be used for protection from the flu if you must be in close contact with someone who has the flu. However, improper use of surgical masks can actually put you at greater risk of getting the flu. This is because masks worn for an extended period of time do not provide an effective barrier to the flu virus. Additionally, if you put the mask on or take it off incorrectly you can spread to your hands and face. If you do decide to use a mask, you should wash your hands before putting  it on. You should only use it once, and only until it gets moist. When you want to remove the mask, wash your hands, take the mask off using the straps, throw it out, and then wash your hands again.

Flu prevention checklist:

• Wash hands before eating and preparing meals
• Wash hands before feeding children – including breastfeeding
• Wash hands after touching objects that may have been in contact with a sick person (i.e. grocery cart/basket, public door handles, public telephone, elevator buttons, computer keyboard, etc.)
• Have children wash hands after playing with shared toys
• Avoid touching eyes, nose, mouth until able to wash hands
• If possible, carry a small hand sanitizer for situations when hand washing is not possible
• Avoid (whenever possible) people who are sick with the flu or flu-like symptoms
• Disinfect hard household surfaces such as doorknobs
• Avoid optional public gatherings, or at least avoid close interpersonal contact as much as possible if there is a flu outbreak in the area/community

Before the flu season or the next wave of pandemic flu, there are other things that you can do to help boost your immune system in case you come into contact with the flu virus.

Eating well, staying hydrated, staying active, managing stress, and getting enough sleep help keep your immune system ready to fight off the flu virus.  Infants, children, and adults can help strengthen their immune system by eating plenty of healthy foods. Vegetables and fruits are full of immune system boosters, such as vitamins and minerals.

Important vitamins for disease prevention:

Vitamin D has been found to have antiviral properties.  You can get vitamin D from sun exposure, however your body’s ability to create vitamin D varies based on latitude, season, age, sunscreen use, time of day, and skin pigmentation. During the winter natural vitamin D production from the sun decreases. Dietary sources of vitamin D include fatty fish (ie. salmon, mackerel, whitefish, and char), and egg yolk.

Niacin (vitamin B3) also has been found to have antiviral properties.  Sources of niacin include barley, beef, fish, chicken, and almonds.

Vitamin C has been shown to have effects on the duration and severity of the flu. All fruits and vegetables have some amount of vitamin C. The best sources of vitamin C include: green and red peppers, citrus fruits, strawberries, broccoli, tomatoes, and leafy greens.

Thiamine (vitamin B1) is found in whole wheat, oatmeal, corn, most beans, and most vegetables.  Thiamine has been found to have anti-viral properties.

Herbal Immune Boosters

• Echinacea is a well known immune system booster and can be used on a continual basis. It stimulates the production of interferon which is produced by the body to fight and prevent infections
• Elderberry can prevent infections and shorten the duration of the flu.
• Licorice can help stimulate production of interferon.
• Larch tree extract has many immune enhancing properties.
• Ginseng can be used as an energy booster, anti-inflammatory, and to treat flu symptoms.
• Garlic can help prevent infections.
• Wheatgrass can be taken in juice form to boost the production of interferon.

• Activity: Ways to protect myself
• Identify things you can do in these various situations to protect yourself from the flu to help you to remember.
• At work:
• At public places (like the store):
• At social events:
• How can I limit contact with others if necessary:
• When a family members gets sick:
• My questions for my health care provider are:
• I have concerns about:
• My back-up plan if I get sick and I can’t go to work:
• My back-up plan for if a family member gets sick and can’t go to school/work:

Ways you can prevent the spread of the flu within your home

The flu spreads quickly and easily and many community members may be sick during a pandemic. At some point a member of your family may become sick. Fortunately, there are some things that you can do around the house to prevent the flu from spreading.

You can teach your children about hygiene. Teach them to wash their hands often, using soap , water, and the proper handwashing technique. Be a good role model for them by practicing good handwashing yourself. Children should be taught to cover their coughs and sneezes using a tissue, their sleeve, or their elbow.

When someone gets sick they should be placed in rooms that are well ventilated, if at all possible.  This will help reduce the amount of virus in the air. The sick person’s dirty clothes, bed linens, and towels will need to be washed and dried, ideally with hot water if at all possible. These items can be dried outside in the sun since the sun has ability to kill the virus. Try to avoid sharing any personal items or drinks with the sick person. The sick person’s dishes and cutlery need to be washed using soapy water. They do not need to be cleaned separately.

You have probably been told since you were a child that is polite to cover your coughs and sneezes. This is a good flu prevention technique; however, you should be aware that if you are sick with the flu, coughing and sneezing into your hands can actually spread the virus. To prevent the spread of flu germs, you should cough or sneeze into your sleeve, your elbow, or a tissue. This will prevent some of the viruses in your cough or sneeze from being inhaled by someone else, keeps your hands clean, and  prevent you from leaving the flu virus on any surfaces that you touch. After you blow your nose, be sure to immediately throw away the tissue and wash your hands.

Wash all hard surfaces, including any toys played with by sick children, with soap and water to disinfect them. Alternatively, you can use a bleach-based disinfectant or other household disinfectant to clean these surfaces. You can make a bleach-based cleaner for these surfaces by mixing  1 part bleach for every 10 parts water. No matter what type of cleaning solution that you use, don’t forget to disinfect commonly touched items such as television remote control and door knobs, since the virus can live on these surfaces for up to 2 days. While you might think that the bathroom is the most likely place for the flu virus to hide, people often do not realize that viruses can thrive in the kitchen as well. Try to disinfect the kitchen counters and sink everyday with soap and water. You do not need to use antibacterial soaps. You can also try using other cleansers, bleach, ammonia, or vinegar to kill the germs.

Remember that sick people need to get rest. In other words, they should not have too many visitors. This will help them get the rest they need while preventing potential visitors from catching the flu themselves. People with the flu need to drink fluids (especially clear fluids like water, juice, tea, etc.) and eat nutritious foods.

Sick people should stay at home so that they don’t infect other people. If you are sick, you should stay home for at least 24 hours after the fever is gone (if you are using fever-reducing medication you’ll have to stay home longer). The same advice applies to sick children. If your kids get sick they should stay home from school if at all possible.

Things I can do to prevent the flu:

1. Examples: Disinfect the computer keyboard and clean the bathroom faucets.

2.

3.

4.

5.

Important numbers in case I get sick

In case you end up with the flu, in this section you can record important numbers and keep them in an easily accessible location so that you can refer to them as needed.

Person	Number
Work Contact:
Someone to look after the kids:
Health Centre:
Nurse Hotline:
School:
Other:

Final Tips

Disease prevention does not require you to use any expensive or fancy measures. Simply washing your hands often is an important step in the prevention of the flu.

There is no way to guarantee that you will not get sick with the flu or other infectious diseases and despite your best prevention efforts, you may get the flu. Therefore, in case you or a family member get the flu, reduce your stress and anxiety by taking some steps to be prepared for the flu and its symptoms. Keep a supply of tissues in your house. You should also remember to have soap available and any other items that you might need if you were to get sick and not be able to leave your house for a few days. The First Nations Centre has developed an emergency preparedness e-workbook that will give you tips on the essential items to keep in your house in case of a situation such as this.

Facts

Antivirals are drugs that can be used to prevent spread of the flu and treat the symptoms. They are most effective if they are taken within the first 48 hours of the beginning of symptoms. After this time, they will not be as effective and may not be useful. This is important to keep in mind because even if these drugs are available, they might not work. Using them when it is not appropriate can actually make the flu virus change to be able to resist the drugs. The new virus can be passed on to people that may have a more severe case and the antivirals will be needed but not effective.

The Public Health Agency of Canada recommends the use of antivirals only for people with severe cases of the flu and people who are at high risk for flu complications. Some recent studies have found that antivirals may have side effects in children, including vomiting, and dehydration, and therefore should only be used on the advice of a health care professional.  Antivirals should not be used for prevention of the flu, and people in the high-risk groups or with severe illness should speak to their health care provider.  The decision to use antivirals will be made by the patient’s doctor.

Although the name “swine flu” may make you think that pigs and pork are unsafe, this is not the case. The name “swine flu” comes from the fact the origins of this particular strain of flu came from pigs. Both pigs and birds (avian flu) can have the flu. Their flu viruses can sometimes be passed to people, usually those in close contact with the animals. In order to be transmitted from human to human the virus must undergo changes that make it a different virus than the original one infecting pigs.

The H1N1 flu is not transmitted from properly handled pork to humans. The temperatures used to cook pork will kill the virus. You should use proper food handling and cooking procedures with pork, as you do with all other meat. You should always wash your hands after handling any meat.

For more information see:

H1N1 Flu Facts

Public health Agency of Canada

Handwashing Techniques

Canadian Coalition for Immunization Awareness & Promotion

Good Home Treatment of Influenza

World Health Organization

WHO Clean Hands Protect Against Infection

Centre for Desease Control and Protection

Turtle Island H1N1 Planning

Canada’s Food Guide for Aboriginals

Vaccination Risk Awareness Network

How to Disinfect Drinking Water

References

Jefferson, T., Rivetti, A., Harnden, A., Di Pietrantonj, C., &Demicheli, V. (2009). Vaccines for preventing influenza in healthy children (Review). The Cochrane Collaboration. 3.

Rivetti, D., Jefferson, T., Thomas, R.E., Rudin, M., Rivetti, A., Di Pietrantonj, C., & Demicheli, V. (2009). Vaccines for preventing influenza in the elderly (Review). The Cochrane Collaboration. 3

The FNC welcomes feedback on our publications.  To provide feedback or obtain

printed copies of any of our resources please contact:  fnc@naho.ca

Last Update: February 03 2011