In April, Mexico reported cases of novel influenza A(H1N1) infection in human beings, previously identified as swine flu, and never before found in humans.

On April 24, the World Health Organization (WHO) alerted the governments about the risks connected with the spread of this new influenza in human beings and a potential pandemic, thus rapidly raising alert levels regarding preparation and response planning activities to combat the pandemic. On 11 June, WHO raised the worldwide pandemic alert level to phase 6, by declaring a pandemic period of the new flu type, i.e., increased and prolonged community level outbreaks in numerous countries worldwide, while also emphasising the “moderate” character of this pandemic. As Deputy Health Minister Ferruccio Fazio pointed out, peak alert levels for this new influenza “are not due to the seriousness of the symptoms, but to the worldwide-level outbreak of the virus”.

The Ministry of Health has set up a special Crisis unit headed by Deputy Health Minister Ferruccio Fazio, to monitor and prevent the spread of the new A (H1N1) virus that first caused illness in Mexico and later in the United States. The crisis unit works in partnership with the international Authorities.

WHO is not recommending travel restrictions also in the pandemic phase, but suggests that people suffering from diabetes, cancer or other chronic health conditions, or pregnant women, should be particularly careful and delay their international travel plans.

Moreover, people suffering from flu-like symptoms similar to the infection caused by the A(H1N1) virus after returning from international trips, should seek medical advice. In Italy, containment and surveillance measures that had been set out in phase 5 have remained unchanged. A circular dated 20 May 2009, which contains guidelines for operators, updates the previous two circulars, respectively dated 28 April and 2 May. Preventive treatment measures against swine flu for passengers returning from Mexico are regulated by Ministerial decree dated 4 May, through to 31 July 2009. Italy has agreed a specific Plan with other EU countries for preparation and response activities to the spread of a potential flu pandemic; it also has large supplies of antiviral drugs that can be used in case of need. Vaccination remains the best illness prevention measure.

A specific vaccine against swine flu is not yet available, and could be ready this autumn.

At a press conference held on 15 July, Minister Maurizio Sacconi and Deputy Health Minister Fazio explained the strategic purpose of flu vaccination as a preventive measure, according to the guidelines issued and circulated by the World Health Organization on 13 July. In particular, based on estimates concerning vaccine availability by next autumn, the Ministry is planning on vaccinating 40 per cent of the population, of which almost nine million people by 31 December 2009, and the rest in the early months of 2010. National supplies of antiviral drugs will also be increased for the preventive treatment and cure of ill people.

Source: Ministry of Health
 

ANSWERS TO FAQ

Has Italy reported cases of swine flu?

Istituto Superiore di Sanità (Italian National Institute of Health) has confirmed that, after the first reported case in Italy on 2 May, the number of people infected has gone up to 56, all treated with antiviral drugs.

Where can I find information updates about the current situation both abroad and at home?

The Ministry has activated several information channels:
for the media – the press office issues two daily bulletins, which can be viewed from the press release archive; for operators – the Office of Infectious Diseases of the General Heath Prevention Department issues memos to the Regions and the independent Provinces under the section Epidemic events abroad; for the general public: the internet portal with dedicated pages and updates, and the call centre 1500, open every day, from 8:00 am to 8:00 pm.

What should the inhabitants of an area where a case of swine flu has been reported do?

The first prevention method is information about the new flu: actual risks and prevention measures, the treatments available and any provisions set out by central and local authorities. It must be said that at the moment, the new virus shows softer symptoms than ordinary seasonal flu symptoms, and risk of contagion is relatively small, although ongoing flu activity is widely accepted as a fact. Furthermore, surveillance networks have already identified all the people that came into contact with the sick person/with the virus – including family members, flight companions at risk, and people that may have touched objects potentially contaminated by respiratory secretions; they have been found and treated with antiviral drugs. It should be noted that passengers at risk are identified among passengers sitting two rows in front and two rows behind on long distance flights (at least 4 hours), through coughs or sneezes, for example.

Finally, respiratory hygiene (using disposable tissues when sneezing and coughing, and avoiding close contact if feeling unwell) and making a simple gesture like washing your hands with water and soap mostly after sneezing or coughing, is the very first and basic preventive measure - although much neglected - which is recommended by all international prevention centres. If you have flu symptoms, you should first of all consult your doctor.

What is swine flu?

Swine flu is a viral infection of the respiratory system and has flu-like symptoms such as: temperature, cough, sore throat and general body aches. Like traditional influenza, this new flu type poses the potential to cause complications associated with pneumonia and deaths. The first reported human cases of swine flu were caused by close contact with pigs; the new A/H1N1 virus is in fact a virus of swine origin. Human cases of swine influenza have been occasionally reported since the 1950s, and are associated with exposure and close contact (1-2 m) with pigs; however, the new A/H1N1 virus has now adapted to humans, resulting in human-to-human transmission. Swine flu is not transmitted through food, and despite the first reported human cases of swine flu, there is no risk of infection from consumption of cooked pork or pork meat products. Given this is a new virus, vaccination using traditional flu vaccines (seasonal vaccines) is highly unlikely to be effective; vaccination against seasonal flu is nonetheless a recommended precautionary measure when travelling.

What is the origin of the new influenza?

When influenza viruses from different animal species infect pigs, the viruses may “reassort”, and new viruses that are a mix of human/avian/swine influenza can emerge. Over the years, different variations of swine flu viruses have emerged. So far, 4 main influenza A sub-types have been identified in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated viruses in pigs have been H1N1 viruses.

What are the symptoms of swine flu in humans?

The symptoms of swine flu are similar to the symptoms of seasonal flu and include: fever, drowsiness, loss of appetite and cough. Some people have reported runny or stuffy nose, sore throat, nausea, vomiting and diarrhoea.

How serious is swine flu in humans?

Like seasonal flu, swine flu in humans may manifest itself with slight or serious symptoms, and like seasonal flu, it may cause chronic health conditions to get worse. Cases of serious complications (pneumonia and respiratory failure) have been reported in the past, as well as deaths associated with A/H1N1 virus infections.

Can people catch swine flu from eating pork?

No. Swine flu viruses are not transmitted by food. You cannot get swine influenza from eating pork or pork meat products. Properly handled and cooked pork meat and pork meat products are safe to eat. Cooking pork to an internal temperature of 70-80° kills the flu virus, as it does other bacteria and viruses.

How does swine flu spread?

Human-to-human transmission of swine flu may occur through coughing or sneezing, or indirectly, by touching hands infected with respiratory secretions. Hence, good hand and respiratory hygiene etiquette practices are essential, as they can limit the spread of swine flu.

For how long can an infected person transmit swine flu from novel A/H1N1 virus to other people?

People infected with swine flu are considered potentially contagious for as long as they feel the symptoms, normally 7 days from the time the first signs of flu appear, plus the day prior to the beginning of the symptoms. Small children in particular, can potentially spread the virus for longer periods of time. How can swine flu be diagnosed in humans? In order to diagnose swine influenza A infection, a respiratory specimen would have to be collected (nasal or pharyngeal tampon) within the first 4 – 5 days from the time the first symptoms appear (when a person is more likely to be shedding the virus). However, some people, and children in particular, can shed the flu virus for 10 days or longer. Identification of the virus requires sending the specimen to a Laboratory for laboratory testing. It is up to your doctor to direct a suspected case of swine flu to the relevant laboratory.

Are there any health checks or quarantine plans in place for passengers returning from Mexico?

With Circular dated 2 May, the Ministry has set up separate arrival areas and strict health control measures for passengers returning from Mexico. All passengers and crew members returning from Mexico will receive all the necessary information from the Ministry of Maritime, Air and Border Health Office (USMAF), also with reference to time taken off work. Passengers with flu symptoms will be referred to the relevant health care units, while passengers with no reported symptoms will be invited to receive medical checks at home for seven days. Please refer to the ministerial circular dated 2 May.

At present, the measures previously implemented remain in place for flight arrivals from all the other countries, including areas with reported cases of infection and the USA. In particular, the compulsory transmission of the health part of the aircraft general declaration, duly filled out as regards the health of passengers and crew members during the flight, has been requested. As to ships, the exclusion of a radio issue of pratique (permission granted to disembark and embark passengers and goods after quarantine or on showing a clean bill of health) to any ship docking in infected areas has been requested; for those areas, a pratique  is issued on board the ship, after all checks have been performed.

(last update: 20 July 2009)

What are the precautions that travellers returning from other centres of infection of the A influenza virus should take?

Passengers returning from areas with pandemic activity should monitor their health for 7 days, as indicated in the leaflets handed out in airports upon their arrival. A doctor should be contacted by telephone and consulted on the onset of influenza symptoms, such as fever, drowsiness, loss of appetite and cough, and follow his/her medical advice: limit contact with family members, wear a mask, use a disposable tissue to cover their mouth and nose when sneezing or coughing. All individuals are urged to wash their hands frequently, either with water and soap or alcohol-based detergent. It should be remembered that human-to-human transmission of the virus occurs through oral secretions of saliva being shed when coughing or sneezing, but also indirectly, through contact with hands infected by respiratory secretions. In any event, patients should be referred to their doctor, who will assess the pharmacological treatment to prescribe.

Source: OMS/CDC and Ministry of Labour, Health and Social Policies – Health Prevention Department