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NMDHB Influenza A(H1N1) - Update 32
27 August 2009
After three months of fervent activity Nelson Marlborough District Health Board's pandemic response is being reassessed.
Nelson Marlborough people are advised to call the national Healthline 0800611 116 for influenza advice as cases of pandemic influenza A H1N1 decrease. Calls to the local freephone line 0800 FLU INFO will still be answered by Procare.
As General Practices are now seeing similar levels of influenza cases as in previous years the DHB's response is being scaled down. With the decrease in volumes of A H1N1 the equipment gathered for the Community Based Assessment Centres is being stored in readiness for future waves of influenza illness.
Health Controller Mike Cummins said, "All indications are that this pandemic is on a downward trend, but it is common for influenza numbers to rise and fall over several months.
"At this stage, it isn't known whether swine flu will re-emerge in coming weeks or months, particularly during the northern hemisphere winter."
He said the Board thanked staff for their significant work in managing the community and hospital response during the pandemic Influenza A H1N1 response.
He said despite a significant amount of staff sickness and absence, there had been minimum impact on elective services, with very few postponements of appointments and procedures.
Mr Cummins said the Board also appreciated the cooperation of both Nelson and Marlborough Primary Health Organisations in meeting the challenges of managing the disease in the community.
"While there is a definite decrease in the number of people presenting with influenza to GPs and hospitals, we should stay alert to how serious influenza can be."
He said pregnant women, and anyone with an underlying medical condition, including asthma should seek medical advice early if they get influenza.
Typical influenza symptoms are fever, cough and sore throat, headache, aches and pains and tiredness. This pandemic influenza can also cause vomiting and diarrhoea. Influenza symptoms are more severe than cold symptoms that include runny or blocked nose, sneezing, a cough and sore throat.
Medical advice is available by phoning your GP or midwife, or Healthline 0800 611 116. Always phone first do not go to a GP or hospital without phoning one of the above. For most people, pandemic influenza will be a mild to moderate illness, and they will recover well at home without needing treatment.
NMDHB Influenza A(H1N1) - Update 30
20 July 2009
Nelson Hospital officials today warned that surgery could be postponed due to high occupancy in the medical ward. Four people in Nelson Hospital have influenza-like symptoms and may have Swine Flu. In Wairau Hospital in Blenheim two people are in hospital with influenza however the occupancy does not indicate the need to postpone surgery.
Nelson Marlborough District Health Board, Health Controller, Mike Cummins said, "People with hospital appointments and procedures scheduled should be aware that changes might need to be made at short notice. However if patients do not receive notice of postponement they should attend as per their original booking.
"Early this morning indications for staff illness looked a lot better than last week which is good news for the hospitals.
"We will continue to monitor the occupancy rate at Nelson Hospital and keep people informed if it becomes necessary to postpone scheduled surgery or appointments."
Mr Cummins advised students and teachers returning to school today that anyone who is sick should stay at home until they were essentially well.
Most people with influenza will begin to feel better after a few days. Sometimes complications, such as asthma, pneumonia or heart problems arise and the ill person may need to medical advice. These complications can develop with seasonal influenza as well as the new pandemic influenza.
Seek advice from the local 0800 FLU INFO line or your GP or Healthline 0800 611 116 if an ill person has an underlying health condition or if the person:
· starts to feel better, then gets worse
· has a temperature of 38°C or greater
· has chills or severe shaking
· has difficulty breathing or chest pain
· has purple or blue discolouration of the lips
· is less responsive than normal, is unusually quiet, or becomes confused
· is vomiting and unable to keep liquids down
· has signs of dehydration such as dizziness when standing, not urinating, and in infants, a lack of tears when they cry
· has seizures or convulsions
NMDHB Influenza A(H1N1) - Update 29
17 July 2009
This morning (17/07) there are two people in Wairau Hospital with suspected Influenza A H1N1 Swine Flu. There were no suspected cases in Nelson Hospital this morning.
Nelson Marlborough District Health Board, Health Controller, Mike Cummins said, "We would like to remind people to phone ahead to the 0800 FLU INFO line (0800 358 4636) before presenting to their GP or hospital."
Nationally the number of confirmed deaths from new Influenza A (H1N1) swine flu has risen to 10, with the death of a Tairawhiti man in his 40s. The man had serious underlying medical conditions.
The Ministry of Health reported that internationally, there are reports of severe illness from swine flu among pregnant women. Pregnant women are one group at greater risk of complications from the swine flu, including pneumonia, and need to be particularly watchful for signs and symptoms of the virus.
Pregnant women are thought to be more susceptible to all types of influenza because of the physiological changes that occur in pregnancy, including changes to the immune system. The baby may also be at increased risk due to the mother's response to infection, such as a high temperature.
In Nelson Marlborough pregnant women who have influenza symptoms were advised to call the local 0800 FLU INFO line (0800 358 4636) their GP or Healthline 0800 611 116 for advice.
Their doctor may prescribe the antiviral medication Tamiflu or Relenza which are most effective if taken as soon as possible after the onset of symptoms. Pregnant women should not take any antiviral medication without consulting their doctor. The doctor will assess the risks and benefits of the medicine on an individual basis and may need to seek advice from an infectious diseases specialist or obstetrician.
Practical steps that pregnant women can take to reduce their chances of exposure to influenza include:
- washing and drying hands frequently
- staying away from people who are sick
- avoiding crowded places
If you get sick with flu-like symptoms:
- stay home and limit contact with others
- call the local 0800 FLU INFO line (0800 358 4636) your doctor or Healthline 0800 611 116 for advice. Your doctor will decide if treatment is needed. Both seasonal influenza and swine flu may make other medical problems worse.
- treat any fever right away. Paracetamol is the best treatment for fever in pregnancy.
- drink plenty of fluids.
- Your doctor will decide if you need antiviral drugs such as Tamiflu or Relenza. These medicines work best when started soon after symptoms begin (within two days), but they may also be given to very sick or high risk people (including pregnant women) even after 48 hours.
- There is little information about the effect of antiviral drugs in pregnant women or their babies, but no serious side effects have been reported.
- Don’t stop breastfeeding if you are ill. Breastfeeding protects babies because breast milk passes on antibodies from the mother to a baby. Antibodies help fight off infection. Limit formula feeds if you can. If you are too sick to breastfeed, express milk and have someone give it to your baby.
NMDHB Influenza A(H1N1) - Update 28
13 July 2009
Nelson Marlborough District Health Board today reiterated that influenza can be severe for people with asthma or other health conditions. Most people with influenza will begin to feel better after a few days. Sometimes complications, such as asthma, pneumonia or heart problems arise and the ill person may need to have a health assessment. These complications can develop with seasonal influenza as well as the new pandemic influenza.
Today there are two people in Wairau Hospital with suspected A H1N1 Swine Flu. Forty two people have tested positive for Swine Flu across the district since the outbreak began in New Zealand on April 25; 24 in Marlborough and 18 in Nelson Tasman. Currently there is no one in Nelson Hospital with suspected Swine Flu.
NMDHB Health Controller Denise Hutchins said signs to look for were if the ill person:
- starts to feel better, then gets worse
- has a temperature of 38°C or greater
- has chills or severe shaking
- has difficulty breathing or chest pain
- has purple or blue discolouration of the lips
- is less responsive than normal, is unusually quiet, or becomes confused
- is vomiting and unable to keep liquids down
- has signs of dehydration such as dizziness when standing, not urinating, and in infants, a lack of tears when they cry
- has seizures or convulsions
If any of these things occur, call the local 0800 FLU INFO line or your GP or Healthline 0800 611 116 for advice.
Infants and Children need clinical assessment if one or more of following is present:
- Shortness of breath (infants may manifest this as feeding difficulties)
- Increased work of breathing
- Unable to keep fluids down and poor urine output
- Very lethargic, irritable or drowsy
- Very pale or blue lips or gums
- Skin rash
- Underlying disease; lung disease asthma, cystic fibrosis, heart disease, severe kidney problems, cerebral palsy, immune compromised, steroids, diabetes
Internationally fatalities associated with Swine Flu have been predominantly in people 30 to 50 years of age. However in Australia hospitalisations are predominantly in children under 10 years of age.
NMDHB Influenza A(H1N1) - Update 27
10 July 2009
Appointments at Nelson Hospital may change at short notice due to the increasing levels of staff illness. Nelson Marlborough District Health Board Health Controller Denise Hutchins said, "Nelson Hospital is experiencing increasing levels of staff illness and patients may have appointments changed at short notice due to this."
Today there is one person in Wairau Hospital and two people in Nelson Hospital with suspected A H1N1 Swine Flu. Thirty two people have tested positive for Swine Flu across the district since the outbreak began in New Zealand on April 25; 16 in Marlborough and 16 in Nelson Tasman.
Nelson and Wairau Hospital patients are also asked to bring their own reading material and toys for children in waiting areas as Swine Flu infection control measures take effect. Ms Hutchins said, "People who have appointments at the hospital should attend as per usual unless they receive notice that they have been rescheduled. We do not anticipate that this will continue for more than a week and we ask for patience during this time.
People were also reminded to phone the local 0800 FLU INFO line for advice on influenza and advice on whether they need to call their GP for clinical assessment. "We suggest the people of Nelson Marlborough use the local 0800 FLU INFO number as we understand there can be some delays for people ringing the national Healthline. Those people who have symptoms and need advice should continue to wait until their calls are answered.
"Do not call into the Emergency Department as the waiting time for advice when staff are busy is considerably longer than what you can expect on the 0800 lines and also takes vital staff away from more urgent cases," she said. "People who are at higher risk of more serious illness from influenza are those who have other significant health conditions. However, there is growing evidence that some previously healthy people can also develop a more serious illness.
Symptoms which may require further medical advice include difficulty breathing or chest pain, a high temperature, drowsiness, severe vomiting or a cough with blood or green phlegm. Further information about symptoms which require medical advice is also on website: www.moh.govt.nz/moh.nsf/indexmh/influenza-a-h1n1-care-advice
"For most people who get influenza this winter, it will be a mild to moderate illness and they will recover at home without needing medical treatment," said Ms Hutchins.
NMDHB Influenza A(H1N1) - Update 26
08 July 2009
The Chief Coroner today confirmed that a post mortem swab on a 46 year-old Blenheim man, who died at home on July 1, was positive for Influenza A H1N1 09 Swine Flu.
Nelson Marlborough Medical Officer of Health Dr Ed Kiddle says, ”The Coroner’s office advises that the cause of death is not yet determined and awaits consideration of the full post-mortem findings.”
The man was reported as having a background of pre-existing medical conditions.
Dr Kiddle says,"It is sad to hear of any death in our community and our thoughts are with the family at this time.
"We know that swine flu is becoming more widespread through the community and this also corresponds to our winter flu season.
"Both types of influenza can be very serious for some people particularly if they have underlying medical conditions. It is important for these people to be alert to early symptoms of influenza, and phone their GP, or 0800 FLU INFO line or the national Healthline 0800 611 116 for advice.
The symptoms are cough, sore throat and fever and may include muscle aches, nausea, headache and gastrointestinal symptoms.
For most people, swine flu is a mild to moderate illness and can be managed at home, by rest, fluids, paracetamol and good home hygiene practice. If symptoms get worse and people are concerned they should phone their doctor or Nelson Marlborough DHB’s 0800 FLU INFO or Healthline 0800 611 116.
We all need to remain vigilant, and our advice remains the same:
If you're sick, stay home and avoid crowded places
~ Cover coughs and sneezes
~ Wash and dry your hands often and thoroughly
~ Seek medical advice either if someone with other significant medical conditions develops flu, or if anyone with flu gets worse - for example if they have difficulty breathing, get drowsier or their temperature gets higher and does not come down after taking medication such as paracetamol or ibuprofen
Phone Nelson Marlborough DHB’s 0800 FLU INFO or Healthline on 0800 611 116 or your own doctor.
NMDHB Influenza A(H1N1) - Update 25
06 July 2009
Nelson Marlborough has 22 confirmed A H1N1 cases in the District 11 in Nelson Tasman and 11 in Marlborough.
There are currently 2 people in Wairau Hospital in isolation with suspected A H1N1 and 1 in Nelson Hospital.
Both Nelson and Wairau Hospitals are experiencing the usual increase in admissions associated with winter illness and some staff illness.
Dr Mark Jacobs, Director of Public Health said, "For most New Zealanders, swine flu will be a mild illness, but in some instances, the virus can cause more severe illness and in a few tragic instances, death.
"We know that people with some significant underlying medical conditions are at greater risk, however, it's important to remember that overseas experience has shown that some previously healthy people have also been seriously affected by swine flu," he said.
We all need to remain vigilant, and our advice remains the same:
~ If you're sick, stay home and avoid crowded places
~ Cover coughs and sneezes
~ Wash and dry your hands often and thoroughly
~ Seek medical advice either if the someone with other significant medical conditions develops flu, or if anyone with flu gets worse - for example if they have difficulty breathing, get drowsier or their temperature gets higher and does not come down after taking medication such as paracetamol or ibuprofen
Phone 0800 FLU INFO or Healthline on 0800 611 116 or your own doctor.
NMDHB Influenza A(H1N1) - Update 24
01 July 2009
General Practice remains the mainstay of managing people unwell with influenza in the community.
Community Based Assessment Centres (CBACs) would be used when normal systems for assessment and treatment could no longer manage either because of the influx of people or staff shortages made services too difficult to maintain.
These centres would allow people who needed to be seen by a doctor or nurse to be kept separate from other people who attended health services.
NMDHB Health Controller Denise Hutchins said, "Assessment centres in Nelson and Marlborough are ready to be activated should the need become apparent however at this time people should phone their GP, 0800 FLU INFO or Healthline on 0800 611 116 for first advice.
"Remember most people can manage their influenza at home with rest, fluids, paracetamol and good home hygiene practice. If symptoms get worse and people are concerned it is important that they phone their doctor or the 0800 number for advice."
The virus is expected to cause many more infections than are seen with seasonal or winter flu because most people have no or little immunity to it, and infections can be expected to continue for months yet. So far, most of the people contracting the virus are experiencing relatively mild to moderate symptoms.
To prepare, everyone should ensure a stock of paracetemol, food, and tissues and have enough of their regular prescription medicines to last a week.
Nelson Marlborough Medical Officer of Health Dr Ed Kiddle said, "Tamiflu has a place in the treatment of some people with influenza; National guidelines are that it should be targeted towards people with severe illness or those at higher risk of influenza-related complications.
"It is inappropriate to use it for mild illness as most people recover with rest and fluids."
In Nelson Marlborough there have been nine confirmed cases of Influenza A H1N1 09 Swine Flu, three in Marlborough and six in Nelson Tasman, however routine testing has been suspended and it was expected that many more cases were now in the community.
NMDHB Influenza A(H1N1) - Update 23
29 June 2009
Nelson Marlborough district has moved into the "Manage It" phase for A H1N1 Swine Flu however Community Based Assessment Centres are not yet needed.
CBAC centres would help to separate people at risk of spreading influenza from others attending health services when numbers were sufficient.
Health Controller Denise Hutchins said, "We have systems, supplies, and venues ready to go when General Practices in the district reach a point where numbers of influenza patients in the community significantly increase.
"The District Health Board is doing staff training in readiness for the opening of these assessment centres however the numbers of more severe cases in the community needing medical assistance does not warrant them being opened at present."
She said in Takaka the GP practice had set up a separate building for the assessment of influenza patients. In Murchison the Health Centre and Hospital had a system in place to "red stream" influenza patients and this was working well.
In Motueka, Nelson, Blenheim and Picton influenza patients were managed in GP practices using infection control measures.
Most people can manage their influenza at home with rest, fluids, paracetamol and good home hygiene practice. If symptoms get worse and people are concerned it is important that they phone their GP, Healthline 0800 611 116 or 0800 FLU INFO for advice.
People with symptoms of A H1N1 Swine Flu and their contacts are no longer being swabbed or quarantined by the Public Health Service but advised to be alert to the symptoms of influenza and if worried to phone their doctor or the 0800 numbers.
Information on protecting and caring for yourself and others is available on www.moh.govt.nz .
The symptoms of Novel A H1N1 09 included fever, cough, sore throat, stuffy nose and may include body aches, headaches, chills and fatigue.
NMDHB Influenza A(H1N1) - Update 22
29 June 2009
Dr Ed Kiddle, Medical Officer of Health, Nelson Marlborough
One of the four confirmed cases of A H1N1 Swine Flu identified in Nelson Marlborough on Friday (26/06) was in Marlborough and three in Nelson, there are also two probable cases in Nelson. However two of the people identified in Nelson have returned to Marlborough to recuperate at home. Ages of the six people mentioned above range from 13 to 30.
Now that we have identified A H1N1 in the community it is not necessary to do the same number of swabs as previously carried out, however the Public Health Service (PHS) will still consider swabs in certain situations e.g. influenza like illness in a rest home. Also if a person has severe symptoms assessed in hospital a swab may well be done. The PHS gives advice to people with H1N1 and cases are asked to self isolate at home. Contacts of people with H1N1 are no longer being quarantined but advised to be alert to the symptoms of influenza and if worried to phone their GP, Healthline 0800 611 116 or 0800 FLU INFO.
General Practice remains the mainstay of managing people unwell in the community but given the likely heavy load of influenza, as numbers of both seasonal and H1N1 Swine Flu increase over the next two months, the DHB is also putting resources into management. These include information out to the public, the 0800 FLU INFO and the establishment of Community Based Assessment Centres (CBACs) where those people who need to be seen by a doctor or nurse can be assessed. These centres will help to separate people at risk of spreading influenza from others attending health services and work is continuing to get these established.
Remember most people can manage their influenza at home with rest, fluids, paracetamol and good home hygiene practice. If symptoms get worse and people are concerned it is important that they phone their doctor or the 0800 number for advice.
Tamiflu has a place in the treatment of some people with influenza; National guidelines are that it should be targeted towards people with severe illness or those at high risk of influenza-related complications. It is inappropriate to use it for mild illness as most people recover with rest and fluids. Also widespread use of Tamiflu may contribute to this particular strain developing resistance.
Tamiflu from the national stockpile will be available for free if people meet the necessary criteria outlined above. Tamiflu is also available, at a cost, to people with influenza-like illness from chemists or on prescription from doctors.
The Public Health Service remains actively involved in working with health professionals and the community in managing the pandemic in this district with work orientated toward flattening the pandemic curve (reducing the peak numbers), and reducing the severity of cases. This work lessens the impact of influenza on the health services, schools and businesses and the community at large.
NMDHB Influenza A(H1N1) - Update 21
26 June 2009
Dr Ed Kiddle, Medical Officer of Health, Nelson Marlborough
Nelson Marlborough has four new confirmed cases of Influenza A H1N1 (Swine Flu), these indicate that community spread of the virus has occurred in the Top of the South.
This was not unexpected and what we have been preparing for. The virus has spread in some other parts of the country and sooner or later it was going to be detected here.
The people sick with influenza had swab tests done early in the week and four came through positive late yesterday (25/06). One person had recently travelled overseas but the other three had not.
One case was in Marlborough and three from Nelson. Two of those were students at Nelson Boys College. The Public Health Service had heard this week about a lot of influenza present in a number of schools around the region. In addition we have two probable cases who developed influenza after being household contacts of a sick person.
All the cases are recovering at home, two spent a brief period of time in hospital, one in Nelson and one in Wairau Hospital.
Now that the Novel Influenza is here, along with our seasonal influenza, it reinforces the need for preparation and good preventive measures. Preparation involves ensuring you have some basic supplies in the house such as, food and parecetemol and can link in with support from family and other networks.
Prevention involves good hand washing, covering coughs and sneezes and not going out when ill, but phoning the doctor or Healthline if you are concerned at all about symptoms.
Most people recover at home with rest and simple treatment however if you are concerned it is important to phone your GP or Healthline 0800 611 116 or 0800 FLU INFO for advice and possible assessment.
Some people particularly, infants, pregnant women and those with other medical conditions can be at greater risk of complications from influenza.
To support the load on General Practice as the number of influenza cases increase the DHB is establishing community based assessment centres (CBACs) in Nelson and Blenheim. There are also assessment centres linked to the Golden Bay Medical Practice and the Murchison Health Centre.
These centres will be for people who are more ill with influenza and need assessment by a doctor or a nurse. Antiviral medication has a place for some people, particularly the more severely ill but will not be used for mild influenza.
It is not anticipated that there will be any closures of schools or public gatherings, but people are reminded to not go to social gatherings when ill as this aids spread of the virus.
NMDHB Influenza A(H1N1) - Update 20
24 June 2009
The District Health Board continues to work on containment of any cases while also preparing for the 'Management" phase by introducing the local freephone number 0800 FLU INFO (0800 358 4636) and preparing Community Based Assessment Centres.
Confirmed cases remained low in Nelson Marlborough (22/06), with one case confirmed on June 14.
Medical Officer of Health, Dr Ed Kiddle said the new 0800 FLU INFO was set up as an additional local helpline to manage Novel A H1N1 09.
"The freephone number now in service would be operated by Procare HML the same company that currently takes after hours calls for the district's GP practices.
"Calls would be answered by a registered nurse who would record the caller's symptoms, and if the background warranted it, advise the caller to phone their GP or. If appropriate some cases may be referred to the Public Health Service for follow-up," said Dr Kiddle.
He said most people who contract the new A H1N1 virus will be able to be cared for at home, however for some people with underlying conditions or severe or prolonged symptoms it would be important to either phone their GP or contact the 0800 FLU INFO line for advice on the next step to care. This may include assessment and treatment at a Community Based Assessment Centre, which are being prepared for use in Nelson, Blenheim, Takaka, Motueka and Murchison.
Information on protecting and caring for yourself and others is available on www.moh.govt.nz.
The symptoms of Novel A H1N1 09 included fever, cough, sore throat, stuffy nose and may include body aches, headaches, chills and fatigue.
NMDHB Influenza A(H1N1) - Update 19
19 June 2009
The announcement from the Ministry of Health that the country will go into the 'Manage It' phase of the pandemic brings no change today for Nelson Marlborough.
NMDHB continues to work on containment of any cases while also preparing for the 'Manage It" phase by introducing a local 0800 number and preparing Community Based Assessment Centres.
Today Wellington and Christchurch would move to the next level of managing the novel A H1N1 09 in the community rather than remain in containment phase. On Monday Auckland would also move into community management where people who were ill would not be tested, treated or quarantined but would manage illness as they do for seasonal influenza.
This would mean fewer school and work place closures as in these areas containment strategies were no longer being applied.
In Nelson Marlborough at present (19/06) at midday there was no one in isolation or quarantine, the district remains in the Containment Phase with Public Health following up people who meet the case definition.
NMDHB will have an 0800 freephone number operating shortly as an additional local helpline to manage Novel A H1N1 09.
The freephone number will be in use from Monday June 22 and will be operated by Procare HML that currently takes after hours calls for the district's GP practices. Calls will be answered by a registered nurse who will record the caller's symptoms. At present, if the background and symptoms warrant it, the caller's details would be passed on to the Public Health Service for follow-up.
This is in addition to the national 0800 611 116 Healthline helpline that continues to operate.
Most people who contract the new A H1N1 will be cared for at home however for some people with underlying conditions or severe or prolonged symptoms it would be important to contact the 0800 FLU INFO line for advice on the next step to care. This may include assessment and treatment at a Community Based Assessment Centre, which are being prepared for use.
An important part of managing the disease in the community will include advising individuals how to An important part of managing the disease in the community will include advising individuals how to look after themselves at home where this is possible - in the same way they would with seasonal flu.
The symptoms of Novel A H1N1 09 included fever, cough, sore throat, stuffy nose and may include body aches, headaches, chills and fatigue.
NMDHB Influenza A(H1N1) - Update 18
16 June 2009
Dr Jill Sherwood said: The confirmed case is doing well at home.
Tests on her close contacts have come back negative however they remain in quarantine until 4 days after the last time they had close contact with the confirmed case during her infectious period. The confirmed case has been self isolating within the home she is sharing with her three household contacts.
The situation this morning is: 28 people across Nelson Marlborough in home quarantine or isolation. There are 23 in Nelson and 5 in Marlborough.
National and local planning is to enable health services to manage large numbers of cases as well as maintain services for those who most need them. An important part of this approach will include advising individuals how to look after themselves at home where this is possible - in the same way they would with seasonal flu.
People with chronic underlying conditions such as severe respiratory illness and severe heart disease will need to be vigilant and seek early medical advice if they develop influenza symptoms, whether seasonal influenza or new H1N1.
Dr Sherwood said that seasonal influenza and the new H1N1 influenza will be mild to moderate for most people but may be serious for some people and they should seek advice either from Healthline 0800 611 116 or their GP – but phone ahead first.
Ministry of Health Advice:
Advice for workplaces
For most workplaces it is business as usual and staff should only stay home if they have flu-like symptoms or if they have received medical advice to stay home. Generally, if a staff member is suspected of having new H1N1 influenza, public health staff will assess them and advise on appropriate action.
How to protect yourself and others
Signs and symptoms of influenza include fever, cough, sore throat, stuffy nose, body aches, headaches, chills and fatigue. Some people also experience diarrhoea and vomiting.
Try to avoid contact with sick people and reduce time spent in crowded settings.
Sick people should stay home until they are well, rather than going to school or work.
If you become sick, stay home for seven days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep you from infecting others. Most people will be able to safely recover at home.
You should seek medical advice if necessary (by phone first), for example if you have a serious underlying health condition or your condition worsens. This is particularly important for people with underlying medical conditions who are at greater risk of developing complications from influenza. If you need medical advice, please phone Healthline 0800 611 116 in the first instance, or your GP. Do not turn up at a hospital or medical centre before doing this as you can spread germs to other people.
If you are caring for someone with the flu, watch for signs that they may need further medical attention, including: difficulty breathing, chest pain, blueness around the lips, inability to keep fluids down, becoming less alert or developing confusion. More information can be found on the Victorian Health website (http://humanswineflu.health.vic.gov.au/public/what_to_expect.htm) and Centre for Disease Control website (http://www.cdc.gov/h1n1flu/qa.htm)
Be prepared - This is the time for people to make sure they’re prepared to be self-sufficient for an extended period of time, should they need to. This means you should have enough food water and basic medical supplies including paracetamol or ibuprofen, as well as regular medications, nappies for babies, cleaning products, tissues and bathroom supplies for at least a week.
Hand hygiene is still the single most effective measure in protecting yourself. Wash your hands with soap and water and dry them thoroughly.
Alcohol-based cleaners are also effective. Avoid touching your eyes, nose or mouth as germs spread this way.
Practise good cough and sneeze etiquette. This means covering your nose and mouth with a tissue when you cough or sneeze, and disposing of the tissue in a lined rubbish bin with a lid or plastic bag
Checklists and advice on how individuals and families can prepare for a pandemic are available on the Ministry of Health's website: http://www.moh.govt.nz/moh.nsf/indexmh/pandemicinfluenza-resources-factsheets
NMDHB Influenza A(H1N1) - Update 17
15 June 2009
Nelson Marlborough's first case of Influenza A(H1N1) was confirmed through laboratory testing yesterday (14/06).
The confirmed case was a traveller who had returned to the Tasman district from Australia. Two close contacts of the confirmed case had been quarantined and all were being followed up by the Public Health Service.
Currently Nelson Marlborough have 1 confirmed case, three suspect cases and 18 people in home quarantine or isolation.
Nelson Marlborough Medical Officer of Health Dr Jill Sherwood said, "The Ministry of Health has refined advice to international travellers arriving in New Zealand or close contacts with a probable or confirmed case. Better information about the incubation period of the disease means that only people with flu like symptoms within four days of travel are now considered to be suspect cases of influenza A (H1N1)."
She said initially the Ministry had advised that travellers who became sick within a fortnight should be treated as suspicious for influenza A(H1N1); this was subsequently changed to seven days and this has now been further modified to four days.
"If you are sick stay home from school or work; cover coughs and sneezes and thoroughly wash and dry hands. Individuals with flu like symptoms should look after themselves at home, but should seek medical advice if necessary, or if they have an international travel history by phone in the first instance said Dr Sherwood.
She said the importance of the “stay home if you are sick” message was that most people do not have immunity to this disease. Unlike with seasonal influenza, where some individuals are protected through vaccination or immunity from previous exposure, Influenza A (H1N1) is a new virus and the vast majority of people are expected to have no natural protection against it.
NMDHB Influenza A(H1N1) - Update 16
12 June 2009
In Nelson Marlborough there are four suspect cases of Influenza A(H1N1) and 21 people in isolation and home quarantine (12/06).
At this time there are still no confirmed cases of A(H1N1) in Nelson Marlborough.
Nelson Marlborough District Health Board, Health Controller Mike Cummins said, "It is inevitable we will get much wider spread through the community at some stage. The DHB has planned for this eventuality and has longstanding plans to deal with the situation."
He said even though the World Health Organisation (WHO) has escalated its response level to global pandemic, Nelson Marlborough DHB response is based on what is happening in New Zealand and we are continuing to focus on containment.
"We have asked staff to update business continuity plans and the hospital Emergency Operations Centres are being established in readiness for any further developments," he said.
Although Influenza has been mild so far for individuals, it is contagious. With community spread there will be many more people using health services.
The DHB Emergency Management Plan had an escalation process that meant as more cases appeared in the community 'red stream' GP practices would be identified in Nelson and Blenheim.
Mr Cummins said these 'red stream' practices could be replaced by Community Based Assessment Centres (CBACs) as A(H1N1) escalates in the community. CBACs would be staffed by health professionals who could triage patients and order further treatment where appropriate.
The DHB Emergency Operations Centre is monitoring the local situation and has plans in place to manage this event.
Employers should review their business continuity plans, for example to consider arrangements for maintaining core services in situations where staff absenteeism may be high, for example where employees may be encouraged to work from home, or who are sick themselves or are required to care for dependents at home (for example, because of sickness or school closures). Employers and employees should not go to work if they are symptomatic.
Mr Cummins said people should continue to go about their daily lives, but be aware that in the weeks and months ahead, there may possibly be some level of disruption to their domestic and work routines.
School closures remained a possibility. Where a school had one or more confirmed case(s) then closure may be recommended, but widespread school closures were not contemplated at this time. However, this would be kept under continuous review and may change at short notice depending on the circumstances.
Human Swine Influenza - Update 15
9 June 2009
Medical Officers of Health in Nelson Marlborough welcome the news that Influenza A(H1N1) has been included to the schedule of the Health (Infectious and Notifiable Diseases) Regulations.
The regulations announced yesterday (08/06) gave Medical Officers of Health legal powers if needed, to require people to isolate themselves at home and to exclude children and teachers from school, if they have Influenza A(H1N1) or are in close contact with someone with has.
Medical Officer of Health Dr Jill Sherwood said, "People have been very cooperative with the Nelson Marlborough Public Health Service and to my knowledge all suspect cases have taken the isolation very seriously.
"It gives us the ability to take further measures if needed, to decrease spread of the virus in the community."
At 4pm, Tuesday 9 June Nelson Marlborough had six suspect cases in isolation, four in Nelson and two in Marlborough.
This regulation does not allow for total school closures which can only be invoked with an authorisation of special powers by the Minister of Health, or if an epidemic notice is in force. No such notice is in force.
Any travellers who have been in countries with high rates of Influenza A(H1N1) and develop symptoms of influenza such as; fever, sore throat, cough, runny nose or nasal congestion within seven days should phone their GP or Healthline 0800 611 116.
Hygiene is the most important step in preventing the spread of influenza. Wash hands thoroughly, for at least 20 seconds with soap and dry hands well, or use an alcohol-based rub. Keep coughs and sneezes covered, and dispose of tissues in a covered, lined rubbish bin. Try to stay a metre away from sick people.
The community is reminded that we are heading into our usual influenza season and individuals are advised to wash hands thoroughly with soap and water on a regular basis, use good cough hygiene and should seek medical attention if their symptoms of influenza are prolonged or severe.
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
Human Swine Influenza - Update 14
02 June 2009
Medical Officers of Health in Nelson Marlborough have said that while there is no evidence of community spread of Influenza A(H1N1) at present, it is expected to occur at some time.
Medical Officer of Health, Dr Ed Kiddle said, "Community spread in New Zealand is expected to occur at some point however early identification of any clusters of cases would support ongoing work to slow any community spread."
He said if clusters were identified in students and Influenza A (H1N1) was confirmed it was possible that some schools could be closed. The Ministry of Health has written to schools about this possibility.
There is one new confirmed case of Influenza A (H1N1) Swine Flu in New Zealand. This is a child who arrived in Auckland from North America on Sunday. As with all other cases, the passenger is in isolation at home and is being treated with Tamiflu. Contact tracing of passengers on the flight is underway. This was the first new case since 15 May.
Dr Kiddle said Australia had an increasing number of confirmed cases, with the majority so far in Victoria and New South Wales but confirmed cases in all States and Territories which was why Australia had been added to the list of areas of concern. All incoming travellers are given information about what to do if they develop influenza symptoms.
He said, "If you have recently travelled overseas, especially to the areas of concern, and develop flu-like symptoms seek medical attention. Contact your health provider by phone first, to avoid potentially infecting others."
In Nelson Marlborough there was one suspect case in isolation today (02/06).
Members of the public with concerns should in the first instance call Healthline 0800 611 116.
Dr Kiddle said tourism operators could also advise people who had been in the country for less than a week and developed a fever, sore throat, cough, runny nose or nasal congestion to contact Healthline or a local GP by phone.
Hygiene is the most important step in preventing the spread of influenza. Wash hands thoroughly, for at least 20 seconds with soap and dry hands well, or use an alcohol-based rub. Keep coughs and sneezes covered, and dispose of tissues in a covered, lined rubbish bin. Try to stay a metre away from sick people.
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
Human Swine Influenza - Update 13
25 May 2009
In addition to the Public Health Emergency Operations Centre (EOC) for Influenza A(H1N1) a District Health Board EOC centre of operations may also been activated.
New Zealand had nine confirmed cases, 10 probable and 17 suspect cases and remained in the Stamp it Out phase of operations. Australia reported 14 confirmed cases and 50 suspect cases on 24/05/09 and has now raised its alert level to “CONTAIN”.
The World Health Organisation (WHO) alert level remained at five with cases in 43 countries with a total of 12 022 confirmed cases reported, with 86 deaths. WHO is warning of a likely increase to level six and noted that health surveillance in all countries continues to be critical in order to identify if community transmission is occurring.
Nelson Marlborough Medical Officer of Health, Dr Jill Sherwood said, "The outbreak continues to spread globally and the situation is evolving rapidly. Although the virus is tending to act more like a typical influenza virus this could mean larger impacts for countries entering the flu prone winter season.
To assist with planning Nelson Marlborough Public Health Service has done advanced planning to account for any change in the situation. The most likely changes are that the infection declines; it becomes like seasonal influenza or the virus mutates and becomes more transmissible and/or virulent.
Dr Sherwood said the latter two scenarios would have a major effect on the community and health services and is why New Zealand continues border and cluster control activity to delay entry.
She said, "If you have recently travelled overseas and develop flu-like symptoms seek medical attention. Contact your health provider by phone first, to avoid potentially infecting others."
Currently in Nelson Marlborough there was one suspect case due to come out of isolation today.
Members of the public with concerns should in the first instance call Healthline 0800 611 116.
Hygiene is the most important step in preventing the spread of influenza. Wash hands thoroughly, for at least 20 seconds with soap and dry hands well, or use an alcohol-based rub. Keep coughs and sneezes covered, and dispose of tissues in a covered, lined rubbish bin. Try to stay a metre away from sick people.
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
Human Swine Influenza - Update 11
6 May 2009
This morning there are three travellers in home isolation in the Nelson Marlborough district who have developed symptoms of influenza within a week of being in North America or Mexico, this includes two people who were in home isolation yesterday (05/05).
The Nelson Marlborough Public Health Service expected the swab test results for these three people to be delivered later today.
In addition six close contacts of these three people are in home quarantine.
Medical Officer of Health Dr Jill Sherwood said, "Any travellers who have been in North America or Mexico who develop symptoms of influenza such as; fever, sore throat, cough, runny nose or nasal congestion within seven days should phone their GP. This includes passengers who transited through continental North American airports."
Once they have contacted their GP a person would be assessed and then if follow up was required the GP would contact the Public Health Service. Anyone requiring further information who has other concerns should phone Healthline 0800 611 116.
The community is reminded that we are heading into our usual influenza season and individuals are advised to wash hands thoroughly with soap and water on a regular basis, use good cough hygiene and should seek medical attention if their symptoms of influenza are prolonged or severe.
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
Human Swine Influenza - Update 10
5 May 2009
The two people who were in home quarantine yesterday (04/05) have been cleared and a further two new suspect cases and their contacts are being followed up by the Nelson Marlborough Public Health Service.
Nelson Marlborough Medical Officer of Health, Dr Jill Sherwood said, "The two new cases are in isolation and have had swabs taken."
She said the two people who were in quarantine yesterday, were released as the suspect case from their flight from San Francisco had been cleared of having Influenza A(H1N1).
"Today's two new suspect cases developed symptoms of influenza within seven days of being in the areas of concern, these areas remain North America and Mexico," said Dr Sherwood.
She said while the number of people in home quarantine had come down, it was still of paramount importance that anyone put in home quarantine remained there until cleared by the Public Health Service.
Dr Sherwood said the cooperation of people who were in home quarantine was appreciated.
"Any travellers who have been in the areas of concern who develop symptoms of influenza such as; fever, sore throat, cough, runny nose or nasal congestion within seven days should phone their GP. This includes passengers who transited through continental North American airports," said Dr Sherwood.
Once they have contacted their GP a person would be assessed and then the GP would contact the Public Health Service if follow up was required. Anyone requiring further information who has other concerns should phone Healthline 0800 611 116.
The community is reminded that we are heading into our usual influenza season and individuals are advised to wash hands thoroughly with soap and water on a regular basis, use good cough hygiene and should seek medical attention if their symptoms of influenza are prolonged or severe.
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
Human Swine Influenza - Update 8
4 May 2009
All of our suspect cases have returned negative swabs for Influenza A.
All contacts from last week are now out of quarantine. Yesterday the Nelson Marlborough Public Health Service was informed of two new contacts from a flight that has a probable case. These people, now in home quarantine, are two close contacts of a probable case identified on a flight that arrived from San Francisco.
Mexico has reported 506 confirmed cases of infection, including 19 deaths. This is a case fatality rate of almost 4%, similar to the 1918 influenza epidemic.
Nelson Marlborough Medical Officer of Health, Dr Jill Sherwood said, "It is likely that there have been many more milder cases in Mexico that have not been counted therefore bringing their case fatality rate down."
The United States Government has reported 226 laboratory confirmed human cases, including one death.
She said the Public Health Service appreciated the cooperation of people who were asked to go into quarantine and wanted to reiterate how important quarantine is to prevent community transmission of the virus within New Zealand.
The World Health Organisation has said that the A(H1N1) virus identified in a swine herd in Canada was highly probable due to the pigs being exposed to the virus from a Canadian farm worker. The farm worker had recently returned from Mexico, exhibited flu-like symptoms and had contact with the pigs. There is no indication of virus adaptation through transfer from human to pigs at this time.
There is no risk of infection from this virus from consumption of well-cooked pork and pork products.
The community is reminded that we are heading into our usual influenza season and individuals are advised to wash hands thoroughly with soap and water on a regular basis, use good cough hygiene and should seek medical attention if their symptoms of influenza are prolonged or severe.
Dr Sherwood said at this time the only people at risk were travellers from North America and Mexico who had influenza like symptoms within seven days of entering New Zealand or close contacts of probable cases identified by the Public Health Service. Any of these returning travellers with symptoms should phone their GP. The GP will assess the person and then contact Public Health if required to follow up. Anyone requiring further information who has other concerns should phone Healthline 0800 611 116.
Routine Infection Control Advice for Seasonal Influenza:
1. Wash your hands with soap under warm running water. Alcohol-based hand gel can also be used if soap and water are not readily available. It’s a good idea to keep some with you in your pocket or purse when you travel.
2. Practice proper cough and sneeze etiquette. Cover your mouth and/or nose with a clean tissue or sneeze into your elbow to reduce the spread of germs. Remember to dispose of the tissue and wash your hands afterwards.
3. Try to avoid close contact with sick people.
4. Monitor your health.
5. Contact your GP if you have prolonged or severe symptoms
Anyone wanting more information should call Healthline 0800 611 116.
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
Human Swine Influenza - Update 7
1 May 2009
Dr Ed Kiddle, Medical Officer of Health, Nelson Marlborough
As the Public Health threat of A/H1N1 Influenza ends its first week the Nelson Marlborough Public Health Service are gearing up for a further two weeks in the Emergency Operations Centre (EOC).
This means DHB staff who have been trained in Coordinated Incident Management will rotate through the EOC maintaining cover for the two weeks.
The EOC centre is notified of all people returning from Mexico and North America who develop symptoms of influenza within seven days of being in the affected area. These are called suspect cases and are put in home isolation and treated with antivirals, and a swab is taken to see if Influenza A can be detected. Their close contacts; people living in the same house, are also requested to stay at home in quarantine and treated with antivirals. Both groups can be released from home quarantine after being on antivirals for 72 hours.
Today 32 people remain in home quarantine and isolation completing their 72 hours on antivirals.
Daily contact is maintained to note any change of health status with people in home quarantine and antivirals are also delivered.
Locally we have had no confirmed or probable cases, this is the important category indicating the presence of this new virus. The work going on around suspect cases in returning travellers is trying to ensure we minimise any spread of the virus by keeping it out or controlling any small cluster of possible cases.
Dr Ed Kiddle, Medical Officer of Health said at present the status of the disease in New Zealand does not warrant Community Based Assessment Centres for the general population. The Auckland CBAC has been set up for travellers from Mexico and North America entering New Zealand, given this is the main entry point to the country for these travellers.
Members of the public who have traveled to Mexico or North America in the last seven days and have developed flu-like symptoms should contact their GP by phone or Healthline 0800 611 116. GPs notify the Public Health Service EOC of any suspect cases and follow up starts from that point. It is not recommended these people commence Tamiflu without being assessed by a GP or the Public Health service. If they are a suspect case they will qualify Tamiflu through the national stockpile.
Nelson Marlborough hospitals are continuing with their regular routine work but are kept up to date and are using this opportunity to reinforce messages around infection control.
The advice to the public who have not travelled to affected areas is also around routine infection control of coughs and colds, washing your hands and covering your coughs with tissues and consider getting an influenza vaccine, however this is for seasonal influenza not the new virus.
Anyone wanting more information should call Healthline 0800 611 116.
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
Human Swine Influenza - Update 6
30 April 2009
Nine swab results received last night, for Nelson Marlborough people suspected of Swine Flu have all returned negative results for Influenza A.
Nelson Marlborough Medical Officer of Health, Dr Jill Sherwood said, "This is good news, these people are now free to come out of home quarantine and resume their normal daily activities.
"We continue to have new suspect cases identified, there are now seven suspect cases who are travellers who have been in North America and Mexico and display influenza-like symptoms. They are being treated with Tamiflu, have swabs taken for testing and are in home quarantine.
"In addition to these suspect cases the Nelson Marlborough Public Health Service are managing 24 close contacts in home quarantine, with Tamiflu and daily follow-up.
"We really appreciate the cooperation of the people in home quarantine."
If you’re feeling unwell and haven’t travelled in the affected areas in the seven days before becoming ill, do what you’d usually do - there is no cause for concern. Stay home, drink plenty of fluids and take panadol for pain or fever. If necessary phone your doctor for further advice.
However, if you have returned from Mexico or the USA in the past seven days, and start to develop symptoms of influenza you should phone a health professional for further advice as soon as you start feeling unwell.
Anyone wanting more information should call Healthline 0800 611 116.
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
Human Swine Influenza - Update 5
29 April 2009
Tonight (29/04) Nelson Marlborough Public Health Service hope to have swab results back from the five remaining suspect cases from Flight NZ1.
Medical Officer of Health Dr Jill Sherwood said, "There are 20 passengers from Flight NZ1 in home quarantine and being treated with Tamiflu, 13 in Nelson Tasman, and seven in Marlborough. From this group six people were initially suspect cases as they had influenza-like symptoms. Since then test results for one person has been come back as negative for Influenza A.
"To identify whether a person has Swine Flu the first stage of testing for Influenza A is done in New Zealand and if a positive test is returned then testing for Swine Flu is done in Melbourne."
"In addition to Flight NZ1 travellers we have one other suspect case whose swab result is also expected back today." said Dr Sherwood.
She said at this time the only people at risk are travellers from North America and Mexico who have influenza like symptoms within seven days of entering New Zealand. Any of these returning travellers with symptoms should phone their GP. The GP will assess the person and then contact Public Health if required to follow up. Anyone requiring further information who has other concerns should phone Healthline 0800 611 116.
If people who have not been in the US or Mexico have influenza-like symptoms then this is probably a seasonal influenza that should be treated in the normal manner with bed rest, fluids, paracetemol and self management unless symptoms are severe or prolonged. If people are concerned they should phone their GP or Healthline.
Routine Infection Control Advice for Seasonal Influenza:
1. Wash your hands with soap under warm running water. Alcohol-based hand gel can also be used if soap and water are not readily available. It’s a good idea to keep some with you in your pocket or purse when you travel.
2. Practice proper cough and sneeze etiquette. Cover your mouth and/or nose with a clean tissue or sneeze into your elbow to reduce the spread of germs. Remember to dispose of the tissue and wash your hands afterwards.
3. Try to avoid close contact with sick people.
4. Monitor your health.
5. Contact your GP if you have prolonged or severe symptoms
For further information go to Nelson Marlborough District Health Board or Ministry of Health.
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