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Interim Guidance for Novel H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home

Novel H1N1 flu virus infection (formerly known as swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with novel H1N1 flu. Like seasonal flu, novel H1N1 flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with novel H1N1 flu infection. Certain groups might be more likely to develop a severe illness from novel H1N1 flu infection, such as pregnant women and persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.
The following information can help you provide safer care at home for sick persons during a flu outbreak or flu pandemic.
How Flu Spreads
The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.
People with novel H1N1 flu who are cared for at home should:
• check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
• check with their health care provider about whether they should take antiviral medications
• stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer, except to seek medical care or for other necessities
• get plenty of rest
• drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
• cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands
• wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza. For more information, see the Interim Recommendations for Facemask and Respirator Use
• avoid close contact with others – do not go to work or school while ill
• be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention.

Medications to Help Lessen Symptoms of the Flu
Check with your healthcare provider or pharmacist for correct, safe use of medications
Antiviral medications can sometimes help lessen influenza symptoms, but require a prescription. Most people do not need these antiviral drugs to fully recover from the flu. However, persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization, might benefit from antiviral medications. Antiviral medications are available for persons 1 year of age and older. Ask your health care provider whether you need antiviral medication.
Influenza infections can lead to or occur with bacterial infections. Therefore, some people will also need to take antibiotics. More severe or prolonged illness or illness that seems to get better, but then gets worse again may be an indication that a person has a bacterial infection. Check with your health care provider if you have concerns.
Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome. For more information about Reye’s syndrome, visit the National Institute of Health website .
• Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.
• Children 5 years of age and older and teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms.
• Children younger than 4 years of age should NOT be given over-the-counter cold medications without first speaking with a health care provider.
• The safest care for flu symptoms in children younger than 2 years of age is using a cool-mist humidifier and a suction bulb to help clear away mucus.
• Fevers and aches can be treated with acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®, Nuprin®) or nonsteroidal anti-inflammatory drugs (NSAIDS). Examples of these kinds of medications include:
Generic Name Brand Name(s)
Acetaminophen Tylenol®
Ibuprofen Advil®, Motrin®, Nuprin®
Naproxen Aleve
• Over-the-counter cold and flu medications used according to the package instructions may help lessen some symptoms such as cough and congestion. Importantly, these medications will not lessen how infectious a person is.
• Check the ingredients on the package label to see if the medication already contains acetaminophen or ibuprofen before taking additional doses of these medications—don’t double dose! Patients with kidney disease or stomach problems should check with their health care provider before taking any NSAIDS.
Check with your health care provider or pharmacist if you are taking other over-the-counter or prescription medications not related to the flu. For more information on products for treating flu symptoms, see the FDA website.

When to Seek Emergency Medical Care
Get medical care right away if the sick person at home:
• has difficulty breathing or chest pain
• has purple or blue discoloration of the lips
• is vomiting and unable to keep liquids down
• has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
• has seizures (for example, uncontrolled convulsions)
is less responsive than normal or becomes confused

Steps to Lessen the Spread of Flu in the Home
When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to:
• keep the sick person away from other people as much as possible (see “placement of the sick person”) especially others who are at high risk for complications from influenza
• remind the sick person to cover their coughs, and clean their hands with soap and water or an alcohol-based hand rub often, especially after coughing and/or sneezing
• have everyone in the household clean their hands often, using soap and water or an alcohol-based hand rub. Children may need reminders or help keeping their hands clean
• ask your health care provider if household contacts of the sick person—particularly those contacts who may be pregnant or have chronic health conditions—should take antiviral medications such as oseltamivir (Tamiflu®) or zanamivir (Relenza®) to prevent the flu
• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. Infants should not be cared for by sick family members. For more information, see the Interim Recommendations for Facemask and Respirator Use
Placement of the sick person
• Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed.
• Unless necessary for medical care or other necessities, people who are sick with an influenza-like-illness should stay home and minimize contact with others, including avoiding travel, for 7 days after their symptoms begin or until they have been symptom-free for 24 hours, whichever is longer. Children, especially younger children, might potentially be contagious for longer periods.
• If persons with the flu need to leave the home (for example, for medical care), they should wear a facemask, if available and tolerable, and cover their nose and mouth when coughing or sneezing
• Have the sick person wear a facemask – if available and tolerable – if they need to be in a common area of the house near other persons.
• If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant (see below).
Protect other persons in the home
• The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
• If possible, have only one adult in the home take care of the sick person. People at increased risk of severe illness from flu should not be the designated caretaker, if possible.
• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use.
• Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of influenza-related complications and immunity can be suppressed during pregnancy).
• Avoid having sick family members care for infants and other groups at high risk for complications of influenza.
• All persons in the household should clean their hands with soap and water or an alcohol-based hand rub frequently, including after every contact with the sick person or the person’s room or bathroom.
• Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
• If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
• Antiviral medications can be used to prevent the flu, so check with your health care provider to see if some persons in the home should use antiviral medications.
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough