Influenza A (H1N1-2009) Swine Flu

Taken from

Public Advice

•What can I do to protect myself and others against the Flu?

Practise good personal hygiene and be socially responsible by:

▪ Washing your hands regularly and thoroughly with soap and water, especially before touching your eyes, nose or mouth.
▪ Turning quickly away from anyone near you if you are about to cough or sneeze, and do not cough or sneeze at him.
▪ Covering your nose and mouth with a tissue when coughing or sneezing. Dispose of the tissue properly in the dust bin after use.
▪ Avoiding crowded places if you are unwell and wear a surgical mask to cover your nose and mouth.
▪ Staying home from work or school when you are sick.
▪ Using a serving spoon when sharing food at meal times.
▪ Seeing your family doctor if you are feeling unwell.

Also, leading a healthy lifestyle helps to build up your immunity and protects you against infection.

▪ Eat a balanced diet, including plenty of fruit and vegetables.
▪ Be active. Do 30 minutes of physical activity at least 5 days a week.
▪ Learn to relax and have enough sleep and rest.
▪ Do not smoke.

• What is the use of tamiflu?

• Currently, there are antiviral medications available to treat Influenza A(H1N1-2009), such as oseltamivir (Tamiflu®) and zanamivir (Relenza®). These antiviral drugs should be used judiciously. Indiscriminate use may ultimately limit their effectiveness as drug-resistant viruses may develop.

• How do I put on a surgical mask?

Steps of putting on surgical mask

• What are the proper steps to wash my hands?

Proper steps to wash hands

Case Definitions

Suspect Case:

Defined as an individual with an acute febrile respiratory illness (fever >38°C) with onset of symptoms:

– Within 7 days of travel history to affected areas1, OR
– Within 7 days of close contact with a person who is a probable or confirmed case of Influenza A (H1N1-2009);

Probable Case:

– A suspect case (as defined above), with an influenza test that is positive for Influenza A but is un-subtypeable by reagents used to detect seasonal influenza virus, OR;
– An individual with a clinically compatible illness or who died of an unexplained acute respiratory illness who is considered to be epidemiologically linked to a probable or a confirmed case.

Confirmed Case:

– Is a probable case (as defined above) with laboratory confirmed Influenza A (H1N1) virus infection by one or more of the following tests:

• Real-time RT-PCR;
• Viral culture;
• Four-fold rise in Influenza A (H1N1) virus specific neutralizing antibodies.

1 Affected areas currently refer to the US, Canada and Mexico. Please refer to MOH website for the
latest list of Affected Areas:

Precautionary Measures Taken

1. Alerting Healthcare Providers

MOH has sent out circulars to doctors and health institutions to alert all doctors to actively look out for cases with Influenza-Like-Illness (ILIs) symptoms and recent travel history to affected areas


Figure 1

2. Healthcare Institutions’ Response Plans

Further details for Healthcare Practitioners are available through the Health Professionals Portal

1. Hospitals

– Enhanced Infection Control Measures

• Healthcare workers in high risk areas (e.g. Intensive Care Units, Operating Theatres/Rooms, Emergency Departments) will be required to use full personal protective equipment (PPE) (e.g. N95 mask, disposable gloves, eye protection & gowns).
• Healthcare workers should continue to use the appropriate PPE in all other clinical areas.

– Enhanced Screening & Visitation Measures

• Enhanced triage and screening measures (such as temperature screening, screening for symptoms of flu-like illness) of visitors to clinical areas.
• Hospitals will enforce visiting hours and limit the number of visitors to 2 visitors per patient at any one time
• Hospitals will record the contact particulars of all visitors to clinical to help facilitate contact tracing.

– Hospital Operations and Patient Care

• Inter-hospital movement of patients restricted to medically indicated transfers only.
• Inter-hospital movement of doctors and healthcare workers restricted to essential services.
• Elective admissions have been reduced to increase hospital capacity.
• All patients with symptoms of influenza and travel history to affected areas will be isolated and managed appropriately.

2. Primary Care Clinics

• Triage of patients at reception to separate flu/febrile patients from other patients by checking symptoms & taking body temperature.
• Patients to declare symptoms, contact and travel history in Patient Declaration Form
• Flu/febrile patients to wear surgical masks and separated from other patients while in clinic
• Exercise strict infection control precautions by staff (temperature screening for all staff; triage staff to don full PPE; doctors to don PPE while attending to high risk patients)

3. Intermediate & Long Term Care Facilities

• Visitors are required to fill in a self-declaration form indicating their NRIC, contact numbers and travel history.
• Patients with flu-like symptoms and/or fever will be instructed to wear surgical masks and will be separated from other patients.
• To minimize cross-infection, patients with influenza will be managed in separate facilities from non-influenza patients.
• Exercise strict infection control precautions by staff (temperature screening for all staff; doctors, nurses and other healthcare workers to done PPE while attending to high risk patients and at triage)

3. Border Screening

– Temperature Screening

• Temperature screening at air, sea and land checkpoints
• Passengers with fever symptoms will undergo a more thorough onsite medical assessment by the medical teams.

4. Travel Health Alert

– Voluntary Self-Monitoring

If you have been to affected areas (Mexico*,USA and CANADA ) in the last 7 days, please continue to monitor your health and

a. If you are unwell with fever (temperature >38C), andcough / sore throat / runny nose, please call 993* and provide the person receiving your call accurate information regarding:
– Your symptoms;
– Where you travelled;
– If you have had contact with any persons suspected of having flu;

[*Such patient will be referred to the Communicable Disease Centre for a thorough assessment via a dedicated ambulance service (tel 993) which will convey such patients to TTSH Emergency Department.]

b. If you remain well, you can continue with your normal activities.

*Home Quarantine Order (HQO) for travellers to Singapore with a recent Mexican travel history will be lifted with effect from 16 May 09.

– Public Travel Advisory

• Members of the public are strongly advised to postpone or avoid non-essential travel to Mexico and affected areas.
• In the event that travel is unavoidable, the public is advised to take precautionary measures such as avoiding crowded areas and maintaining high standards of personal hygiene at all times.

5. Community Measures

– Public education to raise personal and public hygiene standards

• Strengthen and maintain public education on good personal and public hygiene habits, healthy living


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