What to do if you get influenza (swine flu or seasonal flu)

It is important to know what to do to care for yourself or someone at home with the flu, and to be prepared, as in New Zealand swine flu has arrived at the same time as the 2009 annual flu season.

Advice from the Ministry of Health is to treat swine flu as you would any other influenza. If you or a member of your family becomes sick with flu symptoms, stay home and look after yourself. Most people should be able to recover at home without medical care. Stay there for at least seven days, or until you have had no coughing or sneezing symptoms for 24 hours; whichever is longest. This will minimise the further spread of infection, which is by moisture droplets expelled from the lungs or via contaminated surfaces.

Phone your local doctor or practice nurse for advice if your symptoms worsen, or you feel better then get worse again. Pregnant women should also phone for advice. If you have a serious long term health condition such as heart disease, kidney disease, immunological disease, cancer, diabetes, blood disorders, neurological or neuromuscular disease, liver disease, asthma or other respiratory disease, you should phone your doctor for advice when you get the flu. 

The free Healthline 0800 611 116 is also available if you need any advice about flu or the swine flu. 

Symptoms of flu vs a cold

Prevent the spread of the flu: hygiene measures

Influenza is caused by the influenza virus.  It usually spreads through close contact with people who are coughing or sneezing – known as droplet transmission – and through touching contaminated surfaces (eg. door handles) and surfaces, where the virus can survive for up to 48 hours. There are a number of steps that can be taken to reduce the spread of infection.

• Minimise contact with others (if you are unwell, stay at home; if you are well, try to keep at least 1 metre away from people who have flu, if possible).
• Avoid sleeping in the same room as someone who has the flu. 
• Wash and dry your hands properly (with soap and water for 20 seconds, then dry, or use hand sanitiser) and regularly, and especially before preparing food or eating. 
• Clean surfaces and objects, such as telephones and door handles, regularly with disinfectant or a formula of one part bleach to 100 parts water.
• Regularly clean surfaces in bathroom and kitchen. 
• No sharing. Keep eating utensils, glasses and drink bottles to yourself. 
• Wash dishes thoroughly.  
• Cough and sneeze etiquette: 
  –Minimise close contact with other people.
  –Cover your mouth and nose with a tissue when you cough or sneeze, and always put your used tissue into a rubbish tin (preferably a non-touch pedal bin). 
  –If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands.
  –Don’t spit. Cover your nose and mouth when clearing any secretions.
  –Wash your hands after coughing or sneezing (with either an alcohol-based hand rub or soap and hot water). 
• Try to keep your house well ventilated.

Treatment for influenza Relenza and Tamiflu are both antiviral medicines which shorten the length of illness as long as they are taken within two days of the symptoms first appearing. Prescriptions are now being issued only to those who have a strong need for them.

Care of someone with the flu

A person with influenza could be sick for up to two weeks. Here are some things you can do to care for them:

Maintain hydration 
Fever can cause someone to become dehydrated. In addition they may not be eating, so will not be gaining fluids from foods. Babies, especially those under six months, can quickly become dehydrated. If you are breastfeeding, continue to breastfeed your baby and contact your doctor if you are at all concerned that they may become dehydrated.

Signs of dehydration in young children and babies include:

• dry mouth, lips and tongue
• no tears
• sunken eyes and fontanelle (the soft spot on the top of the child’s head)
• cold hands and feet or mottled bluish skin
• unusual lack of energy, sleepiness or difficulty in waking
• fewer wet nappies than usual or refusal to drink.
• If your child has these signs call your doctor or dial 111.

Symptoms of dehydration in adults and older children include: 

• weakness and lethargy
• dizziness when sitting or standing up
• headache
• dry mouth
• concentrated dark urine.

If you are unsure or concerned about dehydration in a family member, call your doctor, or Healthline (0800 611 116), for advice.

Prevent dehydration by getting the person to drink plenty of fluids:

• Adults: up to two litres (20 cups) of clear fluids per day
• Children aged six months or older: one teaspoon (5ml) of clear fluids per minute or about ¼ cup every 15 minutes
• Infants six months or younger: breastfeed or offer formula often.

Appropriate fluids may include:

• Breastmilk or formula for babies six months or younger
• Specialised age-appropriate electrolyte and fluid replacement solutions from the pharmacy
• Clear fluids containing a little sugar and electrolytes (eg, one part flat lemonade to five parts warm water).

Check for fever
Having a fever is uncomfortable and may prevent you from eating, drinking or sleeping. Normal body temperature is 37°C. Aim to keep the temperature as close to normal as possible. If you do not have a thermometer, you may still be able to tell when a person is feverish by the way they look and feel.

Do not wrap up or warm someone who has a fever, is shaking or has the “chills” – if you do this their temperature may become dangerously high.

Apply a wet facecloth to the forehead to ease the distress of a fever.

The best medicine to treat fever (and aches and pains associated with the flu) is paracetamol. Small children will need the liquid form of paracetamol. Paracetamol is an ingredient in many over-the-counter cold and flu remedies, so take care not to double-dose if taking more than one product. The dosages are as follows:

• Adults – take one or two 500mg tablets every four to six hours. Maximum adult dose is eight tablets in any 24-hour period.
• Children (aged 6-12 years) – follow the manufacturer's instructions.
• Discuss with your GP, practice nurse or pharmacist, the appropriate paracetamol doses for children under 6 years.

Warning re 'cough and cold medicines' and young children
The NZ Medicines and Medical Devices Safety Authority (Medsafe) recommends NOT to give cough and cold medicines to children aged less than 6 years. This applies to all oral (taken by mouth) medicines, with the exception of products which only contain bromhexine, which are considered safe to give to children aged 2 years of age and older. Nasal decongestant sprays or drops (such as those containing oxymetazoline or xylometazoline) are also still considered safe to give to children aged 2 years of age and older. Never exceed the maximum recommended dose on the product label. Ask your pharmacist or doctor for further advice on treating cough and cold symptoms in young children.

Feeding those who are sick
Don't make someone with the flu eat if they don't feel like it. It is more important to ensure they are having adequate fluids. As they start to feel better, you might try offering:

• a range of different fluids such as diluted fruit juice, clear or strained soups, sweetened tea or jelly.
• bland, easily digested foods such as dry white toast, water crackers or pasta
• canned fruit and thicker soups
• eventually dairy products, fruit, vegetables, bread and cereals.

Record progress
Keep a record of the person’s condition, eg, temperature, fluid intake, symptoms. Seek medical care if you notice any of the following:

• The person has been unwell for three or four days and is not getting any better, or is feeling worse 
• High temperature that will not come down
• Difficulty with - or noisy - breathing 
• Shortness of breath 
• Pain or pressure in the chest or stomach
• Confusion or disorientation
• Coughing up bloody sputum or green phlegm
• Severe vomiting or vomiting that does not go away
• Severe pain in the ear(s)
• Dehydration that cannot be corrected with fluids
• Fits or uncontrollable shaking
• Blue skin around the lips and/or fingertips
• Symptoms that improve and then suddenly become worse.

Based on an article by Kelly Maw, nursing facilitator at Pegasus Health, in NZ Doctor, and revised by everybody, June 2009. Updated December 2009.