Swine Flu Information (H1N1)
The H1N1 Virus is now a general human flu virus
2009 H1N1 and Seasonal Flu: What You Should Know About Flu Antiviral Drugs
October 8, 2009, 2:00 PM ET (From the CDC)
What are antiviral drugs?
Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu in your body. While CDC recommends flu vaccine as the first and most important step in preventing flu, antiviral drugs are a second line of defense against the flu. Antiviral drugs are not sold over-the-counter and are different from antibiotics. You can only get them if you have a prescription from your doctor or health care provider.
What antiviral drugs are recommended this flu season?
There are two antiviral drugs recommended by CDC this season. The brand names for these are Tamiflu® and Relenza® (The generic names for these drugs are oseltamivir and zanamivir). Tamiflu® is available as a pill or liquid and Relenza® is a powder that is inhaled.
Who should take antiviral drugs?
It’s very important that antiviral drugs be used early to treat flu in people who are very sick (for example people who are in the hospital) and people who are sick with flu and have a greater chance of getting serious flu complications (see box). Other people may also be treated with antiviral drugs by their doctor this season. Most healthy people with flu, however, do not need to be treated with antiviral drugs.
What are the benefits of antiviral drugs?
When used for treatment, these drugs can make you feel better and shorten the time you are sick by 1 or 2 days. They can also prevent serious flu complications.
When should antiviral drugs be taken for treatment?
Studies have shown that flu antiviral drugs work best for treatment if they are started within 2 days of getting sick. There may still be benefit in treating people with antiviral drugs even after two days have gone by, especially if the sick person has a greater change of serious flu complications (see box) or if the person has certain symptoms (such as shortness of breath, chest pain/pressure, dizziness, or confusion) or is in the hospital because of the flu.
How long should antiviral drugs be taken?
To treat flu, Tamiflu® and Relenza® are usually taken for 5 days, although people hospitalized with flu may need the medicine for longer than 5 days.
Can children take antiviral drugs?
Yes. Children can take antiviral drugs.
- Right now, Tamiflu® can be given to children of all ages, including children younger than one year of age. It can come in liquid for children or in capsules.
- Relenza® is approved for use in children 7 years of age and older, but only for people without breathing problems (such as asthma) or heart disease. It is an inhaled powder that comes in a disk inhaler.
Can pregnant women take antiviral drugs?
Yes. At this time, there are no studies suggesting harm to a pregnant woman or her unborn baby if she takes antiviral medicine. The flu can cause severe illness and even death in pregnant women. Taking antiviral medicine can help prevent these complications. At this time, Tamiflu® is the best medicine to treat pregnant women who have 2009 H1N1 flu.
What are the side effects of antiviral drugs?
Side effects differ for each antiviral drug.
Tamiflu® has been in use since 1999. The most common side effects are nausea or vomiting which usually happen in the first 2 days of treatment. Taking Tamiflu® with food can reduce the chance of getting these side effects.
Relenza® has been in use since 1999. The most common side effects are dizziness, sinusitis, runny or stuffy nose, cough, diarrhea, nausea, or headache. Relenza® may also cause wheezing and trouble breathing in people with lung disease.
Confusion and abnormal behavior leading to injury has been observed rarely in people with the flu, mostly children, who were treated with Tamiflu® or Relenza®. Flu can also cause these behaviors. But persons taking these drugs should be closely monitored for signs of unusual behavior or problems thinking clearly. This behavior should be immediately reported to a health care provider.
If an antiviral drug has been prescribed for you, ask your doctor to explain how to use the drug and any possible side effects.
- Children younger than 2 years old*
- Adults 65 years and older
- Pregnant women and women up to 2 weeks from end of pregnancy
- People with certain chronic medical conditions (such as asthma, heart failure, chronic lung disease) and people with a weak immune system (such as diabetes, HIV)
- People younger than 19 years of age who are receiving long-term aspirin therapy
*It is also important to know that children who are 2 years though 4 years of age also have a higher rate of complications compared to older children, although the risk for these children is lower than the risk for children younger than 2 years.
Questions & Answers
2009 H1N1 Influenza Vaccine
September 24, 2009, 10:30 AM ET (From the CDC)
Q: What are the plans for developing 2009 H1N1 vaccine?
A: Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a 2009 H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines will be tested in clinical trials over the few months.
Q: When is it expected that the 2009 H1N1 vaccine will be available?
A: The 2009 H1N1 vaccine is expected to be available in the fall. More specific dates cannot be provided at this time as vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials
Q: Will the seasonal flu vaccine also protect against the 2009 H1N1 flu?
A: The seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu.
Q: Can the seasonal vaccine and the 2009 H1N1 vaccine be given at the same time?
A: It is anticipated that seasonal flu and 2009 H1N1 vaccines may be administered on the same day. However, we expect the seasonal vaccine to be available earlier than the H1N1 vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Individuals are encouraged to get their seasonal flu vaccine as soon as it is available.
Q: Who will be recommended to receive the 2009 H1N1 vaccine?
A: CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.
We do not expect that there will be a shortage of 2009 H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others: pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel with direct patient contact, children 6 months through 4 years of age, and children 5 through 18 years of age who have chronic medical conditions.
The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these target groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.
Q: Do those that have been previously vaccinated against the 1976 swine influenza need to get vaccinated against the 2009 H1N1 influenza?
A: The 1976 swine flu virus and the 2009 H1N1 virus are different enough that its unlikely a person vaccinated in 1976 will have full protection from the 2009 H1N1. People vaccinated in 1976 should still be given the 2009 H1N1 vaccine.
Q: Where will the vaccine be available?
A: Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces. For more information, see State/Jurisdiction Contact Information for Health Care Providers Interested in Providing H1N1 Vaccine.
Q: Will this vaccine be made differently than the seasonal influenza vaccine?
A: No. This vaccine will be made using the same processes and facilities that are used to make the currently licensed seasonal influenza vaccines.
Q: Are there other ways to prevent the spread of illness?
A: Take everyday actions to stay healthy.
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand rub.*
- Avoid touching your eyes, nose or mouth. Germs spread that way.
- Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures will continue to be important after a 2009 H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.
Q: What about the use of antivirals to treat 2009 H1N1 infection?
A: CDC has issued interim guidance for the use of antiviral drugs for this season. CDC also has published Questions & Answers related to the use of antiviral drugs for this season.
Q: Will two doses of vaccine be required?
A: The U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10 years of age and older. Data from trials among children are not available at this time, so dosing schedules for children are not yet known. Data from trials among children will be available soon. At this time, FDA has approved two doses for children 6 months through 9 years of age. Immunogenicity data for the 2009 flu H1N1 vaccine among adults is similar to that for seasonal influenza vaccines. If this is also the case among children, then it is likely that younger children will require two doses and older children will require one dose. As with seasonal vaccine, children 6 months through 35 months of age should get two doses of 2009 H1N1 flu vaccine, which contains one-half of the dose used for older children and adults.
Q: What will be the recommended interval between the first and second dose for children 9 years of age and under?
A: This will not be known until clinical trials are complete. For planning purposes, planners should assume 21-28 days between the first and second vaccination.
Q: Can seasonal vaccine and novel H1N1 vaccine be administered at the same time?A: Inactivated 2009 H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live 2009 H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.
Novel H1N1 Vaccination Planning Q&A
Updated: August 10, 2009, 11:45 AM ET (From the CDC)
Q. When will the decision to administer vaccine be made?
A. For planning purposes, it should be assumed that vaccine will be administered beginning in the fall.
Q. When will vaccine shipping begin?
A. Planners should assume shipping of vaccine will begin mid-October, although there is a possibility that some vaccine will be available for shipping starting late September.
Q. How many manufacturers are producing vaccine?
A. Five manufacturers are producing vaccine for the U.S.: Sanofi Pasteur, Novartis, GSK, Medimmune and CSL.
Q. How much vaccine can be expected to be available for shipping when shipping begins?
A. Planners should use the following scenarios: In the first scenario, approximately 120 million doses will be released beginning around mid-October over a 4 week period, followed by approximately 20 million doses per week (or 80 million doses per month) thereafter. In the second one, up to 20 million doses of vaccine will be released beginning late September, followed by approximately 20 million doses per week (or 80 million doses per month) thereafter.
Q. How will vaccine be shipped to projects areas (CDC Public Health Emergency Preparedness grantees)?
A. Vaccine will be shipped to clinics, offices, health departments, and other project area-designated sites which may include a mix of public health and private sector sites via centralized distribution. This is the same process that is used to ship vaccines for the childhood immunization program to immunization providers. CDC's centralized distribution mechanism will be substantially enhanced to provide capacity for this activity in addition to shipping of other vaccines.
Q. Will project areas (CDC Public Health Emergency Preparedness grantees) be able to limit the amount of vaccine they receive?
A. Yes, project areas will be able to determine what proportion of their allocation they wish to receive.
Q. How frequently will vaccine shipments arrive?
A. As details of distribution are finalized, CDC will communicate with states about the anticipated time period between placing vaccine orders and receiving shipments.
Q. How many sites can be designated as vaccine receiving sites?
A.One of the key benefits of using a centralized, third party distributor to support H1N1 vaccine distribution is that it allows distribution of doses to a much larger number of providers sites than would be feasible with direct manufacturer distribution. Thus, we will be able to serve a significantly larger provider base than the original state ship to sites, and are planning to be able to accommodate more providers than are currently served by the VFC program. More information, including any limitations in the number of vaccine receiving sites, will be shared with state planners as soon as it becomes available.
Q. Will vaccine be in multi-dose vials?
A. The majority of vaccine will be in multi-dose vials, the remainder in single dose syringes or nasal sprayers. The aim is to have enough vaccine in single dose syringes (i.e. preservative free) for young children and pregnant women.
Q. How will vaccine be allocated among project areas (the CDC PHEP grantees)?
A. Vaccine will be allocated to each project area in proportion to its population (pro rata).
Q. Will there be a separate allocation for active duty DOD?
A. Yes, there will be a separate allocation for active duty DoD. It is not included in the project area allocations.
Q. Will there be a separate allocation for DoD dependants, retirees and civilian employees?
A.There is no separate allocation for these groups. Military facilities may be willing to vaccinate these groups, but will need to be allocated vaccine for these populations by the project areas.
Q. Will there be a separate vaccine allocation for IHS-served populations and other tribal communities?
A. There will be no separate allocation. States and local areas need to work with their tribal populations to ensure access to vaccine.
Q. Which ancillary supplies will be provided with vaccine?
A. HHS will provide needles, syringes, sharps containers and alcohol swabs.
Q. How will ancillary supplies be distributed?
A. Ancillary supplies will be distributed to the same project area-designated sites as vaccine. Plans for ensuring the distribution of these products are currently being developed.
Q. Will two doses of vaccine be required?
A. This will not be known until the late summer- early fall, once clinical trials are completed. For planning purposes, planners should assume that two doses will be needed.
Q. What will be the recommended interval between the first and second dose?
A. This will not be known until clinical trials are complete. For planning purposes, planners should assume 21-28 days between the first and second vaccination.
Q. How much Thimerosal-free vaccine will be available?
A. It is anticipated that enough thimerosal-free vaccine in pre-loaded syringes will be available for young children and pregnant women.
Q. Will there be federal requirements to recall persons for their second dose, if a second dose is needed?
A. There will be no federal requirement to send out recall notices. Providing information on second dose at the time of the first dose, as well as using the media to disseminate this message will be the primary means of educating persons about who needs a second dose administered.
Q. Will it be necessary for the first and second dose to be the same product?
A. Ideally, first and second doses would be from the same product. However, practical considerations make this difficult to implement. Planners should assume they will be interchangeable.
Q. Can seasonal vaccine and novel H1N1 vaccine be administered at the same time?
A. Clinical trials are exploring this question. It is anticipated that seasonal vaccine and novel H1N1 vaccines may be administered together.
Q. Will vaccine be adjuvanted?
A. It is unlikely H1N1 vaccine will be adjuvanted. Definitive information will be available once clinical trial data are available.
Q. If vaccine is adjuvanted, how will it be formulated?
A. Formulation will vary by provider. For Novartis, vaccine may be preformulated with adjuvant. For CSL, GSK and Sanofi Pasteur, mixing of vaccine and adjuvant at the site of administration will be necessary. Specific information on storage requirements and procedures for mixing vaccine and adjuvant will be provided by CDC. Medimmune vaccine will not be adjuvanted.
Q. Will the vaccine be administered under EUA (Emergency Use Authorization)?
A. EUA will not be used for unadjuvanted vaccine if FDA licenses the vaccine under the current BLA (Biologics License Application) as a strain change.
Q. For whom will novel H1N1 vaccine be recommended?
A. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) met on July 29th to develop recommendations on who should receive the novel 2009-H1N1 vaccine when it becomes available, and to determine which groups of the population should be prioritized if the vaccine is initially available in extremely limited quantities. The committee recommended that vaccination efforts initially focus on 5 target groups: vaccination for pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months through 24 years, and people ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems. We do not expect that there will be a shortage of novel H1N1 vaccine, but flu vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities. So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities. For more information see the CDC press release CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1. Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older. (see http://www.cdc.gov/h1n1flu/vaccination/acip.htm)
Q. Will there be flexibility in how states implement the recommendations?
A. The ACIP recommendations leave room for flexibility at the local level depending on the local vaccine supply situation.
Q. Given the potential for large amounts of vaccine available during the first month of vaccine shipments, are priority groups needed?
A. It is not expected that there will be a shortage of novel H1N1 vaccine, but availability and demand can be unpredictable, and there is some possibility that initially the vaccine will be available in limited quantities and priority groups may be needed.
Q. Will there be requirements regarding documentation of priority group membership?
A. There will be no federal requirements for vaccinators to require documentation of priority group status such as a doctor’s note documenting pregnancy or risk status.
Doses administered Monitoring:
Q. What are the minimum data elements required by CDC?
A. Minimum data requirements include age group, 1st or 2nd dose, date of vaccination, and state.
Q. Are there any changes in recommendations for pneumococcal vaccines?
A. The ACIP recommends that persons recommended for pneumococcal vaccine receive it in light of the potential for increased risk of pneumococcal disease associated with influenza. There are at present no recommendations to give pneumococcal vaccine to groups for whom it is not currently recommended. ACIP will revisit this question over the summer as epidemiologic data from the Southern hemisphere influenza season and from the U.S. become available.
What is Swine Influenza?
Swine Influenza (H1N1 Flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.
How many swine flu viruses are there?
Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.
Swine Flu in Humans
Can humans catch swine flu?
Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.
How common is swine flu infection in humans?
In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.
What are the symptoms of swine flu in humans?
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.
Can people catch swine flu from eating pork?
No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.
How does swine flu spread?
Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose. This is why it is a good idea to have a flu clinic at your office for your employees to get vaccinated!
What do we know about human-to-human spread of swine flu?
In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.
In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.
How can human infections with swine influenza be diagnosed?
To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.
What medications are available to treat swine flu infections in humans?
There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.
What other examples of swine flu outbreaks are there?
Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).
Is the H1N1 swine flu virus the same as human H1N1 viruses?
No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.
Swine Flu in Pigs
How does swine flu spread among pigs?
Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.
What are signs of swine flu in pigs?
Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.
How common is swine flu among pigs?
H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.
While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.
Is there a vaccine for swine flu?
Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses. As far as we know, the government is working on developing a vaccine for H1N1. Check back often for any updates we may post in the next few weeks.
The information contained in this Midland Health web site is not a substitute for medical advice or treatment, and Midland Health recommends consultation with your doctor or health care professional.