A: National authorities for medicines approve and license pandemic influenza vaccines before they can be used. They examine known and suspected risks and benefits prior to licensing. Expedited regulatory processes in some countries help license the new vaccine in a timely manner. Testing and manufacturing processes for new vaccines are similar to seasonal influenza vaccines to ensure quality and safety.

A: Some side effects can be associated with influenza vaccination. How often they result depends on the type of vaccine, how it is administered and age of the vaccine recipient. There are two main types of vaccines, namely one that is manufactured with inactivated viruses and the other that uses live viruses.

Inactivated vaccines, administered by injection, commonly cause local reactions - soreness, swelling and redness at the injection site and less often can cause fever, muscle/joint/headache. These symptoms are generally mild and do not need medical attention. They may last 1-2 days. Their occurrence may be more frequent in children as compared to elderly people.

It is uncommon for influenza vaccines to cause allergic reactions such as hives, rapid swelling of deeper skin layers and tissues, asthma or severe multisystem allergic reaction due to hypersensitivity to certain vaccine components.

Live vaccines are given via a nasal spray and can commonly cause runny nose, nasal congestion and cough. Less frequently they may cause sore throat, low grade fever, irritability and head/muscle aches. Wheezing and vomiting episodes have been found in children receiving live influenza vaccines.

A: As of late October, there was no indication of adverse events post immunisation, according to clinical trials and adverse event monitoring during deployment of vaccines in early introducer countries. The need for continued vigilance and regular evaluation by health authorities remains an ongoing process.

A: Current evidence does not indicate that seasonal influenza or pandemic influenza vaccines, or any other vaccine against novel human influenza viruses, either induce or aggravate the course of chronic diseases in vaccine recipients. Careful assessment is required to see if adverse events that occur after vaccination are actually caused by an influenza vaccination.

A: Guillain Barré syndrome (GBS) is a rapidly developing, immune-mediated disorder of the peripheral nervous system that results in muscular weakness. Most people recover completely but some have chronic weakness. It can develop following a variety of infections, including influenza. In people who have been immunised with available vaccines, frequency of GBS usually is the same as in unvaccinated people. Extensive studies and data analysis of influenza vaccines find a well established causal association with the 1976 vaccine that contained an H1N1 swine-influenza-like virus. No other clear association has been found with either seasonal or other pandemic influenza vaccines.

A: So far, evidence suggests that current seasonal influenza vaccines will not protect against pandemic influenza.

A: The pandemic vaccines are not expected to provide protection against other influenza A or B viruses that are different from the pandemic (H1N1) 2009. Influenza viruses constantly undergo genetic changes and require vaccines that match the circulating influenza strains to be effective, so seasonal influenza vaccines have to be modified annually.

A: Yes. Every year many people suffer from seasonal influenza, particularly the elderly, children younger than age 2 and people with other medical conditions or weakened immune systems. People should therefore continue to seek seasonal influenza vaccination like any other year.

A: Seasonal influenza and pandemic influenza vaccines can be administered together. There is a public health value in doing so, according to a global panel of immunisation experts.

A: Antivirals should only be used when prescribed by a qualified health care provider, as they will be able to assess each situation and make the appropriate decisions on care. All patients (including pregnant women) and all age groups (including young children and infants) should be treated with oseltamivir in the event of severe or deteriorating illness. Treatment with either oseltamivir or zanamivir should also be offered to all patients in at-risk groups in the event of illness, even if mild or uncomplicated.

A: No, if antiviral drug treatment is indicated by the clinical presentation, then treatment should start as soon as possible. If delayed, the treatment could become less effective

A: You will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help.

Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose.

Seasonal influenza and influenza A(H1N1) can be distinguished based only on the basis of a lab test (rRT-PCR) which is available in designated government labs. However, lab testing is not required in most cases. Take the advice of your physician or the doctor at a designated government screening centre.

A: Some people are more at risk than others of getting more seriously impacted by H1N1. They will need to start taking antivirals as soon as they are confirmed with the illness. On occasion, doctors may advise some high risk patients to take antivirals before they develop symptoms if someone close to them has the novel Influenza flu.

The risk profile of the virus is still being studied but it is already known that certain groups of people are particularly vulnerable. These include:

	Patients who have had drug treatment for asthma in the past three years;
	Pregnant women;
	People aged 65 years and older;
	Children under five years of age;
	People with chronic lung/heart/kidney/liver/neurological disease;
	People with immunosuppression (caused by disease or treatment); and
	People with diabetes mellitus.

A: If you feel unwell, have high fever, cough or sore throat:

	Stay home and keep away from work, school or crowds;
	Rest and take plenty of fluids;
	Cover your nose and mouth when coughing and sneezing and, if using tissues, make sure to dispose them carefully. Clean your hands immediately with soap and water;
	If you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;
	Use a mask to help contain spread of droplets when you are around others, but be sure to do so correctly;
	Inform family and friends about your illness and avoid contact with other people; and
	If possible, contact a health professional before travelling to a health facility to discuss whether a medical examination is necessary

A: Call your family physician/doctor if:

	You have a serious underlying (existing) illness;
	You are pregnant;
	You have a sick child less than one year of age;
	Your condition suddenly gets much worse; and
	Your condition is still getting worse after 7 days (5 for a child).

A: You should seek medical care if you experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or laboured breathing, continuous fever or convulsions (seizures).

- Supportive care at home includes resting, drinking plenty of fluids and using a pain reliever for aches. A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.

	If you have symptoms of flu, then cover your mouth and nose when coughing or sneezing. Use a tissue (Do not share towels/cloth napkins with others at home). Dispose of used tissues carefully. Stay at home and keep at least an arm’s length distance from others to prevent transmission of infection to them;
	Wash your hands frequently with soap and water; alcohol-based hand sanitizers are also good, especially when soap and water are not available; Avoid touching eyes, nose or mouth. Germs spread this way;
	Try to avoid close contact with sick people;
	If you are sick with flu-like illness, it is recommended you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. Keep away from others as much as possible; and
	Clean hard surfaces (kitchen worktops, door handles, computer keyboards) frequently using a normal cleaning product.

A: Majority of cases reported so far in India have been mild. Only a small number have led to serious illness, and these have frequently been where patients have had underlying health problems.

A: No, not unless your doctor advises it. Studies on other influenza infections show that breastfeeding is most likely protective for babies - it passes on helpful maternal immunities and lowers risk of respiratory disease.

Breastfeeding provides the best overall nutrition for babies and increases their defense factors to fight illness.

A: No. Whether you have influenza A(H1N1) or seasonal influenza, you should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your work colleagues and others.

A: Severity of illness associated with novel H1N1 flu virus varies from mild to severe with most people who have been sick recovering without medical treatment, hospitalisation and death from infection.

In seasonal flu, those at “high risk” of serious complications include 65 years and older, children younger than 5, pregnant women and people with certain chronic medical conditions. About 70% of those hospitalised with the virus have had one or more medical conditions previously recognised, placing them at “high risk” of seriousseasonal flu-related complications (pregnancy, diabetes, heart disease, asthma and kidney disease).

One thing that looks different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of virus related complications. Studies show that children and adults younger than 60 do not have existing antibodies to the virus; however, one third of adults older than 60 may have antibodies against the virus. It is unknown how much protection can be afforded against the virus by an existing antibody.

A: In seasonal flu, seasons vary in timing, duration and severity causing mild to severe illness, and at times death. According to WHO, seasonal influenza epidemics result in about 3 - 5 million cases of severe illness worldwide, and 250,000 - 500,000 of people with severe illness dying each year from complications of influenza. Most complications and deaths occur in less than 5 year and more than 65 year-old patients.

Since the emergence of novel H1N1 flu in mid-April 2009, WHO has been working with countries to collect data on the outbreak, collate numbers of confirmed and probable cases and ages of these people. The analysis suggests that the flu has caused greater disease burden in people younger than 25 years of age than older people. Currently, few cases and deaths are reported in those over 64, which is unusual compared to seasonal flu. However, pregnancy and previously recognised high risk medical conditions from seasonal influenza appear associated with increased risk of complications from Novel H1N1. These underlying conditions are asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.

A: No. You should only take an antiviral, such as oseltamivir or zanamivir, if your doctor advises you to do so. Individuals should not buy medicines to prevent or fight this new influenza without a prescription, and they should exercise caution in buying antivirals over the Internet.

A: There is no vaccine available right now to protect against novel H1N1 virus. According to WHO, at least seven manufacturers have started clinical trials and these clinical trials are going on in at least 5 countries (China, Australia, the United Kingdom, Germany and the U.S.A). Dossiers are being submitted to regulatory authorities. The first novel H1N1 vaccine may be out by September.

In India, the government is working closely with manufacturers to take steps to manufacture a novel H1N1 vaccine. Production process has begun in Pune-based Serum Institute, Hyderabad’s Bharat Biotech and Delhi’s Panacea Biotech. All received vaccine seeds from WHO. The Pune firm is in the most advanced stage as it has started animal trials. Current projections for making H1N1 vaccine available for Indian population is anywhere from 3-6 months depending upon regulatory and safety clearances.

A: It is anticipated that seasonal flu and novel H1N1 vaccines may be administered on the same day. However, seasonal vaccine might be available earlier than H1N1 vaccine. The usual seasonal influenza viruses are still expected to cause illness this winter. Individuals are encouraged to seek advice of their doctors to get their seasonal flu vaccine as soon as it is available.

A: Based on the pandemic’s current estimated severity, on 7 July 2009, the Strategic Advisory Group of Experts on Immunization (SAGE) of WHO identified the following groups in order of priority for vaccination against influenza A (H1N1) 2009 pandemic:

	Health-care workers: as first priority to protect essential health infrastructure
	Pregnant women: This group appears to be at increased risk for severe disease, potentially resulting in spontaneous abortion and/or death, especially during the second and third trimesters of pregnancy.
	Individuals aged >6 months with one of several chronic medical conditions: in order to reduce morbidity and mortality. This group includes people with asthma and other chronic conditions such as morbid obesity.
	Healthy young adults (aged >15 years and <49 years): to reduce morbidity and mortality: to reduce transmission; However, there was uncertainty regarding the potential effectiveness of this approach
	Healthy adults aged >49 years and <65 years: to reduce morbidity and mortality.
	Healthy adults aged >65 years: to reduce morbidity and mortality.

SAGE noted that countries could use a variety of strategies to deploy vaccines but any strategy should reflect the country’s epidemiological situation, resources and ability to access vaccine, to implement mass vaccination in the targeted groups and to use other non-vaccine mitigation measures. Such measures include non-pharmaceutical measures and pharmaceutical interventions, including recourse to antivirals. Under all circumstances, strengthening influenza surveillance in developing countries, particularly in Africa, was considered important.

A: Healthy people aged 65 and above appear to have some natural immunity to the H1N1 virus. And while children are disproportionately affected by H1N1, vast majority make full recovery - therefore experts do not advise that children (other than those in at-risk groups) should be vaccinated initially.

A: As of August 18, there were more than 235,000 laboratory confirmed cases, though the actual number of infections is probably much higher. Global H1N1 flu deaths have crossed 2,150. For more information click on: http://www.who.int/csr/disease/swineflu/updates/en/index.html