Influenza A (H1N1) (previously referred to as “Swine Flu”) is a new strain of influenza virus that spreads from human to human. Influenza A (H1N1) is a viral respiratory disease that presents with flu like symptoms.

The symptoms of Influenza A (H1N1) are similar to the symptoms of seasonal flu. These symptoms can vary in severity from mild to severe, and include the following:

High fever (>38°C)	Runny nose
Sore throat	Headaches
Cough	Tiredness
Body aches

Practice 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 tissue when coughing or sneezing. Dispose of the tissue properly in the dust bin after use.
• Avoiding crowded place 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.

There are antiviral medications available to treat Influenza A (H1N1-2009), such as oseltamivir (Tamiflu) and zanamivir (Relenza). They fight against the Influenza A (H1N1-2009) virus reproducing itself in the body. When taken early (within 2 days of the appearance of the symptoms), these medicines may:

• Reduce the severity of the infection with faster recovery from the illness.
• Prevent serious complications.

Monitor your health for seven days from time of contact and watch out for flu-like symptoms. If you become unwell, please follow the advice in paragraph 9 above.

Children who are contacts should refrain from playing with other children outside or inside the home as children may continue playing even when they start having flu-like symptoms and this would put other children at risk.

If you live in the same household as the ill person, practise the following:

a. Observe good personal hygiene. Clean your hands with soap and water or an alcohol-based hand rub frequently, including after every contact with the ill person or the person’s room or toilet. Use paper towels for drying hands after hand washing or have a dedicated cloth towel for each person in the household.

b. Do not have meals together with the ill person as masks would have to be removed during meals.

c. Wear a surgical mask and remain at a distance of at least 2 metres from one another if you need to communicate with the ill person.

d. Maintain good ventilation at home (e.g. keeping windows open in toilet, kitchen and rooms).

Persons who have been infected with pandemic H1N1 infection during the current first wave are likely to have some immunity against possible future waves of infection. Future changes in the virus would mean that the degree of immunity cannot always be predicted.

When the H1N1 vaccine becomes available, it would be offered on 'a voluntary basis'. Those who wish to be vaccinated, after considering their risk of getting flu and flu-related complications and understanding the possible side effects of vaccination, will be able to approach their doctor for it. They will have to pay for the vaccine similar to existing arrangements for other forms of voluntary vaccination. Patients who have difficulties paying will be given the necessary assistance at public sector institutions as per current practice.

Schools will continue to remain vigilant to slow the spread of the virus in our schools.

 

Schools will continue to visually screen students, staff and visitors for fever and flu-like symptoms. From 27 Jul 09, schools will conduct temperature taking once a day for students and staff. From 3 Aug 09, temperature taking will be conducted twice a week. Daily assemblies will also resume from 3 Aug 09. However, schools will continue to assess the need for mass activities and adopt the necessary precautionary measures for these activities.

 

Schools will continue to keep their premises clean and continue to track students with MCs to reduce the risk of a spread of flu-like illnesses within the school community. They will also continue to educate students to maintain high standards of personal hygiene and exercise social responsibility.

 

MOH has revised its approach in tracking H1N1 cases, testing suspected cases only when there is a clinical indication (eg severely ill patients). For patients with influenza-like illness who do not require hospitalisation and are not likely to be tested for H1N1, doctors will issue Medical Certificates (MC) of up to 7 days for staff and students above 12 years old, and up to 10 days for children 12 years and below from onset of symptoms.

 

It has been an on-going practice for students and staff to submit their MCs to schools. In view of MOH’s revised approach, schools are closely monitoring the number of students and staff with MCs due to influenza-like illnesses.

 

In the event that a significant number of students in a class are issued MCs due to influenza-like illnesses, the school would consider taking precautionary measures, such as segregating the class into groups or temporarily suspending lessons for the class. The students will be provided with home-based learning lessons or attend make-up lessons when they return to school.

 

MOE will continue to monitor the situation closely and review measures as the situation develops, in consultation with the Ministry of Health.

 Can I catch H1N1 from eating pork and pork products?
No, you can’t. World health authorities, i.e. the World Health Organisation (WHO), World Organisation for Animal Health (OIE) and Food & Agriculture Organisation (FAO), have jointly stated that there is no evidence that the H1N1 virus is transmitted by food. Pork and pork products, handled in accordance with good hygienic practices to prevent contamination during processing, will not be a source of infection. It is safe to eat processed pork products, such as ham, bacon, sausages and canned pork. Cooking pork to an internal temperature of 70°C kills bacteria and viruses, including the H1N1 virus.

Is it safe to handle pork?
It is safe to handle pork. Generally, people should continue to adopt good hygiene practices when handling pork. World health authorities, i.e. the World Health Organisation (WHO), World Organisation for Animal Health (OIE) and Food & Agriculture Organisation (FAO), have jointly stated that there is no evidence that the H1N1 virus is transmitted by food. Pork and pork products, handled in accordance with good hygienic practices to prevent contamination during processing, will not be a source of infection. It is safe to eat processed pork products, such as ham, bacon, sausages and canned pork. Cooking pork to an internal temperature of 70°C kills bacteria and viruses, including the H1N1 virus.

If pork is safe, why is there a need to inform the public?
H1N1 is a topic of public interest. Whenever consumers perceive that there are issues with food safety, there is always heightened uncertainty and fear as consumers are worried over the potential impact on their health. This is why it is important that we inform the public of the facts and assure them that pork from the Pulau Bulan pigs is safe for consumption.

Can we catch the virus from pigs?
In Singapore, there is no contact between the public and pigs. As for workers in the abattoir, they have been putting on personal protective equipments whenever working since April 2009.
 
What is the purpose of AVA testing for the H1N1 virus?
AVA started collecting samples from pigs to test for the H1N1 virus since the outbreak of the disease in humans in Apr 09. The purpose is to provide an early alert for the emergence of the disease on the farm so that timely risk management measures can be put in place.

Is this the same virus as the H1N1 virus affecting humans?
This is the same virus which is affecting humans.
 
What action will AVA take for those pigs at the Pulau Bulan farm that tested positive for H1N1 virus?
AVA will be participating in a comprehensive disease surveillance programme on the farm which will be led by the Indonesian veterinary authorities, the Directorate-General of Livestock Services (DGLS), to identify and isolate affected pig houses. Restricted animal movement will be imposed to ensure only healthy pigs are exported to Singapore. This is in line with the World Organisation for Animal Health’s (OIE) recommendation that movement restrictions be applied until the pigs have recovered. The Australian and Canadian Veterinary Authorities have also adopted similar approaches when H1N1 infection was detected on their pig farms.
 
What measures have AVA taken to ensure that only healthy pigs from Pulau Bulan are imported into Singapore?
Since April 2009, AVA has put in place an early warning system for the emergence of the disease in live pigs. These include measures such as additional farm inspections, enhanced inspection at the abattoir as well as sampling and testing for H1N1 prior to export and upon arrival. The Pulau Bulan farm has also implemented bio-security measures against the H1N1 virus such as temperature taking and restriction of visitors at the farm. Upon detection of H1N1 through our surveillance programme, AVA has put in place enhanced measures. These include weekly farm inspections and increased pre-export testing.
 
What if there is not enough supply of pigs from Pulau Bulan?
Singapore has diversified our sources of supply over the years. Pigs from Pulau Bulan only constitute about 21% of our supply. We currently have 25 approved countries exporting pork and pork products. Major sources of frozen and chilled pork include Australia and Brazil. Any shortfall in supply can be met by increased import of pork from these sources.
 
What measures are taken to protect the abattoir workers who come into close contact with the pigs?
Abattoir workers are required to put on personal protective equipment like face masks, face shields, gloves and aprons.

Has H1N1 been detected in pigs elsewhere?
Yes, H1N1 has been detected in pigs in Canada and Australia. The Australian and Canadian Veterinary Authorities adopted recommendations by the World Organisation for Animal Health (OIE) on the application of movement restrictions until the pigs have recovered when H1N1 infection was detected on their pig farms.

 

With effect from 30 Apr 09, the World Health Organization (WHO) will refer to the new influenza virus as Influenza A (H1N1). Singapore is changing our terminology in line with WHO's revised terminology.

Influenza A (H1N1) is an illness caused by type A influenza viruses, which affect a range of animals, as well as humans. A new strain of Influenza A (H1N1) virus that spreads from human to human has recently been identified.

Influenza A (H1N1-2009) spreads from human to human in the same way as seasonal flu.

Not necessarily. Pandemic refers to the spread of a disease (an epidemic) that spreads over a wide geographic area, not its severity. The WHO has described Influenza A (H1N1) virus as a possible pandemic because the illness has spread beyond Mexico to other countries in North America, Europe and now, Asia.

The current phase 5 of WHO’s flu alerts is one short of a full-blown pandemic. At phase 6, the disease has spread globally.

Pandemics can be of differing severity. In 1968, the Hong Kong Flu spread to Vietnam, Australia, and India, among other countries, but killed only 0.1 per cent of those with the disease (note: unable to vouch for this figure) compared to the 1918 Spanish Flu which killed by some estimates up to 100 million people. Advances in medical treatment are likely to have contributed to the difference too.

Case-fatality rate, refers to the proportion of people with a disease who will die. The case fatality rate for the 2009 H1N1 infection remains unclear. Initial reports from Mexico cited a high case-fatality rate but recent reports have suggested the mortality rate is high as mild self-limiting cases might have been missed. The virus, like other flu viruses, is also constantly changing. New mutations may be harmless versions of itself but there is also the possibility that the virus may become more infectious and lethal. It will take time for the full picture to emerge.

The World Animal Health Organisation (OIE) had declared that the flu virus currently infecting humans should not be called "swine flu", as it also contains avian and human components and no pigs have been found ill with the disease so far. The World Health Organization (WHO) has referred to the new influenza virus as Influenza A (H1N1) wef 30 Apr 09 and Singapore has also changed our terminology in line with WHO's revised terminology. The new virus is now referred to as Influenza A (H1N1).

In temperate countries, influenza cases are seen mostly in colder and dryer months during winters (usually the months of December to February for countries in the Northen Hemisphere and months of April to June for countries in the Southern Hemisphere).

In tropical country like Singapore where there are no seasons, it has been observed that influenza cases peaked during the months of April to July and November to January (roughly similar to the months when peaks in influenza activities are observed in the Northern and Southern Hemispheres) though there are far fewer cases of influenza in Singapore than in the hemispheric countries.

Many aspects of the current emerging strain of influenza, influenza A (H1N1), are still unknown, hence it is difficult to ascertain how this strain will circulate.

While most people with influenza recover with rest and symptomatic treatment, influenza can result in pneumonia requiring hospitalization or even death, especially in vulnerable groups such as very young children, the elderly and patients with chronic illnesses.

There are about 1 to 2 deaths directly caused by influenza every year. A 2006 study indirectly estimated that influenza is associated with about 600 deaths (out of about 15,000) in Singapore every year, mainly in people over 65 years old. It is thought that influenza could weaken the health of vulnerable groups such as the elderly or people with chronic illnesses, so that they die from other causes.

In contrast, the World Health Organization (WHO) estimated that the annual epidemics of influenza in Northern and Southern Hemispheres' countries result in 3 to 5 million cases of severe illness and 250,000 to 500,000 deaths each year.

Other H1N1 strains (not the 2009 strain) already infect humans every year, and their genes have originated from swine, human and avian sources. This is a characteristic of all human influenza viruses, so just having a hybrid virus with different origins is not a new finding.

However, when the hybrid virus appear to change significantly from current strains, the impact on transmissibility and virulence cannot always be predicted, and we need to link the genetic changes to what we observe in the community and in the affected individuals.

For Influenza A (H1N1), more epidemiological studies will be needed to better define how easily it spreads or whether it causes more severe disease. Scientists are interested in the hybrid nature of H1N1 because it helps them to track its spread and origin more easily.

Historically, influenza pandemics have encircled the globe in two, sometimes three, waves. During the previous century, the 1918 pandemic (or "Spanish Flu"), the most deadly of them all, began in a mild wave and then returned in a far more deadly one. The pandemic of 1957 (or "Asian Flu") began with a mild phase followed, in several countries, by a second wave with higher fatality. The pandemic of 1968 (or "Hong Kong Flu") remained, in most countries, comparatively mild in both its first and second waves.

Influenza A (H1N1) is a new strain of the flu virus and we lack an indepth understanding of it. It is still too early to predict how exactly it will act and if or when another wave might hit. Hence, it is important to be always prepared, by keeping up a high standard of personal hygiene at all times.

Patients who are at highest risk for severe complications of Influenza (H1N1-2009) are likely to include, but may not be limited to, groups at highest risk of severe seasonal influenza, i.e.

(i) Children under age 5 years;
(ii) Adults 65 years or older;
(iii)Children and adults of any age with underlying chronic medical conditions
(iv) Pregnant women

When infected person may be infectious 24 hours before the symptoms appear and throughout the period that he/she is ill.

a. Children < 5 years

b. Pregnant women

c. Adults and children who have chronic lung (such as asthma) or heart disease

d. Adults and children who have required regular medical follow-up or hospitalisation during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, haemoglobinopathies or immunosuppression (including immunosuppression caused by medications for cancer or by the HIV)

e. Children and teenagers aged 6 months to 18 years who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye syndrome after influenza infection

f. Persons aged 65 years and older

According to WHO, the majority of cases have occurred in people under the age of 25 years and around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people.

While the overall risk of death for H1N1 is similar to normal seasonal flu, the risk groups are slightly different. In normal flu, those over 65 years old are at highest risk along with the very young, under five years. But for H1N1, younger adults and those with underlying medical problems, such as chronic problems with breathing (e.g. asthma), diabetes, gross obesity, low immunity or who are pregnant appear to be at higher risk of complications from the infection.

Experts believe that the next wave may come when winter returns to the northern hemisphere. If this virus remains in circulation, then it may be present even in future influenza seasons, either in its current form or as new variants. While we hope for the best, we must always prepare for the worst in terms of numbers infected and complications.

The symptoms of Influenza A (H1N1) in people are similar to the symptoms of seasonal influenza. An early symptom is high fever, and this is followed by cough, sore throat, runny nose, and sometimes breathlessness a few days later.

To diagnose Influenza A (H1N1), 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 the virus). However, some persons, especially those who are immuno-compromised may shed the virus for 10 days or longer.

There are four different antiviral drugs that are licensed for use in Singapore for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most Influenza A (H1N1) viruses have been susceptible to all four drugs, the most recent Influenza A (H1N1) viruses isolated from humans are resistant to amantadine and rimantadine. At this time, the US CDC recommends the use of oseltamivir (Tamiflu®) or zanamivir (Relenza®) for the treatment of infection with Influenza A (H1N1) viruses.

Yearly vaccination is recommended for groups at higher risk of complications of influenza, such as

1. Persons aged 65 years and older;
2. Children who are 6 months to 5 years;
3. Adults and children who have chronic diseases such as asthma, diabetes, or kidney failure on dialysis.

In addition, to prevent transmission to persons identified above, influenza vaccination is recommended for healthy household contacts and caregivers of children aged 5 years and below and persons at higher risk of complications of influenza, and for healthcare workers.

It is not known whether the current seasonal flu vaccine protects against the new 2009 Influenza A (H1N1) strain. Some patients with H1N1 have been reported to have been previously vaccinated with the seasonal flu vaccine. This may mean that the seasonal vaccine is not protective, but because flu vaccine is never 100% protective anyway, we cannot be absolutely sure.

There is no vaccine available for this new strain of H1N1 virus yet. It will take about 4 to 6 months for vaccine manufacturers to produce a vaccine for this new strain of virus. Tamiflu is not a vaccine, but an antiviral drug for the treatment of infection with Influenza A (H1N1) viruses. MOH does not recommend Tamiflu to be taken as a prevention of the virus.

No, no visitors are not allowed to visit you for seven days.

The Ministry of Health (MOH) has built up a national stockpile of antiviral drugs for treatment which is sufficient for those who are living in Singapore.

Any person who is a known or suspected close contact of a probable or confirmed case of Influenza A (H1N1) can be issued a HQO. Currently, the HQO for travellers from Mexico has been lifted.

Unless specified, the period one may be quarantined at pale of isolation is seven days from the day he was last exposed or suspected to have been exposed to Influenza A (H1N1). The quarantine period however is dependent on:

1. when you were identified as a contact or suspected contact of Influenza A (H1N1).
2. when you have been located for the purpose of serving the Quarantine Order on you. The period of quarantine may therefore be less than seven days.

When a person is known or suspected to be in close contact of a probable or confirmed case of Influenza A (H1N1), he/she has to be quarantined at alternative housing besides his residential homes, the government will bear the full cost.

He/She will also be granted paid hospitalisation leave during the period of absence from work. For employees who have used up their hospitalisation leave, their employers are urged to exercise flexibility and compassion in granting additional paid hospitalisation leave, bearing in mind that the employees may face financial hardship. The Ministry of Manpower would be able to provide more information with regards to such matter.

The Aloha Loyang chalet resort has been running as a Government Quarantine Facility since 4 May. With the increase in the number of cases, the Government has decided to convert two more chalet resorts into quarantine facilities.
The HomeTeamNS chalets and Peoples' Association chalets at Pasir Ris have been activated to augment the chalets at Aloha Loyang, bringing the number of rooms available for quarantine to over 200.

GQFs are reserved for those unable to serve their quarantine at home, ie. non-residents or residents whose homes are deemed unsuitable for quarantine by MOH.

As with any other medication, there are potential side effects related to the use of Tamiflu. We would advise instead that they see a doctor early if they are feeling unwell rather than to self-medicate.

Flu vaccination helps protect against flu by building up the body’s immunity against the flu virus. Yearly vaccination is recommended for groups at higher risk of complications of flu (as above). In addition, vaccination is recommended for:

· Healthy household contacts/caregivers of children aged 5 years and below, and persons at higher risk of complications of flu
· Healthcare workers

However, flu virus changes rapidly and every year different strains of virus become predominant. Hence, vaccines need to be reformulated every year.

The current seasonal flu vaccine gives little (if any) protection against the new Influenza A (H1N1-2009) strain. There is no vaccine available for this new strain of H1N1 virus yet. Vaccine manufacturers are in the process of producing and testing a vaccine for this new strain.

Practise good personal hygiene at all times and be socially responsible.

- Wash your hands regularly and thoroughly.
- Cover your mouth and nose with tissue paper when coughing or sneezing. Dispose the used tissue paper in the dustbin properly.

Build up your immunity by leading a healthy lifestyle.

If you feel unwell with flu-like symptoms:

• Visit the nearest Pandemic Preparedness Clinic* (PPC) or polyclinic or your regular primary care doctor. PPCs and polyclinic doctors have been especially equipped to assess the patient's condition and treat him/her. Wear a surgical mask on your way to the clinic and on your way home.
• Stay at home and rest.
• Minimise physical contact with others (e.g. stay away from common areas of house and avoid having meals together with others) especially those that are at higher risk of complications from flu. If you need to come into contact with others, wear a surgical mask and try your best to remain at a distance of at least 2 metres away from one another.
• Do not go to work, school, shopping malls or attend social events.
• Wear a surgical mask if you must go out, and avoid crowded places or public transport.
• Call 995 if symptoms worsen and you experience symptoms such as difficulty in breathing, chest pain, persistent vomiting.

• Consider wearing a surgical mask (especially if you are pregnant, on cancer treatment or renal dialysis) if you need to go out.
• Avoid crowded places.
• Pregnant women, cancer patients and patients undergoing dialysis are advised to call their regular specialist if they have flu-like symptoms. If they do not have a regular specialist they can visit the Polyclinic, PPC or regular primary care doctor who will help you to make the necessary arrangements.

Influenza is usually mild and self limiting. It may however occasionally lead to complications. Please call 995 if your condition worsens (e.g. difficulty breathing or shortness of breath, chest pain, severe vomiting etc).

995 is an a 24-hour Emergency Ambulance Service operated by the Singapore Civil Defence Force (SCDF). The SCDF does not charge for emergency cases that it conveys to hospitals. However, with effect from 15 April 2005, the SCDF charges $165 for each non-emergency case that it ferries to hospital. Further information is available at the SCDF website.

PPCs or Pandemic Preparedness Clinics are primary healthcare clinics that form a vital part of the Health Ministry's Flu Pandemic Response Framework. PPCs are supported with Personal Protection Equipment and Tamiflu from the national stockpile to help manage the flu outbreak in the community. All polyclinics are also part of the PPC framework. Located islandwide, PPCs provide easy access to medical assessment and prompt treatment for people with flu-like illnesses. PPC staff have been trained to manage flu cases and patients with other non infectious health conditions safely, to ensure that there will be no cross infection among patients. Pandemic Preparedness Clinics (PPCs) can be recognised by the “H1N1 ready” symbol.

The PPC list will be updated regularly on the MOH and HPB websites

You can also SMS CLINIC to 70550 (Toll-free for M1 and StarHub only).

PPCs will keep their usual consultation hours. You may wish to call the clinic to check on their operating hours before making your visit. Patients who require urgent medical attention should go to the nearest hospital’s Emergency Department (ED) as per usual.

Laboratory testing for H1N1 is not available at PPCs and polyclinics. There is also no need for GPs to send all suspected H1N1 cases to hospitals for testing. Laboratory testing for Influenza A (H1N1-2009) is not necessary before commencing treatment for the virus. Doctors exercise clinical judgment in prescribing anti-virals on a case-by-case basis, taking into account patients’ medical conditions, risk of developing influenza-related complications, the prevalence of Influenza A (H1N1-2009) in the community and the risks and benefits of treatment.

Members of the public who develop flu--like symptoms (e.g. fever, cough, sore throat, runny nose) can visit the nearest PPC or polyclinic for initial assessment and treatment. Please put on a surgical mask on your way to the clinic and avoid taking public transport if possible. Depending on the severity of your illness and other risk factors, you may be referred to the hospital for further management.

If your condition deteriorates and/or you develop symptoms such as having difficulty in breathing, chest pain, severe vomiting, please call 995 for an ambulance to take you to the nearest hospital for immediate medical attention.

Yes, but you may wish to call the clinic to check their operating hours and their preparedness to manage flu cases during the pandemic.

No. In fact, most mild cases may not require Tamiflu. Doctors decide whether patients need Tamiflu on a case-by-case basis, based on their clinical assessments. Indiscriminate prescription of Tamiflu may also lead to drug resistance and render it ineffective for future treatments.

Yes. The usual consultation fees and costs of medicine will apply.

Members of the public who develop flu--like symptoms (e.g. fever, cough, sore throat, runny nose) can visit the nearest PPC or polyclinic for initial assessment and treatment. Please put on a surgical mask on your way to the clinic and avoid taking public transport if possible. Depending on the severity of your illness and other risk factors, you may be referred to the hospital for further management.

If your condition deteriorates and/or you develop symptoms such as having difficulty in breathing, chest pain, severe vomiting, please call 995 for an ambulance to take you to the nearest hospital for immediate medical attention.

Yes, but you may wish to call the clinic to check their operating hours and their preparedness to manage flu cases during the pandemic.

No. In fact, most mild cases may not require Tamiflu. Doctors decide whether patients need Tamiflu on a case-by-case basis, based on their clinical assessments. Indiscriminate prescription of Tamiflu may also lead to drug resistance and render it ineffective for future treatments.

Yes. The usual consultation fees and costs of medicine will apply.

MOH has advised doctors to give Medical Certificates to patients with influenza-like illness for up to 7 days (for adults) and up to 10 days (for children below 13 years old) from the onset of symptoms.

Please do not go out when you are on medical leave and minimise contact with other household members, especially those who are at high risk for complications. You are also advised to return your doctor if your condition does not improve, or call 995 if your condition worsens (e.g. you become breathless) and you require urgent medical attention.

In general, anti-virals need not be given for pre-exposure prophylaxis (i.e. before you come into contact with a confirmed case). Post-exposure prophylaxis could, however, be considered for contacts of confirmed cases who are at higher risk of influenza-related complications or other circumstances, as deemed appropriate by doctors.

Please note that as with any medication, Tamiflu has its own side effects and should be taken only if prescribed by a doctor.

a. Children < 5 years

b. Pregnant women

c. Adults and children who have chronic lung (such as asthma) or heart diseases

d. Adults and children who have been going for regular medical check-ups or have been hospitalised in the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, haemoglobinopathies or immunosuppression (including immunosuppression caused by medications for cancer or by the HIV)

e. Children and teenagers aged 6 months to 18 years who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye syndrome after influenza infection

f. Persons aged 65 years and older

If you have flu-like symptoms, please consult your regular specialist. If you do not have one, you could go to the nearest PPC where the doctor will do an initial assessment of your condition and then advise you on the management of your condition.

However, if your condition deteriorates and/or you develop symptoms such as having difficulty in breathing, chest pain or severe vomiting, please call 995 for an ambulance to bring you to the nearest hospital for immediate medical attention.

You could bring your child to your nearest PPC, or, if the condition is severe, to KK Hospital’s (KKH) Emergency Department (ED) or National University Hospital’s (NUH) Emergency Department. You could also bring your child to hir or her regular pediatrician. Some paediatricians are also part of the PPC framework.

If your child shows symptoms, the doctors at PPCs, polyclinics or pediatrician may prescribe syrup Tamiflu for your child. However, syrup medication from the national stockpile can only be collected at the polyclinic pharmacies, KKH ED Pharmacy, or NUH ED Pharmacy. This is due to the special transport and storage needs of this medication. Parents and caregivers may wish to collect the syrup medication for their child with the prescription issued by the PPC. There is no need to seek another round of consultation with the doctor at the hospital or polyclinics in order to obtain the medication.

MOH has advised that GPs should not prescribe Tamiflu for children < 1 year of age but should refer the child to KKH/NUH or private sector paediatricians if the GP feels that the child may require Tamiflu. .

In severe cases where your child’s condition deteriorates and/or your child develops symptoms such as having difficulty in breathing, severe vomiting, poor feeding, drowsiness, etc), please call 995 for an ambulance to bring your child to the nearest hospital for immediate medical attention.

Polyclinic pharmacies will continue with their normal operating hours. 6 selected polyclinics will have extended pharmacy opening hours (Monday to Friday: 8.00AM to 8.00PM; Saturday: 8.00AM to 2.00PM). A list of these polyclinics is available on the PPC Tamiflu syrup prescription form. KKH ED Pharmacy and NUH ED Pharmacy are opened 24 hours everyday.

The type of leave for a person served with a HQO will be considered as hospitalisation leave, as mandated by law.

The symptoms of Influenza A (H1N1) in people are similar to the symptoms of seasonal influenza. An early symptom is high fever, and this is followed by cough, sore throat, runny nose, and sometimes breathlessness a few days later.

To diagnose Influenza A (H1N1), 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 the virus). However, some persons, especially those who are immuno-compromised may shed the virus for 10 days or longer.

There are four different antiviral drugs that are licensed for use in Singapore for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most Influenza A (H1N1) viruses have been susceptible to all four drugs, the most recent Influenza A (H1N1) viruses isolated from humans are resistant to amantadine and rimantadine. At this time, the US CDC recommends the use of oseltamivir (Tamiflu®) or zanamivir (Relenza®) for the treatment of infection with Influenza A (H1N1) viruses.

Yearly vaccination is recommended for groups at higher risk of complications of influenza, such as

1. Persons aged 65 years and older;
2. Children who are 6 months to 5 years;
3. Adults and children who have chronic diseases such as asthma, diabetes, or kidney failure on dialysis.

In addition, to prevent transmission to persons identified above, influenza vaccination is recommended for healthy household contacts and caregivers of children aged 5 years and below and persons at higher risk of complications of influenza, and for healthcare workers.

It is not known whether the current seasonal flu vaccine protects against the new 2009 Influenza A (H1N1) strain. Some patients with H1N1 have been reported to have been previously vaccinated with the seasonal flu vaccine. This may mean that the seasonal vaccine is not protective, but because flu vaccine is never 100% protective anyway, we cannot be absolutely sure.

There is no vaccine available for this new strain of H1N1 virus yet. It will take about 4 to 6 months for vaccine manufacturers to produce a vaccine for this new strain of virus. Tamiflu is not a vaccine, but an antiviral drug for the treatment of infection with Influenza A (H1N1) viruses. MOH does not recommend Tamiflu to be taken as a prevention of the virus.

No, no visitors are not allowed to visit you for seven days.

The Ministry of Health (MOH) has built up a national stockpile of antiviral drugs for treatment which is sufficient for those who are living in Singapore.

Any person who is a known or suspected close contact of a probable or confirmed case of Influenza A (H1N1) can be issued a HQO. Currently, the HQO for travellers from Mexico has been lifted.

Unless specified, the period one may be quarantined at pale of isolation is seven days from the day he was last exposed or suspected to have been exposed to Influenza A (H1N1). The quarantine period however is dependent on:

a. when you were identified as a contact or suspected contact of Influenza A (H1N1).
b. when you have been located for the purpose of serving the Quarantine Order on you. The period of quarantine may therefore be less than seven days.

When a person is known or suspected to be in close contact of a probable or confirmed case of Influenza A (H1N1), he/she has to be quarantined at alternative housing besides his residential homes, the government will bear the full cost.

He/She will also be granted paid hospitalisation leave during the period of absence from work. For employees who have used up their hospitalisation leave, their employers are urged to exercise flexibility and compassion in granting additional paid hospitalisation leave, bearing in mind that the employees may face financial hardship. The Ministry of Manpower would be able to provide more information with regards to such matter.

The Aloha Loyang chalet resort has been running as a Government Quarantine Facility since 4 May. With the increase in the number of cases, the Government has decided to convert two more chalet resorts into quarantine facilities.
The HomeTeamNS chalets and Peoples' Association chalets at Pasir Ris have been activated to augment the chalets at Aloha Loyang, bringing the number of rooms available for quarantine to over 200.

GQFs are reserved for those unable to serve their quarantine at home, ie. non-residents or residents whose homes are deemed unsuitable for quarantine by MOH.

As with any other medication, there are potential side effects related to the use of Tamiflu. We would advise instead that they see a doctor early if they are feeling unwell rather than to self-medicate.

The Health Sciences Authority (HSA) will review the quality, safety and efficacy data of the vaccines as part of the prerequisite for the licensing of these vaccines. HSA will also collaborate with its international regulatory counterparts and World Health Organisation (WHO) to discuss and exchange relevant safety information on the vaccines. This will be compared against the risk of ill health and mortality from pandemic influenza. MOH will then make the necessary recommendations when the time comes. These information will also be provided to the public so that the public can make an informed choice.

Tamiflu can be considered for all children above 1 yr of age, especially if they have high-risk conditions that makes the influenza disease more complicated including asthma. 

There is inadequate data about the safety of Tamiflu for infants under 1 year, so parents need to be counselled.

The most frequent side effect reported in children and adolescents admitted to KK Hospital for Influenza A (H1N1-2009) and treated with Tamiflu is nausea. However, this was usually observed after the first dose of Tamiflu and improved with subsequent doses.

Although less common, a small number of patients have shown neuropsychiatric symptoms such as anxiety and panic attack, The symptoms included agitation and panic attack, disorientation and suicidal ideation. However, these symptoms may not necessarily be caused by Tamiflu as influenza infection and a high fever can also cause some of these symptoms.

As a precautionary measure, caregivers of young patients should be on a look out for the remote possibility of abnormal behaviour while on Tamiflu treatment. If abnormal behaviour is noted, they should seek medical attention as soon as possible.

Tamiflu can be given to patients with asthma.

The decision to treat pregnant and/or breast-feeding mothers with Tamiflu will be determined by their doctors.  Antiviral medicines are used only when the potential benefits to the mother justifies the potential risk to the foetus or child.

If a dose of the antiviral medicine has been missed, patient should not double the next dose.  Instead, the patient should take the missed dose as usual as soon as he remembers to do so.

However, if it is near the time for the next dose of antivral medicine, skip the missed dose altogether.  A double dose of antiviral medicine should not be taken because this may increase the risk of adverse or unwanted effects.

Practise good personal hygiene and be socially responsible by:

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

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

1. Eating a balanced diet, including plenty of fruit and vegetables.
2. Being active. Do 30 minutes of physical activity at least 5 days a week.
3. Learning to relax and have enough sleep and rest.
4. Not smoking.

Members of the public who have travelled to affected places and who develop respiratory illness with fever (temperature > 38 degree C) within seven days after their return should put on a surgical mask and seek medical consultation immediately. They should also disclose their travel history to their doctors.

Surgical masks are good for one thing: To stop the spread of “droplets” from the person wearing the mask. In other words, those wearing a surgical mask are less likely to pass on diseases through talking or sneezing.

A respirator mask such as N95 is designed to protect you from breathing in very small particles which might contain viruses. To work effectively, N95 respirator masks must be specially fitted for each person who wears one (called "mask-fitting").

If used correctly, surgical masks and respirators masks may help reduce the risk of getting influenza, but they should be used with other preventive measures such as avoiding close contact and maintaining good hand hygiene. A combination of actions is needed, as no single action will provide complete protection. We would like to encourage a culture of staying home when one is down with flu. Wearing a facemask can be considered if you are sick with flu and think you might have close contact with other people.

Influenza viruses, present mostly in respiratory secretions, are usually transmitted through coughing, sneezing and contacts with respiratory droplets/aerosols. Currently, there are no documented human cases of influenza caused by exposure to influenza-contaminated swimming pool water. No research has been completed on the susceptibility of the Influenza A (H1N1-2009) to chlorine and other disinfectants used in swimming pools or spas. However, the infectivity of the influenza virus has been shown to be inactivated by chlorine.

Yes, you are still allowed to visit hospitals. However, do note that there is a restriction of two visitors per patient at any one time. You are only allowed to visit him or her during the official visiting hours and your particulars would be recorded by hospital staff. This include temperature screening and screening of flu-like symptoms to clinical areas only for example wards, ICU, ED, SOCs, day surgery etc.

As far as possible, there should only be 1 adult caregiver looking after the ill person. If you are pregnant, you should avoid being the caregiver by making alternative arrangements as you are at increased risk of flu-related complications and immunity can be suppressed during pregnancy.

When attending to the ill person, always remember to:

· Wear a surgical mask
· Clean your hands with soap and water (or an alcohol-based hand rub) after you have touched the infected person, soiled linens or laundry
· Be alert and call for help when the infected person’s health deteriorates or the symptoms worsen

Do not give aspirin (acetylsalicylic acid) to children or teenagers who have flu. This can cause a rare but serious illness called Reye’s syndrome.

• Tissue papers and other disposable items that have been used by the infected person should be thrown in the dustbin. Please wash your hands with soap and water or use an alcohol-based hand rub after disposing those items.
• Surfaces soiled with sputum, phlegm, nose discharge or vomit should be washed or wiped with 1:50 diluted household bleach (1 part of bleach to 50 parts of water) immediately. Metallic surfaces can be cleaned with 70% alcohol.
• Bed sheets, towels, eating utensils and dishes used by the infected person do not need to be washed separately, but they should not be shared without washing thoroughly first.
• Bed sheets and towels can be washed using household fabric washing powder in the washing machine on hot setting.
• Do not carry dirty laundry by ‘hugging’ to avoid contaminating yourself. Clean your hands with soap and water or an alcohol-based rub after handling the dirty laundry. 

Eating utensils should also be washed either in a dishwasher or by hand with water and soap.

1) Please ensure that ALL boarders/staff returning from overseas trips report directly to the Temporary Reception Area*, where passports will be checked and temperature taken, before being allowed back to their rooms. Private Student Hostels are to activate SOP1 for boarders/staff who exhibit flu symptoms immediately.

2) All visitors must have their details (such as name, IC/passport no., contact no., time in, time out, travel history) recorded and temperature taken at the Temporary Reception Area*.

3) Private Student Hostels are advised to minimise group activities during this period of time. Boarders/staff returning from current countries listed by MOH should be reminded to exercise social responsibility.

* Private Student Hostels might like to consider setting up a Temporary Reception Area to facilitate checks and temperature taking.

All boarders/staff returning from current countries listed by MOH on www.moh.gov.sg are required to be segregated for seven. Their temperature should be closely monitored during this period.

The Ministry of Community Development, Youth and Sports (MCYS) will be working closely with the Ministry of Health (MOH) to guide and advise child care centres on measures to be taken should there be a chance for an Influenza A (H1N1) outbreak. However, it is still stressed that parents exercise social responsibility and inculcate good hygiene habits in their children.

All the relevant ministries are working closely with child care centres to ensure that the centres are safe for the children. Centres have been advised to put in place stringent measures to ensure that children and staff with influenza symptoms are not allowed into the centre. Children who have travelled to countries and areas affected by Influenza A (H1N1) as defined by MOH should adhere to MOH’s quarantine guidelines. Through stringent screening measures, we hope to keep the virus outside the centres, so that children attending the centres will be cared for in a safe and hygienic environment.

Managing the outbreak is a joint effort among the government, the centre, and the parents. The importance of your role cannot be stressed enough – parents need to exercise social responsibility and co-operate with the centres in the best interests of their children.

All centres are advised to work closely with parents during “peace time” or when there is no outbreak to pre-plan and put in place contingency child care arrangements. Parents may appeal to their support network, such as relatives, neighbours and friends, for assistance should the child care centre be required to close during an outbreak.

If the parents have exhausted all options, parents are advised to share their concerns with the child care centre supervisor and work out an arrangement where the teachers may assist if necessary.

The Government child care subsidy will still be disbursed during the period of closure as long as full fees are paid. Whether fees are chargeable by the child care centre during the period of closure would be a matter between parents and the centre to negotiate. Parents are advised to approach their child care centres directly to raise these concerns.

The closure of child care centres is to ensure that precautionary measures are taken to minimise the spread of any infectious diseases. This is to protect the health and well-being of the children.

The closure of centres is one of the business risks that the child care centre operator takes. MCYS will not interfere in their decision on refunds to parents during the closure period. However, the Government child care subsidy will continue to be disbursed during the period of closure as long as full fees are paid.

MOE has issued advisories to schools, Post-Secondary Education Institutions (PSEIs), kindergartens and special education schools on the above precautionary measures.

According to the Ministry of Health (MOH), the current flu strain is mild, except for complications among some high risk patients. The influenza surveillance data suggest that H1N1 prevalence should peak within a week or two before transmission slows down. Hence, control measures are gradually being stepped down in various sectors. In alignment with MOH’s approach, the Ministry of Education has reviewed the precautionary measures for H1N1 in schools and has adjusted some measures from 27 Jul 09. Schools will remain vigilant in their efforts to slow down the spread of the H1N1 within the school community.

Schools will continue to remain vigilant to slow the spread of the virus in our schools.

 

Schools will continue to visually screen students, staff and visitors for fever and flu-like symptoms. From 27 Jul 09, schools will conduct temperature taking once a day for students and staff. From 3 Aug 09, temperature taking will be conducted twice a week. Daily assemblies will also resume from 3 Aug 09. However, schools will continue to assess the need for mass activities and adopt the necessary precautionary measures for these activities.

 

Schools will continue to keep their premises clean and continue to track students with MCs to reduce the risk of a spread of flu-like illnesses within the school community. They will also continue to educate students to maintain high standards of personal hygiene and exercise social responsibility.

MOH has revised its approach in tracking H1N1 cases, testing suspected cases only when there is a clinical indication (eg severely ill patients). For patients with influenza-like illness who do not require hospitalisation and are not likely to be tested for H1N1, doctors will issue Medical Certificates (MC) of up to 7 days for staff and students above 12 years old, and up to 10 days for children 12 years and below from onset of symptoms.

 

It has been an on-going practice for students and staff to submit their MCs to schools. In view of MOH’s revised approach, schools are closely monitoring the number of students and staff with MCs due to influenza-like illnesses.

 

In the event that a significant number of students in a class are issued MCs due to influenza-like illnesses, the school would consider taking precautionary measures, such as segregating the class into groups or temporarily suspending lessons for the class. The students will be provided with home-based learning lessons or attend make-up lessons when they return to school.

 

MOE will continue to monitor the situation closely and review measures as the situation develops, in consultation with the Ministry of Health.

Candidates who are suffering from influenza-like illnesses are allowed to take the examinations. As a precautionary measure, schools will arrange for candidates who are on influenza-like illness medical leave or exhibit influenza-like symptoms (fever, runny nose, sore throat or cough) to take their examinations in separate examination rooms. In these separate examination rooms, both candidates and invigilators will be required to wear surgical masks. Candidates will be seated at least 2.5 m apart.

Candidates who are diagnosed with H1N1 should seek medical advice on whether they are fit to take the examinations. Those who are diagnosed to have H1N1 and are certified fit to take the examinations will do so in designated examination centres.

Students who have H1N1 and are hospitalised or certified unfit to take the examinations will be exempted from taking the examinations. These students will be given special consideration as per current practice when students fall sick during the national examinations, or are unable to sit for the national examinations for various reasons.

For the PSLE and ‘N’ Level Oral examinations, affected candidates can take make-up oral examinations at a later date.

Candidates with other communicable diseases such as chicken pox or hand-foot-mouth disease and have been certified fit by their doctors to sit for examinations will do so at designated examination centres.

Candidates who are hospitalised for physical injuries such as those resulting from accidents can take their examinations in hospitals, if their doctors have certified them fit to do so.

At this point, there is no plan to postpone or cancel examinations.

Private candidates will take their examinations at designated examination centres. As an additional precautionary measure, centres will arrange for candidates who are unwell with influenza-like illnesses to take their examinations in separate examination rooms.

It is still safe to use public transport. We will continue to monitor the situation closely and reassess when there are further developments.

The public transport operators, SBST and SMRT, are stepping up measures to disinfect their premises, common areas, buses, trains and taxis. They have updated their staff on influenza A (H1N1) and also advised them against non-essential travel to affected countries. Staff who return from affected countries will be monitored closely for the development of any flu-like symptoms. The public transport operators will also issue Personal Protection Equipment (PPE) to their staff if required.

The Land Transport Authority (LTA), together with the taxi companies and the Taxi Operators' Association (TOA) has advised taxi drivers to practice good personal hygiene, avoid non-essential travel to affected countries, clean and disinfect their taxis more often and to seek medical treatment immediately and not to drive if they are unwell. Taxi drivers should also issue receipts to passengers and advise them to retain the receipt in case of contact tracing. The taxi companies will issue Personal Protection Equipment (PPE) to their drivers if required.

Commuters are advised to take similar precautions as they would when they are in public places. Those who are unwell should wear a mask to reduce the risk of infecting others.

The taxi companies and the Taxi Operator Associations (TOA) have updated taxi drivers on Influenza A (H1N1) and also advised them against non-essential travel to affected countries. Taxi drivers who are unwell should not drive and are to seek medical attention immediately.

Although thermal screening has been implemented at Changi Airport, taxi drivers frequenting the airport should still exercise caution and seek medical attention if they develop flu-like symptoms. Taxi drivers should also issue receipts to all passengers and advise them to retain the receipts to facilitate contact tracing.

The Land Transport Authority (LTA) is working closely with the public transport operators (PTOs), taxi companies and the Taxi Operators' Associations on measures to make the public transport system and taxis as safe as possible, as well as to reduce the spread of the H1N1 virus. There is no need for commuters to avoid travelling on public transport or by taxis if they are well.

The transport operators SBST and SMRT have stepped up the cleaning, disinfecting and ventilating of their premises, including common areas of bus interchanges / terminals, MRT / LRT stations, buses and trains. Taxi drivers have also been advised to clean and disinfect their taxis more frequently, ventilate their taxis between trips, and to seek the consent of passengers who are ill to wind down the windows during the trip.

Commuters also have an important part to play by being socially responsible by adhering to MOH’s advice on maintaining high standards of personal hygiene and to refrain from travelling on public transport when they are unwell. If one is unwell he / she should consult a doctor. If there is a need to travel to see a doctor, the preference should be to take private transport and to wear a surgical mask while in transit.

As far as is possible, commuters should also plan their journeys so as to avoid travelling during peak hours when the buses and trains are more crowded.

The LTA and the public transport operators will continue to monitor the situation closely and take additional measures if necessary and / or advised by MOH, so that we can help to slow the spread of the H1N1 virus in the community.

The public transport operators (PTOs) are already operating at maximum capacity during peak periods. With the spread of the H1N1 virus locally, more of the operators’ frontline staff, such as bus and train drivers; and essential personnel, such as control room and maintenance staff, may be infected and hence absent from work. This will affect their ability to maintain current service levels. Hence, the operators are focusing their efforts on maintaining current peak hour bus and train service levels for as long as is possible.

The Land Transport Authority (LTA) is working closely with the public transport operators (PTOs), taxi companies and the Taxi Operators' Associations on measures to make the public transport system and taxis as safe as possible and to safeguard the interest of commuters, drivers, and frontline staff. The PTOs and taxi companies have implemented the precautionary measures recommended by MOH in their advisories, such as:

a) More frequent cleaning and disinfecting of public transport premises, including common areas of bus interchanges / terminals and MRT / LRT stations, buses, trains and taxis;

b) Increase ventilation of trains, buses and taxis;

c) Providing regular updates to their staff and taxi drivers on the H1N1 situation and advise them to:

i) Avoid crowded areas and practice high standard of personal hygiene;

ii) Not to work but seek medical treatment immediately if they develop any flu-like symptoms;

d) Prepared to issue Personal Protective Equipment (PPE), such as masks / gloves to frontline staff and drivers, if required; and

e) Daily temperature screening of bus / train drivers and frontline staff before they go on duty (and advised taxi drivers to similarly check their temperatures before driving and not to drive if they are unwell with fever, cough or sore throat).

The public should exercise social responsibility and not take public transport if ill, or wear a mask if this is unavoidable.

Passengers who are sick when on board the MRT / LRT can call the Operations Control Centre (OCC) who will assess the situation. If necessary, the sick passenger will be advised to go to a Pandemic Preparedness Clinic (PPC) or a polyclinic. If a passenger is sick on board a bus, the bus driver will assess the situation and contact its OCC. If necessary, the sick passenger will be advised to go to a PPC or polyclinic

Commuters are advised to stay vigilant and to take flu symptoms seriously by staying away from others and not travel on public transport when they are unwell. Commuters should observe good personal hygiene practices at all times, such as washing their hands and taking similar precautions as they would when they are in public places. They should cover their nose / mouth when sneezing / coughing and not touch their face / nose after contact with common surfaces, such as handrails and hand-straps on buses and trains.


Those who are unwell should wear a mask to reduce the risk of infecting others. All commuters planning to take public transport should check their own temperature before setting off from their homes on any public journey and to wear masks if they are in doubt. If possible, commuters should plan their schedules so as to travel during the off-peak periods when our buses and trains are less crowded.

Taxi companies and the Taxi Operator Association (TOA) update taxi drivers regularly on the Influenza A (H1N1) situation. Taxi drivers are advised to practice high standards of personal hygiene and to seek immediate medical attention if they develop flu-like symptoms. To reduce the risk of flu transmission, taxi drivers are encouraged to clean and ventilate their taxis frequently. The taxi companies will issue Personal Protective Equipment (PPE) to their drivers if required.

There are no special guidelines for public transport serving hospitals and airport terminals. Once H1N1 is in the community, it is no longer useful to single out specific areas as high risk. At hospitals, discharged patients with residual illness will be wearing masks and taxi drivers can reduce the risk by winding down the windows during the trip and ventilating the taxi thereafter before picking up another passenger.

Taxi drivers who frequent the airport are advised to seek passengers’ consent to wind down the window during the trip if the passenger appears unwell, to ventilate or clean / disinfect the taxi after each trip, and to seek immediate medical attention if they develop flu-like symptoms.

In the event that a taxi driver is served with a Home Quarantine Order or hospitalised, the Taxi Operators Association (TOA) will work with the taxi companies to waive taxi rentals during the quarantine / hospitalisation period. The taxi companies will also pay for the medical expenses of affected taxi drivers

Singapore only imports pork and pork products from AVA-approved sources. At the approved export abattoirs, only healthy pigs, which pass inspection, are allowed to proceed for slaughter. The slaughtered pigs are then subject to post-mortem inspection. Only meat that pass inspection as fit for human consumption is exported to Singapore. When the pork products arrive in Singapore, they are inspected and sampled regularly for testing.

The pig farm on Pulau Bulan, Indonesia, is Singapore's only source of pigs. AVA regularly inspects the farm to ensure that it maintains a high level of biosecurity and that only healthy pigs are sent to Singapore. In addition, AVA collects samples from pigs for lab tests to ensure that they are free from various diseases, including the Influenza A (H1N1).

No. The WHO, OIE and US CDC have stated that the Influenza A (H1N1) virus is not spread by food. In any case, eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 70°C kills all bacteria and viruses, including the Influenza A (H1N1) virus. Similarly, eating properly processed meat products, such as ham, bacon, sausages, canned meat, is safe.

Influenza A (H1N1) virus is not transmitted by food. According to the US CDC, OIE and WHO, there is also no evidence to suggest that someone can become infected by Influenza A (H1N1-2009) from eating pork or pork products. Pork handlers should continue to exercise good personal hygiene in their work.

Singapore imports pork and pork products only from AVA-approved sources. Mexico is not an approved country to export meat products to Singapore.

The current human cases have no history of contact with pigs. There are no reports of the new Influenza A (H1N1) virus in pig farms in the USA or elsewhere. The new virus strain has not been isolated from pigs or other farm animals. Hence, import suspension of pork will not be taken at this juncture. AVA will continue to monitor the situation closely.

AVA is also in contact with its counterparts in the US, and will also work closely with MOH and other authorities on this aspect.

AVA will consider banning imports of pork/pigs from a country if this specific new strain of the flu virus is found to infect pigs in that country.

Singapore has diversified our sources of supply over the years. Currently we have 25 approved countries exporting pork and pork products to us. In times when our supply from one source is affected, we will switch to other sources.

Yes, they are still allowed to. Influenza viruses are not known to be transmissible to people through eating processed pork or other food products derived from pigs. Heat treatments commonly used in cooking meat (e.g. 70°C/160°F core temperature) will readily inactivate any viruses potentially present in raw meat products. Pork and pork products, handled in accordance with good hygienic practices, will not be a source of infection.

The AVA has stepped up inspection and surveillance of the pig farm at Pulau Bulan, and the testing of the pigs to ensure that they are not infected with the virus found in the current outbreaks.

When the imported pigs arrived at the pig abattoir in Singapore, they are further inspected before and after slaughter. AVA also requires abattoir workers and AVA staff, who have contact with pigs to don protective attire, such as face shields and protective clothes.

AVA will test incoming pork imports from the US as well as other sources for the flu virus as a precautionary measure, even though there is no danger of contracting Influenza A (H1N1) from pork.

In addition, the Ministry of Health (MOH) maintains a comprehensive and well established disease surveillance system for the early detection of human cases of novel influenzas such as Influenza A (H1N1). MOH has alerted all medical practitioners and staff in hospitals, national centres, medical clinics and polyclinics to update them on the outbreak of Influenza A (H1N1) and to advise them to be vigilant and take the necessary precautions in line with our alert status. When the situation warrants, MOH will step up public health measures as necessary in accordance with our pandemic response plan.

The Ministry of Health in Singapore has lifted the home quarantine order (HQO) on travellers with a travel history to Mexico.

However, members of the public who are returning from Mexico, and other areas with evidence of community transmission of Influenza A (H1N1) (i.e. states of New York, California, Kansas and Texas in the United States and the state of Nova Scotia in Canada) are should monitor their temperature daily and check themselves for symptoms of flu-like illness. They can continue with their normal routines if they are well.

Those who develop respiratory illness with fever (temperature > 38°C) within seven days after their return should put on a surgical mask and call 993 for an ambulance. They should also disclose their travel histories to their doctors.

If you intend to travel to other areas which have cases of Influenza A (H1N1) (please refer to MOH's website for the latest update on affected areas), you should take note of the following measures to minimise your risk of acquiring Influenza A (H1N1) :

1. Avoid contact with persons with symptoms of influenza.
2. Avoid crowded areas and maintain good ventilation.
3. Observe good personal and environmental hygiene. Wash hands thoroughly with soap and water frequently and when they are contaminated by respiratory secretions e.g. after sneezing.
4. Maintain good body resistance through a balanced diet, regular exercise, having adequate rest, reducing stress and not smoking.

The Immigration and Checkpoints Authority (ICA) in Singapore has issued a press statement on the lifting of the visa requirements for Mexicans:

"The visa requirement for all Mexican national who wish to enter Singapapore will be lifted with effect from 12 May 2009. This takes into consideration the revised medical assessment of the severity of the novel Influenza A (H1N1) and the decreasing number of new cases emerging from Mexico."

According to the latest update by the Ministry of Health in Singapore, the home quarantine order (HQO) on travellers with a travel history to Mexico was lifted with effect from 16 May 2009.

However, members of the public who are returning from Mexico, and other areas with evidence of community transmission of Influenza A (H1N1) (i.e. states of New York, California, Kansas and Texas in the United States and the state of Nova Scotia in Canada) are should monitor their temperature daily and check themselves for symptoms of flu-like illness. They can continue with their normal routines if they are well.

Those who develop respiratory illness with fever (temperature > 38°C) within seven days after their return should put on a surgical mask and call 993 for an ambulance. They should also disclose their travel histories to their doctors.

The World Health Organisation (WHO) does not recommend restricting international travel. However, we advise public to avoid vacations to affected areas*.

In the event that travel to the affected areas is required, travellers should take note of the following measures to minimize their risk of acquiring Influenza A (H1N1):

1. Avoid contact with persons with symptoms of influenza.
2. Avoid crowded areas and maintain good ventilation.
3. Observe good personal and environmental hygiene. Wash hands thoroughly with soap and water frequently and when they are contaminated by respiratory secretions e.g. after sneezing.
4. Maintain good body resistance through a balanced diet, regular exercise, having adequate rest, reducing stress and not smoking.

*The definition of ‘affected areas’ are areas with evidence of community transmission of Influenza A (H1N1-2009).

Yes, it is your social responsibility to protect yourself and others.

If you have travelled to one of the affected areas, you are advised to monitor your health carefully for seven days for symptoms such as fever (>38°C ), cough, sore throat, or runny nose. If you must go out, you should put on a surgical mask and avoid crowded places including taking public transport. By taking these steps, you are helping to reduce the spread of any infectious diseases.

Although the World Health Organisation (WHO) does not recommend restricting international travel, the Ministry of Health (MOH) advises the public to avoid non-essential travel to affected countries.

For people who are unable to avoid travelling to affected areas, the usual precautions apply: they should observe good personal hygiene at all times by washing hands thoroughly with soap and water frequently when they are contaminated by respiratory secretions e.g. after sneezing, and avoid crowded areas whenever possible.

Should you fall ill while overseas, please see a doctor as soon as possible, and refrain from travelling until you are certified fit by the doctor.

The Civil Aviation Authority of Singapore (CAAS) has implemented precautionary measures at Singapore Changi Airport in light of the outbreak of Influenza A (H1N1) cases in Mexico and the United States.

Thermal scanners have been deployed to screen all passengers who arrive in Singapore. The thermal scanners are deployed at the Arrival Halls of Terminals 1, 2 and 3, the Budget Terminal and Seletar Airport. The scanners measure the temperature of passengers just before they undergo immigration checks. Passengers with a higher-than-normal temperature will undergo a more thorough medical assessment.

In addition, health alert notices containing information about Influenza A (H1N1) are placed at the immigration counters for arriving passengers.

These precautionary checks are non-intrusive and have no impact on the time needed by passengers to clear the various airport processes.

Flights in and out of Changi Airport are operating as normal.

Airport companies and airport contractors have been asked to implement preventive measures. These include voluntary staff temperature self-checks and advising staff to seek immediate medical assistance when unwell.

CAAS has stepped up the frequency of cleaning of areas with high passenger traffic. Airport companies, including cleaning contractors, have been asked to implement preventive measures, which include voluntary staff temperature self-checks. They have also been reminded to practice good hygiene.

Temperature screening may not pick up all infected cases. The incubation period of flu viruses can be as long as 7 days. This means that travellers can pass our border checkpoints and then develop symptoms of flu up to 7 days later. Scientists have said that up to one-third of those infected with Influenza do not show any flu-like symptoms. For those who do, the virus is contagious one day before any symptoms – fevers, body aches, sore throats – surface.

In other words, checks at our borders are not fool-proof. Precautionary measures are however in full swing to forestall its spread to Singapore for as long as possible.

You should call 993 if you have symptoms of Influenza A (H1N1) and have recently travelled to areas which have cases of Influenza A (H1N1) (please refer to MOH website for latest list of affected areas). 993 is a special service that will transport suspected cases to Tan Tock Seng Hospital for further investigation.

You should consult a local doctor as soon as possible and refrain from travelling until you are certified fit by the doctor.

Persons who are close contacts of the sick traveller
We will identify and quarantine passengers who were sitting near to the sick traveller or those who had been part of his travelling party, and monitor them. During quarantine, close contacts who develop flu-like symptoms within 7 days from the day they disembark from the plane, should call 993 (a free ambulance service) for the ambulance to transport them to TTSH Emergency Department for a thorough assessment.

Persons who are not close contacts of the sick traveller
Passengers who are not close contacts with the sick traveller are advised to monitor their temperature daily and check themselves for flu-like symptoms. If they develop flu-like symptoms within 7 days from the day they disembark from the plane, they should call 993 (a free ambulance service) for the ambulance to transport them to TTSH Emergency Department for a thorough assessment.

The thermal scanners can only pick up travellers with fever. However, there are one-third of influenza cases who do not develop fever and those who do develop fever, will take some time to develop. Hence, it depends at what stage or condition when the cases land at the airport.

While temperature screening is not a 100% fool proof in picking up patients who may not be feverish at time of arrival, it is still better to pick up those who are feverish. Morever, those who are feverish may likely to have developed coughing and runny nose and hence much more infectious. In any case, temperature screening is non-intrusive.

Temperature screening also provides a symbolic reminder to passengers that if they are unwell, they really should postpone their trip until they are well. We believe that this is beneficial in reducing cross border infection.

Passengers recording higher-than-normal temperatures at the thermal scanners will have their temperatures checked again. They will be asked about their travel histories. If the passenger continues to register higher-than-normal temperatures and has a travel history to areas affected by influenza A (H1N1), the doctor may refer the passenger to the Communicable Disease Centre for follow-up assessment.

Immigration officers will ask passengers for their travel history. Passengers who have travelled to areas affected by influenza A (H1N1) will be asked to monitor their health carefully for 7 days for symptoms such as fever, cough, sore throat or runny nose. If they become sick with fever and other symptoms, within the 7 days after their return, they should call 993 (in Singapore) and seek medical advice and treatment.

Even though there are no cases of Influenza A (H1N1) in Singapore (updated as of 13 May 09), the Ministry of Health (MOH) has upgraded Singapore’s alert level from Yellow to Orange. Please see Ministry of Health’s colour alerts under the Disease Outbreak Response System This indicates that there is a real possibility that such cases may surface in Singapore and we must be prepared on all fronts to delay their spread to Singapore for as long as possible.

In consultation with the Singapore National Employers Federation (SNEF) and National Trades Union Congress (NTUC), the Ministry of Manpower (MOM) recommends that employers should closely monitor Influenza A (H1N1)-related developments, and follow travel and health advisories provided by Government. These may be accessed at www.flu.gov.sg. The information should then be communicated regularly to employees.

Employers are advised to brief employees on business continuity plans.

Plans for continuity in key positions should also be in place. In addition, the plans should also cover actions relating to higher alert levels (i.e. Red and Black).

Employers are strongly encouraged to implement infection control measures at the workplace, including:

1. Maintaining environmental cleanliness to minimize transmission of the Influenza A (H1N1) virus, including frequent disinfection of common areas.
2. Advising employees to maintain high standards of personal hygiene, such as washing hands frequently with soap and water, especially after contact with respiratory secretions (e.g. after sneezing and coughing). Those who have flu-like symptoms should seek medical help promptly, and inform the doctors of their travel histories.
3. Conducting temperature checks routinely. Employees with a higher than normal temperature should be advised to seek treatment immediately. Information of all visitors should also be recorded, including the date and time of visit, personal particulars and contact number of visitors. This will facilitate contact tracing should the need arise.
4. Avoiding or postponing non-essential travel to Mexico. In the event that travel to Mexico is unavoidable, employees should take precautionary measures, such as avoiding crowded areas and maintaining high standards of personal hygiene at all times.

Employers should note that persons with travel history to Mexico over the past seven days will be quarantined for seven days on their return to Singapore and undergo phone surveillance for symptoms for Influenza A (H1N1) .

Employees who are returning from other affected areas (i.e. states of New York, California, Kansas and Texas in the United States and the state of Nova Scotia in Canada) should monitor their temperature daily and check themselves for symptoms of flu-like illness. They can continue with their normal routines if they are well.

Employees who develop respiratory illness with fever (temperature > 38 deg C) within seven days after their return should put on a surgical mask and call 993 for an ambulance. They should also disclose their travel histories to their doctors.

We will not close down the workplace or the hotel. We will quarantine the close contacts and advise others in the workplace or hotel to closely monitor their own health and seek medical attention early, if they are unwell.

Presently, there is no advisory for travellers travelling or arriving from other countries.

Screening for temperature, flu-like symptoms and travel history for visitors to buildings and events have been lifted. Companies are also now not required to carry out the precautionary twice-a-day temperature taking on their staff nor monitor flu-like symptoms.

However, you should still practise good personal hygiene and be socially responsible to protect yourself and others from the flu. Should you feel feverish or unwell, please seek medical attention and disclose any travel history to your doctor.

The affected student will be isolated in a hospital while all students and staff of the school are screened. Only close friends, classmates and teachers are quarantined. The school will remain open.

No, not at the Yellow alert level (as of 11 May 2009). Should the alert level rise back to Orange, hotels would be advised to implement temperature checks on all guests and staff.

For more information, MOH has a Business Continuity Guide that staff and guests can refer to online here: http://www.moh.gov.sg/mohcorp/currentissues.aspx?id=16200#FluPandemicGuides.

At this moment, there is no suspension of selected events to prevent congregation of large groups of people. We encourage individual to practice good personal hygiene at all time, and lead a healthy lifestyle to build up immunity against infection, in order to protect himself and others against flu.

Should there be a development that raises the current alert status and/or requires an event to be cancelled, organisers would be informed by the Singapore Tourism Board, or the Police if the event requires a permit. However, do note that private events and religious events are left up to the respective organisers’ discretion.

He/She should be granted paid hospitalisation leave during the period of absence from work. For employees who have used up their hospitalisation leave, you are urged to exercise flexibility and compassion in granting additional paid hospitalisation leave, bearing in mind that the employees may face financial hardship. The Ministry of Manpower would be able to provide more information with regards to such matter.

Depending on the terms of employment or the Employment Act, the employer is legally obliged to bear the medical examination fee, i.e. medical consultation fee, regardless of the type of illness. For other medical costs such as medication, treatment or ward charges, the employer is obliged to bear such costs depending on the medical benefits provided for in the employee's employment contract or the collective agreement signed between the company and its union.

As childcare centres and schools step up efforts to safeguard the wider interests of its students, children/students who are sick may also be required to stay at home. Employers should grant their affected employees leave such as childcare leave and annual leave.

For employees who have exhausted their leave, employers should exercise flexibility in granting no pay leave or explore alternative work arrangements such as telecommuting to allow these employees to work from home.

The current human “swine” flu is being transmitted between humans, not from pigs to people. However, as humans can spread the disease to pigs, individuals with flu symptoms should avoid close contact with pigs to reduce the possibility of disease transmission to the animal population.

The new Influenza A (H1N1) virus is not transmitted from animals to humans. Nevertheless, visitors to such facilities should always observe proper hygiene practices, such as washing of hands after contact with any animals.

The Zoo and Night Safari do not keep domestic pigs as part of their exhibits. Their exotic pigs are kept in enclosed exhibits surrounded by moats and away from the visitors. It is safe to visit these attractions.

No, you can’t. World health authorities, i.e. the World Health Organisation (WHO), World Organisation for Animal Health (OIE) and Food & Agriculture Organisation (FAO), have jointly stated that there is no evidence that the H1N1 virus is transmitted by food. Pork and pork products, handled in accordance with good hygienic practices to prevent contamination during processing, will not be a source of infection. It is safe to eat processed pork products, such as ham, bacon, sausages and canned pork. Cooking pork to an internal temperature of 70°C kills bacteria and viruses, including the H1N1 virus.

It is safe to handle pork. Generally, people should continue to adopt good hygiene practices when handling pork. World health authorities, i.e. the World Health Organisation (WHO), World Organisation for Animal Health (OIE) and Food & Agriculture Organisation (FAO), have jointly stated that there is no evidence that the H1N1 virus is transmitted by food. Pork and pork products, handled in accordance with good hygienic practices to prevent contamination during processing, will not be a source of infection. It is safe to eat processed pork products, such as ham, bacon, sausages and canned pork. Cooking pork to an internal temperature of 70°C kills bacteria and viruses, including the H1N1 virus.

H1N1 is a topic of public interest. Whenever consumers perceive that there are issues with food safety, there is always heightened uncertainty and fear as consumers are worried over the potential impact on their health. This is why it is important that we inform the public of the facts and assure them that pork from the Pulau Bulan pigs is safe for consumption.

In Singapore, there is no contact between the public and pigs. As for workers in the abattoir, they have been putting on personal protective equipments whenever working since April 2009.

AVA started collecting samples from pigs to test for the H1N1 virus since the outbreak of the disease in humans in Apr 09. The purpose is to provide an early alert for the emergence of the disease on the farm so that timely risk management measures can be put in place.

This is the same virus which is affecting humans.

AVA will be participating in a comprehensive disease surveillance programme on the farm which will be led by the Indonesian veterinary authorities, the Directorate-General of Livestock Services (DGLS), to identify and isolate affected pig houses. Restricted animal movement will be imposed to ensure only healthy pigs are exported to Singapore. This is in line with the World Organisation for Animal Health’s (OIE) recommendation that movement restrictions be applied until the pigs have recovered. The Australian and Canadian Veterinary Authorities have also adopted similar approaches when H1N1 infection was detected on their pig farms.

Since April 2009, AVA has put in place an early warning system for the emergence of the disease in live pigs. These include measures such as additional farm inspections, enhanced inspection at the abattoir as well as sampling and testing for H1N1 prior to export and upon arrival. The Pulau Bulan farm has also implemented bio-security measures against the H1N1 virus such as temperature taking and restriction of visitors at the farm. Upon detection of H1N1 through our surveillance programme, AVA has put in
place enhanced measures. These include weekly farm inspections and increased pre-export testing.

Singapore has diversified our sources of supply over the years. Pigs from Pulau Bulan only constitute about 21% of our supply. We currently have 25 approved countries exporting pork and pork products. Major sources of frozen and chilled pork include Australia and Brazil. Any shortfall in supply can be met by increased import of pork from these sources.

Abattoir workers are required to put on personal protective equipment like face masks, face shields, gloves and aprons.

Yes, H1N1 has been detected in pigs in Canada and Australia. The Australian and Canadian Veterinary Authorities adopted recommendations by the World Organisation for Animal Health (OIE) on the application of movement restrictions until the pigs have recovered when H1N1 infection was detected on their pig farms.