1. United States Army Combined Arms Center H1N1 INFLUENZA INFORMATIONANDRESOURCES

2. United States Army Combined Arms Center H1N1 H1N1 flu is a new influenza virus causing illness in people. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia, plus avian genes and human genes. Scientists call this a “quadruple reassortant” virus.

3. United States Army Combined Arms Center SEASONAL FLU SYMPTOMS Seasonal Flu: All types of flu can cause: Fever Coughing and/or sore throat Runny or stuffy nose Headaches and/or body aches Chills Fatigue

4. United States Army Combined Arms Center H1N1 FLU SYMPTOMS Same as seasonal flu, but symptoms may be more severe: Fever Coughing and/or sore throat Runny or stuffy nose Headaches and/or body aches Chills Fatigue In addition to the above symptoms, a number of H1N1 flu cases reported: Vomiting Diarrhea

5. United States Army Combined Arms Center PREVENTIVE MEASURES Get Vaccinated Vaccination is the best protection against contracting the flu. You need two vaccines to be fully protected this year. The seasonal flu vaccine is different from the H1N1 (Swine) flu vaccine. The Center for Disease Control (CDC) is encouraging people to get both vaccinations. Get both vaccinations as soon as possible.

6. United States Army Combined Arms Center PREVENTIVE MEASURES Take these everyday steps to protect your health: Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. Stay home if you are sick until at least 24 hours after you no longer have a fever (100°F or 37.8°C) or signs of a fever (without the use of a fever-reducing medicine, such as acetaminophen). Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care.

7. United States Army Combined Arms Center IF YOU BECOME ILL If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza- like symptoms: Stay home, except tp get medical care, at least 24 hours after your fever is gone. Avoid contact with other people.

8. United States Army Combined Arms Center IF YOU BECOME ILL If you become ill and experience any of the following warning signs, seek emergency medical care. In children, emergency warning signs that need urgent medical attention include: Fast breathing or trouble breathing Bluish or gray skin color Not drinking enough fluids Severe or persistent vomiting Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms improve but then return with fever and worse cough In adults, emergency warning signs that need urgent medical attention include: Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Flu-like symptoms improve but then return with fever and worse cough

9. United States Army Combined Arms Center MEDICINES USED TO TREAT H1N1 Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that can be used for prevention or treatment of flu viruses.

10. United States Army Combined Arms Center ANTIVIRIALS There are two types of antivirals that may be effective against the H1N1 flu: Oseltamivir (TAMIFLU®) Zanamivir (RELENZA®) In addition: PERAMIVIR IV has been authorized to treat certain patients.

11. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES DoD 2009-2010 Global Influenza Surveillance Questionnaire – Air Force http://chppm-www.apgea.army.mil/flu/FluSurveillanceQ2009-2010_Final.pdf AKO: H1N1 (Swine Influenza) Information Center https://www.us.army.mil/suite/portal.do?$p=610490 Algorithm for Testing and Treatment of Suspected H1N1 Influenza - 29 Jun 2009 http://www.chppmeur.healthcare.hqusareur.army.mil/sites/pi/h1n1/ATTACHMENT8- Algorithm_for_Testing_and_Treatment_of_Suspected_H1N1_Influenza.pdf ERMC H1N1 Flu Health Advisory - 12 Jun 2009 http://www.chppmeur.healthcare.hqusareur.army.mil/sites/pi/h1n1/ERMC_H1N1_Flu_Health_Ad visory.pdf ERMC Provider Tool for Diagnosis, Treatment, and Prevention of H1N1 Flu - 29 Jun 2009 http://www.chppmeur.healthcare.hqusareur.army.mil/sites/pi/h1n1/ATTACHMENT6- ERMC_Provider_Tool_for_Diagnosis_Treatment_and_Prevention_of_H1N1_Flu.pdf H1N1 Surveillance Questionnaire – Army http://chppm-www.apgea.army.mil/documents/H1N1/H1N1SurveillanceForm-WCHANGES.pdf MEMORANDUM: Department of Defense Pandemic Vaccine Guidance for Novel Influenza A (HINI), 30 September 2009 http://www.vaccines.mil/documents/1291DoD_H1N1_Policy_Sep2009.pdf

12. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES DoD (Continued) Military Health System H1N1 Flu Outbreak page http://www.health.mil/swineflu Military Treatment Facility Locator http://www.tricare.mil/mtf/ Pandemic Influenza: Clinical and Public Health Guidelines for the MHS (03 Jun 2009) http://fhp.osd.mil/aiWatchboard/pdf/PI%20Clinical%20and%20Public%20Health%20Guidelines %20for%20the%20MHS%202%20JUNE%202009.pdf Pandemic Influenza Watchboard http://fhp.osd.mil/aiWatchboard/ Preventive Medicine H1N1 Line Listing http://chppm-www.apgea.army.mil/documents/H1N1/PreventiveMedicineLineListing.xls USACHPPM Guidance for US Army MEDDACS http://chppm-www.apgea.army.mil/documents/H1N1/H1N1FluAApr09.pdf USACHPPM Risk Communication Tips http://chppm-www.apgea.army.mil/documents/H1N1/H1N1FlubasicHRguidance.pdf USD(P&R) Public Health Emergency Management of the 2009 H1N1 Flu 11 May 2009 (13 May 2009) http://fhp.osd.mil/aiWatchboard/pdf/H1N1%20Memo(Final).pdf

13. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES General/Family Members CDC Interim Guidance for Novel H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home http://www.cdc.gov/h1n1flu/guidance_homecare.htm CDC Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission http://www.cdc.gov/h1n1flu/masks.htm CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others http://www.cdc.gov/h1n1flu/guidance/exclusion.htm 2009-10 ACIP Recommendations http://www.cdc.gov/flu/professionals/antivirals/agents.htm Q&A: Antiviral Drugs, 2009-2010 Flu Season http://www.cdc.gov/flu/protect/antiviral Community Strategy for Pandemic Influenza Mitigation http://www.pandemicflu.gov/plan/community/community_mitigation.pdf Department of Health and Human Services - Pandemic Influenza Plan http://www.hhs.gov/pandemicflu/plan/

14. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES General/Family Members (Continued) Department of State - Travel.State.gov - H1N1 Influenza http://www.travel.state.gov/travel/cis_pa_tw/pa/pa_4493.html EID Prospects for Universal Influenza Virus Vaccine http://www.cdc.gov/ncidod/EID/vol12no04/05-1020.htm Human Capital Planning for Pandemic Influenza http://www.opm.gov/pandemic/OPM-Pandemic_AllIssuances.pdf OSHA: Guidance on Preparing Workplaces for an Influenza Pandemic http://www.osha.gov/Publications/influenza_pandemic.html ReadyArmy.mil http://www.ready.army.mil/ TRICARE Military Treatment Facilities Locator http://www.tricare.mil/mtf/

15. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES Clinicians CDC Antiviral Agents for Seasonal Influenza: Information for Health Professionals http://www.cdc.gov/flu/professionals/antivirals/ CDC H1N1 Flu Clinical and Public Health Guidance http://www.cdc.gov/H1N1flu/guidance/ CDC Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Healthcare Setting http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm CDC Vaccination Resources http://www.cdc.gov/flu/professionals/vaccination/index.htm HHS Antiviral Drug Distribution and Use http://www.hhs.gov/pandemicflu/plan/sup7.html

16. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES Clinicians (Continued) HHS Clinical Guidelines http://www.hhs.gov/pandemicflu/plan/sup5.html HHS Infection Control http://www.hhs.gov/pandemicflu/plan/sup4.html HHS Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic http://www.flu.gov/professional/hospital/maskguidancehc.html OSHA Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers http://www.osha.gov/Publications/OSHA_pandemic_health.pdf

17. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES External Sources IOM: Reusability of Facemasks During an Influenza Pandemic: Facing the Flu http://www.nap.edu/catalog.php?record_id=11637 WHO recommendations on the use of rapid testing for influenza diagnosis http://www.who.int/csr/disease/avian_influenza/guidelines/RapidTestInflu enza_web.pdf

18. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES Additional Information on H1N1 Flu Army Medicine H1N1 Information http://www.armymedicine.army.mil/news/releases/20090604h1n1flu.cfm Army Medicine Web Site http://www.armymedicine.army.mil/ Army Surgeon General Blog, H1N1 Flu Update https://blog.amedd.army.mil/tsg/?page=PostViewSingle&postId=102 CDC 2009 H1N1 Flu Information http://www.cdc.gov/h1n1flu/ CDC 2009 H1N1 Influenza Vaccine Information http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm CDC Information for Travelers http://wwwn.cdc.gov/travel/ DoD H1N1 Flu Information http://preview.defenselink.mil/home/features/2009/0509_h1n1/

19. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES Additional Information on H1N1 Flu (Continued) Health Affairs H1N1 Flu Page http://preview.defenselink.mil/home/features/2009/0509_h1n1/ MHS H1N1 Flu Outbreak Info http://www.health.mil/Pages/Page.aspx?ID=37 MILVAX H1N1 Influenza Vaccine Information http://www.vaccines.mil/default.aspx?cnt=disease/minidv&dID=60 The Surgeon General's Blog - H1N1 Flu Update https://blog.amedd.army.mil/tsg/ U.S. Army Medical Department Office of the Surgeon General http://www.armymedicine.army.mil/ USACHPPM Risk Communication “Tips” for Army Preventive Medicine/Medical Staff Related to H1N1 Flu http://chppm-www.apgea.army.mil/documents/H1N1/H1N1FlubasicHRguidance.pdf Walter Reed Army Medical Center 2009 Flu Information http://www.wramc.amedd.army.mil/swineflu/pages/default.aspx

20. United States Army Combined Arms Center H1N1 INFLUENZA GUIDANCE, RECOMMENDATIONS AND POLICIES External Resources ASTHO: State H1N1 Flu Travel Advisories and Translated Materials http://www.astho.org/page.aspx?id=602&terms=%22flu CIDRAP News: H1N1 Flu http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/index.ht ml FluNet Statistics http://gamapserver.who.int/GlobalAtlas/home.asp WHO Pandemic (H1N1) 2009 http://www.who.int/csr/disease/swineflu/en/index.html