back of jeep training tool (2)

8/9/2019 Back of Jeep Training Tool (2)

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HALF-DAY TRAININGON

NOVEL H1N1 INFLUENZA VIRUS

F A C I L I T A T O R S G U I D E


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This publication was prepared by AED and funded by USAID under contractnumber GHS-I-00-03-00036. It does not necessarily represent the views ofUSAID or the US Government.

September 2009


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1INTRODUCTION

Who is this training or?

This is a hal-day training or community health workers and volunteersand rst responders on how to counsel and mobilize their communities onkey practices to reduce the risk o contracting the H1N1 infuenza virus.

Community health workers and volunteers are seen as a main source ocorrect inormation on how to prevent illness and treat illness. They alsoare the proessionals that are rst responders when an outbreak such

as a fu outbreak occurs in a village or community. They are in theunique position o talking one-on-one with individuals, amilies, andcommunities, and it is important that they have accurate and easy-to-adopt guidance or their community members.

What is the purpose o the training?

The training is intended to provide guidance and tools to health workerson messages they need to deliver to amilies and communities and how to

use counseling materials to increase the understanding and the adoption ocorrect practices to reduce and contain the spread o the H1N1 virus. Thematerials include counseling cards on the importance o adopting practicesthat will stop the spread o novel H1N1 infuenza, a fyer or caregivers,and fip chart or health workers and volunteers.

Why is this training important?

It is crucial that community members understand the importanceo specic practices to reduce and control the spread o the infuenza.

By adapting these practices at the individual and household levels,communities can reduce the number o people getting sick. Beingcomortable with these practices is also important because vaccines andantiviral medicines may not be available or in limited supply. Thesenon-pharmaceutical interventions isolation and quarantine, hygiene(such as handwashing and respiratory etiquette), and home care or thesick will likely be the most eective and practical measures to take.

INTRODUCTION


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2 BACK OF THE JEEP TRAINING FOR NOVEL H1N1 INFLUENZA VIRUS OUTBREAKS

What the training includes

During the interactive training workshop sessions o the Back o the JeepTraining or Novel H1N1 Infuenza Virus Outbreaks, participants will

use group discussions, role plays, and demonstrations, to increase theirunderstanding o the interventions included in the fip chart, counselingcards, and fyers, which can make a dierence to contain or delay spread othe disease at the community level.

Interpersonal communication has been proven to be successul inincreasing awareness, as well as changing behaviors, to help minimizethe negative health impacts o disease outbreaks. Delivering helpulmessages on specic actions that community members can take, caneectively contain the spread o a pandemic and reduce the cases oillness and death rom the virus.

How to use this Guide

This Guide contains dierent types o guidance or people giving thetraining. For each session, there is a list o objectives, how long the session

should last, which materials should be used, and a list o training tasks.

In most cases, there are Notes to Co-Trainers that provide additionalexplanation on the training tasks, such as how and why they should be

done. To make the training go smoothly, trainers should take the time toread through this Guide and use the supporting materials beore deliveringthe training. Also remember to make copies o the supporting materialsand the Annex, as well as the agenda and evaluation orms.


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3INTRODUCTION

AGENDA

SESSION 1

Welcome And Overview (15 minutes)

SESSION 2

Pandemic Infuenza, What People Should Know

(20 minutes)

SESSION 3

Novel H1N1 Infuenza Virus, What People Should Know

(30 minutes)

SESSION 4

How to Slow the Spread o Novel H1N1 Infuenza Virus

(60 minutes)

BREAK

SESSION 5

Techniques or Counseling: Flip Chart, Counseling

Cards, and Flyers (30 minutes)

Practice and Role Playing (45 minutes)

SESSION 6

Wrap up and Distribution o Materials (15 minutes)

8:30 8:45

8:45 9:05

9:05 9:35

9:35 10:35

10:35 11:00

11:00 11:30

11:30 12:15

12:15 12:30

Back o the Jeep Training or Novel H1N1 Virus Outbreaks


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5SESSION 1

OBJECTIVES

By the end o this session, participants will have:

1. Introduced themselves to each other, the other trainer, and anyspecial guests.

2. Reviewed the workshop objectives and agenda.

DURATION: 15 minutes

MATERIALS: Workshop Objectives and Agenda

WELCOME AND INTRODUCTION

SESSION 1 ACTIVITY#1: Welcome and Introduction

TRAINING TASK

Welcome

Introduce yoursel and other trainers as well as any special guests

Participants introduction

NOTES TO CO-TRAINERSA ormal opening to the workshop rames the importance o the day.I possible, recruit special speakers in advance, such as a respectedgovernment ocial, traditional or community leader or any other

SESSION 1:WELCOME AND OVERVIEW


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proessional who is working in the eld o pandemic infuenza. Havingspecial speakers participate in the ceremony sends an important messageto participants that the inormation they will share is important, timely,and can also save lives.

Ater the speakers have addressed the participants, thank them or comingto open the workshop. Now it is time to meet the workshop participants.

Ask participants to introduce themselves. Provide the ollowing

inormation: Name and place where they work.

SESSION 1 ACTIVITY#2: Workshop Objectives andAgenda

TRAINING TASK

Ask a volunteer to read the workshop objectives written on thefip chart out loud, and encourage discussion to see i participantshave any questions or comments.

Review Workshop Agenda

NOTES TO CO-TRAINERS

Beore the session, clearly write the workshop objectives on a writing boardor fip chart paper. I possible, leave the objectives posted or the entire

course. Inormation on the novel H1N1 infuenza virus and pandemicinfuenza are in Annex 1 o this Guide.

Workshop Objectives

By the end o this workshop, participants will have:

n Reviewed acts and inormation about pandemic infuenza and thenovel H1N1 infuenza virus

n Described non-pharmaceutical practices people can practice at thehousehold level as principle control measures or reducing the spread opandemic infuenza outbreaks


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7SESSION 2

n Examined guidelines to eectively use a fip chart, counseling cards andfyers during community outreach meetings

n Practiced using support materials during one-on-one interactions withcommunity members to increase message retention and lead toadoption o these practices.

Workshop Agenda

For this workshop, we have prepared a hal-day schedule. See agenda onpage 3.


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9SESSION 2

OBJECTIVES


1. Reviewed basic pandemic infuenza inormation2. Identied novel H1N1 infuenza virus inormation included in the fip

chart and counseling cards


MATERIALS:During this session, you need to have available several copies o:

Flip chart: Pandemic Infuenza What People Should Know

SESSION 2:PANDEMIC INFLUENZA: WHAT PEOPLE SHOULD KNOW

Counseling cards


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Flyer: Pandemic Infuenza Protect Your Household

GENERAL PANDEMIC INFLUENZAINFORMATION

SESSION 2 ACTIVITY#1: General Pandemic InuenzaInormation

TRAINING TASK

Divide participants into small groups.

From the Pandemic Infuenza Group Work Questions on theollowing page, assign one question per group and ask them todiscuss and respond to questions about pandemic infuenza.

n To save time, assign more questions per group.n Allow 10 minutes or group discussion.

Flyer: Pandemic Infuenza When to Go to the Health Facility


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11SESSION 2

NOTES TO CO-TRAINERSThe aim o this activity is to review basic pandemic infuenza inormationas described in the support materials such as the fyers, fip chart, andcounseling card. (There is a separate section o this training on the novel

H1N1 infuenza virus specically.) I the support materials do not provide

answers to the questions, participants should view the Frequently AskedQuestions in Annex 1 or complete inormation.

GROUP WORK QUESTIONS ON ABOUT PANDEMIC

INFLUENZA

1. What is pandemic inuenza?

2. How is pandemic inuenza dierent rom avian inuenza?

3. How is pandemic inuenza dierent rom seasonal inuenza?

4. What do the dierent pandemic phases mean?

5. What pandemic phase are we currently in?

SESSION 2 ACTIVITY#2: Discuss and Share PandemicInuenza Inormation

TRAINING TASK

Each small group designates a volunteer to present their responsesto the assigned questions on pandemic.

Groups present their responses to the ull group.

Allow 10 minutes.

NOTES TO CO-TRAINERSResponses to questions are available in Annex 1, Frequently AskedQuestions.

More inormation is also available at: www.pandemicpreparedness.org


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13SESSION 3

OBJECTIVES


1. Reviewed basic inormation about the novel H1N1 infuenza virus2. Identied novel H1N1 infuenza virus inormation included in the fip

chart and counseling cards


MATERIALS:

During this session, you will need to have available several copies o the:

Flip chart: Pandemic Infuenza What People Should Know Counseling cards

SESSION 3:NOVEL H1N1 INFLUENZA VIRUS: WHAT PEOPLE SHOULD KNOW


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Flyer: Pandemic Infuenza Protect Your Household

NOVEL H1N1 INFLUENZA VIRUSINFORMATION

SESSION 3 ACTIVITY#1: Novel H1N1 Inuenza VirusInormation

TRAINING TASK

Divide participants into small groups.

From the H1N1 Group Work Questions on the ollowing page,

assign 3 questions per group and ask them to discuss and respondto questions about the novel HIN1 infuenza virus.

n To save time, assign more questions per group.

n Allow 10 minutes or group discussion.

Flyer: Pandemic Infuenza When to Go to the Health Facility


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15SESSION 3

NOTES TO CO-TRAINERSThe aim o this activity is to review novel H1N1 infuenza virusinormation contained in the various support materials such as thefyers, counseling cards and fip chart. You can also see Frequently

Asked Questions in Annex 1 or complete inormation.

GROUP WORK QUESTIONS ON THE NOVEL H1N1

INFLUENZA VIRUS

1. What is the novel H1N1 inuenza virus?

2. How do people become inected with the virus?

3. What are the symptoms o novel H1N1 inuenza?

4. Most people experience mild illness rom the novel H1N1inuenza virus and recover at home. When should someoneseek medical care?

5. How do I know i I have novel H1N1 inuenza?

6. Why are we so worried about this u when thousands die everyyear rom seasonal inuenza epidemics and other outbreaks?

7. What can I do to protect mysel rom catching the novelH1N1 virus?

8. What about using a mask?

9. What are non-pharmaceutical interventions (NPI)?

10. What good respiratory etiquette practices can help prevent the

spread o novel H1N1 inuenza virus?

11. What are the benefts o isolation and quarantine?

12. What should I do i I think I have the illness?

13. How do you care or those who have the novel H1N1 inuenza virus?

14. How do you protect yoursel and your household i you are caringor a person with novel H1N1 inuenza virus?

15. Should I go to work i I have the u but am eeling OK?


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16. Should I take an antiviral now just in case I catch the new virus?

17. What about breasteeding? Should I stop i I am ill?

18. Are there any special recommendations or pregnant women?

19. Are some people more at risk?

20. Can I travel?

21. Is it sae to eat pork and pork products?

22. Should I worry i there are outbreaks o avian inuenza in

my area?

23. I there are widespread outbreaks, will governments close down

their borders or prevent people rom entering their countrieswithout screening?

24. To which antiviral drugs does novel H1N1 inuenza virus respond?

25. When should antivirals be used?

26. Is an eective vaccine against the novel H1N1 inuenza virus alreadyavailable?

27. Who will be able to get a vaccine or novel H1N1 inuenza viruswhen it becomes available?

28. Has WHO identifed any priority groups that should receive the

novel H1N1 inuenza virus vaccine frst?


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17SESSION 3

SESSION 3 ACTIVITY#2: Discuss and Share NovelH1N1 InuenzaVirus Inormation

TRAINING TASK

Small groups designate a volunteer to present their responses to

the assigned questions on H1N1.

Groups present their responses to the larger group.

Allow 10 minutes.

NOTES TO CO-TRAINERSResponses to questions are available in Annex 1, FrequentlyAsked Questions.

More inormation is also available at: www.pandemicpreparedness.org

SESSION 3 ACTIVITY#3: Novel H1N1 Inuenza VirusInormation in Flip Chart,Counseling Cards and Flyers

Novel H1N1 infuenza virus support materials were designed to help

the community extension worker deliver clear, accurate, and consistentinormation about the novel H1N1 infuenza virus to communitymembers. We will ocus now on the messages that are included in thesupport materials available: fip chart, counseling cards, and fyers.

TRAINING TASK

Have available seven copies o the fip chart: PandemicInfuenzaWhat People Should Know, as well as several setso the counseling cards and the fyers.

n Divide participants into seven small groups. n Assign each group to review one o the seven topics

included in the ip chart: Pandemic Infuenza WhatPeople Should Know, as well as the counseling cards, listedon the ollowing page.


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TOPICS included in the ip chart are:

1. H1N1 virus symptoms

3. How to stop the spread o infuenza:Always wash your hands with soap and water

2. How infuenza spreads

4. Protect yoursel and others rom getting sick


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19SESSION 3

5. What to do i you are sick

7. When to go to the health acility

6. How to treat fu symptoms


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TRAINING TASK

Allow time or the small group to prepare to present thisinormation in the larger-group session. Use fip chart: PandemicInfuenza What People Should Know, and corresponding

counseling cards and fyers.


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23SESSION 4

OBJECTIVES


1. Reviewed specic actions taken to protect against the spread o novelH1N1 infuenza virus.

2. Discussed in-depth inormation about good hygiene practices especially hand washing and covering coughs and sneezes as anintervention to control or to delay the spread o disease at the

community level.3. Reviewed in-depth inormation about keeping at least a 2-meter

distance rom people who are sick as an intervention to control or

to delay the spread o disease at the community level.4. Reviewed in-depth inormation about separating those who are ill

as an intervention to control or to delay the spread o disease at thecommunity level.


SESSION 4 ACTIVITY#1: What Should People Do toProtect Against the Spreado the Novel H1N1Inuenza Virus

TRAINING TASK

Ask participants to orm pairs and discuss/respond to the question:

What simple actions can individuals take to prevent the spreado the novel H1N1 inuenza virus?

n Ater a ew minutes, ask volunteers to read their responsesbeore the larger group.

Write responses on the writing board/fip chart.

SESSION 4:HOW TO SLOW THE SPREAD OF NOVEL H1N1 VIRUS


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NOTES TO CO-TRAINERSThere are two types o ways to prevent the spread o H1N1 infuenza:pharmaceutical interventions and non-pharmaceutical interventions.

Pharmaceutical interventions include vaccines to prevent getting the

virus and taking antiviral medications to reduce symptoms such as achesand pains. Pharmaceutical interventions have the potential to reduceillness and death substantially, but only when they are available and usedproperly. Inadequate supply or wide distribution, high cost, and timelyavailability o these interventions can lessen their positive impact.

Non-pharmaceutical interventions (NPI), on the other hand, are simple

actions that are easy or most individuals and communities to take toreduce contact with the virus and consequently person-to-persontransmission o infuenza. NPI have the potential to contain and delaythe spread o the novel H1N1 infuenza virus and reduce the cases o

illness and death.

What can people do to protect rom becoming sick with the u or slowthe spread o the u?

POSSIBLE ANSWERS to this question are as ollows.

(Note that there are other actions that participants might mentionthat are also correct.)

n

Practice good hygiene and sanitation:

Wash your hands oten with soap and water.

Avoid touching your mouth, nose and eyes with your hands.

Do not spit in public.

Regularly clean areas that many people touch such as door knobs andtelephones and keep household suraces clean using soap and water.

n Practice good respiratory hygiene. Cover your mouth and nose witha tissue or cloth when you cough or sneeze. I you do not have a tissue orcloth, use the crook o your elbow to cover your cough or sneeze.

n Practice social distancing. Keep at least a 2-meter distance (three largesteps away) rom groups o people. Avoid crowded events and locations,and avoid close contact with people who are sick.


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25SESSION 4

n Practice quarantine and isolation. Separate those who are ill romothers in the household, and encourage those who are ill to stay at homeuntil they recover.


Promoting these messages among community members and encouragingthem to adopt these practices is the main task o the community outreachsta/volunteers and will likely have an impact in the community inpreventing the spread o the novel H1N1 infuenza virus.

We will now ocus on the importance o adopting each o these practices.

SESSION 4 ACTIVITY#2: Describing What PracticesPeople Adopt to Minimizethe Spread o the Novel

H1N1 Inuenza Virus

TRAINING TASK

Divide the participants into our smaller groups.

Assign each group one o the ollowing topics identied earlieras actions or measures to minimize the spread o the fu.

1. Practice Good Hygiene and Sanitation

2. Practice Respiratory Etiquette

3. Practice Social Distancing

4. Practice Quarantine and Isolation

Using the support materials and the Frequently Asked Questionsin Annex 1, each group works with one topic and discusses the

eectiveness o adopting these practices to minimize the spreado the fu.

Groups discuss and respond to three questions:

n WHY adopt these practices n WHEN to adopt these practices n HOW to use these practices The our smaller groups present their ndings and responses

beore the larger group.


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1. HYGIENE AND SANITATIONGood hygiene and sanitation practices can help to control the spread othe novel H1N1 infuenza virus. They include:

n Not spitting in public; i you are sick this can spread the diseaseto others.

n Avoiding touching your mouth, nose and eyes with your hands.

n Washing your hands with soap and water beore handling ood or drink,

and ater coughing or sneezing, using the bathroom, caring or a sickperson, or handling garbage or animal waste.

n Cleaning regularly with soap and water areas that many people touch,such as handles, knobs, and telephones.

n Using soap and water to keep household suraces clean and ree romnovel H1N1 infuenza virus.

POSSIBLE ANSWERS about WHY, WHEN, and HOW to adopt these

practices are as ollows.

(Note that there are other responses that participants might have that arealso correct.)

WHY to adopt good hygiene and sanitation practices

Practicing good hygiene and sanitation are important measures to protectourselves and stop the spread o many sicknesses. These practices, such aswashing hands and cleaning suraces, are especially good at preventing thespread o the kinds o sicknesses that move rom person to person through

the breathing out o inected air.

Coughing, sneezing, or contact with human waste or touching some-thing that has a virus or germ on it can get the virus or germ onto hands,clothes, or suraces (tables, door knobs, handles, plates, cups, and so on)where it can live or several days. Hand washing keeps those viruses

or germs rom getting into your body when you touch your eyes, nose,or mouth.

Washing hands with soap and water, in particular, requently willminimize the spread o the fu and is a simple, quick, and inexpensiveaction that individuals can adopt. Parents can tell their children and amilymembers to adopt this practice to minimize the spread o the fu as well asother diseases.


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27SESSION 4

WHEN to practice good hygiene and sanitation

Good hygiene and sanitation are especially important to practice i thereis someone who is sick in your household, or you are near someone whois ill. For example, it is important to try to clean suraces that a sick person

has touched, and to wash your hands with soap and water beore and atercaring or a sick person.

WHEN to wash your hands

n Beore eating or preparing ood and drinkn Beore and ater caring or a person who is sick with infuenzan Ater touching something that a sick person has touchedn Ater coughing, sneezing, or blowing your nosen Beore and ater using the toilet

n Ater handling garbage or animal waste

HOW to practice good hygiene and sanitation

Stop spitting in public; i you are sick this can spread the disease to others.

Use soap and water to clean suraces in the household to remove the virusand other germs.

Use soap and water to clean clothes, or suraces (tables, door knobs,telephones, handles, plates, cups) where virus or germs can live orseveral days.

Clean suraces with soap and water (or other household cleaners) to avoid

sel-contamination. Sel contamination means giving yoursel the virus bytouching your mouth, nose or eyes with hands that have the virus on them.

How to wash your hands

n Wet hands rst with water

n Rub soap with hands

n Actively rub the palms together

n Rub the back o each hand with the other hand

n Wash the spaces between all ngersn Wash under your nailsn Wash your wristsn Rinse well with water


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I locally appropriate, drying hands with a disposable paper towel isalso recommended.

It is important to have a good supply o soap and water or washing. Ihand sanitizer is available, it can be used in place o washing hands with

soap and water.

I clean water is not available, you can use water that has been boiled or 1minute (allow the water to cool beore washing your hands). You may also

use water that has been disinected or personal hygiene use (you can use asolution o teaspoon (~0.75 milliliters) o household bleach per 1 gallon(~2 liters) o water. Let it stand or 30 minutes). I the water is cloudy, use asolution o teaspoon (~1.5 milliliters) o household bleach per 1 gallon(~2 liters) o water.1

2. RESP IRATORY ETIQUETTEGood respiratory etiquette includes taking actions such as covering your

mouth and nose with a tissue or cloth when coughing or sneezing.

POSSIBLE ANSWERS about WHY, WHEN, and HOW to adopt thesepractices are as ollows.


WHY to cover coughs and sneezes

A key to fu ghting is covering coughs and sneezes with something. You

can cover them with a single-use tissue, a cloth that you can wash or throwaway ater using, or a mask.

Covering the nose and mouth prevents the virus-lled droplets rom goinginto the air and into someones lungs, and onto suraces where they can bepicked up.

Covering coughs and sneezes is an easy way to prevent the spread o fu.Parents, teachers, caregivers can tell their children and amily members

to adopt this practice to minimize the spread o the fu as well asother diseases.

1. U.S. Centers or Disease Control, Emergency Preparedness and Response. Cleaning and sanitizing with

bleach ater an emergency.


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29SESSION 4

WHEN to cover coughs and sneezes

People should ALWAYS cover their coughs and sneezes.

This is because most people catch infuenza by breathing in tiny droplets

that are in the air. They get into the air when a person with the virus talks,coughs, spits, sings, or sneezes. A person can have the virus or several daysbeore he or she eels sick, so you cannot tell who has the virus.

These droplets can also land on hands, clothes, and suraces where they cansurvive or several days. Then they stick to a persons hand and enter thebody when the person touches his or her eye, nose, or mouth.

HOW to cover coughs and sneezes

Coughs and sneezes should be covered with a single-use tissue that can be

discarded or a cloth that can be washed preerably immediately ater use.Use your upper arm sleeve or the crook o your elbow to cover your cough

or sneeze i you do not have a tissue or cloth. You can also keep romspreading the droplets by wearing a mask i you are sick.

Dispose o tissues in a trash bin ater wiping your nose or puthandkerchies away to avoid contamination and spread o the fu.

Wash hands ater coughing or sneezing when possible. I hand sanitizer isavailable, it can be used in place o washing hands.

3. SOCIAL DISTANCING

One o the main ways to practice social distancing is to stay at home andavoid contact with people, and to keep at least 2 meters (or three largesteps) away rom others.

In some communities, people may have certain cultural and behavioralissues concerning the adoption o this practice. There are strong attach-

ments among extended amilies and it is very important to highlight

awareness among community members o the importance o adoptingsocial distancing to minimize the spread o the fu. It is important to takethese actions even with your own amily and household members.

It might be dicult or some adults to stay home i they eel they mustgo to work during an outbreak. I your community is experiencing a localoutbreak o fu that is severe, then your community leaders may decide to

establish other social distancing measures.


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POSSIBLE ANSWERS about WHY, WHEN and HOW to adoptthese practices are as ollows.

Note that there are other responses that participants might have that are

also correct.

WHY to keep your distance

Infuenza spreads rom person to person through tiny droplets in the airthat are breathed out through talking, shouting, coughing, sneezing, andsinging. Thereore, it is important to avoid crowds to minimize contactwith these potentially inected droplets.

People should limit travel and stay home as much as possible when the

novel H1N1 infuenza virus is circulating in their area to remain healthy.There may be people around you who are inected with the H1N1

infuenza virus and not know it because symptoms have not yet appeared.

WHEN to keep your distanceI there is a local outbreak o the novel H1N1 infuenza virus, it isimportant to avoid places where people are close together or in crowdedplaces (like markets and buses). I your community is experiencing a local

outbreak o fu and the virus is severe, then your community leaders maydecide to establish more specic social distancing measures, such ascancelling certain public events. I the pandemic virus is not causing

severe illness, some o these measures may not be necessary. Check withyour local Ministry o Health and other leaders on the recommendedactions you should take.

HOW to keep your distance

n Stay at least 2 meters (or three large steps) away rom other people.

n Avoid crowds and groups o people (or example, unerals, church,mosques, temples, social gatherings, market, work).

n Send only one designated person to the market or on other errands.n Limit your travel.n Stay at home.n Avoid visits to sick riends and amily.

n Work rom home i possible.

n Use public transportation at times when it is less crowded.

Stay at home or work rom home i you are sick or i this is recommendedby your local health ocials.


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31SESSION 4

I you are sick, keep your distance rom others, avoid crowds, and try tostay home as much as possible until you recover. I your children are sick,keep them home rom school and being around other children.

4. ISOLATION AND QUARANTINE

I anyone is showing symptoms o the fu, they should be isolated romthe rest o the household members: this means resting and recovering in aseparate room or space to avoid spreading the disease to others. Isolating

those who are sick will encounter resistance in places where cultural normsdictate close contact with those who are sick. Many people live in small,single-room houses so this can also be a challenging practice to adopt.

Quarantine is usually done when people have been exposed to a virus but have not necessarily allen ill and are asked to stay away rom others

or a certain period o time to ensure that they do not have the virus andunknowingly spread it to others.

POSSIBLE ANSWERS about WHY,WHEN, and HOW to adoptthese practices are as ollows.


WHY to separate those who are sick with the u

The virus spreads rom person to person in many o the same ways thatregular, seasonal fu is transmitted: by coughing, sneezing, or touchingsomething that has come in contact with the virus rom peoples sneezes

or coughs. One person can give infuenza to another person i they are inclose contact (generally within arms length) so infuenza can spread easilyin places where there are many people in close contact.

I you are sick, keep your distance rom others, avoid crowds, and try tostay home as much as possible until you recover.

WHEN to isolate sick people

As soon as people begin exhibiting symptoms o the fu, they should be

kept away rom others as much as possible, and should stay home romwork and other commitments.

The sick person should not leave home until they are ully recovered.This means that they have been without a ever or at least 24 hours


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without using ever reducing medicines. Once a person has recovered, heor she should eel condent to return to work. Those who have recoveredare not more likely to catch infuenza again. In act, they may be less likely,and may want to consider volunteering to help in the community.

HOW to keep sick people away rom others in thehousehold

n Create a separate space to take care o the sick person. This should be atleast 2 meters away rom other people in the household.

n I a separate room is not available, use a corner in one room and create a

separation using a curtain. Stay at least 2 meters away rom others.n Assign only one amily member to tend to the sick person to prevent

others in the household rom getting sick.n The caregiver should denitely not be a pregnant woman. I possible,

the caregiver should not be an elderly person, or someone with a chronic

illness like HIV or tuberculosis. Children should always stay away.These groups might be more susceptible to the virus and are more likelyto become very ill i they get the fu.

n Limit visitors to the sick person and amily.

OTHER IMPORTANT POINTS ABOUT NPIs

Most people will experience mild illness and recover at home. Thereore,supportive care at home resting, drinking plenty o fuids and using apain reliever or ever and aches is adequate or recovery in most cases.

A person should seek medical care only i they experience serious dangersigns, such as:

n Diculty breathing

n Chest pains

n Coughing up blood

n Lips or skin turning bluen Severe vomiting or diarrhea (especially in children)n Not waking upn Conusion (such as not recognizing amily or riends) or not

understanding othersn Shaking that cannot be controlled

ALWAYS bring a sick child who is younger than 2 months and reuses toeed to the health care acility.


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WHAT IS PANDEMIC INFLUENZA? 33

I you live in an area where malaria is common, you should always go tothe health care acility i you have a ever.

I you live in an area with avian infuenza (H5N1 virus) outbreaksand have fu symptoms, go to the health acility to get tested or avian

infuenza. This is because avian fu has been ound to be more seriousin people than the novel H1N1 infuenza virus.


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35SESSION 5

OBJECTIVES


1. Reviewed guidelines to improve eectiveness o using support materialsduring community outreach.

2. Described and demonstrated techniques to use a fip chart,counseling cards, and fyers during a one-on-one interaction withcommunity members.

3. Demonstrated techniques to use a fip chart, counseling cards,and fyers.

4. Practiced using a fip chart, counseling cards, and fyers to provide

inormation about H1N1 infuenza prevention and control duringrole plays.


SESSION 5 ACTIVITY#1: Eective One-on-OneInteraction

TRAINING TASK

Ask participants to give examples o support materials they haveused during community outreach interventions.

Ask them when they have used support materials.

List the responses on the writing board/fip chart paper.

Ask the groups to present to the larger group and critique/compliment each other.

SESSION 5:TECHNIQUES FOR COUNSELING: USING THE

FLIP CHART, COUNSEL ING CARDS, AND FLYERS


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NOTES TO CO-TRAINERSHave several support materials or the counseling cards and fip chartsavailable during the training.

Support materials can be pamphlets, booklets, counseling cards,

fip charts, handouts, fyers, or any visual support tool that can be usedby a community extension worker during one-on-one meetings withcommunity members.

The fip charts, counseling cards, and fyers are designed to improveunderstanding o a specic topic to help lead individuals to make positivebehavior change decisions.

It is not enough or community members to understand the messages butalso to make a connection between the pictures and their own lie.

These materials serve as interactive educational devices, as they provideextension workers and health promoters with useul prompts or remindersabout the inormation they need to convey to community members.Inormation presented in the support materials should be action orientedand acilitate a two-way communication.

During one-on-one interaction, health promoters, and extension workerscan bring the materials to lie through questions and the responses theygenerate rom the audience.

SESSION 5 ACTIVITY#2: Techniques to Use a FlipChart and Counseling Cards

TRAINING TASK

Ask participants to brainstorm about the denition o a fip chart.

Demonstrate how to use a fip chart using the fip chart,Pandemic Infuenza - What People Should Know (depicted

on the ollowing pages).

Record their responses on the writing board/fip chart paper.

Review suggestions provided on techniques to use a fip chart.


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37SESSION 5

NOTES TO CO-TRAINERSWhat is a ip chart?

A counseling fip chart is a collection o illustrations arranged in order,ollowed by text that describes the illustration and includes key messages to

be covered by the extension worker while displaying the specic pictures.Usually fip charts are astened at the top. It can be made o paper coveredin plastic or cloth to make it durable and weather proo. Sizes can vary.

How to use a ip chart

1. Position the ip chart so that everyone can see it.

2. Point to the pictures, not the text.

3. Speak loud and clear and use simple language so everyone

can understand.

4. Face the audience and make sure all audience members get involved.

5. Ask the audience questions about the drawings to check or accurateunderstanding.

6. Use the ip chart text as a guide, but amiliarize yoursel with thecontent so that you are not dependent on the text.

July,2009

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July,2009

2

July,2009

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39SESSION 5

July,2009

4

1 2 3 4

5 6 7 8

July,2009

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July,2009

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July,2009

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41SESSION 5

July,2009

8

July,2009

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TRAINING TASK

Ask participants to brainstorm about a denition o counselingcards and fyers.

Demonstrate how to use counseling cards and when to use fyers.Use the counseling cards depicted on the next ew pages.

Record their responses on the writing board/fip chart paper.

Review suggestions provided on techniques to use counselingcards and fyers.

NOTES TO CO-TRAINERSWhat is a counseling card?

A counseling card is a mass-produced, printed material that includes text

and illustrations, usually on a one-page ormat or double-aced ormat.Counseling cards are designed to reinorce or support verbal messageso health and extension workers during one-to-one interventions.

Extension workers can decide to ocus more on one specic topic/counseling card than the others i they are speaking with a communitymember who has extensive questions or should receive as much reinorcinginormation as possible.

Counseling cards can be used by community members to help theirdecision making regarding the adoption o a specic practice.


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45SESSION 5


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What is a yer?

A fyer is a mass-produced, printed material that includes text andillustrations, usually on a one-page ormat. It is usually distributed atera counseling session with the health worker. Community members can

take home the inormation as a reminder o the inormation they heardduring the meeting. They can also share the fyer with others in theircommunity. Use the fyers depicted on this page as examples.


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47SESSION 5

How to use counseling cards and yers

The ollowing are suggestions on how to use counseling cards:

1. Go through each side o the card with the community member. This

will give you a chance to both show and tell about a health problem orpractice and answer any questions.

2. Point to the pictures, not to the text. This will help people to rememberwhat the illustrations represent.

3. Speak clearly, use simple language, and avoid technical terms.4. Observe the individuals reactions. I the community member looks

puzzled or worried, encourage him/her to ask questions or talk aboutany concerns. Discussion helps establish a good relationship andbuilds trust.

5. Give the yers to community members as a way to reinorce andremind them o the inormation covered during the meeting. Suggest

that he/she share the inormation with others or consult it at alater time.

SESSION 5 ACTIVITY#3: DEMONSTRATIONHow to Use a Flip Chart,Counseling Cards andFlyers During One-on-OneInteraction With CommunityMembers

TRAINING TASK

Ask a volunteer to do a demonstration on how to use a fip chart.

Follow the guidelines on the best techniques or using a fip chart.

Ask a volunteer to do a demonstration on how to use thecounseling cards and fyers.

Follow the guidelines on the best techniques or usingcounseling cards and fyers.


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SESSION 5 ACTIVITY#4: Practice Skills or EectiveOne-On-One Interaction

TRAINING TASK

Divide participants in groups o three as they will use the role playscenarios. See Session 5 Handout 1, Activity 4.

Hand out the role play scenarios and have participants select thescenarios to role play; one person can play the community

member, one person is the health promoter/extension worker,and the other person is the observer.

Health promoters/extension workers will use the fip chart and

counseling cards during the role plays.

The observer pays attention to the skills used by the healthpromoter/extension worker and can provide comment ontheir skills and perormance.

Once the rst role play is done, the group members switchroles and start again. This should be repeated until each groupmember has played all three roles in dierent scenarios.

Each group reviews and discusses the comments o the observeron the dierent skills used by the person playing the communityextension worker during the ace-to-ace meeting with the

community member.

NOTES TO CO-TRAINERSFollowing are guidelines that participants ollow during the practice roleplays. Have support materials available so they can be used during the roleplays, such as fip charts, counseling cards, and fyers.

Guidelines on eective one-on-one interactions:

n Greet the community members with respect.

n Position the ip chart so everyone can see it.

n Speak loud and clear, use the same words as on your materials,and correct misperceptions expressed by the community members.

n Point to pictures that correspond with what you are saying.


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49SESSION 5

n Face the audience members to:

Ask questions and generate a dialogue with the community members.

Use text as a guide to provide consistent and accurate inormation.


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51SESSION 5

1. You (health promoter/extension worker) are walking to your oce andhear some community member talking about this fu that is everywhere.One o the community members says that his brother is ill now andmentions going to the health center. What do you do?

2. You (health promoter/extension worker) have been called by a localpastor to talk with some church members about what they can doto prevent the spread o the novel H1N1 infuenza virus.

3. You (health promoter/extension worker) have been assigned to visita neighborhood, and in one o the homes you meet a pregnantwoman who also has two small children. What can you tell her aboutways she can protect hersel and her children rom the spread o the

novel H1N1 infuenza virus?

4. You (health promoter/extension worker) are doing some house visits,and during one home visit you notice a amily member coughing.What can you tell them about ways to protect themselves against thespread o the novel H1N1 infuenza virus?

5. You (health promoter/extension worker) are riding the bus to workand the two women sitting behind you are talking about the novel

H1N1 infuenza virus and discussing that i you wear a mask youwill denitely be protected rom getting the virus. What can youtell them?

6. You (health promoter/extension worker) are talking with a amily thatdoes not have running water available at their home or hand washing.What can you tell them to do to protect the amily rom the spreado the novel H1N1 infuenza virus?

7. During a meeting with the Community Elders Council, you are askedto explain the dierence between a regular infuenza season andoutbreaks o the novel H1N1 infuenza virus. What do you say?

8. You (extension worker/health promoter) are waiting to cross the street,and a man close to you sneezes and he does not cover his mouth.What do you do?

SESSION 5: HANDOUT#1, ACTIVITY 4ROLE PLAY SCENARIOS


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COMMUNITY RESPONDERS, VOLUNTEERS, AND STAFF52

9. You are walking to the market and meet your avorite cousin.She hugs you as she is happy to see you. She explains that she hasbeen taking care o her sister who is sick at home and has a high ever.She asks i you could come and visit her later today to see i you cantell i she has this fu. What do you tell her?

10. You (extension worker/health provider) are on your way home whenyou see your neighbor, waiting or you. She tells you she has beenringing the bell and trying to open the gate o your house since 4 p.m.

She tells you her husband is very ill and she thinks he should see adoctor. She asks i she should take him to the hospital and needs yourhelp. What do you tell her?


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53SESSION 6

OBJECTIVES


1. Described how workshop objectives were accomplished.2. Evaluated the workshop.3. Received support materials such as counseling cards, fyers and the

fip chart.


MATERIALS: Workshop Objectives and Agenda

SESSION 6 ACTIVITY#1: Workshop Objectives

TRAINING TASK

Ask participants to describe the importance o using eective andcorrect counseling to reduce the spread o the novel H1N1infuenza virus.

Ask participants to read the workshop objectives.

Ask participants to comment on meeting the workshop objectives.

Workshop Results

By the end o this workshop, participants will be able to:

1. Understand basic pandemic infuenza acts and inormation.

SESSION 6:WRAP-UP AND DISTRIBUTION OF MATERIALS


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2. Understand novel H1N1 infuenza virus acts and inormation.3. Practice counseling individuals and households on the best practices

that can reduce the spread o the novel H1N1 infuenza virus.4. Use the communication materials such as a fip chart, counseling

cards, and fyers when counseling individuals and households and

health workers on the virus.

NOTES TO CO-TRAINERSThis is the last opportunity or participants to ask nal questions about

course content on pandemic infuenza and the novel H1N1 infuenza virus,as well as the importance o using support materials during one-on-oneinfuenza prevention interactions and their eect on behavior changein community members. Participants can also discuss how theyaccomplished the workshop objectives.

Make sure that participants receive all o the support materials, including

the counseling cards, fyers, and the fip chart so they can use them duringtheir one-on-one meetings with community members.

SESSION 6 ACTIVITY#2: Course Evaluation

TRAINING TASK

Distribute the course evaluation orm, Handout#1, Session 6,

Activity 2 to be completed anonymously.

NOTES TO CO-TRAINERS:Make photocopies o the course evaluation orm Handout #1, Session 6,Activity 2. The aim o this activity is to receive eedback rom participantsabout the workshop content and eectiveness.

SESSION 6 ACTIVITY#3: Workshop Wrap Up

TRAINING TASK

Conduct a brie closing ceremony.

Thank participants or their participation and cooperation duringthe workshop sessions.


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55SESSION 6

NOTES TO CO-TRAINERSThank all participants or attending the workshop and sharinginormation during the day, and ormally close the workshop.


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57SESSION 6

COURSE EVALUATION FORM

This orm is anonymous. Do not put your name on this orm. Thank you.

1. What did you learn in this workshop?

2. Why do you think that using support materials during communityoutreach activities will help community members remember messagesand lead them to practice preventive behaviors?

3. Which sessions did you like most? Why?

SESSION 6: HANDOUT#1, ACTIVITY 2COURSE EVALUATION FORM


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4. Which sessions did you like the least? Why?

5. How would you rate the interactive learning style o the training?(Circle one)

a. Excellent b. Fair

c. Good d. Poor

Explain:

6. What could we do dierently to improve the content o the training?

Other comments:


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59ANNEX 1

GENERAL INFORMATION ONPANDEMICS

1. What is pandemic inuenza?

Pandemic infuenza or an infuenza pandemic is when a new orm o an

infuenza virus spreads across a wide geographic area. Since it is a newvirus, people have no resistance to it making it easier to spread globally

rom person-to-person.

According to the World Health Organization, a virus is classied apandemic i it is registered in two or more regions o the world. Itdoes not reer to the severity o the virus. Novel H1N1 infuenza virushas spread to more than one region and that is why it is classied asa pandemic.

2. How is pandemic inuenza dierent rom avian

inuenza?

Avian infuenza is a strain o the infuenza virus (such as H5N1) that isgenerally ound in birds, and in a ew cases the virus has inected people.

It does not easily inect and spread among humans, and is thereore notconsidered a pandemic virus.

3. How is pandemic inuenza dierent rom seasonalinuenza?

There are several key dierences between pandemic and seasonalinfuenzas. Seasonal outbreaks o the fu are caused by fu viruses that arealready circulating among people, so people have some resistance to them.Pandemic infuenza is caused by a new strain o the virus that people haveno resistance to. Because people have no resistance to the new virus,pandemic infuenza is likely to inect many more people and cause

complications in more otherwise healthy people than seasonal infuenza.

ANNEX 1: FREQUENTLY ASKED QUESTIONSPANDEMICS AND THE NOVEL H1N1 INFLUENZA VIRUS

(Adapted rom the World Health Organization Frequently Asked Questions, 2009)


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4. What do the dierent pandemic phases mean?

WHO defnes the stages o a pandemic as ollows:

INTERPANDEMIC PERIOD (the time between the declaration

o infuenza pandemics)

Phase 1: No new infuenza virus subtypes have been detected in humans.An infuenza virus subtype that has caused human inection

may be present in animals. I present in animals, the risk ohuman inection or disease is considered to be low.

Phase 2: No new infuenza virus subtypes have been detected in humans.However, a circulating animal infuenza virus subtype posesa substantial risk o human disease.

PANDEMIC ALERT PERIOD

Phase 3: Human inection(s) with a new subtype but no human-to-humanspread, or at most rare instances o spread to a close contact.

Phase 4: Small cluster(s) with limited human-to-human transmission butspread is highly localized, suggesting that the virus is not welladapted to humans.

Phase 5: Larger cluster(s) but human-to-human spread still localized,

suggesting that the virus is becoming increasingly better adaptedto humans but may not yet be ully transmissible (substantialpandemic risk).

PANDEMIC PERIOD

Phase 6: Pandemic: Increased and sustained transmission in generalpopulation in two or more regions (as dened by the

World Health Organization).

The distinction among Phases 3, 4, and 5 is based on an assessment o

the risk o a pandemic and its geographic spread. Various actors may beconsidered, including the rate o transmission, geographical location andspread, severity o illness, presence o genes rom human strains (i derivedrom an animal strain), and other scientic parameters.


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5. What pandemic phase are we currently in?

The outbreak o novel H1N1 infuenza is considered to be in Phase 6 orhighest level o pandemic progression. The virus was ocially classiedas a pandemic in June 2009 by the World Health Organization denition.

This means that it has been conrmed that this is a new virus to whichmost people do not have immunity that has caused sustained person-to-person transmission on two or more continents.

INFORMATION ON THE NOVELH1N1 INFLUENZA VIRUS

6. What is the novel H1N1 inuenza virus?

The current pandemic infuenza is an infuenza A (H1N1) virus that hasnever beore circulated among humans.

7. How do people become inected with the virus?

The virus is spread rom person-to-person. It is transmitted as easily asthe normal seasonal fu and can be passed to other people by exposure to

inected droplets expelled by coughing or sneezing that can be inhaled, orthat can contaminate hands or suraces.

8. What are the symptoms o novel H1N1 inuenza virus?

Signs o H1N1 are similar to those o regular, seasonal fu: ever higherthan 38 C, headache or body aches, chills, atigue, sneezing or runny/stuynose, and diarrhea and vomiting (this symptom is more commonin children).

9. Most people experience mild illness rom the novelH1N1 inuenza virus and recover at home. When shouldsomeone seek medical care?

A person should seek medical care i they experience diculty breathing,chest pain, shaking that cannot be controlled, lips or skin turning blue,

severe vomiting or diarrhea, not waking up, or conusion such as notrecognizing amily members. For parents with a young child who is ill,seek medical care i a child has ast or labored breathing, continuing everor convulsions (seizures).


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Always bring a sick inant younger than 2 months and reuses to eed tothe health care acility.

I you live in an area where malaria is common, you should always go tothe health care acility i you have a ever.

10. How do I know i I have novel H1N1 inuenza?

You will not be able to tell the dierence between seasonal fu and thenovel H1N1 infuenza virus without medical help. Typical symptomsto watch or are similar to seasonal viruses and include ever, cough,

headache, body aches, sore throat and runny nose. Only your medicalpractitioner and local health authority through tests can conrm a caseo H1N1.

However, people should avoid going to the health care acility unless they

have serious health problems or complications because otherwise healthacilities maybe become overwhelmed by people seeking tests. In mostcases, the novel H1N1 virus symptoms will go away on their own within2 weeks.

11. Why are we so worried about this u whenthousands die every year rom seasonal inuenzaepidemics and other outbreaks?

Seasonal infuenza occurs every year and the viruses change each year, but

many people have some immunity to the circulating virus which helpslimit inections. Some countries also use seasonal infuenza vaccines toreduce illness and deaths.

There are three aspects o this virus that are causing the worry amonghealth proessionals.

Novel H1N1 infuenza appears to be more contagious than seasonal

infuenza, and has been spreading ast particularly among young people(rom ages 10 to 35). The severity o the disease ranges rom very mildsymptoms to severe illnesses that can result in death.

Pharmaceutical interventions such as vaccines are just beingdeveloped and are not ready or wide distribution.

There is the potential or community services and unctions such as

transportation, markets and health care to become disrupted due to highnumbers o people becoming ill and staying home rom work.


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63ANNEX 1

Community leaders should plan or these types o scenarios to lessen thesesecondary eects o the novel H1N1 infuenza.

PREVENTION AND PROTECTION

FROM THE NOVEL H1N1INFLUENZA VIRUS

12. What can I do to protect mysel rom catching thenovel H1N1 virus?

The main route o transmission o the novel H1N1 virus seems to besimilar to seasonal infuenza, via droplets that are expelled by speaking,sneezing, or coughing. You can prevent getting inected by avoiding closecontact with people who show infuenza-like symptoms (try to maintain

a distance o about 2 meters or three large steps away i possible) andtaking the ollowing measures:

n Washing your hands with soap and water oten

n Regularly cleaning objects that sick people use like phones, eatingutensils, and door knobs.

n Covering your mouth and nose with a cloth or tissue when you sneezeor cough. I you do not have a cloth or tissue, you can cough or sneezeinto the crook o your elbow.

n Avoiding public places where many people gather, such as markets,church or mosque, workplaces, and schools.

13. What about using a mask?

I you are caring or a sick person, you can wear a mask when you are in

close contact with the ill person. Remember to dispose o it immediatelyater using it, and wash your hands thoroughly aterwards.

I you are the one who is sick, wearing a mask, scar, or other piece o cleancloth over your mouth and nose may protect others rom getting the novelH1N1 infuenza virus, and protect you rom other illnesses.

14. What are non-pharmaceutical interventions (NPI)?

NPI are actions that that individuals and communities can take to reducecontact and consequently person-to-person transmission o infuenza tocontain and delay the spread o the novel H1N1 infuenza virus and reduce

the number o cases o morbidity and mortality.


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Non-pharmaceutical interventions reer to measures such as:

n Maintaining good personal hygiene

n Good respiratory etiquetten Isolation and home care o the sick andn Social distancing isolation, quarantine, separation

15. What good respiratory etiquette practices can helpprevent the spread o novel H1N1 inuenza virus?

In addition to always covering your mouth and nose with a cloth or tissuewhen you sneeze or cough, you can wear a mask, scar, or other piece oclean cloth over your mouth and nose to protect others rom getting thenovel H1N1 infuenza virus, and protect you rom other illnesses. I youwear a disposable mask over your nose and mouth, throw it away in a trashbin immediately ater use. I you wear a cloth over your nose and mouth,

wash it with soap and warm water immediately ater use. You should alsoavoid spitting in public.

16. What are the benefts o isolation and quarantine?

Keeping sick people and people who have been exposed to the novelH1N1 infuenza virus away rom others may help to slow the spread othe disease.

WHAT TO DO IF YOU HAVE THENOVEL H1N1 INFLUENZA VIRUS

17. What should I do i I think I have the illness?

I you are showing symptoms o the fu, stay at home, rest, and drinkplenty o fuids. Do not go to work or school, and avoid public gatheringsi you can, so you can avoid spreading the virus to others. Even at home,you should rest in a separate room, away rom others in the household.Also remember to cover your nose and mouth with a tissue or cloth whencoughing and sneezing, and washing your hands immediately ater with

soap and water. I you do not have a tissue close by when you coughor sneeze, cover your mouth as much as possible with the crook oyour elbow.


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65ANNEX 1

18. How do you care or those who have the novel H1N1inuenza virus?

As soon as symptoms develop, you should make sure that the sickperson stays at home and rests. Keep them separate rom others in

the household in a separate room or in a space that is at least 2meters (three large steps) away rom others. Try to limit visitors tothe sick person.

It is best to have only one person in the amily take care o the sick personto prevent others in the household rom getting sick. The person chosen

as the caregiver should ideally be healthy and not have medical conditionsthat would put him or her at risk or severe infuenza disease.

Pregnant women also should avoid caring or those who are sick with thenovel H1N1 infuenza virus.

19. How do you protect yoursel and your householdi you are caring or a person with novel H1N1

inuenza virus?

I you are caring or a person with the novel H1N1 infuenza virus, takecare o your own health rst. I you become sick, you will be o little useto those who need you. Wear a mask or cloth over your mouth and nose

whenever you are within an arms length o them. Ater contact with a sickperson or anything the sick person touches, wash your hands with soap

and water.

Place tissues used by the sick person in a bag and throw them awaywith other household waste. Consider placing a bag at the bedside orthis purpose.

20. Should I go to work i I have the u but ameeling OK?

No. Whether you have the novel H1N1 infuenza virus or a seasonal

infuenza, you should stay home and away rom work through theduration o your symptoms. This is can help to protect your workcolleagues and others.


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21. Should I take an antiviral now just in case I catch thenew virus?No. You should only take an antiviral, such as oseltamivir or zanamivir, iyour health care provider advises you to do so. Individuals should not buy

medicines to prevent or ght this new infuenza without a prescription.

22. What about breasteeding? Should I stop i I am ill?

No, not unless your health care provider advises it. Breasteeding providesthe best overall nutrition or babies and increases their deense actors toght illness.

OTHER RISKS AND CONCERNS

23. Are there any special recommendations orpregnant women?

Yes. This is because there seems to be a higher risk o seriouscomplications in women who are pregnant and inected with thenovel H1N1 infuenza virus, especially in the second and third trimesters.

Thereore, pregnant women should avoid situations where they could beexposed to the novel H1N1 infuenza virus, such as large social gatherings.Pregnant women who work in health care acilities should try to avoid

patients with known or suspected novel H1N1 virus inection, and i pos-sible, ask to be assigned tasks that do not involve being near people withthe novel H1N1 infuenza virus. I pregnant health care workers cannotavoid patients with the novel H1N1 infuenza virus, they should alwayscover their nose and mouth with a mask.

In areas where novel H1N1 infuenza virus is widespread, pregnant womenshould pay attention to symptoms o infuenza-like illness and tell their

health care provider i they suspect they might have the novel H1N1infuenza virus.

24. Are some people more at risk?

Yes, in addition to pregnant women, there are some people who seem tobe at greater risk or illness and death rom the novel H1N1 infuenzavirus, such as older people and young children. People who already have a


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67ANNEX 1

health problem such as tuberculosis or other lung diseases, HIV/AIDS,diabetes, heart problems, and kidney disease are at higher risk o majorhealth problems related to novel H1N1 infuenza virus.

As with pregnant women, people with HIV and other serious illnesses

should avoid situations where they could be exposed to the novel H1N1infuenza virus. I they need to go out in public, they should cover theirmouth and nose with a mask or cloth. I they are currently taking medi-cations or a pre-existing illness, they should continue to take them and

ollow their doctors orders. For example, i you have HIV or AIDS andare taking medicines to prevent inections continue with your prescribedtreatment and ollow the advice o your health care provider to keep yourimmune system healthy.

25. Can I travel?

I you are eeling unwell or have symptoms o novel H1N1 infuenza virus,you should avoid travel, i possible. I you are travelling to an area with

outbreaks o novel H1N1 infuenza virus, take precautions such as alwayscovering your mouth and nose with a tissue or cloth when coughing orsneezing, washing your hands requently with soap and water, and keepingat least a two-meter distance (or three large steps) rom other people.

Wherever you travel, it will be important to observe and ollow the rulesrom the local health authorities. You should also expect additional healthscreening procedures at airports.

26. Is it sae to eat pork and pork products?

Yes. The novel H1N1 infuenza virus has not been shown to be spread topeople through eating properly handled and prepared pork (pig meat) orother products made rom pigs. The novel H1N1 infuenza virus is killedby cooking temperatures o 160F/70C.

27. Should I worry i there are outbreaks o avianinuenza in my area?

I you live in an area with avian infuenza outbreaks and you have beenin contact with poultry and have fu symptoms, you should visit your

health care acility to nd out i you have the H5N1 virus. When you goto your health acility, tell the doctor or health provider that you have beenworking or living with poultry and now have fu symptoms.


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28. I there are widespread outbreaks, will governmentsclose down their borders or prevent people romentering their countries without screening?

According to the revised International Health Regulations (2005),

countries are asked to ollow directions rom the World HealthOrganization and not impose any travel restrictions or bans unlessnotied by WHO.

Decisions about screening people upon entry to a country are made by theindividual countries.

PHARMACEUTICALINTERVENTIONS

29. To which antiviral drugs does novel H1N1 inuenzavirus respond?

Antiviral drugs may reduce the symptoms and duration o H1N1 infuenzaillness, just as they do or seasonal infuenza. There are two antiviral drugsthat have been ound to reduce the symptoms o novel H1N1 infuenzavirus, and to reduce the time people are sick. They are oseltamivir andzanamivir.

30. When should antivirals be used?

Worldwide, most patients inected with the novel H1N1 infuenza

virus continue to experience typical infuenza symptoms and ullyrecover within a week, even without any orm o medical treatment.Healthy patients with uncomplicated illness do not need to be treatedwith antivirals.

Where the drugs are available, health care workers can make thedecision or each individual patient based on a clinical assessment andknowledge about the presence o the virus in the community. WHO

recommends that people with severe illness or whose condition beginsto deteriorate should receive oseltamivir as soon as possible.

In most cases, do not worry i you cannot obtain an antiviral medicine.So ar, most people who have novel H1N1 infuenza virus have recoveredwithout antiviral treatment.


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69ANNEX 1

31. Is an eective vaccine against the novel H1N1inuenza virus already available?

No, but work is well under way to develop and manuacture such a vaccine.Health authorities are estimating that a vaccine may be available by the

middle o October 2009. The exact date it will be available, however, is notyet known.

32. Who will be able to get a vaccine or novel H1N1inuenza virus when it becomes available?

When a vaccine rst becomes available, the demand or it will probably begreater than the supply. National authorities will likely make the decisionon which people will be vaccinated against novel H1N1 infuenza virusonce the vaccine becomes available.

Do not worry i you cannot obtain the novel H1N1 infuenza virusvaccine. Other practices such as regular hand washing, covering coughsand sneezes, and staying away rom people who are sick are also eectiveto prevent getting the novel H1N1 infuenza virus.

33. Has WHO identifed any priority groups that shouldreceive the novel H1N1 inuenza virus vaccine frst?

WHO has recommended that i possible, health care workers and pregnantwomen should be immunized rst against the novel H1N1 infuenza virus.

For pregnant women, this is because there seems to be a higher risk oserious complications in women who are pregnant and inected with novel

H1N1 infuenza virus.

For health care workers, it is because they will have the most contact withpeople who are ill with the virus. I a novel H1N1 infuenza virus vaccineis not available, health care workers should treat all patients who arrive attheir acility with fu-like symptoms as having novel H1N1 infuenza virusand take precautions to protect themselves.

These precautions include:

n During an outbreak o novel H1N1 infuenza virus, health careworkers should treat all patients who arrive at their acility withfu-like symptoms as having novel H1N1 infuenza virus andprotect themselves.

n Health care workers should wear acemasks over their nose and mouthwhen they are caring or patients with fu-like symptoms.


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n Have patients with fu-like symptoms wear a mask or cloth over theirnose and mouth.

n I possible, place patients with fu-like symptoms in a room separaterom other patients, or at least 2 meters away rom others.

n Wash your hands with soap and water beore and ater caring or the

sick person.n Remind the sick person to cover their coughs and sneezes with a tissue,

and to wash their hands with soap and water oten especially atercoughing or sneezing.

n Dispose o used tissues along with other medical waste, away rompeople.

n Health workers should regularly clean areas that have come in contactwith sick patients.

For more inormation on the 2009 Novel H1N1 Inuenza Virus, visit theollowing web sites:

Humanitarian Pandemic Preparedness (H2P) Initiativehttp://www.pandemicpreparedness.org

World Health Organization:

http://www.who.int/

U.S. Government Pandemic Preparedness:http://www.u.gov/

1 September 2009


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