Food and Agriculture

Organization of
the United Nations

International Food Safety Authorities Network (INFOSAN)

The influenza outbreak in humans caused by Influenza A/H1N1

SUMMARY NOTES
The World Health Organization (WHO) has declared an outbreak of human cases of
Influenza A/H1N1 a Public Health Emergency of International Concern (PHEIC)1 under the
International Health Regulations (2005), and has now raised the influenza pandemic alert
level from phase 4 to phase 5.
The implicated virus is being described as a new subtype of Influenza A/H1N1 not
previously detected in swine or humans, containing a mix of swine, human and avian
influenza virus genes.
The implicated virus has not been isolated in pigs, research efforts are needed to
investigate its possible presence in pigs and the susceptibility of animals to this new virus.
If this virus is shown to infect or cause disease in animals, virus circulation in animals could
worsen the regional and global situation for public health.
Influenza A/H1N1 has not been shown to be transmissible to people through eating pig
meat or other products derived from pigs.

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ADVICE TO CONSUMERS
In the on-going spread of Influenza A/H1N1, concerns about the possibility of this virus being
found in pigs and the safety of pork and pork products has been raised.
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 recommended by
the WHO, FAO, Codex Alimentarius Commission and the OIE, will not be a source of infection.
Authorities and consumers should ensure that meat from sick pigs or pigs found dead are not
processed or used for human consumption under any circumstances.
For further information, please refer to the INFOSAN information note on this issue
(http://www.who.int/foodsafety/fs_management/infosan_archives/en).
Introduction
Following information from the United States of America (USA) and Mexico, WHO has declared the
ongoing outbreak of human cases of Influenza A/H1N1 virus infection as a Public Health
1

PHEIC means an extraordinary event which is determined, as provided in these Regulations: (i) to constitute a public health
risk to other States [Countries bound by the IHR] through the international spread of disease and (ii) to potentially require a
coordinated international response; (Article 1, Definitions, IHR (2005))

Emergency of International Concern (PHEIC)2. In addition, WHO has raised the influenza
pandemic alert level from phase 4 to 5 in a range of 6 phases3. The human outbreak has now
spread with many suspected cases in countries outside Mexico and USA, primarily in persons
travelling from Mexico. WHO is continuously updating Member States about human health issues
related to the outbreak through the National IHR Focal Points. Since the pathogen involved has
genetic material of animal (avian and swine) origin, the three international Organizations, the Food
and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal
Health (OIE) and WHO, involved in diseases at the human-animal interface, have taken steps to
inform Member States further about this aspect of the outbreak. This INFOSAN Note has been
prepared in collaboration between the Organizations to elucidate issues related to the humananimal interface as well as considerations related to handling and trade of animals and animal
products.
General information about the current outbreak in humans
An unusual increase in the number of influenza-like illness (ILI) cases was detected in Mexico
starting at the end of March 2009. From 17 to 28 April 2009, 1551 suspected cases of influenza
with severe pneumonia have been reported (7 confirmed deaths)4. These do not necessarily all
represent cases of Influenza A/H1N1 virus infection.
As of 30 April 2009, the US Government has reported 91 laboratory confirmed human cases of
Influenza A/H1N1 virus infection. One death has been reported. The viruses have the same
genetic pattern based on preliminary testing. The virus is being described as a new subtype of
H1N1 not previously detected in swine or humans. Also, as of 30 April, the Government of Mexico
has reported 26 laboratory-confirmed human cases of Influenza A/H1N1 virus infections.
Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspect
clinical cases have been reported in 31 of the country's 32 states.
Human-animal interface aspects of Influenza A/H1N1 in pigs
Swine influenza (not the Influenza A/H1N1 virus currently causing human infections) is, in general,
a highly contagious respiratory disease of pigs caused by one of several swine influenza viruses
(SIVs). Morbidity in pigs tends to be high and mortality low (1-4%). Often, pigs do not show signs of
infection. Outbreaks in pigs occur year round, with an increased incidence in autumn and winter in
temperate zones. Swine influenza is not notifiable to the OIE (www.oie.int), therefore its
international distribution in animals is not well characterized. Respiratory disease in pigs due to SIV
is thought to occur in most countries in the world, and outbreaks have been reported from North
and South America, Europe, Africa and in parts of eastern Asia. Many countries routinely vaccinate
swine populations against swine influenza.
Swine influenza viruses do not normally infect humans. However, outbreaks and sporadic human
infection with SIVs have been occasionally reported and serosurveys have demonstrated exposure
of humans in certain risk groups. Most commonly, infection occurs in people in direct and close
contact with pigs such as farm and abattoir workers. Onward transmission of SIVs among people
in close contact with each other has occurred on a few occasions. Human influenza viruses have
also been transmitted from people to pigs.
Transmission among and between pigs and humans is likely to occur through direct or indirect
contact with respiratory secretions or inhaling large droplets or aerosols spread through coughing
and sneezing. The clinical picture of SIV infection in people is generally similar to that of human
seasonal influenza. It is likely that most people, especially those who do not have regular contact
with pigs, do not have immunity to SIVs and thus would be susceptible to SIV infection, although
cross-protectivity studies are ongoing to explore this question further. Currently, there is no vaccine
to protect people from SIV infection.
Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also
circulating in pigs (e.g., H1N2, H3N1, H3N2). As with all influenza viruses, SIVs change, evolve
2

http://www.who.int/csr/don/2009_04_26/en
http://www.who.int/csr/disease/avian_influenza/phase/en
4
http://new.paho.org/hq/index.php?option=com_content&task=view&id=1283&Itemid=569
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and reassort continuously. Pigs can be infected by avian influenza and human influenza viruses,
as well as SIVs. When influenza viruses from different species infect pigs (or other animals)
simultaneously, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine,
human and/or avian influenza viruses can emerge. This type of reassortment has already
happened in pigs, for example, a triple reassortant with swine, avian and human genes has been
circulating in the swine population of the USA since at least 1998. This type of reassortment can
also occur in humans. The currently circulating influenza A/H1N1 virus is also such a reassortant,
composed of genes of swine, avian and human origin. This particular combination has so far not
been seen in humans or in swine, and the origin of this reassortment, and when and where it
happened, is not known. This virus is now being transmitted from human to human is a sustained
manner. The role of swine in the emergence of this virus is currently under further investigation.
Explanation about International Health Regulations principles in relation to this event
The International Health Regulations (2005) (IHR (2005))5 are the overall public health framework
for WHO, WHO Member States and other partners to deal with public health events of international
concern. The IHR (2005) provides critical mechanisms5 which facilitate interaction and information
sharing between WHO, countries and other partners, to coordinate actions and to manage public
health across the globe. These mechanisms have, and continue to be, followed and utilized during
this event.
In response to cases of Influenza A/H1N1, the Director-General of WHO convened a meeting of
the IHR Emergency Committee to assess the situation and advise her on appropriate responses.
Following this meeting, the Director-General declared this event a PHEIC on the 25 April 2009.
The declaration of a PHEIC allows the Director-General to issue Temporary Recommendations6,
to prevent or reduce the international spread of disease and avoid unnecessary interference with
international traffic. The Director-General is recommending, on the advice of the Committee, that
all countries intensify surveillance for unusual outbreaks of ILI and severe pneumonia. WHO is
recommending that trade and travel is not restricted in response to this event at this time.
Further recommendations may be developed once new information is available and as this event
evolves. Countries will be informed of additional recommendations through their National IHR
Focal Point and the WHO public website. Any recommendations associated with pigs and pork will
also be communicated through the International Food Safety Authorities Network (INFOSAN).
Such INFOSAN information will be shared with National Chief Veterinary Officers through the OIE
and FAO networks.
Assessment and management of risk - as it relates to pigs, pig movement, and pig meat
To improve our understanding of the current situation it is important to determine: (1) if the
Influenza A/H1N1 virus currently affecting humans is circulating in the pig populations in Mexico;
(2) the prevalence and distribution of the virus in swine populations (if any); and (3) the clinical
presentation of infections with this virus in pigs (it is known that pigs infected with SIVs do not
always show signs of infection, thus this virus may be circulating without associated clinical signs).
Urgent research efforts are needed in order to know the susceptibility of animals to this new virus,
and if relevant to implement biosecurity measures including possible vaccination to protect
susceptible animals.
Swine influenza, per se, is not an OIE listed disease and there is currently no justification in the
OIE Animal Health Standards Code for the imposition of trade measures on the importation of pigs
or their products. However, if Influenza A/H1N1 virus would be shown to cause disease in animals,
virus circulation could worsen the regional and global situation for public health. These
assessments will inform possible decisions regarding implementation of movement restrictions of
pigs in affected regions and underpin any decisions regarding trade restrictions relative to live pigs.

5
For further information, see http://www.who.int/ihr/en and the INFOSAN Information Note on The identification, assessment
and management of food safety events under the International Health Regulations (2005) at:
http://www.who.int/foodsafety/fs_management/infosan_archives/en. Both are available in 6 languages.
6
See Article 15, IHR (2005)

Following the declaration of this event by the Director-General of WHO as a PHEIC, countries of
the world are introducing increased surveillance for respiratory disease in humans. It would
therefore be important to complement such measures by similarly increasing surveillance in pigs.
Influenza viruses can occur in meat, particularly if the animal was clinically diseased at the time of
slaughter. It is important to apply the international standards set by the OIE and the Codex
Alimentarius Commission to minimize the likelihood of viral presence in meat. However, the risk of
spreading influenza viruses to naive animal populations through trade of meat and meat products
is negligible. No specific measures are presently recommended in addition to the good biosecurity
practices currently recommended by the OIE and the FAO. Depending on the outcome of scientific
investigations, additional measures to protect animal health and prevent the spread of influenza
viruses to other previously unaffected animal populations could be contemplated in the future.
However, such measures are subject to the above-described assessment investigations and they
should not be introduced for food safety reasons. Pork meat is usually cooked or otherwise
processed prior to consumption, and cooking time/temperature regimes for pork meat will readily
inactivate any influenza virus potentially present. Thus, it can be concluded that consumption of
pork and its products, processed in accordance with good hygienic practices recommended by the
Codex Alimentarius Commission and the OIE, will not be a source of infection.
In the regions where this novel influenza virus is circulating among humans, and possibly may be
circulating in pigs, investigations of ILI among persons in at-risk groups such as farm workers,
owners (and their families) of backyard pigs, slaughterhouse workers, specialized pig workers such
as farrowers, veterinarians and pig processing factory workers and associated pig populations
should be conducted. Specific information campaigns and targeted guidelines on protection
measures should be developed and disseminated to these groups pending the outcome of needed
animal investigations.
Suggested action for countries where Influenza A/H1N1 virus may be circulating in pigs
Competent local authorities (veterinary and medical) should work in collaboration with relevant
national agencies to monitor the situation with regard to the presence and prevalence of respiratory
illness in pigs and more specifically the infection by Influenza A/H1N1 virus. Compilation of this
type of information will assist to better understand the origin of the emergence and the dynamics of
this virus.
Suggested recommendations to persons in contact with pigs (in general)
Until we know more about this event, veterinary authorities should remain vigilant and investigate
unusual swine respiratory illness reported by pig farmers. Veterinary and human health authorities
need to consider possible associations of unusual swine respiratory illness and human ILI.
Precautions for handling swine potentially infected with swine influenza virus are assumed to be
the same as for poultry potentially infected with Highly Pathogenic Avian Influenza (HPAI),
although further work is needed. Because this virus has already demonstrated transmissibility
among humans, it might pose an additional zoonotic risk when compared to H5N1 avian virus.
Proper hygiene precautions should be taken when handling and disposing of sick or dead pigs.
The review of existing biosecurity measures on farms is recommended.
ILI in workers who are in contact with pigs should be immediately reported to responsible
community and national health authorities and the etiology investigated.
As specific information becomes available, targeted guidelines on protection measures will be
developed and disseminated.
Suggested communication messages relative to pork consumption
The risk of infection of H1N1 virus through ingestion pig meat or other products derived from pigs
has never been established. In any case, heat treatments commonly used in cooking meat
(e.g. 70 C/160 F) or other appropriate processing will readily inactivate any viruses potentially
present in raw meat products. It can therefore be concluded that pork meat and its products,
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handled in accordance with good hygienic practices recommended by the Codex Alimentarius
Commission and the OIE, will not be a source of infection.
Food safety recommendations (in general)
Pork meat and pork products from healthy pigs can be safely consumed provided these
items are properly cooked (i.e. 70 C/160 F in all parts of the food, no pink meat and the
juices run clear) and properly handled during food preparation to avoid cross-contamination.
Good hand hygiene and proper cleaning and disinfection of surfaces and utensils are always
important.
Meat from sick pigs or pigs found dead should not be processed or used for human
consumption under any circumstances7.
Additional Information:
The WHO Five Keys to Safer Food initiative can be useful in educating food handlers and
consumers with regards to the safe handling of food, as well as a general precautionary measure
against foodborne illnesses.
We have included the link to information regarding the initiative below:
5 keys for safer food website: http://www.who.int/foodsafety/consumer/5keys/en
5 keys for safer food manual: http://www.who.int/foodsafety/consumer/5keysmanual/en
5 keys for safer food poster: http://www.who.int/foodsafety/publications/consumer/5keys/en
Additional Information on Influenza A/H1N1 in humans: http://www.who.int/csr/disease/swineflu/en
Additional Information on Influenza A/H1N1 in animals: http://www.fao.org/index_en.htm

INFOSAN serves as a vehicle for food safety authorities and other relevant agencies to exchange food safety information
and to improve collaboration among food safety authorities at both the national and international level.
INFOSAN Emergency, embedded in INFOSAN, links official national contact points to address outbreaks and
emergencies of international importance and allows for the rapid exchange of information. INFOSAN Emergency is
intended to complement and support the existing WHO Global Outbreak Alert and Response Network (GOARN).
INFOSAN is operated/managed by WHO, Geneva. It currently includes 177 Member States.
More information is available at: www.who.int/foodsafety

Codex Alimentarius Commission Code of Hygienic Practice for Meat