What is 2009 H1N1 flu?
2009 H1N1 flu is a new influenza virus causing illness in people. Most people do not have immunity to this virus, so it spreads quickly.

People with the flu spread the virus through coughing or sneez¬ing near others. Sometimes people may become infected by touching something with flu viruses on it and then touching their eyes, mouth, or nose.

What are the signs and symptoms of 2009 H1N1 flu in people?
The symptoms of seasonal and 2009 H1N1 flu virus in people include fever or chills AND cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting. Like seasonal flu, 2009 H1N1 flu may cause a worsening of underlying chronic medical conditions.

• 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 

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
   

How long should a person stay out of work if they have an influenza-like illness?
Workers who have symptoms of influenza-like illness (see above) should stay home and not come to work until at least 24 hours after their fever has resolved. You should plan now to allow and encourage sick workers to stay home.

When will it hit my community and how serious will it be?
The 2009 H1N1 flu influenza virus may affect different com¬munities at different times and in different ways. The flu may make many more people sick then usual, or it may not. We will likely see a re-emergence or continued outbreak in communities as the regular 2009–2010 flu season begins this fall.

Why should small business owners plan for 2009 H1N1 flu?
Small businesses are especially susceptible to the negative economic impacts of a flu pandemic. An estimated 25 percent of businesses do not reopen following a major disaster, according to the Institute for Business and Home Safety. Planning from the outset can help offset business losses, and protect your business and your employees when this flu hits. Benefits of planning are:

• Minimize disruption to business activities
• Protect employees’ health and safety
• Limit the negative impact to the community, economy and society

What steps should you be prepared to take when the H1N1 flu hits your community?
CDC recommends that sick people stay home and away from the workplace. The best way to slow the spread of the disease is to keep sick people away from well people, given that the 2009 H1N1 flu virus is a new virus and most people will not have prior immunity to protect them from acquiring infection. If sick people come to work, they may infect other workers, and this has the potential to lead to a high rate of absenteeism in the workplace.

Your business’s actions should be tied to the extent and severity in your local area. Choose someone to be responsible for flu issues at the workplace. They should contact the local heath department for guidance and monitor the level and severity of 2009 H1N1 flu illness in your business’ community and region, and sign up for e-mailed updates from www.cdc.gov/h1n1flu.

Where can I go for more resources?
Additional website links can be found on the last page of this guide. More resources can be found online at www.flu.gov, a one-stop access to U.S. Government 2009 H1N1 flu, avian and pandemic flu information. Also go to http://www.ready.gov/business/ for help on preparing a business continuity plan.

In addition to the actions a small business employer can take to help protect the health of their employees, there are actions which employees may take to protect their own health, and that of those around them. Employers should review this list and encourage employees to read it and practice good health habits.

1. Stay home if you are sick with influenza-like illness for example, fever or chills AND cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting. CDC recommends that sick workers stay home if they are ill with influenza-like illness until at least 24 hours after they are free of fever (100° F [37.8° C] or greater) or signs of a fever without the use of fever-reducing medications. This would require employees to stay home for 3 to 5 days in most cases. CDC recommends this time period away from work regardless of whether or not antiviral medications are used.
   
   
2. Wash your hands frequently with soap and water for 20 seconds or use an alcohol-based hand sanitizer if soap and water are not available.
   
   
3. Avoid touching your nose, mouth and eyes.
   
   
4. Cover your coughs and sneezes with a tissue, or cough and sneeze into your upper sleeve. Dispose of tissues in no-touch trash receptacles.
   
   
5. Wash your hands or use an alcohol-based hand sanitizer after coughing, sneezing, or blowing your nose.
   
   
6. Keep frequently touched common surfaces clean. For example, telephones, computer equipment, etc.
   
   
7. Try not to use other workers’ phones, desks, offices, or other work tools and equipment. If necessary, consider cleaning them first with a disinfectant.
   
   
8. Maintain a healthy lifestyle; attention to rest, diet, exercise, and relaxation helps maintain physical and emotional health.

Employees are a crucial resource at any business, and especially small businesses. There are steps you can take now, and during the flu season, to help protect the health of your employees.

1. Develop policies that encourage ill workers to stay at home without fear of any reprisals.
   
   
2. Develop other flexible policies to allow workers to telework (if feasible) and create other leave policies to allow workers to stay home to care for sick family members or care for children if schools close.
   
   
3. Provide resources and a work environment that promotes personal hygiene. For example, provide tissues, no-touch trash cans, hand soap, hand sanitizer, disinfectants and disposable towels for workers to clean their work surfaces.
   
   
4. Provide education and training materials in an easy to understand format and in the appropriate language and literacy level for all employees. See www.cdc.gov/h1n1flu/business.
   
   
5. Instruct employees who are well but who have an ill family member at home with the flu that they can go to work as usual. These employees should monitor their health every day, and notify their supervisor and stay home if they become ill. Employees who have a certain underlying medical condition or who are pregnant should promptly call their health care provider for advice if they become ill.
   
   
6. Encourage workers to obtain a seasonal influenza vaccine, if it is appropriate for them according to CDC recommendations (http://www.cdc.gov/flu/protect/keyfacts.htm). This helps to prevent illness from seasonal influenza strains that may circulate at the same time as the 2009 H1N1 flu.
   
   
7. Encourage employees to get the 2009 H1N1 vaccine when it becomes available if they are in a priority group according to CDC recommendations. For information on groups recommended for seasonal and H1N1 vaccines, please see www.flu.gov. Consider granting employees time off from work to get vaccinated when the vaccine is available in your community.
   
   
8. Provide workers with up-to-date information on influenza risk factors, protective behaviors, and instruction on proper behaviors (for example, cough etiquette; avoid touching eyes, nose and mouth; and hand hygiene).
   
   
9. Plan to implement practices to minimize face-to-face contact between workers if advised by the local health department. Consider the use of such strategies as extended use of e-mail, websites and teleconferences, encouraging flexible work arrangements (for example, telecommuting or flexible work hours) to reduce the number of workers who must be at the work site at the same time or in one specific location.
   
   
10. If an employee does become sick while at work, place the employee in a separate room or area until they can go home, away from other workers. If the employee needs to go into a common area prior to leaving, he or she should cover coughs/sneezes with a tissue or wear a facemask if available and tolerable. Ask the employee to go home as soon as possible.

2009 H1N1 Flu Resources for Businesses and Employers
http://www.cdc.gov/h1n1flu/business/
http://www.flu.gov/professional/business/index.html

CDC Guidance for Businesses and Employers To Plan and Respond to the 2009–2010 Influenza Season
http://www.cdc.gov/h1n1flu/business/guidance/

Preparing for the Flu: A Communication Toolkit for Businesses and Employers
http://www.cdc.gov/h1n1flu/business/toolkit/

Occupational Safety and Health Administration (OSHA) Hotline
1-800-321-OSHA

What Employers Can Do to Protect Workers from Pandemic Influenza (OSHA)
https://www.osha.gov/Publications/employers-protect-workers-flu-factsheet.html

CDC/NIOSH Occupational Health Issues Associated with 2009 H1N1 Influenza Virus
http://www.cdc.gov/niosh/topics/h1n1flu/

Healthcare Workplaces Classified as Very High or High Exposure Risk for Pandemic Influenza
http://www.osha.gov/Publications/exposure-risk-classification-factsheet.html

Cover Your Cough
http://www.cdc.gov/flu/protect/covercough.htm

Stopping the Spread of Germs at Work
http://www.cdc.gov/germstopper/work.htm

Workplace Questions:
http://www.flu.gov/faq/workplace_questions/index.html

Community Mitigation Measures
http://www.flu.gov/professional/community/commitigation.html

OSHA Website for Businesses
https://www.osha.gov/dsg/topics/pandemicflu/index.html

DHS.gov: For General Updates on 2009 H1N1 Influenza Preparedness and Response
http://www.dhs.gov

Disaster Assistance and Recover Resources from the ASBDC
http://www.asbdc-us.org/Resources/Disaster.html

Central Repository of Federal Disaster Assistance from 13 Agencies
http://www.disasterassistance.gov/daip_en.portal

FEMA’s Guidance on Business Continuity
http://www.fema.gov/business.index.shtm

SBA’s Disaster Preparedness Page
http://www.sba.gov/services/disasterassistance/disasterpreparedness/index.html

Every Business Should Have an Emergency Plan
http://www.ready.gov/business/