This fact sheet explains how cleaning and disinfecting surfaces in homes and public places (like schools) can help to prevent the spread of pandemic influenza (flu). This fact sheet is updated as needed.

How Flu Viruses Spread

• Flu pandemic is an outbreak of illness caused by a new flu virus that spreads around the world. Because the virus is new to people, nearly everyone will be at risk of getting it. 
• The main way that illnesses like colds and flu are spread is from person to person by coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person moves through the air and makes contact with the mouth or nose of people nearby.
• Droplets from an infected person can also make contact with environmental surfaces (like the tops of tables). The virus can then be spread from those surfaces if a person touches the droplets and then touches his or her own eyes, mouth, or nose before washing his or her hands. 
• The virus can also be spread when an infected person coughs or sneezes into their hands and then touches a surface (like a phone, remote control, or toy) before washing their hands. Others could become sick if they touch that surface and then touch their own eyes, mouth, or nose before washing.
• Flu viruses and other germs can live 2 hours or longer on hard environmental surfaces like tables, doorknobs, and desks. Surfaces are likely to be touched much more often than they can be cleaned and disinfected. Thus, it is important to wash your hands often, keep your hands away from your face, and keep such surfaces clean to help prevent the spread of germs.

• Cover your mouth and nose with your upper sleeve (not your hands) if you do not have a tissue and need to cough or sneeze.
• Clean your hands as soon as possible after coughing, sneezing, or blowing your nose.
• Use soap and water and wash your hands for 15 - 20 seconds; or
• Use alcohol-based hand wipes or alcohol-based (60-95% alcohol) gel hand sanitizers; rub these on the hands until the liquid or gel dries.
• Clean your hands often when you or others are sick, especially if you touch your mouth, nose, or eyes.
• Always clean your hands before eating.
• Carry alcohol-based hand wipes or alcohol-based (60-95% alcohol) hand sanitizing gels with you to clean your hands when you are out in public. 
• Teach your children to use these hygiene practices because germs are often spread at school. 

• Follow label instructions carefully when using disinfectants and cleaners.
• Pay attention to any hazard warnings and instructions on the labels for using personal protective items (such as household gloves).
• Do not mix disinfectants and cleaners unless the labels indicate it is safe to do so. Combining certain products (such as chlorine bleach and ammonia cleaners) can be harmful, resulting in serious injury or death. 
• Keep hard surfaces like kitchen countertops, tabletops, desktops, and bathroom surfaces clean and disinfected. 
• Clean the surface with a commercial product that is both a detergent (cleans) and a disinfectant (kills germs). These products can be used when surfaces are not visibly dirty.  Another way to do this is to wash the surface with a general household cleaner (soap or detergent), rinse with water, and follow with a disinfectant. This method should be used for visibly dirty surfaces. 
• Use disinfectants on surfaces that are touched often. Clean the surface as explained above before using disinfectants.  If disinfectants are not available, use a chlorine bleach solution made by adding 1 tablespoon of bleach to a quart (4 cups) of water; use a cloth to apply this to surfaces and let stand for 3–5 minutes before rinsing with clean water. (For a larger supply of disinfectant, add ¼ cup of bleach to a gallon [16 cups] of water.)
• Wear gloves to protect your hands when working with strong bleach solutions.
• Keep surfaces touched by more than one person clean and disinfected. Examples of these surfaces include doorknobs, refrigerator door handles, and microwaves. Clean with a combination detergent and disinfectant product. Or use a cleaner first, rinse the surface thoroughly, and then follow with a disinfectant.
• Use sanitizer cloths to wipe electronic items that are touched often, such as phones, computers, remote controls, and hand-held games. Use sanitizer cloths to wipe car door handles, the steering wheel, and the gearshift.

Recommended laundry practices

• Gently gather soiled clothing, bedding, and linens without creating a lot of motion or fluffing; for example, do not shake sheets when removing them from the bed.
• Clean your hands after handling soiled laundry items.
• Use washing machine cycles, detergents, and laundry additives (like softener) as you normally do; follow label instructions for detergents and additives.
• Dry the cleaned laundry items as you normally do, selecting the dryer temperature for the types of fabrics in the load.  Line- or air-drying can be used to dry items when machine drying is not indicated.
• Clean your hands before removing clean laundry from the washer or dryer, especially if you have coughed or sneezed on your hands.
• Use recommended waste disposal practices.
• Toss tissues into wastebaskets after they have been used for coughs, sneezes, and blowing your nose.
• Place wastebaskets where they are easy to use.
• Avoid touching used tissues and other waste when emptying wastebaskets.
• Clean your hands after emptying wastebaskets.

• When purchasing disinfectant products (sanitizer cloths and liquid disinfectants) available from grocery stores, hardware stores, or commercial cleaning product suppliers, read the label to see that they are registered with the U.S. Environmental Protection Agency (EPA).
• Always follow label instructions carefully when using these products. For more information about EPA-registered disinfectants, visit www.epa.gov/oppad001/chemregindex.htm. 

• For more information about cleaning and disinfection of surfaces to protect against pandemic influenza virus, consult “Interim Guidance on Environmental Management of Pandemic Influenza Virus.”
• To learn more about pandemic influenza, visit www.pandemicflu.gov. 

• The Influenza (Flu) Viruses
  Types of Flu Viruses, how viruses change, and how animals are affected…
• Key Facts About Seasonal Flu
  A summary of key flu facts and who should get vaccinated…
• Symptoms & Severity
  Flu symptoms and how some people are at greater risk from severe complications…
• How Flu Spreads
  How the virus spreads and how long people may be contagious…
• Flu Season
  General information on flu season in the United States…
• Seasonal Flu and Staph Infections
  Information about flu and staph infections, MRSA…

• H1N1 flu viruses do not normally infect humans. However, sporadic human infections with H1N1 flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry).
• Human-to-human transmission of H1N1 flu can also occur. This is thought to happen in the same way as seasonal flu occurs in people, which is mainly through coughing or sneezing of people infected with the influenza virus. Touching something with flu viruses on it and then touching their mouth or nose may infect people.
• In the past, CDC received reports of approximately one human H1N1 influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with H1N1 influenza were reported. For the information on the number of H1N1 flu cases that have occurred since then, visit the Center for Disease Control and Prevention (CDC) H1N1 website.
• H1N1 influenza viruses are not transmitted by food. You cannot get H1N1 influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the H1N1 flu virus as it does other bacteria and viruses.

• The symptoms of H1N1 flu in people are similar to the symptoms of regular human seasonal influenza.
• To diagnose H1N1 influenza infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be contagious). However, some persons, especially children, may be infectious for 10 days or longer. Confirmation on an H1N1 virus requires sending the specimen to CDC for laboratory testing.

The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

• Check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema.
• Check with their health care provider about whether they should take antiviral medications.
• Keep away from others as much as possible. This is to keep from making others sick. Do not go to work or school while ill.
• Stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.)
• Get plenty of rest.
• Drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated.
• Cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands.
• Wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza.  For more information, see the Interim Recommendations for Facemask and Respirator Use.
• Be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention.

Antiviral medications can sometimes help lessen influenza symptoms, but require a prescription. Most people do not need these antiviral drugs to fully recover from the flu. However, persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization, might benefit from antiviral medications. Antiviral medications are available for persons 1 year of age and older. Ask your health care provider whether you need antiviral medication.

Influenza infections can lead to or occur with bacterial infections. Therefore, some people will also need to take antibiotics. More severe or prolonged illness or illness that seems to get better, but then gets worse again may be an indication that a person has a bacterial infection. Check with your health care provider if you have concerns.

Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome. For more information about Reye’s syndrome, visit the

National Institute of Neurological Disorders