Throughout the years, the Committee on Divine Worship's Newsletter has addressed the liturgical implications of the transmission of pathogens on numerous occasions. With the H1N1 (swine) flu virus appearing in the United States, the Secretariat for Divine Worship, having consulted with experts, offers the following brief reflections on "influenza/H1N1 (swine) flu and the Liturgy."

1. What is H1N1 (swine) influenza?
   According to the Centers for Disease Control and Prevention (CDC), “2009 H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.”
   
   
2. Why is there particular concern for the spread of H1N1 (swine) flu at this moment?
   Numerous cases of H1N1 (swine) flu have been confirmed in the United States, with more expected during the fall and winter of 2009.  The CDC continues to monitor this health issue and will provide further guidance as the situation warrants.
   
   
3. What is the best way to prevent the transmission of the H1N1 (swine) flu virus?
   The CDC suggests that, "as with other infectious illnesses, one of the most important and appropriate preventive practices is careful and frequent hand hygiene. Cleaning your hands often using either soap and water or waterless alcohol-based hand sanitizers removes potentially infectious materials from your skin and helps prevent disease transmission."
   
   
4. How is the influenza virus transmitted?
   According to the CDC, "influenza viruses are spread when a person who has the flu coughs, sneezes, or speaks and spreads virus into the air, and other people inhale the virus. When these viruses enter the nose, throat, or lungs of a person, they begin to multiply, causing symptoms of the flu."
   
   
5. Does transmission of the flu require direct contact between persons?
   "The viruses can also be spread when a person touches a surface with flu viruses on it (for example, a door handle) and then touches his or her nose or mouth. A person who is sick with the flu can spread viruses – that means they are contagious. Adults may be contagious from one day before developing symptoms to up to seven days after getting sick. Children can be contagious for longer than seven days."
   
   
6. How can the spread of the influenza virus be prevented?
   The single best way to prevent the flu is to get vaccinated.  In addition to the yearly seasonal flu vaccine, the CDC is monitoring the production of a vaccine for the H1N1 (swine) flu, which should be available in the fall of 2009.  The CDC recommends these other ways to prevent the flu: "Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too; stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness; cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick; clean your hands. Washing your hands often will help protect you from germs. Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth."
   
   
7. In previous years, what has the Church done in localities where the outbreak of Influenza is most significant?
   In those localities where the outbreak of the disease has been the most significant, bishops have introduced several liturgical adaptations in regard to such practices as the distribution of Holy Communion and the exchange of the Sign of Peace in order to limit the spread of contagion.
   
   
8. What measures should be taken in Roman Catholic liturgies in the United States of America now?
   Priests, deacons, and extraordinary ministers of Holy Communion should be especially reminded of the need to practice good hygiene. Ministers of Holy Communion should always wash their hands before Mass begins; a further precaution suggests using an alcohol-based anti-bacterial solution before and after distributing Holy Communion.  The faithful should be instructed not to receive from the cup if they feel ill.
   
   
9. What about further adaptations or the restriction of options at Mass?
   The Diocesan Bishop should always be consulted regarding any changes or restriction of options in the celebration of Roman Catholic Liturgy. However, the need for the introduction of widespread liturgical adaptations for the prevention of the transmission of influenza in the dioceses of the United States of America is not evident at this time.
   
   
10. What is the Secretariat of Divine Worship doing to address this question?
    While the Secretariat will continue to monitor the situation and provide the best advice possible to Diocesan Bishops and their Offices for Worship, it is ultimately the responsibility of the Diocesan Bishop to recommend or mandate liturgical changes in response to influenza in particular local areas.  The Secretariat likewise appreciates whatever information Diocesan Offices for Worship are able to provide concerning local conditions and the pastoral responses developed by Diocesan Bishops. Continuously updated information is available from the CDC at www.CDC.gov/h1n1flu.

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