SOUTH WEST WALES BRANCH

SWINE FLU

Swine Flu Latest from the NHS - Case Numbers Continue to Fall, latest Advice and the Possible Second Wave:

There has been another significant fall in the number of new swine flu cases in England , with an estimated 3,000 people catching the virus in the week to September 10. This is down from 5,000 the week before and 130,000 a week at the outbreak's height.

In his weekly update, Sir Liam Donaldson, the chief medical officer, also said that plans have begun to ensure that critical care units in the UK would be ready to deal with a possible second wave of swine flu if it happened in the autumn.

This includes doubling the number of critical care beds and ventilators and training more medical staff in critical care.

Measures that may be necessary to deal with a surge in people who are seriously ill with swine flu include temporarily postponing planned surgery, cancelling staff leave and placing older children in adult wards where appropriate.

Other recent developments:

• There continues to be a downward trend in new swine flu cases.
• There are 132 swine flu patients in hospital in England (as of 8am on September 9).
• A further five people with swine flu died in England in the last week, bringing the UK total to 75. So far there have been 66 deaths in England , seven deaths in Scotland , one in Wales and one in Northern Ireland .
• The majority of cases continue to be mild. There is still no sign that the virus is changing.
• Internationally, there have been 3,491 deaths related to swine flu.
• Many countries in the southern hemisphere have now passed the peak of their winter flu epidemic.
• Flu activity in Australia is returning to normal levels and in total there have been 35,897 confirmed cases and 165 deaths.

 Revised planning assumptions

It was announced on September 3 that estimates of deaths in the worst-case scenario for swine flu have been lowered. The government's expert advisers on swine flu, the Scientific Advisory Group for Emergencies (SAGE), said that new data from the UK , north America, Australia and elsewhere give a better picture of how the virus might spread in the autumn.

The revised planning assumptions have cut the estimated death toll in a worst-case scenario from 65,000 people in the UK to 19,000, assuming that 30% of the population is infected.

These forecasts and others in the report are based on a "reasonable worst case" value and should not be taken as a prediction of how the pandemic will develop. Planning against the reasonable worst-case scenario will ensure, however, that plans for all likely scenarios are robust.

The Department of Health said: “In light of this new information, the estimates for the number of people who might need hospitalisation and the proportion of people with swine flu who could die have been reduced.”

Vaccination should cut hospitalisation

These new planning assumptions do not take account of the vaccination programme which, once it has begun, will help to further reduce the number of people needing hospitalisation. However, the department added, we must not be complacent. While in the majority of people it is mild, for some this virus can be a serious illness.

 Advice for antivirals

Several newspapers reported that the World Health Organization (WHO) had changed its advice regarding use of antivirals for swine flu. Its advice suggests that while antivirals should always be given in serious cases, they may not always be necessary for otherwise healthy people.

The papers pointed out that this appeared to differ from the approach taken in the UK , where Tamiflu is being widely used.

However, the Department of Health said: "We believe a safety-first approach of offering antivirals, when required, to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects.

"The WHO recommendations are in fact in line with UK policy on antivirals. We have consistently said that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them.”

Vaccinations for the vulnerable

Andy Burnham, the Secretary of State for Health, has confirmed which priority groups will be given the first doses of swine flu vaccine, which is expected to arrive in October.

Burnham said that the earliest doses of the vaccine would be given to at-risk groups in the following order:

• People aged between six months and 65 years in the clinically at-risk groups for seasonal flu.
• Pregnant women, subject to licensing by the European Medicines Agency, which will indicate whether it can be given throughout pregnancy or only at certain stages of pregnancy.
• Household contacts of people with compromised immune systems.
• People aged 65 and over in the current seasonal flu vaccine clinical at-risk groups.

The Health Secretary said: “Although the virus has so far proved to be mild in most people, for others it has been more serious. By vaccinating high-risk groups first, we aim to protect those most vulnerable to this virus.” He confirmed that frontline health and social care workers will begin to be vaccinated at the same time as the first at-risk group.

At-risk groups

At-risk groups will be the same as for seasonal flu vaccination. This includes people with serious heart disease, diabetes, and weakened immune systems due to cancer treatment.

The list has been drawn up according to advice from independent experts at the Joint Committee on Vaccination and Immunisation, which reviewed the evidence and advised the Department of Health on the crucial risk groups to be offered vaccination to help prevent serious illness.

A vaccination programme for the rest of the population will be based on the evolution of the pandemic as well as new clinical data on the use of the vaccine.

People in the priority groups outlined above do not need to take any action yet. Further announcements will be made as the vaccination strategy progresses, and those who need a vaccine will be contacted.

Swine flu medicines

To learn about the medicines used to treat pandemic flu, including the benefits and side-effects, go to the pandemic flu medicine guide at:. http://nhs.medguides.medicines.org.uk/NHS/condition.aspx?condition=Pandemicflu

Reporting side effects

If you take an antiviral and have suspected side effects, first contact your GP to check that you are OK. You can then report your side effects on MHRA's new online system at: http://www.mhra.gov.uk/Safetyinformation/Swinefluinformation/index.htm

National Pandemic Flu Service

  For an explanation of swine flu, its symptoms and treatment, go to Swine flu A-Z at: http://www.nhs.uk/Conditions/Pandemic-flu/Pages/QA.aspx

  For quick questions and answers go to Swine flu Q&A at: http://www.nhs.uk/conditions/pandemic-flu/Pages/Introduction.aspx

  For information in other languages and formats go to Swine flu: other languages  at: http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Otherlanguages.aspx

  To check your symptoms go to the National Pandemic Flu Service at: http://www.direct.gov.uk/en/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_178842.htm

Latest advice

If you have flu-like symptoms and are concerned that you may have swine flu, the advice is to stay at home and check your symptoms at the National Pandemic Flu Service at: http://www.direct.gov.uk/en/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_178842.htm.

Patients with swine flu typically have a fever or a high temperature (over 38°C / 100.4°F) and two or more of the following symptoms:

• unusual tiredness,
• headache,
• runny nose,
• sore throat,
• shortness of breath or cough,
• loss of appetite,
• aching muscles,
• diarrhoea or vomiting

Call your GP if:

• you have a serious underlying (existing) illness, 
• you're pregnant, 
• you have a sick child under one year old, 
• your condition suddenly gets much worse, or 
• your condition is still getting worse after seven days (five for a child).

People in Scotland , Wales and Northern Ireland can visit www.direct.gov.uk/pandemicflu at: http://www.direct.gov.uk/en/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_178842.htm

Other National Swine Flu Websites:

Scotland - NHS24: http://www.nhs24.com/content/default.asp?page=home_SwineFlu

Wales - NHS Direct Wales: http://www.nhsdirect.wales.nhs.uk/

Nothern Ireland - NI Direct: http://www.nidirect.gov.uk/index/health-and-well-being/swine-flu.htm

Advice for pregnant women

Pregnant women are one of the higher risk groups for swine flu, as they are for all influenza viruses. It is therefore important for them to take precautions.

The NHS website provides full and up-to-date advice for pregnant women and parents of young children. The advice has not changed recently and is available at the following links:

Swine flu advice for pregnant women at: http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Adviceforpregnantwomen.aspx.
Swine flu pregnancy and parenting Q&A at: http://www.nhs.uk/Conditions/Pandemic-flu/Pages/QA.aspx#Arepregnantwomen.
Swine flu symptoms, including high-risk groups at: http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Symptoms.aspx 
Chief medical officer's advice on pregnancy, holidays, and parents at: http://www.nhs.uk/news/2009/07July/Documents/CMOAdviceonholidayspregnancyandparents.doc.

How dangerous is swine flu?

The vast majority of cases reported so far in this country have been mild. Only a small number have led to serious illness, and these have frequently been where patients have had underlying health problems. 

Reduce the risk of catching or spreading flu

• Cover your mouth and nose when coughing or sneezing. Use a tissue.
• Dispose of used tissues carefully.
• Wash your hands frequently with soap and water.
• Clean hard surfaces (e.g. kitchen worktops, door handles) frequently using a normal cleaning product.

There has been an argument put forward that the government should restrict antivirals to those groups who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, then the NHS should let the virus run its course, treating it with paracetamol and bed rest, as for normal flu.

However, the government’s Scientific Advisory Group for Emergencies (SAGE) believes there is still some uncertainty about the risk profile of the virus. For instance, there are reports of some cases in Argentina where young, healthy adults have apparently become extremely ill from swine flu.

While there is still this doubt, the government has decided to continue offering Tamiflu to everyone with swine flu at their doctor's discretion.

"We will keep this matter under review, with advice from SAGE," said health minister Andy Burnham.

You can read the Department of Health's guide for further information on the science of swine flu treatment at: http://www.nhs.uk/news/Pages/Swinefluscienceoverview.aspx

Who is at greatest risk of serious complications from flu?

Some people are more at risk than others of serious illness if they catch swine flu. They will need to start taking antivirals as soon as they are confirmed with the illness. On occasion, doctors may advise some high risk patients to take antivirals before they have symptoms if someone close to them has swine flu.

The risk profile of the virus is still being studied but it is already known that certain groups of people are particularly vulnerable. These include:

• Patients who have had drug treatment for asthma in the past three years
• Pregnant women
• People aged 65 years and older
• Children under five years old
• People with chronic lung disease
• People with chronic heart disease
• People with chronic kidney disease
• People with chronic liver disease
• People with chronic neurological disease
• People with immunosuppression (whether caused by disease or treatment)
• People with diabetes mellitus

Why are healthy people over 65 and children not a priority for the swine flu vaccine?

Healthy people aged over 65 appear to have some natural immunity to the swine flu virus. And while children are disproportionately affected by swine flu, the vast majority make a full recovery - therefore the experts do not advise that children (other than those in at-risk groups) should be vaccinated initially.

Catch it, Bin it, Kill it

Although the UK has moved to a treatment phase for swine flu, it’s important that people continue to do everything they can to stop the virus from spreading.

The most important way to stop it spreading is to have good respiratory hygiene (i.e. sneezing and coughing into a tissue) and hand hygiene (keeping your hands clean). The video Catch it, Bin It, Kill It explains the importance of catching your sneeze in a tissue, placing it quickly in a bin and washing your hands and surfaces regularly to kill the virus. The Video can be seen at: http://www.nhs.uk/video/pages/medialibrary.aspx?Page=1&Filter=&Id={BFDE6027-5A36-4C38-934C-9C380DC66F13}&Tag=Infections+and+viruses&Uri=video/2009/January/Pages/Sneezing.aspx

[Compiled with the assistance of the NHS]

BRIEFING ISSUED BY ROYAL MAIL 30th April 2009

Wash your hands often – especially after coming in from outside

Copyright © CWU South West Wales Branch 2008