Saturday November 21 2009
Coughing or sneezing like this will spread germs
Last updated: 01.00 BST
A strain of swine flu which is resistant to Tamiflu appears to have spread between patients at a hospital in Wales.
The Health Protection Agency (HPA) has confirmed that five patients at the unit, who all have serious underlying health problems and suppressed immune systems, are resistant to the antiviral drug.
The HPA said the risk to the general healthy population was low and there was no evidence that the new strain is more virulent than any other type of flu.
The resistant virus is still sensitive to the other frontline antiviral drug, Relenza.
Dr Tony Jewell, Chief Medical Officer for Wales, said: “We know that people with suppressed immune systems are more susceptible to the swine flu virus.
“We have stringent processes in place for monitoring for antiviral resistance in the UK. Identifying these cases shows that our systems are working, so patients should be reassured.
“Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.”
Two of the patients with Tamiflu-resistant swine flu have recovered and been sent home from the unit at the University of Wales Hospital, Cardiff. One other remains in critical care and two are being treated on the ward.
Earlier this week, Sir Liam Donaldson, the Chief Medical Officer, announced that young children would soon be offered the swine flu vaccine.
Children between the ages of six months and five years have been prioritised based on evidence that they are more likely than other groups to be hospitalised. There have also been high rates of admission to critical care in this age group.
Sir Liam made the announcement at the weekly update and urged everyone who is offered the vaccine to accept it:
“While the risks of serious complications from flu may be small, the impact on those affected can be devastating.
“Protecting those most at risk from the disease will reduce the levels of serious illness and deaths. That’s why we will shortly offer the vaccine to young children”.
Parents of children who are over six months and under five years old should wait to be contacted by their local GP surgery.
Until now, the vaccine has only been given to people with long-term health conditions, pregnant women, people who live with those whose immune systems are compromised, and health workers.
Also announced at this week’s update:
- UK swine flu cases have fallen for the second week in a row. There were an estimated 53,000 new infections in the past week, down from 64,000 the week before.
- Despite the fall in new infections, the number of people in hospital with the virus remains high, with 783 patients in hospital, 180 of whom are in critical care.
- There has been a substantial increase in the number of under-5s in hospital, including in critical care.
- There has been a further substantial increase in the number of deaths related to swine flu, with 32 deaths in the UK in the past week. To date, there have been 142 deaths in England, 38 in Scotland, 21 in Wales and 13 in Northern Ireland.
- GP consultation rates and use of the National Pandemic Flu Service have stayed roughly the same.
- GP consultation rates among school-aged children have risen following a decrease during half-term.
- The Department of Health has published a leaflet for pregnant women.
Vaccinations
Vaccination of people in clinical risk groups is well under way, with more than seven million doses of vaccine already distributed. NHS hospitals and GPs are now vaccinating patients facing the greatest risk of complications. Patients will be contacted by their GPs if they fall into one of the at-risk categories.
Healthcare staff dealing with the public are also being vaccinated to help keep medical services running smoothly and to prevent them from passing the virus to patients.
Recently, healthy children aged six months and over to under five years were added to the priority groups. Vaccination of this group will begin shortly. Parents of children of this age should wait to be contacted by their local surgery.
Who is a priority for vaccination?
People who are most at risk from swine flu need to be vaccinated first. These groups are, in order of priority:
- People aged between six months and 65 years in the seasonal flu vaccine at-risk groups.
- All pregnant women. The European Medicines Agency has indicated the vaccine can be given to pregnant women regardless of their stage of pregnancy.
- People who live with those whose immune systems are compromised, such as cancer patients or people with HIV/AIDS.
- People aged 65 and over in the seasonal flu vaccine at-risk groups.
- Healthy children aged six months and over to under five years.
Frontline health and social care workers will also be offered the vaccine at the same time as the first clinical at-risk groups. Health and social care workers are both at an increased risk of catching swine flu and of spreading it to other at-risk patients.
What are the seasonal flu vaccine at-risk groups?
These are people with:
- chronic respiratory disease, such as chronic obstructive pulmonary disease (COPD),
- chronic heart disease, such as heart failure,
- chronic kidney disease, such as kidney failure,
- chronic liver disease, such as chronic hepatitis,
- chronic neurological disease, such as Parkinson's disease,
- diabetes requiring insulin or oral hypoglycaemic drugs, and
- immunosuppression (a suppressed immune system), due to disease or treatment.
Planning assumptions
Revised guidance for planners was issued on October 22. The new guidance is based on the latest scientific understanding of the swine flu virus, drawing on our own experience to date and the southern hemisphere’s experience of winter.
This improved understanding means it is now anticipated that the impact of the virus on the UK is likely to be less severe than previously thought.
The additional information now available confirms earlier guidance that children under 16 are significantly more susceptible to the virus, and up to 30% may fall ill during this second wave.
The worst-case clinical attack rate is revised down from 30% to 12% between October 1 and the end of the normal flu season. The worst-case hospitalisation rate is now considered to be 35,000 with up to 5,300 requiring critical care over the same period. The worst case number of deaths is now assumed to be a further 1,000 spread across all age groups.
The threat that swine flu still poses should not, however, be underestimated.
Up to 1.5 million people could still become ill in the peak week. Children under 16 are particularly susceptible to the illness and unfortunately in rare cases healthy children have developed severe complications.
Who is at greatest risk of serious complications from swine flu?
Some people are more at risk of complications if they catch swine flu, and need to start taking antivirals as soon as it is confirmed that they have the illness. Doctors may advise some high-risk patients to take antivirals before they have symptoms, if someone close to them has swine flu.
It is already known that people are particularly vulnerable if they have:
- chronic (long-term) lung disease,
- chronic heart disease,
- chronic kidney disease,
- chronic liver disease,
- chronic neurological disease (neurological disorders include motor neurone disease, multiple sclerosis and Parkinson's disease),
- immunosuppression (whether caused by disease or treatment), or diabetes mellitus.
Also at risk are:
- patients who have had drug treatment for asthma in the past three years,
- pregnant women,
- people aged 65 and over, and
- children under five.
National Pandemic Flu Service
The National Pandemic Flu Service was launched in July. This online service assesses patients for swine flu and, if required, gives them an authorisation number that can be used to collect antiviral medication.
The system, which can also be accessed by phone, will take the strain off GPs as swine flu spreads. For the moment, it is being used only in England.
“The National Pandemic Flu Service is a new self-care service which will give people with pandemic swine flu symptoms fast access to information and antivirals,” said a Department of Health spokesman.
“This new service will free up GPs, enabling them to deal with other illnesses that need their urgent attention.”
The launch of the system brought important changes to the official advice that is given to people who think they may have swine flu. That advice – and the new system – is supported by the Royal College of General Practitioners.
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.”
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.
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).
For people who do not have internet access, the National Pandemic Flu Service can be accessed by phone on:
Telephone: 0800 1 513 100
Minicom: 0800 1 513 200
For more information on the National Pandemic Flu Service, go to Flu Service: questions and answers.
People in Scotland, Wales and Northern Ireland can visit www.direct.gov.uk/pandemicflu
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.
This 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.
Swine flu pregnancy and parenting Q&A.
Swine flu symptoms, including high-risk groups.
Chief medical officer's advice on pregnancy, holidays, and parents.
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.
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.
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.
