Tuesday, June 30, 2009

Girl dies after catching swine flu - 3rd death / 6000 with swine flu in Britain

The girl, who already suffered from what was described as an "underlying health problem" was being treated at Birmingham Children's Hospital. If her death is confirmed to have been linked to the illness she will become the third Briton to die of the virus.

As news of the death emerged, the Department of Health announced a big jump in the number of patients in England confirmed with swine flu - up 1,604 since Friday, taking the UK total so far to 5,937.

Earlier today, Dr Hamish Meldrum, head of the British Medical Association (BMA), said the public can rely upon doctors to "step up to the mark" as swine flu spreads.

He said flu plans were currently working quite well across the UK, apart from in some areas where NHS trusts thought they could "do better" by departing from national guidance.

Some 366 retired GPs have joined a BMA register, saying they are willing to treat patients if the flu pandemic reaches crisis point.

Dr Meldrum told doctors attending the BMA conference in Liverpool: "As yet, we haven't seen how well the UK will respond to the effects of a full-blown pandemic, but what I can say and where I can reassure the public is that, whatever the crisis, you can rely on the doctors of the UK to step up to the mark."

Elsewhere, six revellers were sent home from the Glastonbury festival over the weekend with suspected swine flu and three or four ball boys and girls suffering from a "flu-like illness" were asked to stay away from the Wimbledon tennis tournament.

However, the West Midlands has seen the highest number of cases, with 2,104 confirmed so far - more than a third of the UK's total and more than two-fifths of all the cases in England.

Last week health officials said the West Midlands, along with London which has 1,564 confirmed cases so far, would adopt a policy of outbreak management, with swine flu cases being clinically diagnosed rather than being confirmed by laboratory results.

The new policy means swabbing will take place only for a small number of cases to keep track of the strength of the virus.

Doctors will also use the drug Tamiflu more selectively, targeting only people with symptoms.

The drug is unlikely to be handed out to everyone who has come into contact with a swine flu sufferer as a precaution.

Chief medical officer Sir Liam Donaldson stressed that many parts of the country were still in the containment phase.

But he warned there could be "tens of thousands of cases" of swine flu each week by the autumn because the virus is more likely to thrive in the colder months.

Monday, June 29, 2009

First resistance to swine flu treatment Tamiflu reported in Denmark

The first case of resistance to Tamiflu, considered to be the most effective treatment for swine flu by the World Health Organisation, has been reported in Denmark.

First resistance to swine flu treatment Tamiflu reported in Denmark
The Danish national is no longer suffering from the illness and is not displaying symptoms, the Danish Institute of Serology said in a statement Photo: REUTERS
A patient who had been in direct contact with a person suffering from the new H1N1 influenza strain was given a dose of Tamiflu as a preventative measure.
But she still contracted the virus after her body resisted the treatment leading doctors to give her another type of medication, Relenza, made by GlaxoSmithKline, the British pharmaceutical company.
The Danish national is no longer suffering from the illness and is not displaying symptoms, the Danish Institute of Serology said in a statement.
"It does not constitute a risk to public health and does not cause changes to the recommendations for the use of oseltamivir (Tamiflu)," the institute said in a statement.
A spokesman for the Swiss company Roche, which manufactures Tamiflu, said the patient's resistance was likely to be an individual case.
David Reddy, Roche's pandemic task force leader, said the case was within the 0.5 per cent rate of case resistance to Tamiflu that had been established in clinical trials.
The World Health Organisation declared an influenza pandemic earlier this month and advised governments to prepare for a long-term battle against the new flu virus. The WHO had no immediate comment on the case of Tamiflu resistance.
The United Nations agency has raised its pandemic flu alert to its highest alert level of 6, indicating the first influenza pandemic since 1968 is under way.

Friday, June 26, 2009

UK cases double in a week - US cases top one million

Fergus Walsh | 20:11 PM, Friday, 26 June 2009

The sun has been shining, the temperature rising, and it really does feels like summer. So not the traditional time one would expect a flu virus to flourish.

UV light cooks the viral goose pretty quickly, and people are outside more rather than being huddled together swopping germs (let's not spoil this theory by mentioning air conditioning or public transport).

But the H1N1 swine flu virus is not like seasonal flu.

It's sufficiently novel and contagious that it is continuing to spread despite the warmer weather. Let's look at what's happening in the UK and USA.

The number of cases of swine flu in the UK has doubled in a week. Laboratory confirmed cases stand at 4322. England saw its biggest daily increase today with 535 new cases, most of them coming because of a surge in London and the West Midlands.

Both areas now have more cases than the whole of Scotland, where the virus continues to flourish in the Glasgow area.

With the virus now very firmly established in London it's likely that further big increases will follow. And remember that many cases are going unreported.

Does that mean a peak in cases - a full-blown national epidemic - will come earlier than expected, perhaps in late August or September? Possibly, but the expectation is that once the school holidays begin there could be a pause with a peak coming from autumn onwards.

Then we could see tens of thousands of cases a week and every part of the UK will be affected. At present, in Wales, north-east and north-west England, there's still hardly any flu at all, so the virus is still not fully embedded here.

Now to the United States. The CDC in Atlanta has given another of its very helpful briefings to journalists.

Dr Anne Schuchat set out the situation there: 27,717 laboratory-defined cases with more than 3000 hospitalisations and 127 fatalities.

"This virus is not going away" she said, "and the reported cases are the tip of the iceberg. We are estimating there have been at least one million cases in the United States - not perfectly accurate but a ball-park figure."

That estimate is based on some telephone polls asking people whether they'd had flu-like symptoms in the past three weeks (not the most accurate way of estimating illness) and some community surveys which suggested 6% of people in hot-spot regions may have had the virus.

While not terribly accurate, the CDC appears confident that at least one million Americans have been infected.

If so, that is very reassuring news because it means the fatality rate is really very low. North America is about a month or so ahead of the UK with its outbreak so what happens there is a good guide to what may happen here.

So who is getting H1N1 swine flu in the US? Dr Schuchat said the virus was affecting mainly younger people rather than the elderly and made these points:

1.Nearly 80% of those hospitalised have been under 50
2. Average age for hospitalisation is 19
3. Average age for those who've died is higher, at 37
4. About 75% of those who've died have had underlying health conditions
5. There've been very few cases in people over 65, so they are very unlikely to be infected, but when they do get it, elderly people have a higher risk of complications and death

So how mild is mild and what sort of symptoms do people have? Dr Schuchat said most had a fever and respiratory symptoms, a cough, a cold, with some having diarrhoea. People may be miserable in bed for a few days, but the illness clears up on its own.

The US, unlike the UK, has restricted antivirals to those at most risk of complications, so comparitively few doses of Tamiflu have been handed out.

The CDC can't say yet how many people are asymptomatic - ie they have such mild illness they don't even realise they've had swine flu, but with a million plus Americans thought to have had swine flu, it must be a pretty sizeable number.

But a minority can have a much tougher time according to Dr Schuchat: "It's important for everyone to be aware of the virus, and especially for those with underlying health conditions, asthma, diabetes, chronic lung disease, and pregnant women: these people need to be especially concerned if they develop a fever and respitory illness."

Some mention has been made of obesity being a risk factor.

Dr Schuhat said that those who were obese, and especially the morbidly obese (those with a BMI - Body Mass Index - above 40) often have chronic lung disease and that's why they were at risk of complications. Being obese on its own does not seem to be a risk factor.

To sum up, swine flu is here to stay. For the vast majority it is nothing to worry about. For a small minority it can cause serious illness. It should neither be dismissed out of hand nor be a reason for panic.

Scientists must continue to monitor the virus to see if it mutates or becomes more virulent or becomes resistant to antivirals - thankfully there's no sign of either at present.

Radical shift in antiviral use considered


Let's start with antivirals. At present, everyone in the UK who is suspected of having H1N1 swine flu is offered them. But the virus is proving so mild that it has got health officials wondering whether this really is a sensible policy.

The Department of Health, like global health bodies, was expecting the next pandemic to be a more aggressive virus with a higher mortality rate.

There are plenty of antivirals to go round - enough Tamiflu (and the lesser-known Relenza) for half the population, and eventually for eight in ten people in the UK. Sir Liam Donaldson said that he'd asked scientists to look into the issue. "People with seasonal flu don't get antivirals," he said. "Should we be treating only those who are at higher risk of complications?"
It would represent a big shift in policy on Tamiflu. Already, some of those offered the drug are turning it down because they don't see the point in taking it when they have only mild symptoms or are simply a close contact of someone infected, or because they want to avoid possible side-effects like nausea.

But before people say that the whole pandemic issue has been a lot of fuss over very little, a word of caution. Sir Liam pointed out that they were working on the basis of three potential scenarios for this autumn and winter:

(1) the virus is largely unchanged and remains mild;
(2) it changes and becomes more severe (bear in mind that all flu viruses mutate, which is why we need a new seasonal flu vaccine each winter);
(3) (and the least likely option, says Donaldson) it combines with another virus subtype and a new strain emerges.

If (2) or (3) occurs, then the pandemic would become more serious.

Another topic that came up was vaccines. Sir Liam said the government hoped to get the first doses of H1N1 vaccine in August.

By the end of the year, we were told, there might be 60 million doses, enough for about half the population, based on the assumption that each person would need two jabs.

Sir Liam said there was a "cookery book element" to vaccine production, which I took to mean that the yield and dosing strategy varied from year to year. As a result, we can't yet be sure when we will get all the vaccine. Another issue, not discussed, is that the UK is just one of many countries which has contracts for vaccine, and there will be pressure from all governments to get their doses first.

Another issue that the government must grapple with is who to vaccinate first.

Sir Liam said that they had to strike a balance between protecting people at higher risk and targeting the vacine to slow the spread of the virus. The latter could be done by vaccinating everyone in outbreak areas. But Sir Liam indicated it was more likely that at-risk groups would be protected first. Nothing was said about front-line health workers, but I would expect this group to be among the first to be immunised. Andy Burnham said that, as with all such issues, they would be "led by the science".

Mr Burnham pointed out that the vaccine contracts would eventually supply 130 million doses. But officials can't yet say when all the jabs will arrive. It's quite possible that millions of Britons will encounter the virus before they are offered a vaccine - it all depends on what happens this autumn.

But Sir Liam pointed out that the vaccine will be useful even after this autumn: "In all previous pandemics, excess mortality has occured for three years after the virus appeared".

Finally, how do you know what will happen if you, your child or a friend feels ill with suspected swine flu?

The answer is: it depends entirely on where you live.

In parts of London, the west Midlands and east Berkshire (all swine flu "hot spots"), there is a shift away from containment towards "outbreak management" because there are so many cases in the community. I will set out the three phases involved in managing the outbreak in the UK:

• Containment phase: this is still be used in many areas where there are few cases. Contacts of infected people are traced and offered antivirals, schools may be closed and all those suspected of infection are tested via nasal and throat swabs, to produce a laboratory diagnosis. In this phase, it is the Health Protection Agency that takes the lead.

• Outbreak management phase: this is the policy in hotspots. Only a small proportion of suspected cases will be swabbed (so that the HPA can keep tabs on the spread of the disease) and instead, GPs will do clinical diagnosis. Schools are unlikely to close. Contacts are not traced and Tamiflu might be restricted only to those with suspected infection. Areas will change to this policy once the virus is spreading widely in their community. Each area might adapt the policy to suit their local circumstances - "flexibility" is the buzzword.

• Treatment phase: this will be a UK-wide policy, according to Sir Liam. He suggested it would be triggered when there were "west Midlands-style outbreaks in five parts of the country". The NHS takes the lead instead of the HPA and it's treated a bit like a large outbreak of seasonal flu. But the aim would be to take pressure off GPs and to encourage people to use a telephone line to report symptoms. Those who are thought to have the virus will get a unique number which will allow a "flu friend" to collect antivirals from a collection point - which may not be a traditional pharmacy. The HPA willl keep tabs on the virus and check if it is changing or developing resistance to antivirals.

Saturday, June 20, 2009

What's happening in the United States ?

Fergus Walsh (BBC News) Jun 19, 2009 20:15:54 GMT

The CDC in Atlanta has held another useful briefing on the progress of H1N1 swine flu in the United States. Since the US is the global centre of the outbreak with far more cases than anywhere else, though fewer deaths than Mexico, we can learn from their experience about how the virus is behaving now and what may happen in the coming months.
Dr Daniel Jernigan, Deputy Director of the Influenza Division at the Centers for Disease Control and Prevention made these comments:

"The U.S. will likely continue to see influenza activity through the summer, and at this point we're anticipating that we will see the novel H1N1 continue with activity probably all the way into our flu season in the fall and winter. The amount of activity we expect to be low, and then pick up later.
In terms of the numbers of infections that have been laboratory confirmed as H1N1, there are now more than 17,800 of those in the United States, including around 1,600 that have been hospitalized and 44 that have died.
As we have been saying all along, these numbers are likely an underestimate of the number of cases that are out there. There are some surveys that indicate that the amount of disease in the areas that are having activity with H1N1 is perhaps around 7% of the population reporting symptoms due to influenza-like illness.
The virus continues to impact mostly younger people. So far it is not causing significant illness and death in the elderly like we would see with seasonal influenza.
And the symptoms that are being reported are consistent with influenza, that being predominantly fever, cough, some shortness of breath, fatigue and chills. There is some vomiting and diarrhea that have been associated with cases of this infection. Everyone needs to be alert to the symptoms of the illness, and especially if you have underlying conditions, such as asthma, diabetes and heart disease. "

For me the 7% figure jumps out. That would mean many millions of cases in the US already, and be good news because it would mean the risk of serious illness death (already small) was even lower. Earlier CDC estimates reckoned that 19 out of 20 cases were going undetected.
Jon Cohen from Science Magazine put this question:

"Dr. Jernigan, you said there might be as many as 100,000 Americans infected. With the finding that 7% had influenza-like illness in affected communities, that extrapolates to 20 million Americans. Could you give an estimate that's more up to date than the 100,000?

Dan Jernigan: "Well, the 100,000, as you know, is a rough generalization to try to give a sense of the magnitude of infections that might be there relative to the numbers of laboratory confirmed that we actually had.
And so as you can see, in some areas, where there have been a lot of transmissions, like New York City, they're finding maybe around 7% of the community was infected, or had influenza-like illness. There's some other parts of the U.S. where some of our preliminary data suggests the same thing. I think it would be inaccurate to try and take an attack rate of 7% or an area that's highly affected and apply that to the U.S. population. Because as we all know, the amount of disease is different in different parts of the U.S. And so clearly there are hundreds of thousands of cases that have occurred in the U.S. We are working to get a very good estimate of that. But at this point, it would be incorrect to take that percent and apply it to the U.S."
So the CDC clearly don't yet have a clear idea of the true number of cases in the US beyond saying that there have clearly been hundreds of thousands. One final quote from Dr Jernigan on those who are most at risk of complications responding to a question from Emma Hitt at MedScape:
Dan Jernigan: "Your question is, what numbers of individuals that are hospitalized have underlying diseases, and about 70% have some kind of underlying disease. The most predominant of that is asthma. The second being diabetes. Immunocompromised status, either through cancer chemotherapy or other compromising conditions is about 13%. And chronic underlying heart disease. The things that we see normally as underlying diseases that are associated with increased influenza risk are the same that we're seeing with H1N1.
Cases seem to be declining in New York, one of the worst affected areas. For those interested in the impact on health and hospitalisations in the city, there is more detail available from the NYC Department of Health.

Wednesday, June 17, 2009

Birmingham 'cannot contain swine flu'

City 'cannot contain swine flu'

It is thought that 34 schools in the city have been affected by the virus.

Health officials in Birmingham say the spread of swine flu in the city can no longer be contained.
Fifty-five new cases have been confirmed in the West Midlands region taking the total to 567 - more than half of the total cases in England.

The city council's health scrutiny committee was told officials want to move to "mitigating" the outbreak.

Sean Connolly, the city's director of resources, said the Department of Health was listening to its concerns.

'Different response'

He said:
"Containment is too late in Birmingham. We are planning for the mitigation phase."
Under the containment policy all those people who may potentially have come into contact with an infected individual are offered anti-viral drugs.

The aim is effectively to isolate the virus, allowing no opportunity for it to spread further.
But once cases become too frequent to contain, drugs are only given to those people, such as family members, who are at significant risk of infection.

It is also thought that health officials will now rely for an initial diagnosis on GPs rather than waiting for confirmation by laboratory test results.

Mr Connolly said he would "like to proceed" to a policy of mitigation.

"The Department of Health is listening to what we are saying. I would be very surprised if the DoH didn't look at our circumstances and use a different response."

There are currently 1,582 confirmed cases of swine flu in the UK.

Health officials have blamed the extent of the virus in the West Midlands on an outbreak at Welford Primary School, Handsworth, Birmingham.

It shut in May with nearly 200 people connected to the school diagnosed with the virus although it has since reopened.

Dr Sue Ibbotson, of the Health Protection Agency, said it was not surprising cases had spread to other schools in the area. The BBC understands 34 of the city's schools have been affected by the virus.

Why it pays to be old

Fergus Walsh (BBC News)Jun 12, 2009 15:08:08 GMT

Do you want to avoid catching H1N1 swine flu?

You could find a remote, uninhabited island until a vaccine is created. I think that's going a bit far. But the best defence is age.

So far, the over-65s has been the group least likely to catch the infection. This has led to me receiving cheery comments from retired people saying that it's the first time in some while that they've felt glad to be old.

margaret chanSo why aren't they falling ill? The likeliest explanation is that they have built up immunity over years of exposure to other H1N1 flu viruses. That might also help to explain why most other people get a mild infection.

But I'm still puzzled as to why 30- to 50-year-olds are suffering a disproportionate amount of severe illness. In fact, I'm a bit puzzled as to exactly which age groups - under the age of 65 - are most at risk of severe illness.

In her speech in Geneva yesterday, Margaret Chan, the WHO director-general, had this to say:

"We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years.
"In some of these countries, around 2% of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia. Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years. This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people. Many, though not all, severe cases have occurred in people with underlying chronic conditions.
"Based on limited, preliminary data, conditions most frequently seen include respiratory diseases, notably asthma, cardiovascular disease, diabetes, autoimmune disorders, and obesity.
"At the same time, it is important to note that around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people. Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups."

This was very similar - up to a point - to the briefing yesterday by the CDC in Atlanta. You'll notice the same emphasis on younger age groups, pregnant women and those with underlying health problems. This is what Dr Anne Schuchat had to say about the US experience of H1N1 swine flu:

"It is a very new virus. 57% of the cases that we're having reported to us occur in people five to 24 years of age, and 41% of the hospitalisations are in that same age group - the older children and young adults. But I also want to tell you about the rates, the cases per 100,000 population, and let you know that the highest rates of hospitalization are actually in children under five. And the next highest rates are in those people 5 to 24. So it looks like this is a virus that's disproportionately affecting younger people but there are still lots of infections and hospitalizations in older persons.
"According to the US statistics, 71% of the hospitalized patients have occurred in people who have an underlying condition - respiratory illness like asthma or conic obstructive pulmonary disease, immune deficiencies, and so forth. As we have noted, there's been a disproportionate amount of pregnant women among those who have had infection."

Did you spot the difference? Dr Schuchat made no direct mention of the 30-50 age group, although she did mention that there were lots of people over 24 who are taken to hospital. If the 30-50 year group is especially at risk, it would be good to know. I'm still just in that age group myself, so maybe it's self-interest at work here. No doubt all will become clearer in the months ahead. When it does, I will let you know.

Scotland and Australia: What's really happening

Fergus Walsh (BBC News)Jun 10, 2009 23:02:37 GMT

Swine flu warning in Melbourne
Hours before the World Health Organization is expected to declare a pandemic of H1N1 swine flu, I've been seeking expert comment from two of the worst affected countries outside North America - Scotland and Australia.
Along with Chile and Japan, these are the countries which are forcing the move to Phase 6, a global epidemic or pandemic.
Dr Ian Barr is the Deputy Director of the WHO Influenza Centre in Australia.
He's based in Melbourne, which is the centre of the flu outbreak there.
The state of Victoria has had more than 1,000 confirmed cases of swine flu and Dr Barr said that the government was now changing the way it managed the outbreak.
"If someone is ill then we will continue to ask that they stay at home and don't go out and risk infecting anyone. But there won't be a recommendation for quarantining whole families as has happened.
"Unless someone falls quite ill they won't be given antiviral treatment like Tamiflu and we won't trace their contacts. We won't close schools if there's a single case, so it's a much more relaxed approach than we've had prior to this phase."
But Dr Barr said that the virus was not causing serious problems:
"We've had just a handful of cases admitted to hospital and no deaths.
"There've been very mild symptoms among the 1,000 laboratory confirmed cases and probably thousands more that have not been tested."
With the southern hemisphere moving into its peak winter flu season, it will be vital to keep a close watch on what happens there in the months ahead.
Scotland, by contrast, is heading into summer. That did not stop 47 new cases being confirmed there today, the highest number for a single day. It takes the total to 311.
Ten people are in hospital. Dr Harry Burns, the Chief Medical Officer for Scotland, said that there was no doubt that they were seeing community transmission well beyond the confirmed cases.
"The last figures I saw there were between 30 and 40 cases where there was no known source for the infection - it did not seem to be travel-related or connected to a particular outbreak. But sometimes people don't always remember their contacts".
Dr Burns said that there was also no doubt that there were plenty of cases going untested and unmeasured, just as was happening in other countries.
I asked him whether it was time for a change in approach as is happening in Australia, with fewer school closures and so on.
"We are getting close to a change in strategy, but quite how and when it is rolled out we can't say yet. We will continue to take scientific advice.
"If you have a new travel-related case in a rural part of Scotland where there have been no cases, then you may look for contacts. That might be less so in other areas where there have been lots of cases."
He has no doubt that the virus is here to stay and he hoped that it would remain a largely mild infection.
"But it's worth preparing for the worst. The nightmare scenario a few years ago was that H5N1 avian flu would reassort with a human flu virus in pigs.
"If H1N1 reassorted with H5N1, it would be important to have some initial protection against the H1N1 strain. That's why it's worth creating a vaccine."

Tuesday, June 16, 2009

Should I worry about a flu pandemic?

Fergus Walsh | 15:34 PM, Thursday, 11 June 2009

Flu pandemics are an inevitable fact of life.

There were three in the 20th Century. The worst, Spanish flu in 1918, killed perhaps 50 to 100 million people - but that was before the antibiotic era.

The pandemics of 1957 and 1968 killed one to two million. Even that sounds alarming, but bear in mind that normal seasonal flu contributes to up half a million deaths per year.

And H1N1 flu is currently so mild that, in terms of deaths, it might not be much worse than a bad normal winter of flu.

But it is different in the groups it targets. Very few elderly people are catching H1N1 flu, probably because they have immunity due to exposure to similar flu viruses.

Instead, the peak groups are children and young adults aged 5-24, followed by children under five, and then adults under 50. Most of those who fall seriously ill, with complications like pneumonia, have underlying health problems.


But of the 140 or so deaths so far worldwide, about half have been in previously-healthy people. That is what prompted the World Health Organization to change its description of the virus from a mild to a moderate disease.

People will want to know when they are likely to be exposed to H1N1. That's impossible to say with any accuracy, but the summer months may suppress the virus somewhat in Britain, and it may be the late autumn or beyond before we see a full-scale epidemic in every community.

The government's pandemic plans suggest that perhaps a third of the population could get infected, causing huge rates of absenteeism from work, and extra pressure on the health service.

There is concern that the virus might mutate in the southern hemisphere over its winter and become more virulent, but there's no sign of that yet.

A pandemic vaccine is in early development; it will be autumn before the first doses are ready; they will be earmarked for front-line health workers and those with health problems.

How Swine Flu Outbreak Emerged

Swine flu: Country by country

Swine flu: Country by country - use the slider to view swine flu day by day.

Swine flu: keep perspective over death

Europe's first death from H1N1 swine flu was a horrible tragedy for the family of the pregnant woman who died. But it does need to be kept in perspective.

By Prof Angela McLean, director of the Institute for Emerging Infectious Diseases at Oxford University.
Published: 7:00AM BST 16 Jun 2009

As of yesterday there have been 1,320 confirmed cases in the UK. In the United States, as of Friday, there had been 17,855 confirmed cases and 45 deaths – amounting to one death for each 400 confirmed cases.

By that count, one death in the UK is not unexpected. Nor is it a surprise that pregnant women should be at particularly high risk – that pattern occurs in seasonal influenza and in previous influenza pandemics.

In America, where the outbreak is several weeks ahead of ours, they have seen relatively few infections in the elderly with half of known cases in people between five and 24 years of age. The highest rates of admission to hospital are in children under the age of five, followed by people aged five to 24.

Seven in ten of those in admitted to hospital had an underlying health condition, like asthma, cardiovascular disease, diabetes or, indeed, pregnancy.

So far swine flu has been compared with seasonal flu and in the last twenty years there have been three flu seasons when the estimated number of deaths in England and Wales has exceeded 20,000.

There are around 42m people under the age of 60 in England and Wales.

If a quarter contract swine flu, as has been predicted, and one in 400 of those were to die the arithmetic says there would be around 26,000 deaths from swine flu – as bad as the 1989/90 season which was the worst in the last twenty years.

Sunday's tragic death reminds us that all flu can be serious. But we have time to learn from how swine flu behaves during a winter flu season in the southern hemisphere. We can learn from the risk groups, how many people fall ill, and fatalities in Australia over the coming months to understand who in our communities will be at highest risk, and just how large those risks will be.

Monday, June 15, 2009

Britain's first swine flu death confirmed - questions answered

A 38-year-old woman has become the first person with swine flu to die in Britain. Here Rebecca Smith, Medical Editor answers questions on what this means.

Swine flu: Woman becomes first UK death after dying in Scottish hospital
Woman becomes first UK death after dying in Scottish hospital Photo: REUTERS
Q – Why did the woman in Scotland die when experts say most people suffer mild symptoms?
A – It is understood the woman had underlying health conditions including suffering from seizures which increases the likelihood of complications and the majority of deaths from swine flu have been in people with long-term ill health.
Q – Did she die because she was pregnant and the baby was born early?
A – Experience of the larger swine flu outbreaks in Mexico and the United States has shown that pregnant women are at greater risk of complications if they contract the virus. However it is not known if the woman contracted while she was pregnant or after she gave birth.
Q – I thought flu only killed old people, but this woman was only 38. Isn’t that unusual?
A – Swine flu is behaving slightly differently to normal seasonal flu in the age range it is striking. The majority of cases and deaths have been in the 20 to 54 age bracket. It is thought that older people may have been exposed to a similar flu virus and may have some residual protection.
Q – Does this mean the virus is more dangerous?
A – The virus itself has not changed and has remained stable since it was first discovered. Deaths from complications due to flu are to be expected, even with normal winter flu. In a bad flu season around 22,000 people die from complications such as pneumonia. As the UK has now seen more than 1200 cases of the H1N1 swine flu virus it was expected there would be a death.
Q – Has this changed the Government’s response to the pandemic?
A – The death in itself has not changed anything. However in Scotland and in England the number of cases has been rising sharply and there are now clusters of cases not connected to travel abroad. This means that the virus is beginning to break out of the containment measures used so far and is getting into the general community. This is also to be expected but experts do not believe there will be widespread infections in Britain until the Autumn.
Q – Should I buy Tamiflu and start taking it?
A – No, the advice is that if you or anyone in your family has flu-like symptoms to contact your GP or NHS Direct for advice. There is Tamiflu available for people who need it. Tamiflu is a prescription-only drug and it should not be possible to obtain it without a prescription. Buying medicines online is hazardous because a large proportion of products are counterfeit and may not work or may even be harmful. Taking Tamiflu in an attempt to avoid catching flu is not advised because it would have to be taken continually and the medicine can cause side effects such as nausea