H1N1 Flu by crabsallover

Half of schoolchildren in some areas had swine flu: government scientists

2010-01-23T05:13:00.001-08:00

Up to half of children in some areas have had swine flu even though they may not have shown symptoms, government scientists have found.

Up to a third of children in some areas have been infected

2009-11-26T10:45:00.001-08:00

Fergus Walsh | 16:54 UK time, Tuesday, 24 November 2009

It's been one of the big questions of this pandemic. Just how many of us in Britain have actually had swine flu?

Knowing that would be incredibly useful, as the bigger the proportion infected, the further we are into this pandemic and the less likely there will be a further sting in its tail.

The Health Protection Agency (HPA) has done blood tests of hundreds of children and parents connected to early school outbreaks.

With one school in south west England they tested around 500 people. They found that although around one in 10 children fell ill, three to five times as many got infected and developed antibodies.

After analysing this and other data relating to the number of children being seen by GPs, the HPA has now come up with these interesting estimates:

• Up to one third of children in swine flu hotspots (such as England and the West Midlands) have already been infected with the H1N1 virus.
• Across the UK up to one in five children has had had swine flu.
• About half of those who get infected show no symptoms.

This is all very reassuring. Professor Maria Zambon from the HPA said:

"We didn't get the pandemic that we planned for and you might say that we've been lobbed a soft ball. There hasn't been high case mortality, the virus is sensitive to drugs, and we've been able to make vaccine and roll it out. I am incredibly grateful that we are not dealing with a pandemic of H5 (bird flu)."

Professor Zambon said the virus had had a relatively low impact on older adults and that was probably explained by pre-existing immunity. The HPA has these estimates:

• For those aged over 50 up to four in 10 people have pre-existing protective antibodies to the H1N1 pandemic virus.
• If you are under 50 it falls to around one in 10 of the population.

The professor, who is an acknowledged world expert on flu, did utter a few words of caution. "Influenza is full of mystery and intrigue. It has lots of twists and turns" and she predicted that mutations of the swine flu virus should be expected. She also pointed out that there could still be a substantial outbreak of seasonal flu over winter.

WHO: Swine flu jab as safe as seasonal vaccine

2009-11-01T08:30:00.000-08:00

Fergus Walsh | 16:56 UK time, Friday, 30 October 2009

Many readers of this blog may be about to get a letter from their GP offering them a vaccine against H1N1 swine flu, or will receive an invitation in the coming weeks, if they fall into specific at-risk groups.

If so, they may well be interested in the latest advice from the World Health Organization(WHO).

The experts who advise the WHO and governments about immunisation have said that the H1N1 pandemic vaccines appear to be as safe as seasonal flu jabs.

The Strategic Advisory Group of Exerts (SAGE) on immunisation met earlier this week to review both clinical trials involving several thousand volunteers and the ongoing mass immunisation campaigns being conducted in at least 14 countries where several hundred thousand doses had been administered.

Details of its decision were released by the WHO.

This is what it says about vaccine safety and the use of the vaccine in pregnant women:

"The experts reviewed early results from the monitoring of people who have received pandemic vaccines and found no indication of unusual adverse reactions. Some adverse events following vaccination have been notified, but these are well within the range of those seen with seasonal vaccines, which have an excellent safety profile. Although early results are reassuring, monitoring for adverse events should continue.

"Concerning vaccines for pregnant women, SAGE noted that studies in experimental animals using live attenuated vaccines and non-adjuvanted or adjuvanted inactivated vaccines found no evidence of direct or indirect harmful effects on fertility, pregnancy, development of the embryo or foetus, birthing, or post-natal development.

"Based on these data and the substantially elevated risk for a severe outcome in pregnant women infected with the pandemic virus, SAGE recommended that any licensed vaccine can be used in pregnant women, provided no specific contraindication has been identified by the regulatory authority."

At a subsequent briefing, Dr Marie-Paule Kieny, WHO Director of the Initiative for Vaccine Research said:

"All the reports received to date... have shown that the safety profile of this pandemic vaccine is good and is very similar to the one known for seasonal flu vaccine. Nothing special about adverse events has been noted.

Therefore SAGE has considered that in view of the particular importance to vaccinate pregnant women who are at significantly higher risk of severe adverse outcome following infection with a pandemic virus, especially in the second and third trimester of pregnancy, that these women can be vaccinated with any of the licensed vaccines."

Pregnant women and young people

I would like to quote another section of the SAGE advice as it highlights the increased risks facing both pregnant women and the young:

"Globally, teenagers and young adults continue to account for the majority of cases, with rates of hospitalization highest in very young children. Between 1% to 10% of patients with clinical illness require hospitalization. Of hospitalized patients, from 10% to 25% require admission to an intensive care unit, and from 2% to 9% have a fatal outcome.

"Overall, from 7% to 10% of all hospitalized patients are pregnant women in their second or third trimester of pregnancy. Pregnant women are ten times more likely to need care in an intensive care unit when compared with the general population."

What stands out for me is the greatly elevated risks among pregnant women.

Pregnancy leads to changes in the immune, respiratory and cardiovascular systems and it has always been a risk factor for seasonal flu, but nothing like the potential threat posed by this pandemic strain.

Bear in mind, though, that since the outbreak began, the number of deaths from swine flu has been very low compared to seasonal flu (which mostly kills the frail elderly). The latest global death toll is 5,700 up around 700 in the past week.

This can be partly explained by the start of the northern hemisphere flu season. But set that against the fact that many millions of people worldwide had been exposed to the virus (around 500,000 in Britain alone).

All these figures are estimates only, but they help in setting in context the level of risk. The availability of a vaccine means that this is now a preventable disease.

SAGE said both the pandemic and seasonal flu vaccines can be given at the same time. As with the UK recommendation, it said one dose of vaccine is enough to protect those from 10 years of age.

For those older than six months and under 10, it says data are limited and more studies are needed. The UK is giving two doses, spaced three weeks apart to those under 10, but only to children in at-risk groups.

But as I said in my previous post, it seems just a question of time before this is extended to all children. SAGE had this to say:

"Where national authorities have made children a priority for early vaccination, SAGE recommended that priority be given to the administration of one dose of vaccine to as many children as possible."

When you bear in mind that SAGE is chaired by Professor David Salisbury, who is also the head of immunisation at the Department of Health, it appears to be a further pointer towards an eventual move to the mass immunisation of all children in the UK.

Vaccination gets the green light

2009-10-16T12:11:00.000-07:00

Fergus Walsh | 17:42 UK time, Friday, 16 October 2009

The long-awaited UK-wide programme of vaccination against H1N1 swine flu will begin next week.

The first to get immunised will be the most vulnerable people in the population - namely, high-risk patients in hospital (for example, those with leukaemia who have a weakened immune system).

The Chief Medical Officer for England, Sir Liam Donaldson, who is the government's main advisor on tackling the virus, gave further details (for England) at his weekly press briefing.

The GSK vaccine Pandemrix has become the jab of choice for the NHS, despite the government also buying stocks of a second vaccine Celvapan, from another manufacturer, Baxter. This is partly due to production problems with the Baxter vaccine.

Sir Liam Donaldson urged at risk groups, including pregnant women, to get immunised:

"I don't want to see anyone dying of an illness that can be prevented by vaccination. Only this week we have seen two deaths among pregnant women: one in Scotland and another in Wales."

The head of immunisation at the Department of Health, Professor David Salisbury, said those over 10 years of age would need just one dose of Pandemrix vaccine, because clinical trials had shown that it was sufficient to offer good immunity.

Those under 10 will need two jabs, spaced three weeks apart, because their immune systems don't respond as well.

By contrast, anyone who has Celvapan will require two doses. Professor Salisbury said he specifically wanted pregnant women to have the Pandemrix GSK jab, because it meant they would be protected quicker. He said:

"If a pregnant woman has an interval of three weeks to wait for immunity to kick in, that could put the pregnancy at risk, so it is seriously beneficial for them to be protected after one dose of Pandemrix."

Professor Salisbury pointed out that both vaccines had been licensed and were safe. The Baxter vaccine, which is not made using eggs, would be used for those who have a rare egg allergy. The key difference between the two vaccines is that Pandemrix has an adjuvant, or booster chemical, which is designed to boost the body's immune response.

Adjuvanted flu vaccines have been around for at least a decade, but there is not nearly the same degree of clinical data as with unadjuvanted flu jabs.

Because of the lack of clinical data, the WHO suggested in July [267KB PDF] that swine flu vaccines without adjuvants, should be used in pregnant women, where possible.

This suggestion came from the influential Strategic Advisory Group of Experts on Immunization (Sage). That would have meant Celvapan being used, not Pandemrix.

But Professor Salisbury, who chairs Sage as well as being the head of immunisation at the Health Department, indicated that this advice was now out of date.

"It was made before the GSK vaccine was licensed and based on what we knew at the time. The regulators were able to look at studies involving pregnancy in animals and at other clinical data."

SAGE meets in two weeks and is expected to revise its earlier guidance. So what should pregnant women do?

The clear advice is that those who are pregnant should be immunised because they are at considerably higher risk, as a result of the body's natural suppression of the immune system.

The further along the pregnancy, the greater the risk to the mother and her unborn child. Earlier this week, a pregnant teenager in Scotland died after contracting swine flu, leading to the death of her unborn child. Recently, a new mother in Wales died two weeks after giving birth following infection with the virus.

Many will want to find out as much information as possible about Pandemrix before agreeing to be immunised. There have been clinical trials - including data published today.

To date, 2,000 people have received the jab. None of those was pregnant because ethical committees will not usually allow pregnant women to take part in trials.

So what is in the adjuvant, known as AS03, found in the GSK jab? The key ingredient is something called squalene, which is derived from fish oil. The World Health Organization has an explanatory note on this.

Squalene (wikipedia) has been used in flu vaccines before, as the WHO makes clear:

"22 million doses of Chiron's influenza vaccine (FLUAD) have been administered safely since 1997. This vaccine contains about 10mg of squalene per dose. No severe adverse events have been associated with the vaccine."

and WHO say

Are squalene-containing vaccines safe?

Over 22 million doses of squalene-containing flu vaccine have been administered. The absence of significant vaccine-related adverse events following this number of doses suggests that squalene in vaccines has no significant risk. This vaccine has been given primarily to older age groups.
As this vaccine and new squalene-containing vaccines are introduced in other age groups, post-marketing follow-up to detect any vaccine-related adverse events will need to be performed.

GSK has a briefing note on its H1N1 swine flu vaccine.

"Lucky break" slows spread of swine flu - Donaldson

2009-10-10T11:25:00.000-07:00

"Lucky break" slows spread of swine flu

Chief medical officer now optimistic about the scale of the epidemic

Britain's swine flu outbreak is slowing down, possibly as the result of a "lucky break" in the way the virus has behaved, the chief medical officer said today.

Sir Liam Donaldson, who has been generally cautious in his weekly predictions on the likely course of the epidemic, was more optimistic as he suggested during a news conference that the peak number of cases may be lower than previously thought.

The rate of increase looks to be nothing like the weekly doubling of cases that experts had predicted. Last week, there were 18,000 new cases of swine flu, rising from 14,000 the previous week and 9,000 the week before that.

"We are well into the second wave of pandemic flu, having had the first wave in July, but it's proving so far to be a slow burner," Donaldson said. "It's possible that it might peak at a lower level – and an earlier level – than expected which would be incredibly positive news.

"It means we could get the vaccine programme well under way. If this virus has another peak up its sleeve, as in 1968, we might be able to avert that completely."

.....

"We may have got a lucky break in how the virus has behaved at the start of our flu season and we may be able to get the vaccine out there before our flu season really gets under way," said Donaldson. "I'm looking at it very optimistically."

Vaccine

The body which advises ministers on vaccination - the Joint Committee on Vaccination and Immunisation - has been meeting today and a key point of discussion has been whether to extend H1N1 swine flu vaccination beyond at-risk groups. If this does happen, it would be healthy children who would be the first group targeted, on the grounds that children are the most likely to catch the disease, and the most likely to require hospital treatment.

Vaccination against seasonal flu has already begun in many parts of the UK and swine flu jabs will be sent to GPs from later this month. Sir Liam said:

"There's been a supply of half a million doses of Baxter vaccine in warehouses for some time. We expect to get considerable numbers of the GSK vaccine quite soon. The only doses here so far (of the GSK vaccine) have been for clinical trials and there hasn't been a major delivery yet."

Seasonal flu vaccine offers 'some protection'

2009-10-07T23:32:00.000-07:00

Fergus Walsh | 00:01 UK time, Wednesday, 7 October 2009

Research from Mexico City published on BMJ.com suggests that the seasonal flu vaccine may offer some protection against swine flu, particularly the most severe complications of the disease.

Swine flu science: overview

2009-10-02T12:46:00.001-07:00

Swine flu science: overview

NHS ChoicesOct 02, 2009 12:30:00 GMT

This page brings together the latest science and developments on the swine flu pandemic, offering a single accessible resource for both health professionals and the general public.

You will find a range of regularly updated links to scientific resources on the Pandemic (H1N1) 2009 virus listed below. We will also be critically appraising new research on swine flu as it is published.

For the latest, more general news on swine flu in the UK, including prevalence, NHS policy and guidance, go to swine flu latest from the NHS.

We encourage comments and suggestions from the scientific community on the development of this page.

Recent swine flu appraisals by Bazian

For a full list of related articles see our archive of swine flu news.

Useful links

Journals and research

The Lancet H1N1 Flu Resource Centre brings together swine flu related content from over 40 journals and 11 learned societies. Free access to all content.
Nature includes articles on the history of swine flu and a blog rounding up the latest swine flu news from around the globe.
The New England Journal of Medicine H1N1 Influenza Center features articles, review papers and surveillance updates of swine flu news.
The British Medical Journal's swine flu blog is updated regularly. The site also has a swine flu patient information leaflet and a section on swine flu in BMJ BestPractice.
The Center for Infectious Disease Research and Policy (CIDRAP). A good resource with the latest news, and a useful overview of the pandemic.
Public Library of Science influenza feed: a rolling list of influenza research and data
Eurosurveillance. An open access peer-reviewed journal about infectious diseases surveillance, prevention and control.

UK government

International government

World Health Organization Pandemic (H1N1) 2009
European Centre for Disease Prevention and Control
US Centers for Disease Control and Prevention
US Pandemic Flu.gov
US National Library of Medicine. Enviro-Health links 2009 H1N1 Flu (Swine Flu)
European influenza surveillance from the World Health Organization
Medline Plus, health information for the US public
Promed, from the international society for infectious diseases, is a useful electronic global reporting system for emerging infectious diseases

The genetics of swine flu

Gene sequencing and related information. GenBank, National Center for Biotechnology Information
Database of influenza genome sequences and background information. BioHealthBase Bioinformatics Resource Center
Analysis of genetic data on the origin and evolution of swine flu. Human/Swine A/H1N1 Influenza Origins and Evolution

Health & Medical organisations

The Royal College of General Practitioners: Information for GPs looking to prepare for enquiries about H1N1 and a preparation checklist
British Medical Association: pandemic flu guidance for GPs

Blogs, wikis, alerts and other tools

BBC: Fergus on flu
WHO: interactive swine flu map
Nature blog: swine flu
Virology blog by Dr Vincent Racaniello
Flu Wiki
Wikipedia 2009 flu pandemic
Flu tracker Map
HealthMap. Global Disease Alert Map
Microsoft Bing. 2009 Swine Flu H1N1
Outbreak and Migration Map
Facebook group. AH1N1 Swine Flu 2009
Twitter aggregator. Outbreak.tweetmeme

Swine flu vaccines get first UK trial

2009-09-28T23:02:00.000-07:00

Fergus Walsh | 22:23 UK time, Monday, 28 September 2009

Researchers in Oxford have started the first trial of Britain's two swine flu vaccines. Working with teams in Bristol, Exeter, Southampton and London, they are aiming to recruit 1,000 youngsters aged six months to 12 years. Although both vaccines are likely to get licensed in the next few weeks, none of the trials has taken place in Britain. Pandemrix (made by GSK) was approved by the European Medicines Agency on Friday, while Baxter's H1N1 jab seems likely to get approved this week.

http://www.swineflutrial.org/

This is the first time the vaccines have been used in the UK and the first comparative study of the jabs.

Professor Andrew Pollard from the University of Oxford is heading the research: "We are doing this trial to compare head-to-head the two vaccines which are going to be used in the UK against swine flu to see which one works best in children and which one is best tolerated. We are sort of in a race against time because we know the flu season is already started. We hope to immunise the children over the next 10 days or so.

The GSK vaccine is made using the traditional means of growing the virus in embryonated hens' eggs, before the virus is broken and deactivated. The Baxter vaccine is made in cell culture, so is suitable for those who have an egg allergy. The sort of side effects that are expected are sore arms and fevers. The information given to parents also lists rare side effects including Guillian-Barré syndrome which can cause ascending paralysis and even be fatal.

It's worth quoting here from the trial information: "Other very rare events that have been seen with routine flu vaccines include seizures and temporary bleeding disorders. In the past Guillian-Barré syndrome (a rare disorder of nerves) has been associated with flu vaccines but the relationship remains uncertain, with some studies suggesting a possible link but others not finding it. One large study in the UK found that influenza-like illness itself was associated with an increased risk of the Guillian-Barré syndrome but there was no link with the seasonal influenza vaccines, suggesting that vaccination might actually protect against the disorder by preventing flu."

What I take that to mean is that, if you have the vaccine, there is a remote, theoretical possibility that you could get GBS (as happened in the USA in 1976 with their swine flu vaccine), but you are more likely to get it as a result of contracting flu. So while it is impossible to rule out the risk of GBS from the vaccine, it is very remote, and this must be balanced against the very real and proven risks of complications from flu.

Weekly pandemic flu media update

2009-09-26T05:12:00.000-07:00

Weekly pandemic flu media update

24 September 2009

KEY POINTS
The rates of flu-like illness and related activity have shown further increases in England.
The flu-like illness rate in England from the Royal College of General Practitioners (RCGP) scheme increased to 16.2 per 100,000 in week 38. Most age groups saw an increase.
This week, the antiviral collection numbers in the National Pandemic Flu Service have continued to increase and this has been seen in all age groups under 65. Once again, the biggest increase has been seen in the 5-15 year old age group with antiviral collections again doubling from 2,886 to 5,580.
Interpretation of data to produce estimates on the number of new cases continues to be subject to a considerable amount of uncertainty. HPA modelling gives an estimate of 9,000 new cases in England last week (range 5,000 to 20,000). This is the second weekly increase since week 30.
This estimate incorporates data from National Pandemic Flu Service and GP consultations.
Sharp rises in influenza activity in recent weeks are reported from the USA - concentrated particularly in school age children. Increasing activity has also been reported in a number of European countries, particularly France.

X-179A - Pandemrix - based on HA & NA - May 27 2009

2009-09-26T04:56:00.002-07:00

A candidate reassortant vaccine virus (X‐179A) has been developed, using classical reassortment technology, from an A/California/7/2009 (H1N1)v virus, by the New York Medical College, New York, USA.

The haemagglutinin (HA) and neuraminidase (NA) sequences of the A/California/7/2009 (H1N1)v virus can be found on the public web site of GenBank via the following links:
HA gene sequence
http://www.ncbi.nlm.nih.gov/nuccore/227977171?ordinalpos=1&itool=EntrezSystem2.PEntrez.Sequence.Sequence_ResultsPanel.Sequence_RVDocSum

NA gene sequence
http://www.ncbi.nlm.nih.gov/nuccore/229396468?ordinalpos=1&itool=EntrezSystem2.PEntrez.Sequence.Sequence_ResultsPanel.Sequence_RVDocSum

EMEA homepage

2009-09-26T04:56:00.000-07:00

European Medicines Agency has approved Pandemrix

Vaccines for swine flu by Fergus Walsh

2009-09-26T04:06:00.002-07:00

Vaccines for swine flu

Fergus Walsh | 16:30 UK time, Friday, 25 September 2009

Plans to vaccinate millions of people in Britain against H1N1 swine flu have taken a step forward today. The European Medicines Agency (EMEA) has approved Pandremrix, manufactured by GlaxoSmithKline (GSK) [36Kb PDF].

A licence won't be granted until it's been approved by the European Commission, but that is expected in the next couple of weeks. GSK is one of two suppliers of pandemic vaccine to the UK, the other being Baxter. But its vaccine did not get approved today. The EMEA said that there had been an issue about the quality of the vaccine, but that they hoped to resolve that next week. The Baxter vaccine is not made using eggs, so it will be useful for those rare people with an anaphylactic reaction to egg.

The UK has contracts for up to 132 million doses of pandemic vaccine - enough for everyone in Britain to receive two shots. But early data suggests one jab may be sufficient. This is what the EMEA had to say on this:

"The Committee is currently recommending a two-dose vaccination schedule, at an interval of three weeks, for adults, including pregnant women, and children from six months of age. The Committee acknowledged that there are preliminary data suggesting that one dose may be sufficient in adults. The Agency is expecting further data from ongoing clinical studies over the coming months and these recommendations may be updated."

It should mean that Britain is on track to begin begin an immunisation campaign next month. Just a reminder of which groups will be vaccinated first. Here's the list, in order of priority:

• individuals aged six months and up to 65 years in the current seasonal flu vaccine clinical at-risk groups
• all pregnant women, subject to licensing considerations on trimesters
• household contacts of immunocompromised individuals
• people aged 65 and over in the current seasonal flu vaccine clinical at-risk groups

So how many people will that involve? Getting figures for the whole of the UK means contacting four separate health departments, which is why very often, you will see only the figure for England. My understanding is that the total is 11.45 million people for the UK (9m England; 1.3m Scotland; 0.75m Wales; 0.4m Northern Ireland). In addition, more than two million frontline health workers will be immunised in tandem with the above groups.

The government now has an agreement with GPs to vaccinate the at-risk groups. But this will take a huge amount of organisation, especially since the seasonal flu campaign will continue.

There are many questions which arise from the planned immunisation campaign, not least how big the uptake will be. NHS staff members have a very poor record of taking the seasonal flu jab, with only 16% uptake.

Many pregnant women may also be loath to have the jab and rather hope for the best that they don't get the virus, and that if they do, get it mildly. Pregnant women are at elevated risk of both catching swine flu and getting complications. In order to carry a child through pregnancy, the body's immune system is naturally suppressed.

The first person to die from complications of swine flu in June was a 38-year-old woman in Scotland who'd given birth prematurely. She had underlying health conditions. Andremember Sharon Pentleton? She got swine flu when six months pregnant and had to be flown to Sweden for specialist treatment. Fortunately, she is now recovered and her baby is due next month.

Both of those cases are extreme examples. The vast majority of pregnant women who catch swine flu will have a mild infection. But the expert advice is that they should be immunised. What is not clear yet is how early in the pregnancy it will be recommended and whether or whether it will be restricted to women who are in the second and third trimesters (that is, from three months onwards).

The final recommendation on timing rests with the Joint Committee on Vaccination and Immunisation (a sort of NICE for vaccines). I've been looking at the minutes of their meeting in August [63Kb PDF] and it gives an idea of what they are thinking on this:

"The committee supported the use of either vaccine once licensed in pregnant women. The committee noted that many women are advised not to take any kind of drug in their first trimester unless recommended by a medical practitioner. The committee advised that all pregnant women, including those in their first trimester, could receive the vaccine. Both swine flu vaccines are inactivated and there is no evidence that the foetus is at any risk when the mother is immunised with an inactivated vaccine such as the seasonal flu vaccine. Seasonal flu vaccines have been used for a number of years in the US with no evidence of harm. The committee noted that vaccinating pregnant women would not only provide benefit to them but also provide benefit to the infant, when born, through vertical transfer of maternal antibodies."

The JCVI also sees no reason why you can't have your pandemic flu jab at the same time as a seasonal flu vaccine. This is what they had to say on that:

"The committee advised that since the swine influenza vaccines are inactivated, they could be co-administered with all other vaccines including seasonal influenza and childhood vaccines. Vaccines should be given at separate sites, preferably in different limbs. If given in the same limb, they should be given at least 2.5 cm apart."

So what will the government do with all those extra vaccines, once the at-risk groups are immunised? My hunch is that they may decide to offer the jab to all children, not just to those who are at risk of complications. But that decision does not need to be taken now, and instead officials will wait to see how the virus behaves in the months ahead.

Pandemrix (pdf) data sheet

2009-09-26T04:06:00.000-07:00

PRESS RELEASE
European Medicines Agency recommends authorisation of two vaccines for influenza pandemic (H1N1) 2009

Q&A from EMEA

Pandemrix (pdf) data sheet includes constituents & adverse side effects

Pandemrix @ Wikipedia

1. NAME OF THE MEDICINAL PRODUCT
Pandemrix suspension and emulsion for emulsion for injection.
Pandemic influenza vaccine (H1N1)v (split virion, inactivated, adjuvanted)
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
After mixing, 1 dose (0.5 ml) contains:
Split influenza virus, inactivated, containing antigen* equivalent to:
3.75 micrograms**
A/California/7/2009 (H1N1)v-like strain (X-179A)
* propagated in eggs
** haemagglutinin
This vaccine complies with the WHO recommendation and EU decision for the pandemic.
AS03 adjuvant composed of squalene (10.69 milligrams), DL-α-tocopherol (11.86 milligrams) and polysorbate 80 (4.86 milligrams)
The suspension and emulsion, once mixed, form a multidose vaccine in a vial. See section 6.5 for the number of doses per vial.
Excipients: the vaccine contains 5 micrograms thiomersal
For a full list of excipients see section 6.1.

Adjuvant in Pandemrix (pdf) data sheet

Mass swine flu vaccination could begin within weeks -

2009-09-26T03:25:00.000-07:00

Mass swine flu vaccination could begin within weeks

European Commission expected to rubber-stamp regulator's recommendations within days

Sarah Boseley, health editor
guardian.co.uk, Friday 25 September 2009 16.23 BST
Article history

A couple wearing masks kiss in Mexico City during an outbreak of swine flu. Photograph: Alfredo Estrella/AFP/Getty

Mass vaccination against swine flu could begin within weeks, following the approval of two vaccines by the European regulator today.

One of the two recommended for a licence by the European Medicines Agency (EMEA) is Pandemrix, the vaccine made by British company GlaxoSmithKline (GSK) which is under contract to supply the UK. The other is Focetria, made by the Swiss company Novartis.

The UK has also signed a contract with Baxter, but the EMEA said yesterday that it needed some information about its vaccine, called Celvapan. The agency hopes to be able to approve it next week.

The EMEA's recommendations go to the European Commission, which is expected to rubber-stamp them within days.

The approval follows an expedited procedure which was based mainly on mock-ups of how the vaccines were expected to behave if bird flu rather than swine flu had sparked a pandemic.

But the EMEA says it is satisfied that inserting the new strain into the vaccine "should not substantially affect the safety or level of protection offered".

It has asked manufacturers actively to investigate and monitor any side-effects from the vaccine "so that action can be taken as early as possible if a safety issue emerges". It points out that "as with all medicines, rare adverse reactions may only be detected once the vaccines are used in large numbers of people". The manufacturers have agreed to conduct post-licensing safety studies on 9,000 people for each vaccine.

GSK has said that volunteers suffered only very mild side-effects in trials, including headache, joint pain, muscle pain, pain and redness at the site of the injection, fever and fatigue.

A spokesman for the Department of Health said they planned to start vaccination in October, but were "still dependent on production and delivery of sufficient vaccine to start protecting people". Those most at risk because of their state of health will be prioritised.

Some countries, including China and Hungary, have already approved swine flu vaccines and begun vaccination, but these are variants of existing vaccines and will not protect to the same extent as a vaccine incorporating the pandemic virus strain.

The EMEA is recommending that people should be given two shots, at an interval of three weeks. It says it recognises there is evidence that one dose may be enough, and may change its advice later. The vaccines are approved for use in pregnant women and children over the age of six months.

The clinical trials on which approval was based involved more than 6,000 people for each vaccine, who received a version which was basically the same as the one to be rolled out, but originally contained an avian flu (H5N1) strain – which had been expected to cause a pandemic – instead of H1N1.

"Decades of experience with seasonal influenza vaccines indicate that insertion of a new strain in a vaccine should not substantially affect the safety or level of protection offered," said the EMEA in its statement.

Across the UK, 82 deaths have been linked to the virus, with 70 in England (up three in the last week), nine in Scotland, one in Wales and two in Northern Ireland.

Across England, the number of people being treated in hospital has risen by more than 50%, from 143 last week to 218 this week. Of these, 25 patients are in intensive care.

Swine flu cases almost double

2009-09-26T03:19:00.000-07:00

Schools across the country have seen new outbreaks of swine flu as children returned to lessons this month, Government officials said.

By Rebecca Smith
Published: 5:00PM BST 24 Sep 2009

Liam Donaldson - Swine flu second wave starting as 66 schools suffer outbreaks in first weeks of autumn term Photo: ANDREW CROWLEY

There have been 66 reported outbreaks of the H1N1 virus in schools in England since the end of the summer holidays, Sir Liam Donaldson, Chief Medical Officer said.

In total there have been an estimated 9,000 new cases of the disease last week, almost double the previous week's total showing that the disease is now rising again, he said.

Sir Liam said the H1N1 vaccines are expected to be licensed soon by the European regulators and that he would have 'preferred more breathing space' before cases started to rise this Autumn in order to get the immunisation programme in place.

Pregnant women, health and social care workers, people aged between six months and 65 years who have underlying health conditions and people living with patients who have compromised immune system will be vaccinated this year.

Early trials show that one dose may be effective but early data from tests in children suggest they may still require two doses for a full immune response, Dr David Salisbury, head of the Immunisation at the Department of Health said.

The World Health Organisation announced that several countries including Australia, China, Hungary and the US have already licensed vaccines for the pandemic strain of H1N1.

Japan and several countries in Europe will shortly follow, according to the WHO.

Dr Salisbury said other countries have different licensing procedures and other vaccines which has meant they have been approved earlier.

Sir Liam added that in some areas swine flu cases have risen at a slower rate than during the first wave in July and some test results suggest that a larger number of children may have been infected earlier this year but not shown symptoms.

This has given them some protection and they are not falling ill now.

The largest number of school outbreaks has been in Yorkshire and Humber, with 27 outbreaks, but Sir Liam said this is probably because the data collection there has been more stringent.

He added that were 'probably more (outbreaks) than that , that we have not heard about'.

The number of pupils infected in an outbreak will vary and it is not known how many children in total are involved in those outbreaks. Schools are not being closed any more when an outbreak occurs as officials say this causes disruption and does little to slow the spread.

Swine flu vaccine Pandemrix, from GSK, approved for use

2009-09-26T03:17:00.000-07:00

The swine flu vaccine which will form the bulk of the British immunisation programme has been approved by European drugs regulators meaning it can be used within weeks.

By Rebecca Smith, Medical Editor
Published: 10:38AM BST 25 Sep 2009

Vaccinations of priority groups is due to start next month in Britain Photo: GETTY

European Medicines Agency has recommended that the GlaxoSmithKline vaccine, called Pandemrix, be authorised for use and the European Union now needs to rubber stamp the decision.

Vaccinations of priority groups is due to start next month in Britain with pregnant women, people aged between six months and 65 years with long-term illnesses, health and social care workers and people living with patients who have a compromised immune system being offered the jabs.

The vaccine will be licensed on a two-dose basis even though some early clinical trials had suggested that one dose may be sufficient in healthy adults.

The EMEA will monitor clinical trials on dosing and may update the recommendations at a later stage.

The British government has ordered enough vaccine from GlaxoSmithKline and Baxter, to provide two-doses for the whole population but will offer the vaccine to 13 million people in the priority groups first before deciding if it is necessary to offer the jabs more widely.

The Baxter vaccine is still going through the licensing procedure.

Sir Liam Donaldson said the second wave of the H1N1 virus is starting to take off since the schools went back and there were an estimated 9,000 new cases last week.

He said he had hoped for more 'breathing space' before cases took off again in order to get the vaccination programme in place.

The EMEA also recommended that the Novartis vaccine called Focetria be licensed.

The recommendation to license the vaccines was based on mock-up products using the H5N1 strain of flu which was extensively tested. The products then had the strain switched for the current H1N1 pandemic strain with further smaller scale trials.

This is how the seasonal flu vaccines are licensed every year and has proved extremely effective in allowing flu vaccines to be produced and licensed quickly, the EMEA statement said.

Further clinical trials in adults and in children are ongoing and more results will become available in the coming months.

A statement from the EMEA said: "As with all medicines, rare adverse reactions may only be detected once the vaccines are used in large numbers of people.

"The Agency has requested that vaccine manufacturers implement plans to actively investigate and monitor the safety of vaccines as soon as they are used across the EU, so that action can be taken as early as possible if a safety issue emerges.

" As part of this, the manufacturers have committed to carry out post-authorisation safety studies in about 9,000 subjects for each vaccine."

Fergus Walsh - One dose vaccine trials and more intensive care beds planned

2009-09-13T23:22:00.000-07:00

Intensive care, and more on vaccines

Fergus Walsh | 11:32 UK time, Friday, 11 September 2009

Plans to double the amount of intensive care provision to deal with H1N1 swine flu cases have been outlined by health officials.

It's an acceptance that hospital critical care is likely to come under intense pressure when the next wave of swine flu comes.

The plans for England were outlined by Ian Dalton, National Director of NHS Flu Resilience.

They would see a doubling of the current 1,982 adult intensive care beds. There are 363 paediatric critical care beds which would also be increased substantially. Similar arrangements will occur throughout the UK.

A doubling of intensive care beds is no easy task, because of the need for specialist ventilators and other equipment.

Equally important are the highly-trained members of staff who work in critical care. So how will it be done?

More ventilators are being bought. Staff who currently work in other areas are being trained in critical care. Recently retired hospital workers will be placed on a reserve list to be called up if necessary. Critical care teams may be asked to work longer hours.

All these measures will help, but there is one other dramatic measure required to increase intensive care provision - cancelling operations.

As and when a huge peak of swine flu cases occurs, the NHS is ready to postpone as much planned surgery as required in order to free up intensive care beds.

This will free ventilators currently used in theatre as well as critical care beds used for patients recovering from cardiac and other major surgery.

This would be a temporary measure which would last for weeks rather than months during the peak of any outbreak.

The plans are based on the assumption that 2% of swine flu cases require hospitalisation, but this has since been downgraded to 1%.

Meanwhile, cases of swine flu continue to decline. There were an estimated 3,000 new cases in England in the past week, down from 4,500 last week and the rate of GP consultations stands at just 8.6 per 100,000.

In Scotland, where the schools went back first, there has been a slight increase in GP consultations to 43.9 up from 40.2, so this might be a very early indication that cases are about to rise.

The United States has seen a sharp increase in swine flu in recent weeks.

The Chief Medical Officer, Sir Liam Donaldson, has spoken in upbeat terms about swine flu. He said "we are tantalisingly close to being able to win the battle against the virus".

He explained that the current dip in cases meant that there was a real chance that they could vaccinate at-risk groups before the outbreak took hold again.

And more pandemic H1N1 vaccine trials results have been published, this time from Australia [Response after One Dose of a Monovalent Influenza A (H1N1) 2009 Vaccine, New England Journal of Medicine].

The early results show that a single dose of the vaccine shows an immune response similar to that gained from seasonal flu jabs.

This is significant because it suggests that just one dose may be required to offer protection. All the worldwide planning to date on pandemic vaccines has worked on the assumption that two injections would be required.

The study involving 240 healthy adults aged 18-64 also found that the vaccine has a similar side-effect profile to that of seasonal influenza vaccines. The vaccine was produced by CSL in Melbourne.

Dr Alan Hampson, Chair of the Australian Influenza Specialist Group said:

"The study showed that a very high percentage of the adult recipients produced a good antibody response, which should provide a high level of protection, to a single dose of vaccine made by conventional methods and formulated at the usual potency. This is great news as it means that available vaccine supplies will go much further than might have been anticipated and that protection can be achieved with a type of vaccine that has a long history of safe and effective use."

Professor Robert Booy, Head of Clinical Research at the National Centre for Immunisation Research & Surveillance (NCIRS) at the University of Sydney said:

"This is indeed very encouraging and perhaps as good as we could have hoped for in that it appears only one dose of vaccination is required. It is important too that the safety profile is good. Results in children are keenly awaited."

This follows similar results from an early trial using a pandemic vaccine made by Novartis.

Results from trials involving the vaccines which will be used in the UK - being produced by GSK and Baxter - are yet to be published.

Swine Flu Vaccine Results - one dose only required

2009-09-13T23:12:00.000-07:00

SEPTEMBER 11, 2009

HHS Celebrates Early Swine Flu Vaccine Results

by Jon Cohen

In an effort to assuage growing concerns about the swine flu pandemic, the U.S. Department of Health and Human Services (HHS) pulled out all stops today to broadcast the news that one dose of a vaccine against the novel H1N1 virus will likely will protect adults.

As HHS Secretary Kathleen Sebelius explained at a press conference this afternoon, the preliminary findings from clinical studies that one dose triggers a strong antibody response in adults “is critically important news.” Flanked by top officials from the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration, Sebelius noted that if two doses were necessary, as some had predicted, it would take longer to immunize the population and require more product. But she also emphasized that no data yet exist about how the vaccine works in children and pregnant women, two groups that remain at high risk for developing severe disease from the virus. And the timing of the vaccine's arrival remains a major concern, she said.

Anthony Fauci, head of the NIH’s National Institute of Allergy and Infectious Diseases, described early data from adult trials sponsored by his institute. In people ages 18 to 64 who received one of two different pandemic H1N1 vaccines, 80% to 96% developed a “robust immune response” 8 to 10 days after a single 15 microgram dose. People 65 and older did not respond as well, with only 56% to 60% reaching similar antibody levels. The new data mesh with data reported yesterday in The New England Journal of Medicine of trials conducted outside the United States.

The unusual high-level press conference to discuss preliminary results from clinical studies reflects the high level of anxiety in the country about the pandemic. The new information, Sebelius said, “shortens the window of worry, and more people can be protected much earlier.” It also means that the limited supply of vaccine, which will not start to arrive in the United States until mid-October, can be made available to more people in other countries more quickly.

Still, many experts say it appears that the pandemic may well peak in the United States in mid-October, before the vaccine arrives. “The models are based on assumptions,” said Fauci. “Certainly there could clearly be peaks before people get vaccinated, but there are other ways to mitigate the spread.” Anne Schuchat, head of the CDC’s National Center for Immunization and Respiratory Diseases, stressed that the virus pops up in different communities at different times. “We do believe that many prevention opportunities will be possible with vaccine, particularly now that we have this great news that protection might be possible in adults after that first dose,” said Schuchat.

US Vaccine may arrive just too late but only one dose needed

2009-09-11T10:55:00.000-07:00

SEPTEMBER 11, 2009

U.S. Swine Flu Vaccine: Good News, Bad News

by Jon Cohen

An increasing number an influenza experts in the United States are worried that the wave of the swine flu epidemic that has started to hit the country may peak before a vaccine can do much good, a news storyin today’s issue of Science explains.

On 15 October, the U.S. government expects to receive the first batches of a vaccine designed to thwart the novel H1N1 virus causing the pandemic. But that is right around the time when many experts now think the spread of the virus may peak in the country. Given that it takes about 2 weeks to build immunity after vaccination and that there will be a limited supply for at least a month or more, the vaccine may have little impact in the United States this fall. “This potential mismatch in timing could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk of serious disease,” predicted the President’s Council of Advisors on Science and Technology in a report the White House released on 24 August.

On the good news front, many researchers had worried that a vaccine against the novel H1N1 virus would require two doses to build substantial immunity—which would mean further delays in the time required to protect the population as well as twice as much product. But clinical tests of novel H1N1 vaccines published online yesterday by The New England Journal of Medicine show that a single dose can trigger high levels of antibodies in adults. No data are yet available for trials in children, who typically have much less robust immune responses to the seasonal influenza vaccine and require a second dose.

As another paper published yesterday, this one in Science Express, emphasizes yet again, widespread use of a vaccine could have a powerful impact against the H1N1 virus—if it arrived early enough and was widely used. Biostatistician Ira Longini from the University of Washington, Seattle, and his colleagues show that the vaccine would need to reach at least 70% of the population, starting with children first, to significantly impede spread. But Longini, a noted influenza modeler, also suspects that the pandemic now spreading across the United States as children return to school may crest in mid-October.

Longini and others note that this pandemic closely mirrors the one that hit the United States in the fall of 1957. If that occurs, Longini said in an e-mail note, “given the current vaccine production and distribution plan, we will be too late to have any effect on the epidemic.” That is precisely what happened with the vaccine effort in 1957.

With the novel H1N1 pandemic, the vaccine effort began almost immediately after the virus was isolated in late April. “In May, it seemed like we were in good shape with vaccine,” noted Longini. “There seemed to be time.” But now time seems to be running out quickly.

Early suppression of H1N1 with antivirals is crucial, When this flu is bad, it's very bad.

2009-09-09T00:11:00.000-07:00

"Either you're off work a few days, or you go to hospital, often to the intensive care unit. There's no middle ground."

In the southern hemisphere, 15 to 33 per cent of hospitalised cases went to ICU in the past two months. "That's very high for flu," ... "When this flu is bad, it's very bad."

In these cases the virus rapidly destroys the lungs' alveoli, where gas transfer occurs, often causing acute respiratory distress syndrome (ARDS), which usually kills in half of all cases. ... found that this past winter in Mauritius and New Caledonia, H1N1 caused ARDS 100 times as often as ordinary flu.

The direct viral damage inflicted on the lungs by severe H1N1 contrasts with SARS and bird flu, whose impact is mainly due to a runaway, body-wide immune response, ... This means early suppression of H1N1 with antivirals is crucial, which in turn requires spotting cases fast.

Who will get severe H1N1? Kumar is coordinating a multi-hospital study of severe H1N1 to find out, .. results suggest severity is linked to HLA, a genetic variation in immune systems. This could be why flu is worse in some ethnic groups.

(194 words, New Scientist max. 200)

Swine flu death estimate 'reduced by two-thirds'

2009-09-04T12:20:00.000-07:00

The second wave of the swine flu pandemic will not be as bad as first feared, the Government's most senior doctor claimed as he lowered the death toll forecast by two-thirds.

Lucy Cockcroft and Martin Beckford
Published: 7:00AM BST 04 Sep 2009

Sir Liam Donaldson, the Chief Medical Officer, estimated that 19,000 people would die from the virus under the "worst case scenario", a significant drop from the figure of 65,000 given in July.

He said the revised estimations, calculated by Government scientists, were "assumptions and not predictions".

They are based on one in three people across Britain becoming infected, and do not take into account what impact the swine flu vaccine, due next month, will have.

one in three = 20,000,000 get swine flu and if 0.1% of these die then 20,000 die. The previous estimate assumed 0.35% would die.

Sir Liam also predicted that the second wave of the pandemic will hit Britain in about seven weeks, according to analysis of how the virus has spread so far.

He said: "We are very unlikely to see a peak before the second half of October, which is something we are very pleased about because we are expecting to be able to use the vaccine by then."

Figures show that cases of confirmed swine flu continue to drop, with only 4,500 diagnosed this week, down from 5,000 last week. Just over a month ago there was a high of 100,000.

There has also been a 26 per cent decrease in people consulting their GP with flu-like symptoms, while the death toll in the UK stands at 70.

The revised predictions came as a medical researcher accused world health authorities of making an "alarmist" response to swine flu, which only considered the worst case scenario.

Writing online at Bmj.com, Peter Doshi, a doctoral student at the respected Massachusetts Institute of Technology, said: "Experts are unsure that the 2009 pandemic will be any worse than seasonal flu.

"Officials responded to the H1N1 outbreak as an unfolding disaster.

"Measures were taken that in hindsight may be seen as alarmist, overly restrictive, or even unjustified.

"If the 2009 influenza pandemic turns severe, far exceeding the impact of seasonal influenza, early and enhanced surveillance may prove to have bought critical time to prepare a vaccine that could reduce morbidity and mortality.

"But if this pandemic does not increase in severity, it may signal the need to reassess both the risk assessment and risk management strategies towards emerging infectious diseases."

Employers are being warned not to underestimate the potential threat posed by swine flu, however, even though it has so far proved less catastrophic than at first feared.

The Chartered Institute of Personnel and Development (CIPD) and the Business Continuity Institute (BCI) issued joint guidance advising firms to prepare for up to half of their staff being off work for as long as a month this winter.

The organisations say that even if employees themselves remain healthy, they may be call in sick or request time off if their children's schools are closed or childcare providers fall ill.

Ben Willmott, senior public policy adviser at the CIPD, said:

"There is a real danger that senior management teams ignore the threat to their business posed by a second and more serious wave of swine flu after seeing the first wave subside much more quickly than anticipated.

"The media and public hysteria sparked by the initial stage of the pandemic has created a 'cry wolf' effect where the temptation for business leaders is to ask what all the fuss was about and get on with the priority of competing and surviving in recession.

"Evidence shows that still only a minority of employers have an adequate contingency plan in place to deal with a flu pandemic, which is extremely worrying considering that staff absence levels could peak for some businesses at levels which will make business as usual extremely difficult.

The CIPD and the BCI believe all businesses should plan for a worst case scenario where staff absence rates reach 50 per cent.

www.E-bug.eu - a New online learning tool launched to help kids protect themselves from infections

2009-09-03T18:02:00.000-07:00

New online learning tool launched to help kids protect themselves from infections

3 September 2009

School children across England and Europe can now learn about protecting themselves from swine flu and other infections, following today's launch of an education programme and interactive website by the Health Protection Agency (HPA).

e-Bug is made up of educational activities for primary and secondary school-age children, complemented by online games, on microbes, hygiene, antibiotic use and vaccines. The programme features age-appropriate animated characters and cartoon microbes; and lesson plans and materials for teachers. Topics include hygiene measures to stop the spread of swine flu and other respiratory infections.

The programme also educates children - our future generation of antibiotic users - on the importance of the prudent use of antibiotics. Antibiotics are currently the most common medicines given to children, and increased antibiotic use is linked to increased resistance.

e-Bug was developed by a team of healthcare experts at the HPA's Primary Care Unit, Gloucester, after research in English and European schools found teaching about antibiotics and resistance varied widely. This research also found that the majority of hand hygiene campaigns were targeted towards adults, with few school-based resources available for children.

Eighteen European countries assisted the HPA with the development of e-Bug: ten are immediately implementing e-Bug as part of the junior and senior school curriculum, or making it available to schools; and eight plan to roll it out in the future. e-Bug will be available as a resource for all English junior and secondary schools from this month.

The HPA's Dr Cliodna McNulty, who led on the development of e-Bug, said:

"With the current swine flu epidemic as well as seasonal flu, we have seen how children are not only more susceptible to acquiring viruses, but are also more infectious to others. Since many swine flu cases have been centred around school outbreaks, the implementation of e-Bug in schools this autumn is particularly timely.

"e-Bug provides practical information on these topics in a fun, hands-on way; which means children are more likely to retain and use what they learn."

The HPA's Chairman, Dr David Heymann, said: "A key role of the HPA is to provide advice and information on issues of public health to specific audiences, so I'm delighted that one of our units has led on the development of this interactive tool for schools.

"I am also very pleased that we have been able to collaborate with schools in so many EU countries in developing e-Bug. Working across national boundaries is crucial if we are to tackle pressing global health issues, such as the spread of swine flu and antibiotic resistance, so I see this as a really positive project."

Ends

Notes for Editors:

The e-Bug website is www.e-bug.eu
e-Bug is being launched in ten EU countries with some of the highest antibiotic use and largest populations, making up 55% of the EU population. The 10 countries which will be implementing e-Bug are Belgium, Czech Republic, Denmark, England, France, Greece, Italy, Poland, Portugal and Spain. The eight countries which are seeking funding to implement it are Croatia, Lithuania, Latvia, Finland, Hungary, Ireland, Slovenia and Slovakia
e-Bug is sponsored by the European Commission Director General for Health, and Consumer Protection Directorate General. 40% of funding is contributed by the ten countries implementing e-Bug
e-Bug has already been endorsed by the Ministries of Health and Education in 10 EU countries
e-Bug will not be formally included in the English school curriculum but the pack will be sent to all schools as a hard copy resource for teachers. e-Bug has been evaluated within schools in Gloucestershire and London
Notes to editors
General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including swine flu. This includes:
- Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of virus from your hands to face or to other people.
- Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product.
- Covering your nose and mouth when coughing or sneezing, using a tissue when possible.
- Disposing of dirty tissues promptly and carefully.
- Making sure your children follow this advice.
Further information on swine flu is available on the Health Protection Agency's website at www.hpa.org.uk/swineflu.

Weekly pandemic flu media update

2009-09-03T17:59:00.000-07:00

Weekly pandemic flu media update

3 September 2009

KEY POINTS
This week there has been a further reduction in the rates of flu-like illness and related activity.
Weekly GP consultation rates continued to decrease over the last week in England.
The majority of cases continue to be mild. There is no sign that the virus is changing. It is not becoming more severe or developing resistance to anti-virals.
Interpretation of data to produce estimates on the number of new cases continues to be subject to a considerable amount of uncertainty. HPA modelling gives an estimate of 4,500 new cases in England last week (range 2,500 to 10,000). There has been a decrease in estimated number of cases in all age groups and in all regions.
This estimate incorporates data from National Pandemic Flu Service and GP consultations.
Figure 1: Current estimated weekly RCGP consultation rates of flu-like illness
Figure 2: QSurveillance® - weekly consultation rate for flu-like illness in England, Wales and Northern Ireland (all ages)
VIRAL CHARACTERISTICS
Viral characteristics (including antiviral susceptibility (as at 26/08/09): Testing for antiviral susceptibility is carried out by the Agency's Respiratory Virus Unit, Centre for Infections, in Colindale. 786 viruses have been analysed for the marker commonly associated with resistance to oseltamivir in seasonal influenza (H274Y); none were found to carry this marker. In addition, 252 specimens have been fully tested for susceptibility; all were found to be sensitive to oseltamivir and zanamivir.
SEVERITY
Disease severity continues to be monitored. The disease is generally mild in most people so far, but is proving severe in a small minority of cases.
Swine flu hospitalisations in England: 159 patients (currently hospitalised as of 8am on 02 September).
Deaths - the number of deaths related to swine flu in England is 61. (This figure represents the number of deaths in individuals with swine flu but does not represent the number of deaths that can be attributed to swine flu).
INTERNATIONAL SUMMARY
Confirmed global deaths reported by ECDC (Update 17:00 CEST 01 September 2009)
Total deaths reported
2,594
In the last 7 days, the number of deaths reported globally has increased by 13%. This compares to a 21% increase in the previous week.
NB: Laboratory confirmed case numbers are no longer being reported for most countries as they do not give a representative view of the actual number of cases worldwide.
General trends
Most southern hemisphere countries (represented by Chile, Argentina, New Zealand, and Australia) appear to have passed their peak of influenza activity and have either returned to baseline levels or are experiencing focal activity in later affected areas; while a few others (represented by South Africa and Bolivia) continue to experience high levels of influenza activity. Many countries in Central America and tropical regions of Asia continue to see increasing or sustained high levels of influenza activity with some countries reporting moderate strains on the healthcare system. In temperate areas of the northern hemisphere (North America, Europe, and Central Asia), influenza and respiratory disease activity remains low overall, with some countries experiencing localised outbreaks.
Source: WHO Disease Outbreak News
http://www.who.int/csr/don/2009_08_28/en/index.html
Notes to editors
General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including swine flu. This includes:
Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of virus from your hands to face or to other people.
Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product.
Covering your nose and mouth when coughing or sneezing, using a tissue when possible.
Disposing of dirty tissues promptly and carefully.
Making sure your children follow this advice.
Further information on swine flu is available on the Health Protection Agency's website at www.hpa.org.uk/swineflu.

Swine flu vaccine successful, study show

2009-09-03T17:49:00.000-07:00

A swine flu vaccine being tested for use in Britain has provided a ''strong immune response'' after just one dose, researchers have said.

Published: 7:05AM BST 03 Sep 2009

After initial success larger trials are now under way around the world involving up to more than 6,000 adults and children Photo: GETTY

Scientists from the University of Leicester said they tested 100 healthy volunteers with a cell-based drug to see how their immune system responded.

Trial leader Dr Iain Stephenson found 80 per cent of the volunteers showed a ''strong, potentially protective'' response after one dose, with more than 90 per cent showing the same response after two doses. He said: ''The results suggest that one vaccine dose may be sufficient to protect against A(H1N1) swine flu, rather than two.

''The aim of the trial was to find out how many doses and what type of vaccine is needed to give protection.

''These initial results should help to plan vaccination campaigns in the autumn, including doses and timings.''

Larger trials are now under way around the world involving up to more than 6,000 adults and children.

The Government plans to vaccinate large swathes of the population following the swine flu outbreak.

It is currently expected the first vaccinations of people in at-risk groups - such as those with asthma and diabetes - are expected to take place in October after the vaccine receives its licence.

Dr Stephenson, from Leicester University's Department of Infection, Immunity and Inflammation, said of his study: ''Results showed that the serum antibody responses were highest among subjects who received two doses of vaccine, however a single vaccine dose also induced responses associated with protection against influenza.''

Its volunteers were aged between 18 and 50, and was carried out at Leicester Royal Infirmary.

The number of deaths linked to swine flu in the UK currently stands at 66.

8 pictures of glass sculptures of deadly viruses

2009-09-03T17:46:00.000-07:00

1 / 8

Luke Jerram spent five years working on his translucent glass sculptures. Depicted here is H1N1 – better known as the swine flu virus

Photograph: Luke Jerram

Swine flu woman saved by Relenza drip

2009-09-03T17:41:00.000-07:00

Sarah Boseley, health editor
The Guardian, Friday 4 September 2009
Article history

Doctors saved the life of a 22-year-old woman critically ill with swine fluby experimentally giving her a high dose of an antiviral drug directly into her bloodstream, they report today.

Relenza is licensed for use only through an inhaler, but attempts to treat the woman with the oral drug Tamiflu and Relenza in the usual way had little effect.

In the case study, published online by the Lancet medical journal, Dr Michael Kidd and Dr Mervyn Singer from University College London Hospitals call for studies to find out whether Relenza given intravenously could save more lives.

The patient, whose immune system had been compromised by chemotherapy to treat Hodgkin's disease, was taken into intensive care on 8 July. Tamiflu and antimicrobials failed to help her, and she was put on a ventilator. Eight days of Relenza through a nebuliser did not work so doctors were given permission by her relatives and the hospital to put the drug in an intravenous drip. They also gave her a corticosteroid to reduce lung inflammation.

Within 48 hours she had improved, with no drug-related side-effects. Just over three weeks after her arrival in intensive care, she was discharged.

NHS guidance has lowered the estimate of the number of swine fludeaths in the UK, putting the range from 3,000 deaths to a "worst-case scenario" of 19,000, down from 65,000 in July. There have been 70 deaths so far.

Swine flu won't be as dangerous as we thought, official says

2009-09-03T15:52:00.001-07:00

The estimate of the number of Britons who will die of swine flu this winter has fallen dramatically after health experts admitted the virus is less lethal then they feared

Severin Carrell, Scotland correspondent
guardian.co.uk, Thursday 3 September 2009 14.52 BST
Article history

Scottish health secretary Nicola Sturgeon has revised downwards the official predictions for the swine flu death toll this winter. Photograph: CS Goldsmith/AP

The official estimate of the number of Britons who could die this winter from swine flu is to be reduced substantially to roughly 20,000 because health experts have decided the virus is far less lethal than first feared.

Ministers and health officials predicted in July that up to 65,000 people could be killed across the UK by the H1N1 virus, as infection rates accelerated over the summer and deaths began to mount.

But the Scottish health secretary, Nicola Sturgeon, said this morning that that official worst case scenario had been revised downwards, with experts now predicting a death rate of 0.1%, much lower than the initial estimate of 0.35%.

Swine flu infections have continued over the summer and at least 66 people have died. Ministers still believe the number of cases will rise steeply this winter, causing a full-blown epidemic and putting public services and businesses under severe strain.

The new estimate is expected to be confirmed by Sir Liam Donaldson, the chief medical officer for England and Wales, this afternoon.

Sturgeon's statement to the Scottish parliament today confirms strong signals from government advisers, including the Scottish chief medical officer Harry Burns, that H1N1 is a relatively mild virus. Burns and other health experts noted that in the US, fatalities were rare.

Even so, health services, council morgues and crematoria, and the economy could be put under severe strain. Sturgeon said that up to 30% of the population could fall ill. Millions of people may have the H1N1 at the same time.

An official UK report published today warns: "It is possible that the virus may mutate, becoming more virulent, and it is important to remain prepared for the full range of possibilities."

Sturgeon disclosed that the first swine flu vaccines are due to be given to key target groups, such as pregnant women, people with weak immune systems and their immediate families, and people over 65, from mid-October onwards.

The European Medicines Agency is expected to license the vaccines later this month or in early October. The vaccination programme would be backed up by a UK-wide publicity and public information campaign, and 13 million people across the UK are expected to be vaccinated in the first phase.

She said: "Estimates of delivery of vaccine from the manufacturers are subject to change, but the current assessment suggests over 54m vaccine doses will be delivered to the UK by the end of December. From this we estimate a potential delivery to Scotland in the region of 300-350,000 doses per week from the date when the vaccine is licensed."

She said the revised death rates estimate did not take account of the vaccination programme, which could significantly cut the death rates by targeting some of the most vulnerable groups.

"Furthermore, they are not predictions; they are assumptions that allow us to plan for the worst, while continuing to hope for the best," she said. "And while having lower estimates for hospitalised cases and fatalities is positive, the assumptions will be kept under review."

Latest Science Summary - NHS

2009-09-03T00:41:00.000-07:00

Swine Flu latest http://www.nhs.uk/news/2009/04April/Pages/Swineflulatest.aspx - see latest Science from NHS.

"Almost nine out of 10 of those suspected of having swine flu had some other viral illness"

2009-09-02T01:30:00.000-07:00

Dr James Le Fanu: swine flu

Swine flu? Pigs may fly

By Dr James Le Fanu
Published: 7:00AM BST 02 Sep 2009

Dr James Le Fanu Photo: MARTIN POPE

There is nothing like a fortnight’s holiday for putting things in perspective. I flew to Greece, leaving Britain in the grip of the swine flu epidemic with an estimated 100,000 new cases per week – only to discover on my return that this major threat to the nation’s health seems to have evaporated.

Or perhaps, as the British Medical Journal suggests, there never was an epidemic. After considerable difficulty, Edinburgh doctor Wilfrid Treasure tracked down confirmed cases in his area – just 13 per cent of those in whom it was originally diagnosed. Almost nine out of 10 of those suspected of having swine flu had some other viral illness. It was a similar story at Middlesbrough’s University Hospital, which set aside a special swine flu ward. In July, 28 patients were admitted but the diagnosis was confirmed in just two. It will be interesting to see if a more realistic assessment of the scale of the “epidemic” will influence plans for a mass immunisation campaign this autumn. I doubt it

My son has got Swine Flu

2009-09-01T23:35:00.000-07:00

3am 2 September: Dominic (18) wakes with a high temperature (100.4F (4.30am) -101.3F (5.30am). He has a throbbing headache and vomitting (6 times in 2 hours). The National Pandemic online website advises he has Swine flu and prescribes Tamiflu - an antiviral treatment course and issues prescription number and tells us to phone GP because he may have complications. The authorisation number for this patient is: R10-123xx123-B

We give him a capsule of Tamiflu (prescribe via www.pimsreg.com) but he vomits within 10 minutes. He vomits with paracetemol tablets - which come up.

We phone our GP and then the west Hampshire Out of hours service 0844 811 3060. Catherine Trusson, a call handler for the antivirus service advises that Mike (nurse) will phone in <1 hour which he does.

Mike, the nurse reviews his symptons (5.30-5.45am) and says that this is probably a "simple viral illness" probably not "swine flu" or "meningitis".

At 5.55am Dominic has diarrhoea.

I take a Tamiflu capsule but wife refuses to do so (I've been taking a Tamiflu capsule every other day since early August, as a preventative measure). We both wash hands since we've touched the glass that Dominic was holding.
9.05am: Dominic has a rash around shoulders, temperature 100.3F, he says he is 'confused'. I phone GP, Dr Nigel Savage will call before 9.35am.

10.30am: Nigel says rash is not meningites/meningococal. 38.2C= 101F. His 'symptoms tick all the Swine flu boxes'. After some obfuscation (government has made a mess of it..) he agrees with me for Dominic to take Tamiflu. Will be in bed for a few days, take fluids and anti-vomiting tablets.

Dr Savage after mentioning economics / health tradeoff, agrees that other members of my family should take Tamiflu once a day as paliative (prevention) measure.

Parents and GPs warned not to mistake meningitis for swine flu

2009-09-01T21:02:00.000-07:00

The two illnesses have many symptoms in common – but a wrong diagnosis could be fatal

Staff and agencies
guardian.co.uk, Tuesday 1 September 2009 12.25 BST
Article history

As the school year begins, parents are warned to look out for symptoms of meningitis. Photograph: Peter Dazeley/Getty Images

Parents and GPs were warned today not to mistake meningitis for swine flu as millions of children began the new school year.

The two illnesses have similar symptoms, including aches and pains and cold hands and feet.

Cases of meningitis typically rise in the autumn – the same time experts have predicted a surge in the number of cases of swine flu.

Schools and universities going back means people are in close proximity, making it easy for illness to spread, and the flu virus tends to thrive in the cooler months.

At least two people are already known to have died from meningitis after mistakenly being diagnosed with swine flu.

Today, Steve Dayman, chief executive of the charity Meningitis UK, said parents should "trust their instincts" and watch out for the disease, which can kill in under four hours.

He lost his son Spencer to meningitis in 1982, when the boy was just 14 months old.

Dayman said: "Meningitis occurs throughout the year but very shortly we will see the number of cases going up.

"It's very difficult for GPs to identify meningitis in its early stages because it's very similar to flu – with symptoms such as cold hands and feet and aching limbs."

He said a pin prick rash that can turn into purple bruising is a classic sign of a meningococcal meningitis and requires urgent attention.

But he said parents should be on their guard even before this happens and seek medical attention if their child appears to deteriorate rapidly.

Children under five are most at risk from meningitis, followed by teenagers and students.

"The issue with children is that there is a rapid deterioration in their condition – within a matter of hours," Dayman said.

"I think it's important for parents of children to contact their GP if they feel concerned – meningitis should be a consideration.

"This is about parents and GPs working together – it's better to be safe than sorry. If hospitals are inundated with young children, then that's just the way it's got to be."

Pupils start to return to schools across the UK this week and experts have predicted there will be a rise in swine flu cases over the next few months.

At present, there are about 5,000 people being newly diagnosed with the virus in England every week, down from a peak of around 100,000 some weeks ago.

Research commissioned by Meningitis UK shows that nearly seven out of 10 adults are unaware there is no vaccine to protect against the most common form of the illness, meningitis B.

The strain causes almost 90% of cases and can kill in under four hours.

Dayman said: "We're urging [parents] to know the facts and be extra vigilant as their children return to the crowded environment of a school, where germs spread more easily due to close human contact.

"Meningitis and septicaemia can be hard to recognise in the early stages because the initial symptoms are similar to many mild childhood diseases.

"A child with bacterial meningitis or septicaemia will usually get ill quickly and get worse fast."

Classic symptoms of meningitis include a headache, stiff neck and a dislike of bright light. Other symptoms are difficulty supporting own weight, fever, vomiting and diarrhoea, confusion and drowsiness.

Septicaemia leads to aching limbs, cold hands and feet and a rash.

In 2008, there were around 3,000 cases of meningitis in the UK. Every year, 300 people die and hundreds more are left with permanent disabilities.

Most companies in Britain unprepared for possible second wave of swine flu

2009-08-31T13:10:00.000-07:00

Julia Kollewe
guardian.co.uk, Monday 31 August 2009 18.37 BST
Article history

Most companies in Britain have not been affected by the outbreak of swine flu, research has found, confounding fears that the virus could derail the country's fledgling economic recovery.

But the survey of 450 companies by the British Chambers of Commerce (BCC) found that fewer than half of firms had contingency plans in place to cope if the swine flu outbreak gets worse, despite warnings of a second wave in the autumn.

The report, the first of its kind, said 83.7% of businesses had not been affected by the spread of swine flu and only a third believed the disease could threaten the UK's recovery from recession.

As a result, many have failed to draw up contingency plans for dealing with large numbers of workers taking time off if they contract the H1N1 virus.

There had been fears that businesses, shops and distribution centres could be forced to shut if the virus spread rapidly. Airlines and other transport services could also be disrupted.

The BCC's findings refute claims that workers are using the virus as an excuse to take sick days. Anecdotal evidence shows employers are more likely to tell staff to stay away if they have symptoms.

The TUC general secretary, Brendan Barber, said: "This shows that, contrary to what some have been claiming, workers are not using swine flu as an excuse to take time off work."

He called on employers not to become complacent about the threat to their staff simply because infection levels had declined in recent weeks. The government's chief medical officer, Sir Liam Donaldson, has repeatedly warned of a second wave of swine flu in the autumn.

Barber said: "Employers should be using this time to work with their staff to ensure they have contingency plans in place to deal with any possible resurgence of the virus in the autumn."

A BCC spokesman said: "We haven't seen any evidence of employees skiving en masse because of swine flu." But he said the government needed to exercise caution in its plans to allow employees infected with swine flu to stay off work for 14 days without a doctor's note, rather than seven days.

GPs have been seeing a high number of patients at the start of the week and Donaldson said the National Pandemic Flu Service for England received most calls from patients on Mondays.

But he shrugged off the idea that workers were faking sickness: "I think people traditionally hold on to their illnesses over the weekend, then see their GP on Monday."

As schools reopen, health authorities are bracing themselves for another rise in swine flu. The UK and the US governments say they will not close schools except under exceptional circumstances after experts claimed closures did not reduce the number of cases, but spread them over a longer period.

Obesity linked to swine flu deaths Study of pandemic reveals that weight problems and pregnancy are significant factors in fatal cases

2009-08-29T18:28:00.000-07:00

Jamie Doward, Home Affairs Editor
The Observer, Sunday 30 August 2009
Article history

Obesity has emerged as a possible contributing factor in fatal swine flu cases, according to ground-breaking research looking at deaths caused by the pandemic in countries around the world.

The claim is made by a team from the French Institute for Public Health Surveillance, which has studied the characteristics of 574 deaths associated with the pandemic H1N1 influenza up until the middle of July. According to the team's findings, published in medical journal Eurosurveillance, underlying disease was found in at least half of all fatal cases.

Mortality patterns were in many cases similar to those associated with normal, seasonal flu. But the team observed: "Nevertheless two risk factors are noticeable: pregnancy and obesity."

Pregnancy is already a well-documented risk factor in seasonal influenza and in previous pandemics. The study found that 16 women – representing 10% of all female deaths that were studied – were pregnant or had recently delivered at the time of their death. Half of these also had other health issues.

But the conclusion that obesity may be a factor in some swine flu deaths opens up a new line of investigation for epidemiologists. Where an underlying disease was found to be present after someone had died of swine flu, in more than one in four cases the deceased had a metabolic condition – diabetes and/or obesity.

The team, which concluded further research needed to be done to establish the link between obesity, severe influenza and mortality, also found significant demographic variations among those affected by the pandemic.

"Compared to younger age groups, the elderly seem to be protected from infection to some extent, perhaps due to previous exposure to strains akin to influenza A(H1N1)v virus," the team claim.

There has been a view that fatal cases involving the pandemic have tended to occur among the young, according to the team. And they found the average age of those who have died was 37. More than half of all deaths occurred among the 20- to 49-year-old age group. Overall, 12% of deaths occurred in cases aged 60 years or more.

According to the latest update from the Health Protection Agency (HPA): "In the last seven days, cases reported globally have increased by 8% and the number of deaths by 21%." However, the HPA suggested flu rates in England were now coming down.

Concerns remain, however, that infection rates will start to increase again come the autumn.

The French team warns: "The pandemic… is far from over, and deaths will unfortunately continue to occur. As in previous pandemics, available data show that age groups are not equally affected."

Weekly pandemic flu media update

2009-08-27T22:22:00.000-07:00

27 August 2009

KEY POINTS
More points....
This week there has been a further reduction in the rates of flu-like illness and related activity.
Weekly GP consultation rates continued to decrease over the last week in England.
The majority of cases continue to be mild. There is no sign that the virus is changing. It is not becoming more severe or developing resistance to anti-virals.
Interpretation of data to produce estimates on the number of new cases continues to be subject to a considerable amount of uncertainty. HPA modelling gives an estimate of 5,000 new cases in England last week (range 3,000 to 12,000). There has been a decrease in estimated number of cases in all age groups and in all regions.
This estimate incorporates data from National Pandemic Flu Service and GP consultations.

Following the move from laboratory testing for confirmation of swine flu to clinical diagnosis of cases, the level of flu in the community is being monitored using a range of surveillance mechanisms, including the RCGP consultation rates, QSurveillance®, and the National Pandemic Flu Service.

A more detailed UK weekly epidemiology update can be accessed at:
www.hpa.org.uk/swineflu/surveillance&epidemiology

Figure 1: Current estimated weekly RCGP consultation rates of flu-like illness

Figure 2: QSurveillance® - weekly consultation rate for flu-like illness in England, Wales and Northern Ireland (all ages)

VIRAL CHARACTERISTICS

Viral characteristics (including antiviral susceptibility (as at 26/08/09): Testing for antiviral susceptibility is carried out by the Agency's Respiratory Virus Unit, Centre for Infections, in Colindale. 719 viruses have been analysed for the marker commonly associated with resistance to oseltamivir in seasonal influenza (H274Y); none were found to carry this marker. In addition, 210 specimens have been fully tested for susceptibility; all were found to be sensitive to oseltamivir and zanamivir.

SEVERITY
Disease severity continues to be monitored. The disease is generally mild in most people so far, but is proving severe in a small minority of cases.

Swine flu hospitalisations in England: 218 patients (currently hospitalised as of 8am on 26 August).

Deaths - the number of deaths related to swine flu in England is 57. (This figure represents the number of deaths in individuals with swine flu but does not represent the number of deaths that can be attributed to swine flu).

INTERNATIONAL SUMMARY

Confirmed cases and deaths reported by ECDC (Update 17:00 CEST 25 August 2009)

Grand total of cases confirmed *

254,947

Total deaths reported

2,594

* This figure represents the number of laboratory confirmed cases and is therefore not representative of the actual number of cases worldwide.

In the last 7 days, cases reported globally have increased by 8% and the number of deaths by 21%.

Europe
In the latest Euroflu bulletin, all countries reported low or moderate intensity indicating a normal or slightly increased proportion of their populations were affected by respiratory illness. Widespread activity was reported for Austria, Israel, England and Swedenhttp://www.euroflu.org/index.php. The majority of new confirmed cases are being reported from Germany (ECDC).

General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including swine flu. This includes:

Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of virus from your hands to face or to other people.
Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product.
Covering your nose and mouth when coughing or sneezing, using a tissue when possible.
Disposing of dirty tissues promptly and carefully.
Making sure your children follow this advice.

Further information on swine flu is available on the Health Protection Agency's website at www.hpa.org.uk/swineflu.

Swine flu vaccine arrives in UK but roll-out will have to wait

2009-08-27T22:13:00.000-07:00

Swine flu vaccine must sit in storage for over a month while manufacturers wait to see whether it will be given a licence

Sarah Boseley, health editor
guardian.co.uk, Thursday 27 August 2009 19.04 BST
Article history

The first batch of swine flu vaccine has arrived in the UK, but it must sit in storage for more than a month while the manufacturers wait to see whether it will be given a licence, the chief medical officer said today.

The news of the delivery of around 200,000 packs of the vaccine came as it was announced that the UK death toll from swine flu has risen to 66 after 11 fatalities in the past week.

The vaccine packs made by Baxter Healthcare – one of two drug companies with whom the government has signed contracts – have been delivered ahead of the drugs being approved, in contrast to the normal process for new drugs and treatments.

The European Medicines Agency will now decide whether to licence this vaccine and one made by GlaxoSmithKline. Both manufacturers hope to have their licence by early October, which will mean the roll-out can begin later that month. ..

When the vaccine is available, many people may be reluctant to be immunised because of fears it has not been tested properly, recent surveys of health care workers and the public suggest.

A Canadian study published on Monday indicated that a successful vaccination campaign would need to win over people who believe that alternative therapies and a good diet are a better option than vaccines.

Today the chief medical officer, Sir Liam Donaldson, said the health professionals he had spoken to seemed to want the vaccine as soon as it became available. "It still remains the case that this disease is not a killer but it can kill," he said.

While the vaccine sits in storage, the epidemic in the UK continues to abate.

Donaldson, who repeated warnings of a second wave of swine flu in the autumn, said the number of cases was currently down to what would be normal levels of flu if this was winter – although clearly this was abnormal for summer.

In the last week, the Health Protection Agency said there were an estimated 5,000 cases of swine flu - although the true figure could be anywhere between 3,000 and 12,000. There have been three swine flu deaths in England, seven in Scotland and one each in Wales and Northern Ireland over the last week. There were 218 people hospitalised with swine flu in the last week, which is a fall, but is high for the summer.

In contrast to most countries, only 22% of deaths in the UK have been among healthy people, said Donaldson. Figures from the World Health Organisation suggested 40% of those who had died were previously healthy. The proportion ending up in intensive care in the UK also appeared to be lower, he said.

More than 460,000 packets of the antiviral Tamiflu have been given out via the government's National Pandemic Flu Service for England since it launched in July.

Swine flu: Doctors who refuse vaccine 'putting patients at risk'

2009-08-26T15:29:00.000-07:00

Doctors and nurses are potentially putting patients at risk if they refuse the swine flu vaccine, experts have warned.

By Kate Devlin, Medical Correspondent
Published: 7:30AM BST 26 Aug 2009

Officials said that NHS staff had a duty to take the jab, to ensure they did not pass on the virus to those who were already sick.

The warning follows a spate of surveys which suggest that many healthcare workers will refuse the vaccine, despite being on the Government's “priority list”.

Up to half of GPs and one in three nurses say that they do not plan to take the vaccine, some because of concerns over safety.

Vivienne Parry, a member of the Joint Committee on Vaccination and Immunisation, (JCVI) who advise ministers on vaccines, said that health professionals should protect “vulnerable patients” from the virus.

She said: “This (protection) aspect does not seem to feature at all in medical staff responses about flu vaccination, which is extremely concerning.

“Indeed the word ‘patient’ hardly seems to figure at all in responses in this and other surveys of healthcare workers, even though 75 per cent of deaths fromswine flu are in those with serious underlying medical conditions who are in regular contact with healthcare workers.”

Prof David Salisbury, the Department of Health's director of immunisation, toldGP magazine, which carried out the poll, that frontline health workers had a “duty” to have the vaccine.

“They have a duty to their patients not to infect their patients and they have a duty to their families,” he said.

More than two thirds of GPs who told Pulse magazine that they would turn down the jab believe that it has not undergone enough tests.

Doctors have been warned to look out for possible signs of Guillain Barre Syndrome, a rare neurological condition, which can cause paralysis and even death.

A vaccine used against flu in America in 1976 caused a number of cases of the condition.

However, the World Health Organisation (WHO) insists that the production of vaccines has become much safer since then.

Human trials are currently underway and will be scrutinised by the regulatory authorities before the vaccines will be licensed for use, probably in October.

Earlier this month a poll of almost 1,500 Nursing Times readers revealed that one in three said that they would not have the swine flu vaccine.

Uptake of the seasonal flu vaccine among NHS staff has been traditionally low, and just 16 per cent of all those employed by the health service took the vaccine last year.

Another study published online by the British Medical Journal shows that half of 8,500 healthcare workers in Hong Kong say that they would refuse a swine flu vaccine, because of safety concerns and worries that it would not work very well.

Researchers said that the figures were surprisingly low given the impact the SARS (Severe Acute Respiratory Syndrome) virus had on the area.

However, some experts insisted that the polls did not prove that NHS staff were “irresponsible” or had serious concerns about the safety of the vaccine.

Prof Robert Dingwall, Director of the Institute for Science and Society at the University of Nottingham, said that it was important not to blow the apparent reluctance of healthcare workers to have the vaccine “out of proportion”.

He said: “(These polls) identify a communication challenge for those managing the pandemic but they are not evidence of a crisis of confidence in the vaccine or of professional irresponsibility by health workers."

Doctors may refuse swine flu vaccine

2009-08-24T13:49:00.000-07:00

Several studies suggest up to 60% of GPs would oppose being immunised because they are concerned the safety trials will be rushed

Sarah Boseley
Health editor
guardian.co.uk, Monday 24 August 2009 16.01 BST
Article history

Half of GPs said they believe swine flu is too mild to justify taking a vaccine … a nurse prepares a syringe during a mass immunisation exercise at Bolton arena in 2006 to test procedures in case of a flu pandemic. Photograph: Martin Rickett/PA

Many GPs, as well as their patients, may be reluctant to be immunised against swine flu once a vaccine is developed, surveys suggest today.

A survey of GPs published on Healthcare Republic, the website of GP magazine, found that up to 60% of GPs may decline vaccination. Although the numbers who responded were small – 216 GPs – they are in line with a much bigger survey of nurses published a week ago by Nursing Times, which found that a third of 1,500 nurses would refuse vaccination.

A Canadian study published today in the journal Emerging Health Threats suggests the public, too, will have reservations that must be overcome if a vaccination campaign is to be successful in the autumn or winter. The study, which used focus groups to establish the likely response of different people to a vaccine, pointed to the need to win over people who believe that alternative therapies and a good diet are a better option than vaccines.

But the biggest problem in persuading people and healthcare professionals to have the jab may be the relative shortage of evidence from trials about its safety and efficacy. Because of the urgent need for a vaccine, testing will be limited.

Among the GPs who responded to the survey published by Healthcare Republic, 29% said they would not choose to have the vaccine and 29% said they were unsure whether or not they would.

The biggest reason given by those who said they would not have it was concern that the safety trials would not be adequate: 71.3% said they were "concerned that the vaccine has not yet been through sufficient trials to guarantee safety". Half – 50.4% – said they "believe that swine flu is too mild to justify taking the vaccine". Only 8.7% said they did not believe they were at risk.

Professor David Salisbury, director of immunisation for the Department of Health, commented on the website that frontline health workers have responsibilities to other people. "They have a duty to their patients not to infect their patients and they have a duty to their families," he said. "I think you solve those responsibilities by being vaccinated."

The Department of Health played down the results, saying that the small number of responders could not accurately be said to reflect the opinions of all GPs. But a spokesman added: "GPs will have an important role in the height of a pandemic. Getting the swine flu vaccine will protect them and their patients. That's why we're offering GPs the vaccine as a priority. Of course, vaccination will be optional, but the vaccine is being carefully assessed for safety and will be licensed before it is used."

Many of those questioned in focus groups for the study in Emerging Health Threats felt uneasy about vaccination for an illness perceived as mild. Others felt they could protect themselves through handwashing, keeping their distance from other people and even a good diet.

The survey results appeared as the department of health announced 14 new fast-tracked research projects into various aspects of swine flu, costing £2.25m. These include work to establish how long somebody with the virus is contagious and to establish the "safe distance" from a patient. Other projects will look at whether closing schools – which was the early response to the epidemic – stops spread and whether facemasks for healthcare workers are worthwhile.

Pandemic (H1N1) 2009 - update 62 (revised 21 August 2009) - WHO

2009-08-21T12:11:00.000-07:00

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 13 August 2009

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 61) as of 13 August 2009 are:

Ghana, Zambia, and Tuvalu

Map of affected countries and deaths as of 13 August 2009 [png 313kb]

Region	Cumulative total
Region	as of 13 Aug 2009
	Cases*	Deaths
WHO Regional Office for Africa (AFRO)	1469	3
WHO Regional Office for the Americas (AMRO)	105882	1579
WHO Regional Office for the Eastern Mediterranean(EMRO)	2532	8
WHO Regional Office for Europe (EURO)	Over 32000	53
WHO Regional Office for South-East Asia (SEARO)	13172	106
WHO Regional Office for the Western Pacific (WPRO)	27111	50

Total	Over 182166	1799

*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.

Qualitative indicators (Week 31: 27 July - 2 August 2009 and Week 32: 3 August - 9 August 2009)

The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

Interim WHO guidance for the surveillance of human infection with A(H1N1) virus
A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

The attached maps display information on the qualitative indicators reported for weeks 31 and 32. Information is available for approximately 50 to 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

List of definitions of qualitative indicators

Geographic spread of influenza activity during week 31 and 32

Geographic spread of influenza activity during week 31 [png 157kb]

Geographic spread of influenza activity during week 32 [png 269kb]

Trend of respiratory diseases activity compared to the previous week during week 31 and week 32

Trend of respiratory diseases activity compared to the previous week during week 31 [png 155kb]

Trend of respiratory diseases activity compared to the previous week during week 32 [png 266kb]

Intensity of acute respiratory diseases in the population during week 31 and week 32

Intensity of acute respiratory diseases in the population during week 31 [png 153kb]

Intensity of acute respiratory diseases in the population during week 32 [png 262kb]

Impact on health care services during week 31 and week 32

Impact on health care services during week 31 [png 151kb]

Impact on health care services during week 32 [png 259kb]

Weekly update

As of this week, there have been more than 182,000 laboratory confirmed cases of pandemic influenza H1N1, 1799 deaths, in 177 countries and territories have been reported to WHO. As more and more countries have stopped counting individual cases, particularly of milder illness, the case number is significantly lower than the actually number of cases that have occurred. However, through the WHO monitoring network, it is apparent that rates of influenza illness continue to decline in the temperate regions of the southern hemisphere, except in South Africa where pandemic influenza H1N1 appeared slightly later than the other countries of the region. Active transmission is still seen in some later affected areas of Australia, Chile and Argentina even as national rates decrease.

Areas of tropical Asia are reporting increasing rates of illness as they enter their monsoon season, as represented by India, Thailand, Malaysia, and Hong Kong, four places in the region which have active surveillance programs. Tropical regions of Central America, represented by Costa Rica and El Salvador, are also seeing very active transmission.

In the northern temperate zones, overall rates are declining in both North America and Europe though the virus is still found across a wide area throughout both regions and pockets of high activity are being reported in 3 U.S. states and a few countries of Western Europe.

It has been noted throughout the temperate zones of the southern hemisphere, which are now passing out of their winter season, that when pandemic H1N1 began to circulate, the relative importance of seasonal strains, represented by H3N2 in nearly all countries, rapidly diminished and pandemic H1N1 became the dominant strain. Some seasonal H1N1 strains were reported but were even less common than seasonal H3N2. It is too early to tell if this co-circulation of multiple strains will continue into the coming season of the Northern Hemisphere but it appears very likely that pandemic H1N1 will be the dominant influenza virus in the early part of the winter months.

Many countries including Australia, Canada, New Zealand, and the U.S. have noted that their indigenous peoples appear to be at increased risk of severe disease related to pandemic influenza. While it still has not been clearly determined how much of the increased risk observed in these groups is due to issues related to access to care, high rates of chronic medical conditions that are known to increase risk, or other factors, countries with indigenous and other vulnerable populations should carefully evaluate the situation and consider ways to mitigate the impact of the pandemic in the coming season in these populations.

WHO has also been notified of 12 cases of oseltamivir resistant virus. These isolates have a mutation in the neuraminidase (referred to as H275Y) that confers resistance to oseltamivir, though the viruses remain sensitive to zanamivir. Of these 8 have been associated with oseltamivir post exposure prophylaxis, one with treatment of uncomplicated illness, and two have been from immunocompromised patients receiving oseltamivir treatment. These isolated cases have arisen in different parts of the world (Japan 4, USA 2, China, Hong Kong SAR China 2, and 1 in Denmark, Canada, Singapore and China), and there are no epidemiological links between them. There is also no evidence of onward transmission from these cases.

Virology data update as of 8 August 2009

Download update (.pdf)

Recommended use of antivirals - WHO

2009-08-21T11:59:00.000-07:00

"Healthy patients with uncomplicated illness need not be treated with antivirals" WHO

Recommended use of antivirals

Pandemic (H1N1) 2009 briefing note 8

Treat serious cases immediately

Evidence reviewed by the panel indicates that oseltamivir, when properly prescribed, can significantly reduce the risk of pneumonia (a leading cause of death for both pandemic and seasonal influenza) and the need for hospitalization.

For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends treatment with oseltamivir as soon as possible. Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome. For patients with severe or deteriorating illness, treatment should be provided even if started later. Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.

This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.

For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests.

As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset.

At the same time, the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness. Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years.

Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day 5 or 6 following the onset of symptoms.

Clinical deterioration is characterized by primary viral pneumonia, which destroys the lung tissue and does not respond to antibiotics, and the failure of multiple organs, including the heart, kidneys, and liver. These patients require management in intensive care units using therapies in addition to antivirals.

Clinicians, patients, and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir.

In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.

Antiviral use in children

Following the recent publication of two clinical reviews, [1,2] some questions have been raised about the advisability of administering antivirals to children.

The two clinical reviews used data that were considered by WHO and its expert panel when developing the current guidelines and are fully reflected in the recommendations.

WHO recommends prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness. This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness.

Otherwise healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens.

Danger signs in all patients
Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:
shortness of breath, either during physical activity or while resting
difficulty in breathing
turning blue
bloody or coloured sputum
chest pain
altered mental status
high fever that persists beyond 3 days
low blood pressure.

In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.

________________________________

[1] Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. Shun-Shin M, Thompson M, Heneghan C et al. BMJ 2009;339:b3172; doi:10.1136/bmj.b3172
[2] Prescription of anti-influenza drugs for healthy adults: a systemic review and meta-analysis. Burch J, Stock C et al. Lancet Infect Dis 2009; doi:10.1016/S1473-3099(09)70199-9

Flu drugs 'not needed' in healthy

2009-08-21T11:51:00.000-07:00

Tamiflu is the main antiviral being used in the UK. The World Health Organization has said healthy patients who catch swine flu do not need to be treated with Tamiflu.

Antiviral drugs should be used in patients who are severely ill or those in high-risk groups including the under fives and pregnant women, it said.

The cost of the drug and the potential for resistance were taken into account by the expert panel.

But the UK government said it was taking a "safety first" approach by offering antivirals to everyone.
A spokesman for the Department of Health said they would keep the policy under review.
The UK has stockpiled enough antivirals - the mainstay of treatment until a vaccine becomes available - to cover half the population.
They are being offered in England to anyone who has the symptoms of swine flu - in many cases through the national pandemic flu helpline.

Minimising the number who take the drug is a good idea
Dr Chris Smith, Cambridge University
Wales and NI flu deaths

In the last week almost 46,000 courses of antivirals were handed out in England.
It is not the first time prescribing of antiviral drugs has come under scrutiny.
Earlier this month research suggested that the drugs should not be used in children because they rarely prevent complications but yet carry side effects.
Infections in England are continuing to fall with an estimated 11,000 cases last week compared with 100,000 a month ago.
There have now been 61 deaths across the UK - 56 of those in England.
Experts expect to see a big surge in infections in autumn when flu viruses traditionally start to circulate more widely.
Mild illness
In updated guidance, the WHO said most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any medical treatment.
So it said healthy patients with uncomplicated illness need not be treated with antivirals, which include Tamiflu and Relenza.
High-risk groups, who should receive treatment include infants and children under five, the over 65s, nursing home residents, pregnant women, and patients with chronic conditions such as asthma or diabetes and those with reduced immunity such as people with HIV.
And patients who initially present with severe flu or whose condition begins to deteriorate should also get the drugs as quickly as possible.
The report also called for more research into the safety of Tamiflu given its widespread use in the UK, Australia and the USA.
Dr Christ Smith a virologist at Cambridge University said when the virus first emerged little was known about how dangerous it would be and how best to treat it.
"We now know it's no more severe than seasonal flu for which we don't make Tamiflu available for healthy members of the general population.
"No drug is without side-effects, and it is expensive.
"Minimising the number who take the drug is a good idea."
But a Department of Health spokesman 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.
"WHO state that 40% of severe cases worldwide have been in previously healthy children and adults and that serious cases should be treated immediately.
"This emphasises the need not to become complacent about the mildness of the illness and the reasoning behind a precautionary policy."

Vaccination, antivirals and some respite

2009-08-21T00:36:00.000-07:00

Fergus Walsh | 12:04 UK time, Thursday, 20 August 2009

After several weeks' absence, I was delighted to see that the discussion has continued at Fergus On Flu. I haven't read all your comments yet, but I am really pleased that the blog has become established as a forum for discussion on an issue that now appears only sporadically in the media.

I had a very good break - and encountered no H1N1 swine flu - and then filmed some news stories, so I have not been on holiday all this time! Many thanks for your kind wishes and for continuing the conversation.

A few issues which emerged while I've been away:

• First, vaccination policy on H1N1 swine flu. The decision to immunise those with existing medical problems, pregnant women and healthcare workersthis autumn was no surprise and had been widely predicted. Holding back from a wider immunisation campaign at this stage is interesting. Limiting the vaccine to at-risk groups will still create a huge logistical problem for the health service which will also be immunising the elderly and the vulnerable this autumn. I anticipate some public confusion about who is eligible for what.

• Another interesting development concerned the study about antivirals and children. This questioned the policy of giving Tamiflu or Relenza to otherwise healthy children who catch the H1N1 virus. The research suggested that the side-effects outweighed the benefits, but was based on seasonal flu, not on H1N1 swine flu. It seems to me that the research raises important issues, but is not a definitive study or the final word on whether antivirals should be available to all.

• Finally, as many had hoped, the incidence of flu has dropped sharply in August. This gives the NHS - and us all - some respite. The question now is: when will cases start to rise? I suggest looking to Scotland, where children are heading back to school well before those in England and Wales (see also BBC Northern Ireland's Flu meeting ahead of school start). If Scotland experiences a sudden increase in cases in the coming few weeks, then a similar surge can be expected elsewhere in the UK.

H1N1 Flu by crabsallover

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