Swine Flu Pandemic Weekly Report Thursday 22 October 2009

Transcription

1 Key points Swine Flu Pandemic Weekly Report Thursday 22 October 2009 Levels of flu like illness continue to increase in Wales. Levels are higher than usual for the time of year. Swine flu usually leads to a mild illness although in a minority of cases it can be severe. The vaccination programme has started with the vaccine being offered to people at most risk of complications of the virus and frontline health and social care workers. Two further swine flu-related deaths in Wales confirmed. New guidance for planners for the UK published. Summary The clinical consultation rate for influenza in Wales during the week ending 18 October was cases of flu like illness diagnosed by GPs out of every 100,000 people in Wales. It was per 100,000 in the previous week. Current levels of flu in Wales remain higher than usual for this time of year. 255 laboratory confirmed cases of swine flu have been reported by NPHS Health Protection Teams in Wales (as at midday on 21 October). Of the laboratory confirmed cases, a total of 126 people confirmed with swine flu in Wales have been admitted to hospital since the start of the outbreak. Fifteen of these cases were still hospitalised (as at midday on 21 October). The Welsh Assembly Government has been notified formally of two further swine flu-related deaths in Wales since the last report. This brings the total of swine flu-related deaths in Wales to six. We are also aware of a swine flu-related death of a person from Wales abroad. No further details will be released. According to the NPHS daily GP surveillance scheme, as at 20 October, the influenza consultation rate in Wales as a whole was cases of flu like illness diagnosed by GPs in the previous seven days out of every 100,000 people in Wales. This is the equivalent of 2,013 1

2 people contacting their GPs in the last seven days with flu like symptoms. Consultation rates are between 26.6 and 97.3 per 100,000 in all 22 LHB areas in Wales. Consultation rates are highest in young people. Latest figures show that the percentage of total calls to NHS Direct Wales which were influenza related increased to 32.3 per cent. 2

3 1. GP Surveillance of Infections Scheme During the flu season (October to March), the NPHS releases weekly influenza data which is available for both health professionals and the public and is posted on the NPHS Health Protection website. The data detail rates of influenza circulating in Wales including geographical and age range distributions and results of virological testing of submitted swab samples. Figure 1. Clinical consultation rate per 100,000 practice population in Welsh sentinel practices (as of 20/10/09) Consultation rate per 100, Higher than average seasonal activity Normal seasonal activity Baseline activity Note consultation rate starting from week (red line) consultation rate starting from week and running to week (green line)/ Week Table 1. Age specific consultations (per 100,000) for influenza in Welsh sentinel practices, week week (as of 21/10/09). Age Week group Total

4 Figure 2. Historical clinical consultation rate per 100,000 practice population in Welsh sentinel practices (week week ). Consultation rate per 100, Epidemic activity Higher than average seasonal (winter) activity Normal seasonal activity (winter) 0 October 1996 April 1997 October 1997 April 1998 October 1998 April 1999 October 1999 April 2000 October 2000 April 2001 October 2001 April 2002 October 2002 April 2003 October 2003 April 2004 October 2004 April 2005 October 2005 April 2006 October 2006 April 2007 October 2007 April 2008 October 2008 April 2009 October Enhanced virological surveillance for influenza and respiratory viruses During the week ending 18 October (week 42) 16 samples were submitted for testing by sentinel GPs, seven of which tested positive for swine flu. Since week 25 (week ending 21 June), 117 samples have been received and tested from sentinel GPs (including 10 Out of Hours GP Service samples). Twenty-two samples have tested positive for influenza A and were further identified as swine influenza A(H1N1)v and ten samples have tested positive for rhinovirus. 4

5 Table 2. Specimens submitted for virological surveillance as at 21/10/09, by week of sample collection, combined results from GP sentinel surveillance and Out of Hours GP sentinel surveillance. Week Specimens Specimens Positive identifications submitted tested influenza A influenza Total A A(H1N1)v* B RSV parainfluenza rhinovirus Total * swine influenza A(H1N1)v Figure 3. Specimens submitted for virological surveillance as at 07/10/09, by week of sample collection, week week Samples tested Total influenza A positive Swine influenza A(H1N1)v positive Influenza B positive Rhinovirus positive Consultation rate per 100, Rate per 100, Week (2009) Samples tested (n) 5

6 3. Laboratory confirmed swine flu cases As at 21 October, there have been 255 laboratory confirmed cases in Wales since the start of the outbreak. Of the 255 laboratory confirmed cases, 126 have been admitted to hospital since the start of the outbreak. Fifteen of these cases are still in hospital. Latest data from the Welsh Assembly Government indicate that, as at 20 October, there were 27 clinically diagnosed patients in hospital in connection with swine flu, with seven in critical care and thirteen with underlying health conditions. 4. Rapid Surveillance of Influenza The NPHS influenza rapid surveillance scheme, which records reports of diagnoses of flu from more than 300 GP practices across Wales, shows increasing levels of influenza activity across Wales. Further detail can be found on the NPHS website: As at 20 October the consultation rate for Wales as a whole was per 100,000. Consultation rates in all 22 Local Authority areas are above 25 per 100,000 (see figure 5). Consultation rates are highest in those aged 5 to 14 years (figure 6). Figure 4. Rapid surveillance of influenza in Wales using Audit+, clinical consultation rate, rolling 7 day rate as at 20/10/09. 6

7 Figure 5. Rapid surveillance of influenza in Wales LHB influenza consultation rates (per 100,000 practice population), rolling 7 day rate as at 20/10/09. 7

8 Figure 6. Rapid surveillance of influenza in Wales (using Audit+) influenza age group specific 7 day consultation rates (per 100,000 practice population) as at 20/10/ Consultation rate per 100, < Age group Table 3. Rapid surveillance of influenza in Wales local authority areas influenza consultation rates (per 100,000 practice population), rolling 7 day rate and estimated numbers as at 20/10/09. County Influenza consultation rate (per 100,000 population) at 20 October Estimated number of GP consultations within LA for previous seven days as at 20 October Carmarthenshire Ceredigion Pembrokeshire Powys Dyfed Powys Blaenau Gwent Caerphilly Monmouthshire Newport Torfaen Gwent Anglesey Conwy Denbighshire Flintshire Gwynedd Wrexham North Wales Bridgend Cardiff Merthyr Tydfil Neath Port Talbot Rhondda Cynon Taf Swansea Vale of Glamorgan South Wales WALES

9 5. NHS Direct Wales calls During week 42, the percentage of total calls to NHS Direct Wales which were influenza related increased to 32.3 per cent (figure 6). Figure 7. Influenza related calls to NHS direct Wales 1 (as a percentage of total calls) to week (as of 20/10/09) Percentage Dec Jan Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct-09 Week commencing Data supplied by Health Statistics and Analysis Unit, Welsh Assembly Government. Flu related calls are the sum of calls recorded as 'cold/flu', 'cough', 'headache', 'fever' and 'sore throat'. 6. New guidance for planners on swine. New guidance for planners for swine flu for the UK have been published by the Department of Health and Cabinet Office. Swine flu guidance for planner Comment from the Chief Medical Officer and National Public Health Service for Wales The Chief Medical Officer for Wales, Dr Tony Jewell, said: We are continuing to see a gradual increase in the number of swine flu cases in Wales, but the increase appears to be at a slower rate than during the first wave. This week, the first people in the priority groups and NHS and social care workers began receiving their swine flu vaccination. Those people in the priority groups will be invited by their GP in the coming weeks to have their vaccination. These people those with chronic 9

10 conditions, pregnant women, people with compromised immune systems and people who live with others whose immune system in compromised are most at risk of complications of swine flu and I would urge them to have their vaccine as soon as they are invited as this is the simplest way of protecting their health. We hope to have completed this vaccination programme for the priority groups by the end of the year. The swine flu vaccine is the simplest and most effective way of protecting people s health and will help in our efforts to minimise its impact on individuals and communities. Sadly, as the number of swine flu cases rise, the number of people experiencing severe symptoms or complications or even death will inevitably increase. This is the same for seasonal flu in the winter. The latest planning assumptions are released today (see above). It is important to stress that the planning assumptions are a reasonable worst case scenario on which to plan for the period up to mid May They are not a prediction of what we expect to see. This new information will be used to help the NHS, local planners and businesses to prepare. These new planning assumptions also do not take account of the vaccination programme which will begin in the autumn. Clearly the vaccine will help to reduce the number of people needing hospitalisation. The Health Minister has also announced the purchase of more ventilations for hospitals across Wales. We are well prepared to deal with this virus. This latest investment will provide another tool for the NHS in caring for the small, but vulnerable, group of patients who experience severe swine flu symptoms or complications. I want to praise NHS staff for their efforts so far in managing the pandemic. I know they have worked extremely hard and will continue to do so as the number of cases increases. Dr Roland Salmon, Director of the Communicable Disease Surveillance Centre, National Public Health Service for Wales, said: The number of people contacting their GP with flu like symptoms is increasing. It seems that the winter wave is getting underway. 10

11 Not everyone who has contacted their GP with flu like symptoms will have swine flu. It s also true that not everyone with flu like symptoms will contact their GP. The vaccine against swine flu has been tested and approved. It is now being offered to people at most risk of complications from the virus as well as front line health and social care workers. Vaccination is the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery. People with flu like symptoms should check their symptoms on or by calling the Swine Flu Information Line on Most people will get better at home with rest, plenty of fluids, and medication such as paracetamol. If symptoms worsen or people have underlying health problems they should call their GP. People should not go to Accident and Emergency Departments, a pharmacy or to their GP surgery unless advised to do so as this may risk spreading the infection. It also places undue pressure on the emergency services. This week saw the closure of two schools in communities where swine flu is circulating. Our advice remains that schools do not usually need to close on public health grounds. In some instances however, head teachers may have to close a school if there are not enough staff to supervise the children adequately. Over the last five months, the symptoms of swine flu have generally been like those of seasonal flu. Most people recover from the infection without needing to be admitted to hospital or to call a doctor. However, a few people go on to develop complications and as the pandemic continues we are seeing deaths from swine flu in Wales, just as we do most years from seasonal flu. Sadly, the number of deaths in Wales has increased. However, the great majority of people make a full recovery. By following public health advice if they become ill, and taking up the swine flu vaccine now it is available to those in at-risk groups, people can help prevent the spread of the virus and by the same token help prevent death and serious disease. It is still important that people practice good respiratory and hand hygiene to reduce the chance of catching or spreading viruses. 11

12 Public health advice and messages If you have flu-like symptoms stay at home. You can check your symptoms by visiting the NHS Direct Wales website on or by calling the Swine Flu Information Line on If you are still please phone your GP. Do not go into your GP surgery, pharmacy or Accident and Emergency department unless you are advised to do so or are seriously ill. If you do so you may spread the illness to others. Further information including health advice can be found at and You can also call the Swine Flu Information line on for recorded information, or NHS Direct Wales on for health advice. It is always good practice to follow respiratory and hand hygiene such as: o Always carrying tissues o Covering your nose and mouth when coughing or sneezing, using a tissue when possible. o Disposing of dirty tissues promptly and carefully. o Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people. o Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product. o Helping your children follow this advice. Control measures The European Medicines Agency has granted marketing authorisation to Celvapan (Baxter), Focetria (Novartis) and Pandemrix (GlaxoSmithKline) H1N1 swine flu vaccines. The European Medicines Agency has strict processes in place for licensing pandemic vaccines. In preparing for a pandemic, appropriate trials to assess the safety and the immune responses have been carried out on vaccines very similar to the swine flu vaccine. Supplies of the vaccine have arrived in Wales and the vaccination programme has started to protect those at most risk of complications of the virus and front line health and social care workers. The four UK nations have accepted the advice of the Joint Committee on Vaccination and Immunisation on priority groups for swine flu vaccination: o People aged over six months and under 65 years in current seasonal flu vaccine clinical at-risk groups o All pregnant women, subject to licensing conditions on trimesters 12

13 o Household contacts of people with compromised immune systems e.g. people in regular close contact with patients on treatment for cancer o People aged 65 and over in the current seasonal flu vaccine clinical at-risk groups. This does not include otherwise healthy over 65s, since they appear to have some natural immunity to the virus. Vaccination of frontline health and social care workers will begin at the same time as the first at-risk group, and will continue for as long as necessary. This group is at increased risk of infection and of transmitting that infection to susceptible patients. Protecting these people will help the NHS workforce to remain resilient and able to treat sick patients. GPs will administer the vaccination programme following agreement between the Department of Health, the Devolved Administrations, the General practitioners Committee and NHS employers. Around 60 million doses of vaccine are expected by the end of the year enough for 30 million people to be vaccinated with more following after that. The Foreign and Commonwealth Office has produced a webpage providing information for British citizens planning to attend the Hajj. The page is available at A leaflet providing advice for British Hajjis is available at: Key advice included in the leaflet is that the elderly, pregnant women, people with chronic diseases and children should postpone the Hajj and Umrah pilgrimages this year due to the high likelihood of transmission of flu in the course of the pilgrimage. Although health care facilities for the Hajj are generally of a high standard, due to the large number of pilgrims, it might be less than would normally be expected in the UK for people who are vulnerable to complications. Features of the outbreak Based on assessment of all available information and following several expert consultations, the World Health Organization (WHO) declared the level of influenza pandemic alert at phase six on 11 June Phase six indicates there is human-to-human spread of the virus in at least two countries in one World Health Organization region, with community level outbreaks in at least one other country in a different WHO region. 13

14 On 2 July the four UK nations agreed to move to the treatment phase in their response to the pandemic treating people most at risk. Contact tracing and the use of antivirals preventively have been ended. GPs will now provide clinical diagnosis of swine flu cases rather than awaiting laboratory test results. Further information Further information for the public is available on the Swine Flu Information Line on Further health information for the public on swine flu is available bilingually from Further public health information on swine flu and Pandemic Flu is available bilingually from Further information from the Welsh Assembly Government response is available bilingually at Contacts for the Media Welsh Assembly Government press office on (24 hours) NPHS Communications Team on (24 hours) 14