Key points Swine Flu Pandemic Weekly Report Thursday 20 August 2009 Levels of flu in Wales have decreased in the week ending 16 August. Current levels of flu in Wales are still higher than usual for this time of year. However, in the last week, levels have fallen below the range normally seen in winter. Swine flu usually leads to a mild illness although in a minority of cases it can be severe. Summary The clinical consultation rate for influenza in Wales decreased during week ending 16 August to 21.8 cases of flu like illness diagnosed by GPs out of every 100,000 people in Wales. It was 49.4 per 100,000 in the previous week. Current levels of flu in Wales are still higher than usual for this time of year. However, in the last week, levels have fallen below the range normally seen in winter. 108 laboratory confirmed cases of swine flu have been reported by NPHS Health Protection Teams in 20 LHB areas (as at 10am on 19 August). Of the laboratory confirmed cases, 38 people confirmed with swine flu in Wales have been admitted to hospital. 36 of these have now been discharged (as at 10am on 19 August). According to the NPHS daily GP surveillance scheme, as at 19 August, the influenza consultation rate in Wales as a whole was 29.1 cases of flu like illness diagnosed by GPs in the previous seven days out of every 100,000 people in Wales. Consultation rates are between 14 and 56 per 100,000 in all 22 LHB areas in Wales. Consultation rates appear highest in Gwent. During the week ending 16 August, the percentage of total calls to NHS Direct Wales which were influenza related decreased to 23 per cent.
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. Due to the ongoing swine flu pandemic this weekly reporting has been extended until further notice. 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 19/08/09). 200 1999-2000 2007-2008 2008-2009 180 160 140 120 100 80 60 40 20 0 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 Consultation rate per 100,000 Higher than average seasonal activity Normal seasonal activity Baseline activity Week Table 1. Age specific consultations (per 100,000) for influenza in Welsh sentinel practices, week 28 2009 week 33 2009 (as of 19/08/09). Age group 28 29 30 31 32 33 0-4 34.8 58.0 189.0 92.1 86.6 71.5 5-14 18.4 9.4 104.9 56.4 43.4 6.2 15-24 27.0 66.7 109.6 110.2 61.9 40.6 25-34 16.7 57.9 129.2 106.9 97.2 30.1 35-44 12.0 40.5 91.2 58.4 48.1 27.5 45-64 17.2 34.6 75.0 74.2 37.9 16.1 65 + 1.9 9.9 45.6 24.7 19.3 3.8 Total 15.8 36.0 92.8 69.9 49.4 21.8 Age specific consultation rate during week 33 were highest among patients aged 0-4 yrs
Figure 2. Historical clinical consultation rate per 100,000 practice population in Welsh sentinel practices (week 41 1996 week 33 2009). Consultation rate per 100,000 450 400 350 300 250 200 150 100 50 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 March 2009 2. Enhanced virological surveillance for influenza and respiratory viruses During the week ending 16 August (week 33) five samples were submitted for testing by sentinel GPs, all of which tested negative for swine influenza A(H1N1)v and one of which tested positive for rhinovirus. Since week 26 (22 June), 60 samples have been received and tested from sentinel GPs (including nine Out of Hours GP Service samples). Four samples have tested positive for influenza A and were further identified as swine influenza A(H1N1)v and four samples have tested positive for rhinovirus. Table 2. Specimens submitted for virological surveillance (as at 19/08/09, 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 26 3 3 0 0 0 0 0 0 27 4 4 1 1 0 0 0 0 28 10 10 0 0 0 0 0 0 29 13 13 1 1 0 0 0 1 30 4 4 0 0 0 0 0 0 31 11 11 1 1 0 0 0 2 32 10 10 1 1 0 0 0 1 33 5 5 0 0 0 0 0 0 Total 60 60 4 4 0 0 0 4 * swine influenza A(H1N1)v
3. Laboratory confirmed swine flu cases As at 18 August, there have been 108 laboratory confirmed cases in Wales. The age group currently with the highest numbers of cases are 15 to 24 year olds (Table 5). Confirmed cases have been reported in 20 out of 22 LHB areas in Wales (Table 3). Of the 108 laboratory confirmed cases, 38 have been admitted to hospital, 36 of whom have been subsequently discharged. Table 3. Confirmed Swine influenza A(H1N1)v cases reported to NPHS Wales, as at 19/08/09, by LHB area of residence. LHB Laboratory confirmed cases Anglesey 2 Blaenau Gwent 2 Bridgend 1 Caerphilly 7 Cardiff 31 Carmarthenshire 4 Ceredigion 3 Conwy 2 Denbighshire 5 Merthyr Tydfil 5 Monmouthshire 5 Neath Port Talbot 2 Newport 17 Pembrokeshire 2 Powys 4 Rhondda Cynon Taf 3 Swansea 8 Torfaen 2 Vale of Glamorgan 2 Wrexham 1 Total 108
Tables 4 and 5. Confirmed Swine influenza A(H1N1)v cases reported to NPHS Wales, as at 19/08/09, by reporting week (Table 4) and age group (Table 5) 4 Week notified Laboratory confirmed cases Number Hospitalised 5 22 1 0 23 1 0 24 1 0 25 2 0 Age group Laboratory 26 19 1 confirmed cases 27 34 0 <1 2 28 6 5 1-4 8 29 13 9 5-14 12 30 8 8 15-24 43 31 6 2 25-34 15 35-44 7 32 8 7 45-64 17 33 8 6 65-74 3 34 1 0 75+ 1 Total 108 38 Total 108 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 decreasing levels of influenza activity across Wales. Further detail can be found on the NPHS website: http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=38241 As at 19 August the consultation rate for Wales as a whole was 29.1 per 100,000. Consultation rates in all LHB areas exceed 14 per 100,000 (see figure 4), with no LHB area exceeding a consultation rates of 54 per 100,000. Consultation rates appear highest in Gwent. Consultation rates appear highest in those aged 15-24 and lowest in those aged 75 years and over (figure 5).
Figure 3. Rapid surveillance of influenza in Wales using Audit+, clinical consultation rate, rolling 7 day rate as at 19/08/09. 400 350 Consultation rate per 100,000 300 250 200 150 100 50 0 01/05/2009 05/05/2009 09/05/2009 13/05/2009 17/05/2009 21/05/2009 25/05/2009 29/05/2009 02/06/2009 06/06/2009 10/06/2009 14/06/2009 18/06/2009 22/06/2009 26/06/2009 30/06/2009 04/07/2009 08/07/2009 12/07/2009 16/07/2009 20/07/2009 24/07/2009 28/07/2009 01/08/2009 05/08/2009 09/08/2009 13/08/2009 17/08/2009 21/08/2009 25/08/2009 29/08/2009 Figure 4. Rapid surveillance of influenza in Wales LHB influenza consultation rates (per 100,000 practice population), rolling 7 day rate as at 19/08/09.
Figure 5. Rapid surveillance of influenza in Wales LHB influenza age group specific consultation rates (per 100,000 practice population), rolling 7 day rate as at 19/08/09. 400 Consultation rate per 100,000 350 300 250 200 150 100 50 0 <01 1-4 5-14 15-44 45-64 65-75 75+ Age group Table 6. Rapid surveillance of influenza in Wales LHB influenza consultation rates (per 100,000 practice population), rolling 7 day rate and estimated numbers as at 19/08/09. County Influenza consultation rate (per 100,000 population) at 18 August Estimated number of GP consultations within LA for previous seven days Carmarthenshire 24.2 43 Ceredigion 26.0 20 Pembrokeshire 36.1 43 Powys 14.0 18 Dyfed Powys 22.7 115 Blaenau Gwent 54.8 38 Caerphilly 32.9 57 Monmouthshire 32.9 57 Newport 42.3 59 Torfaen 36.8 34 Gwent 38.6 217 Anglesey 21.5 15 Conwy 25.7 29 Denbighshire 14.9 14 Flintshire 30.8 46 Gwynedd 26.3 31 Wrexham 32.7 43 North Wales 27.0 183 Bridgend 32.4 43 Cardiff 24.1 77 Merthyr Tydfil 56.3 31 Neath Port Talbot 33.9 47 Rhondda Cynon Taf 17.4 41 Swansea 30.2 69 Vale of Glamorgan 31.0 38 South Wales 28.1 347 WALES 29.1 862
5. NHS Direct Wales calls During the week ending 16 August, the percentage of total calls to NHS Direct Wales which were influenza related decreased to 23 per cent (figure 6). Figure 6. Influenza related calls to NHS direct Wales 1 (as a percentage of total calls) to week 33 2009 (as of 19/08/09). 60.0 50.0 Percentage 40.0 30.0 20.0 10.0 0.0 06-Dec-05 31-Jan-06 27-Mar-06 22-May-06 17-Jul-06 11-Sep-06 06-Nov-06 01-Jan-07 26-Feb-07 23-Apr-07 18-Jun-07 13-Aug-07 08-Oct-07 03-Dec-07 28-Jan-08 24-Mar-08 19-May-08 14-Jul-08 08-Sep-08 03-Nov-08 29-Dec-08 23-Feb-09 20-Apr-09 15-Jun-09 Week commencing 1 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. Comment from the Chief Medical Officer and National Public Health Service for Wales The Chief Medical Officer for Wales, Dr Tony Jewell, said: The number of people contacting their GP with flu-like symptoms continues to fall as we as come to the end of the first wave of the pandemic in Wales. We expect the rate to increase again as we see further waves during the winter. Therefore, we must all remain vigilant and do all we can to reduce the risk of spreading swine flu. We have been planning for this for some time, and the roll out of the swine flu vaccination programme later this year will help in our efforts to minimise the impact of the infection on individuals and communities. Based on independent scientific and medical advice from the UK s Joint Committee on Vaccination and Immunisation, the swine flu vaccine will be offered in the first instance to those with chronic conditions and pregnant women as they are particularly at risk of the complications of this flu virus. It is also being offered to frontline health and social care workers who are at high risk of infection and transmitting the infection to vulnerable people, and household contacts of immunocompromised individuals. "It is important that people do make sure they receive their vaccination when it becomes available as this is the simplest and most effective way of protecting themselves against swine flu.
In the meantime, I would remind people that at this stage Wales, along with Scotland and Northern Ireland, have decided not to join the National Pandemic Flu Service set up in England due to the pressure on services there. We believe that people prefer to deal with the services that they know and are comfortable with. If people do have flu-like symptoms, they should stay at home and check their symptoms on the NHS Direct Wales website at www.nhsdirect.wales.nhs.uk or by phoning the swine flu information line on 0800 1 513 513. If the symptoms are causing concern, or people are in an at-risk groups such as those with a chronic condition, children under 5 or pregnant women, people should phone their GP or NHS Direct Wales on 0845 46 47 as they are a priority for early antiviral treatment. People with flu-like symptoms should not go to their A&E, local GP or pharmacy in case they spread the virus to others. The NHS has managed extremely well so far in Wales and I would like to thank staff for their continued hard work. If we all play our part, we will be able to manage swine flu without causing undue pressure on the NHS. Dr Roland Salmon, Consultant Epidemiologist for the National Public Health Service for Wales, said: The number of people contacting their GP with flu like symptoms over the last few weeks has gone down but we expect numbers to rise again in the autumn. Over the summer we have identified that other respiratory viruses such as rhinovirus, also known as a summer cold, are circulating in Wales. Of the 55 samples received from primary care and tested since the end of June, four samples have tested positive for swine flu and four samples have tested positive for rhinovirus. This shows that 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. People with flu like symptoms should check their symptoms on www.nhsdirect.wales.nhs.uk or by calling the Swine Flu Information Line on 0800 1 513 513.
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 contact NHS Direct Wales on 0845 4647 or 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. In the majority of cases over the last three months, swine flu has been generally mild, though it has proved severe for a small minority. Most people recover from infection without the need for hospitalisation or medical care. It is still important that people practice good respiratory and hand hygiene to reduce the chance of catching or spreading viruses. 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 www.nhsdirect.wales.nhs.uk or by calling the Swine Flu Information Line on 0800 1 513 513. If you are still concerned contact NHS Direct Wales on 0845 4647. 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 www.nhsdirect.wales.nhs.uk, www.wales.gov.uk and www.nphs.wales.nhs.uk. You can also call the Swine Flu Information line on 0800 1 513 513 for recorded information, or NHS Direct Wales on 0845 46 47 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 Agreements have been signed between the UK Government and vaccine manufacturers to secure enough vaccine for the whole population. The first batches are expected in August with around 60 million doses by the end of the year enough for 30 million people to be vaccinated with more following after that. 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. It is expected that by the end of August, the UK government will publish a vaccination plan that will include decisions on priority groups and the method of delivery. The Welsh Assembly Government's Health Emergency Preparedness Unit has issued guidance to Local Health Boards on anti-viral distribution. The unit is co-ordinating work on identifying appropriate collection points and the necessary arrangements to support this process. 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 2009. 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. 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 0800 1 513 513 Further health information for the public on swine flu is available bilingually from www.nhsdirect.wales.nhs.uk Further public health information on swine flu and Pandemic Flu is available bilingually from www.nphs.wales.nhs.uk
Further information from the Welsh Assembly Government response is available bilingually at www.wales.gov.uk Contacts for the Media Welsh Assembly Government press office on 029 2089 8100 (24 hours) NPHS Communications Team on 01443 824166 (24 hours)