An extra 12 million doses of swine flu vaccine are being made available to GPs, England’s Chief Medical Officer announced yesterday, in a tacit acknowledgement that the NHS had failed to meet a late surge in demand for the jab.
The Pandemrix vaccine made by GlaxoSmithKline was left over from last year’s pandemic and will be supplied to GPs who request it from today. However, it only protects against swine flu, unlike the seasonal flu vaccine, which also protects against two other strains of the virus as well as swine flu.
Another 11 people died from flu across the UK last week, taking the total to 50, but other figures suggested this winter’s outbreak may have peaked. Flu jabs obtained today, which take seven days to provide partial immunity and two to three weeks to provide full immunity, will offer diminishing benefit if the outbreak subsides.
Cases of flu recorded by GPs dipped to 99 per 100,000 of the population this week after rising throughout December to 124 per 100,000 last week. Calls to NHS Direct fell and the number of people in intensive care rose to 850 before falling back to 783, compared with 738 in the previous week.
Swine flu
Dame Sally Davies, the interim Chief Medical Officer, said: “We may be nearing the peak. We have not got a crystal ball and we cannot be certain. The numbers in critical care are still rising but not on the same trajectory – it is much improved. It looks like the beginning of a plateau. Only next week will tell.”
Recorded cases drop each year over Christmas because there are only three working days for reporting, and may rise again next week.
Health department officials earlier said they were “mystified” by reports from GPs of a shortage of vaccines in some parts of the country. GPs are responsible for ordering their own stocks of vaccine in the summer based on their experience the previous winter and 14.8 million doses had been distributed.
Dame Sally said: “We hear reports of a mismatch between vaccine supply and demand. The data we have is there should be enough in the system. GPs who run out should get extra supplies from neighbouring practices of the primary care trust.”
However, she went on to announce that she was writing to GPs to tell them they could order last year’s pandemic vaccine to cope with the shortages. “The message to the public is: if you need the vaccine because you are in an at-risk group [pregnant or with a chronic condition such as asthma] you can get it,” Dame Sally added.
Professor David Salisbury, director of immunisation at the Department of Health, rejected a suggestion that it was a “second-class vaccine” because it was left over from last year and only provided protection against one strain of the virus (H1N1 swine flu) instead of three.
“The key is to protect as many people as we can while flu is still circulating. H1N1 is the dominant strain,” he said.
There were six deaths in Scotland last week, taking the total to 10 with 61 people in intensive care. The death rate of one in six is more than three times that in England. Officials were unable to explain the discrepancy but experts believe deaths are being under-counted in England.
One of those who died this week was 32-year-old Sarah Applin, of Thurston, Suffolk, following swine flu complications two weeks after giving birth to a son at West Suffolk Hospital in Bury St Edmunds. Her parents, Jane and Barry Waterman, said: “Our daughter sadly died of complications with pneumonia following treatment for swine flu. We would like to strongly urge any person at risk, especially pregnant women, to have the flu vaccination.”
Family members said Mrs Applin, who died on Tuesday, gave birth to her son, William, by Caesarean section on 22 December. Mrs Applin and her husband, Richard, also have a four-year-old daughter.
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Severe cases of flu are crippling the NHS with an estimated 800 intensive care beds being occupied by sufferers.
Chances are that you or a member of your family have suffered from it, or will do, but you may feel frustrated if you cannot get through to your doctor and need guidance.
Here are all the facts you need to know, starting with the latest statistics from the Health Protection Agency, the national disease surveillance organisation.
* The highest rates of flu have been among those aged one to four.
* The second-highest rates are among those aged between 15 and 44.
* Most fatalities have been aged between five and 65.
* More than a third of deaths have not been in high-risk groups.
* Nearly all of those who died had not been immunised. Here we guide you through the different types of flu, how to avoid it, and how to deal with the symptoms if you do catch it.
What is the difference between a cold, flu and swine flu?
A cold is a mild illness caused by a respiratory virus that generally causes sneezing, a cough, a sore throat and a runny nose. It lasts for a short time and causes no complications.
Flu is a more serious illness caused by a different group of viruses (the influenza viruses). The symptoms are muscle pain, marked tiredness, sweating, shivering, fever and congestion. Chest complications are common in those with chest or heart disease. Flu can be caused by a number of different influenza viruses and swine flu is one of these. Swine flu causes diarrhoea and very high temperatures, more so than other flu.
If I’ve had the flu jab, am I covered for swine flu?
Yes. The seasonal flu vaccine this year contains three strains of influenza virus including swine flu.
If I’ve already had flu, is it still worth me having the jab?
If in a high risk group then it is definitely worth it. It may be you have had flu caused by a different strain of influenza virus and the vaccination can offer you protection from other strains, including swine flu.
How can a ‘healthy’ person suddenly die of swine flu?
They will have died from pneumonia and respiratory failure. It is important to remember that every year people die from flu. Dr Bob Winter, president of the Intensive Care Society, has said that the majority of those seriously ill are pregnant, have underlying conditions or are overweight.
Can I be a carrier of the virus without having symptoms?
We have seen people test positive for swine flu who have shown very mild symptoms or no symptoms at all. This means you can infect others without showing any symptoms yourself. This is not really being a carrier – we call this a sub-clinical infection.
Does the flu virus react differently in each of us?
Yes. All infections cause a spectrum of symptoms ranging from mild to severe and it is hard to predict how we will react. As well as background health, factors including how many virus particles the body takes on – known as viral load – are important.
What medicine should I take if I have flu?
Healthy adults should take 1g paracetamol (usually two tablets) every six hours. In addition, you can take 400mg ibuprofen every eight hours. It is safe to take the two together.
How can I get Tamiflu, and will it work if I already have flu?
Tamiflu is being prescribed in certain situations for high risk patients under strict national guidelines. It can work to diminish symptoms and infectiousness even once flu has started. It is most effective in the first 72 hours of the illness.
Can I get it prescribed privately?
Yes, and it is approved for adults and children over 12 months of age. It is not suitable for women who are pregnant or nursing.
How does it work?
It is an anti-viral and attacks the virus and stops it from spreading inside your body. It will not reduce symptoms but will reduce the length of time you have flu.
When should I take it?
Only under the guidance of a doctor. It causes unpleasant side effects (usually vomiting) and should be taken only when there is an absolute medical indication. It should never be taken ‘just in case’ or preventatively.
When should we call a doctor?
Anyone in one of the high risk groups who has not been vaccinated should call the doctor immediately if you suspect swine flu.
What are the red flag signs for calling a doctor if not high risk?
Red flag signs are breathlessness, a fever that is not going down, or reduced urination. It is important to remember lethargy is normal with flu – but drowsiness is not.
What is a fever?
Body temperature of between 36.5C and 37.2C is normal but a fever is 38C and upwards. In children under five, a fever is a temperature above 37.5C.
I can’t get through to a doctor, NHS direct is always busy and my symptoms are worsening. Should I go to A&E?
If you are in a high risk group or are experiencing any of the red flag symptoms mentioned above, then you should go. If your flu is continuing with no red flag signs, ask a friend or family member to go to the surgery to get advice for you or book a telephone consultation.
Are there symptoms we should watch out for in our children? Dehydration is important so watch for poor drinking and little urine output. Do not worry about appetite which is not a good indicator. Warning signs of severe illness include fast breathing and a fever not reducing with medicine.
When am I contagious?
You are most infectious/contagious soon after developing symptoms. You can continue to spread the virus, by sneezing, for up to five days. You become less infectious as symptoms subside, and once symptoms are gone, no longer considered infectious.
Can flu be carried on/in food?
There is no research to suggest swine flu can be carried on or in food, including pork products. Contaminated objects can transfer the virus so basic hygiene is important when handling everything, including food.
How long can flu germs exist on a surface?
Up to 48 hours, depending on the temperature and humidity. Flu viruses survive longer on surfaces than cold viruses.
Should I be putting my dishwasher on at a higher temperature?
No. Washing with any detergent and water is enough to remove virus particles.
And the washing machine?
Flu viruses cannot survive on clothes for long and washing at normal temperatures is sufficient to remove them.
Can I transmit it to others via my skin or clothes?
It does seem to be more contagious than other flu illnesses with more people getting ill from any one contact. Coughing and sneezing creates an aerosol of virus that spreads up to a metre and infection is also possible from contaminated hard surfaces such as door handles rather than clothes. Keep hands clean and there should be no virus to transmit.
Should we avoid crowded places such as swimming pools and cinemas?
No. It is important to keep a sense of proportion. We are not in the midst of a swine flu pandemic and the vast majority of people will not be seriously ill with it. Flu is prevalent every winter and crowded public places are a breeding ground for all infections.
The Government has admitted that there is a shortage of flu vaccinations in some parts of the country.
Suppliers are being asked to gather left-over flu jabs licensed for use in the UK from factories across Europe. Patients have complained of being unable to get jabs from their GP.
Around 15 million doses of seasonal flu vaccine are ordered by GPs in England every year.
GPs have begun giving patients doses of last year’s swine flu vaccine to try to overcome the shortage of seasonal flu vaccines, as the death count from this winter’s outbreak rises to 50 people.
The Department of Health approved the move today, and Labour claimed that that was further evidence of ministers being “slow to act at every stage” as the threat posed by flu escalated.
Coming a week after it was forced to reinstate a national advertising campaign on good hygiene, it is the second unexpected step the department has taken to try to lessen the serious harm being caused by swine flu.
The government is releasing 12.7m doses of the Pandemrix swine flu vaccine, left over from the 2009-10period, when an outbreak killed almost 500 people.
“I’m writing to GPs to tell them that they can start using H1N1 vaccine on clinical need,” said Dame Sally Davies, the interim chief medical officer for England.
John Healey, the shadow health secretary, said: “This is a sensible step, but once again late in the day from a government that has been slow to act at every stage of this flu crisis. And coming the day after calls for vaccine suppliers to scour Europe for stocks, this will add to public confusion about what treatment is available and where.”
Eleven more people have died from flu in the last week, taking the toll from 39 to 50. Of those, 45 deaths were due to swine flu, the main strain of flu circulating this winter; the other five were influenza B.
Of the 48 cases where details were known, 33 people were in an “at-risk” group because they had an underlying medical condition such as diabetes, obesity or a breathing condition, or were pregnant. In 39 cases where vaccination status was known, 36 had not had this winter’s seasonal flu jab at least two weeks before they fell ill, and 33 had not had a swine flu jab last year, despite vulnerable health.
Among the dead, five were aged under five, eight were five to 14, 33 were 15 to 64, and four were older than 64.
Ministers have now ordered a review of the way the NHS procures seasonal flu vaccines. This could lead to the health departments in England, Scotland, Wales and Northern Ireland taking over from individual GP practices the job of ordering and paying for supplies for next winter.
Meirion Evans, of the Faculty of Public Health, said doctors wanted the switch so as to prevent shortages. All childhood vaccines, such as for MMR, tetanus and diptheria, were already obtained this way.
However, any move to adopt the same system for seasonal flu vaccines could lead to a dispute between the health department and the BMA, because it would lessen GPs’ income.
The number of people receiving critical care in hospital because of serious complications brought on by flu also rose this week, from 738 to 783, and a record number of people were receiving intensive support with breathing difficulties, called extracorporeal membrane oxygenation, .
Davies and the head of the NHS today were cautiously optimistic that the outbreak would peak soon then start to subside. They said that last week fewer people in England and Scotland went to see their doctor with flu-like illnesses; in England the rate dropped from 124 to 98 per 100,000 people. The rate of increase in people ending up in critical care also slowed sharply.
The Countess of Chester hospital, in Chester, has become the latest hospital to ask the public not to visit “in order to reduce the risk of patients and staff becoming ill”. People have been advised to visit only come if “absolutely essential”.
As the UK and a number of European countries are now experiencing epidemics of influenza, including A(H1N1) which was the 2009 pandemic virus, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) warns that the consequences of non-vaccination could emerge as a new flu emergency and are calling for greater efforts to encourage vaccination, not only for at risk groups but also health care workers.
The UK has been experiencing a surge in both mild and very severe cases of influenza primarily associated with A(H1N1), which according to the World Health Organization (WHO) has not yet peaked. With the return to schools and work after the Christmas holidays, numbers are expected to stay high for some time. To date, those severely affected are young adults (notably including pregnant women), some without any underlying chronic illness. And most of the very severe cases and identified deaths associated with A(H1N1), as well as other influenza viruses, have been under the age of 65 and largely unvaccinated.
There are concerns that what is happening in the UK could be mirrored in other parts of Europe with France, the Russian Federation and Ukraine already reporting influenza rates above their usual thresholds. “Whilst the 2009 pandemic may not have had the catastrophic outcomes that many first feared, what we are seeing in the 2010 seasonal flu period is a return of A(H1N1) with vengeance to parts of Europe, and now in combination with other respiratory viruses including influenza B”, said Professor Giuseppe Cornaglia, President of ESCMID. “Influenza viruses are unpredictable and we are currently witnessing A(H1N1) affecting groups not usually hit by the old (pre 2009) seasonal influenza, such as young adults and those without underlying health risks, many of whom are not vaccinated.”
The return of A(H1N1) influenza is the focus of an editorial in the Clinical Microbiology and Infection (CMI) journal authored by the ESCMID President, Professor Cornaglia, and the CMI Editor-in-Chief, Professor Didier Raoult.
“We know that the flu vaccine works and is very safe, yet uptake in many European countries is much lower than desired. Whether this is a result of general vaccine scepticism, doubts about the safety of a new vaccine or the perception that A(H1N1) is not a threat, the risks of opting out of the vaccine have to be made clear,” said Professor Cornaglia. “Much better public health communication is imperative to increase vaccination rates and there is simply no reason for those at risk or who are being offered it not to get vaccinated.”
The increased cases of severe influenza are also putting pressure on some intensive care units, for example in the UK with such patients occupying more than 20% of intensive care space. In countries with limited capacity for higher level care, such additional strain on health systems struggling in the middle of winter carries real public health risks.
A research team has hurriedly been re-formed to investigate whether the swine flu virus has started to mutate in a way that will render the vaccine ineffective.
Senior Government scientists have already discovered slight genetic mutations in the H1N1 virus.
They are checking whether this is causing some people to be more severely affected, although there is no evidence at this stage to suggest the changes would stop the vaccine working or prevent the anti-viral drug Tamiflu from being effective.
So far, 45 people are known to have died from swine flu since October.
The team, based at Imperial College London, are testing the DNA samples of hundreds of swine flu victims.
Professor Peter Openshaw, director of the Centre for Respiratory Infection at Imperial, said: ‘We have paid particular attention to whether the mutations are affecting how well the vaccine works and whether the slight mutations have led to it becoming more severe.’
The study, known as MOSAIC, was set up in 2009 to monitor the virus during the pandemic, but it was swiftly re-assembled last month with the latest outbreak.
Asthma specialist nurse Katy Odeadra, who works in the Chest and Allergy Clinic at St Mary’s Hospital, said: ‘All the talk among doctors and nurses dealing with swine flu cases is of a mutated form of the virus.’
The Health Protection Agency said yesterday: ‘The vaccine still works.’
Health officials in England have hit back at Scottish accusations that they never asked for its spare flu vaccines to plug the shortfall.
Reports emerged in England this week of GPs running out of the jabs.
The Scottish government told the BBC on Friday it had “plenty” of jabs in an emergency pot and would have been willing to try to help out if asked.
But England’s Department of Health said it was told in talks on Tuesday that Scotland could not free up much.
Vaccination ordering differs in the two countries. In England, GPs order flu vaccines direct from manufacturers.
In Scotland, pharmacists order on behalf of GPs, but the government also gets in extra itself for a contingency pot.
It currently has 40,000 doses in that stockpile.
Contingency pot
A Scottish government spokeswoman said: “We would always consider helping England in any way appropriate should a request be made, while our priority has to be public health in Scotland which is what we have planned for.”
But even though there was no formal request, the BBC understands the issue of vaccines was brought up in discussions between civil servants straight after the bank holiday weekend.
The Department of Health said its understanding was that there was only a “nominal” amount that could be made available and even this would not be freed up straight-away. A spokeswoman said that was why no formal approach was made.
English health officials have also spent time this week asking suppliers whether there are any available vaccines in Europe.
But with little on offer, they took the decision on Thursday to let GPs who have run out access the 12m stockpile of vaccine left over from 2009.
It is still in date, but only protects against the swine flu strain, just one of three circulating this winter albeit the dominant one.