Swine flu- move to recover cost of vaccine

The government is attempting to claw back tens of millions of pounds from flu vaccine manufacturers as it seeks to scale down an immunisation plan to protect the country from a severe pandemic.

Officials have cancelled further orders from Baxter, and are finalising a deal to limit purchases from GlaxoSmithKline, in an effort to recoup part of a £500m deal with the two companies for sufficient vaccine to cover the entire population.

Ministers have decided to abandon the aim of a universal flu vaccination programme, although they are pursuing the drive to vaccinate children under five as well as pregnant women, people with underlying health problems and health and social care workers.

The mild nature of the swine flu virus, the need for only a single rather than a double dose of vaccine and public suspicion and indifference to vaccination have led to lower take-up than anticipated in the UK and other countries.

The government's decision - in the context of severe pressure on public spending - comes at a time of similar moves by other countries including France, Germany, the Netherlands and Spain.

Sir David Salisbury, director of immunisation at the Department of Health, said a break clause had now been activated in the contract agreed with Baxter of the US, while discussions were under way with GSK, from which most of the vaccine had been purchased.

Similar formal break clauses were not included in many countries' contracts with vaccine suppliers, because they were drawn up at a time when governments and manufacturers expected demand would substantially outstrip supply.

However, GSK, like other large suppliers, including Sanofi-Aventis of France, is coming under political pressure to accept a scaling back of previously agreed volumes of orders.

GSK stands to lose tens of millions of pounds alone from the UK renegotiations and smaller amounts from other large purchasers such as France.

The drugmaker had previously estimated total sales of its pandemic flu vaccine across more than 70 countries at £2bn over 2009 and 2010.

It may be able to recover some losses from sales to other countries including in Latin America. Sanofi-Aventis, the world's largest supplier of flu vaccine, stands to lose significant sales, with smaller losses from Novartis, while other suppliers such as Baxter, CSL and MedImmune - part of AstraZeneca - had lower initial sales and much lower exposure.

The UK and other countries are in talks about making donations of surplus vaccine stocks available to poorer countries and selling excess stocks to richer ones - although there are concerns about the issue of liability in such cases.

Sir David said the UK would keep some surplus stocks, both to prepare for any possible third wave of the pandemic and for a future different infection.

The vaccine contains an antigen to protect the body against the current H1N1 virus which would not be useful against future mutations.

But it has an adjuvant stored separately until just before vaccination, which enhances the body's immune response and could be stored over longer periods to help fight a future pandemic.

The latest figures from England show that fewer than 3.8m people have been vaccinated against pandemic flu since last autumn, although 12.5m doses of vaccine have been sent out for health services ready to be used.

From:
http://www.ft.com/cms/s/0/182021e8-fe52-11de-9340-00144feab49a.html?nclick_check=1

Swine flu chaos for children over vaccinations

Plans to vaccinate healthy children under the age of five against swine flu are in disarray after doctors refused to sign up to a deal.

GPs are already immunising people with health problems and pregnant women.

But the British Medical Association and labour government have ended talks on children after they failed to agree a deal.

Health visitors and district nurses are now to be asked by local NHS managers to step in - but the programme may will now start in December as planned.

However, the vaccination of the first wave groups, which also include health workers, is continuing as normal as they were covered by a deal that was brokered in early autumn.

It is thought the latest talks broke down over the amount of flexibility the government was willing to give doctors over the rest of their workload.

Negotiators had offered doctors £5.25 per dose - the same as they are getting for the first priority group.

But the BMA had argued doctors should be given leeway over fulfilling their obligations on access to appointments.

Under the terms of their contract, doctors are paid bonuses to give most patients appointments within 48 hours as well as allowing them to book in advance.

Without this, the BMA argued vaccinating 3m children during the busy winter period would leave doctors out of pocket - doctors consider young children to be time-consuming as parents often have to be reassured.

Dr Laurence Buckman, chairman of the BMA's GPs committee, said: "We sincerely wanted to be able to reach a national agreement. Unfortunately this has not been possible, because the government would not support adequate measures to help free up staff time."

"At the busiest time of the year for general practice, with surgeries already dealing with the additional work of vaccinating the first wave of at-risk groups, we felt this was vital in order to ensure this next phase could be carried out quickly."

Health Secretary Andy Burnham said the breakdown of talks was "disappointing", but he still hoped to get the vaccination of children going by Christmas.

It is still possible that some doctors will agree to vaccinate children if they can reach individual deals with their local health managers.

However, the government has asked health chiefs to focus their attention on other NHS workers.

District nurses routinely carry out vaccinations for housebound patients as part of other immunisation programmes, but it remains to be seen whether they will be able to vaccinate large numbers of children.

Health visitors are also likely to be asked to help, but many of them do not have experience of vaccinating and will need extra training.

The British Medical Association believes it will be "very difficult" to get this all in place this year.

And David Stout, of the Primary Care Trust Network, which represents local health managers, agreed there was still a lot of work to do.

"It is more complicated to get separate agreements in place and will take several weeks. We don't know who will want to do this so from that point of view it is untested. I can't see it happening before Christmas."

From:

http://news.bbc.co.uk/1/hi/health/8402096.stm

Swine flu deaths in England reach highest level

Deaths from the swine flu pandemic in England rose to their highest peak yet last week, new figures have shown.

The number of confirmed deaths for the week ended November 26 were 21, three higher than the week before and two higher than the previous high a fortnight ago.

However at the same time the overall number of people catching swine flu in England fell to an estimated 46,000 new cases in the last week, 7,000 less than the week before.

There has also been a drop in the number of people in hospital, from 783 to 753.

A total of 154 of those being cared for are in intensive care.

The figures are dropping so low that the government said that it was reviewing its online and telephone flu service with a view to withdrawing it after Christmas.

Sir Liam Donaldson, the chief medical officer for England, said that the number of people who have had swine flu or died means the current pandemic is comparable with a normal winter flu season.

But he said: "If you look at the levels you would say they are comparable with a winter flu outbreak but a winter flu outbreak does not kill young people and does not take under-fives into hospital and intensive care on this scale."

Meanwhile more than a million people at high risk from swine flu have been vaccinated, according to Government estimates.

About a million people in England and thousands more in Scotland, Wales and Northern Ireland have received their jab in the first month of the programme.

GPs are currently vaccinating people at risk – such as those with asthma, heart disease and diabetes – before moving on to the under-fives.

The number of deaths in England now stands at 163 and the UK total stands at 242, up from 214 last week.

Sir Liam said the one million figure did not include health care workers, who have also been having the vaccine.

One million is about one in 10 of all the people in at-risk groups who are being offered the vaccine.

So far, 10 million doses of the jab have been sent out to GP surgeries, primary care trusts and acute hospitals in England.

A total of 14 million doses of the vaccine Pandemrix have been delivered to the Government, with another 2.3 million doses of Celvapan also delivered.

From:

http://www.telegraph.co.uk/health/swine-flu/Swine-flu-deaths-in-England-reach-highest-level

Swine flu- strain resistant to Tamiflu spreads between UK hospital patients

A strain of Tamiflu resistant swine flu has spread between patients in a hospital as five patients on a unit for people with severe underlying health conditions at the University Hospital of Wales, in Cardiff, were diagnosed with swine flu that is resistant to the drug.

Three appear to have acquired the infection in hospital, the National Public Health Service for Wales (NPHS) said.

Two of the five have recovered and have been discharged from hospital, one is in critical care and two are being treated on the ward.

The service said the resistant strain does not appear to be more severe than the swine flu virus circulating since the spring.

All patients on the unit have been tested and patients diagnosed with Tamiflu-resistant swine flu have been given other antivirals.

Patients have been isolated or are being cared for in a designated area for influenza cases.

Cardiff and Vale University Health Board has put appropriate infection control measures in place on the unit, the NPHS added.

Staff and patients have been offered swine flu vaccinations, and patients due to come into the unit for treatment are being warned to get the jab from their GP.

Close contacts of the patients are being warned to make sure they are treated quickly if they show any symptoms.

Dr Roland Salmon, director of the NPHS Communicable Disease Surveillance Centre, said: “The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

“In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April. For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness.

“Vaccination remains 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.”

It comes after it was announced that more than 3million healthy children under five across the UK are to be offered the swine flu jab.

Parents will be invited by their GPs to bring their children into surgeries, with vaccinations expected to start in December.

Health ministers across the UK agreed children aged six months to five years should be included in the next phase of the vaccination programme after GPs have finished vaccinating at-risk groups, including people aged six months to 65 with conditions like asthma, diabetes and heart disease. Pregnant women and frontline health workers are also currently being given the jab.

Figures released on Thursday showed an estimated 53,000 new cases of swine flu in England in the last week, down from 64,000 in the week before. In Scotland, the figure was 21,200, down from about 21,500 in the previous seven days.

The rate of flu-like illnesses diagnosed by GPs in Wales dropped to 36 cases for every 100,000 people from 65.8 the previous week.

Seven swine flu-related deaths were recorded in Wales in the previous week, taking the total to 21.

Wales’s Chief Medical Officer Dr Tony Jewell said people with suppressed immune systems were designated as a priority group for vaccination because they were known to be more susceptible to the virus.

“We have stringent processes in place for monitoring for antiviral resistance in the UK so that we can spot resistance early and the causes can be investigated and the cases managed,” he said.

“Identifying these cases shows that our systems are working so patients should be reassured.

“Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.

“It’s also important that good hygiene practices are followed to further prevent the spread of the virus.”

Meanwhile, Norwegian health authorities said they had discovered a potentially significant H1N1 mutation that could be responsible for causing the severest symptoms.

The mutated virus was found in the bodies of two people who died of the virus, although medics do not believe it has been transmitted between humans.

From:

http://www.telegraph.co.uk/Swine-flu-Strain-resistant-to-Tamiflu-spreads-between-UK-hospital-patients

Sharp rise in England swine flu deaths

The latest weekly bulletin showed a sharp rise in patient deaths and the number of children being admitted to hospital.

The overall number of new cases showed a second successive weekly fall. Health officials estimate there were 55,000 new cases this week in England compared with 64,000 last week. There was a slight drop in Scotland.

The number of people who have died from swine flu in the UK has reached 214. There were 18 deaths in England last week. The figures since the start of the outbreak in May are 142 fatalities in England, 21 in Wales, 38 in Scotland and 13 in Northern Ireland.

The number of people needing hospital care for the virus is 783, down slightly from 785, in the previous week. Of those in hospital, 180 were in intensive care, up from 173 in the previous week.

The Conservative party has been pressing the government to give vaccinations to healthy children because those under the age of 16 are in one of the more vulnerable groups.

About 21% of all H1N1 deaths in the UK have been among under 14s.

So far the priority groups have included those with pre-existing medical conditions, their carers and pregnant women. Children with asthma or diabetes are already being vaccinated. Now, children aged six months to five years are to be offered the vaccination from next month.

From:

http://www.guardian.co.uk/world/2009/nov/19/swine-flu-vaccines-healthy-children

Swine flu jab to be given to healthy children under five

Healthy children aged under five are to be given the swine flu jab, the Government has confirmed.

Currently people in priority groups - including young children with asthma or diabetes - are being vaccinated.

But the programme will now be rolled out to children with no underlying health issues, aged over six months and under five .

The UK-wide policy was officially confirmed by the Scottish Government today ahead of a similar announcement in England, expected later.

Nicola Sturgeon, the Scottish Health Secretary, said: "I am able to announce today that the next group in the population that will be vaccinated, or offered vaccination, is children aged over six months and under five years."

The announcement came as it emerged that an 11-year-old girl from Berkshire who had tested positive for the H1N1 virus died on November 11.

NHS figures show that children under 16 are the age group most likely to be admitted to hospital with swine flu, and 21 per cent of deaths in England are among under-14s.

Last week, the death toll in the UK stood at 182, with 124 deaths in England, 33 in Scotland, 11 in Northern Ireland and 14 in Wales.

Currently nine million people in priority groups are being vaccinated against swine flu including those with long-term illnesses and pregnant women. Frontline health and social care workers are also being offered the vaccine.

Britain has ordered enough vaccine for everyone to have two doses, but data from clinical trials has shown that one dose is effective.

Children have been hardest hit by swine flu and are the under fives are the most likely age group to be admitted to hospital with the virus.

Researchers warned that intensive care beds for children could run out in Britain this winter due to swine flu.

All of Britain's 303 intensive care beds for children could be filled with swine flu patients this winter and this would leave no beds available for children suffering other illness, recovering from surgery or accidents, according to a study conducted by Dr Art Ercole, of Cambridge University and colleagues.

The research was published online ahead of the print edition of the journal Archives of Disease in Childhood.

Dr Ercole said over half of admissions to paediatric intensive care units (PICUS) are unplanned and respiratory illness is the second largest cause of admission, accounting for around one in four cases.

From

http://www.telegraph.co.uk/health/swine-flu/6606561/Healthy-children-below-age-of-five-to-get-swine-flu-jab.html

Half term helps curb swine flu infections

Half term holidays may have temporarily eased the rise in the number of cases of swine flu, the government's chief medical officer said yesterday.

Unveiling the latest data showing a decline to an estimated 64,000 new infections this week, compared with 84,000 last week, Sir Liam Donaldson said it could be explained by the school holidays.

The reversal caused some surprise, with the trend in recent weeks suggesting the UK was experiencing an escalating "second wave" of the H1N1 virus in the build-up to winter. "We don't know whether this is the start of a downturn or not," Sir Liam said.

Officials said the decline could also reflect fewer cases of children reporting to doctors during the holidays even if they did develop symptoms.

The school summer holidays were seen as helping suppress the first pandemic wave, since the virus spreads most easily among children. Since the start of the autumn term there have been 241 school outbreaks recorded, with the highest number of 92 in Yorkshire and Humberside.

There was also a drop over the past week in hospitalisations in England from 848 to 785. An estimated 670,000 people have been infected to date. Vaccination programmes are now under way, with 6.6m doses sent to doctors and 3m new doses arriving each week.

From:

http://www.ft.com/cms/s/0/55aecc3a-cff4-11de-a36d-00144feabdc0.html?nclick_check=1

NHS told to brace itself over swine flu epidemic

The NHS has been told to brace itself for action after a steep rise in swine flu infections.

The number of new cases reported in England over the past week has nearly doubled to 53,000. In Scotland, there was a slight rise to 14,650.

It comes as more and more people are being admitted into intensive care and the number of deaths hit 128 in the UK.

Ian Dalton, head of flu planning at the NHS, said if the rises continued critical care would be expanded.

Plans have been drawn up over the last few months to double the number of intensive care beds to over 4,000.

And with the UK well into the second peak, concerns are being raised about the sustained pressure that will be put on the health service.

Mr Dalton said: "If current trends continue we are going to have to surge capacity. My message now is that the NHS must be ready."

In England, there are 99 people in critical care beds - the highest since the pandemic began. But it is the rate of admission to these specialist beds which is causing particular concern.

During the summer, about 1 in 10 patients in hospital with swine flu ended up in critical care, compared with one in five now.

'Sustained pressure'

Sir Liam Donaldson, the government's chief medical officer, said the pattern emerging on intensive care wards was "mystifying".

There are no signs the flu strain has mutated to become more deadly - indeed the latest worst-case scenario for total deaths over the winter has been reduced from 19,000 to 1,000.

But Sir Liam said: "What we are starting to worry about is the sustained pressure over the winter.

"The NHS has never before had a run from mid July to March and April with intensive infectious disease like this."

Latest estimates suggest there could be another 35,000 admissions in the coming months - more than 5,000 of which could require intensive care support.

Sir Liam also said while the 1,000 death-toll was low even compared to the normal number of deaths from seasonal flu, which normally stands at about 6,000 to 8.000, the tragedy was that the victims of swine flu were often young.

From:

http://news.bbc.co.uk/1/hi/health/8321202.stm

National swine flu vaccination to start this week

A national swine flu vaccination campaign will begin this week, with high risk patients and frontline health workers the first to receive a single dose jab, the Chief Medical Officer has announced.

Sir Liam Donaldson said that from today hospitals would start vaccinating priority patients, such as people receiving cancer treatment, with the first deliveries to GPs for other at-risk groups including those with chronic conditions and pregnant women from October 26.

Sir Liam said that while overall rates of infection were rising slowly, and at similar rate to recent weeks, he was more concerned at the proportion of people ending up in critical care. Of the 364 patients currently in hospital, 74 are in critical care – the highest total in the pandemic so far.

The death toll also rose at a sharper rate, with 10 recorded in the last week, taking the UK total past 100. 

There have been a total of 83 deaths in England, 4 in Wales, 4 in Northern Ireland and 15 in Scotland. The announcement came as it was confirmed that a 17-year old pregnant woman from the Borders had died after contracting swine flu in the last 24 hours – the second pregnancy fatality of the week.

Professor David Salisbury, the Department of Health’s head of immunisation, said that Pandemrix, the vaccine made by GlaxoSmithKline, would be used for the first roll-out. He dismissed suggestions that as an adjuvant vaccine it carried more risks for pregnant women, and said that the fact that it could offer immunity with a single dose - rather than the more lengthy time period required with the UK’s other supply, the two-dose Celvapan – made it far more preferable.

Sir Liam added that postal workers’ decision to stage a national strike was “extremely unwelcome piece of timing” which, though it would not impact on vaccine delivery, would disrupt GPs’ letters sent out to those being called up for vaccination.

“While the rates of infection are not increasing more quickly, I am concerned at the relatively high proportion of patients in hospital in a serious category,” he said, adding that there was a school of thought suggesting that while the virus had not changed, it might carry a greater impact now the country was entering its seasonal flu period. “I also remain concerned at the rates of child hospitalisation," he said.

On the topic of vaccinations for pregnant women, he added: “While the disease is mild for the majority of people including pregnant women, pregnant women are at higher risk of complications caused by flu. I know they wish to reduce risks to themselves and their unborn babies and therefore the sensible would be to have the vaccine. I do not want to see pregnant women dying from a preventable disease, and that is the bottom line.”

From:

http://www.timesonline.co.uk/tol/news/uk/health/Swine_flu/article6876657.ece

Half of pregnant women will refuse swine flu vaccine

Almost half of pregnant women say they would refuse to take the swine flu vaccine, suggesting many are worried about the safety of the jab, according to a new poll.

Expectant mothers have been designated as one of the priority groups to be given the injection because they are more likely to develop complications if they do catch the virus.

There have been 66 deaths have been linked to swine flu in Britain since the outbreak began in April, including at least two pregnant women.

But almost half, 48 per cent, of pregnant women who responded to a poll by Mumsnet, the website, said that they would probably or definitely not have the jab once it is available.

Only six per cent said that they definitely would have the vaccine, while another 22 per cent said that they probably would.

The study also reveals that many women do not plan to have their children vaccinated.

In total 46 per cent of those with children aged under five said that they probably or definitely would not take their children to receive the vaccine.

Again small numbers said that they would definitely want their child to be vaccinated, just five per cent, while 22 per cent said that they probably would.

The labour Government has received the first batches of the vaccine but it is still being tested in scientific trials.

Regulatory agencies expect to have analysed the safety data and licensed the vaccine for use by October, at which point vaccinations can begin.

However, no decision has been made at this stage on whether everyone will be given the jab.

Officials have designated priority groups, including pregnant women, “at risk” children and adults with underlying health problems and healthcare workers who will receive the vaccine initially.

The poll follows claims that children vaccinated in the first weeks could be given a vaccine only tested on adults.

Doctors have also been ordered to monitor whether the vaccine triggers a neurological disease, called Guillain-Barré syndrome, which can be deadly.

However cases of a vaccine triggering the syndrome are very rare and the World Health Organisation insists that modern vaccines are extremely safe.

In total 1,458 people responded to the mumsnet poll, including 562 pregnant women.

Mumsnet suggested that the fact that many cases of swine flu had so far been mild meant that many people were unconcerned about catching the disease.

However, the organisation also warned that the Government faces an uphill task convincing the majority of pregnant women to take the jab.

The organisation warned that many seemed more worried about the vaccine than the virus that it was designed to combat.

"It's obvious from these results and from discussions about this on Mumsnet.com that lots of mums and mums-to be are questioning whether or not to have the swine flu vaccine or give the vaccine to their children,” said Carrie Longton, one of the founders of the website.

“Some are worried about how well it's been tested, others about its effectiveness and side-effects. Everyone wants to do the best for their child or unborn child, but many parents seem, from our poll, to be more anxious about the safety of the vaccine than they do about catching swine flu."

But England’s top nurse insisted that the vaccine would undergo thorough safety checks before it was used.

Christine Beasley, the Chief Nursing Officer, said: “Vaccination offers the best protection against swine flu and will be carefully assessed for safety.

“Strict processes are in place for licensing pandemic vaccines and it will not start to be used on anyone, including pregnant women, until a license has been granted.”

She added: “"Pregnant women are a top priority for vaccination because they are more at risk of complications from swine flu.”

From:

www.telegraph.co.uk/Half-of-pregnant-women-will-refuse-swine-flu-vaccine

UK children receive swine flu jab

The first children in Britain to receive a vaccine against swine flu have begun to be immunised.

Doctors at five sites in England are comparing vaccines from two manufacturers to see which works best and has the fewest side-effects.

Over the next two weeks 1,000 children aged six months to 12 years are being recruited in Oxford, Bristol, Southampton, Exeter and London.

Both vaccines are expected to be licensed in the coming weeks.

One has already been recommended for use.

Professor Andrew Pollard, from the University of Oxford, says vaccines are the best way to protect against flu and any side effects should be limited to sore arms or sometimes a fever.

This clinical trial comes just a month before more than 11 million people considered to be most at risk from flu will be offered the swine flu vaccine.

It will also be made available to more than two million front-line health workers.

From:

http://news.bbc.co.uk/1/hi/uk/8279826.stm

Swine flu- nanny state criticises naughty professionals who refuse vaccine putting patients at risk

Doctors and nurses are potentially putting patients at risk if they refuse the swine flu vaccine, labour's nanny state has warned.

Nanny state 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. Even though the vaccine has not met their own NICE drug guidelines.

The warning follows a spate of surveys which suggest that many healthcare workers will refuse the vaccine, despite being on the labour 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 from swine flu are in those with serious underlying medical conditions who are in regular contact with healthcare workers.”

Prof David Salisbury, the nanny states's Department of Health director of immunisation, told GP 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."

From:
http://www.telegraph.co.uk/Swine-flu-Doctors-who-refuse-vaccine-putting-patients-at-risk

It's Monday, so it must be Swine Flu- Swine Flu rise points to Monday sickies

A weekly rise in cases of swine flu across the country on Mondays suggests that employees are using the pandemic as an excuse for throwing a Monday morning "sickie".

While the rate of infection in recent weeks has risen and fallen in line with experts' predictions - and a similar if staggered trend for flu elsewhere in the world - health specialists have found the weekly fluctuations more puzzling.

Regardless of the total number of cases recorded each week, data from the official National Pandemic Flu Service show a consistent pattern for a maximum number of cases on Monday, declining steadily on every subsequent day before peaking again seven days later.

"We just don't know why," said Sir Liam Donaldson, chief medical officer, last week when asked to explain the "Monday effect", adding that there was no obvious medical reason. The World Health Organisation also said it was unaware of any weekly pattern.

One possible explanation is that people socialise more over the weekend, increasing their likelihood of infection. But with flu symptoms typically taking two days to develop, any peak in demand for help should come on Tuesdays or Wednesdays. Friday evening socialising is often with colleagues, suggesting little more risk of infection than on other days of the week in the workplace.

With clinics closed or open for only limited hours over the weekend, many doctors' show a surge in consultations on Mondays for all sorts of ailments that have developed over the weekend.

But the government's dedicated pandemic flu service, which began operations in July, operates by both telephone and internet around the clock, including on weekends, offering no such barriers to access outside working hours.

People might wrongly believe that the service is closed on weekends and wait until Monday before getting in touch. But data from NHS Direct, open 24 hours a day for phone consultations on all medical conditions, shows the proportion of calls is roughly equal on each working day of the week, with peaks at weekends.

On Mondays, those calling in specifically with suspected colds or flu in the 12 months to May accounted for 13 per cent of weekly calls, against 12 per cent for the rest of the working week, rising to 19 per cent on Saturdays and 20 per cent on Sundays.

One difference between NHS Direct and the pandemic flu line is that the latter offers a code allowing access to the antiviral drug Tamiflu, and a receipt that can be used to justify sick days and insurance claims.

Aaron Ross, chief executive of FirstCare, a consultancy that manages sickness-related absences from the workplace, said 43 per cent of all his calls each week for all causes take place on Monday. "The only natural conclusion is that people are using the service as a reason to take time off work," he says.

"A number of employers we have spoken to are suggesting employees are calling the hotline, requesting Tamiflu and then using it as justification to phone their manager to start an absence."

That does not explain the steady decline over the rest of the week. But if a second "wave" of flu takes place later this year as predicted, employers should be braced for a new peak in absences, especially on Mondays.

From:

http://www.ft.com/cms/s/0/bbd95eb8-9821-11de-8d3d-00144feabdc0.html?nclick_check=1

WHO says that otherwise healthy people should not be given Tamiflu

Healthy people who catch swine flu should not be given antiviral drugs, the World Health Organisation (WHO) has said, as most people will recover from symptoms within a week.

The drugs are currently offered to anyone in England with flu like symptoms but the WHO’s guidance contradicts this policy, suggesting that the side effects may outweigh the benefits for otherwise healthy people.

But Tamiflu (oseltamivir) or Relenza (zanamivir) should still be used as “soon as possible” if people present with severe illness or whose condition was deteriorating, the UN’s health agency said.

Those in at-risk groups — such as pregnant women or people with an underlying medical condition such as diabetes — should also receive treatment promptly.

The latest WHO advice, from a panel of international experts, comes as new figures show that 45,986 courses of antivirals were given to patients in England last week.

In the previous week, 90,363 had been given out after people contacted the National Pandemic Flu Service, the telephone and internet service which allows people to obtain medication without seeing a doctor.

There have been fears that mass use of Tamiflu will encourage the H1N1 swine flu strain to become resistant to the antiviral.

Researchers have also expressed concern over the side-effects of the drug, including sickness, nightmares and insomnia in children.

A team from the University of Oxford said earlier this month that children with mild symptoms should not be given the antiviral to combat swine flu and urged the Department of Health to urgently rethink its policy.

The advice, published on the WHO website, said that most patients were experiencing typical flu symptoms and would get better within a week.

A statement said that the new guidelines “represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs.

“Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalisation, and reduce the duration of hospital stays.

From:
http://www.timesonline.co.uk/tol/news/uk/health/Swine_flu/article6805254.ece

One in three nurses say they will not be immunised against swine flu, despite being offered the vaccine as a priority to protect patients.

Concerns about the swine flu vaccine’s safety and a perception that the infection is mild are among reasons that NHS staff gave for refusing to have the jab, a survey of nearly 1,500 staff found.

Frontline health and social care workers will be offered the jab from October, along with patients in at-risk groups — such as those with diabetes, asthma or pregnant women.

In the online survey for Nursing Times magazine, 30 per cent of nurses said that they would not get immunised when the vaccine for H1N1 became available; 37 per cent said they would. Thirty-three per cent were undecided.

Of those who said that they would not be vaccinated, 60 per cent cited concern about the safety of the vaccine as the main reason.

Thirty-one per cent said they did not consider the risks to their health from swine flu to be great enough, and 9 per cent did not think they would be able to take time out of work to visit their GP to be immunised.

Two possible vaccines are being tested in trials run by the University of Leicester and the Health Protection Agency to assess immunity levels and identify side-effects.

A decision on licensing is expected at the end of September, with nearly 55 million doses expected to be delivered to Britain by the end of the year.

David Salisbury, the Department of Health’s director of immunisation, said it was unfortunate that nurses could “knowingly leave themselves at risk” of contracting the illness.

“They have a duty to themselves, they are at risk. They have a duty to their patients not to infect their patients and they have a duty to their families. I think you solve those responsibilities by being vaccinated,” he said.

He added: “The evidence that we’ve had is sufficient to persuade the regulators that these are vaccines that will be licensed.”

Professor Salisbury’s comments follow a warning from Sir Liam Donaldson, the Chief Medical Officer for England, that swine flu could leave up to 12 per cent of the NHS workforce on sick leave at any one time.

Low vaccination rates among NHS staff have previously been blamed for causing disruption to services and illness among patients during typical winter flu seasons.

Transmission by staff of contagious viruses was blamed for some hospital outbreaks of flu last winter, when fewer than one in seven NHS staff received the annual flu vaccine, while shortages of workers also put pressure on accident and emergency departments.

Reported cases of swine flu this summer have already surpassed the levels typically seen during a winter flu season, and the figures are expected to surge in the coming months.

George Kassianos, the immunisation spokesman for the Royal College of GPs, said: “More than any other year, this year it is extremely improtant that people get vaccinated against flu. It is very important that nurses, doctors and healthcare workers do not get influenza themselves and have to go off sick, and also that we do not give it to our patients.

“We are lucky that we will have enough doses of this vaccine in Britain, and we as health professionals need to put it in our own arms first to better protect our patients.”

Dr Kassianos added that it was understandable that people were unsure about having a new vaccine, “but its ingredients and the way it's being manufactured are almost exactly the same as the annual flu vaccine. I see no reason why this vaccine should be any different to the flu vaccines of the past. People’s confidence should rise as the programme gets under way.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/Swine_flu/article6799297.ece

Swine flu shirkers cost firms more than virus, say employers

Staff using the swine flu pandemic as an excuse to take time off work are causing more disruption to businesses than the virus itself, according to employers.

Thousands of healthy workers are thought to have taken advantage of official guidelines on the pandemic to extend their summer holidays.

By simply phoning the NHS swine flu hot line or visiting its website, unscrupulous workers can get themselves a course of antiviral medicine and do not need a sick note from their GP for the first seven days’ absence.

The labour Government is considering doubling this period to a fortnight, which companies fear could make the situation worse and cost them millions of pounds in lost productivity at a time when they are struggling with the effects of the recession.

There are predictions that more healthy workers will be tempted to call in sick as the weather improves over the next week, after the wettest July on record.

The Employment Law Advisory Service, which provides legal advice to companies on personnel problems, disclosed yesterday that it had begun receiving calls from concerned managers as soon as the self-diagnosis website was set up last month.

It has since heard from more than 1,000 companies that believe staff have exploited concern about the spread of the H1N1 virus to take an extra week off. It believes that the Department of Health’s guidance risks creating a “skiver’s charter”.

Peter Mooney, the service’s head of consultancy, said: “Managers feel that some staff are simply taking advantage of concerns about the transmission of swine flu to take an extra few days off work. Because the emphasis has been on not going to your local GP but using websites to assess the infection and the risk to others, those who stay at home are not going to need a doctor’s note or have too many people calling on them to see how they feel.

“Based on the volume, and the nature, of calls we have been taking, the number of deliberate false cases of the condition is having a significant impact on workplaces across the country — something bosses are keen to tackle.”

The Department of Health’s own planning assumptions state that nine per cent of the workforce could be absent at any one time during August, rising to 12 per cent in the winter. Ministers set up emergency measures to reduce the pressure on the NHS and slow the transmission of the virus amid predictions of a worst-case scenario in which one in three of the population falls ill and 65,000 people die.

Those who believe they have symptoms are advised to contact the National Pandemic Flu Service over the phone or online, rather than visit a family doctor.

If they are diagnosed with swine flu, they are given a number to allow them to collect a course of antiviral drugs and told to stay at home for a minimum of seven days in order to prevent further spread of the virus.

The flu service website and phone line handed out over 150,000 doses of Tamiflu in its first week. However, there is evidence that only about one in four recipients actually has the H1N1 virus.

GPs have said that they are being inundated with calls from patients claiming to have swine flu and requesting a note to sign them off work for longer than a week. Many are concerned that they are being asked to certify that people are ill without having seen them, meaning shirkers could take advantage.

Recent figures suggest the average worker takes 7.4 days off sick a year at a total cost of £17.3?billion to the economy, so the impact of staff taking another fortnight off for self-diagnosed swine flu could cripple some small businesses.


Ben Willmott, a senior public policy adviser at the Chartered Institute of Personnel and Development, said: “Obviously some employers are concerned that employees could take advantage of that.”

He urged managers to make sure they have contingency plans in place so they can cope if staff are genuinely ill with swine flu, and also to ensure that workers know that absence levels are monitored in order to catch those “swinging the lead”.

Meanwhile, GPs have been warned that a Tamiflu solution designed for babies will run out if it continues to be given to people who do not like to swallow capsules.

The Royal College of General Practitioners has told doctors not to prescribe the antiviral liquid to older children or adults. In a bulletin to members, the college said this was happening “across the country” and was “causing an unprecedented demand for the solution”.

Those who cannot swallow capsules should instead open the capsule and dissolve the powder in a sweet drink, it recommended.

http://www.telegraph.co.uk/Swine-flu-skivers-cost-firms-more-than-virus-say-employers

GPs fear illness could be missed by swine flu hotline

Many GPs are concerned patients with serious health problems could be missed if they seek advice from the National Flu Pandemic Service.

A poll for GP magazine found nearly 90% of family doctors fear conditions such as tonsilitis, bronchitis and meningitis may be overlooked.

The symptoms are so vague and wide ranging, swine flu can masquerade as a vast array of other diseases

Since the National Pandemic Flu Service was launched last month, it has prescribed the anti-viral drug tamiflu to 150,000 people.

But concerns have been raised that the phone lines are staffed by people with no medical training, working from a check list.

In the survey of 251 GPs, 87% said it was possible that diagnosing swine flu over the phone could mean that other diseases may be missed.

Just 3% were confident that this would not happen.

The poll comes after it was revealed that a 13-year-old boy from Yate, south Gloucestershire became seriously ill with a kidney infection after being misdiagnosed with swine flu.

Responding to the poll, one GP said: "The symptoms are so vague and wide ranging, swine flu can masquerade as a vast array of other diseases."

Another doctor said it was "blindingly obvious that a telephone diagnosis will very rarely, but very significantly, miss an alternative diagnosis which could lead to severe morbidity or mortality".

Professor Steve Field, chairman of the Royal College of GPs, accepted that the poll was an accurate reflection of doctors' concerns.

He admitted there would be a few patients who should be going straight to their GP, rather than contacting the flu service.

But he said patient safety had been the top priority when the checklists for the new service were being drawn up.

He also stressed that the service was not designed to give a diagnosis, but to enable patients suspected of having swine flu to get speedy access to anti-viral drugs.

Professor Field said: "The National Pandemic Flu Service has taken a lot of pressure off GPs previously swamped by calls from worried patients.

"This has freed up a lot more of GPs' time to concentrate on patients whose conditions are worsening or have developed complications as well as those people continuing to access their GP for advice and treatment for other conditions."

http://news.bbc.co.uk/1/hi/health/8184877.stm

Swine flu- rise in UK deaths but overall numbers decline

The number of deaths in England linked to swine flu jumped by nine to 36 over the past week, according to the Health Protection Agency.

The Health Protection Agency (HPA), at a briefing in London, said 530 patients had been admitted to hospital in England - down on the previous week's total of 793.

The HPA estimated there were 30,000 new cases of swine flu in England, but said the majority of cases continued to be "mild".

"There is no sign that the virus is changing," said the HPA. "It is not becoming more severe or developing resistance to anti-virals."

The number of weekly GP consultations dropped over the past week, coinciding with the launch of the National Pandemic Flu Service.

Chief Medical Officer Sir Liam Donaldson said the rise in the death toll did not indicate that the virus was becoming more potent.

"I don't think it suggests any increase in severity in the disease because we would have expected a higher proportion to be in intensive care or in hospital if the severity was increasing," he said.

"I think we are probably seeing the level of increase in the disease that would be expected, really, from the proportion of people in hospitals with serious disease."

Sir Liam predicted a second wave of the virus could strike after children returned to school but was unable to state exactly when this was likely to hit.

"It's just guesswork," he said. "We would anticipate when the schools were back, at some point after that, it will start to rise again."

He added there were no plans to close schools or delay their opening on a national scale.

"I think we are pretty certain we will see a second wave," said Sir Liam.

The HPA said 56 of the 530 people admitted to hospital after contracting swine flu were in "critical care".

Globally, the total of confirmed cases has reached 193,000 and the number of deaths is 1,362.

Sir Liam said the National Pandemic Flu Service would remain in place although the briefing was told it could be "scaled up or down" depending on the number of new cases reported.

http://www.telegraph.co.uk/health/swine-flu/5983531/Swine-flu-rise-in-deaths-but-overall-numbers-decline.html

Swine flu five times more virulent than normal

Swine flu has been blamed for two more deaths– as the first full analysis of the virus shows it is five times more virulent than ordinary seasonal flu.

Experts said the deaths were "very sad", although not unexpected given the tens of thousands infected, but warned that any cluster of deaths could indicate the virus had mutated and become nastier.

Wendy Barclay, professor of influenza virology at Imperial College, London, said: "With so many people becoming infected we must expect that some fatalities will occur. It is very important to keep a careful look for clusters of severe cases that might indicate that a mutated virus has arisen that can be more virulent than the swine flu that has circulated until now. Each severe or fatal case should be carefully characterised using our best science to understand the reasons why this has happened."

The first full analysis of the H1N1 virus, published in Nature, shows it causes more lung damage in animals than seasonal flu. For two strains of virus tested, five times less was needed to cause the same damage as seasonal flu. Damage to the lungs increases the risk of pneumonia which is the commonest cause of complications, severe illness and death in flu epidemics.

Professor Ian Jones, director of research at the University of Reading, said: "This complete analysis of the current H1N1 is what we've been waiting for. For a number of measures it shows that the new virus is more serious than seasonal H1N1 but that, nonetheless, the major outcome to infection is recovery. For the few cases of severe infection the data should help in the clinical management of hospitalised patients."

The British Medical Association said it was saddened by the death of GP Dr Day, and the other victims, but urged the public not to panic. Dr Day, who qualified as a doctor in 1970, had recently retired from the Priory Gardens Health Centre in Dunstable but still worked there part time as as a locum.

Dr Laurence Buckman, chairman of the BMA's GPs committee, said: "Doctors have always accepted that there are risks associated with their job. Obviously these are smaller than they used to be with the advent of modern medicine, but they can never be eliminated altogether.

"It is understandable that people will be worried when they hear that a GP has died but we urge them to follow the recommended advice and contact their family doctor, rather than physically going to the surgery if they have symptoms. The vast majority of people will recover quickly by taking paracetamol or ibuprofen, and drinking plenty of fluids. Anyone who is not recovering quickly should get extra advice as a small number will need more intensive treatment.

"We must remember that every year there are deaths from complications of seasonal flu; this is unfortunately inevitable with any strain of influenza."

Liberal Democrat health spokesman Norman Lamb said: "Dealing with the flu crisis is a mammoth task and NHS staff need access to support and advice given the anxiety that many of them may face.

"The labour Government needs to ensure that all frontline NHS staff are given access to flu vaccines as a matter of urgency.

http://www.independent.co.uk/life-style/health-and-families/health-news/swine-flu-five-times-more-virulent-1744351.html

Tamiflu side effects linked to children reports find

More than half of children taking Tamiflu to combat swine flu suffer side effects such as nausea, insomnia and nightmares, new research claims.

The antiviral drug, which is being handed out to hundreds of thousands of Britons, can also produce stomach pains, vomiting and diarrhoea, research suggests.

A study found that almost one in five youngsters experience neuropsychiatric side effects, such as poor concentration, confusion, and sleeping problems.

Thousands of schoolchildren were given the drug as a preventive measure during the early stages of the swine flu pandemic in Britain.

The findings are likely to lead to concern among parents that their children's performance at school has been jeopardised by taking the drug.

Only people with suspected or confirmed swine flu are now being prescribed Tamiflu, and around 150,000 packs have been distributed by the newly launched National Pandemic Flu Service in the past week alone.

Two studies from experts at the Health Protection Agency (HPA) showed a "high proportion" of British schoolchildren reporting problems after taking Tamiflu.

Data was gathered from children at three schools in London and one in south west England who were given Tamiflu earlier this year after classmates became infected.

One study, of 248 children aged 11 and 12 at a school in south west England, which was closed after a pupil contracted the virus, found that more than half suffered side effects from taking Tamiflu.

The report said: "Fifty-one per cent experienced symptoms, such as feeling sick (31.2 per cent), headaches (24.3 per cent) and stomach ache (21.1 per cent).

"Although some children were ill with flu-like symptoms, those tested did not have A (H1N1) v (swine flu) infection."

The researchers said "likely side effects were common" and the "burden of side effects needs to be considered" when deciding on giving Tamiflu to children prophylactically.

Another study of 103 schoolchildren found 45 suffered side-effects such as nausea, stomach pain, problems sleeping, vomiting and diarrhoea.

Almost one in five (18 per cent) reported a neuropsychiatric side effect, such as poor concentration, inability to think clearly, problems sleeping, feeling dazed or confused and nightmares.

The report concluded: "This may be of particular concern to exam year students (and their parents)."

The studies were carried out in the early stages of the pandemic, when everyone sharing a classroom with a child who developed swine flu was given the drug, even if they showed no symptoms.

The findings were disclosed as it emerged that Japanese authorities are advising doctors not to prescribe Tamiflu to youngsters aged 10 to 19 over fears of neuropsychiatric side effects.

A statement from Roche, which manufactures Tamiflu, said the contribution of Tamiflu to neuropsychiatric effects "has not been established".

Tamiflu-linked-to-side-effects-among-children-reports-find

Labour Ministers unprepared for swine flu second wave Lords warn

The labour Government appears to be unprepared for an expected second wave of swine flu in the autumn, according to a report by peers published this week.

The House of Lords Science and Technology Committee said that ministers had failed to offer reassurances that NHS services could deal with the predicted surge, when several million people may become ill.

It called for clarity on how intensive and critical care departments will cope with high patient numbers. It expressed concerns about NHS staff providing services outside their usual expertise if they are transferred around the country to the areas experiencing most demand.

The committee also criticised ministers for not setting up the National Pandemic Flu Service for England earlier in the year.

An interim service is now in operation to diagnose cases over the phone or internet and distribute drugs at pharmacies and health centres. But this was beset by problems when it launched last week, with the website crashing in the first few minutes.

The committee praised the Government’s actions in stockpiling antiviral drugs such as Tamiflu and entering into advance purchase agreements for a vaccine for the H1N1 flu strain, but said ministers needed to offer better guidance over who could have access to these treatments.

Swine flu is affecting about 100,000 people a week, and hundreds are being treated in hospital.

Lord Sutherland, the chairman of the committee, said that he was disappointed that tests to examine how the full range of health services would respond in a pandemic had not been carried our earlier.

“While the Government have got some things right in preparing for a flu pandemic, such as the stockpiling of antivirals, there are other areas where we appear to be under-prepared,” he said.

“We were surprised and disappointed that the Government had not undertaken ‘whole system’ testing of health services preparations for a flu pandemic before swine flu emerged.”

The peers said that the national swine flu helpline in England should also have been set up sooner and asked for assurances that it will cope with high demand this autumn.

Lord Jenkin of Roding, a former health secretary, who was asked to sit on the committee’s flu pandemic inquiry, told The Times earlier this year that ministers had said the hotline would be ready by April or May.

From:
http://www.timesonline.co.uk/tol/news/uk/health/Swine_flu/article6730118.ece

Pregnant women up to four times more likely to become seriously ill with swine flu

Pregnant women are up to four times more likely to be seriously ill and require hospitalisation when they have swine flu than the general population, new research from the United States suggests.

They are also more likely to die of swine flu or even seasonal flu, meaning they should be prioritised for the flu vaccine as soon as it is available, a study by the US Centers for Disease Control and Prevention (CDC) concluded.

So far, at least two pregnant women are known to have died in Britain after contracting the H1N1 flu strain, while a third had to be flown to Sweden for emergency treatment.

The researchers said that pregnant women with flu symptoms should start taking antiviral treatment as soon as possible, while all expectant mothers should receive a vaccine once one becomes available in coming months.

Little is known about the possible ill-effects of the drugs on the foetus but scientists say their benefits are likely to be greater than the risks.

Data collected by the CDC showed there were 34 confirmed cases of swine flu among pregnant women in the United States between mid-April and mid-May, the first month of the outbreak that has since been declared a global pandemic by the World Health Organisation.

Eleven of the pregnant women, or about a third, were admitted to hospital. The hospitalisation rate for members of the general public infected with swine flu was around eight per cent, or a quarter of the rate among pregnant women, the study showed.

One of the women who became ill in that first month died, but five more pregnant women died of swine flu in the United States during the following month of the outbreak, the report said.

None of the women who died had been given antiviral drugs promptly, within the first 48 hours of symptoms occurring. All of them had developed pneumonia and “acute respiratory distress syndrome” which required them to go on a ventilator, it said.

Denise Jamieson, the CDC’s lead author of the study, which is to be published next month in the Lancet medical journal, said: “We know that in seasonal influenza as well as in pandemic influenza, situations that pregnant women have an increased risk of severe disease and of dying.”

The increased risk is likely to be due to the changes that take place in a woman’s body during pregnancy, she said.

“There are mechanical and hormonal changes in pregnancy, there are changes in the cardiovascular and respiratory systems, there are immunologic changes.

“Lung capacity decreases because as the uterus grows it moves the diaphragm up and there’s basically less room for the lungs. All these changes make pregnant women more susceptible to and more severely affected by certain viruses, including influenza."

Once a vaccine is available, pregnant women will be a high priority, Dr Jamieson suggests. However, she said she was concerned that women may not come forward to be vaccinated because of fear of any effect on their baby.

The babies of five of the six pregnant women who died during the study period were delivered by Caesarean section.

None had any evidence of influenza infection and all but one, who was born 13 weeks before term, have been discharged in good health, the study said.

Boon Lim, Pandemic Flu Planning spokesman for the Royal College of Obstetricians and Gynaecologists (RCOG) said today: “The World Health Organization (WHO) have stated that pregnant women should be prioritised to receive the swine flu vaccines when these are available. Currently, in the UK, pregnant women are advised to be immunised against the seasonal flu. The recommendation by the CDC to immunise pregnant women from swine flu is an extension of this principle and one which we support.

“The RCOG is working closely with the Department of Health to examine the evidence around safety of vaccination against the swine flu virus. Further guidance on vaccination will be issued in the near future.”

Sir Liam Donaldson, the Chief Medical Officer for England, said that most pregnant women with swine flu would only get mild symptoms but pregnancy brought a higher risk of complications.

Mothers to be were currently advised to continue “normal activities” such as going to work, travelling on public transport and attending events and family gatherings.

“We are not advising pregnant women to cut down on their normal daily activity - some might choose to be very precautionary and not want to go into crowded places, but that is not the advice,” Sir Liam said.

From:
http://www.timesonline.co.uk/tol/news/uk/health/Swine_flu/article6731659.ece

Swine flu could become resistant to Tamiflu because of over prescribing

Swine flu could become resistant to Tamiflu, the only drug that can treat the virus, because it is being over prescribed, a leading doctor has warned.

Dr Holden, the British Medical Association's lead authority on pandemic flu, said he thought the thresholds for issuing Tamiflu had been set too low, a policy which he fears will come back to haunt the Department of Health if the H1N1 virus becomes resistant to Tamiflu.

The GP, based in Matlock, Derbyshire, helped draft the clinical algorithm used by operators on the National Pandemic Flu Service telephone line, but said doctors are being encouraged to dish out a "pill for every ill".

Writing in Pulse mageazine, he also accused Andy Burnham, the Health Secretary, and Sir Liam Donaldson, the Chief Medical Officer, of giving different advice to GPs and the public.

"Both ... have contradicted themselves by telling the public they can have Tamiflu if and when they want it, but at the same time telling GPs to use their clinical judgement.

"They are running with the hares and hunting with the hounds.

"People are finding it a bit hard to swallow that we are getting beaten up by the DH for antibiotics prescribing but that the same principle doesn't seem to apply to the judicious use of Tamiflu.

"Personally I feel the flu line will help to relieve pressure on GPs but my concern is that the threshold for giving out Tamiflu will be set too low. For most people, given that is a mild illness the amount of medication being given out is overkill."

As more courses of Tamiflu are distributed, GPs are seeing an increase in the number of patients who have experienced side-effects caused by the antiviral, including nausea, vomiting, diarrhoea and headaches.

"Every day GPs are saying they are seeing people with side effects from Tamiflu," said Dr Holden. People are going for second and third consultations with their GP. It's putting even more strain on the NHS."

Swine-flu-could-become-resistant-to-Tamiflu-because-of-over-prescribing

Cutting doctors hours during swine flu outbreak is unnecessary risk labour Government is warned

Cutting junior doctors hours during the swine flu outbreak will be "a sledgehammer that breaks the camel's back" medics have warned.

Implementing the European Working Time Directive next Saturday, when the NHS is already under pressure with 100,000 new cases of swine flu being diagnosed in a week, is the 'probably the worst time in living memory to do this', the junior doctors' campaign group RemedyUK said.

Junior doctors are the last group of NHS staff to come into the Directive this Saturday by cutting their working week from 56 hours to 48.

Experts have warned that the NHS is not ready for the change and there will be gaps left in rotas putting patients at risk.

John Black, president of the Royal College of Surgeons said if swine flu turns into a major crisis, the Government should show leadership and suspend the Directive.

He said: “We could have a one, two or three-stage serious pandemic. If that happens everybody of course will work whatever hours are necessary to keep the patients alive in a crisis."

“I trust that if that happens the Government will not fudge it and they will actually say that the European Working Time Directive leaves no slack at all in the system and if there is a major crisis it should be suspended.”

Richard Marks, Head of Policy at Remedy, said: “Millions have been spent on staff call-centres using non-medical staff to diagnose and prescribe (for swine flu) but at the same time they are reducing doctors’ working week by one full day.

"It’s probably the worst time in living memory to do this.”

Doctors are likely to be in short supply during a flu outbreak as they are in the frontline of exposure to the virus and are at increased risk of falling ill themselves and may also have sick children to care for during the peak of a pandemic.

RemedyUK has called for the introduction of the Directive to be delayed until the uncertainties over how the flu outbreak are resolved.

Dr Matt Jameson Evans, chairman of Remedy, said: “Unfortunately we have a camel’s back situation and swine-flu is more of a sledge hammer than a straw.

"We already know most doctors are against EWTD, we just need the leadership to do the right thing here.”

Dr Andy Thornley, Chairman of the BMA’s Junior Doctor Committee said: “Clearly pandemic flu is going to place additional pressure on an NHS that is trying to adapt to the introduction of the 48-hour week for junior doctors.

"The government need to be much clearer in communicating how it plans to deal with these additional pressures as it is unacceptable that so little information is trickling down to junior doctors.

"It is also important that the NHS works hard to reduce unnecessary bureaucracy and inappropriate work so that junior doctors can do what they do best – treat their patients.

The Directive does not allow for wholesale suspension but if individual staff work longer than the 48-hour limit the time can be balanced out over the coming months.

A report due from the House of Lords Science and Technology Committee is expected to criticise ministers for not setting up the National Pandemic Flu Service in April.

From:
Cutting-doctors-hours-during-swine-flu-outbreak-is-unnecessary-risk-Government-is-warned

Swine flu- labour ministers blamed for chaos

The labour Government will be criticised over its handling of the swine flu crisis by a powerful parliamentary committee this week.

The report will attack the labour Government's failure to keep its promise to set up a flu telephone helpline by April.

Labour Ministers will be held to account for the delay in setting up the national flu helpline and for giving confusing advice to vulnerable groups and NHS staff.

The report will be published as senior doctors hold an urgent meeting with Andy Burnham, the Health Secretary, in a last ditch attempt to persuade him to drop controversial European rules limiting the hours doctors can work, which are due to come into force on Saturday.

One doctor gave warning that the NHS was facing a “triple whammy” as it struggled with swine flu, the introduction of the European Union Working Time Directive and– four days later – the movement of more than 30,000 junior doctors between hospitals as part of the annual rotation of specialities.

Further concerns over Britain’s swine flu response are raised today by a Sunday Telegraph investigation, which has exposed major security lapses in the national flu pandemic service.

The flaws would allow fraudsters to obtain dozens of doses of Tamiflu – the main drug being issued to swine flu victims.

The Sunday Telegraph has also discovered that maternity units are planning to cancel home births and planned caesarean sections if the outbreak turns into a major epidemic.

Andrew Lansley, the shadow health secretary, said government planning failures had created a response to the pandemic that already appeared to be “riddled with problems”. He accused ministers of taking “an ad hoc approach” to a situation which needed careful planning.

This week’s report by the House of Lords science and technology select committee is the first to look into the Government’s preparedness for pandemic flu. It will attack its failure to keep its promise to set up a flu telephone helpline by April when the world was on the brink of a pandemic.

This newspaper disclosed in May that the delay was caused by the Treasury, which took seven months to sign off on the deal.

The hold-up meant the Government had to introduce a stopgap flu phoneline, introduced last week, manned by staff given just one day of training.

In the meantime, NHS Direct, which should have been running the service, has made hundreds of its highly trained staff redundant.

The Lords report will also question the adequacy of advice being issued to the public, in particular that offered to vulnerable groups such as expectant mothers. In evidence sessions, committee members described the lack of public advice for pregnant women as “extraordinary”.

The advice was only publicised last week, leading to further confusion when ministers appeared to distance themselves from recommendations they had previously endorsed.

Last night senior doctors said ministers must take urgent action to avert an impending crisis.

From Saturday, doctors will not be allowed to work more than 48 hours a week, under EU rules. The change has been fiercely resisted by many senior doctors who say it will put lives at risk.

It could mean that the NHS is short of doctors just as pressure on hospitals caused by the swine flu outbreak intensifies.

Britain’s top surgeon has urged ministers to suspend changes to working hours. John Black, the president of the Royal College of Surgeons, accused ministers of “having their heads in the sand”.

He said: “The courageous thing to do would be to step in and suspend the 48-hour limit for the whole of the NHS, once we come under pressure, but that would require political leadership. I don’t expect it to happen.”

Mr Black said despite warnings the Government had made no useful concessions over the rules which he says will put lives at risk, and “devastate” the training of health professionals. He will restate his plea for concessions over doctors’ hours in a meeting with Mr Burnham on Wednesday.

The weekly 48-hour limit for doctors is measured over a sixth-month period, allowing doctors to work extra hours some weeks, if they then cut back on others.

Doctors can opt out of the directive on a voluntary basis, but only individually, throwing rota planning into “chaos”, according to senior doctors. They want whole departments or specialities to be allowed to suspend the rules.

Both Mr Black, and John Heyworth, the president of the College of Emergency Medicine, said they did not expect the introduction of the working directive to have an immediate impact, but they fear it could cause shortages of doctors by September, when flu cases may soar. Mr Heyworth, an A&E consultant at Southhampton General Hospital, said: “There is a triple whammy heading inexorably our way – the directive, doctor rotations, and swine flu, and the impact of all of this happening at once is unknown.”

He said doctors had explained their concerns to ministers about the changes to working hours “at great length”. Last night the Government defended the operation of its Pandemic Flu Service. It said that on the first day of the service, Thursday, it carried out more than 58,000 assessments, and almost 6,000 courses of antiviral drugs were collected in England.

From:
http://www.telegraph.co.uk/health/swine-flu/Swine-flu-ministers-blamed-for-chaos

Swine flu helpline hit by problems

The launch of the national pandemic flu service for England yesterday was marred by some early hiccups as the number of the country’s swine flu cases was estimated to have almost doubled in a week from 55,000 to 100,000.

Despite the steep rise in cases, there was a smaller increase in the numbers in hospital with the disease – up to 840 against 652 last week – and a rise of just 10 in the number in intensive care to 63. All strategic health auth­ority areas are classified as suffering from “exceptional influenza activity”. Some areas, including eastern districts of London, are hot spots.

But at 150 consultations per 100,000 population, the number of patients visiting the GP nationally remains below the rates seen in the last sizeable outbreak of flu like illness in 1999-2000 and the number of actual cases is far below the peak of the last flu pandemic in 1969-70.

Sir Liam Donaldson, the chief medical officer, said more detailed investigation of the deaths that have to date been attributed to swine flu had resulted in some new cases being counted in and others discounted, leaving the provisional total at 26.

The English figures were disclosed as Professor Hugh Pennington, a leading virologist at the University of Aberdeen, said that Scotland was “possibly through the worst” of the first phase of the virus as latest figures showed far lower GP consultation rates than in ­England.

The relatively small rise in those being admitted to hospital in England and an apparent drop in the GP consultation rate in some parts of the country provided a possible first hint that the initial wave of the infection might also be peaking in England, as it has in the US.

But Sir Liam warned against “reading too much” into those figures. If the data held for another week or so they might indicate a lull in the pandemic, “but I don’t think so yet”.

The infection remains mild in most people and continues disproportionately to affect children. Two thirds of those who have died had other severe underlying medical conditions, Sir Liam said, with only 16 per cent of the small number of deaths in otherwise healthy people.

“The bad thing would be if 100 per cent of the deaths were healthy people,” he said. With the current state of the virus, “the vast majority, even with an underlying condition, will get flu and recover well”.

The Federation of Small Businesses wrote on Thursday to Andy Burnham, the health secretary, calling for measures to help its members through the pandemic.

It wants routine inspections of businesses suspended in areas with high levels of infection and a simpler system for the smallest companies to reclaim statutory sick pay.

“A small firm employing only three people could expect to have all of its workforce off for up to two weeks this autumn,” John Wright, the federation’s national chairman, said.

Sir Liam said that school closures had not been ruled out for the autumn, but “it would be a huge step to close schools across the country”, with a considerable economic impact.

The pandemic flu service is intended to lift the burden from GPs and give swift access to anti virals. Patients whose replies to a list of questions indicate they may have swine flu will be given an access number and told where a relative or friend can, with suitable ID, collect their Tamiflu.

The Association of British Insurers said its members would accept the number as the equivalent of a medical diagnosis of flu for travel insurance claims.

Early callers to the swine flu hotline on Thursday afternoon were greeted with the slightly disconcerting question asking whether they were “conscious”, write FT reporters.

More worrying was the fact that the online version had already crashed after being swamped, though the telephone service seemed to be working well and call centre staff were responding promptly.

One potential sufferer with flu-type symptoms said the person taking his call appeared to be reading from a similar list of “do you have swine flu?” questions as seen online. The questions ranged from “do you have trouble speaking?” to “do you have a patch of purple dots underneath your skin?” and “can you bring your chin down to your chest?”

Callers are also told that if they misused the service they would be prosecuted.

No questions were asked of the caller whether he was part of an “at risk” group, such as asthmatics.

He described the process as similar to “ringing a bank or an insurance company”, with the call-centre worker “clearly not a medical professional”. The 2,000 operators will liaise with GPs to report problems. So far, the hotline is available only in England.

From:
http://www.ft.com/cms/s/0/909e04e0-7794-11de-9713-00144feabdc0,dwp_uuid=819fc44c-33e2-11de-9eea-00144feabdc0.html