The Swine flu H1N1 virus that swept the world last year causing a global health emergency has returned to claim the lives of 10 adults in the UK in the past six weeks.The 10 deaths were in younger adults under 65 and associated with H1N1 swine flu. Most had underlying conditions but “a small proportion” were healthy before being struck down by the virus, according to the Health Protection Agency (HPA).

Seasonal flu normally causes severe illness and death in the elderly. The H1N1 swine flu virus targets pregnant women, younger adults, and those with chronic conditions, making it a cause of particular alarm.

No other similar reports of deaths linked with swine flu have been received from elsewhere in Europe.

Official figures show GP consultations for flu-like illness in England were at 13.3 per 100,000 population last week, well below baseline levels.

Flu experts expressed surprise at the relatively high incidence of deaths and severe illness in the context of the low consultation rates. John Watson, head of respiratory diseases at the Health Protection Agency, said: “We seem to be in the vanguard on this. Other European countries are just beginning to see some H1N1 activity.”

Calls to NHS Direct and other indicators show there is “quite a lot” of H1N1 swine flu about, despite the low GP consultation rate.

Around 30 per cent of those who fell ill, went to their GP and got tested for the virus, were coming up positive for H1N1, which was a high rate. Flu was very difficult to predict, Dr Watson added. “I am a little surprised to see as much activity as we seem to be seeing – both in terms of its spread in the community and its severity. I don’t see it as being extraordinary but it is more than I would have expected.”

All parts of the country are affected with deaths reported from each region, according to the HPA. There were nine flu outbreaks last week, eight in schools and one in an army barracks in Yorkshire.

Pressure has been building on intensive care in recent days with the worst affected patients treated on Extra-Corporeal Membrane Oxygenation (ECMO) machines which bypass the lungs to artificially oxygenate the blood. “A good many intensive care units are seeing severely ill cases including some using ECMO beds,” Dr Watson said.

Swine flu arrived last year from Mexico creating the first flu pandemic for 40 years. In the UK, the first wave of the pandemic struck in the summer – unusually for flu – followed by a second smaller wave before Christmas.

Dr Watson said: “A lot of people were infected through the two waves of the last pandemic. We estimate something like two-thirds of children and a half of adults are likely to have been infected even though they may have had no symptoms.

“We wouldn’t anticipate a big epidemic wave of flu activity due to H1N1 this year. “But there are still a substantial number of people who remain susceptible.”

Many who caught swine flu last year suffered only minor illness but a small number were severely ill. There were 494 deaths in the year to April 2010.

The fear among flu experts is that the virus could mutate to cause more severe illness or target a different section of the population such as the elderly who are more vulnerable.

But laboratory analysis has shown that the circulating strain of the virus is “very much the same” as last year and has not shown “any significant change”, according to the HPA.

Five of the 10 adults who died for whom information was available had not received the flu vaccine, the HPA said. National figures show vaccination rates are lower than in previous years covering 66 per cent of the over-65s and 40 per cent of younger adults at risk (pregnant women and those with chronic diseases such as asthma).

Professor David Salisbury, director of immunisation at the Department of Health said: “These figures demonstrate that the effects of flu are not to be underestimated. It is not the same as getting a cold and can seriously affect your health.

“The seasonal flu jab protects against the dominant strains – this year it protects against three types of flu, including the type known as swine flu. If you are in a risk group, then I would urge you to visit your GP surgery and get the vaccination as soon as possible. It is not too late to get vaccinated for your protection and that of your family.”

In addition to H1N1 swine flu, which has become the dominant Influenza A virus in Britain, about 40 per cent of virus strains isolated this winter are Influenza B, which is most common in children, causes mostly mild illness, and has been responsible for several outbreaks in schools in recent weeks.

The last year in which it caused widespread illness was 2005-6. “There is plenty of B about,” Dr Watson said.

http://www.independent.co.uk/doctors-shocked-by-spread-of-swine-flu-ndash-and-its-severity

The swine flu pandemic cost the UK 457 lives and more than £1.24 billion, the official report into the outbreak has revealed.
Dame Deirdre Hine, a former chief medical officer for Wales who carried out the review, said that the death toll could have been much higher but for the swift response and mild nature of the disease.

She denied the contingency plans amounted to an overreaction and said that it was important that the relative success did not make us complacent.

She concluded that the UK’s response to last year’s outbreak was “proportionate and effective”.

“It is imperative that the experience of 2009 doesn’t lead to complacency,” she said. “It is a bit like childbirth – when it’s all over, you forget quite how serious and how difficult it all was.

“The threat of a flu pandemic remains very high. Both the successes and the lessons from this pandemic should inform policy and planning for the next one because there will be a next one, and the next one might be more severe.

“If the UK government had not responded to the unexpected threat. Had it turned out to be more severe then we would have been having a very different press conference today.”

She highlighted the lack of flexibility in the contracts signed by the Government for vaccines against the H1N1 virus, meaning that Britain was left with many doses it did not need, many of which were donated to the Third World.

There were 457 reported and confirmed swine flu-related deaths across the UK between the outbreak in April last year and March this year.

Figures in the report show that Britain spent £654 million preparing for a possible flu pandemic, and £587 million responding to the H1N1 outbreak – a total of £1.24 billion.

This includes £1.01 billion on drugs, among them antivirals, doses of vaccine and antibiotics.

The report said there was a lack of flexibility once the Department of Health (DoH) signed contracts for swine flu vaccine with drug manufacturers GlaxoSmithKline (GSK) and Baxter.

Baxter agreed to a “break clause” allowing the Government to cancel its order for some of the doses but GSK refused.

The report noted that the DoH eventually agreed to take 35 million doses of the vaccine from GSK.

“I think we have got to set these figures, which seem enormous, against the potential for saving lives,” she said.

“It is fairly clear, although we can’t actually identify the number, that there probably were lives saved of very young people, young children and so on. These are extremely valuable lives.”

From: http://www.telegraph.co.uk/Swine-flu-killed-457-people-and-cost-1.24-billion-official-figures-show

Three scientists who drew up the key World Health Organisation guidelines advising governments to stockpile drugs in the event of a flu pandemic had previously been paid by drug companies which stood to profit.
An investigation by the British Medical Journal and the Bureau of Investigative Journalism, the not-for-profit reporting unit, shows that WHO guidance issued in 2004 was authored by three scientists who had previously received payment for other work from Roche, which makes Tamiflu, and GlaxoSmithKline (GSK), manufacturer of Relenza.

City analysts say that pharmaceutical companies banked more than $7bn (£4.8bn) as governments stockpiled drugs. The issue of transparency has risen to the forefront of public health debate after dramatic predictions last year about a swine flu pandemic did not come true.

The UK, which warned that 65,000 could die as a result of the virus, spent an estimated £1bn stockpiling drugs and vaccines; officials are now attempting to unpick expensive drug contracts.

The cabinet office has launched an inquiry into the cost to the taxpayer of the panic-buying of drugs.

Although the experts consulted made no secret of industry ties in other settings, declaring them in research papers and at universities, the WHO itself did not publicly disclose any of these in its seminal 2004 guidance. In its note, the WHO advised: “Countries that are considering the use of antivirals as part of their pandemic response will need to stockpile in advance.”

Many nations would adopt this guidance, including Britain. In 2005, the government said it had begun bulk-buying the drug Tamiflu, initially ordering 14.6m doses after bird flu killed 40 in Asia.

The specific guidance on antivirals was written by Professor Fred Hayden. He has confirmed in an email that he was being paid by Roche for lectures and consultancy work at the time the guidance was produced and published. He received payments from GSK for consultancy and lecturing until 2002. He said “[declaration of interest] forms were filled out for the 2002 consultation”.

The previous year Hayden was also one of the main authors of a Roche-sponsored study that asserted what was to become a main Tamiflu selling point – its claim of a 60% reduction in flu hospitalisations.

Dr Arnold Monto was the author of the WHO annex dealing with vaccine usage in pandemics. Between 2000 and 2004, and at the time of writing the annex, Monto had openly declared consultancy fees and research support from Roche and GSK. No conflict of interest statement was included in the annex published by the WHO.

When asked if he had signed a declaration of interest form for WHO, Dr Monto said “conflict of interest forms are requested before participation in any WHO meeting”.

The third scientist, Professor Karl Nicholson, is credited with the WHO’s influential work Pandemic Influenza. According to declarations he made in the BMJ and Lancet in 2003, he had received sponsorship from GSK and Roche.

Even though the previous year these declarations had been openly made, no conflict of interest statement was included in the annex. Nicholson said he last had “financial relations” with Roche in 2001.

When asked if he had signed a declaration of interest form for WHO, he replied: “The WHO does require attendees of meetings, such as those held in 2002 and 2004, to complete declarations of interest.”

A WHO official told the BMJ it had to balance an individual’s privacy with the robustness of guidelines, which were subject to a wide external review process.

From: http://www.guardian.co.uk/business/2010/jun/04/swine-flu-experts-big-pharmaceutical