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The government have just launched the National Pandemic Flu Service, which is a new online service that will assess patients for symptoms of swine flu and, if required, provide an authorisation number that can then be used to collect anti-viral medication.

The system, which can also be accessed by telephone, is designed to take the strain off GPs as the swine flu pandemic spreads. For the moment, this service is only being used in England.

“The National Pandemic Flu Service is a new self-care service which will give people with pandemic swine flu symptoms fast access to information and antivirals”, said a department of health spokesman.

“This new service will free up GPs, enabling them to deal with other illnesses that need their urgent attention”.
The launch of the new system means important changes to the official advice given to those who think that they may have swine flu.

Latest advice from the NHS:

If you have flu-like symptoms and are concerned that you may have swine flu:
• Stay at home and check your symptoms using the National Pandemic Flu Service
• You should call your GP directly if:
- you have a serious underlying illness
- you are pregnant
- you have a sick child under one year old
- your condition suddenly gets much worse
- your condition is still getting worse after seven days (five for a child)

Note: The National Pandemic Flu Service is a new online service that will assess your symptoms and, if required, provide an authorisation number that can be used to enable you to collect antiviral medication from a local collection point. For those who do not have internet access, the same service can be accessed by telephone on:

Swine Flu Telephone Helpline Phone Number: 0800 1 513 100
Minicom: 0800 1 513 200
Website: www.direct.gov.uk/pandemicflu

Latest figures at week ending 19th July 2009:

There were an estimated 100,000 new cases of swine flu in the UK in the week ending July 19. Total deaths from swine flu currently stand at 31. More than 800 people with swine flu have died worldwide since the beginning of the pandemic.

At this week's update on the swine flu situation, Sir Liam Donaldson, Chief Medical Officer, also said:
• There are 840 seriously ill people in hospital with swine flu. Of these, 63 are in intensive care
• Under 14-year-olds continue to be the age group predominantly affected
• The provisional number of deaths in England related to swine flu is 26, and around 16% did not have any underlying health conditions. The figure is the same as last week because some unrelated deaths have been removed and others added. (This figure represents the number of deaths in individuals with swine flu but does not represent the number of deaths that can be attributed to swine flu).
• The disease is generally mild in most people so far, but is proving severe in a small minority of cases.

Pregnant women at risk of swine flu

Many newspapers reported last weekend that pregnant women are being given confusing advice on swine flu.
Pregnant women are one of the higher risk groups for swine flu, as they are for all influenza viruses. It is therefore important for them to take precautions.

How dangerous is swine flu?

The vast majority of cases reported so far in this country have so far been mild. Only a small number have led to serious illness, and these have frequently been where patients have had underlying existing health problems.
There has been an argument put forward that the government should restrict anti-virals to those groups who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, then the NHS should let the virus run its course, treating it with paracetamol and bed rest as you would normal flu.

However, the government’s Scientific Advisory Group for Emergencies (SAGE) believes there is still some uncertainty about the risk profile of the virus. For instance, there are reports of some cases in Argentina where young, healthy adults have apparently become extremely ill from swine flu.

While there is still this doubt, the government has decided to continue offering Tamiflu to everyone with swine flu at their doctor's discretion.

"We will keep this matter under review, with advice from SAGE", said Burnham.

Planning assumptions

Recently, the government released a Planning Assumptions paper outlining possible scenarios for how the pandemic might develop in the UK. It says that if the current growth in cases is sustained, a substantial wave of cases with up to 30% of the population experiencing symptoms could peak in early September 2009, although a smaller but earlier peak is also possible.

Alternatively, seasonal effects might substantially slow the epidemic in July and August – perhaps to the extent of leading to a decline in weekly cases in August, before resurgence in the autumn, for example when schools re-open after the summer holidays. If so, the overall peak of the pandemic might be delayed to October or possibly even later.

These forecasts and others in the report are based on a "reasonable worst case" scenario and should therefore not be taken as a prediction of how the pandemic will develop. Planning against the reasonable worst-case scenario will ensure, however, that plans are robust against all likely scenarios.

Mortality planning assumptions range from 3,100 deaths in the UK to 65,000 deaths in a reasonable worst case scenario.

Which groups are at greatest risk of catching swine flu?

Some people are more at risk than others of serious illness if they catch swine flu. They will need to start taking antivirals as soon as they are confirmed with the illness. On occasion, doctors may advise some high risk patients to take antivirals before they have symptoms if someone close to them has swine flu.

The risk profile of the virus is still being studied but it is already known that certain groups of people are particularly vulnerable. These include:

• Patients who have had drug treatment for asthma in the past three years
• Pregnant women
• People aged 65 years and older
• Children under five years old people with chronic lung disease
• People with chronic heart disease
• People with chronic kidney disease
• People with chronic liver disease

• People with chronic neurological disease
• People with immunosuppression (whether caused by disease or treatment)
• People with diabetes mellitus

Is there a vaccine available for swine flu?
A vaccine to protect against swine flu is still being developed but it is not available yet.
The first batches of vaccine are expected to arrive in the autumn, and 30m double doses – enough for half the population – are expected to be available by the end of the year.

The government has ordered enough vaccine for the whole population and, when it becomes available, will focus on those at the greatest risk first.

What is the current global situation?
To date, there are now more than 143,000 laboratory confirmed cases, though the actual number of infections is probably much higher. More than 800 deaths have been confirmed worldwide.

Helping Prevent the Spread of Swine Flu - Catch it, bin it, kill it.
Although the UK has moved to a treatment phase for swine flu, it’s important that people continue to do everything they can to stop the virus from spreading.

The key is to practise good respiratory and hand hygiene. In other words, remember to Catch it, Bin It, Kill It. Catch your sneeze in a tissue, place it quickly in a bin and wash your hands and surfaces regularly to kill the virus.

A History of Swine Flu:

Swine influenza was first proposed to be a disease related to human influenza during the 1918 flu pandemic, when pigs became sick at the same time as humans. The first identification of an influenza virus as a cause of disease in pigs occurred about ten years later, in 1930. For the following 60 years, swine influenza strains were almost exclusively H1N1. Then, between 1997 and 2002, new strains of three different subtypes and five different genotypes emerged as causes of influenza among pigs in North America. In 1997-1998, H3N2 strains emerged. These strains, which include genes derived by reassortment from human, swine and avian viruses, have become a major cause of swine influenza in North America. Reassortment between H1N1 and H3N2 produced H1N2. In 1999 in Canada, a strain of H4N6 crossed the species barrier from birds to pigs, but was contained on a single farm.

The H1N1 form of swine flu is one of the descendants of the strain that caused the 1918 flu pandemic. As well as persisting in pigs, the descendants of the 1918 virus have also circulated in humans through the 20th century, contributing to the normal seasonal epidemics of influenza However, direct transmission from pigs to humans is rare, with only 12 cases in the U.S. since 2005. Nevertheless, the retention of influenza strains in pigs after these strains have disappeared from the human population might make pigs a reservoir where influenza viruses could persist, later emerging to reinfect humans once human immunity to these strains has waned.

Swine flu has been reported numerous times as a zoonosis in humans, usually with limited distribution, rarely with a widespread distribution. Outbreaks in swine are common and cause significant economic losses in industry, primarily by causing stunting and extended time to market. For example, this disease costs the British meat industry about £65 million every year.

1918 pandemic in humans
The 1918 flu pandemic in humans was associated with H1N1 and influenza appearing in pigs; this may reflect a zoonosis either from swine to humans, or from humans to swine. Although it is not certain in which direction the virus was transferred, some evidence suggests that, in this case, pigs caught the disease from humans. For instance, swine influenza was only noted as a new disease of pigs in 1918, after the first large outbreaks of influenza amongst people. Although a recent phylogenetic analysis of more recent strains of influenza in humans, birds, and swine suggests that the 1918 outbreak in humans followed a reassortment event within a mammal, the exact origin of the 1918 strain remains elusive. It is estimated that anywhere from 50 to 100 million people were killed worldwide

1976 U.S. outbreak
On February 5, 1976, in the United States an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that the cause of death was a new strain of swine flu. The strain, a variant of H1N1, is known as A/New Jersey/1976 (H1N1). It was detected only from January 19 to February 9 and did not spread beyond Fort Dix.
This new strain appeared to be closely related to the strain involved in the 1918 flu pandemic. Moreover, the ensuing increased surveillance uncovered another strain in circulation in the U.S.: A/Victoria/75 (H3N2) spread simultaneously, also caused illness, and persisted until March. Alarmed public-health officials decided action must be taken to head off another major pandemic, and urged President Gerald Ford that every person in the U.S. be vaccinated for the disease.

The vaccination program was plagued by delays and public relations problems. On October 1, 1976, the immunization program began and by October 11, approximately 40 million people, or about 24% of the population, had received swine flu immunizations. That same day, three senior citizens died soon after receiving their swine flu shots and there was a media outcry linking the deaths to the immunizations, despite the lack of positive proof. According to science writer Patrick Di Justo, however, by the time the truth was known — that the deaths were not proven to be related to the vaccine — it was too late. "The government had long feared mass panic about swine flu — now they feared mass panic about the swine flu vaccinations." This became a strong setback to the program.

There were reports of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, affecting some people who had received swine flu immunizations. This syndrome is a rare side-effect of modern influenza vaccines, with an incidence of about one case per million vaccinations. As a result, Di Justo writes that "the public refused to trust a government-operated health program that killed old people and crippled young people." In total, less than 33% of the population had been immunized by the end of 1976. The National Influenza Immunization Program was effectively halted on December 16.

Overall, there were about 500 cases of Guillain-Barré syndrome (GBS), resulting in death from severe pulmonary complications for 25 people, which, according to Dr. P. Haber, were probably caused by an immunopathological reaction to the 1976 vaccine. Other influenza vaccines have not been linked to GBS, though caution is advised for certain individuals, particularly those with a history of GBS. Still, as observed by a participant in the immunization program, the vaccine killed more Americans than the disease did.

1988 zoonosis
In September 1988, a swine flu virus killed one woman and infected others. 32-year old Barbara Ann Wieners was eight months pregnant when she and her husband, Ed, became ill after visiting the hog barn at a county fair in Walworth County, Wisconsin. Barbara died eight days later, after developing pneumonia. The only pathogen identified was an H1N1 strain of swine influenza virus. Doctors were able to induce labor and deliver a healthy daughter before she died. Her husband recovered from his symptoms.

Influenza-like illness (ILI) was reportedly widespread among the pigs exhibited at the fair. 76% of 25 swine exhibitors aged 9 to 19 tested positive for antibody to SIV, but no serious illnesses were detected among this group. Additional studies suggested between one and three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection. However, there was no community outbreak.

1998 US outbreak in swine
In 1998, swine flu was found in pigs in four U.S. states. Within a year, it had spread through pig populations across the United States. Scientists found that this virus had originated in pigs as a recombinant form of flu strains from birds and humans. This outbreak confirmed that pigs can serve as a crucible where novel influenza viruses emerge as a result of the reassortment of genes from different strains.

2007 Philippine outbreak in swine
On August 20, 2007 Department of Agriculture officers investigated the outbreak (epizootic) of swine flu in Nueva Ecija and Central Luzon, Philippines. The mortality rate is less than 10% for swine flu, unless there are complications like hog cholera. On July 27, 2007, the Philippine National Meat Inspection Service (NMIS) raised a hog cholera "red alert" warning over Metro Manila and 5 regions of Luzon after the disease spread to backyard pig farms in Bulacan and Pampanga, even if these tested negative for the swine flu virus.

2009 outbreak in humans
The H1N1 viral strain implicated in the 2009 flu pandemic among humans often is called "swine flu" because initial testing showed many of the genes in the virus were similar to influenza viruses normally occurring in North American swine. But further research has shown that the outbreak is due to a new strain of H1N1 not previously reported in pigs.

In late April, Margaret Chan, the World Health Organization's director-general, declared a "public health emergency of international concern" under the rules of the WHO's new International Health Regulations when the first cases of the H1N1 virus were reported in the United States. Following the outbreak, on May 2, 2009, it was reported in pigs at a farm in Alberta, Canada, with a link to the outbreak in Mexico. The pigs are suspected to have caught this new strain of virus from a farm worker who recently returned from Mexico, then showed symptoms of an influenza-like illness. These are probable cases, pending confirmation by laboratory testing.

The new strain was initially described as an apparent reassortment of at least four strains of influenza A virus subtype H1N1, including one strain endemic in humans, one endemic in birds, and two endemic in swine. Subsequent analysis suggested it was a reassortment of just two strains, both found in swine. Although initial reports identified the new strain as swine influenza (i.e., a zoonosis originating in swine), its origin is unknown. Several countries took precautionary measures to reduce the chances for a global pandemic of the disease. The Swine flu has been compared to other similar types of influenza virus in terms of mortality: "in the US it appears that for every 1000 people who get infected, about 40 people need admission to hospital and about one person dies". There are fears that swine flu will become a major global pandemic in the winter months, with many countries planning major vaccination campaigns.

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