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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