SWINE FLU NEWS

Subject: FW: A (H1N1) Flu Update: (16/10/09)

VACCINE PROGRAMME FORMALLY ANNOUNCED

The four UK countries have formally announced the commencement of the

H1N1 vaccination programme. Vaccination of frontline Health and Social Care workers will start on 21 October, closely followed by the 'at-risk'

groups. NHS organisations have developed plans to vaccinate frontline staff and will now be moving to mobilise them. The clinical risk groups are listed below in order of priority (although the DH has advised that to deliver the programme most efficiently GPs may wish to invite all the groups at the same time):

a) Those aged 6 months to 65 years in current seasonal flu vaccine at risk groups

b) Pregnant women

c) Household contacts of immunocompromised individuals

d) People aged 65 and over in the current seasonal flu vaccine clinical at risk groups

Those with a clinical history of unconfirmed or confirmed swine flu in the 'at risk' groups should be vaccinated (HPA advice). It is anticipated that the vaccine will provide protection against swine flu for the duration of the pandemic. The vaccine may also provide some protection should the virus change.

Vaccine delivery timetable

The earliest delivery date to general practices is the week beginning Monday 26 October 2009, with all NHS practices supplied within 3-4 weeks of that date. Private doctors will not be supplied and until further notice their patients must register with an NHS practice to receive swine flu vaccination ( Ordinary flu vaccines are freely available )

Vaccine schedule (Pandemrix)

- From 6 months to under 10 years: Two half doses (0.25ml) with a minimum of three weeks between.

- From 10 years and over: One dose (0.5ml).

- For immunocompromised individuals aged 10 years and over: Two doses

(0.5ml) with a minimum of three weeks between.

Vaccine schedule (Celvapran)

Celvapan will be delivered to PCTs, who will make arrangements to vaccinate those with confirmed anaphylaxis to egg. From 6 months of age two doses (0.5ml) of Celvapan should be given, with a minimum of three weeks between doses.

Children

Only children over 6 months in the priority at-risk groups will be vaccinated initially. Where vaccination is indicated, the JCVI advises that Pandemrix (GSK) should be the vaccine of choice for those up to 18 years of age. This is because currently there are no paediatric data available for Celvapan. Pandemrix should not be given to individuals, including children, with a history of severe anaphylactic reaction to products containing egg. Pandemrix should be given in the case of less severe allergic reactions to egg.

Pregnancy

All UK pregnant women have been prioritised for the H1N1 vaccine as an 'at risk' group. The JCVI advises that pregnant women should be given Pandemrix since a one-dose schedule with this vaccine appears to give adequate levels of antibodies and thereby confer more rapid protection that would be afforded by a two-dose schedule. There is no evidence that thiomersal-containing vaccines present a risk to pregnant women or their offspring. There is no evidence of risk from vaccinating pregnant women, or those who are breast-feeding, with inactivated virus vaccines.

INTERACTION OF SEASONAL AND H1N1 FLU VACCINE

The Joint Committee on Vaccination and Immunisation (JCVI) and WHO have discounted the findings of a Canadian study suggesting a link between seasonal influenza vaccine and susceptibility to swine flu. The HPA has also stated that: 'There is no published evidence to support these findings. Indeed data published by Australia shows that seasonal influenza vaccination neither protects against nor increases the risk of infection with swine flu, highlighting the importance of the pandemic influenza vaccination programme.'

The HPA has emphasised the importance of delivering both flu programmes (seasonal and H1N1) because, although the majority of circulating flu is H1N1, other flu strains are also active.

NEW ANTIVIRAL PROPHYLAXIS GUIDANCE

New DH guidance advises that antiviral prophylaxis should NOT routinely be given to contacts of a case of H1N1 infection. Prophylaxis may be considered in certain rare situations (see below and detailed in Annex A of full guidance), following a risk assessment by a clinician.

Prophylaxis may be indicated for those who have had close contact within the last seven days with a person with flu symptoms, and:

- Have depleted immunity and are less able to cope with secondary bacterial infection after pandemic flu.

- Have advanced chronic illness, which would be destabilised by a severe viral illness.

- Have been recently discharged from hospital, having been treated for a serious illness, whose recovery would be destabilised by a severe viral illness.

- Are pregnant and have co-morbid conditions or morbid obesity.

For preventative purposes a single dose of antiviral is to be given each day for 10 days (doses of antiviral for prophylaxis can be found in the British National Formulary (and BNF for Children). Oseltamivir is indicated for the majority of patients while zanamivir is currently recommended for patients with chronic kidney disease stage 4 or 5, and as first choice prophylactic antiviral for pregnant women.

NHS Direct: 0845 4647 / www.nhsdirect.nhs.uk
Swine Flu helpline: 0800 0514 142 / http://www.nidirect.gov.uk/index/health-and-well-being/swine-flu.htm

The Treatment Line number (0800 1 513 100 / 0800 1 513 200) is not intended for general information. To access general information, the public will be advised to call the Information Line on 0800 1 513 513 or go to www.direct.gov.uk/pandemicflu.

As you might expect we are receiving an ever increasing number of enquiries about Swine Flu and the possiblity of being prescribed TAMIFLU.

If you believe that you require a prescription for TAMIFLU or wish to consult Dr Edmonds on the subject we suggest you apply for one of our patient TAMIFLU requests forms (for use EXCLUSIVELY by our patients and corporate companies ONLY). You can request this by simply clicking on enquiry to be sent a form which is subject to the following charges.

    Submission of Tamiflu Questionnaire (admin fee)          - £30.00
    Telephone/email consultation with Dr Edmonds from    - £40.00
    Dispensed TAMIFLU  (Current price July 09)                 - £57.50
    TAMIFLU Prescription Request                                   - £15.00

PLEASE NOTE : if you are not a registered patient we are sorry that the volume of enquiries does not permit us to respond to individual requests. Apologies.

Update 38

VACCINATION

The following groups will be prioritised in this order (numbers given are approximate and are for England only):

1. People aged over six months and under 65 years in current seasonal flu vaccine clinical at-risk groups (about 5 million people).
2. All pregnant women, subject to licensing conditions on trimesters (about 0.5 million people).
3. Household contacts of people with compromised immune systems e.g.
people in regular close contact with patients on treatment for cancer (about 0.5 million people).
4. People aged 65 and over in the current seasonal flu vaccine clinical at-risk groups (about 3.5 million people). This does not include otherwise healthy over 65s, since they appear to have some natural immunity to the virus.

TAMIFLU / SIDE EFFECTS

In the past week the media has focused greatly on the effectiveness and safety of antivirals. This follows the publication of a British Medical Journal (BMJ) article which concluded that the benefits of using antivirals to tackle the swine flu outbreak are likely to be limited.
The RCGP position remains that GPs should use their clinical discretion in prescribing antivirals. However, under 5s (and especially infants under 1) are in higher risk groups and should, when appropriate, be prescribed antivirals.

The Department of Health's response is as follows:

'The extent to which the findings can be applied to the current pandemic is questionable - after all, we already know that swine flu behaves differently to seasonal flu, and past pandemics have hit younger people hardest.

'We believe a safety-first approach of offering antivirals to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects.'

A spokesperson for Roche, the manufacturer of Tamiflu, told Pulse there is 'significant data' showing the drug is safe and well-tolerated in children.

USEFUL INFORMATION FOR PATIENTS

Please see the National Pandemic Flu Service page which contains information for patients in England, Wales, Northern Ireland and
Scotland:

https://www.pandemicflu.direct.gov.uk/

Update 36

FLU PATIENTS SHOULD STAY AT HOME FOR SEVEN DAYS

The Health Protection Agency (England) is advising people with confirmed swine flu to remain at home for a minimum period of seven days until symptom free.

ADVICE FOR PREGNANT WOMEN

On 29 July, the Lancet published findings from a USA based study on influenza virus infection during pregnancy. It showed that pregnant women might be at increased risk of complications from pandemic H1N1 virus infection; and results supported the present recommendation to promptly treat pregnant women with the H1N1 influenza virus using anti-influenza drugs.

SWINE FLU - Update 35

MANAGEMENT AND TREATMENT OF CHILDREN
Young children are considered to be at particular risk of severe influenza and the complications of influenza. The Royal College of General Practitioners (RCGP), the Royal College of Paediatrics and Child Health (RCPCH) and the British Medical Association (BMA) General Practitioners Committee (GPC) have teamed together to draft a letter on current guidance for assessing children with a possible diagnosis of swine flu. It is particularly important that all children under the age of 1 year with flu-like symptoms should be seen and assessed by GPs to exclude other serious treatable diseases, to establish the severity of infection and assess whether additional treatment is required (e.g. oral antibiotics). The letter can be accessed in full by using the link below:
http://www.rcgp.org.uk/pdf/Pandemic_Planning_Assessment_of_Children_in_Primary_Care_Comments-Final.pdf

SWINE FLU - Update 34

THE NATIONAL PANDEMIC FLU SERVICE
The National Pandemic Flu Service is intended to reduce pressure on GP surgeries and local NHS organisations and prevent the spread of the illness in the community.( Private patients will conmtinue to contact their personal physicians as before but to access NHS prescriptions they must comply with guidelines as follows )

If members of the public suspect that they have swine flu, they are instructed to:

1) Go online at www.direct.gov.uk/pandemicflu or call the Treatment Line on 0800 1 513 100. Textphone is available on 0800 1 513 200.

2) They will be taken through a list of basic questions about their symptoms and medical history, and asked to confirm their date of birth, name and address including their postcode.

3) If they are confirmed as having swine flu, they will be given a unique access number and told where their nearest antiviral collection point is. They should then ask a flu friend - a friend or relative to who doesn't have swine flu - to go and pick up their antivirals.

Anyone who suspects they have swine flu must not go to their GP or Accident and Emergency.
People should contact their doctor direct rather than using the National Pandemic Flu Service if:

- they have a serious underlying illness,
- they are pregnant,
- they have a sick child under one year old
- their condition suddenly gets much worse, or
- if their condition is still getting worse after 7 days (5 for a child)

Symptoms:
The Department of Health advises that people who have any of the following symptoms and a temperature of 38° C and above or feels hot may have swine flu.
The typical symptoms are:

- sudden fever (a high body temperature of 38C/100.4F or above), and
- sudden cough.

Other symptoms may include:

- headache,
- tiredness,
- chills,
- aching muscles,
- limb or joint pain,
- diarrhoea or stomach upset,
- sore throat,
- runny nose,
- sneezing, and
- loss of appetite

It is understood that the public will be advised that if they have a fever or a high temperature (over 38°C / 100.4°F), and any two of the following symptoms (Tiredness, headache, runny nose, sore throat, shortness of breath or cough, loss of appetite, aching muscles, diarrhoea or vomiting), they may have swine flu.

Flu friends:

The flu friend must show their own ID as well as that of the patient. The authorisation number and ID information will be checked to ensure it matches the information provided when the assessment of symptoms was completed.