SUBSCRIBE TO BIG MED AT THE BIG MED SITE ON GOOGLE GROUPS.
Friday November 13, 2009
| AMERICAS | OCEANIA | EUROPE | MIDDLE EAST | ASIA | POLITICS | BUSINESS | RESEARCH | EDUCATION | WORKFORCE |
Big Medicine is published by Team EMS Inc.
Managing Editor
Contact: ideas@tems.ca
Views
Contributor Emeritus
Tools
Stop Violence Against Women & Girls
The views expressed here reflect the views of the authors alone, and do not necessarily reflect the views of any of their organizations. In particular, the views expressed here do not necessarily reflect those of Big Medicine, nor any member of Team EMS Inc.
NEWS: EUROPE
1113 More than 1.2 million cases of ARI and 239 deaths in the Ukraine [Europe update]--All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 474 deaths have been reported and the number of deaths by week has being clearly increasing over the last 3 weeks.
Situation in Ukraine
From 18 October to 12 November, the Ministry of Health has reported
a total of 1,253,558 cases of acute respiratory illness and 239
deaths. The majority of cases is concentrated in the Western oblasts
in Ukraine, but spreads to Kyiv and other parts of the country.
Influenza A(H1N1) has been identified in a number of samples in
national laboratories and confirmed by the WHO’s reference
laboratory in London. The last official number of laboratory
confirmed A(H1N1) cases in Ukraine was 32 (data from 06/11/09).
CDC estimates number of cases infected with H1N1
CDC estimated that between 14 million and 34 million cases of influenza A(H1N1)v occurred between April and October 2009. The methods are described in detail in the attached documents and are based on laboratory surveillance, published hospitalization estimates and multipliers derived from previously published prevalence estimates.
Mexican study shows protective effect of seasonal influenza vaccine
A study published in the Lancet describes the first 63 479 notified
pandemic influenza cases in Mexico up to 31st July, 2009 and
analyzes risk and protective factors for infection, hospitalisation
and fatal outcome. According to this study the risk of infection
with influenza A(H1N1), verified mainly by rapid tests, was lower
among people vaccinated for seasonal influenza.
A CDC study finds no protective effect of seasonal influenza vaccine
The CDC Mortality and Morbidity Weekly Report (MMWR) published an
analysis on the effectiveness of the 2008-09 trivalent seasonal
influenza vaccine against pandemic influenza H1N1. This case-cohort
analysis was based on notifications data and did not show any
vaccine effectiveness.
Eurosurveillance update
In their paper H Nishiura et al. present a study comparing the risk
of clinical attack rates between one- and two-dose vaccination
schemes. They demonstrate that if the efficacies do not greatly vary
between one- and two -dose schemes, a one-dose vaccination scheme
may well be supported. Nevertheless, two-dose vaccination is shown
to result in less morbidity if the vaccine efficacies are greatly
diminished by reducing the dose. From the results the authors
conclude that as long as the detailed efficacy estimates rest on
theoretical assumptions, single-dose vaccination may only be
sufficiently justified in a specific setting where the number of
vaccines is extremely limited.
A second paper in yesterday’s Eurosurveillance issue reports about an ongoing outbreak in pigs of infections with pandemic influenza A(H1N1)v virus in Norway. According to M Hofshagen et al. the first herd was confirmed positive on 10 October 2009 and as of 26 October, a total of 23 herds have been diagnosed as positive. The majority of the herds seem to have been infected by humans. Sequence analysis of pig viruses from the index farm shows that they are identical or virtually identical to human viruses from the same geographical region. Currently further investigations are being carried out to clarify the extent of the outbreaks in the rest of Norway and studies are underway to evaluate risk factors for the infection at farm level.
A third paper by Columbier et al. reports on a notable surge in messages communicated through the Early Warning and Response System (EWRS) for the prevention and control of communicable diseases in the European Union recorded since the start of 2009 H1N1 influenza pandemic. In order to measure the impact of this increase on the reporting of other events, the authors compared the messages posted in the EWRS since April 2009 with those posted in the previous years (2004-2008). The analysis revealed that a ten-fold increase in messages was recorded during the pandemic period, from April to September 2009, and that the reporting of other threats dropped to a significantly low rate. They authors conclude that their results suggest an important impact on the notification process of events in case of a situation requiring extensive mobilisation of public health resources and emphasise the importance of keeping an appropriate balancing of resources during sustained emergencies, in particular in view of a possible second wave of pandemic influenza cases, to ensure prompt detection and reporting of potential concomitant emerging threats.
1113 Cas probable de syndrome
de Guillain-Barré [France]--Un cas probable de syndrome
de Guillain-Barré a été signalé mardi dernier dans le cadre du
dispositif de pharmacovigilance de la vaccination de la grippe A
(H1N1). Il s’agit d’une forme modérée et uniquement sensitive, qui a
évolué favorablement.
L’origine n’a pas été établie. Ces éléments figureront dans le
bulletin de pharmacovigilance qui sera publié demain par l’AFSSAPS,
qui a en charge l’étude du cas.
Chaque année en France, 1700 à 1800 cas de syndrome de
Guillain-Barré donnent lieu à une hospitalisation, soit 5 par jour.
Dans la plupart des cas, la survenue d’un syndrome de Guillain-Barré
est liée à un épisode infectieux, bactérien ou viral, dont la
grippe.
L’attribution d’un syndrome de Guillain-Barré à une vaccination,
nécessite une expertise approfondie. Roselyne Bachelot-Narquin,
ministre de la santé et des sports, s’est engagée à la transparence
sur les effets secondaires de la vaccination contre la grippe
A(H1N1). Elle a chargé l’AFSSAPS d’assurer toute la communication à
ce sujet.
1113 Sanidad centra la segunda fase de la campaña sobre la gripe A en la vacunación de los grupos prioritarios [Spain]--La ministra de Sanidad, Trinidad Jiménez, ha presentado hoy la segunda fase de la campaña informativa sobre Gripe A. La prevención es la mejor medida. Esta campaña se inició el pasado 14 de agosto con el objetivo de promover entre la ciudadanía una serie de medidas básicas como el lavado frecuente de manos y el uso de pañuelos desechables al estornudar para prevenir el contagio por el virus de la gripe pandémica A/H1N1.
1113 Plus de 29,000 nouveaux
cas de grippe A/H1N1 pour la semaine passée [Belgium]--Sur
un total de 52 053 consultations de patients s’étant présentés chez
leur médecin avec un état grippal, l’extrapolation de l’Institut
Scientifique de Santé Publique a livré 29 744 nouveaux cas de grippe
A/H1N1 pour la semaine passée.
L’enregistrement effectué par les médecins vigies indique donc que
pour la première fois en cinq semaines, il y a une baisse
significative du nombre de cas dans notre pays.
Cette diminution par rapport aux semaines précédentes est
probablement liée aux vacances scolaires et au fait que beaucoup de
personnes étaient en voyage à l’étranger. Ceci pourrait aussi
expliquer le fait que les consultations pour symptômes grippaux
étaient également en baisse par rapport aux dernières semaines.
Selon une évaluation de l’Institut Scientifique de Santé Publique,
nous nous trouvons actuellement dans la première phase épidémique et
nous ne pouvons pas encore, sur base de cette première diminution,
tirer de conclusions sans attendre l’évolution du nombre de cas. Le
nombre de personnes contaminées par la grippe A/H1N1 reste
relativement limité. Pour le moment, l’épidémie n’a pas eu d’impact
significatif sur la population.
Depuis le déclenchement de la pandémie, le Commissariat Influenza a
été informé de 11 décès attribués à des complications liées à une
infection grippale. La présence de la grippe A/H1N1 n'a actuellement
aucun impact significatif sur le taux de mortalité.
Depuis le déclenchement de la pandémie A/H1N1 fin avril, 157 123
personnes ont été contaminées dans notre pays.
La campagne de vaccination contre la grippe pandémique continue de
suivre son cours. Notre pays fait partie des premiers états-membres
européens à avoir commencé la vaccination des groupes à risque au
sein de la population. Actuellement, en Belgique, plus de 1 500 000
doses de vaccin ont été livrées aux pharmacies, aux hôpitaux et aux
médecins généralistes.
1113 H1N1 flu related death
reported from NHS Dumfries and Galloway [Scotland]--A
patient who had contracted H1N1 has died. An adult from NHS Dumfries
& Galloway has died bringing the total number of H1N1 related deaths
in Scotland to 34. The patient was reported as having an underlying
health condition.
Health Secretary Nicola Sturgeon said:
"I send my condolences to the patient's loved ones at this sad time.
"Fortunately, for most, H1N1 is mild and symptoms shouldn't persist
longer than a week, but some people are at greater risk of influenza
complications and that is why priority groups have been identified
as part of the vaccination programme.
"Everyone who is in the priority groups will be invited, by their
GP, to take up the vaccine. The vaccination programme is well
underway and people will be invited on a rolling basis."
If you are concerned about flu-like symptoms contact your GP for
advice or call NHS 24 on 08454 24 24 24.
Further information on the vaccine programme is available via the
Scottish Swine Flu Vaccination Helpline on 08000 28 28 16.
1113 Increased rate of
ILI-related GP consultations [Scotland]--The latest
figures about the incidence of influenza A (H1N1) in Scotland have
been published by Health Protection Scotland today.
The findings are:
* A rate of GP consultations for flu-like illnesses - not
necessarily H1N1 - across Scotland of 114.2 per 100,000. This is an
increase from last week's figure of 105.6
* The number of community samples that tested positive for H1N1 is
higher than the previous two weeks at 44.6 per cent
* These rates suggest that an estimated figure of 7,500 people have
consulted their GP. However, taking account of the number of people
having H1N1 but not consulting their GP, HPS estimate that around
21,500 people have contracted H1N1 in the past week. Both of these
figures represent an increase from last week
* As of November 11, there have been 908 people with influenza A
(H1N1) hospitalised since the start of the outbreak. 150 people have
required hospital admission in the last week and, as of yesterday,
there were 109 in hospital in Scotland
* There have been 33 deaths linked to influenza A (H1N1) since the
start of the outbreak From next week, figures on the uptake of the
vaccine will be given.
NHS Scotland has now received just under 550,000 doses of the
Pandemrix vaccine - around 40 per cent of the total required for the
1.3 million people in the priority groups.
Speaking about the weekly reported figures, Ms Sturgeon said:
"This week's figures show an overall increase in the number of
people consulting their GP with flu-like symptoms, the total number
of estimated cases and the number of positive samples.
"This rise is not unexpected as we move further into the winter
season and we must prepare for an almost continual rise in cases
until the effects of the vaccination programme are evident.
"People must do everything they can to protect themselves
,maintaining good hygiene practices and taking advantage of the
vaccination programme and seeking medical advice where necessary.
"With the vaccination programme now well underway, I urge everyone
in the priority groups to get the vaccine when invited to do so by
their GP. This is a rolling programme but everyone in the priority
groups should be vaccinated by Christmas."
Anyone who is concerned about flu-like symptoms should continue to
contact their GP for advice, or NHS 24 on 08454 24 24 24. Further
information on the vaccine programme is available via the new
Scottish Swine Flu Vaccination Helpline on 08000 28 28 16.
1113 H1N1 flu related death
reported from NHS Greater Glasgow and Clyde [Scotland]--A
further death from H1N1 has been reported in Scotland. An adult from
NHS Greater Glasgow and Clyde with a significant underlying health
condition has died.
This brings the Scottish total of H1N1 related deaths to 33.
Health Secretary Nicola Sturgeon said: "It is with regret that have
to announce another death from H1N1 and my thoughts are with the
patient's family and friends at this difficult time.
"Fortunately in the vast majority of H1N1 cases, most people have
fairly mild symptoms and make a full recovery within a week.
"However, we must all remain vigilant and I would underline the
importance of maintaining hygiene standards. Please seek medical
advice immediately if you believe you are at greater risk of
suffering influenza complications.
"Vaccination is our best defence against this virus and I urge
everyone who is in the priority groups to accept the vaccine when
invited to do so.
"The vaccination programme is being rolled out, but please wait
until you are invited before visiting your GP for the vaccine.
"If you are concerned about flu-like symptoms contact your GP for
advice or call NHS 24 on 08454 24 24 24.
"Further information on the vaccine programme is available via the
new Scottish Swine Flu Vaccination Helpline on 08000 28 28 16."
1113 Use of antiviral drugs
stepped up as flu epidemic spreads [Finland]--The H1N1
influenza epidemic has developed into a widespread epidemic in
Northern Finland, and figures are showing a significant acceleration
in the spread of the virus in many parts of Southern Finland as
well. As the epidemic spreads, many people diagnosed with a
respiratory tract infection will contract the influenza. However,
the majority will experience only a mild disease that is much like
the so-called seasonal influenza we see every winter.
In preparation for the epidemic, Finland has stockpiled a great
number of doses of the antiviral drugs oseltamivir (Tamiflu) and
zanamivir (Relenza). Widespread use of these drugs during the
epidemic is designed to prevent severe forms of the disease
especially among those in at-risk groups of influenza, who are more
vulnerable to complications from
the illness.
Who gets antiviral drugs?
Treatment with antiviral drugs (oseltamivir/Tamiflu) should be
initiated for people who (1) are suspected to have a severe illness
as indicated by the clinical presentation, (2) are pregnant or (3)
have an underlying medical condition that increases the risk of
complications. There are a number of chronic diseases that increase
the risk of complications, such as chronic heart diseases and
metabolic diseases. At the clinical discretion of the treating
physician, antivirals may also be given to a person who is not in
the above groups. For more information on who will receive antiviral
drugs, go to the swine flu pages on THL’s website.
Antiviral drugs shorten the duration and reduce the severity of the
illness and work best when treatment is initiated within 48 hours
after the onset of symptoms. Critically ill and at-risk individuals
will benefit from even later treatment with antivirals. There is no
need to wait for laboratory confirmation to begin treatment with
antiviral drugs, but the goal is to obtain laboratory results at
least for all hospitalised patients. In principle, preventive
antiviral medication is not generally recommended, as it may lead to
virus strains becoming resistant to the drugs.
People in at-risk groups of influenza are advised to contact their
local health centre if they develop flu-like symptoms (sudden fever,
cough and/or sore throat). The symptoms that require immediate
medical attention are similar to those that can occur in other
illnesses.
Finland has managed to secure a good supply of oseltamivir (Tamiflu),
and the instructions issued earlier still apply. Oseltamivir (Tamiflu)
is available from pharmacies by prescription only. The treating
physician will assess the need for antiviral treatment based on
clinical observations and the patient’s symptoms.
Pharmacies have been advised to provide antiviral drugs if they
have been prescribed by a physician.
Norway recently decided to make both Tamiflu and Relenza available
as over-the-counter drugs, by temporarily (until June 2010) allowing
pharmacists and chemists to prescribe the drugs for the treatment of
swine flu. Finland is not considering pursuing the same course of
action. According to EU regulations, these antiviral drugs are
prescription-only medicines. There are other ways to ensure a good
supply of antivirals. Taking antiviral drugs without seeing a doctor
involves a risk: it could lead to other illnesses and conditions,
such as meningitis and severe pneumonia requiring hospitalisation,
being missed
Providing fast access to antivirals
While some municipalities do provide good access to treatment, many
local health centres report delays as they struggle to absorb the
increasing patient load. In response, the Ministry of Social Affairs
and Health (MSAH) wants to highlight a number of key methods to
improve access to antiviral drugs:
1) The distribution of work between professional groups should be
made use of effectively. Experienced nurses and public health nurses
interview and examine the patients, and the physician decides
whether to prescribe the medicines.
2) Emergency departments prescribe or dispense antiviral drugs. If
the patient lives a long distance from the pharmacy, or if the
pharmacy is closed, the local emergency department can provide the
medication needed for immediate antiviral treatment.
3) Prescription by telephone: the doctor can assess the need for
medication and obtain other necessary information over the phone.
1113 Case of infant botulism
[Scotland]--What appears to be the first recorded case of
infant botulism in Scotland has been identified in a 16-week old boy
from Fife currently being treated in the Royal Hospital for Sick
Children in Edinburgh.
The patient was admitted on 19 October, following which clinical
suspicions centred on this very rare infection. Microbiological
tests have since confirmed Clostridium botulinum in both the child
and samples of honey present in the child’s household. Final
confirmation is awaited that these are indistinguishable.
A report on infant botulism from the Advisory Committee on the
Microbiological Safety of Food in 2006 confirmed existing advice
from the Food Standards Agency and the UK Department of Health that
honey should not be given to infants less than 12 months of age. The
ACMSF also recommended that honey should not be added to foods
specifically targeted at infants under 12 months of age unless these
foods received a full botulinum cook or an equivalent process
control.
The child’s condition is currently reported to be stable.
1113 Currently 191 hospitalized
with pandemic flu with 22 of those in ICU [Ireland]--The
HSE and the Department of Health and Children today (12th November
2009) gave a weekly update on Swine Flu pandemic and the Swine Flu
Vaccination programme.
The weekly rate of influenza-like illness (ILI rate) is
approximately 175/100,000 population, a slight decrease compared to
last week’s rate of 178/100,000. Admissions to hospital and
intensive care units decreased by 10% this week and currently there
are 191 people hospitalised as a result of swine flu, with 22 of
those in intensive care.
The Department of Health and Children and the HSE regret to advise
that two further deaths from swine flu have occurred, bringing the
number of deaths from swine flu in the Republic to 16. The deaths
relate to a pregnant woman and a child, both from the east of the
countr. The cases are not connected, and the HSE and the Department
of Health wish to extend their sincere sympathies to the families
concerned.
We remind all those in the at-risk groups, including pregnant women,
to get their Swine Flu vaccine from their GP or from the HSE clinics
nationwide. In addition, those who are most at-risk from Swine Flu,
including pregnant women, should contact their GP by phone if they
have flu-like symptoms. Their GP will assess them and prescribe
anti-viral treatment (Tamiflu) if required.
The National Immunisation Advisory Committee has also confirmed that
for the Pandemrix vaccine (manufactured by GSK), one dose of the
vaccine will be sufficient to protect most people from Swine Flu.
Children aged under 13 years and people with immunosuppression will
still require two doses of this vaccine. For the Celvapan vaccine
(manufactured by Baxter), 2 doses of vaccine are still required to
give full protection from Swine Flu. Both vaccines are considered to
be equally effective and have the same safety profile.
The Swine Flu vaccination programme is proceeding well. Since the
start of the vaccination campaign on Monday November 2nd over 55,000
people in the first at-risk groups have been vaccinated in HSE
clinics. This first group includes pregnant women and people aged
under 65 with long term illnesses. 400,000 vaccine doses have been
distributed to General Practitioners and though vaccination figures
from GPs will be reported over the coming weeks, it is thought that
GPs will already have vaccinated many multiples of the numbers seen
at HSE Clinics over the last nine days.
The HSE also confirmed that its Swine Flu vaccination programme is
being extended to include children from 6 months to under 5 years of
age and people aged 65 and over. This is part of the phased roll out
of the vaccine to the Irish population. We wish to move through this
group in an orderly manner, so to avoid queues at clinics.
The HSE has begun writing to parents of children aged from 6 months
to under 5 years, tolet them know when it is time for them bring
their child to the HSE clinic for their vaccine. Parents of children
in this group will begin to receive letters starting this week and
throughout November and early December. During the same timeframe
(November/December) letters will also issue to people aged 65 and
over, inviting them to attend for their vaccine.
These people – children 6 months to under 5 and over 65s – should
not attend their GP or HSE vaccine clinic without an appointment.
Invitation letters to attend for vaccination will be issued over the
coming weeks in a planned and controlled way. The HSE is first
writing out to people in areas where there is capacity in the
current clinics.
The vaccine is the best defence we have against the Swine Flu or
Pandemic (H1N1) 2009 virus. Both vaccines available in Ireland,
Pandemrix and Celvapan, have been licensed by the European Medicine
Agency and the Irish Medicines Board and are being used in many
European countries, including Ireland, over the coming weeks and
months.
Remember, you can get information about the swine flu vaccine as
follows:
From
www.swineflu.ie or
www.hse.ie
From the automated HSE Flu line 1800 94 11 00
From the HSE infoline 1850 24 1850
From your GP
1113 Contingency planning for
24-hour strike on 24 November [Ireland]--A meeting
between HSE and representatives of health sector unions to discuss
contingency planning for the forthcoming day of industrial action,
scheduled for Tuesday 24 November 2009, took place today. At the
commencement of the meeting, the HSE expressed its serious disquiet
that a critical essential service such as health was being targeted
at this time and outlined our concerns at the impact of such action
on vulnerable patients and clients.
IMPACT, Irish Nurses Organisation, SIPTU, Psychiatric Nurses
Association and the Craft Unions indicated that they will be fully
participating in the industrial action on the proposed date. The
Irish Medical Organisation, the Irish Hospital Consultants
Association, the Medical Laboratory Scientists Association and the
Irish Dental Association advised that their members would be working
as normal.
Management sought the derogation of critical areas and national
specialities from the proposed action. These areas include intensive
care, cancer services, dialysis, theatres, maternity, burns units,
acute mental health facilities, drug treatment, sexual assault
units. The HSE also specifically requested that the Mass Vaccination
Clinics established to deal with the H1N1 Swine Flu crisis be fully
exempted from the action.
The unions response was that the level of service to be provided on
24 November 2009 would, at most, be at levels obtaining on Christmas
Day and that no general exemptions in respect of any group or grade
of staff, or any specific speciality would be forthcoming.
Management responded by advising that this position was totally
unsatisfactory and would pose serious risks for patient care and
safety on the day.
The meeting adjourned without agreement, however, it was agreed that
lines of communication between the parties would be maintained.
Speaking at the conclusion of the meeting, Brendan Mulligan, Head of
Corporate Employee Relations, HSE, expressed his disappointment at
the attitude of the unions and of their failure to recognise the
critical nature of the health services and the likely impact of the
proposed action on health service users and their families. Mr
Mulligan added that the HSE would strongly urge that the unions
would reflect on their position with a view to meeting the HSE’s
minimum requirements for the provision of services on that day, thus
minimising the concerns and worries of service users and their
relatives of the likely impact of the action.
1113 Dalkey residents to have
easier access to primary care services [Ireland]--The HSE
officially launched the Dalkey Primary Care Team, Tuesday 13th
October 2009. The HSE Regional Director of Operations, Mr Gerry
O'Dwyer performed the opening ceremony.
The Dalkey PCT team aims to provide easier access to health services
for people in the area. The team provides services, such as, GP
Practice services, community nursing, physiotherapy, occupational
therapy, home help and network services such as psychology,
dietetics, community welfare, speech and language therapy and other
health services.
The team serves a population of approximately 6,700 in Dalkey and
the surrounding areas with the support of Dr. Louis Lavelle and Dr.
Helen Cronin and a team of allied health professionals which include
a Physiotherapist, Psychologist, Occupational Therapist and
Dietician.
Speaking at the launch Mr Gerry O'Dwyer said, "I would like to take
this opportunity to commend the Dalkey Primary Care Team for their
work in the area. There has been a huge amount of work invested in
this initiative by all professionals on the team and by the local
health office staff."
"This team will endeavour to ensure that patient's receive high
quality services as close to home as possible from a team of
professionals. The launch of this service shows that real progress
is being made and delivered to people that matter the most, our
patients," he added.
The Primary Care Team will serve to strengthen the primary care
system in the Dalkey area and play a more central role as the first
and ongoing point of contact for clients within the health-care
system. The Team will enable patients to access services more
readily and enhance the capacity for primary care in the areas of
disease prevention, rehabilitation and personal social services to
complement the existing diagnosis and treatment focus.
The Team currently engage in team meetings to plan integrated
patient care, these meetings have proved beneficial for the patient
as it means the patient receives a more integrated informed service,
it also allows the patient access and engagement to a diversity of
professional skills to deliver optimal care in the community.
The Dalkey PCT is now hoping to create links with the people and
communities in their catchment area to engage in a meaningful way
with the Community.
1113 First team of HSE South
advanced paramedics deployed in West Cork [Ireland]--A
team of advanced paramedics have joined the HSE South Ambulance
Service in West Cork and are now available to respond to emergency
calls in the region.
The new advanced paramedic service was officially launched in Bantry
General Hospital on Tuesday 10th November.
Introduced as part of the reconfiguration of the health service in
Cork and Kerry, the advanced paramedics (APs) are the first such
team to be deployed in the region and are an additional resource who
will work side by side with their paramedic colleagues round the
clock seven days a week.
Advanced paramedics are already qualified paramedics and specialists
in pre-hospital emergency care who have at least six years
experience in the ambulance service. The APs have obtained a higher
diploma from UCD and undergone further training which enables them
to perform additional procedures at the scene of an emergency
including:
- Intubation - during advanced cardiac life support procedures, an
advanced paramedic can place a sterile tube into the trachea or
throat to help the casualty breathe;
- Cardiac resuscitation including CPR, defibrillation and drug
administration;
- Intravenous fluid resuscitation - administration of fluids to
support critically ill patients;
- Pain management - administration of drugs to relieve pain;
- Chest decompression - placement of a needle/tube in the chest to
relieve pressure due to a collapsed lung;
- Administration of intravenous (IV) and intramuscular (IM)
medications (drugs or fluids introduced directly into a vein or a
muscle) to treat various medical conditions;
- Stabilisation of cardiac conditions: drugs may be administered to
regulate the patient's heart rate when required.
The advanced paramedics are alerted to an emergency call by
Ambulance Control and respond in their own fully medically equipped
rapid response vehicle ensuring the most efficient and comprehensive
response to the incident. While at scene, the APs have a direct link
via a dedicated emergency number to the Emergency Department at Cork
University Hospital (CUH). This ensures the APs can liaise directly
with an ED doctor for consultation and decision making around
patient care.
Prof. John Higgins, Director of Reconfiguration welcomed the
introduction of the advanced paramedics in West Cork and said, "The
introduction of this new service in West Cork is a solid example of
how we can reconfigure our health service to ensure it works better
for those who need it. West Cork covers a large rural geographical
area and by deploying these highly trained advanced paramedics to
the scene of an incident, more comprehensive care can be delivered
as quickly as possible to those who live in such remote areas. "
Michael Norris, Asst. Chief Ambulance Officer, HSE South said, "West
Cork is the first area to benefit from the introduction of a team of
advanced paramedics. These additional personnel will compliment and
enhance the professional service offered by our existing paramedics
and will ensure that people in the remote and rural areas of West
Cork have access to this highly skilled resource when they most need
it."
Speaking at the launch, Pat Healy, Regional Director of Operations,
HSE South said, "This is a very positive development for
pre-hospital emergency care in West Cork. It is important to
highlight the critical role of paramedics and advanced paramedics in
treating and sustaining life at the scene of an accident until a
person can be safely taken to hospital. The addition of these highly
skilled advanced paramedics brings more comprehensive care to the
casualty at the earliest given opportunity. I wish both the new
advanced paramedics and the existing paramedic teams in West Cork
the best and thank them for embracing a new and improved way of
working that will benefit people in the West Cork region."
The West Cork advanced paramedics team comprises Kieran Henry, Bryan
Kelly, Mick Lynch, Alan Sheehan and Paul O'Driscoll.
1113 HSE updated statement on C
Diff at Our Lady of Lourdes Hospital Drogheda [Ireland]--There
are currently 13 confirmed cases and 20 symptomatic cases of C
difficile at Our Lady of Lourdes Hospital Drogheda.
In consultation with the Louth County Coroner our Clinical Director
has agreed that all deaths occurring at the hospital during the
escalation phase of the outbreak will be notified to the Coroner as
a matter of routine. To date four deaths have been notified to the
Coroner.
Strenuous steps are being taken within the hospital to ensure that
the infection is properly managed in accordance with best practice.
Intense cleaning is continuing at the hospital. While hospital
hygiene is clearly important, evidence shows that hand hygiene is
the single most effective defence against the spread of infection.
All staff at the hospital are being reminded of the necessity to
observe good hand hygiene. We are also inviting patients to ask
their healthcare workers if they have cleaned their hands before
treating them.
GPs and Ambulance services have been requested to refer adult
patients, with medical complaints to Louth County Hospital Dundalk,
Our Lady's Hospital, Navan or the nearest appropriate hospital.
Adult patients with surgical complaints should be referred to Cavan
General Hospital, Our Lady's Hospital, Navan or the nearest
appropriate hospital.
Members of the public are asked to only attend the Emergency
Departments at the hospital in the case of a genuine emergency and
to contact their GP or out of hours service in the first instance.
Patients may experience delays in the Emergency Department and
regrettably due to the number of beds closed to new admissions we
have delays in patients awaiting admission. 77 beds are currently
closed at the hospital.
Strict visiting restrictions remain in place and where visitors are
permitted they are being advised of the need for appropriate hygiene
protocols. As is good practice, all visitors to the hospital are
urged to wash their hands thoroughly before and after their visits
and to use antibacterial hand gels provided.
Elective admissions and elective scopes have been cancelled until
further notice. However, all outpatient appointments are proceeding
as normal.
1113 HSE to write to parents
and older people shortly inviting them for a Swine Flu Vaccine
appointments [Ireland]--The HSE announced that its Swine
Flu vaccination clinics around the country will shortly begin
inviting children from 6 months to under 5 years of age and people
aged 65 and over to be vaccinated against swine flu. This is part of
the phased roll out of the vaccine to the Irish population.
The Swine Flu vaccination campaign kicked off in earnest on Monday
November 2nd, and over the last week, over 30,000 people in the
first at-risk groups have been vaccinated in HSE clinics, and many
more by their GP. This first group included pregnant women and
people aged under 65 with long term illnesses.
We continue to vaccinate this group, but we also wish to start
moving on the next priority groups for Swine Flu vaccination. These
will be children aged from 6 months to under 5 years, and people
aged 65 and over.
We wish to move through this group in an orderly manner, so to avoid
queues at clinics. Starting this week, the HSE is writing to parents
of children aged from 6 months to under 5 years, to let them know
when it is time for them bring their child to the HSE clinic for
their vaccine. Parents of children in this group will begin to
receive letters starting this week and throughout November and early
December. People aged 65 and over will begin to be invited over the
coming fortnight.
Dr. Brenda Corcoran, HSE National Immunisation Office, said “We have
been giving the first supplies of vaccine to people more at risk
from Swine Flu such as pregnant women, people with long term illness
and cancer patients. We now want to start offering the vaccine to
all children aged over 6 months and under 5 years. Children in this
age group are more at risk of getting Swine Flu and are also more at
risk of being hospitalised because of complications so we want to
make sure that we protect as many children as possible from the
effects of the flu.’
‘The next group that we will focus on will be people aged 65 and
over. Again, we will shortly be writing to people in this age group
to invite them to attend our vaccine clinics for an appointment.
This will ensure that people do not have to queue for a long time
and will also ensure that busier clinics are not over run. Once
these two target groups have been commenced, we will move on to
begin vaccinating older children.”
‘We would ask people in these groups to be patient and to wait for
their invitation to arrive. Everyone in these groups will be offered
the vaccine throughout November and December.’
Parents of young children and people over 65 who are not part of the
original at-risk group (long term illness/cancer patient or
pregnant) should not attend their GP or HSE vaccine clinic without
an appointment - Invitation letters to attend for vaccination will
be issued over the coming weeks in a planned and controlled way. The
HSE will first be writing out to people in areas where there is
capacity in the current clinics.
The vaccine is the best defence we have against the Swine Flu or
Pandemic (H1N1) 2009 virus. Both vaccines available in Ireland,
Pandemrix and Celvapan, have been licensed by the European Medicine
Agency and the Irish Medicines Board and are being used in many
European countries, including Ireland, over the coming weeks and
months.
Remember, you can get information about the swine flu vaccine as
follows:
From
www.swineflu.ie or
www.hse.ie
From the automated HSE Flu line 1800 94 11 00
From the HSE infoline 1850 24 1850
From your GP
1113 HPA modelling estimate of
64,000 new cases of pandemic flu last week [England]--The
consultation rate for flu-like illness in England from the Royal
College of General Practitioners (RCGP) scheme decreased to 36.0 per
100,000 in week 45 compared to 37.7 in week 44.
The main burden of flu-like illness
nationally in week 45 is in the <1 and 1-4 years age groups.
This week, the antiviral collection
numbers in the National Pandemic Flu Service decreased in all age
groups.
The recent half-term school holidays
may have continued to influence the figures this week, and so it is
difficult to predict future trends.
Interpretation of data to produce
estimates on the number of new cases continues to be subject to a
considerable amount of uncertainty. HPA modelling gives an estimate
of 64,000 new cases in England last week (range 32,000 to 140,000).
This represents an 24% decrease on the previous week. This estimate
incorporates data from National Pandemic Flu Service and GP
consultations.
The HPA estimates a cumulative total number of cases of 668,000 (with a range 313,000 to 1,382,000 since the pandemic began.
To date (as of 11 November 2009) 2,834
viruses have been analysed by the Centre for Infections for the
genetic marker commonly associated with resistance to oseltamivir in
seasonal H1N1 flu (H274Y). Six viruses have been found to carry this
marker in the UK. In addition, 293 specimens have been fully tested
for susceptibility.
The Agency is continually assessing its advice to government on
health protection policies such as antiviral use. Currently there is
no requirement to change existing guidance.
There have been no significant changes in the virus.
Disease severity continues to be monitored. The disease is generally
mild in most people so far, but is proving severe in a small
minority of cases.
Swine flu hospitalisations in England: 785 patients (currently
hospitalised as of 8am on 11 November).
Deaths - the number of deaths related to swine flu in England is 124
(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 World Health Organization (WHO)
reported on 6 November that for:
* Tropical regions: active influenza transmission and increasing
levels of respiratory disease continue to be reported in parts of
the Caribbean, with most other countries in the tropical region of
Central and South America reporting declining activity. Transmission
continues to decline in most parts of tropical South and Southeast
Asia. Unconfirmed media reports suggest increased disease activity
in sub-Saharan Africa.
* Temperate northern hemisphere regions: intense and persistent
influenza activity continues be reported in North America without
evidence of a peak in activity. Rates of influenza like illness,
proportions of samples positive for influenza, and numbers of
outbreaks in educational settings continue to increase in Canada
with activity spreading eastward. Significantly more cases of
pandemic H1N1 have been reported in Mexico since September than were
observed during the initial springtime epidemic.
* In Europe and Central and Western Asia: influenza activity
continues to increase signalling an unusually early start to the
winter influenza season. Active circulation of the pandemic virus
was reported in Belgium, Ireland, the Netherlands, Norway, Spain,
Sweden and Germany. Increasing transmission was also reported across
Northern and Eastern Europe, and Eastern Russia. In Western Asia and
the Eastern Mediterranean Region increasing activity has been
reported in Oman and Afghanistan.
* In East Asia: intense and increasing influenza activity continues
to be reported in Mongolia. Sharp increases in pandemic influenza
activity continue to be reported throughout Japan.
1107 Forte recommandation de
vaccination contre le virus A(H1N1) - Maintien, à ce stade, d’un
schéma vaccinal à deux doses [France]--Roselyne
Bachelot-Narquin, ministre de la santé et des sports recommande
fortement la vaccination contre le virus A(H1N1). Elle maintient, à
ce stade, un schéma vaccinal à deux injections pour l’ensemble de la
population
La question du schéma vaccinal à une ou deux injections pour la
vaccination contre le virus A(H1N1) est tributaire des résultats des
essais cliniques en cours pour chacun des vaccins utilisés dans le
cadre de la campagne.
Les résultats obtenus confirment, à ce stade, le bon niveau de
protection acquis après la première dose. En revanche, des résultats
complémentaires sont nécessaires pour garantir définitivement que
cette protection est durable, face à un virus nouveau, dont la durée
de circulation est aujourd’hui inconnue.
La ministre rappelle que l’ensemble des mesures de gestion prises
depuis l’émergence de la menace pandémique liée au virus A(H1N1)
s’appuient sur le plus large consensus scientifique possible. A ce
jour, la position des experts sur la question du schéma de
vaccination est nuancée.
Les agences française et européenne du médicament (AFSSAPS et EMEA)
préconisent d’attendre les « données complémentaires attendues dans
les semaines à venir avant d’envisager de pouvoir conclure que
l’administration d’une seule dose offre une protection suffisante
face au virus pandémique ». Dans un avis qui sera rendu public ce
jour, le Haut conseil de la santé publique (HCSP) recommande
fortement la vaccination et propose d’envisager de passer, dès à
présent, à un schéma à une injection pour certains adultes de 18 à
60 ans, suivant en cela l’avis de l’Organisation mondiale de la
santé (OMS), pour élargir la couverture vaccinale dans les meilleurs
délais.
Dès lors que l’impact d’un schéma vaccinal à une dose sur
l’élargissement de la couverture vaccinal n’aura un impact
significatif qu’à partir de début décembre, lorsqu’il concernera
l’ensemble des personnes appelées à se faire vacciner en centre de
vaccination, et, à défaut d’un véritable consensus scientifique à ce
jour, la ministre maintient à ce stade un schéma vaccinal prudentiel
à deux injections pour l’ensemble de la population. Elle s’inscrit
ainsi dans le strict respect des autorisations de mise sur le marché
(AMM) délivrées par l’EMEA. Cette position est aussi celle des
autorités sanitaires allemandes.
Cette position fera l’objet d’un réexamen régulier au regard des
nouvelles données scientifiques sur le sujet. Un nouvel avis de
l’agence européenne du médicament est, en particulier, attendu dans
les semaines qui viennent.
1107 Informe semanal de
situación gripe pandémica A (H1N1) [Spain]--Como
consecuencia de la estrategia acordada por el Pleno del Consejo
Interterritorial del Sistema Nacional de Salud, la vigilancia de
gripe pandémica A (H1N1) se realiza a partir de la información
remitida por la Red de Médicos Centinelas del Sistema de Vigilancia
de Gripe en España. La tasa estimada de gripe clínica en atención
primaria en la semana del 25 al 31 de octubre fue de 292,45 casos
por 100.000 habitantes.
Esto permite calcular que en España se podrían haber producido en la
semana mencionada 130.907 casos de gripe clínica. De los casos
analizados, el 97% ha resultado positivo para el nuevo virus de la
gripe A (H1N1), por lo que se estima que el número de casos de nueva
gripe pandémica A (H1N1) que podrían haber ocurrido esta semana
sería de unos 126.999.
La práctica totalidad de los casos cursan con un cuadro leve y
responden a los tratamientos convencionales.
A fecha 5 de noviembre se han producido 73 fallecimientos
relacionados con la gripe A (H1N1).
La tasa de letalidad desde la semana 27 (desde que se informa a
partir del sistema de vigilancia por Médicos Centinela) es de 0,13
fallecidos por cada mil afectados de gripe A (H1N1).
* Desde el 31 de agosto de 2009, fecha del último Pleno del Consejo
Interterritorial del Sistema Nacional de Salud, y según acuerdo del
mismo, la información sobre los fallecidos por gripe A (H1N1) se
comunicará semanalmente, todos los jueves, en la web del Ministerio
de Sanidad dentro del informe de situación general.
1107 Grippe A/H1N1 : la vaccination des groupes prioritaires débute demain [Belgium]--Lors d’une conférence de presse cet après-midi, la Ministre de la Santé publique Laurette Onkelinx a annoncé le début de la campagne de vaccination contre la grippe A/H1N1, en présence du Commissaire interministériel Influenza Marc Van Ranst et de Xavier De Cuyper, administrateur-général de l’AFMPS.
Dès demain, les vaccins contre la grippe A/H1N1 seront disponibles auprès de tous les pharmaciens qui en ont commandé. Les médecins généralistes pourront donc aller chercher leurs doses et débuter la vaccination des professionnels de santé et des autres groupes cibles prioritaires.
La semaine dernière, 1.000.000 de vaccins ont été livrés par les autorités auprès de 42 grossistes-répartiteurs. Ceux-ci ont ensuite distribué les différentes doses auprès des pharmacies. Aujourd’hui, 273.000 doses supplémentaires seront encore insérées dans le système de distribution.
Les hôpitaux belges ont précédemment reçu 242.160 vaccins pour la vaccination de leur personnel. 9.510 doses de vaccins ont également été livrées aux cercles de médecins. Cette première vague de vaccination, qui a débuté en octobre, avait pour but de limiter la transmission du virus aux patients déjà affaiblis et de garantir la disponibilité de notre système de soins de santé.
Le matériel d’injection, des notices et des brochures d’information pour les patients seront livrés en même temps que les vaccins. Les médecins généralistes recevront une brochure destinée aux vaccinateurs expliquant l’utilisation du vaccin.
Les groupes prioritaires suivants peuvent prendre rendez-vous dès demain auprès de leur médecin généraliste pour recevoir la vaccination :
- les personnes de plus de 6 mois qui courent un risque médical ;
- les parents ayant des enfants de moins de 6 mois ;
- les femmes enceintes (2ème ou 3ème trimestre de la grossesse) et les femmes en programme de procréation médicalement assistée ;
- toute personne travaillant dans l’enseignement, dans l’accueil d’enfants ou dans une profession en lien avec des enfants ;
- les professionnels de santé.
Les personnes se rendant chez leur médecin pour recevoir une vaccination doivent emporter leur carte SIS et leur carte d’identité (électronique). Le vaccin est gratuit et uniquement disponible chez le médecin généraliste. Les patients devront payer le tarif normal d’une consultation mais recevront un remboursement intégral via leur assurance santé.
Toutes les informations sur la campagne de vaccination sont disponibles sur le site
www.influenza.be. Les autorités communales organisent également la distribution d’une brochure d’information sur la vaccination pour leur population.
1107 Évolution de la grippe A/H1N1 en Belgique : rapport hebdomadaire [Belgium]--Sur un total de 85.197 consultations de patients s’étant présentés chez leur médecin avec un état grippal, l’extrapolation de l’Institut Scientifique de Santé Publique a abouti à 50.415 nouveaux cas de grippe A/H1N1 pour la semaine dernière.
L’enregistrement effectué par les médecins vigies indique donc toujours une augmentation du nombre de cas dans notre pays, même si l'augmentation est moins prononcée qu'au cours des cinq dernières semaines. Les échantillons prélevés par les hôpitaux confirment cette tendance.
Selon une évaluation de l’Institut Scientifique de Santé Publique, nous nous trouvons actuellement toujours dans la première phase épidémique. Le nombre de personnes contaminées par la grippe A/H1N1 reste relativement limité mais le nombre de cas continue à augmenter. Pour le moment, l’épidémie n’a pas encore d’impact significatif sur la population.
Depuis le déclenchement de la pandémie, le Commissariat Influenza a été informé de 8 décès attribués à des complications liées à une infection grippale. La présence de la grippe A/H1N1 n'a actuellement aucun impact significatif sur le taux de mortalité. Depuis le début de la pandémie A/H1N1 fin avril, 127.379 personnes ont été contaminées dans notre pays.
La campagne de vaccination est en cours actuellement. Notre pays est l'un des premiers États membres de l'Union européenne à être prêt à entamer la vaccination de la population. À partir du 7 novembre les médecins généralistes pourront retirer les vaccins commandés dans une pharmacie et commencer à vacciner. Des vaccins avaient déjà été fournis précédemment aux hôpitaux et aux cercles de généralistes.
Toutes les informations sur la campagne de vaccination sont disponibles sur le site www.influenza.be. Les Media et autres partenaires qui veulent offrir l’information à la population peuvent télécharger le banner de la campagne et le placer sur leur site web: http://www.influenza.be/fr/banner.asp.
1107 Avis du Conseil Supérieur de la Santé (CSS) relatif à l’augmentation du nombre de dons de sang durant une pandémie [Belgium]--Dans le contexte de la pandémie de grippe A(H1N1) et d’un éventuel risque de pénurie, la loi influenza du 16 octobre 2009 octroie notamment au Roi le pouvoir de «déterminer le nombre maximum de dons de sang par an».
Cette mesure exceptionnelle se justifie par la diminution du nombre de donneurs attendue en cas de pandémie.
Afin de prévenir une éventuelle pénurie, les autorités belges ont souhaité pouvoir réglementer cette matière et, le cas échéant, être en mesure d’augmenter provisoirement le nombre de dons de sang autorisés par personne sur une base annuelle. Actuellement, ce nombre est limité à quatre.
La mise en œuvre de cette mesure nécessitait l’avis préalable du CSS. Cet avis vise à déterminer si, dans ce contexte, le nombre maximum de dons de sang autorisés par an peut temporairement être relevé par rapport à la limite, tout en respectant l’obligation d’un délai d’au moins deux mois entre chaque prise. L’avis ne concerne pas les dons de plasma ni les plaquettes prélevées par aphérèse.
Le CSS estime que le nombre maximum de dons de sang par an peut être augmenté, durant une pandémie, pour autant que tous les critères habituels soient respectés. Selon les recommandations du Conseil de l'Europe, le nombre de dons de sang maximum par an doit être limité à six chez les hommes et à quatre chez les femmes. Etant donné que la législation belge autorise déjà quatre dons de sang annuels pour les femmes, le nombre maximal ne sera pas modifié pour ces dernières.
En pratique, dans l’éventualité de telles circonstances exceptionnelles, les hommes pourraient donc donner du sang jusqu’à 6 fois par an.
Pour des informations plus détaillées relatives à ces limites, nous vous invitons à consulter le texte intégral de l’avis à l’adresse http://www.css-hgr.be dans la rubrique « Avis et recommandations » sous la référence CSS n° 8611.
1107 Accord entre le Comité
scientifique Influenza et les gynécologues sur l’utilisation du
vaccin contre la grippe A/H1N1 chez les femmes enceinte [Belgium]--Cet
après-midi, le Comité scientifique Influenza a examiné,
conjointement avec une représentation de gynécologues, l’utilisation
chez les femmes enceintes du vaccin contre la grippe pandémique
A/H1N1 acheté par notre pays.
A la demande des gynécologues, le Comité a expliqué, au cours de la
réunion, l’ensemble de la stratégie de vaccination, ainsi que les
considérations scientifiques qui ont donné lieu à l’achat du vaccin
Pandemrix auprès de la firme pharmaceutique GSK.
Au terme de la réunion, le Comité scientifique Influenza et les
représentants des gynécologues ont souligné, dans une opinion
commune, qu’ils sont convaincus que l’utilisation de ce vaccin est
sûre pour les femmes enceintes au cours des 2è et 3è trimestres de
grossesse, d’une part, et qu’il est nécessaire de vacciner
prioritairement ce groupe cible, d’autre part.
La note reprenant les arguments scientifiques concernant la
stratégie de vaccination actuelle, le choix du vaccin et la liste
des groupes à risque a également été examinée par le Comité. Le
Comité scientifique publiera cette note, cette semaine encore,
accompagnée de toutes les informations scientifiques les plus
récentes, sur le site
www.influenza.be et apportera ainsi
une réponse aux questions qui ont été posées par les professionnels
des soins de santé.
1107 Another H1N1 flu-related
death from NHS Ayrshire and Arran brings toll to 32 [Scotland]--An
adult from NHS Ayrshire and Arran has died after contracting H1N1.
The patient was reported as having a significant underlying health
condition.
This death brings the total number of H1N1 related deaths in
Scotland to 32.
Health Secretary Nicola Sturgeon said:
"My deepest sympathy is with the patient's family and friends during
this heartbreaking time.
"Fortunately, for most, H1N1 is mild and symptoms shouldn't persist
longer than a week, but some people are at greater risk of influenza
complications and that is why priority groups have been identified
as part of the vaccination programme.
"Everyone who is in the priority groups will be invited, by their
GP, to take up the vaccine. The first phase of the programme is
already underway and people will be invited on a rolling basis."
If you are concerned about flu-like symptoms contact your GP for
advice or call NHS 24 on 08454 24 24 24.
Further information on the vaccine programme is available via the
Scottish Swine Flu Vaccination Helpline on 08000 28 28 16.
1107 Decrease in rate of GP
consultations for ILI [Scotland]--The latest figures
about the incidence of influenza A (H1N1) in Scotland have been
published by Health Protection Scotland today.
The findings are:
* A rate of GP consultations for flu-like illnesses - not
necessarily H1N1 - across Scotland of 106.2 per 100,000. This is a
decrease from last week's figure of 111.4
* The number of community samples that tested positive for H1N1 is
similar to the previous two weeks at 39 per cent
* These rates suggest that an estimated figure of 6,120 people have
consulted their GP. However, taking account of the number of people
having H1N1 but not consulting their GP, HPS estimate that around
17,487 people have contracted H1N1 in the past week. Both of these
figures represent a decrease from last week
* As of November 02, there have been 691 people with influenza A
(H1N1) hospitalised since the start of the outbreak. 135 people have
required hospital admission in the last week and, as of yesterday,
there were 82 in hospital in Scotland
* There have been 31 deaths linked to influenza A (H1N1) since the
start of the outbreak
* There are currently no reports o f abnormal school absence rates
Speaking about the weekly reported figures, Ms Sturgeon said:
"This week's figures show an overall decrease in the number of
people consulting their GP with flu-like symptoms, the total number
of estimated cases and the number of positive samples.
"There is no trend to the figures, and they can fluctuate, but we
must prepare for an almost continual rise in cases throughout winter
until the effects of the vaccination programme are evident.
"However, people must do everything they can to protect themselves,
including getting any medical advice they feel necessary,
maintaining strict hygiene levels and taking advantage of the
vaccination programme.
"The vaccination programme is now underway, and I urge everyone who
is in the priority groups to accept the vaccine when invited to do
so by their GP. This is a rolling programme but everyone in the
priority groups should expect to be vaccinated by the end of the
year."
Anyone who is concerned about flu-like symptoms should continue to
contact their GP for advice, or NHS 24 on 08454 24 24 24. Further
information on the vaccine programme is available via the new
Scottish Swine Flu Vaccination Helpline on 08000 28 28 16.
1107 H1N1-related flu death
from NHS Ayrshire and Arran [Scotland]--An adult from NHS
Ayrshire and Arran has died after contracting H1N1. The patient was
reported as having significant underlying health conditions.
This death brings the total number of H1N1 related deaths in
Scotland to 31.
Health Secretary Nicola Sturgeon said:
"It is with regret I need to confirm another H1N1 fatality. I send
my condolences to the patient's family and loved ones.
"A rise in influenza cases is to be expected as we enter the winter
months but fortunately, for most, H1N1 is mild and symptoms
shouldn't persist longer than a week.
"However, we must all remain vigilant and I would underline the
importance of maintaining hygiene standards and urgently seeking
medical advice if you believe you are at greater risk of influenza
complications. If you are concerned about flu-like symptoms contact
your GP for advice or call NHS 24 on 08454 24 24 24.
"The roll out of the vaccination programme is now underway, and I
urge everyone who is in the priority groups to accept the vaccine,
when invited to do so by their GP.
"Further information on the vaccine programme is available via the
new Scottish Swine Flu Vaccination Helpline on 08000 28 28 16."
To protect patient confidentiality we will now only be reporting the
following information in any H1N1 death:
* Whether the patient was a child, elderly person or adult
* Which health board area they were a patient of
* The presence of underlying health conditions or pregnancy
However, the weekly report from Health Protection Scotland will
breakdown any fatalities into an age range and the gender will be
given.
1107 Updating H1N1/ILI/Acute Respiratory Infections numbers in Ukraine outbreak - 936,804 cases and 144 deaths [Ukraine]--The Ministry of Health is now reporting 936,804 cases of influenza and acute respiratory infections and their complications, an increase of 65,813 cases since yesterday.
The number of hospitalizations has gone from 951 on October 29 to 43,762 on November 7, with 4,478 new hospitalizations in the last day. 345 of those who are hospitalized are in ICUs with 39 on ventilators.
Source: http://www.moz.gov.ua/ua/main/icsm/ah1n1/
1107 H1N1 update from Ukraine - Nearly 200,000 more cases of ARI since Nov 4 [Stockholm Sweden]--The Ministry of Health has reported yesterday 633,877 cases of acute respiratory illness and 95 deaths related to acute respiratory illness, which represents a significant increase compared to the previous day (+32% for the number of cases and + 10% for the number of deaths). The number of hospitalizations has gone from 951 on October 29 to 28,836 on November 5.
Influenza A (H1N1) has been identified in a number of samples in domestic laboratories and confirmed by the WHO’s reference laboratory in London. A 9-person WHO outbreak assessment team, including experts from ECDC and EU Member States has been deployed at the request of the ministry of health in Ukraine and are presently in Kiev and Lviv.
It is clear that the pandemic (H1N1) 2009 has established itself in Ukraine and it is likely that the rapidly evolving situation in Ukraine is mainly related to the pandemic. However, at this stage, other causes for clusters of respiratory illness, specifically in the western oblasts cannot be ruled out.
Ukraine called on the EU through the Community Civil Protection Mechanism on 31 October for help to deal with this situation. The European Commission's Monitoring and Information Centre (MIC), is today dispatching a coordination and assessment team of experts. Adding to that, several countries has already offered their help to control this outbreak.
1027 Two more H1N1 flu-related
deaths reported [Scotland]--Twenty-second and
twenty-third pandemic flu deaths reported in Scotland.
An 81 year old woman at the Royal Alexandra Hospital in Paisley and
a 50 year old woman at Glasgow's Western Infirmary, who had both
been suffering from Influenza A (H1N1), have died.
Both women had significant underlying health conditions and at the
request of their families no further details will be released.
Health Secretary Nicola Sturgeon said:
"I send my sincere condolences to the friends and families of both
these women at this very difficult time.
"Vaccination is our best defence against this virus. I urge everyone
who is offered the vaccine to accept it, in order in order to help
minimise the impact of this virus.
'The vaccination programme is on track. It will have a phased
introduction as supplies become available from the manufacturers.
Supplies will start to arrive in GP practices from tomorrow but GPs
have been advised that it will be into November before all practices
have supplies.
"Patients in priority groups will be contacted by their GP when they
have to attend for vaccination and we expect to have offered
vaccination to all in the priority groups by the end of the year.
"Anyone who is concerned about flu-like symptoms should continue to
contact their GP for advice, or NHS 24 on 08454 24 24 24."
Dr Dean Marshall, Chairman of the BMA's Scottish General
Practitioners Committee, said:
"Plans for the Scottish vaccination programme haven't changed and
are continuing as intended. Patients should still wait to be
contacted by their GP.
"GP practices have been planning the vaccination programme for
several months and once sufficient supplies arrive in their
Practices, they will begin contacting patients in the priority
groups."
1027 Another pediatric
H1N1-related death reported [Ireland]--It is with regret
that the Department of Health and Children and the HSE wish to
advise that a youth died in the east of the country from Pandemic
(H1N1) 2009 (Swine Flu). The patient had an underlying medical
condition. No further details will be made available by either the
Department of Health & Children or the HSE.
Mary Harney TD, Minister for Health and Children, the Department of
Health & Children and the Health Service Executive offer their
sympathy to the family and friends of the patient.
1027 H1N1 flu epidemic about to
start - First death confirmed [Finland]--The first death
in Finland associated with the A(H1N1)v influenza virus, or swine
flu, has been confirmed in Northern Ostrobothnia.
A 25-year-old woman suffering from a serious chronic disease died
last Saturday, on 24 October, in the Hospital District of Northern
Ostrobothnia. On 16 October, the woman had been diagnosed with a
respiratory infection caused by the swine flu virus and was promptly
treated with the antiviral drug oseltamivir (Tamiflu). Authorities
are investigating the cause of death.
A death associated with the influenza A(H1N1) virus was expected in
Finland, because the virus has spread widely around the world. The
country is well prepared to deal with a flu epidemic. On average,
swine flu appears to behave much like seasonal influenza in terms of
the severity of illness.
As of 26 October 2009, there have been 522 confirmed cases of
influenza A(H1N1)v in Finland. Most of the around 150 cases detected
during the past two weeks have been in Northern Finland. There have
been no signs of extensive community-wide infections elsewhere in
Finland.
The epidemic has continued its spread throughout Europe, and last
week nine European countries reported epidemic activity: Belgium,
Bulgaria, England, Iceland, Ireland, Northern Ireland, Spain, Sweden
and The Netherlands. These levels of activity are higher than usual
for this time of year.
Vaccinations started
Vaccination of health care personnel against influenza A(H1N1)v has
already been initiated around the country and the plan is to start
vaccinating pregnant women this week. After this, local authorities
will begin vaccinating at-risk groups, according to the stated
schedule. The local authorities are responsible for informing
residents about the local vaccination arrangements.
The Ministry of Social Affairs and Health (MSAH) and the National
Institute for Health and Welfare (THL) both recommend the vaccine,
especially to the priority groups (health care professionals,
pregnant women and persons aged from 6 months to 64 years belonging
to a risk group due to another illness), to prevent the spread and
severe complications of the illness.
At-risk groups include people from 6 months to 64 years with one or
more of the following chronic illnesses: heart or lung disease
requiring regular medication, metabolic disease, chronic liver
failure or chronic kidney disease, immune system disease, a
condition whose treatment reduces the immune response, or chronic
neurological or neuromuscular disease.
The next phase is to vaccinate healthy children aged from 6 to 35
months and healthy children and young people aged from 3 to 24
years, as well as conscripts. The sixth group to be vaccinated is
persons over 65 years who because of their other illness belong to
an at-risk group. The need to vaccinate the whole population will be
assessed after it is seen how the situation develops towards the end
of the year.
The proposal for the order of vaccination in Finland was approved by
the Government in September this year. The order was determined on
medical grounds. It was important to decide on the order since the
vaccine is imported in batches. Finland is among the first countries
in Europe to receive the vaccine.
This week, local authorities have 437 000 doses available for
vaccination, and each week more will be delivered in batches of 100
000–200 000. It is expected that all special groups will have
received their vaccine by the end of the year.
WHO recommends the vaccine being administered in Finland
The influenza vaccine being used in Finland has been approved by the
European Medicines Agency (EMEA), and it is also recommended by the
World Health Organisation (WHO). The vaccine contains an adjuvant, a
substance that enhances the immune response so less extract of the
virus is needed in each dose. This immune response-enhancing
substance has been thoroughly reviewed and tested even before it has
been considered for use in vaccines. The adjuvant is by no means a
new invention, since a similar enhancing substance is also found in
the seasonal flu vaccine that has been used in Finland in more than
40 million doses since 1997.
As such, the pandemic influenza vaccine has not been used in
practice, but previous vaccines have provided much data and
knowledge on the behaviour of parts of it and other closely related
vaccines. For example, thiomersal, a preservative used in the
vaccine, has been used widely in vaccines administered to both small
children and pregnant women.
The vaccine does not contain agents that could harm a pregnant woman
or the foetus, or cause complications in the pregnancy. There is
evidence that swine flu is more dangerous to pregnant women than
non-pregnant women. However, it can be prevented by vaccination.
Furthermore, vaccination in particular at the later stages of
pregnancy protects the baby, as the baby cannot be vaccinated
directly.
The pandemic influenza vaccine available in Finland will not produce
minor infections in vaccinated people. It may cause side effects
similar to seasonal flu vaccines. Those vaccinated with the vaccine
commonly get a sore arm from the shot. Some people may also
experience headache, muscles aches, joint pains and mild fever. The
side effects usually last only a day or two.
The swine flu vaccine used in Finland is a pandemic-specific
vaccine: the virus has not had time to mutate after the vaccine
virus selection six months ago. The vaccine effectiveness is
expected to be good, about 90 per cent.
1017 Informe semanal de
situación gripe pandémica A (H1N1) [Spain]--Como
consecuencia de la estrategia acordada por el Pleno del Consejo
Interterritorial del Sistema Nacional de Salud, la vigilancia de
gripe pandémica A (H1N1) se realiza a partir de la información
remitida por la Red de Médicos Centinelas del Sistema de Vigilancia
de Gripe en España. La tasa estimada de gripe clínica en atención
primaria en la semana del 4 al 10 de octubre fue de 98,65 casos por
100.000 habitantes.
Esto permite calcular que en España se podrían haber producido en la
semana mencionada 44.084casos de gripe clínica. De los casos
analizados, el 95,3% ha resultado positivo para el nuevo virus de la
gripe A (H1N1), por lo que se estima que el número de casos de nueva
gripe pandémica A (H1N1) que podrían haber ocurrido esta semana
sería de unos 42.001.
La práctica totalidad de los casos cursan con un cuadro leve y
responden a los tratamientos convencionales.
A fecha 15 de octubre se han producido 45 fallecimientos
relacionados con la gripe A (H1N1).
La tasa de letalidad desde la semana 27 (desde que se informa a
partir del sistema de vigilancia por Médicos Centinela) es de 0,15
fallecidos por cada mil afectados de gripe A (H1N1).
Desde el 31 de agosto de 2009, fecha del último Pleno del Consejo
Interterritorial del Sistema Nacional de Salud, y según acuerdo del
mismo, la información sobre los fallecidos por gripe A (H1N1) se
comunicará semanalmente, todos los jueves, en la web del Ministerio
de Sanidad dentro del informe de situación general.
1017 Evolution de la grippe
A/H1N1 et des mesures en Belgique : rapport hebdomadaire [Belgium]--Aujourd’hui,
le Commissariat interministériel Influenza publie une nouvelle
estimation du nombre de cas de grippe A/H1N1 dans notre pays, sur
base du suivi réalisé par le réseau des médecins vigies, avec un
bref aperçu des mesures récemment prises sur le terrain.
Sur un total de 25.080 consultations de patients se présentant avec
un état grippal chez leur médecin, l’extrapolation a livré 7.534
nouveaux cas de grippe A/H1N1 pour la semaine passée.
Le suivi de la situation effectué par les médecins vigies indique
une tendance à la hausse du nombre de cas dans notre pays, en
comparaison aux chiffres des trois dernières semaines. Les
échantillons réalisés par les hôpitaux confirment cette tendance
mais la mortalité reste normale pour cette époque de l’année.
Depuis le déclenchement de la pandémie A/H1N1 fin avril, 20.100
personnes ont été contaminées dans notre pays. Quatre personnes sont
décédées des complications de la grippe.
A partir du 18 octobre, la première phase de la campagne de
vaccination contre le virus de la grippe pandémique A/H1N1 sera
lancée avec la livraison de vaccins à tous les hôpitaux belges, pour
que ceux-ci puissent vacciner leur personnel médical ainsi que les
médecins-stagiaires et le personnel infirmier. A cet effet les
hôpitaux ont placé leurs commandes au courant de la semaine passée,
et la vaccination du personnel est effectuée sur base volontaire.
Dans la même semaine, ce sont les cercles des médecins généralistes
qui recevront une livraison de vaccins destinés à la vaccination
volontaire des médecins généralistes.
Chaque livraison de vaccins est accompagnée d’un mode d’emploi pour
le vaccinateur et d’un stock de notices explicatives et de brochures
pour les vaccinés.
La vaccination des professionnels de la première et deuxième ligne
des soins de santé vise à garantir la disponibilité de notre système
de soins de santé pendant une pandémie, et à prévenir la
transmission du virus par des professionnels contaminés vers des
patients déjà affaiblis.
Dès que des réserves suffisantes de vaccins seront disponibles, la
deuxième phase de la campagne de vaccination sera mise sur pied
début novembre. A partir de ce moment seront vaccinés les autres
professionnels de la santé (tels que les infirmiers et infirmières à
domicile, et les pharmaciens) ainsi que les personnes appartenant à
un groupe à risques médicaux, les femmes enceintes dans le deuxième
et troisième trimestre de la grossesse, les parents d’enfants de
moins de six mois, le personnel enseignant, et les collaborateurs
des garderies.
Dès le début de la campagne, le Commissariat Interministériel
Influenza se chargera d’informer ces groupes cibles sur le
déroulement pratique des vaccinations.
1017 Quatrième cas mortel de
grippe pandémique A/H1N1 [Belgium]--Le Commissariat
interministériel Influenza informe que mercredi dernier, le 14
octobre 2009, un enfant de 5 ans originaire du Hainaut est décédé à
l’hôpital des suites d’une infection due au virus pandémique A/H1N1.
Le 8 octobre, le jeune garçon a présenté de la fièvre et une
détresse respiratoire. Il a été admis à l’hôpital le 9 octobre et a
reçu un traitement à base de médicaments antiviraux. Sa situation a
cependant empiré et il est décédé mercredi des suites de l’infection
grippale. L’enfant présentait de multiples facteurs à risque.
Le diagnostic de l’infection au virus de la grippe A/H1N1 a été
confirmé hier par le laboratoire de l’Institut Scientifique de Santé
Publique.
Il s’agit du quatrième décès dans notre pays d’un patient présentant
des complications après avoir contracté la grippe A/H1N1. La
mortalité due à cette grippe n’est actuellement pas plus élevée que
celle pour la grippe saisonnière.
1017 Troisième cas mortel de
grippe pandémique A/H1N1 [Belgium]--Le Commissariat
interministériel Influenza informe que dimanche dernier, le 11
octobre 2009, une dame de 37 ans habitant la province d’Anvers est
décédée à l’hôpital des suites d’une infection due au virus
pandémique A/H1N1. Elle ne présentait pas de facteur à risque connu.
Cette dame a présenté les premiers symptômes grippaux le 26
septembre. Etant donné que sa santé se dégradait, elle a été admise
à l’hôpital le 3 octobre avec une pneumonie bilatérale et a été
placée sous respirateur artificiel. Sa situation a encore empiré et
elle est décédée le 11 octobre des suites de l’infection grippale.
Le diagnostic de l’infection au virus de la grippe A/H1N1 a été
confirmé aujourd’hui par le laboratoire de l’Institut Scientifique
de Santé Publique.
Il s’agit du troisième décès dans notre pays d’une patiente
présentant des complications après avoir contracté la grippe A/H1N1.
La mortalité due à cette grippe n’est actuellement pas plus élevée
que celle pour la grippe saisonnière. La semaine dernière, d’après
l’extrapolation, 4160 personnes ont attrapé la grippe A/H1N1 en
Belgique. Depuis le début de l’épidémie, 12 678 cas ont été
constatés dans notre pays.
Jusqu’à présent, 201 personnes sont décédées en Europe des suites de
la grippe A/H1N1. A l’échelle mondiale, 4675 décès dus au virus
grippal pandémique ont été constatés.
1017 Seventeen-year-old
pregnant woman dies after contracting H1N1 flu [Scotland]--A
17-year-old woman from the Borders who was pregnant when she
contracted influenza A (H1N1) has died.
Due to the sudden nature of this death, a report has gone to the
Procurator Fiscal.
Health Secretary Nicola Sturgeon said: "The death of this young
mother-to-be and her baby is deeply saddening and my thoughts are
with her family and friends.
"Medical experts have been telling us that pregnant women are more
vulnerable to developing complications after contracting the virus.
For this reason, they will be among the priority groups for
vaccination when the H1N1 vaccine becomes available later this
month.
"I would urge all pregnant women to get vaccinated to ensure the
maximum protection for themselves and their babies.
"While there is no evidence to suggest that the virus is becoming
any more dangerous for the public at large, this tragic death
highlights that some groups are at greater risk and should take up
the offer of vaccination."
The latest figures about the incidence of influenza A (H1N1) in
Scotland have been published today.
800 GP practices are now supplying surveillance reporting figures,
compared to 58 in previous weeks. This allows a more comprehensive
picture of consultation rates.
Today's findings are:
* A rate of GP consultations for flu-like illnesses - not
necessarily H1N1 - across Scotland of 106.4 per 100,000. This is an
increase from last weeks figure of 86.1.
* The number of community samples that tested positive for H1N1 has
increased to 29.3 per cent from 16.4 per cent last week.
* These rates suggest that an estimated figure of 4,370 have
consulted their GP. However, taking account of the number of people
having H1N1 but not consulting their GP, HPS estimate that around
12,500 people have contracted H1N1 in the past week.
* As of October 7, there have been 315 people with influenza A
(H1N1) hospitalised since the start of the outbreak. 64 people have
required hospital admission in the last week and, as of yesterday,
there were 50 in hospital in Scotland. 64 represents the highest
number of weekly admissions to hospital since the outbreak began.
* There have been fifteen deaths linked to influenza A (H1N1) since
the start of the outbreak.
* Although there are increased absence levels currently in a few
schools, these instances are localised and do not signal an overall
increase in absence levels in schools across Scotland this past
week.
Speaking about the weekly reported figures, Ms Sturgeon said:
"This week's figures show an increase in the number of people
consulting their GP with flu-like symptoms and the number of overall
estimated cases.
"Flu epidemics by their very nature are unpredictable and weekly
increases and decreases are to be expected. Even if H1N1 continues
to be a relatively mild virus for most people affected, its effects
on the health service and on the wider community could be highly
disruptive and we can not be complacent about the threat presented
by the outbreak.
"Hospitalisations continue to increase and this means that it is
even more vital that those deemed at risk do all they can to protect
themselves.
"Vaccination is the best defence we have against the H1N1 virus and
Scotland is preparing very well for the first phase of the
vaccination programme which is due to start later this month.
"Anyone who is concerned about flu-like symptoms should continue to
contact their GP for advice, or NHS 24 on 08454 24 24 24."
1017 H1N1 vax program to begin
Oct 21 [Scotland]--The H1N1 vaccination programme will
begin in Scotland on October 21. Further details on the plans which
will be phased in over the next few weeks were announced today by
Cabinet Secretary for Health and Wellbeing Nicola Sturgeon.
Ms Sturgeon also revealed that the majority of the vaccine will be
administered in a single dose. Children under the age of ten and in
the at risk group will require two doses. Frontline health and
social care workers will be offered the vaccine at the same time as
the first clinical risk group.
A total of 1.3 million people are in the Scottish priority groups
for the first stage of the vaccination programme.
Ms Sturgeon said:
"Vaccination is the best defence we have against the H1N1 virus and
I am pleased to be able to announce today the start date for the
programme.
"Scotland is one of the first countries in the world to receive the
vaccine supply thanks to contracts put in place before this
outbreak.
"I strongly urge people in the at risk groups to have the vaccine.
It is also vital that our health workers, who are at increased risk
of infection and transmission, are protected against this virus so
that they can continue their invaluable work.
"People should be reassured that the NHS in Scotland and its partner
agencies are continuing to do everything they can to minimise the
impact of this outbreak.
"Everyone can also play a part in minimising the spread of flu-like
illness by following sensible hygiene measures."
GPs will begin to invite people in the at risk groups to come
forward for the vaccination over the next few weeks. People should
wait for this invitation from their GP. NHS Boards in Scotland are
leading on the vaccination of the health and social care workforce.
1017 Details of H1N1 flu vax
program announced [Ireland]--The HSE and Department of
Health announced this evening that the Swine Flu Vaccination
Programme will commence on 2nd November. As very few people in
Ireland have any immunity to Swine Flu, over the coming months, the
HSE will offer a Swine Flu vaccine to the entire population.
Everyone will be offered the Swine Flu vaccine. However, as the
vaccine is being delivered in phases, we will start with the people
who are more at risk from Swine Flu.
An agreed schedule of vaccine delivery was put in place earlier this
year, but manufacturers have been delayed in meeting these delivery
schedules. This problem is not limited to Ireland but is a worldwide
problem. As such, the more at risk groups (set out below) will be
offered the vaccine first.
At Risk Groups
* Pregnant women - from 14 weeks pregnant to 6 weeks after giving
birth
And
* Anyone aged over 6 months and under 65 years who has:
- Long-term Lung Disease (like Asthma and Cystic Fibrosis)
- Long-term Heart Disease
- Long-term Kidney Disease
- Long-term Liver Disease
- Long-term Neurological Disease (like MS, Cerebral Palsy)
- Immunosuppression e.g. cancer treatment (and their household
contacts)
- Haemoglobinopathies
- Diabetes
- Morbid Obesity (check with your GP)
People aged 65 and over seem to have some immunity to Swine Flu so
they are not in the most at-risk group and will be vaccinated at a
later stage.
The HSE and Department of Health have been in touch with GPs and
their representatives over the last ten days, seeking their
partnership in helping to vaccinate this group.
It is our view that the general practice setting is by far the best
place to vaccinate this group - this is because GPs are familiar
with this group of people and their specific needs. More
importantly, the people in this group are among the most unwell and
vulnerable in our society and in the most part know their GP, are
comfortable with them as their regular caregiver, and will find this
the easiest location to attend.
We are delighted with the strong positive response from over 1,800
General Practitioners, who have indicated to the HSE their readiness
to participate in this important vaccination programme.
From Monday next week we will start delivering vaccine and
supporting supplies to those GPs who have indicated their
participation, and those supplies will build up to the required
capacity over the following ten days.
Then, on November 1st, a national information campaign will
commence, inviting those in the at-risk groups to make contact with
their GP and make an appointment to receive their vaccine at
specific clinics. In the eventuality that an individual's GP is not
participating, alternative arrangements will be put in place.
We will continue to answer any outstanding queries that arise from
GP organisations, and will work to satisfy any ongoing concerns they
may have.
Once this group has been completed, over the coming weeks and months
we will move to the other groups, including healthcare workers (to
provide protection to their vulnerable patients), children and older
people, before offering vaccines to the wider population. More
detail on the timing of vaccination for these other groups will be
announced at a later date and through the HSE's information
campaign.
The HSE's GP sentinel sites reported a further increase in rates of
influenza-like illness this week, with a rate of 97.1 per 100,000
cases.
The number of people currently hospitalised is 48, bringing the
total number of people hospitalised from this illness since April to
302. The number of people currently in ICU is 11, the cumulative
total number of people admitted to ICU since April is 24.
1017 H1N1 flu rate increasing with main burden of disease remaining with school-aged children and young adults [England]--The flu-like illness rate in England from the Royal College of General Practitioners (RCGP) scheme increased to 29.1 per 100,000 in week 41. An increase was seen in most age groups except those over 65 years.
The main burden of flu-like illness
nationally is in the 5-14 and 15-24 years age groups.
This week, the antiviral collection
numbers in the National Pandemic Flu Service have continued to
increase and this has been seen in all age groups except the over
65s. The largest increase (17%) in week 41 was seen in the 5-14 year
olds.
Interpretation of data to produce
estimates on the number of new cases continues to be subject to a
considerable amount of uncertainty. HPA modelling gives an estimate
of 27,000 new cases in England last week (range 13,000 to 58,000)
compared with 18,000 in week 40. This indicates a doubling every two
weeks.
This estimate incorporates data from National Pandemic Flu Service and GP consultations.
The National Pandemic Flu Service (NPFS) continues to issue antiviral drugs to people in England with an influenza-like illness who call or log onto the internet site. The number of assessments and antiviral collections through this service has continued to increase gradually over the past week.
At least 70 schools throughout England have reported outbreaks of
ILI, since the beginning of the autumn term, with virological
confirmation of pandemic influenza in at least one case in 48 of the
schools. School outbreaks have also been reported from Scotland,
Wales and Northern Ireland.
In England, since the beginning of the autumn term, there have been 48 schools with virologically confirmed pandemic influenza in the following regions; North East (5); North West (5); Yorkshire and Humber (10); West Midlands (12); East Midlands (4); South East (4); London (3). A further 14 schools are currently under investigation because of increased absenteeism due to influenza-like illness and seven schools investigated have not been confirmed as pandemic influenza. Of the schools with confirmed outbreaks, 37 were day schools (20 secondary, ten primary, one middle and six special schools) and 11 were boarding schools (six secondary, one primary, one middle and three special schools). In week 41, three school outbreaks were reported in Northern Ireland.
Interpretation of data to produce estimates on the number of new
cases continues to be subject to a considerable amount of
uncertainty with the move to the National Pandemic Flu Service (NPFS).
HPA modelling gives an estimate of 27,000 (range 13,000 – 58,000)
new cases in England in week 40. The estimated number of new cases
has increased in all regions and age groups.
The main influenza virus circulating in the UK continues to be the
pandemic (H1N1) 2009 strain, with few influenza H1 (non-pandemic),
H3 and B viruses detected. Two of 1562 pandemic viruses tested have
been confirmed to carry a mutation which confers resistance to the
antiviral drug oseltamivir; both have been shown phenotypically to
be resistant to the drug but retain sensitivity to zanamivir.
The majority of pandemic influenza cases continue to be mild. The
cumulative number of deaths reported due to pandemic (H1N1) 2009 in
the UK is 105. There was a total of 667 new patients hospitalised in
England with suspected pandemic influenza in the week from 08-14
October, an increase from 520 in the previous week. The highest
hospitalisation rates have consistently been in the under 5-year age
group, and have increased in this group recently.
Disease severity continues to be monitored. HPA receives data on hospitalisation and deaths due to pandemic influenza in England from the Department of Health, and from the relevant bodies in Scotland, Wales and Northern Ireland.
In England, on 14 October there were 363 hospitalised patients with
suspected pandemic influenza, which is an increase from 290 seven
days previously. Of the 363, 74 (20.4%) were in intensive care and
124 were newly hospitalised in the 24 hours up to 8am. In the week
from Thursday 08 October to Wednesday 14 October, 667 new patients
were hospitalised with suspected pandemic influenza corresponding to
a rate of 1.3 per 100,000 population, which is an increase from the
previous week’s rate of 1.0 per 100,000. The highest hospitalisation
rate has consistently been in those aged under 5 years; the weekly
rates in all age groups have increased in this group in the past
week. It should be noted that the hospitalisations are current, not
cumulative, and are for suspected pandemic influenza rather than
virologically confirmed infection. Historical data for
hospitalisation for influenza-like illness are not available for
comparison. In Scotland there have been 272 cumulative
hospitalisations of patients with confirmed pandemic influenza, 193
in Wales and 280 in Northern Ireland.
1017 H1N1 flu levels continue
to increase [Wales]--Levels of flu like illness continue
to increase in Wales. Levels are higher than usual for the time of
year. Swine flu usually leads to a mild illness although in a
minority of cases it can be severe.
The clinical consultation rate for influenza in Wales during the
week ending 11 October was 62.35 cases of flu like illness diagnosed
by GPs out of every 100,000 people in Wales. It was 53.48 per
100,000 in the previous week. Current levels of flu in Wales remain
higher than usual for this time of year.
192 laboratory confirmed cases of
swine flu have been reported by NPHS Health Protection Teams in
Wales (as at 12noon on 14 October).
Of the laboratory confirmed cases, a
total of 92 people confirmed with swine flu in Wales have been
admitted to hospital since the start of the outbreak. Twelve of
these cases were still hospitalised (as at 12noon on 14 October).
As of 14 October, four people who had
tested positive for swine flu had died in Wales.
According to the NPHS daily GP
surveillance scheme, as at 13 October, the influenza consultation
rate in Wales as a whole was 54.81 cases of flu like illness
diagnosed by GPs in the previous seven days out of every 100,000
people in Wales. This is the equivalent of 1,644 people contacting
their GPs in the last seven days with flu like symptoms.
Consultation rates are between 22.7
and 91.8 per 100,000 in all 22 LHB areas in Wales. Consultation
rates are highest in those aged 5 to 14 years.
Latest figures show that the percentage of total calls to NHS Direct Wales which were influenza related increased to 28.6 per cent.
The Chief Medical Officer for Wales,
Dr Tony Jewell, said:
“The number of people contacting their GP with flu-like symptoms is
gradually increasing in Wales and similar increases are being seen
across the UK. We are now seeing levels of flu-like symptoms that we
would routinely see during the normal winter flu season.
“Sadly, as we have seen this week, as the number of swine flu cases
rise, the number of people experiencing severe symptoms or
complications or even death will inevitably increase. This is the
same for seasonal flu in the winter.
“The GSK and Baxter H1N1 swine flu vaccines have now been given the
appropriate licence and we should start to receive supplies next
week, with the vaccination programme expected to start before the
end of October.
“Those most at risk of complications from the virus and frontline
health and social care workers will be the first to receive the
vaccine.
“I must stress that for the vast majority of healthy people, the
infection remains mild and they should recover within five to seven
days with rest, plenty of fluids and paracetamol.
“People with underlying health
conditions, especially heart and lung diseases, are at most risk.
Even in the at risk groups – those with chronic conditions, pregnant
women and children under 5 and those 65 and over – most people get
over the infection with no major concerns.
“If people are concerned, or if they
are in these at risk groups, they should contact their GP.
Antivirals have the most impact within 48 hours of the onset of
flu-like symptoms.”
Dr. Roland Salmon, Director of the Communicable Disease Centre,
National Public Health Service for Wales, said:
“The number of people contacting their GP with flu like symptoms is
increasing. It seems that the winter wave is getting underway.
“Not everyone who has contacted their GP with flu like symptoms will
have swine flu. It’s also true that not everyone with flu like
symptoms will contact their GP.
“People with flu like symptoms should check their symptoms on
www.nhsdirect.wales.nhs.uk or by calling the Swine Flu
Information Line on 0800 1 513 513.
“Most people will get better at home with rest, plenty of fluids,
and medication such as paracetamol.
“If symptoms worsen or people have underlying health problems they
should call their GP. People should not go to Accident and Emergency
Departments, a pharmacy or to their GP surgery unless advised to do
so as this may risk spreading the infection. It also places undue
pressure on the emergency services.
“Over the last five months, the symptoms of swine flu have generally
been like those of seasonal flu. Most people recover from infection
without needing to be admitted to hospital or to call a doctor.
However, a few people get severe disease and as the pandemic
continues, we expect to see a number of deaths from swine flu in
Wales, just as we do most years from seasonal flu. Sadly one death
has already occurred. However the great majority of people make a
full recovery. By following public health advice if they become ill
and taking up the swine flu vaccine when it becomes available,
people can help prevent the spread of the virus and by the same
token help prevent death and serious disease.
“It is still important that people practice good respiratory and
hand hygiene to reduce the chance of catching or spreading viruses.”
1004 H1N1 : Le recours aux
soins pour grippe clinique et infections respiratoires aiguës tend à
se stabiliser [France]--Du 21 au 29 septembre 2009,
l’incidence des consultations pour grippe clinique estimée par le
réseau Sentinelles a légèrement augmenté pour atteindre 234 cas pour
100 000 habitants se situant toujours au-dessus du seuil épidémique
(96 cas pour 100 000 habitants). L’excès hebdomadaire de
consultations pour grippe clinique, est estimé à 130 000
consultations. La proportion d’infections respiratoires aiguës (IRA)
parmi les actes médicaux est relativement stable selon le réseau
Grog. Les réseaux SOS Médecins et Oscour indiquent une légère baisse
de l’activité liée aux syndromes grippaux.
Le taux de prélèvements positifs pour le virus A (H1N1) 2009
réalisés par le réseau des Grog, reste faible et permet d’évaluer le
nombre de consultations pour grippe A (H1N1) 2009 à 28 000 pour la
semaine 38.
En semaine 38 parmi les virus grippaux, le A (H1N1) 2009 représente
la quasi-totalité des virus circulants, selon les CNR Influenzae. Le
nombre de cas graves liés au virus A (H1N) 2009 depuis fin août
reste stable.
Au total, en métropole, la part prise par la grippe liée au virus A
(H1N1) 2009 dans le recours aux soins est difficile à mesurer compte
tenu de la circulation d’autres virus respiratoires. Il faut
également tenir compte d’une augmentation probable du recours aux
soins liée au contexte de forte sensibilisation au virus pandémique.
Dans tous les départements français d’Amérique, l’activité grippale
continue d’augmenter. Sur l’île de la Réunion, l’activité grippale a
atteint le pic épidémique en semaine 35. Depuis, la baisse se
poursuit.
Au niveau international, la vague épidémique A (H1N1) 2009 prend fin
dans les pays de l’hémisphère Sud. Dans la zone intertropicale, la
tendance est globalement à la baisse. Une deuxième vague semble
débuter au Mexique et aux Etats-Unis, notamment dans les Etats du
Sud. En Europe, l’activité grippale est fluctuante dans de nombreux
pays. On note une augmentation, notamment au Royaume-Uni, en Ecosse,
en Irlande et aux Pays-Bas et une diminution dans d’autres pays tels
que la Suède et la Norvège.
Au cours de la semaine du 21 au 27 septembre en France métropolitaine: 1 décès en Polynésie française. Depuis le début de l’épidémie en France: 30 décès de malades porteurs du virus A (H1N1) 2009 (dont 6 en métropole, 1 en Guyane, 1 en Martinique, 6 à la Réunion, 9 en Nouvelle Calédonie et 7 en Polynésie Française).
1004 H1N1 : Deuxième décès
suite à la grippe pandémique A/H1N1 [Belgium]--Le
Commissariat interministériel Influenza annonce qu’aujourd’hui, le
1er octobre 2009, une femme de 44 ans originaire de la province du
Hainaut est décédée à l’hôpital des suites d’une infection au virus
pandémique A/H1N1. Elle ne présentait pas de facteur à risque connu.
Le 11 septembre, la femme a présenté les premiers symptômes grippaux.
Sa situation s’aggravant, elle a été admise le 14 septembre à
l’hôpital avec une détresse respiratoire aigue, et a été placée sous
respirateur artificiel. Le diagnostic d’une infection au virus de la
grippe a été confirmé le 16 septembre. Son état clinique ne s’est
pas amélioré et elle est décédée le 1er octobre.
Cette dame est la deuxième patiente décédant des suites de la grippe
A/H1N1 en Belgique, après le décès le 30 juillet d’une anversoise de
34 ans.
La semaine dernière, l’extrapolation a livré 1873 cas de grippe.
Depuis le début de l’épidémie, 8597 personnes ont été touchées par
la grippe pandémique.
Dans le monde, 4334 personnes sont décédées des suites de la grippe
A/H1 N1. Actuellement, la mortalité de cette grippe n’est pas plus
élevée que celle de la grippe saisonnière qui sévit annuellement
dans notre pays.
1004 H1N1 : Govt to pay for
nurses returning to work as result of flu pandemic [Scotland]--Nurses
and midwives returning to work to help in any worsening of the H1N1
outbreak will have their re-registration costs paid for by the
Scottish Government.
The Nursing and Midwifery Council has written to former members
whose registration has lapsed in the previous four years to
encourage them to re-register. This would make them available to
employers in the event of a surge in the pandemic.
Announcing the move Cabinet Secretary for Health and Wellbeing
Nicola Sturgeon said:
"We are continuing to work closely with boards and other
organisations to ensure Scotland is prepared for any NHS staffing
implications as a result of the pandemic.
"The extra resource former nurses and midwives can provide if the
pandemic worsens will be vital and that is why we are offering to
meet any costs that re-registering will incur."
Ms Sturgeon also revealed a further increase in Scotland's critical
care capacity.
£1.4 million has already been invested in purchasing 40 extra adult
ventilators and 15 extra paediatric ventilators.
In addition to this eight further neo-natal ventilators and three
further adult ventilators have now been acquired.
Commenting, Ms Sturgeon said:
"Critical care capacity is not just an issue of available beds or
cots. It requires, amongst other things, consideration of necessary
equipment, such as these ventilators.
"Even if H1N1 continues to be a relatively mild virus for most
people affected, its effects on the health service and on the wider
community could be highly disruptive.
"That is why we continue to press ahead with our plans for
responding to the virus and the impact of seasonal flu.
"We are already in a strong position to cope with the peak in cases
expected over autumn and winter and we must remember in the vast
majority of H1N1 cases, most people have fairly mild symptoms and
make a full recovery within a week."
There are approximiately 9,500 nurses and midwives in Scotland who
would meet the criteria set out by the Nursing and Midwifery
Council.
The first four ventilator machines are expected within the next few
weeks and the expectation is that the remainder will be delivered in
November.
1004 H1N1 : New actions to
combat virus outbreak [Scotland]--A range of actions
being taken to combat the influenza A (H1N1) outbreak were today
outlined as the latest figures on its incidence were published.
This week's figures consist of data from 732 Scottish practices for
the first time, compared to 58 practices last week, to allow a more
comprehensive picture of consultation rates. Using this data Health
Protection Scotland have estimated that the total number of people
in Scotland who have contracted H1N1 over the last week is 13,800,
approximately double compared to last week.
The new developments are:
* Confirmation from the EU Commission that the GSK vaccine is now
officially licensed
* UK Health Ministers have agreed to double ECMO facilities at the
UK centre in Leicester
Health Secretary Nicola Sturgeon said:
"Today's announcements show that we are continuing to do all we can
to minimise the impact of the pandemic.
"The fact that the European Commission has licensed the vaccine
means we will be able to start our vaccination programme as soon as
vaccines are distributed by the manufacturer and reach GP practices.
"I am also pleased to confirm that all four UK Health Ministers have
agreed to a recommendation from the Critical Care Clinical Group
that the ECMO facilities at Leicester will be doubled. In Scotland
we have our own review group which will consider ECMO provision in
the medium to longer term. The group will provide recommendations in
due course."
Today's H1N1 figures, published by Health Protection Scotland, are:
* A rate of GP consultations for flu-like illnesses - not
necessarily H1N1 - across Scotland of 103.7 per 100,000
* Using the new methodology this represents a 7% increase from last
week.
* The number of community samples that tested positive for H1N1 has
almost doubled from 17.6 to 34.1 per cent
* These rates suggest that an estimated figure of 4,850 people have
consulted their GP
* As of September 30, there have been 188 people with influenza A
(H1N1) hospitalised since the start of the outbreak. Fifteen people
have required hospital admission in the last week and, as of
yesterday, there were 13 in hospital in Scotland
* A patient from NHS Lanarkshire who went to Glenfield Hospital in
Leicester has now been transferred back to Glasgow Royal Infirmary
* A Scottish patient who is currently in hospital in Ibiza has been
reported as making good progress
* There have been nine deaths linked to influenza A (H1N1) since the
start of the outbreak
* There have been no overall increases in school absence levels this
past week
Speaking about the weekly reporting figures, Ms Sturgeon said:
"I am pleased that data is now being received from 71 per cent of
Scottish practices. This enables us to present more robust GP
consultation rates for Scotland and provides a more comprehensive
picture.
"The figures show another increase in the number of people
consulting their GP with flu-like symptoms over the last week.
"The proportion of samples testing positive for H1N1 and as a result
the total estimated cases has significantly increased this week.
"The potential threat from H1N1 remains serious, even if it
continues to be a relatively mild virus.
"Vaccination is the best defence we have against the H1N1 virus and
Scotland is well prepared for the vaccination programme. It is very
good news that the GSK vaccine is now licensed.
"Simple hygiene measures like frequent handwashing and using tissues
can do a huge amount to help prevent flu spreading.
"Anyone who is concerned about flu-like symptoms should continue to
contact their GP for advice, or NHS 24 on 08454 24 24 24."
1004 H1N1 : 62-year-old female
death on Oct 1 [Scotland]--The death of a 62 year old
woman from Forth Valley who had been suffering from H1N1 has been
reported.
The patient had significant underlying health conditions. At the
family's request, no further details will be released. This woman is
the tenth person, in Scotland, to die who had been suffering from
H1N1.
Health Secretary Nicola Sturgeon said:
"Our thoughts are with the patient's family and friends, and I'd
like to send my sincere condolences to her loved ones at this very
sad time.
"As we have seen in previous cases, this patient was suffering from
underlying health conditions and her death should not cause alarm
among the general population.
"Fortunately in the vast majority of H1N1 cases, most people have
fairly mild symptoms and make a full recovery within a week. But
it's important that you get the help you need as quickly as possible
if you are at greater risk."
1004 E.coli in Surrey update 18
[England]--The Health Protection Agency (HPA) reports
that the total number of cases of E. Coli O157 linked to Godstone
Farm in Surrey is 88.
Three children remain in hospital all of whom are described by the
hospital today as 'stable'.
1004 HPV vax update [England]--Following
tragic news of the death of a girl in Coventry yesterday, the
Department of Health is working closely with the NHS, regulatory
bodies, to thoroughly investigate the details of the case.
As a purely precautionary measure, we have asked the NHS to
quarantine all stocks of HPV vaccine from the batch related to this
case.
No link can be made between the death and the vaccine until all the
facts are known.
Results of tests on the batch of vaccine will be announced as soon
as they are known.
The HPV vaccination programme can continue as planned – there is no
reason for the campaign to be suspended or interrupted. However, we
recognise that minor delays may occur in the next day or so in some
areas.
Where the local NHS has supplies of vaccine from other production
batches, they should continue with the vaccination programme. PCTs
that need more supplies of HPV vaccine to replace quarantined stock
should order it in the usual way.
Results of investigations into this sad event will be announced as
soon as possible.
Safety
The HPV vaccine has passed the rigorous safety testing needed for it
to be used in the UK and other European countries.
More than 1.4 million doses have now been given in the UK – the
vaccine has a strong safety record, and the quarantining of this
batch is a purely precautionary measure.
It is important that we get all the facts before we draw conclusions
on the cause of this tragic event.
The vaccine has a strong safety record so there is no reason to
suspend the HPV programme. Several million doses of the vaccine have
been given around the world, and more than 1.4 million doses have
now been given in the UK.
Half of all sexually active women will be infected by a strain of
HPV in their lifetime, which is responsible for causing more than
99% of cervical cancer cases. The vaccine could eventually prevent
up to 400 deaths due to cervical cancer every year.
If parents or young people are concerned about the safety of any
vaccine they should speak to their GP to discuss their concerns,
visit NHS Choices or call NHS Direct on 0845 46 47.
1001 E.coli in Surrey update 17
[England]--The Health Protection Agency (HPA) reports
that the total number of cases of E. Coli O157 linked to Godstone
Farm in Surrey remains at 87.
Three children remain in hospital all of whom are described by the
hospital today as 'stable'.
1001 H1N1/ILI : Rates of flu-like illness have shown further increases [England]--Rates of flu-like illness and related activity have shown further increases in England. The largest rises in England have been seen in the North West and Yorkshire and Humber.
The flu-like illness rate in England from the Royal College of
General Practitioners (RCGP) scheme increased to 22.2 per 100,000 in
week 39. Most age groups saw an increase.
This week, the antiviral collection
numbers in the National Pandemic Flu Service have continued to
increase and this has been seen in all age groups. The largest
increase was in the 25-44 year olds (8,796 in week 38 to 12,055 in
week 39).
Interpretation of data to produce
estimates on the number of new cases continues to be subject to a
considerable amount of uncertainty. HPA modelling gives an estimate
of 14,000 new cases in England last week (range 7,000 to 30,000).
This is a 50 per cent rise since the previous week.
This estimate incorporates data from
National Pandemic Flu Service and GP consultations.
Globally, activity is generally increasing in the northern hemisphere, is variable in the tropical regions and has largely returned to baseline in the southern hemisphere.
Headlines link directly to articles:
1113 More than 1.2 million cases of ARI and 239 deaths in the Ukraine [Europe update]
1113 Cas probable de syndrome de Guillain-Barré [France]
1113 Plus de 29,000 nouveaux cas de grippe A/H1N1 pour la semaine passée [Belgium]
1113 H1N1 flu related death reported from NHS Dumfries and Galloway [Scotland]
1113 Increased rate of ILI-related GP consultations [Scotland]
1113 H1N1 flu related death reported from NHS Greater Glasgow and Clyde [Scotland]
1113 Use of antiviral drugs stepped up as flu epidemic spreads [Finland]
1113 Case of infant botulism [Scotland]
1113 Currently 191 hospitalized with pandemic flu with 22 of those in ICU [Ireland]
1113 Contingency planning for 24-hour strike on 24 November [Ireland]
1113 Dalkey residents to have easier access to primary care services [Ireland]
1113 First team of HSE South advanced paramedics deployed in West Cork [Ireland]
1113 HSE updated statement on C Diff at Our Lady of Lourdes Hospital Drogheda [Ireland]
1113 HPA modelling estimate of 64,000 new cases of pandemic flu last week [England]
1107 Informe semanal de situación gripe pandémica A (H1N1) [Spain]
1107 Grippe A/H1N1 : la vaccination des groupes prioritaires débute demain [Belgium]
1107 Évolution de la grippe A/H1N1 en Belgique : rapport hebdomadaire [Belgium]
1107 Another H1N1 flu-related death from NHS Ayrshire and Arran brings toll to 32 [Scotland]
1107 Decrease in rate of GP consultations for ILI [Scotland]
1107 H1N1-related flu death from NHS Ayrshire and Arran [Scotland]
1107 H1N1 update from Ukraine - Nearly 200,000 more cases of ARI since Nov 4 [Stockholm Sweden]
1027 Two more H1N1 flu-related deaths reported [Scotland]
1027 Another pediatric H1N1-related death reported [Ireland]
1027 H1N1 flu epidemic about to start - First death confirmed [Finland]
1017 Informe semanal de situación gripe pandémica A (H1N1) [Spain]
1017 Evolution de la grippe A/H1N1 et des mesures en Belgique : rapport hebdomadaire [Belgium]
1017 Quatrième cas mortel de grippe pandémique A/H1N1 [Belgium]
1017 Troisième cas mortel de grippe pandémique A/H1N1 [Belgium]
1017 Seventeen-year-old pregnant woman dies after contracting H1N1 flu [Scotland]
1017 H1N1 vax program to begin Oct 21 [Scotland]
1017 Details of H1N1 flu vax program announced [Ireland]
1017 H1N1 flu levels continue to increase [Wales]
1004 H1N1 : Deuxième décès suite à la grippe pandémique A/H1N1 [Belgium]
1004 H1N1 : Govt to pay for nurses returning to work as result of flu pandemic [Scotland]
1004 H1N1 : New actions to combat virus outbreak [Scotland]
1004 H1N1 : 62-year-old female death on Oct 1 [Scotland]
1004 E.coli in Surrey update 18 [England]
1001 E.coli in Surrey update 17 [England]
1001 H1N1/ILI : Rates of flu-like illness have shown further increases [England]
The contents of this site, unless otherwise specified, are copyrighted by © Big Medicine 2001-2009. The news provided is for personal use only. Reproduction or redistribution of the this site, in whole, part or in any form, requires the express permission of Big Medicine or the original source. For questions or comments pertaining to this site, contact the web administrator. Big Medicine is not responsible for the content of external sites linked and does not endorse their content. Advertisers are not responsible for Big Medicine contents, the content of external sites linked and do not endorse their content.