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Friday November 13, 2009

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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.

 
En esta segunda fase, que se ha presentado hoy y se desarrollará hasta finales de este mes, el Ministerio de Sanidad y Política Social recuerda que el próximo 16 de noviembre se iniciará la vacunación contra el nuevo virus, tal y como acordó el Consejo Interterritorial del Sistema Nacional de Salud el pasado 22 de octubre. 
 
La campaña destaca la efectividad de la vacuna contra la gripe pandémica y señala cuáles son los grupos prioritarios de vacunación, entre los que se encuentran:
 
1.      Trabajadores sociosanitarios: tanto de atención primaria como hospitalaria, pública y privada, así como el personal de residencias de la tercera edad y centros de atención a enfermos crónicos.
 
2.      Trabajadores de servicios públicos esenciales: fuerzas y cuerpos de seguridad del Estado, bomberos, servicios de protección civil, personas que trabajan en los servicios de emergencias sanitarias y trabajadores de instituciones penitenciarias y de centros de atención al refugiado e inmigrantes.
 
3.      Mujeres embarazadas.
 
4.      Personas mayores de 6 meses con patologías como:
 
·        Enfermedades cardiovasculares crónicas (excluyendo la hipertensión).
·        Enfermedades respiratorias crónicas.
·        Diabetes tipo I y tipo II con tratamiento farmacológico.
·        Insuficiencia renal moderada o grave.
·        Hemoglobinopatías y anemias moderadas o graves.
·        Asplenia (ausencia de bazo).
·        Enfermedad hepática crónica avanzada.
·        Enfermedades neuromusculares graves.
·        Pacientes con inmunosupresión (incluida la originada por infección por VIH o por fármacos o en los receptores de trasplantes).
·        Obesidad mórbida (índice de masa corporal igual o superior a 40).
·        Niños y adolescentes, menores de 18 años, que reciben tratamiento prolongado con ácido acetilsalicílico, por la posibilidad de desarrollar un síndrome de Reye.
 
El Ministerio de Sanidad y Política Social recomienda a todas estas personas la vacunación y hace un llamamiento a la responsabilidad de algunos colectivos, como el de los profesionales sanitarios, cuya vacunación no es sólo una medida preventiva para su propia salud sino también para la de las personas enfermas a las que atienden y que pueden sufrir complicaciones en caso de contagio.
 
PLAN DE DIFUSIÓN
 
La segunda fase de la campaña Gripe A. La prevención es la mejor medida, cuenta con un presupuesto de 801.720,95 euros. Al igual que en la primera fase, para su difusión se utilizarán distintos medios: inserciones en prensa y revistas; emisión de 333 cuñas en las principales emisoras generalistas y radiofórmulas, y colocación de 3.305 carteles en soportes de mobiliario urbano y en centros comerciales.
 
En internet, la página web www.informaciongripea.es seguirá ofreciendo de manera fácilmente comprensible toda la información de interés sobre la gripe A. Como novedad se facilitarán fichas informativas en formato electrónico sobre vacunación y embarazadas. También se ofrecerá la posibilidad de descargar en las lenguas del Estado, y en inglés y francés, el material informativo de la campaña (gráfica, cuñas y fichas).
 
Además, esta segunda fase de la campaña incorpora al CANAL LAE (Loterías y Apuestas del Estado) para la difusión de los mensajes en las pantallas situadas en las administraciones de Loterías y Apuestas del Estado.
 
OTRAS ACCIONES PREVISTAS
 
En esta segunda fase de la campaña informativa, también se prevé emplear, sin coste alguno, las revistas del Ministerio del Interior (Guardia Civil y Policía Nacional), Defensa y la revista de MUFACE, con el fin de dirigirse específicamente a los colectivos de la Administración General del Estado para los que está recomendada la vacunación.
 
Del mismo modo, está prevista la remisión por correo electrónico del material de la campaña a los organismos públicos y sociedades científicas para que colaboren en su difusión e incorporen enlace en sus páginas web.
 
Para próximas fases de la campaña también está prevista la utilización de spots televisivos.

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 Sanidad centra la segunda fase de la campaña sobre la gripe A en la vacunación de los grupos prioritarios [Spain]

 

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 HSE to write to parents and older people shortly inviting them for a Swine Flu Vaccine appointments [Ireland]

 

1113 HPA modelling estimate of 64,000 new cases of pandemic flu last week [England]

 

1107 Forte recommandation de vaccination contre le virus A(H1N1) - Maintien, à ce stade, d’un schéma vaccinal à deux doses [France]

 

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 Avis du Conseil Supérieur de la Santé (CSS) relatif à l’augmentation du nombre de dons de sang durant une pandémie [Belgium]

 

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]

 

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 Updating H1N1/ILI/Acute Respiratory Infections numbers in Ukraine outbreak - 936,804 cases and 144 deaths [Ukraine]

 

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 rate increasing with main burden of disease remaining with school-aged children and young adults [England]

 

1017 H1N1 flu levels continue to increase [Wales]

 

1004 H1N1 : Le recours aux soins pour grippe clinique et infections respiratoires aiguës tend à se stabiliser [France]

 

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]

 

1004 HPV vax update [England]

 

1001 E.coli in Surrey update 17 [England]

 

1001 H1N1/ILI : Rates of flu-like illness have shown further increases [England]

 

 

 

 

 

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