As the world continues to come to terms with the first global flu pandemic since the Hong Kong Flu of 1968, and as the outbreak continues to gain further traction over the autumn and winter months to come, this series of weekly ‘Swine Flu Update’ articles will attempt to provide both informed editorial analysis and key national – and supranational – updates.
With the Healthcare Protection Agency (HPA) estimating that there were around 110,000 new cases of Swine Flu in the UK for the week ending July 26th, the virus is doubtless continuing to gain considerable momentum. GP consultation rates continued to grow above those of a typical seasonal flu outbreak and the under 5s and 5-14 year olds continued to be age groups most predominately affected by the infection. The total number of deaths as a result of the virus in the United Kingdom currently stands at 31. Figures for deaths worldwide now stand at upwards of 800 victims.
Yet beyond all of the rising numbers – that are arguably to be expected in the event of such an un-controlled outbreak – what are the real key developments of the past week? What of the H1N1 vaccine currently in development and when will it be available? Are pregnant women really at a greater risk and how does the World Health Organization’s advice stack up against that of National Governments? These are the questions that really matter.
In terms of the vaccine itself, the good news is that clinical trials have now begun in the USA and Australia and several manufacturers have also begun to test the vaccines on healthy human volunteers. Not only will these tests monitor for the potential immunogenicity of the vaccine, but they will also screen for any adverse reactions, in addition to testing the vaccine’s efficacy when used in conjunction with the vaccination for seasonal influenza. And whilst distribution of the vaccine is likely to occur well before the conclusion of the first wave of clinical trials, sufficient results should be available for analysis right before the point of initial dispensation in September or October.
Further to the aforementioned updates from The National Institute of Allergy and Infectious Diseases (NIAID) in the United States, the World Health Organization (WHO) has also revised its strategic guidelines for worldwide vaccination, following a special meeting of the Strategic Advisory Group of Experts (SAGE) on July 7th. Whilst the UK government has ordered enough of the vaccine to eventually cover the entire population, the first batches of the vaccine - expected to arrive in late autumn – will be enough to cover at least 50% of the population in the form of 30m double-doses.
In the case of pregnant women, new research now forces us to consider that pregnant women may be considerably more at risk of contracting a particularly severe strain of the disease than the majority of other risk groups. Specifically, and in the U.S. alone, pregnant women constitute 6% of all swine flu deaths since April- a particularly concerning statistic given that pregnant women only make-up 1% of the entire national population. Therefore, whilst the WHO has yet to deliver any concrete recommendations on the matter, alongside care workers and other front-line civil servants, pregnant women are likely to be at the top of the list for early access to the vaccine. Pregnant women are also typically more susceptible to seasonal influenza, especially during the third trimester, where the female body undergoes considerable changes – particularly in relation to the immune system.
The latest advise from the The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists recommends that pregnant women exhibiting flu-like symptoms be treated through a course of the antiviral, Relenza. A statement from the Royal College of Midwives read: “Pregnant women have got a strong instinct to protect their baby, but we have to be realistic about the kinds of adjustments people can make. If they normally have to travel on the Tube or on crowded trains in rush hour they might be better to come in later or earlier, but of course it is difficult to avoid crowds entirely. This is about being sensible and being aware of the risks”.
So whilst it’s not clear precisely clear how the WHO intends to address the problem, it is doubtless clear that a differentiation exists and that pregnant women should take the same sensible, commonsensical precautions as everyone else.
Alongside these developments, last week also saw the launch of the Government’s new ‘National Pandemic Flu Service’ or ‘Fluline’. Finally inaugurated after several weeks of somewhat predictable delay, the new telephone hotline and internet service will allow up to 200,000 people a day to seek necessary re-assurance over any troubling flu-related symptoms. If needed, patients will also be able to obtain unique prescription reference numbers allowing their friends or family to collect the prescribed anti-virals from their nearest distribution centre on their behalf. And whilst only running for 15 hrs a day initially, the service could subsequently be extended to service round-the-clock requirements in the near future. In hailing the inauguration of the groundbreaking new service, Prime Minister Gordon Brown said "I think the evidence is that people are responding to the scheme. There have been some teething troubles, (but) people are getting through. The collection points are working well”.
In terms of the economy, the number of people taking time off from work with flu-esque symptoms continues to grow rapidly. A development that The British Chambers Of Commerce contends will have a “clear impact” on the UK economy - stunting productivity and delaying future economic recovery. The group’s director-general, David Frost, said that "If the projected figures for the number of people contracting swine flu comes to pass, companies will be hit by intense periods of staff absence”. Mr. Frost also added that "Both supply and demand could be impacted and businesses need to be prepared."
Last updated on: 27/08/2010 11:40:18