Swine Flu Update: 11/12/2009

Despite the near-recent emergence of the second wave of pandemic H1N1, the past four weeks have proven increasingly positive in the global fight against the virus. Here in the UK, numbers have fallen steadily. In the week leading up to December 3rd, the number of cases fell from 46,000 to an estimated 22,000. The previous three weeks also witnessed a considerable fall in the number of new cases, with the numbers amongst young adults and children taking a significant hit. After several months of increasing concern and rising national and international casualties, the news comes as a reminder of the sheer unpredictability of the virus in question - for good or for worse. For those frontline NHS staff gearing up to face the busy Christmas period, any drop in the frequency of new cases will bring some much needed breathing space for the nation’s health workers. It was of course only a few weeks ago that the UK’s Chief Medical Officer, Liam Donaldson, was voicing serious concerns over hospital bed shortages – amongst several other resource-based concerns. For Sir. Liam, then, the news comes as a relief as well as a warning against future complacency. “We’re not sitting here claiming victory, because there are still many things to worry about”, he said. And with due reason, too. For while the number of overall cases has continued to drop in the past weeks, the number of hospital admissions has remained at relatively high levels. In the case of the latest figures, around 747 people still remain in hospital with the virus. Over 161 are in a ‘critical condition’. Furthermore, an additional 15 people died from swine-flu last week - an unpleasant statistic regardless of any temporary reduction in figures. Moreover, despite the fall in the number of new cases, children and young adults continue to be one of the demographic groups most affected in terms of hospital admissions. Late last week, Donaldson spoke of his greatest fear for the future. Namely, that the current virus could mutate into a much more deadly and contagious entity over Christmas and into the New Year. "The biggest worry of all is the fear of mutation”, he said. “We hear people saying something funny has happened (to the virus) in Norway or France but fortunately we have not seen any change in the virus so far”. And while this is very good news today, Donaldson’s fear is a real one and serves as a strong reminder that however positive the news may be today, this isn’t over yet. Writing for the Independent earlier this week, Jeremy Lawrence wrote of ‘the pandemic that ended with a whimper’. But ‘can we relax’, he asks? ‘Not yet’. Indeed, to suggest that we’ve seen the worst of the virus would be to court extreme folly. Donaldson and his colleagues are well aware of this. Moving forward then, attack remains the best possible line of defense against the virus. Beyond that, one can only hope that this positive trend continues long into the New Year.

“4 December 2009 -- As of 29 November 2009, worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 8768 deaths. As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data. In the temperate zone* of the northern hemisphere, the early arriving winter influenza season continues to intensify across central Europe and in parts of central, eastern, and southern Asia. Disease activity has peaked and is declining in North America and has either recently peaked or is currently peaking in much of western and northern Europe. In both Canada and the United States, influenza virus circulation remains active and geographically widespread, however, disease activity appears to have peaked in past 3 to 4 weeks. In the United States, deaths due to pneumonia and influenza (P&I mortality) continued to increase past the epidemic threshold for the past 8 weeks and cumulative rates of hospitalizations for the current influenza season have exceeded rates seen in recent seasons among all age groups except those aged ≥ 65. In Europe, widespread and intense transmission of pandemic influenza virus continued to be observed across most of the continent. In western and northern Europe the peak of disease activity has passed in Belgium, Iceland, Ireland, Netherlands, Norway and parts of the United Kingdom (Northern Ireland, Wales); activity may be peaking or plateauing in Spain, Portugal, Italy, Sweden and Denmark. Influenza activity continues to increase in much of Central Europe in the region between the Baltic and Balkan countries and from Germany to Romania. In Eastern Europe, recent peaks or plateaus in disease activity have also been observed in Ukraine, Belarus, Bulgaria and the Republic of Moldova. In the Russian Federation, influenza activity remains active and intense in some regions, with an overall increasing trend. A moderate impact on the healthcare system has been reported in parts of Northern and Eastern Europe. Over 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009. In Western and Central Asia, influenza transmission remains active. Disease activity continues to increase in Kazakhstan, Kyrgyzstan, Uzbekistan, Iran and Iraq, while activity may have peaked in Israel, Jordan, and Afghanistan. In East Asia, increasing ILI** or respiratory disease activity has been reported in Southern China and Japan. A recent decline in activity has been observed in Northern China. In South and Southeast Asia, influenza activity continues to increase in the north-western parts of India, Nepal, Sri Lanka, and Cambodia, while activity in the rest of region remain low. In the tropical zone of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining except for focal areas of increasing activity in Jamaica, Venezuela, and Ecuador. In Africa, pandemic H1N1 2009 virus continues to be isolated from all parts of the continent, and there is evidence of continued co-circulation of pandemic (H1N1) 2009 and seasonal H3N2 viruses. In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported. The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect, humans including seasonal influenza.”
*The information above is a copy of the latest WHO regulations and guidelines for Swine Flu and can be found in more detail at the WHO Website, here.
• The consultation rate for flu-like illness in England from the Royal College of General Practitioners (RCGP) scheme has decreased slightly to 33.1 per 100,000 in week 49 compared to 38.6 in week 48. This remains above the English baseline threshold of 30/100,000. • The estimated cases self referring to the National Pandemic Flu Service have shown decreases in all areas of assessments, authorisations and collections. This is across all age groups. • 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 11,000 new cases in England last week (range 6,000 to 24,000) which represents a significant decrease from 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 795,000 (with a range 380,000 to 1,665,000) since the pandemic began. *The information above is a copy of the latest NHS key updates for Swine Flu and can be found in more detail at the NHS Swine Flu Website, here.
• WHO Twitter – ‘WHO's official Twitter channel. Who is the directing and coordinating authority within the UN system for public health’. • NHS Swine Flu Overview – ‘This page brings together the latest science and developments on the swine flu pandemic into a single accessible resource for both health professionals and the general public’. • NHS Swine Flu Vaccine – Detailed information on the development of the H1N1 vaccine, along with logistical updates on clinical trials in the U.S. and Australia, efficacy and WHO recommendations. • The Lancet H1N1 Flu Resource Centre – With over 40 journals, Lancet is one of the leading scholarly resources on the topic of Swine Flu – if not any healthcare issue. With free, unlimited access for all, this is one powerful research resource. • Nature – A number of interesting feature articles and blogs pertaining to the topic of Swine Flu. • Fergus on flu – Great Swine Flu blog from the BBC’s Chief Medical Correspondent. • Microsoft Bing Swine Flu Tracker – ‘Map of 2009 Swine Flu H1N1 outbreaks and migration paths reported from news and government agencies. The map lists reported dates and paths of infected persons traveling’. • Facebook Group for H1N1 – With over 3,500 members – and literally hundreds of personal accounts on the current outbreak, this Facebook Group provides an interesting view into the potential future impact of Social Media on healthcare related issues.