Swine Flu Pandemic home page

Did the WHO over do the release of the news? Or should they have approached it differently?

Over 100 prescriptions for antiviral medication are being handed out in Northern Ireland each day — with health experts warning the worst of the swine flu pandemic is yet to come.

Latest government figures on the spread of swine flu throughout Northern Ireland are to be released today and are expected to show a further sharp hike in the number of laboratory confirmed cases, GP consultations and hospitalisations across the province due to swine flu.

Government statistics relating to the four-week period between the weeks ending September 4 and September 25 have already reinforced warnings by health officials of an explosion in swine flu cases, while the death on Tuesday of a young child with the virus has raised further fears among parents across Northern Ireland.

At the beginning of September there were an average of two new laboratory confirmed cases each day but this had risen to eight every day by the end of the month.

However, laboratory confirmed cases do not reveal the true extent of the spread of the H1N1 virus as very few people have been tested for swine flu since the government stopped routine testing of suspected cases as the UK moved to a treatment approach.

But in the week ending September 25, there were 831 antiviral prescriptions handed out, almost three times as many given to patients at the beginning of the month.

This brings to 10,623 the number of antiviral prescriptions given to patients since the beginning of the swine flu outbreak.

An average of six people were hospitalised across Northern Ireland each day as a result of swine flu during the week ending September 25, while GP consultations for flu and flu-like symptoms had risen to record levels for the time of year.

While Dr Brian Dunn, chairman of the British Medical Association’s Northern Ireland General Practitioner’s committee, has urged the public to remain calm in light of the latest tragic death, he has warned the number of cases is likely to rise.

“I think the figures we are seeing at the moment are what we were expecting but I think it's just the beginning,” he said.

“We escaped the worst of swine flu when the schools broke up for summer but with the new school term swine flu is going to spread again and I think the figures reflect that.

“The number of GP consultations could be multiplied by three or four but we are as prepared as we can. GPs have certainly seen a rise in their workload but they are coping well.”

The Department of Health, Social Services and Public Safety (DHSSPS) has yet to announce when it will begin its swine flu vaccination programme for at risk groups and frontline healthcare staff although it has said it hopes the programme will begin by the end of the month.

Doctors across Northern Ireland have also reached an agreement with the government on how best the vaccination programme can be carried out so that vulnerable people, such as those with chronic illnesses, can be protected from the virus.

The cost of the DHSSPS swine flu strategy in Northern Ireland is expected to run into millions of pounds although a final figure has not yet been released.

Despite this, the DHSSPS has not yet received any additional funding to cover the massive cost of fighting the swine flu pandemic and it is not known when a decision will be made regarding making additional cash available to the Health Minister.

A row erupted earlier this year when Finance Minister Sammy Wilson refused a request by Michael McGimpsey for funds.

Are we ready for the winter months? With the schools opening, is Swine Flu going to get out of hand? Is the UK ready? Please send us your thoughts.

Chemists believe that the Swine Flu may mutate? If this happens, what do we do? Your thoughts please

Drug to combat swine flu leaves '1,000 patients in suffering'

Officials insist Tamiflu is safe as reports of side effects continue to rise

By Steve Connor, Science editor

Wednesday, 12 August 2009

Health officials yesterday defended the Government's policy of giving the antiviral drug Tamiflu to everyone claiming to be suffering from the symptoms of swine flu despite more than 400 reports of adverse drug reactions since the start of the outbreak.

Critics of the policy of widespread distribution of Tamiflu have also warned that people who fail to complete the course of treatment may be fuelling the evolution of drug-resistant forms of the type of H1N1 influenza A virus behind the swine flu pandemic.

The Medicines and Healthcare products Regulatory Agency (MHRA) said yesterday that between 1 April and 6 August there had been 418 reports of adverse side effects to Tamiflu and a further 686 suspected cases of adverse reactions. Last week alone there were 125 reports of adverse side effects in people taking Tamiflu, although not all of them may be due to the drug, the MHRA said.

For the same four-month period, there were 10 reports of adverse reactions and 14 suspected side effects in people taking Relenza, the other anti-viral drug used to treat swine flu symptoms. Unlike Tamiflu, which is a pill taken orally, Relenza is taken as a nasal spray.

A spokesman for the Department of Health said that Britain is a world leader in monitoring the side effects of drugs and that this is done precisely so that health authorities can make sure that such treatments are safe and effective.

"Both Relenza and Tamiflu have been through rigorous safety and efficacy tests. They are effective against swine flu and help relieve the symptoms and length of infection," he said.

"As with many medicines, a small proportion of patients may experience some side effects, and nausea is one of them. Side effects are clearly indicated on patient information leaflets. A safety-first approach of offering antivirals to everyone remains a sensible and responsible way forward," he added.

About 300,000 people have been given Tamiflu since the start of the swine-flu outbreak and anyone who fulfils the criteria of the National Pandemic Flu Service can collect the drug free of charge after answering a series of questions about their symptoms on a questionnaire completed online or over the telephone.

A spokesman for the MHRA spokesman said that both Tamiflu and Relenza are acceptably safe medicines and that most people will not suffer any side effects. "The potential side effects are listed in the product information. The MHRA will continue to monitor the safety of Tamiflu and Relenza as their use increases during the swine-flu pandemic and we will take appropriate action should any new risks come to light," he said.

"There is a dedicated team which monitors the incoming reports from the public and healthcare professionals on an ongoing basis. The balance of risks and benefits for Tamiflu and Relenza remains positive," he added.

Tamiflu, which is manufactured by Roche, has vomiting and nausea listed as its main side effects on its packaging. A total of 11 per cent of adults and adolescents taking the drug experience nausea and 8 per cent suffer from vomiting, according to the summary of product characteristics.

Headaches are another side effect when the drug is taken preventatively rather than as a treatment. In children, the most commonly reported side effect is vomiting, with 15 per cent suffering it, and 10 per cent having diarrhoea. A total of 3 per cent of children will get nausea and 5 per cent have reported abdominal pain.

*Georgina Castle was one of the first people to suffer serious side effects from Tamiflu during a swine flu outbreak at her school in May. The 16-year-old was prescribed a double dose of the drug because she had asthma but within hours she was in hospital suffering from severe complications.

Yesterday her father, the GMTV presenter and former tennis star Andrew Castle, challenged the Health Secretary Andy Burnham live on television over the Government's policy of just "handing out" the drug without a proper diagnosis. Mr Castle said: "I can tell you that my child – who was not diagnosed at all – she had asthma, she took Tamiflu and almost died."

Mr Burnham said he sympathised with Mr Castle, saying it must have been "very worrying", but maintained that advice to parents to treat swine flu with Tamiflu remained unchanged.

Speaking after the programme Mr Castle said he had been shocked at how quickly his daughter's condition deteriorated. "She had a very quick descent and within 12 hours she had developed terrible breathing difficulties and seemed to be turning blue. We spoke to a GP friend of ours who advised us to call an ambulance. In the end she spent three days in hospital."

Mr Castle's wife Sophia said even at the hospital, doctors still wanted to give her the drug. "I told them: 'I don't want my daughter to have it,'" she said. "But they insisted. It was only when she tested negative for swine flu that they agreed to stop." Georgina went on to make a full recovery but her parents said they are still concerned that Tamiflu is being overprescribed while the side effects are not fully understood.

"I've told everybody I know: 'Don't give that drug to your child,'" said Mrs Castle.

"At Georgina's school we've heard stories about girls who took it getting depression during their A-levels."

Her husband added: "We've got a number of friends who are GPs and they are concerned about this. We appear to be handing out Tamiflu willy-nilly without being aware of its effects."

The Health Protection Agency estimates there were 110,000 new cases of swine flu in England last week. This is only slightly up from 100,000 the previous week.

This suggests that the rate of infection has started to slow. This may be down to the start of the school holidays and the launch of the National Pandemic Flu Service.

There is no sign that the virus is becoming more severe or developing resistance to antivirals. The small number of deaths has mainly been in older children and adults with underlying risk factors.

There has been a decrease in the estimated number of cases in 5-14 year olds. Estimated cases have continued to increase in other age-groups and in the North.

Symptomes of Swine Flu

What are the signs and symptoms of H1N1 (swine) flu in people?

The symptoms of H1N1 (swine) flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 (swine) flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with H1N1 (swine) flu infection in people. Like seasonal flu, H1N1 (swine) flu may cause a worsening of underlying chronic medical conditions.

In children emergency warning signs that need urgent medical attention include:

In adults, emergency warning signs that need urgent medical attention include:

In reality we are told only what the governments want us to hear. The Swine Flu, is no longer to be taken lightly. The number of sick people over a weekend has increased from 2339 to 4379. That is almost 100% increase. It is no longer just a flu. It is killing people. The governments should do more.

In the UK the goverment is placing advertisements on TV & radio, but is that enough? Place your feedbacks here.

It is a contagious respiratory disease that usually affects pigs. It's caused by type A influenza viruses, and pigs are hit by regular outbreaks. There are many different types of swine flu. The current cases involve the H1N1 strain of type A influenza virus.

Doctors don't yet know how easily the virus spreads between people, but experts believe it spreads in the same way as seasonal flu - through coughing and sneezing.

If you are experiencing flu-like symptoms. What should you do?

If you’ve recently been in the affected areas of Mexico and the USA, and are experiencing symptoms, stay at home and limit contact with other people.

You should then contact your GP by phone, not in person, or call NHS Direct on 0845 4647.

How dangerous is it?

So far thousands of people have been made ill by swine flu - with 314 cases proving fatal.

Tests show that the antiviral drugs oseltamavir (Tamiflu) and zanamivir (Relenza) appear to be effective against the human swine influenza H1N1 strain.

Should we be worried about it?

The World Health Organization has warned that the outbreak has "pandemic potential," and countries have been advised to step up surveillance and preparation in case the infection spreads rapidly.

Flu viruses have the ability to change and mutate, making it difficult for drugs manufacturers to ensure effective vaccines are available.

The new version of the H1N1 virus is a mix of different animal and human versions of the disease. Mixing can lead to the development of changed viruses to which humans have little immunity.

What is a pandemic?

When a virus spreads over a wide geographic area and affects a large proportion of the population it goes beyond an epidemic and becomes a pandemic.

Therefore, there is a risk that Swine Flu viruses could develop into a pandemic if the virus passes easily from human-to-human.

What is being done in the UK to prevent the infection spreading?

Absolutely nothing. The British Government has talked. We are waiting for the action. All house hold received a leaflet, but then what? That is not enough.

Is it enough? your comments

Are the governments doing enough?

Mexico City, one of the world's largest cities, has taken drastic steps to curb the virus' spread, starting with shutting down schools and on Tuesday expanding closures to gyms and swimming pools and even telling restaurants to limit service to takeout. People who venture out tend to wear masks in hopes of protection.

The number of confirmed swine flu cases in the United States rose to 66 in six states, with 45 in New York, 11 in California, six in Texas, two in Kansas and one each in Indiana and Ohio, but cities and states suspected more. In New York, the city's health commissioner said "many hundreds" of schoolchildren were ill at a school where some students had confirmed cases.

The new virus and the fatality count is at 49 and 1,626 illnesses across Mexico, said Health Secretary Jose Cordova, who called the death toll "more or less stable" even as hospitals are swamped with people who think they have swine flu. Based on figures from WHO 1626 swine flu patients are confirmed.

The positive news came as the swine flu appeared to spread from hundreds of students at a New York school who fell ill after a small group's spring break trip to Mexico, and confirmed cases were reported in New Zealand and Israel, joining the United States, Canada, Britain and Spain.

The United States stepped up surveillance at its borders and warned Americans to avoid non-essential travel to Mexico. Canada, Israel and France issued similar travel advisories.

Cuba became the first country to impose an outright ban on travel to the epicenter of the epidemic. Argentina soon followed with its own ban, and ordered 60,000 visitors who arrived from Canada, Mexico and the U.S. in the past 20 days to contact the Health Ministry.

Meanwhile, Mexico was eliminating reasons for tourists to visit. On Tuesday, the pyramids and all other archaeological sites were put off limits nationwide and restaurants in the capital were closed for all but take-out food in an aggressive bid to stop gatherings where the virus can spread.

"Border controls do not work. Travel restrictions do not work, said: WHO spokesman Gregory Hartl, recalling the SARS epidemic earlier in the decade that killed 774 people, mostly in Asia, and slowed the global economy.

Instead, they say, governments should do more to provide medical help to people with swine flu symptoms, since the virus is proving to be treatable if diagnosed early.

U.S. officials stressed there is no need for panic, noting that flu outbreaks are quite common every year. The CDC estimates about 36,000 people in the U.S. alone died of flu-related causes each year, on average, in the 1990s.

Cordova said many of the people crowding hospital waiting rooms complaining of swine flu symptoms actually suffered from other ailments — and many of those suspected of having the virus were treated and sent home.

"You can see the total of new cases," Cordova said, pointing to bar charts that showed a rise and fall. "In the last days there has been a drop.

29 April 2009 press briefing

1976 Swine flue outbreak

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Assessing the severity of an influenza pandemic

11 May 2009

The major determinant of the severity of an influenza pandemic, as measured by the number of cases of severe illness and deaths it causes, is the inherent virulence of the virus. However, many other factors influence the overall severity of a pandemic’s impact.

Even a pandemic virus that initially causes mild symptoms in otherwise healthy people can be disruptive, especially under the conditions of today’s highly mobile and closely interdependent societies. Moreover, the same virus that causes mild illness in one country can result in much higher morbidity and mortality in another. In addition, the inherent virulence of the virus can change over time as the pandemic goes through subsequent waves of national and international spread.

Properties of the virus

An influenza pandemic is caused by a virus that is either entirely new or has not circulated recently and widely in the human population. This creates an almost universal vulnerability to infection. While not all people ever become infected during a pandemic, nearly all people are susceptible to infection.

The occurrence of large numbers of people falling ill at or around the same time is one reason why pandemics are socially and economically disruptive, with a potential to temporarily overburden health services.

The contagiousness of the virus also influences the severity of a pandemic’s impact, as it can increase the number of people falling ill and needing care within a short timeframe in a given geographical area. On the positive side, not all parts of the world, or all parts of a country, are affected at the same time.

The contagiousness of the virus will influence the speed of spread, both within countries and internationally. This, too, can influence severity, as very rapid spread can undermine the capacity of governments and health services to cope.

Pandemics usually have a concentrated adverse impact in specific age groups. Concentrated illnesses and deaths in a young, economically productive age group will be more disruptive to societies and economies than when the very young or very old are most severely affected, as seen during epidemics of seasonal influenza.

Population vulnerability

The overall vulnerability of the population can play a major role. For example, people with underlying chronic conditions, such as cardiovascular disease, hypertension, asthma, diabetes, rheumatoid arthritis, and several others, are more likely to experience severe or lethal infections. The prevalence of these conditions, combined with other factors such as nutritional status, can influence the severity of a pandemic in a significant way.

Subsequent waves of spread

The overall severity of a pandemic is further influenced by the tendency of pandemics to encircle the globe in at least two, sometimes three, waves. For many reasons, the severity of subsequent waves can differ dramatically in some or even most countries.

A distinctive feature of influenza viruses is that mutations occur frequently and unpredictably in the eight gene segments, and especially in the haemagglutinin gene. The emergence of an inherently more virulent virus during the course of a pandemic can never be ruled out.

Different patterns of spread can also influence the severity of subsequent waves. For example, if schoolchildren are mainly affected in the first wave, the elderly can bear the brunt of illness during the second wave, with higher mortality seen because of the greater vulnerability of elderly people.

During the previous century, the 1918 pandemic began mild and returned, within six months, in a much more lethal form. The pandemic that began in 1957 started mild, and returned in a somewhat more severe form, though significantly less devastating than seen in 1918. The 1968 pandemic began relatively mild, with sporadic cases prior to the first wave, and remained mild in its second wave in most, but not all, countries.

Capacity to respond

Finally, the quality of health services influences the impact of any pandemic. The same virus that causes only mild symptoms in countries with strong health systems can be devastating in other countries where health systems are weak, supplies of medicines, including antibiotics, are limited or frequently interrupted, and hospitals are crowded, poorly equipped, and under-staffed.

Assessment of the current situation

To date, the following observations can be made, specifically about the H1N1 virus, and more generally about the vulnerability of the world population. Observations specific to H1N1 are preliminary, based on limited data in only a few countries.

The H1N1 virus strain causing the current outbreaks is a new virus that has not been seen previously in either humans or animals. Although firm conclusions cannot be reached at present, scientists anticipate that pre-existing immunity to the virus will be low or non-existent, or largely confined to older population groups.

H1N1 appears to be more contagious than seasonal influenza. The secondary attack rate of seasonal influenza ranges from 5% to 15%. Current estimates of the secondary attack rate of H1N1 range from 22% to 33%.

With the exception of the outbreak in Mexico, which is still not fully understood, the H1N1 virus tends to cause very mild illness in otherwise healthy people. Outside Mexico, nearly all cases of illness, and all deaths, have been detected in people with underlying chronic conditions.

In the two largest and best documented outbreaks to date, in Mexico and the United States of America, a younger age group has been affected than seen during seasonal epidemics of influenza. Though cases have been confirmed in all age groups, from infants to the elderly, the youth of patients with severe or lethal infections is a striking feature of these early outbreaks.

In terms of population vulnerability, the tendency of the H1N1 virus to cause more severe and lethal infections in people with underlying conditions is of particular concern.

For several reasons, the prevalence of chronic diseases has risen dramatically since 1968, when the last pandemic of the previous century occurred. The geographical distribution of these diseases, once considered the close companions of affluent societies, has likewise shifted dramatically. Today, WHO estimates that 85% of the burden of chronic diseases is now concentrated in low- and middle-income countries. In these countries, chronic diseases show an earlier average age of onset than seen in more affluent parts of the world.

In these early days of the outbreaks, some scientists speculate that the full clinical spectrum of disease caused by H1N1 will not become apparent until the virus is more widespread. This, too, could alter the current disease picture, which is overwhelmingly mild outside Mexico.

Apart from the intrinsic mutability of influenza viruses, other factors could alter the severity of current disease patterns, though in completely unknowable ways, if the virus continues to spread.

Scientists are concerned about possible changes that could take place as the virus spreads to the southern hemisphere and encounters currently circulating human viruses as the normal influenza season in that hemisphere begins.

The fact that the H5N1 avian influenza virus is firmly established in poultry in some parts of the world is another cause for concern. No one can predict how the H5N1 virus will behave under the pressure of a pandemic. At present, H5N1 is an animal virus that does not spread easily to humans and only very rarely transmits directly from one person to another.

Swine Flu Pandemic

Updated on 20 May 2010 19:30 GMT

Official cases

numbers from WHO don't match

Confirmed Fatal Cases

Countries effected

The latest numbers are from WHO, hope they tell us ALL THE TRUETH.

What about severity?

Is it not time that WHO restricts travel? If it does what will the consequence be? How will it effect us? How will the businesses cope. What will be the down side? Please email your thoughts