Thursday, 30 April 2009

Pandemic 'Flu

As readers will doubtless be aware, the World Health Organisation pandemic alert stands at level 5, which is potentially a precursor to a pandemic (level 6), and countries are gearing up to ensure the response to the outbreak if effective, efficient and clearly communicated.

Before talking about what you should do, I think it's worth making the point that at the moment we have very few cases in the UK (5:60,000,000), which is a tiny fraction of the UK population. At the moment, it is highly unlikely that you will have come into contact with someone infected with H1N1 influenza virus (aka swine 'flu, Mexican 'flu).

The Department of Health (DH), Health Protection Agency (HPA) and National Health Service (NHS) have been planning for pandemic 'flu for more than 5 years, and the NHS will take the lead in implementing the plan.

It worth noting that the response to crises of many types has been practised on many occasions. In the UK, the Civil Contingencies Act, which places a duty on many agencies to plan for public emergencies, has been in operation for a number of years, and the response to different situations is well practiced; for those who are interested I will prepare a later post on this topic.

As the pandemic plan is put into operation, stores of oseltamivir (aka Tamiflu) and zanamivir (aka Relenza) will be distributed to appropriate agencies. You will shortly be receiving a leaflet from DH outlining what your response should be, there is additional information at NHS Choices which may be of interest.

If you have flu-like symptoms, and have either returned from Mexico or another affected area or been in contact with someone who has you should ensure other people are not affected by phoning NHS Direct (0845 46 47) and not attending your GP surgery.

To prevent spread, you should practice good hygiene, as I know most people with primary immunodeficiency already do routinely.

In order to effectively prepare for the pandemic, you should:

  • Establish a network of "flu friends" who can help if you come down with the illness.
  • Ensure you have about two weeks worth of food and 'flu remedies.

As a slight aside, I personally recommend not worrying about "branded" drugs; the cheaper "supermarket brand" will do; I'd also not go with combination products (such as LemSip) because they're often not full dose. Consider paracetamol, ibuprofen, pseudoephedrine (Sudafed - sometimes only available branded): you know which drugs you can take. Don't forget to get paracetamol and ibuprofen suspension for children.

Once the pandemic is confirmed, there are rules on the issuance of antivirals.

The NICE (National Institute of Health and Clinical Excellence) guidance for prescribing antivirals when influenza is circulating in the community are:

oseltamivir and zanamivir are recommended to treat at-risk adults who can start treatment within 48 hours of the onset of symptoms; oseltamivir is recommended for at-risk children who can start treatment within 48 hours of the onset of symptoms.

The definition of "at risk" is:

At-risk patients include those aged over 65 years or those who have one or more of the following conditions:
  • chronic respiratory disease (including chronic obstructive pulmonary disease and asthma)
  • significant cardiovascular disease (excluding hypertension)
  • chronic renal disease
  • immunosuppression
  • diabetes mellitus

Prophylactic (preventative) therapy is indicated in at-risk patients when they "have been in close contact with someone suffering from influenza-like illness in the same household or residential setting".

Oseltamivir is available both as a capsule and in a sugar-free tutti-frutti flavour suspension (syrup) for children. Zanamivir is taken as an inhaled powder and is suitable for both adults and children over the age of 5.

If you need to seek help for a person with an immune deficiency who has 'flu-like symptoms, you should mention they are immunodeficient when you contact NHS Direct or your GP.

If you have concerns about attending school or work, the current advice is that staying off school (or work) is not necessary, but if you are concerned about your child you should discuss your concern with the head teacher.

ALL THIS SAID, I remain convinced there is no need to panic. Most people who have had this disease have been poorly, but it doesn't seem to have a very high mortality rate. The biggest risk is transmission, which is controlled by good hygiene; panic will tend to prevent good hygiene.

Good luck and keep your hands clearn!


  1. GREAT information. However I am keeping my children home from school today & tomorrow. I would rather be safe than sorry!

  2. Interesting post, David.

    Do you have any information about patterns in the spread of infection? I work in a large residential college, and we were discussing yesterday how outbreaks sometimes seem to have a delay in transmission, so that we gear up for a problem only to have it occur several weeks later than we expected it. This may be relevant to paxhouse9's comment about keeping away from school for a few days - how to choose which days?

    For those WITHOUT a particular susceptibility to complications from infection, I'd hope the hygiene message would be the single most important one. Any instance when you put unwashed hands near your face ... learn new behaviour! Whether that's snacking at your desk, biting your nails or smoking ... clean hands.

    Now, where did I read "sneeze into your elbow" ....

  3. Seriously since all 3 of my children are in the at risk catagory how long before I can breathe a sigh of relief that this is over?

  4. Hey Josie

    I think what you're describing is one of those quirks of human behaviour. Let's assume that a pandemic occurs: it is likely that the disease will be present in the community at a constant low level.

    That low level is maintained by people following the basic hygiene and contact rules: keep clean, keep contacts to a minimum. If everyone keeps this us, the disease will soon be unable to sustain its endemicity and will effectively disappear.

    The problem arises when, after a couple of weeks, people get used to the alarm signal, and start relaxing. As soon as that occurs, the disease starts spreading as it gets more and more opportunities to infect people, and we get a sudden spike of cases a few weeks after expected.

    And I agree: hygiene is the single most important message, both for those who are and are not "at risk".


    To answer your question: WHO, CDC and HPA will update us as to when the current outbreak is over. However, H1N1 will still be circulating in the community after the outbreak (and pandemic, if one occurs) is over. And it's worth remembering it's *just* flu: it's no different to the seasonal flu. If we all hold our breath until 'flu is completely a non-issue, we'll all be dropping dead from hypoxia!


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