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Swine Flu. Preparing for the pandemic 12 th May 2009. Different types of ‘flu. Seasonal influenza Pandemic influenza Avian influenza. The Influenza Virus. Changes in the virus. Antigenic drift - mutation - gradual change Antigenic shift - reassortment of antigens

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Swine Flu

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Swine flu
Swine Flu

Preparing for the pandemic

12th May 2009

Different types of flu
Different types of ‘flu

  • Seasonal influenza

  • Pandemic influenza

  • Avian influenza

Changes in the virus
Changes in the virus

  • Antigenic drift

    - mutation

    - gradual change

  • Antigenic shift

    - reassortment of antigens

    - abrupt change

    - new sub type

Spread of virus
Spread of virus

  • Person to person

  • Survives for a short time on surfaces

  • Incubation period of 18-72 hours

  • Infectious 24 to 48 hours after onset of symptoms

  • Children may be infectious for longer

Uncomplicated influenza
Uncomplicated influenza

  • Fever (38-40oC)

  • Headache

  • Myalgia

  • Dry cough

  • Nasal discharge

Pulmonary complications
Pulmonary complications

  • Croup in young children

  • Primary influenza virus pneumonia

  • Secondary bacterial pneumonia

    • Strep pneumoniae

    • Staph aureus

    • Haem influenzae

Non pulmonary complications
Non-pulmonary complications

  • Myositis

  • Cardiac complications

  • Encephalopathy

    Also, Reye’s Syndrome and Guillan Barre

Swine flu from mexico
Swine Flu from Mexico

Initial reports:

  • about 60-70 deaths

  • A few hundred cases

    Subsequent epidemiology:

  • Infects about 1 in 3(seasonal flu is 1 in 10)

  • Slightly higher death rate than seasonal flu

  • Severity of symptoms and complications?

  • All deaths outside Mexico in people with co-morbidities


  • Nose and throat swabs

  • Use of PCR but can also grow the virus

    Suspect/possible case

    - based on clinical symptoms and one of

    a) travel or

    b) contact with a case

    Probable case

    - swab has confirmed influenza A (usually in a few hours)

    Confirmed case

    - tests confirm H1N1 (takes a few days)


Neuroaminidase inhibitors

  • Oseltamivir – Tamiflu

  • Zanamivir – Relenza

  • reduce duration of uncomplicated influenza by 1 day in 70-90% of people

    2. Limited evidence - may reduce serious complication in high risk

  • Approved for prophylaxis and treatment

    4.How do they work in pandemic situations?

Cases in the uk as of 11 th may 2009
Cases in the UK(as of 11th May 2009)

  • 65 confirmed cases

  • 336 people still awaiting results

  • No deaths

  • Worldwide – over 5000 cases in 30 countries, and 4 deaths outside Mexico

Approach to containment in uk
Approach to containment in UK

  • No restrictions on travel and mass gatherings

  • Identification of potential cases

  • Treatment of cases

  • Administration of prophylaxis to close contacts

  • First 3000 cases

Handling in general practice
Handling in general practice

  • Managing high anxiety amongst patients/population

  • Discouraging possible cases from attending health care premises

  • Swabbing and treating on advice of Health Protection

Pct workstreams 1
PCT workstreams (1)


1. Manage large numbers of people with symptoms

2. Prevent spread to the vulnerable

3. Reduce burden on existing health services

Pct workstreams 2
PCT workstreams (2)

- Arrangements for assessment of cases

under PGD

-Distribution of antivirals

to patients we assess

to patients assessed by GPs

to front line health care workers

-Use of personal protective equipment

getting supplies

training in use/fitting

-Communicating to MOP

What happens if things get worse
What happens if things get worse?

Large numbers of ill people and people with severe illness

  • General practice may be swamped

  • Hospitals may be under huge pressure

  • Significant numbers of health and care service staff may become ill

  • People may need to take time off to look after children and relatives

  • Supplies of health related products (eg antibiotics)

  • General supplies

What have we planned for
What have we planned for

  • Practices have had a template and many have thought about business continuity

  • A borough influenza pandemic plan to oversee the response

  • Distribution of antivirals

  • GP/Community services plan

    - practices continuing as normal for as long as possible

    - eventually a single command and control arrangement for practices that cannot continue – use of EMdoc

Practices need to now consider 1
Practices need to now consider (1)

  • What is essential care?

  • Which services need to be prioritised?

  • Have all practice staff been engaged in thinking about the issues?

  • Is basic information easily available (eg telephone numbers)?

  • Resilience around different functions eg if clinical staff are not in, how will others manage.

Practices need to now consider 2
Practices need to now consider (2)

  • Roles of individuals, eg practice manager

  • Supplies for the surgery

  • Length of prescriptions

  • Telephone consultations

  • Can things be done differently

  • Buddy up with neighbouring practices

  • Checklist from RCGP


  • With practice staff

  • With hospitals/hospices/mental health trusts

  • With London Borough of Bromley

    - carers


  • With patients and the public!

Bbc news 12 th may 09
BBC news – 12th May 09

Professor Niall Ferguson at Imperial:

“full pandemic potential”

“virus similar to 1957 pandemic”

(which caused about 2 million deaths worldwide)

“major epidemic in autumn and winter in the Northern Hemisphere”

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