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Swine Flu Preparing for the pandemic 12th May 2009
Different types of ‘flu • Seasonal influenza • Pandemic influenza • Avian influenza
Changes in the virus • Antigenic drift - mutation - gradual change • Antigenic shift - reassortment of antigens - abrupt change - new sub type
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 • Fever (38-40oC) • Headache • Myalgia • Dry cough • Nasal discharge
Pulmonary complications • Croup in young children • Primary influenza virus pneumonia • Secondary bacterial pneumonia • Strep pneumoniae • Staph aureus • Haem influenzae
Non-pulmonary complications • Myositis • Cardiac complications • Encephalopathy Also, Reye’s Syndrome and Guillan Barre
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
Diagnosis • 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)
Treatments 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 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 • 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 • 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) Aims: 1. Manage large numbers of people with symptoms 2. Prevent spread to the vulnerable 3. Reduce burden on existing health services
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? 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 • 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) • 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) • 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
Communications • With practice staff • With hospitals/hospices/mental health trusts • With London Borough of Bromley - carers -schools • With patients and the public!
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”