Who will be first to get vaccine?
A lot of people have asked who will be the first to get immunised against H1N1 swine flu.
A letter sent to immunisation co-ordinators last week gives a long list of priority groups.
But it's not clear whether the list is in descending order of priority; it is all rather vague. Some GP surgeries, I'm told, are seeking clarification. See if you can work what it all means from this section:
It's interesting that poultry workers but not pig farmers are mentioned. And there's another bit of confusion that I'm hearing about. Some NHS staff apparently thought that the H1N1 immunisation programme would be instead of - rather than in addition to - the regular seasonal flu campaign. It's not.
There's a very important public health message here for the NHS and for the public. Vaccination against seasonal flu this autumn will continue as normal. H1N1 swine flu vaccination is an add-on.
That means a lot of work for immunisation teams. They will have their regular at-risk groups and the over 65s for seasonal flu. They will also be giving H1N1 swine flu vaccine to at-risk groups, but not (initially) to the elderly.
Is there scope for confusion this autumn? You bet.
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It would make real sense to get the animal farmers vaccinated first because they are in the front line of vector mix and match and if they mix it, we catch it.
Health workers, including ward cleaners, hospital caterers and anyone working in the medical environment should be next because they are going to be in contact with the virus on a daily basis. These people will be using public transport each day. Hospital staff should be politely requested to change out of their uniforms when off duty as the uniform has the potential to harbour infection for 6 hours. I watched a nurse catch the bus wearing nursing uniform, with her baby in a pushchair and thought that was a potential health hazard.
School staff are next in the highest level of infection contact and transmission because they could potentially be within 1-2 meters of at least 1,000 young people each day, and they use public transport.
The children themselves need to be vaccinated because they are in very close proximity with each other, within 1 meter, for over 1 hour each day and they use public transport.
Public transport workers because they are in 1-2 meter contact with us lot every day and without them, many of your invisible work force won't be able to turn up to work because they either have no alternative transport or cannot afford the daily expense of a tax i(not that these will be in free supply either)
Anyway, who am I to say, I am just a silly old grannie with an interest in planning and organisation, to prevent my family and others from becoming ill.
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PS. Why does the Department of health poster look like an old fashioned soap box advert? Do they think this whole thing is a soap opera, and are trying to sell soap?
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PPS. economic biological washing powder?
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Fergus wrote:
"It's interesting that poultry workers but not pig farmers are mentioned"
My guess is that the letter is a hastily re-edited H1N5 Avian Flu letter and it has not been proofread properly, perhaps!
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I am no fan of DOH's managers and do wonder just why these well paid civil servants are seemingly incapable of issuing clear and straight forward advice, i.e. can they really not send out guidance that does NOT require additional explanation?
However, I will also say that I do think I do understand what they mean.
Normally, there are a range of people, including those over 65 years of age who are prioritised for the seasonal flu jab over the Autumm/Winter period by GPs.
I take the statement "Individuals aged between six months and 65 in the current seasonal flu risk groups" to mean that the first priority is to give it to the same high-risk vulnerable groups, e.g. those with respiratory illness, and other such health problems, but to exclude from the normal trawl the over 65 group - as a) they would probably have an immunity anyhow and b) they are included further down the list of priorities.
That seems quite a sensible approach really, though I think perhaps some would argue that 'children aged from 3 years to 16 years of age' should perhaps have higher priority than 'other health and social care workers'.
Though some of that criticism might depend upon what the difference really is between a health and social care worker directly involved in patient care and 'other' such workers. Which category, for example, would workers in a residential or nursing care home fall into, I wonder. Or nursing staff in a psychiatric or other non-medical unit? If they all fall into the first then who do they mean by the second?
Or will that be for individual GPs to interpret?
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As this is a DOH letter and not one for public consumption I would argue that it is pointless people discussing exactly what it means - those in the know will know. Those are the priority groups. The immunisation coordinators will have all the info they need to implement this. Frankly trying to decide who is the top of the list etc. is a bit pointless without all of the other info. Still it might make a nice game to while away the hours... if you have nothing better to do!
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If I were in authority I would be careful not to make too many patronizing and insensitive remarks. Those of whom you tread on, on the way up, are those you will meet again on your way down. Doasyouwouldbedonebyasyoudid. Face up to it, the blog is here to air worries and, if we do a bit of backseat driving and armchair politics, so what.
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Imho all people directly vital to the infra structure of our country should be vaccinated first-beginning with all medical staff and associated ancilliary workers. They will be under a huge amount of additional pressure from Swine flu on top of seasonal flu on top of the usual day to day problems that occur. All non essential surgeries should be cancelled for the next 6 months. It won't be popular, but if I was really sick from Swine Flu, I'd like to think I would have immediate access to medical help. As far as I can see, this would be the only way to do it.
Just a little note, the HPA are no longer doing a daily count up on their website. Weekly media announcements only. Annoying to say the least! We have little enough info as it is. Now our own official body thinks we only deserve info once a week!
Thanks Fergus, for your explanation of the disparity in WHO numbers. Apparently Argentina think they may have 100,000 cases.
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6. At 00:27am on 04 Jul 2009, TroyTempest99 wrote:
"As this is a DOH letter and not one for public consumption I would argue that it is pointless people discussing exactly what it means .."
Oh, do give over, mate!
You mean as it's a letter (not marked 'restricted' or 'Top Secret') from public servants (paid out of the public purse) to other public servants (also paid out of the public purse) the contents of which is about the intended service outcomes they are going to provide to the public, to protect the public's health, it is only too right the public should comment upon it if they so wish to.
That was what you REALLY meant to say, wasn't it?
Oh, but no-one is allowed to say boo to, or criticise, any one in the NHS or DOH, are they? After all, they can do what they like, they're not accountable to anyone and transparency is something they neither understand nor manage to incorporate into their corporate operational cultures. After all, they're the "Men from the Ministry"!
Next you'll be telling us that Jo Public has no right to comment upon MP's expenses!!!
And, by the way, EVERYTHING that public servants do is for the 'public consumption' unless specifically restricted by law or regulation, e.g. the Offical Secrets Act, the Data Protection Act, etc., etc.
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It seems interesting no one has mentioned those people with egg allegies on any of the swine flu information sheets- Am i one of the only people more aprehenisve of recieving the vaccine than the flu itself?
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When there is a real medical emergency, the government moves faster than a rattlesnake and you would be surprised at just how quickly, things get done. While I was at university, one of the students from our cohort developed meningitis C and died. We didn't know anything about it until, during a lesson, we were interrupted by a faculty administrator who came in looking very serious. We were asked to follow him to to the main hall. The hall looked quite surreal as it had been rapidly turned into a mass vaccination room. Across the centre of the room was a row of vaccination stations where we had to line up in our groups and sign a paper to accept the vaccine. Each of us received a jab and were told to wait for a while in case we had a bad reaction. More medical people were observing us for 20 minutes to make sure we were ok. We then all went back to our lessons.
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Cleo
I share your concerns over flu vaccinations. I went for my first one a few years ago and had such a bad reaction, I didn't dare to go back for the second jab of the course. Now I know I have an autoimmune condition, I'm not convinced that a vaccination is a good idea. Against that, I had chicken pox pneumonia and a lung infection as a flu complication years ago, so maybe it is a good idea! Damned if I do and damned if I don't it seems! Bit tricky I think!
As Sensible Old Grannie points out, things can move very fast indeed if need be-I recall the MMR booster in primary schools. However, we are talking of millions of people and children, so logistically it's one hell of a programme to roll out!
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What about all the people in higher education Im starting uni in September and the virus would be very likely to infect a lot of people and spread easily there, and I also think delivery people should have some priority
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Steady on Fergus.
The vaccine isn't even here yet, so it seems a bit much to expect a detailed priority list until we know exactly when and how much is available. I know it's controversial these days to say something positive about DH planning, but it seems like a very sensible list to me. FWIW, this is my take on how prioritisation might go when we get closer to the time, assuming the swine flu infection rate snowballs as expected.
Healthcare workers will probably rise to the top of the priority list. Without preserving the functioning of the health workforce, all other measures are moot.
Poultry workers will be right up there too- the last thing we want is the unlikely (but potentially disastrous) situation of a new influenza strain emerging from people co-infected with the contagious-but-mild H1N1 swine flu and the dangerous-but-not so contagious H5N1 bird flu. Poultry workers are in the front line of that scenario, so it makes sense that they're highlighted on the list.
Then the high risk groups- those with immune deficiencies, chronic respiratory illnesses and pregnancy for instance.
People over 60 seem to have some immunity to the current virus from previous exposure to pandemic H1N1 in the 1960s, so maybe they won't be as high up the list as you might expect.
I imagine all these issues and more are under active discussion right now. It sounds like there might be a good amount of vaccine ready by the autumn, so if we can slow the progress of the pandemic sufficiently before then, hopefully some of the more difficult prioritisation decisions won't be necessary...
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A little nugget of info for you all regarding the disparate figures reported by the WHO for different countries.
I was chatting to a friend of ours staying with us from Paris-apparently, only those people diagnosed with Swine Flu at hospital are included in the numbers. Visits to GP's are not. Also, their media has reported the first case of Tamiflu resistance as being in Asia-wasn't the first Demmark, the second Japan and the Chinese one the third?
I will check with our Portugese friends in a couple of weeks and see what they say. I expect it is the same with them. After all, if it costs £30 to see a GP, and all they will say is take paracetamol and drink plenty of fluids, and by the way, Tamiflu will cost you £60. Your family will have to each visit the doctor (at a further cost of £30 plus £60 for Tamiflu), therefore costing a family of 4 £360, and that assumes no complications!
Would you visit the doctor if that is what it cost you?!
Will we now get EU nationals making a mad dash across the channel when they get flu as their treatment here as a temporary patient is free?
Curiouser and curiouser....this info out of France would also make sense of the 'higher' mortality percentage in other countries. Just how many people have had this flu worldwide but not been included in national figures? I bet the figures run into thousands!
A very clever way of making it look as though countries are 'healthier' than they really are!
Personally I'm sticking with my own plan if I get it-bed, rest, fluids and paracetamol. Any breathing difficulties (I don't mean a cough either!) I'll dial 999. No point calling my GP or NHS Direct as they'd send me to hospital anyway.
Perhaps the WHO should be policing the reporting policies around the world to see what's really happening!
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RE: who will be the first to get vaccine.
The department's mentioned paragraph is not confusing about prioritisation. The previous sentence to the one quoted is: "The decision on prioritisation will be taken on the basis of epidemiological evidence, vaccine supply and capacity of the NHS to implement the programme. This decision will be subject to further work over the summer period."
What makes a nonsense of the whole list is the last item: "all others not in the above groups". In other words everybody!!!
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Yes, I agree - the words 'all others not in the above groups' does then imply everybody.
The 'poultry workers' thing is almost certainly because they have just distributed the letter from the bird flu contingency plan without carefully looking at it and editing.
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What 'all others not in the above groups' really means is that if nationally, or locally, there is a shortage of vaccine, or some problem with distributing it, then those people who are not in a 'priority category', i.e. the 'all others', will be told either that they won't be getting vaccinated, or that they will have to wait until further vaccine supplies are available to them.
As they are seemingly at the lowest risk, that would semm to be reasonable.
(Oh, and I suppose it could just be feasible that there was enough vaccine available but not enough trained people to administer it at a specific point in time).
My personal and subjective experience of flu vaccines has been that sometimes it seems not to have prevented me from getting the flu but appears to have resulted in me having a less serious episode of it (compared to colleagues).
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Does 'social care workers' include teachers. It should. If not, schools will end up closing because teachers are ill, and then the vaccinated healthcare workers will be unable to work because they are at home looking after children sent home from school.
It would also be good to know why elderly people are so high on the list, when they aren't a high risk group. I'm 37, and therefore at, from the US figures, the highest risk of dying of any age-group.
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19. At 2:48pm on 06 Jul 2009, JuniaRocks wrote:
"Does 'social care workers' include teachers."
I would doubt it, but the category is 'health and social care workers'.
(I think the subtlety there is that 'residential care' is perceived as social care rather than nursing (health) care. So, the underlying idea of including social care workers might be about protecting the services of many vulnerable people who are in residential care settings and the like).
But no scheme of prioritisation will be seen by everyone as being '100%perfect'.
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"It would also be good to know why elderly people are so high on the list, when they aren't a high risk group. I'm 37, and therefore at, from the US figures, the highest risk of dying of any age-group."
Good point. By that same logic, kids aren't really a high risk group either - sure they mix a lot in school and therefore pass on the virus very easily, but so do healthy young people at work.
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The over 65 are not a high-risk group in terms of this particular flu strain, but they ARE a high-risk group for flu infections generally.
At the moment, it is suggested that many of the more elderly may have an immunity to this flu, which probably accounts for them - unless included in one of the other higher priorty grouping - only being the the category immediately above poultry workers which is itself immediately above 'all others'.
But of course, if the virus mutates to something that would invalidate that apparent immunity, then the whole ballgame would change.
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I see there is a 'harmless' mystery illness that has killed 50 swans over the last few days, near Cork, in Ireland.
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We now have 7 deaths-whilst this is still a lower mortality percentage rate than seasonal flu (just) these poor people had 'underlying health issues'. Some of these have been mentioned, but not enough detail quickly enough. And still no detailed location info, not to mention the withdrawal of the publication of daily numbers locally or nationally.
A ridiculous state of affairs-hiding info like this just increases the fear of the people, especially after the announcement of the expected exponential increase in numbers. When will someone in this country sort this out!
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24. At 08:23am on 07 Jul 2009, Tigerjayj wrote:
"A ridiculous state of affairs-hiding info like this..."
As it is highly likely that - at some point in time - the identities of at least some of these fatalities will end up in the public domain, it would be a serious breach of information governance procedures to release the personal and confidential medical history of individual patients.
The DOH or any Trust thus doing would expect to get seriously 'strung up' in Court, and by the Information Commissioner, and other regulators.
Perhaps - but only perhaps - if we have many fatalities, say over 100 or so, we might get, into the public domain, some anonymous statistical breakdown of underlying health issues, e.g. w% had immune deficiency, x% had severe learning disabilities, y% had chronic respiratory disorder, z% had a history of heart issues.
Of course, if things got extremely drastic, and the release of such information was deemed highly necessary by Government, then the Secretary of State could probably use emergency powers to authorise the publication of more specific information.
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23. At 8:55pm on 06 Jul 2009, sensibleoldgrannie wrote:
"I see there is a 'harmless' mystery illness that has killed 50 swans over the last few days, near Cork, in Ireland."
Clearly not 'harmless' to swans though.
But then our current human flu problem is harmless to lots of other species.
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Guys,
Worldwide there have been around 95,000 'official' cases of swine flu and under 500 deaths. Bear in mind in reality there have probably been hundrads of thousands of cases, I wouldnt worry too much. True, things can change but as of yet they havnt so dont worry yourselves and enjoy the few days of sun we get in this country!
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The incorrect presumption that some people are making here is that everybody MUST automatically want, or need, to be vaccinated.
That may, or may not, turn out to be the case.
Just one scenario is that the DOH wouldn't want everyone to be vaccinated if, in actual fact, the efficacy of the vaccine (when it arrives) turns out to be not all that good - though the DOH may still want to vaccinate the most vulnerable to protect them the best they can.
Another issue is that some flu vaccines can result in people having mild flu-like episodes which may be a minor problem for some, but a significantly more serious problem for others. So the vaccination programme may need to be carefully monitored. Then again, it might just be no problem at all.
They also won't be likely to vaccinate anyone who is showing symptoms of a flu-like illness for fear of making their episode worse, so there probably will need to be various 'sweeps' of patients to 'mop up' the ones who missed the first session(s) of vaccinations.
Please remember that you're talking probabilities here.
For sure, the A&E nurse is more likely to contract flu from the contacts in his/her workplace, but s/he could also contract it from the tube or bus journey into work, or from the queue in the bank or post office, or from his/her children or partner. The fact is no-one will ever know where s/he got it from, for sure.
Equally, the probabilities of being an infection risk to others (rather than contracting it yourself) are also not mathematical certainties.
There isn't going to be a single, universal, 'one-size-fits-all' solution for each and every citizen.
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Hi Fergus, I notice that the list doesn't prioritise babies under 1 or toddlers - I was led to believe that babies are a high risk group for flu in the same way the elderly are. I ask with a vested interest - I have a 10 month old (no underlying health issues I know of although premature and v small)who starts nursery in the Autumn - I'm terrified he may catch this flu and his immune system won't cope - and that's even before the flu may mutate or before the hospitals get full as numbers rise. Do we have any data about numbers of babies worldwide who have contracted this flu and survived/died? What are their chances?
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I see they have changed the format of the world health map for H1N1. It makes a joke of the statistics because there are no believable reports from the Middle East, Africa, Old Russia etc. I do not believe the WHO are getting accurate feedback from these countries and no-one is naive enough to believe that they have an invisible barrier around them. It would be helpful for all, including the unmentioned countries, to 'cough up' their statistics (excuse the pun). Disease knows no barriers and all of us 'share' the same planet and resources. Fergus, can you find out what is happening in the unmentioned countries please? Or, are there other flu surveylance maps which show the true world picture of these events?
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30. At 08:46am on 08 Jul 2009, sensibleoldgrannie wrote:
"It would be helpful for all, including the unmentioned countries, to 'cough up' their statistics"
For them to do that they need fairly robust systems of verification and reporting to be in place. Not all countries have these.
One of the things about the UK is that we have a rather good 'command and control' structure in the guise of NHS and DOH. (Not infallible, but not bad). That brings with it established and tested reporting structures and information handling and collation processes. In many respects, we're probably one of the better set-up countries to do this.
Others may not have such mechanisms in place and may not see a political or economic value in putting the necessary resources in place to create them.
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On another note, anyone noticed that Fergus has gone??? We havnt had a post from him since Friday. And its been days since we have had any updated figures about the number of cases, which up until now has been daily.
Anyone of the opinion that the information is being filtered now?
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32. At 12:13pm on 08 Jul 2009, oliverpbessell wrote:
"Anyone of the opinion that the information is being filtered now?"
Now, don't go getting paranoid and getting into conspiracy theories.
I think you'll find that Fergus reported on the TV yesterday on the Marco Polo / norovirus outbreak on the ship in Invergordon, or perhaps he's having a day or two's holiday.
And, anyhow, 'filtered' by who exactly?
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oliverpbessell,
...OR could it be that there is nothing much to report on?
I don't see any 'new' information on any other news providers' sites.
If you're suggesting the DOH / NHS are 'gagging' news, I would have thought that an immensely stupid thing to do, incredibly irresponsible of any civil servant to get involved with, and pretty unsustainable too.
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What I mean is up until a few days ago, we were hearing 300-400 new cases a day, now there is no news at all? Bit weird dont you think? It could be that now we have moved into a new phase they are not recording the number of new cases anymore but I still think its a bit odd that no news agency has reported anything for days now when it is suppose to be getting worse.
Im not jumping to conclusions but I have been following this story closely since April and it dosnt follow the previous reporting trend for everything to go silent.
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oliverpbessell,
But I thought we all knew that they weren't testing for the virus as they have now gone to dealing with the virus mainly by phone diagnosis and remote access to Tamiflu if needed - thus ensuring better infection control.
That being the case you wouldn't expect anyone to still be issuing the number of (laboratory) confirmed cases, would you?
I mean, my understanding is that most people who contract the flu now will not get a laboratory confirmation, they'll just get a remote, telephone diagnosis and an arrangement for someone to go for the patient to somewhere to collect Tamiflu (or other anti-viral).
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Why are people saying that giving poultry workers priority has to be a mistake? It makes sense to me.
When we were talking about Bird flu, it made sense to imunise poultry workers then, because of the chance of poultry being a source of infection. Domestic birds can be infected by migrating wild birds. Domestic pigs however are not likely to be a source of infection to their keepers, more the other way round. Unless we get flying pigs on migration of course... There's also the fact that, should we get human cases of bird flu in the UK, it would be good to be sure it's not swine flu. I seem to remember that was the argument a few years ago for imunising poultry workers against seasonal flu.
Meanwhile, we have the worry of mixing of the two viruses. There we have two scenarios: human with swine flu meats chicken with bird flu. Or human with bird flu meats pig with swine flu. It's pretty obvious which is more likely, at least in the UK. So it makes more sense to imunise those working with poultry.
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Thanks to all for your comments. I haven't posted since Friday because of other commitments - covering a Lords debate on assisted suicide on Monday and the creation of human sperm in the laboratory on Tuesday. So the news is not being filtered, but there's only one of me!
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I am very concerned that no-one is factoring in the need to vaccinate the country's Carers. These people, myself included, do an immense amount that currently eases the burden on health and social care. If carers are not protected, immeasurable pressure will fall upon healthcare. Well established patterns of care and support will collapse. The knock on effect of many many carers falling sick must not be underestimated. I am extremely concerned regarding this.
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As someone who is in one of the most at risk groups (under 65 and diabetic) it would be useful to have some specific and targeted advice readily available. I am constantly reminded that I am at risk but can't find any information that is different to normal people (I use this phrase advisidly - I am quite normal!). I have looked at diabetes websites and nhs sites an am still trying to work this out for myself. If you are going to report on a regular basis that the people dying tend to be in "at risk" groups, please can someone ask what these "at risk" groups should be doing to minimise the risk?
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Suatara wrote
"You mean as it's a letter (not marked 'restricted' or 'Top Secret') from public servants (paid out of the public purse) to other public servants (also paid out of the public purse) the contents of which is about the intended service outcomes they are going to provide to the public, to protect the public's health, it is only too right the public should comment upon it if they so wish to.
That was what you REALLY meant to say, wasn't it?"
Ooh just back form my hols and find this lovely missive. Thanks for trying to interpret what you thought I was saying but can't really leave this without a reply.
Actually you are the one who is wrong.
What I should have been a little clearer about was that I meant the letter was sent to particular people with specific knowledge who could interpret it appropriately. As has been demonstrated here, looking at it in isolation without seeing the bigger picture can often lead to scaremongering and ill informed debate.
It was part of a series of letters which- if you put them all together give you the whole picture. If you would like to wander along to the DoH website you can find all of these letters there available to the public and have been for several years now. So to suggest that there is some desire to hide this is quite bizarre.
Try picking other individual letters at random - it will be just as difficult to interpret them without seeing the rest of the correspondence.
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I thought the letter was concise, to the point and pretty sensible and no I didnt write it. However, three thoughts occur to me: firstly can vaccinated people carry the flu - if so perhaps poultry workers are not the people to give it to - but I have nothing to base this on, its just a question. Secondly, is the vaccine contraindicated for babies. Certainly looks that way from the priority groups. But thirdly I'm rather pleased that there is no civil servant/politician priority group.
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