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Intensive care, and more on vaccines

Fergus Walsh | 11:32 UK time, Friday, 11 September 2009

Plans to double the amount of intensive care provision to deal with H1N1 swine flu cases have been outlined by health officials.

Hospital wardIt's an acceptance that hospital critical care is likely to come under intense pressure when the next wave of swine flu comes.

The plans for England were outlined by Ian Dalton, National Director of NHS Flu Resilience.

They would see a doubling of the current 1,982 adult intensive care beds. There are 363 paediatric critical care beds which would also be increased substantially. Similar arrangements will occur throughout the UK.

A doubling of intensive care beds is no easy task, because of the need for specialist ventilators and other equipment.

Equally important are the highly-trained members of staff who work in critical care. So how will it be done?

More ventilators are being bought. Staff who currently work in other areas are being trained in critical care. Recently retired hospital workers will be placed on a reserve list to be called up if necessary. Critical care teams may be asked to work longer hours.

All these measures will help, but there is one other dramatic measure required to increase intensive care provision - cancelling operations.

As and when a huge peak of swine flu cases occurs, the NHS is ready to postpone as much planned surgery as required in order to free up intensive care beds.

This will free ventilators currently used in theatre as well as critical care beds used for patients recovering from cardiac and other major surgery.

This would be a temporary measure which would last for weeks rather than months during the peak of any outbreak.

The plans are based on the assumption that 2% of swine flu cases require hospitalisation, but this has since been downgraded to 1%.

Meanwhile, cases of swine flu continue to decline. There were an estimated 3,000 new cases in England in the past week, down from 4,500 last week and the rate of GP consultations stands at just 8.6 per 100,000.

In Scotland, where the schools went back first, there has been a slight increase in GP consultations to 43.9 up from 40.2, so this might be a very early indication that cases are about to rise.

The United States has seen a sharp increase in swine flu in recent weeks.

The Chief Medical Officer, Sir Liam Donaldson, has spoken in upbeat terms about swine flu. He said "we are tantalisingly close to being able to win the battle against the virus".

He explained that the current dip in cases meant that there was a real chance that they could vaccinate at-risk groups before the outbreak took hold again.

And more pandemic H1N1 vaccine trials results have been published, this time from Australia [Response after One Dose of a Monovalent Influenza A (H1N1) 2009 Vaccine, New England Journal of Medicine]. The early results show that a single dose of the vaccine shows an immune response similar to that gained from seasonal flu jabs.

This is significant because it suggests that just one dose may be required to offer protection. All the worldwide planning to date on pandemic vaccines has worked on the assumption that injections would be required.

The study involving 240 healthy adults aged 18-64 also found that the vaccine has a similar side-effect profile to that of seasonal influenza vaccines. The vaccine was produced by CSL in Melbourne.

Dr Alan Hampson, Chair of the Australian Influenza Specialist Group said:

"The study showed that a very high percentage of the adult recipients produced a good antibody response, which should provide a high level of protection, to a single dose of vaccine made by conventional methods and formulated at the usual potency. This is great news as it means that available vaccine supplies will go much further than might have been anticipated and that protection can be achieved with a type of vaccine that has a long history of safe and effective use."

Professor Robert Booy, Head of Clinical Research at the National Centre for Immunisation Research & Surveillance (NCIRS) at the University of Sydney said:

"This is indeed very encouraging and perhaps as good as we could have hoped for in that it appears only one dose of vaccination is required. It is important too that the safety profile is good. Results in children are keenly awaited."

This follows similar results from an early trial using a pandemic vaccine made by Novartis. Results from trials involving the vaccines which will be used in the UK - being produced by GSK and Baxter - are yet to be published.

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