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Department of Health reveals its 'worry list'

Fergus Walsh | 17:40 UK time, Thursday, 3 December 2009

At the weekly briefing for journalists the Chief Medical Officer for England, Sir Liam Donaldson revealed his "worry list" regarding H1N1 swine flu. It went like this:

1. The continuing flow of under-5s into hospital (which is why the push to vaccinate this group is a priority)
2. The continuing deaths from swine flu
3. That we might have a bad winter ahead with normal seasonal flu and other winter ailments
4. The "fear of mutation", the biggest worry of all - though there is no sign of that yet

This week has seen another fall in the number of cases of swine flu so I asked whether it was possible to say that we were over the worst with the pandemic this winter. Sir Liam's response was:

"We are not claiming victory because there are too many things to worry about. I won't be confident until March to say it's over for this winter because in the 1957/8 pandemic we saw a further peak after Christmas among older adults and with seasonal flu we often see a peak early in the New Year."
A few topline figures:
  • The estimated number of cases of swine flu in England this week is 22,000 (range 11,000 to 47,000)
  • The estimated cumulative number of cases in England is 790,000 (range 370,000 to 1,650,000) but given that one in five schoolchildren may well have had swine flu that estimate is probably several million out
  • 747 people were in hospital in England at at 0800 on 2 December, of whom 161 were in intensive care

Deaths linked to H1N1 swine flu:
• England 178
• Wales 25
• Scotland 54
• Northern Ireland 13
• UK total 270

So bearing in mind that we may have had 5-10 million cases in the UK (a wild guess of my own I admit, based on school children etc), then 270 deaths is a very small proportion. That low death rate is no comfort of course to those who have lost family or who currently have relatives in hospital, but it is worth mentioning as this blog is there to inform and not to alarm.


The Head of Immunisation, Professor David Salisbury said that H1N1 swine flu had so completely replaced seasonal H1N1 flu that the WHO had already recommended that the pandemic strain replace it in next year's standard trivalent flu jab for the southern hemisphere, which is already under production. He predicted the same would apply in the northern hemisphere in 2010, although the WHO strain selection recommendation would not be made until February.

Professor Salisbury was also loathe to claim the worst was over:

"We have no way of knowing what will happen with seasonal flu early next year and what the pandemic virus might do, especially as immunity expands in the population, which may force the swine flu virus to drift. It makes us very cautious."
Immunisation figures
  • 275,000 front-line health workers have been immunised in England - twice the number immunised the whole of last winter against seasonal flu. While that is a dramatic improvement, there are two million health workers on the target list, so there is a long way to go

  • 1.6 million doses of vaccine have been given to the priority groups (up from 1 million last week)

  • 11.2 million doses of GSK vaccine have been distributed throughout the UK to GPs, PCTs and hospitals

  • 500,000 doses of Baxter vaccine have been distributed to health services
The head of NHS flu resilience, Ian Dalton, confirmed that there is still no agreement with GPs for immunising all children between six months and under five years, but they are "still negotiating".

The hope must be that this will be resolved very quickly - I will investigate this further, although the department says the details of the contract negotiations are confidential.

A few graphs to end on:

Graph showing Influenza like illness in England and Wales
Look at the red line - which is pretty static - and continues to be reassuring.

Chart showing age distribution of fully investigated deaths
This shows that almost six out of 10 deaths are among the under-45s.

Underlying conditions information for fully investigated deaths
17% of deaths are among people who had been without any health conditions.
55% of deaths were among those with severe health problems.

Graph showing consultations due to influenza like illness - USA

I thought I'd show you this as it clearly displays that the second peak of flu in the United States is now on the wane. It's interesting that the US second wave was bigger than the first (the reverse of the UK). Likewise France is in the midst of a big peak of flu having had almost no first wave this summer.

More information on swine flu across the UK:

Swine flu figures for England
Swine flu figures in Northern Ireland
Swine flu figures in Scotland
Swine flu figures in Wales

PS. Many thanks to all of you who've sent get well wishes to my son and all the excellent suggestions for keeping him amused during his time off school with suspected swine flu. Hugo is now pretty much recovered and has started on his Christmas cards so is very busy (why do eight-year-olds have so many Christmas cards to send?).

Yesterday, a home swab kit arrived from the Health Protection Agency, so we'll know in a couple of weeks whether he really had H1N1 swine flu. My guess is yes, but I'll tell you whether I was right.


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