Swine Flu, Treatment and Prevention, pc cleaning

Another child with swine flu has died in Northern Ireland - the second in less than 48 hours.

The 12-year-old boy died in the Ulster Hospital at Dundonald on the eastern outskirts of Belfast.

The Department of Health in Belfast said the boy had a "serious underlying medical condition" but would not elaborate.

Health Minister Michael McGimpsey, who conceded there was now a high level of swine flu in Northern Ireland, said: "It is very sad when a child dies and my thoughts and sympathies are with the family. I would ask everyone to respect the privacy of the family at this very sad time."

He warned: "Incidents of swine flu in Northern Ireland remain high and we must expect further increases in cases in the weeks ahead.

"Swine flu remains a major public health threat but we are well prepared and have been planning for a pandemic for some time."

Hugh McCaughey, chief executive of the South Eastern HSC Trust, which runs the Ulster Hospital, said: "Our thoughts at this time are with the boy's family. We should also not forget our staff who have cared for him on a regular basis during his many hospital visits."

The boy's death was the fourth related to swine flu in Northern Ireland. On Wednesday it was announced a toddler under the age of three had died in the south east of the province on Tuesday.

A baby died last month but a pre-existing heart condition was determined as the cause of death. In August the mother of two young children died. She had been fighting cancer for five years.

A soldier from Co Londonderry, who was based in the south of England, also contracted the virus and died in Surrey at the end of July.

Swine flu vaccine arriving in Florida

The first swine flu vaccine doses have arrived in two North Florida counties. More vaccine will be flooding into Florida soon

The first swine flu vaccine arrived in Florida on Thursday, in Jefferson and St. Johns counties -- two northern Florida counties that together have had only one flu death since the H1N1 influenza began its spread in April.

'Lucky break' slows spread of swine flu

Chief medical officer now optimistic about the scale of the epidemic

Britain's swine flu outbreak is slowing down, possibly as the result of a "lucky break" in the way the virus has behaved, the chief medical officer said today.

Sir Liam Donaldson, who has been generally cautious in his weekly predictions on the likely course of the epidemic, was more optimistic as he suggested during a news conference that the peak number of cases may be lower than previously thought.

The rate of increase looks to be nothing like the weekly doubling of cases that experts had predicted. Last week, there were 18,000 new cases of swine flu, rising from 14,000 the previous week and 9,000 the week before that.

"We are well into the second wave of pandemic flu, having had the first wave in July, but it's proving so far to be a slow burner," Donaldson said. "It's possible that it might peak at a lower level – and an earlier level – than expected which would be incredibly positive news.

"It means we could get the vaccine programme well under way. If this virus has another peak up its sleeve, as in 1968, we might be able to avert that completely."

The news did not look as good in Northern Ireland, however, where a 12-year-old boy died in the Ulster hospital at Dundonald on the eastern outskirts of Belfast – the second death in less than 48 hours.

The Department of Health in Belfast said the boy had a "serious underlying medical condition" but would not elaborate.

The health minister, Michael McGimpsey, who conceded there was now a high level of swine flu in Northern Ireland, said: "It is very sad when a child dies and my thoughts and sympathies are with the family. I would ask everyone to respect the privacy of the family at this very sad time."

He warned: "Incidents of swine flu in Northern Ireland remain high and we must expect further increases in cases in the weeks ahead. Swine flu remains a major public health threat, but we are well prepared and have been planning for a pandemic for some time."

Four people from Northern Ireland have now died from the complications of swine flu. The last death, on Tuesday, was of a three-year-old in the south-east. The two previous victims were a mother of two young children, who died in August, and a soldier from Co Londonderry who was serving in the south of England and died in July.

There have been 76 deaths in England, one in Wales and two in Scotland. There are 290 people in hospital in England with diagnosed swine flu, of which 47 are in intensive care. Sir Liam said the number of people in intensive care was the highest figure for the last two months. He said this was a "bit of a concern".

Half a million doses of one of the two swine flu vaccines ordered by the government, made by Baxter, are now in stock in the UK, but deliveries from GlaxoSmithKline are still awaited. The government hopes to start vaccinating frontline health workers and priority groups by the end of this month.

"We may have got a lucky break in how the virus has behaved at the start of our flu season and we may be able to get the vaccine out there before our flu season really gets under way," said Donaldson. "I'm looking at it very optimistically."

8/10/09

Swine flu latest from the NHS

A large clinical trial to compare two UK swine flu vaccines in children was launched at the weekend. It will assess which vaccine will be most suitable for children to have during the national vaccination programme.

The vaccines, which last week received positive recommendations from the European Medicines Agency health watchdog, will be given to 1,000 children aged six months to 12 years. Following two doses of either vaccine, blood tests will confirm which vaccine stimulates the greatest immune response to the swine flu virus. The testing will also check for potential side effects, although the trial leaders believe any will be mild.

The news comes as the chief medical officer (CMO) announced that the second wave of swine flu has now begun, with the latest official figures showing that swine flu infections are steadily mounting. In the past week there were 14,000 new cases, a 45% increase over the previous week. Schoolchildren were the group most affected.

During his weekly update the CMO, Sir Liam Donaldson, said he expected the vaccine to be available to at-risk patients later this month.

He said, “The good news is, we’ve got the green light to approval of the vaccine at European level and we’re expecting to be able to start administering it in the second part of October."

Weekly update

Although flu season will not peak until the weather gets cold, in New York, which was the nation’s hardest-hit city, officials say that flu activity is no higher than it normally is at this time of year and that school attendance is normal.

Last week, Dr. Anne Schuchat, the director of immunization at the federal Centers for Disease Control and Prevention, said, “Most states do have quite a lot of disease right now, and that’s unusual for this time of year.”

Sky News understands that the first batch of flu vaccine is expected at hospitals on October 14.

This will be given to front-line health workers and the most vulnerable patients first.

Around 4.7m batches of the vaccine were due to be delivered by end of September but only 300,000 were delivered.

The government's chief medical officer Professor Sir Liam Donaldson told Sky News: "We've not quite seen a doubling (in cases), which is better news.

Normally at this point in the second wave of a pandemic we would be starting to see explosive increases in numbers. We're seeing it steadily mounting.

"On vaccination, the good news is that we've got approval of the vaccine at European level and we're expecting to be able to start administering in the second part of October."

Asked if there was enough vaccine available, he replied: "We'll actually have enough to treat the priority groups to begin with.

"Ultimately, the virus is going to be around for quite a time, so everybody will have the chance to be protected, even though some people probably get the disease before the vaccine's available.

The first children in Britain have started receiving a swine flu vaccine as part of a major new trial.

Researchers are hoping to use around 1,000 youngsters over the next fortnight to see which of two different drugs perform the best.

The children, aged between six months and 12 years, are being recruited at five test venues in Oxford, Bristol, Southampton, Exeter and London.

One vaccine being used - Pandremix, made by GlaxoSmithKline (GSK) - has been approved by European regulators.

Another made by Baxter is still being considered by the European Medicines Agency but could get approval this week.

Head researcher Professor Andrew Pollard, from the University of Oxford, said: "We are doing this trial to compare head-to-head the two vaccines which are going to be used in the UK against swine flu to see which one works best in children and which one is best tolerated.

"We are sort of in a race against time because we know the flu season is already started. We hope to immunise the children over the next 10 days or so."

The most recent data from the Government showed the number of swine flu cases across the country almost doubled in a week, from an estimated 5,000 to 9,000, prompting speculation a second wave of infections could be on its way.

The Government is hoping to start vaccinating millions of people in high-risk groups, such as those with asthma and diabetes, and health workers, next month.

Across the UK, 82 deaths have been linked to the virus, with 70 in England, nine in Scotland, one in Wales and two in Northern Ireland.

The increase – from 5,200 cases in the previous week to 9,000 last week – appears to be the beginning of a second wave of infections. So far there have been 82 deaths in the UK. The number of patients in hospital has also begun to climb again.

The race to licence and distribute the anti-pandemic flu vaccine before the next peak of cases may be close, the government's chief medical officer, Sir Liam Donaldson, implied today, at the weekly swine flu briefing. "Our suspicion is that we will start to see a speedier increase."

The first swine flu vaccines are expected to be given out in October to vulnerable risk groups and key health workers.

The government is waiting for European regulators to license the swine flu vaccine before it can be given out. One dose per person may be sufficient to deliver immunity, Donaldson said, although vulnerable groups, such as children, may need two.

Infection rates are rising, even though the flu season has not yet started. France, which had few cases earlier in the summer, is now suffering a major outbreak.

In Geneva, the World Health Organisation warned today that not enough of the anti-pandemic flu vaccine will be produced this year to safeguard the planet. It has downgraded its estimate of the number of doses that will be manufactured globally from 5 billion to 3 billion. The problem, said Dr Marie-Paule Kieny, director of WHO's initiative for vaccine research, was a poor yield from viruses grown in hen's eggs. It had been half or a third the amount of virus that is normally produced for seasonal flu vaccines. Inevitably, rich countries will get the quantities of vaccine they want, because they already have contracts with manufacturers. Countries with their own production capacity, such as China and possibly Russia, will also get good supplies, she said.

For the first time, the Department of Health released numbers of schools reporting outbreaks. There are 27 schools with swine flu cases in Yorkshire and the Humber, 12 in the West Midlands, eight in the east Midlands, six in London and 13 in other parts of the country. In Yorkshire and the Humber, two schools reported infected pupils last Thursday, six by the following day, 10 by Monday, 16 on Tuesday and by Wednesday this week 27 schools reported cases.

Across England the number of people being treated in hospital has risen by more than 50%, from 143 last week to 218 this week. Of those, 25 are in intensive care.

In Scotland about 7,000 people are thought to have the virus – a slight increase on last week. Of the deaths in the UK, 70 have been in England (up three in the last week), nine in Scotland, one in Wales and two in Northern Ireland.

Prof Sir Liam Donaldson, the Chief Medical Officer, admitted that he would have liked “more breathing space” before infections, always predicted to increase in the autumn, started to rise again.

He also announced that Britain has seen its first cases of the flu resistant to Tamiflu, the main anti-viral drug used to reduce the severity of symptoms.

Over a third of GP surgeries have seen patients suffering complications after being misdiagnosed with swine flu including at least three deaths, a survey suggests.

Family doctors have reported effects ranging from mild adverse reactions to the antiviral drug Tamiflu to severe case of tonsillitis, meningitis and pneumonia.

Three out of 205 family doctors and practice managers surveyed by the health magazine Pulse reported a patient dying after being misdiagnosed.

The findings have been published within days of Government figures showing a jump in the number of swine flu cases in the last week.

Experts have been predicting a second wave of the disease will hit the UK in the winter months after a lull during the summer break.

There have been 67 deaths linked to the virus in England, nine in Scotland, two in Northern Ireland and one in Wales.

More than 1.3 million people have been assed via the National Pandemic Flu Service for England with 522,890 collecting anti-viral drugs.

The Government is currently waiting for European regulators to license a swine flu vaccine before issuing it to health workers and at-risk groups across the UK.

Earlier this month prescribing experts called for the NHS to urgently review the use of Tamiflu, with concerns that the public has been misled about the effectiveness of the drug.

One GP, who did not want to be identified, told Pulse that a patient had died from meningitis after being wrongly diagnosed over the telephone.

Two other practices, in Dorset and Wiltshire, also reported that one of their patients had died. There has been a range of lesser side-effect to anti-viral treatment including, diarrhoea, vomiting and lethargy.

Dr Ellen Wright, a GP in Greenwich, south London, whose son contracted swine flu early in the first wave, said mild adverse reactions to anti-viral drugs had been widely reported.

She added: “There have been a lot of complications, especially in children given it in schools at the beginning of the outbreak, and I suspect that is what a lot of GPs have been seeing.”

A family doctor in Derbyshire reported the case a three year old girl who was diagnosed with swine flu and prescribed Tamiflu by the National Pandemic Flu Service.

She was later found to have bacterial pneumonia and admitted to hospital a few days later.

The GP said: “It was unlikely she ever had swine flu. It is near-impossible to diagnose a febrile illness over the phone, and I am afraid one could miss meningitis or other serious illnesses by presuming it is wine flu.”

Another GP in Tyne and Wear reported that one of her patients who was initially thought to have swine flu was later diagnosed with salmonella.

The patient was later admitted to hospital after extreme dehydration as a result of the food poisoning.

A deal has been struck with GPs in the UK, who will receive £5.25 for each dose of the swine flu vaccine they give to patients.

It is hoped that at-risk groups, such as those with diabetes or asthma, will be able to get their normal seasonal flu jab at the same time.

However, GPs are being told not to hold off starting the seasonal flu vaccine programme until the swine flu vaccine arrives.

A total of 132 million doses have been ordered by the UK Government - enough for the entire population with two doses each.

WALES is on the cusp of a second wave of swine flu, health officials have warned.

Figures for the past two weeks show there were 510 cases of swine flu in Wales, up almost 50% on the start of September.

They come as research will today show that flu can trigger heart attacks and cause cardiovascular disease.

An article in The Lancet Infectious Diseases said the influenza vaccine may offer protection for heart patients.

The review’s author, Dr Andrew Hayward, of University College London, said more efforts were needed to encourage people with heart disease and diabetes – which increase the risk of heart attacks – to have the flu jab.

He said this could be especially important with the looming double blow of the H1N1 influenza pandemic and a seasonal flu outbreak, when many more people are expected to catch the flu.

Dr Roland Salmon, director of the communicable disease surveillance centre for the National Public Health Service for Wales, said there were already “a few pointers” that a second wave of swine flu will emerge before Christmas.

“We are starting to see the number of cases drift up in Scotland and parts of England and I expect Wales to follow suit,” he said.

“Although the number of cases being reported fell from the high rates in July and August it has never actually gone away, it was always still out there.”

The latest figures show that in the past week 510 people across Wales reported swine flu symptoms, rising from 300 a week at the beginning of the month.

Dr Salmon added: “I’m expecting to see a build-up in the number of new cases but whether that is in four, eight or 10 weeks I don’t know.

“If it’s towards the end of October and beginning of November then this would coincide well with the new vaccine once trials have been completed and it is licensed for use.

“When this comes on stream it will give us a good opportunity to reduce the second wave.”

At his weekly briefing, the chief medical officer for England, Sir Liam Donaldson, said:

The estimated number of cases in England rose last week from 3,000 to 5,000. In Scotland, cases also rose sharply to around 6,000. There were small rises in Northern Ireland and Wales.

So swine flu is back. It never, of course went away. It's worth remembering that in one week in July, there were more than 100,000 cases. It seems likely that we are at the start of the next upturn. There have been outbreaks in several schools, but it's unlikely that schools will close because the virus is so entrenched in the community.

It bears repeating that the vast majority of people who get infected will get a mild illness. Very few people die from H1N1 swine flu, although it does cause complications in a minority. On the morning of 16 September, there were 143 people in hospital in England with swine flu, of whom 23 are in critical care.

So far, 79 people have died after contracting the virus, far lower than the number of those who die from seasonal flu (anything from 4,000-12,000 in a normal year). The difference is that swine flu is targeting younger age groups whereas seasonal flu usually kills the frail elderly. About one in five of the deaths from swine flu has been in previously entirely healthy people.

The NHS is preparing to double its intensive care capacity to cope with the predicted surge in swine flu cases in the autumn, the chief medical officer said today.

Routine operations will be cancelled so theatre staff and equipment can be redeployed on flu patients, and new ventilators will be bought, Sir Liam Donaldson said. He also launched a consultation on allowing one doctor rather than two to section a mentally ill person and send them to hospital, in the event that the second wave of swine flu drastically reduces numbers of NHS staff able to work.

The announcements came as the government's chief scientist, Professor John Beddington, said it was "virtually impossible" that Britain would be spared an autumn outbreak coinciding with the traditional flu season. It could be with us in less than a month, he said.

"It's hard to imagine there won't be a second wave, in fact it's virtually impossible, but whether it comes early in October at a high level, or in more moderate waves late in the year is not possible to predict," said Beddington at the British Science Association festival in Guildford.

At the Department of Health in London, Ian Dalton, national director of NHS flu resilience, said it had been decided to carry on with contingency plans originally devised to cope with bird flu, even though the government's expert advisory committee now believes that only 1% of patients, instead of 2%, will be hospitalised. "But that's still the basis on which we are planning – which we think is the prudent place to be," said Dalton.

Donaldson denied that doubling critical care beds was a political decision. Last week the Tories claimed the NHS might not have enough intensive care beds to cope with a second wave.

"I don't think it is political," said Donaldson. "I think we're tantalisingly close to being able to win the battle against this pandemic virus. In the past we have had to take whatever it throws at us and chalk up the extra deaths.

"Albeit it is mild, it can still kill … We are closer and closer to having a vaccine available. Every patient counts."

Neither Donaldson nor Dalton were able to put figures on the amount of money that scaling up critical care will cost.

The plans are to double intensive care beds from the current 1,982 for adults in England and 363 for children. Scotland, Wales and northern Ireland will make similar arrangements.

Beddington also defended the decision to make Tamiflu available to all through GPs. Some scientists are concerned that the move would increase the chances of the virus becoming resistant before a vaccine was ready. So far, only a dozen or so cases of drug-resistant swine flu have been confirmed worldwide.

The NHS may not have enough intensive care beds to cope if a second wave of swine flu hits the country, the Conservative party claims today. Hospitals are already at "breaking point" and having to close critical care beds to new admissions for large parts of the year, shadow health secretary Andrew Lansley says. The allegation comes amid intensifying party exchanges over the NHS. According to FOI requests returned to the Tories, almost 2,000 people in England had to be discharged early from intensive care last year while 20,000 were discharged belatedly because of shortages of other beds.

Doctors may refuse swine flu vaccine

Several studies suggest up to 60% of GPs would oppose being immunised because they are concerned the safety trials will be rushed.

Many GPs, as well as their patients, may be reluctant to be immunised against swine flu once a vaccine is developed, surveys suggest today.

A survey of GPs published on Healthcare Republic, the website of GP magazine, found that up to 60% of GPs may decline vaccination. Although the numbers who responded were small – 216 GPs – they are in line with a much bigger survey of nurses published a week ago by Nursing Times, which found that a third of 1,500 nurses would refuse vaccination.

18/08/09

The number of cases of swine flu in England continued to fall last week (week ending 9 August). The Health Protection Agency (HPA) estimates there were 25,000 new cases of swine flu in England last week, compared with 30,000 the week before and 100,000 the week before that. Cases of swine flu have fallen in all regions and among all age groups.

The disease is generally mild in most people so far, but is proving severe in a small minority of cases. So far 371 people have been hospitalised in England, while 44 people have died.

Swine flu vaccine

The government has announced that priority for the swine flu vaccine will be given to at-risk groups. These include pregnant women and people with serious underlying health conditions.

Vaccinations for these groups are expected to begin in the autumn. Steps are being taken to extend the vaccination programme to other people once this stage has been completed.

Children should not be given Tamiflu, Oxford researchers

Children should not be given the antiviral drug Tamiflu for swine flu because its harms outweigh any benefits and the Government should review its policy on dealing with the pandemic, researchers have said.

Anti-viral drugs Tamiflu and Relenza, reduce the length of time children are ill with flu by about one day and can cause vomiting as a common side effect, Oxford researchers found.

Vomiting is more dangerous in children than in adults as it can rapidly lead to dehydration and admission to hospital, they said.

It comes after research last week showed that Tamiflu reduced the length of flu in adults by just half a day.

Together the findings will question whether the Government's policy of stockpiling enough antiviral drugs for 80 per cent of the population was a waste of money. The exact cost of the stockpile has been kept secret for 'commercial reasons' but is expected to run to tens of millions of pounds.

Countries around the world have stockpiled around 50m doses of Tamiflu, made by Roche, for use during a flu pandemic.

Tamiflu has also been linked to side effects such as insomnia and nightmares in children.

Dr Matthew Thompson, a GP and senior clinical scientist at Oxford University and Dr Carl Heneghan, a clinical lecturer at Oxford University, said the findings review of seven research studies should prompt the Department of Health to reconsider its policy.

The study, published online in the British Medical Journal, reviewed trials where children aged between one and 12 were either given Relenza or Tamiflu to treat seasonal flu or where one of their family had flu and they were given medicine to stop them becoming ill.

The researchers said although the studies were carried out on seasonal flu the findings are relevant to the current swine flu outbreak.

The drugs may still be of some benefit for children who have underlying conditions such as cystic fibrosis or whose immune system is compromised because they are being treated for leukaemia, for example, but there was not enough evidence to be conclusive about this, the researchers said.

Dr Thompson said the Government's current policy of giving Tamiflu to all symptomatic people was 'inappropriate'.

GPs are using their clinical judgement and providing anti-virals to severe cases of flu but the National Pandemic Flu Service is handing out the drugs to anyone who fits the criteria for having a flu-like illness. Data from the Health Protection Agency has suggested only one in four of those with symptoms will actually have swine flu.

The Flu Service handed out 150,000 doses of Tamiflu in its first week as cases peaked at around 110,000 in seven days.

Dr Thompson said: "Reserving these antiviral drugs for children who are more likely to have complications may be a more sensible strategy and would take some of the pressure off the current public demand for anti-virals."

Dr Heneghan warned that prescribing the drugs so widely will encourage flu to become resistant to the medicine.

He said: "Going forward we have a treatment which is ineffective because we've given it to everybody."

He also warned that people were relying on Tamiflu, 'like a magic bullet', and this meant that serious complications of swine flu could be dismissed in those on the drug.

Parents should treat flu in children with paracetamol and rest but watch carefully for complications and contact their GP if they are worried, the authors said.

The research trials which were reviewed have been available for over a year and the Government could have carried out its own study in this before the outbreak of swine flu began, they said.

The findings also showed that when using antiviral drugs in children who have been exposed to flu but do not yet have symptoms, as preventive treatment, they were of limited use. They found 13 children need to be treated to prevent one case, meaning onward transmission was only reduced by eight per cent.

Government data released on July 30th suggested that by then one in 77 children aged between one and four had already had swine flu along with one in 95 of those aged between four and 14.

Norman Lamb, Liberal Democrat health spokesman said: "An urgent review must be carried out into whether the benefits of prescribing certain antiviral drugs are worth the risks when it comes to our children’s health.

“Parents will now need urgent guidance and reassurance about what exactly they should be doing to look after their children. This is even more crucial given that health experts are predicting a surge in swine flu cases this autumn.”

A Department of Health spokesman said: "The BMJ review is based on seasonal flu and not swine flu. As the authors note, the extent to which the findings can be applied to the current pandemic is questionable - after all, we already know that swine flu behaves differently to seasonal flu, and past pandemics have hit younger people hardest.

"Whilst there is doubt about how swine flu affects children, we believe a safety-first approach of offering antivirals to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects.

"For those who experience severe symptoms, the best scientific advice tells us that Tamiflu should still be taken as soon as possible - and to suggest otherwise is potentially dangerous.

"If people are in any doubt about whether to take Tamiflu, they should contact their GP."

The latest figures have suggested the first wave of the swine flu outbreak has peaked with officials saying around 30,000 new cases were diagnosed in the week ending August 1st but a second wave it still expected later in the autumn.

The Chief Medical Officer Sir Liam Donaldson said he remained "cautious" about the current fall in the number of new swine flu cases

The number of new cases of H1N1 swine flu in England and Scotland has fallen significantly, latest figures show.

England recorded an estimated 30,000 cases last week, compared with 110,000 the week before. In Scotland estimated numbers fell from 1,500 to 1,050.

The Health Protection Agency said there was no sign that the virus was mutating into a more lethal form, or developing resistance to drugs.

In all, 530 patients were admitted to hospital in England last week, down on the previous week's total of 793.

Wales is also reporting falling but widespread levels of "influenza like illness" with an estimated 2,670 new cases compared with 4,410 last week.

Cases in Northern Ireland seem to have risen with 83 new cases compared with 10 the week before.

HIGHEST FLU RATES IN ENGLAND

Wakefield District 188 GP consultations per 100,000

Tower Hamlets 163

Gateshead 161

Greenwich 137

Southwark 130

Hackney 129

Islington 126

Milton Keynes 123

North Tyneside 119

South Birmingham 117

Officials have always predicted rates of infection would fall away in the summer before a large surge in the autumn to coincide with the normal flu season.

England's Chief Medical Officer, Professor Sir Liam Donaldson, said it was very difficult to predict when a second wave would hit.

"It's guesswork really - we would anticipate that when the schools go back, at some point after that it would rise.

"We can't be complacent about this, we have to continue planning, we have to be ready for what happens in the autumn."

He added that the national pandemic flu service, launched two weeks ago to take the pressure off GPs, was "flexible enough" to scale up or down dependent on levels of swine flu.

Figures from the Department of Health suggest three-quarters of the general public are not very or not at all worried about swine flu.

Awareness is high, with 37% saying they heard a great deal about swine flu in the media in the past week.

Experts are currently looking at what is happening in the southern hemisphere to help predict what could happen in the UK over the winter months.

In the past week deaths in Argentina from swine flu have risen sharply and currently stand at 337.

There are also indications that Mexico may be now seeing a second wave of cases.

Meanwhile, the World Health Organization has announced that the first swine flu vaccines are likely to be licensed for use in the general population in September.

Several manufacturers have produced initial batches of a H1N1 vaccine and some clinical trials are already underway.

WHO director of vaccine research Dr Marie-Paule Kieny also sought to calm fears about safety of new vaccines.

We can't be complacent about this, we have to continue planning, we have to be ready for what happens in the autumn

Professor Sir Liam Donaldson

Although it has not yet been clarified who would be first in line for a vaccine, it is likely to be those who are most vulnerable, such as pregnant women and young children.

Some experts have raised concerns about the lack of safety data on flu vaccines in these groups.

In particular a very rare neurological condition called Guillain-Barre syndrome, which affected 500 people during a US vaccine programme against swine flu in 1976.

Dr Kieny said much was known about flu vaccines in these groups from seasonal vaccines given every winter and added that regulatory agencies would be monitoring for any signs of adverse reaction.

"The quality controls on today's vaccine are much better than they were 30 years ago," she added.

Regulators in the US and Europe have special plans in place to fast-track swine flu vaccines, some of which are based on conventional seasonal flu vaccines and some which use newer technology.

It comes as drug company, Baxter, has announced the production of the first commercial batches of its swine flu vaccine Celvapan.

The vaccine has been grown using cell culture, a much faster method than the traditional way of growing it in eggs.

Baxter is one of two companies contracted to provide pandemic flu vaccine to the UK, the other being GlaxoSmithKline, and both plan to start clinical trials this month.

One key part of the trials is to work out whether people need one or two doses of the vaccine.

Ministers have repeatedly said they expect to have enough doses for half the UK population by the end of the year.

Sir Liam said vaccine advisors were still finalising plans on who would get the first doses.

The number of deaths in England linked to swine flu has jumped by nine to 36 in the past week.

At a briefing in London, the HPA said 530 patients had been admitted to hospital in England which is down on last week's total of 793.

Meanwhile, company bosses have reported a steep rise in the number of staff self-diagnosing themselves with swine flu and taking time off.

Employment Law Advisory Services says it has received many more calls than normal from managers who claim "swine flu skivers" are causing more disruption to the workplace than the virus itself.

Thousands of healthy workers are thought to have taken advantage of official guidelines on the pandemic to extend their summer holidays.

Treatment resistant swine flu detected in US

Health officials said they had found cases of Tamiflu-resistant swine flu along the US border with Mexico, as India and South Africa announced their first deaths from the A(H1N1) virus.

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the Pan-American Health Organization office in La Jolla, California.

Cases of A(H1N1) that were resistant to the anti-viral medicine have now been found in the United States, Canada, Denmark, Hong Kong and Japan.

Experts had gathered in La Jolla on Monday to discuss the response to the outbreak, and warned that resistant strains were likely emerging because of overuse of antivirals like Tamiflu.

"In the United States Tamiflu is sold with a prescription, but in Mexico and Canada it is sold freely and taken at the first sneeze. Then, when it is really needed, it doesn't work," said Cerqueira.

The Tamiflu-resistant cases were reported as South Africa and India both announced their first fatalities from the A(H1N1) virus, which emerged in Mexico in April and has since spread worldwide, gaining pandemic status.

In South Africa, health authorities said Ruan Muller, a 22-year-old student at Stellenbosch University near Cape Town, had died after contracting the virus.

"He died on the 28th (of July), but there had to be some testing done to ensure the cause of death. It was the A(H1N1) influenza," said Fidel Hadebe, spokesman for South Africa's Department of Health.

With the world's highest number of HIV/AIDS-affected people -- nearly 19 percent of a 49-million-person population -- South Africa is considered particularly at risk because people with compromised immunity are more likely to fall prey to the disease.

South Africa's swine flu caseload has increased fourfold since the country's first case was reported on June 14. The government has said its stockpile of Tamiflu will only be used for the seriously ill, but that schools may also be closed on a case-by-case basis.

In India, authorities said a 14-year-old girl in the western city of Pune became the country's first fatality from the virus.

The teenager first felt unwell on July 21, complaining of a sore throat, runny nose and headaches. She returned to school the following day after the general symptoms improved, the Ministry of Health and Family Welfare said.

She then developed a fever again on July 25 and two days later was admitted to a private clinic for treatment. She was put on a ventilator in an intensive care unit and was treated with Oseltamivir, a generic brand of Tamiflu.

"Her condition deteriorated again with multi-system involvement and (she) expired on the evening of 03.08.09," the ministry said in a statement.

Meanwhile, the Russian state health agency warned the country's football fans to stay away from the national team's World Cup qualifying tie with Wales in Cardiff on September 9.

"This would be an extremely unnecessary and inappropriate undertaking at a time of a flu epidemic," the head of Russia's state health agency Gennady Onishchenko said, according to local news agencies.

Onishchenko expressed fear that "the expressions of emotion on the part of football fans involving intense shouting" could lead to the airborne transmission of the flu virus.

Russia has to-date been relatively spared by the swine flu pandemic, with just 55 confirmed cases in the country.

Experts remain puzzled as to why different countries have not always been affected to the same degree, with England and Scotland both heavily hit proportionately, yet neighboring France's tally appearing light by comparison.

Some have argued that gargantuan sums being spent by rich economies on a disease that is no more lethal than seasonal flu are grotesquely disproportionate when thousands die each day of diseases which receive less media coverage.

http://uk.news.yahoo.com/18/20090804/thl-treatment-resistant-swine-flu-detect-5effa79.html

Pandemic flu death toll passes 1,000 mark: WHO

The death toll in the swine flu pandemic has passed the 1,000 mark, with 1,154 deaths since the outbreak was uncovered in April, data published Wednesday by the World Health Organisation showed.

As of July 31, Azerbaijan, Gabon, Grenada, Kazakhstan, Moldova, Monaco, Nauru, Swaziland, and Suriname were added to the ranks of countries reporting laboratory confirmed cases of influenza A(H1N1).

The total number of laboratory confirmed infections worldwide reached 162,380, but the figure understates the full number since individual cases no longer have to be tested or reported.

Most of the deaths -- 1,008 -- have occurred in the WHO's America's region, encompassing North and South America and including Mexico and the United States, the countries where the new A(H1N1) pandemic strain first appeared.

Sixty-five deaths were reported in the WHO's regional office for South East Asia and 39 in its Western Pacific region since the outbreak began. Forty-one were reported in Europe.

By comparison, seasonal flu causes about 250,000 to 500,000 deaths a year, and results in about three to five million cases of severe illness, according to the WHO.

Cutting junior doctors' working hours during the swine flu outbreak could leave hospitals in chaos, health experts warned yesterday.

The EU Working Time Directive - implemented yesterday - reduces their working week from 56 to 48 hours.

Royal College of Surgeons president John Black called on the Government to suspend rules to cope with swine flu.

The number of new cases of swine flu in England appears to be levelling off, with an estimated 110,000 new cases reported last week. This compares to an estimated 100,000 cases the week before. http://www.nhs.uk/news/2009/04April/Pages/Swineflulatest.aspx

Sir Liam Donaldson, the Chief Medical Officer, noted that the change coincided with the break up of schools for the summer and the introduction of the National Pandemic Flu Service last week.

It made the announcement after confirming that 29 people in the UK - 26 in England and three in Scotland - have already died after getting the virus.

The Health Protection Agency (HPA) estimates there were 55,000 new cases of swine flu in England in the last week, including people visiting GPs and those who are looking after themselves at home.

People were urged not to panic on Tuesday as two children and a man died after contracting swine flu, although all had pre-existing health conditions.

The UK has moved from the 'containment' to the 'treatment' phase of swine flu as the number of people catching swine flu continues to rise.

Health Secretary Andy Burnham said that cases are doubling every week and if it continues at this rate there could be over 100,000 cases per day by the end of August.

The UK has moved from the 'containment' to the 'treatment' phase of swine flu as the number of people catching swine flu continues to rise.

The move from containment to treatment will apply in all four nations of the UK - England, Scotland, Wales and Northern Ireland.

Together with 44 cases in Scotland, one case in Northern Ireland and four cases in Wales, there have now been 6,929 cases of swine flu confirmed in the UK.

Together with 196 cases in Scotland, two cases in Northern Ireland and nine cases in Wales, there have now been 6,538 cases of swine flu confirmed in the UK.

A further 1,604 people in England were confirmed with swine flu over the weekend.

Together with 72 cases in Scotland, six cases in Northern Ireland and five cases in Wales, there have now been 5,937 cases of swine flu confirmed in the UK.

Some areas with high numbers of swine flu cases have moved from the 'containment' phase to an 'outbreak management' phase. This gives affected areas more flexibility to deal with the outbreak.

A further 535 people in England were confirmed with swine flu on Friday. This follows 111 cases in Scotland and five cases in Northern Ireland confirmed on Thursday and three cases in Wales announced earlier on Friday.

This follows a further 40 cases in Scotland and one case in Northern Ireland announced on Tuesday, and three cases in Wales confirmed earlier today.

Together with the 21 cases in Scotland, three cases in Northern Ireland and two cases in Wales confirmed on Monday, there have now been 2,905 cases of swine flu confirmed in the UK.

WHO has now raised the level of the swine flu alert from Phase 5 to Phase 6 – its highest alert level. By raising the alert level to phase 6 the WHO is indicating that "a global pandemic is under way".

Dr Margaret Chan, WHO's Director-General, also said that "pregnant women are at increased risk of complications". Follow the 'Pregnancy and swine flu' link below for more information.