News Archives |
Volume 3 No 17; 1 May 2009
- Influenza A/H1N1 (‘swine-lineage’): UK situation at 1 May 2009
- Confirmed measles cases in England and Wales: update to end-March 2009
Influenza A/H1N1 (‘swine-lineage’): UK situation at 1 May 2009
On 25 April 2009, the World Health Organization (WHO) declared the outbreak of swine-lineage influenza A/H1N1 ('swine influenza') [1] previously reported in Mexico and the United States to be a Public Health Emergency of International Concern. The influenza pandemic alert level was raised to level 4 (verified human-to-human transmission able to cause 'community-level outbreaks') on 27 April and to phase 5 ('human-to-human spread of the virus into at least two countries in one WHO region') on 29 April [2].
On 30 April, the UK Department of Health circulated further information to all health authorities for general practitioners and other health professionals indicating appropriate steps to be taken to deal with potential cases, including details of: the WHO alert levels; known details of the virus; who should be offered antivirals; and suggested actions in a number of different clinical scenarios [3].
Surveillance information - UK
As at 1400 hours on Friday 1 May, the number of confirmed and possible cases of swine-lineage influenza A/H1N1 in England was as follows [4]:
Case category* |
Number |
Confirmed |
9** |
Possible |
642 |
An update on the number of confirmed cases in England, and the number under laboratory investigation, is being published daily on the Agency website.
Syndromic surveillance in the UK
NHS Direct recorded a greater-than-normal volume of calls for colds/flu, cough and fever during the last week of April (while in other respects these calls were similar to normal in age and outcome breakdown). However, this increase in calls is difficult to interpret against the background of heightened national concern about the threat of swine influenza.
Surveillance information - international
The European Centre for Disease Control (ECDC) in its update at 0800 hours on 1 May 2009 [5] reported the following numbers of confirmed cases and related deaths:
Country |
Total cumulative confirmed cases (including deaths) |
Total cumulative number of deaths |
Austria |
1 |
- |
France |
- |
- |
Canada |
28 |
- |
Germany |
3 |
- |
Israel |
2 |
- |
Mexico |
312 |
12 |
New Zealand |
14 |
- |
Spain |
13 |
- |
UK |
8 |
- |
USA |
109 |
1 |
Case investigation and management
An HPA case definition for use by health professionals is available on the Agency's website [6].
The Agency's advice is that individuals returning from affected areas who become unwell within seven days of their return should stay at home and contact their GP or NHS Direct.
An updated algorithm on the management of returning travellers is available on the Information for Health Professionals pages on the Agency website [7].
The Agency has posted practical advice for health professionals investigating individuals with possible swine influenza infection [8].
Contact management
The Health Protection Agency is working to ensure that any close contacts of confirmed cases are traced and offered antivirals as a precautionary measure. Precautionary measures (appropriate to the current WHO Pandemic Alert Phase 5 situation) are summarised in an algorithm, available on the Agency website, covering the following seven categories of contact [9]:
- individuals who live in the same household as a case, including those who stayed overnight;
- individuals who provided informal care to a case, coming within speaking distance (less than one metre);
- health or social care workers who provided direct clinical or personal care or who examined a symptomatic patient without wearing appropriate personal protective equipment;
- household visitors who stayed longer than one hour at a time when a case was symptomatic;
- other individuals exposed to a probable or confirmed case at a distance of less than one metre with continuous exposure for greater than one hour;
- anyone caring for a case, or sitting in the same row, or two rows in front or two rows behind a case on an aircraft for one or more hours.
Advice on the management of school age cases
The Agency has issued advice on appropriate responses to probable or confirmed cases of swine flu occurring in school settings. Although it should be considered unusual to close a school in response to a single case of influenza, in the light of the evidence emerging that the swine influenza can spread rapidly in the school setting, it is recommended that, if a probable or confirmed case occurs in a school setting, consideration should be given to closing the school temporarily (initially for a period of seven days); however, an individual risk assessment should be carried out in such cases, looking at the risk in relation to the specific school circumstances [10].
Other general advice
The Agency has circulated advice to the media related to the use of face masks [11]. This stresses that, although it is generally accepted that there are some circumstances where wearing a face mask may be beneficial (eg healthy people wearing a facemask when they are caring for a patient with flu), the wearing of face masks by healthy individuals who are not involved in caring for people who are ill (ie the general public) is not recommended.
The UK Border Agency has made available posters and leaflets for air passengers and other travellers returning from affected parts of the world [12].
Future developments
The evolving nature of the situation means that some of the detailed guidance documents referred to above (eg for investigating cases [10] and managing contacts [9]) are likely to change if and when there is a substantial increase in the incidence of cases.
Further information
Further information on the developing situation is available on the Swine Influenza pages on the Agency website which includes links to specific areas dedicated to information for the general public, healthcare professionals, and the press and media.
References and links
1. WHO is currently referring to the new influenza virus as 'influenza A/H1N1'.
2. The World Health Organisation is posting daily updates on its dedicated Influenza H1N1 website: http://www.who.int/csr/disease/swineflu/en/index.html.
3. Department of Health. 'Swine flu alert', Chief Medical Officer Alert, 30 April 2009.
4. 'Update on confirmed swine flu cases in England', HPA press release, 1 May 2009.
5. ECDC situation report: influenza A/H1N1 infection, update 01 May 2009. Available at: http://www.ecdc.europa.eu/en/files/pdf/Health_topics/.
6. Swine flu case definition (version 1), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
7. Algorithm for the management of returning travellers and visitors from countries affected by swine influenza A/H1N1 presenting with febrile respiratory illness: recognition, investigation and initial management (version S5), 30 April 2009, available from the Swine Influenza Information for Health Professionals pages on the Agency website.
8. Standard practical advice for investigating individuals with possible swine influenza infection (version 1), 30 April 2009, available from the Swine Influenza pages on the Agency website.
9. WHO Pandemic Alert Phase 5: actions and post exposure prophylaxis for close contacts of probable or confirmed human case(s) of swine influenza A/H1N1, 1 May 2009, available from the Swine Influenza Information for Health Professionals pages on the Agency website.
10. HPA advice on consideration of school closure in the event of a probable or confirmed case of 'swine flu' in a school setting. Available on the Swine Influenza pages on the Agency website.
11. 'Information for the media on face masks - updated', HPA press release, 29 April 2009.
12. Advice for people entering the UK with influenza type symptoms (leaflet and poster) 29 April 2009, available from the Swine Influenza Information for Health Professionals pages on the Agency website.
Confirmed measles cases in England and Wales: update to end-March 2009
Although the number of laboratory confirmed cases of measles in England and Wales has appeared to plateau (100 in January and 126 in both February and March) the geographical distribution of the reported cases is changing. The number of cases reported from London decreased whilst the North West region observed the highest increase in cases between February and March. The highest total of cases remains the South East region (table). Outside London, regions continue to identify clusters of cases linked to the travelling communities and to schools/nurseries. Wales has reported it's first cases this year associated with localised outbreak in an under-vaccinated local resident population.
Compared to the last quarter of 2008, the provisional total of laboratory confirmed measles cases in the first quarter of 2009 has fallen from 403 to 352 cases.
Confirmed cases of measles by region and month of onset, England and Wales:
January 2009 to February 2009
Month |
Lond-on |
East Mids |
East of Engl'd |
North East |
North West |
South East |
South West |
West Mid's |
Wales |
York & Humb |
N/k |
| Total 2008 | 664 |
48 |
90 |
17 |
178 |
129 |
42 |
113 |
39 |
49 |
1 |
Jan 09 |
38 |
7 |
4 |
1 |
8 |
19 |
3 |
13 |
- |
7 |
- |
Feb 09 |
39 |
- |
3 |
- |
3 |
52 |
1 |
23 |
- |
5 |
- |
Mar 09 |
19 |
3 |
6 |
- |
27 |
38 |
3 |
9 |
18 |
3 |
- |
Figure 1: Number of laboratory confirmed cases in England and Wales by month of onset: January 2007 to March 2009
The MMR catch-up campaign announced in August 2008 targeted children and young adults aged 1 to 18 years. In the last six months, the majority of confirmed cases remain in this group (figure 2).
Figure 2: Confirmed cases by age group and six-month period, England and Wales
