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Volume 3 No 45; 13 November 2009

Pandemic influenza: UK situation at 12 November 2009



The Health Protection Agency's Weekly National Influenza Report of 12 November (week 46) [1] described the UK (and international) situation as follows:
  • Pandemic influenza activity was variable across the UK;
  • In week 45 (ending 8 November), for the second week running the weekly influenza/influenza-like illness (ILI) consultation rates decreased, although they remained above the winter baseline thresholds in England, Scotland and Northern Ireland;
  • The National Pandemic Flu Service (NPFS) continued to issue antiviral drugs to people in England but the number of assessments and antiviral collections decreased slightly over the past week;
  • Interpretation of data to produce estimates on the number of new cases continued to be subject to a considerable amount of uncertainty with the move to NPFS. HPA modelling gave an estimate of 64,000 (range 32,000 - 140,000) new cases in England in week 45. The estimated number of new cases increased in most regions and age groups;
  • The fact that week 44 (26 October to 1 November 2009) had been the half-term holiday for most schools across the UK was thought still to have affected some of the indicators in the Weekly Report, although it was unclear to what extent;
  • The main influenza virus circulating in the UK continued to be the pandemic (H1N1) 2009 strain, with few influenza H1 (non-pandemic), H3 and B viruses detected. Three of 2834 pandemic viruses tested have been confirmed to carry a mutation which confers resistance to the antiviral drug oseltamivir; all three are phenotypically resistant to the drug but retain sensitivity to zanamivir;
  • The majority of pandemic influenza cases continued to be mild. The cumulative number of deaths reported due to pandemic (H1N1) 2009 in the UK was 180. There was a total of 1355 new patients hospitalised with suspected pandemic influenza in the week from 5 to 11 November, a decrease from 1431 in the previous week. The hospitalisation rates have increased in the under-5-year age group but have decreased in most other age groups recently;
  • The UK pandemic influenza vaccination programme continues in people at high risk for severe disease and in health-care workers. For further information see the Department of Health website;
  • According to the European Centre for Disease Prevention and Control (ECDC), by 11 November, 592 deaths due to pandemic influenza had been reported globally; according to the World Health Organisation (23 October), influenza activity was low in temperate southern hemisphere regions, was increasing in the temperate northern hemisphere regions and was variable in tropical areas.

Reference
1. HPA. Weekly National Influenza Report: week 46 (12 November2009, PDF 397 KB), HPA website: www.hpa.org.uk/swineflu/surveillance&epidemiology.

Military-civilian health partnership award for CfI scientists

Staff at the HPA's Centre for Infections (CfI) have been recognised at an awards ceremony for the part they played in protecting British armed forces personnel in Afghanistan against pneumonia.

Dr Robert George, director of the CFI Respiratory and Systematic Infection Laboratory, and Dr Alison Bermingham, clinical scientist in the Virus Reference Department, were part of a team that won the Health Improvement and Promotion Award at the Military and Civilian Health Partnership Awards 2009.

The award was given in recognition of their work in stopping a potential epidemic of community-acquired pneumonia in Kandahar Air Field, Afghanistan.

Alongside colleagues in the Ministry of Defence (MOD) and medical staff based at Kandahar Air Field, the CfI experts advised on control of the outbreak which, if it had continued, would have seriously compromised frontline military operations. The HPA contribution included preparation and despatch by military transport of rapid diagnostic kits for pneumococcal pneumonia and virus swabs and transport medium for urgent return to CfI.

Diagnostic support and public health advice was provided to help identify the agent that was causing illness and advise on what measures needed to be put in place to prevent further spread of infection.

The Military and Civilian Health Partnership Awards are a partnership between the Ministry of Defence and the health departments of Scotland, England, Wales and Northern Ireland. The Health Improvement and Promotion Award aims to recognise exceptional work in promoting and maintaining the health of military personnel or for significant contributions to the health of military patients in primary, environmental, occupational, public health or occupational medicine areas.

Health professionals encouraged to support European antibiotic awareness campaign

Health professionals throughout Europe are being encouraged to promote and support the second European Antibiotic Awareness Day (EAAD 2009) which takes place on 18 November 2009 [1].

The annual event, co-ordinated by the European Centre for Disease Prevention and Control (ECDC) aims to promote prudent antibiotic use and raise awareness among the public and primary care prescribers of the threat to public health associated with antibiotic resistance. EAAD 2009 focuses on stopping unnecessary use of antibiotics - for example, for common colds and influenza - particularly in parts of the European Union where over-the-counter sale of antibiotics without prescription is widespread.

A wide range of materials for use in national campaigns (and other background and briefing documents) are available on the EAAD website [1]. For example, under a website homepage heading "Using antibiotics responsibly", factsheets (for the general public and for experts) and "key messages" documents (both for the general public and for primary care prescribers; and about antibiotics and pandemic flu) have been made available.

Variations in antibiotic use among EU member states

An ECDC Factsheet for Experts explains the relevance of the awareness campaign to the separate public health problems of nosocomial/healthcare-acquired infections and antimicrobial resistance [2]. It stresses that large intra-EU variations exist in levels of antibiotic consumption and that levels of consumption consistently correlate with levels of antimicrobial-resistant bacteria circulating.

Referring to European Antimicrobial Resistance Surveillance System (EARSS) data, it notes that, taking account of size of population, the member states that use the most antibiotics for outpatients - ie Greece and Cyprus - use approximately three times more per inhabitant and per year than the member state that uses the least, the Netherlands. An illustrated four-page summary of latest data on antibiotic resistance and antibiotic use in different EU member states is also available [3].

References
1. European Antibiotic Awareness Day (EAAD) website, http://antibiotic.ecdc.europa.eu.
2. EEAD Factsheet for Experts, http://ecdc.europa.eu/en/eaad/antibiotics/Pages/factsExperts.aspx.
3. “Summary of latest European data on antibiotic resistance and antibiotic use”.