Weekly pandemic flu media update

14 January 2010

NOTE: The HPA will no longer be producing a weekly pandemic flu media update. Should the position change in relation to the course of the pandemic then the updates will be resumed.

Information on the agency's surveillance of flu and other respiratory illnesses will be available in the routine HPA National Influenza Report, produced weekly by the agency and available on its website at www.hpa.org.uk 

KEY POINTS

• A small increase in the rate of flu-like illness in England has been reported this week. The rate remains low and well within the baseline zone. Any increase should be interpreted with caution, however, as flu indicators may have been influenced by the holiday period in recent weeks.
• The consultation rate for flu-like illness in England from the Royal College of General Practitioners (RCGP) scheme has increased to 19.9 per 100,000 in week 01 compared to 11.2 in week 53. This is below the English baseline threshold of 30/100,000.
• In week 01 overall weekly numbers showed a slight decrease in the number of assessments, antiviral authorisations and collections through the National Pandemic Flu Service. Rates remain very similar across all regions.
  

Following the move from laboratory testing for confirmation of swine flu to clinical diagnosis of cases, the level of flu in the community is being monitored using a range of surveillance mechanisms, including the RCGP consultation rates, QSurveillance®, and the National Pandemic Flu Service.

A more detailed UK weekly epidemiology update can be accessed at:
www.hpa.org.uk/swineflu/surveillance&epidemiology

CLINICAL INDICATORS
Clinical data are obtained from GP surgeries that report the weekly and daily consultations for flu-like illness and other acute respiratory illness.

Current estimated weekly Royal College of General Practitioners (RCGP) consultation rates of flu-like illness

From a network of approximately 100 general practices covering a population of approximately 900,000 with an equal distribution within each of three defined reporting regions; North, Central and South.

In week 01 GP consultation rates for flu-like illness in England have increased compared to the previous week (11.2 per 100,000 in week 53 to 19.9 per 100,000 in week 01). This remains below the English baseline threshold of 30 per 100,000.

Figure 1: Current estimated weekly RCGP consultation rates of flu-like illness

QSurveillance®
Set up by the University of Nottingham and EMIS (the main supplier of general practice computer systems within the UK) in collaboration with the Health Protection Agency, QSurveillance® is a not-for-profit network of over 3,300 general practices covering a total population of almost 22 million patients (> 25% of the UK population).

The weekly QSurveillance® flu-like illness consultation rate showed an increase from 13.3 per 100,000 in week 53 to 19.7 per 100,000 in week 01.

NB: QSurveillance® is based on data from 43% of England's population (about 3000 practices), 10% of the population in Wales, 17% in Northern Ireland, and 0% in Scotland.

Figure 2: QSurveillance® - weekly consultation rate for flu-like illness in England, Wales and Northern Ireland (all ages)

Figure 3: QSurveillance® - weekly consultation rate for influenza-like illness by English SHA (all ages)

Figure 4: QSurveillance influenza-like illness rate by age band in week 01 (ending 10 January)

The latest weekly flu-like illness rates show that rates have increased in all age bands. However, rates in weeks 52 and 53 will have been influenced by the holiday period so any increase here should be interpreted with caution. The highest flu-like illness consultation rates remain in the <1 year="year" age="age" band.</p="band.</p" />

SYNDROMIC SURVEILLANCE

NHS Direct
On 23 July the National Pandemic Flu Service was implemented. This had an impact on the number of 'cold/flu' calls received through the routine NHS Direct service. For this reason, data from NHS Direct do not reflect the true pattern of cold/ flu callers and so are not currently an accurate surveillance tool.

VIRAL CHARACTERISTICS
To date (as of 13 January 2010) 4,707 viruses have been analysed by the HPA Centre for Infections for the genetic marker commonly associated with resistance to oseltamivir in seasonal H1N1 flu (H274Y). 34 viruses have been found to carry this marker in the UK with three of these, through additional testing, showing evidence of resistance when viral growth is tested in the presence of oseltamivir. These viruses are still sensitive to zanamivir. In addition, 293 specimens have been fully tested for susceptibility to antivirals. 

Information on medical history was available for 25 cases, 23 of whom had an underlying medical condition: 18 were immunosuppressed and the remaining five had other underlying illnesses. Probable person to person transmission has occurred in an outbreak in a hospital ward.

The agency is continually assessing its advice to government on health protection policies such as antiviral use. Currently there is no requirement to change existing guidance.

There have been no significant changes in the virus.

SEVERITY
Disease severity continues to be monitored. The disease is generally mild in most people so far, but is proving severe in a small minority of cases.

Swine flu hospitalisations in England: 268 patients (currently hospitalised as of 8am on 13 January). 

Deaths - the number of deaths related to swine flu in England will be provided in the Department of Health's fortnightly bulletin, the first of which will be issued on Thursday 21 January.

INTERNATIONAL SUMMARY

Confirmed global deaths reported by ECDC (Update 09:00 CEST 12 January 2010)

Total deaths reported: 13,938

In the last 7 days, the total number of deaths reported globally has increased by 4.6% on the previous week.

NB: Laboratory confirmed case numbers are no longer being reported for most countries as they do not give a representative view of the actual number of cases worldwide.

WHO reported on 8 January that for:

• North America: Flu activity has continued to decline or remain low in all countries. In Canada, rates of flu-like illness have now dropped below the historical seasonal baseline.
• Europe: intense virus circulation has continued in several countries of central, eastern, and south-eastern Europe - particularly in Poland, Serbia, Ukraine, Georgia. In most of western and northern Europe, rates of flu-like illness and acute respiratory infection have continued to decline substantially, and, in many places, have returned to near seasonal baselines.
• Central and western Asia: in Central Asia, there is evidence of declining rates of flu-like illness and acute respiratory infection while in West Asia limited data suggest that, although flu transmission remains active, rates may have peaked.
• Eastern and southern Asia: in South Asia, pandemic flu transmission remains geographically widespread and active across the subcontinent, particularly in northern India, Nepal, and in Sri Lanka, where an increasing trend in respiratory diseases activity was reported. In South East Asia, flu transmission remains geographically regional to widespread; however, overall flu activity appears to be low but variable. Localised increases in flu-like illness have been reported in parts of Thailand over the past three weeks. In East Asia, flu transmission remains widespread and active but appears to be declining except in Mongolia where a slight increase in rates of flu-like illness was reported again.
• Tropical regions: in the tropical regions of America and the Caribbean overall pandemic flu activity continued to decline or remain low.
• Temperate southern hemisphere region: sporadic cases of pandemic flu continued to be reported without evidence of sustained community transmission.

More information on the latest global situation can be found on the WHO website at: http://www.who.int/csr/don/2010_01_08/en/index.html

ENDS

Notes to editors
General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including swine flu. This includes:

• Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of virus from your hands to face or to other people.
• Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product.
• Covering your nose and mouth when coughing or sneezing, using a tissue when possible.
• Disposing of dirty tissues promptly and carefully.
• Making sure your children follow this advice. 

Further information on swine flu is available on the Health Protection Agency's website at www.hpa.org.uk/swineflu.

For media enquiries only please contact the Health Protection Agency's Centre for Infections press office on:  

020 8327 7080   
020 8327 7097  
020 8327 7098
020 8327 6690  
020 8327 6647

Last reviewed: 19 May 2010