General Health Protection Advice
The government has distributed an advice leaflet on Swine Flu to all UK households. This leaflet advises on the simple steps that everyone can take to help prevent catching colds and flu based on good respiratory and hand hygiene. Always carry tissues, always use a clean tissue to cover your mouth and nose when you cough and sneeze, bin the tissue after use and regularly wash your hands with soap and hot water. The simple way to remember this is CATCH IT, BIN IT, KILL IT. Alternative language and large print versions of the Government leaflet are also available on the Directgov website and NHS Choices as detailed below. The wearing of facemasks by healthy individuals who are not involved in caring for people who are ill (i.e. the general public) is not recommended by the Health Protection Agency. The available scientific evidence does not suggest that this is an effective preventative measure. The HPA will continue to monitor the situation over the summer months and working in active partnership with the NHS and other centres in the UK and will use this information to plan any wider public health response if required. The HPA has issued revised FAQs which can be found on their website at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1240812255 916 Key Actions As swine flu is spreading fast in the UK with several hundred new cases being confirmed daily it is important to prepare now and consider the following useful measures: For students - Look after your mates and look out for each other. For example, by encouraging friends to seek medical advice if they seem unwell, helping them to obtain prescriptions if they are ill and also checking that they have registered with a GP. For staff - Set up a network of flu friends – these are friends, neighbours and relatives who can help you if you get ill and you are not able to leave your home. They could, for example, collect medicines and food for you Make sure that you have an adequate amount of paracetamol-based cold remedies in the house in case you become ill Keep up to date with university information and advice. Keep up to date with latest information on swine flu and follow public health advice and instructions.
Antivirals and Vaccines The UK government has enough antiviral to treat over half the population of the country if they become ill and steps have been taken to increase the stockpile to cover 80% of the population. Arrangements are being put into place with local healthcare services for antivirals to be made available to those who need them. The shift to a treatment phase has important practical implications for the public and the NHS. The way in which the antiviral medicines Tamiflu and Relenza are used and
distributed will also change:
The medicines will continue to be offered to all those who show symptoms of swine flu at their doctor's discretion. They will no longer be given to completely healthy people simply to slow the spread of swine flu. They will be used for prevention (prophylaxis) only on the advice of a doctor in high-risk groups. These include people with certain long-term conditions, those over 65, children under five and pregnant women. Individuals who require antivirals will be given a prescription by their G.P entitling them to the medication.
There has been an argument put forward that the government should restrict antivirals to those groups who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, then the NHS should let the virus run its course, treating it with paracetamol and bed rest as you would normal flu. However, the government’s Scientific Advisory Group for Emergencies (SAGE) believes there is still some uncertainty about the risk profile of the virus. For instance, there are reports of some cases in Argentina where young, healthy adults have apparently become extremely ill from swine flu. While there is still this doubt, the government has decided to continue offering Tamiflu to everyone with swine flu at their doctor's discretion. Further, as part of the move to a treatment phase, the health secretary has also announced the launch, "when it is needed", of a National Pandemic Flu Service. This is a new telephone system that will support GPs in the diagnosis of swine flu and the distribution of antivirals. It will allow people with suspected swine flu to be diagnosed and given vouchers for antivirals via a dedicated call centre or online. There have been some reports of side-effects from antivirals including nausea and stomach pain. These are in line with the manufacturers written warnings. The HPA has reiterated advice that where antivirals are prescribed, they are best taken with food and that the specified course of treatment is followed and completed. Antivirals used in the treatment of flu are not a 'cure'. They reduce the virus spreading in the body, help the patient to recover more quickly and reduce the risk of complications. They also reduce shedding of the virus by infected people so that its spread may be delayed. However they do not offer longer term protection. Once the virus is widespread within the community, the value of antivirals in terms of slowing the spread of the disease or offering individual protection is greatly reduced. This is because people are likely to be repeatedly exposed to the disease and extensive use of prophylaxis would no longer be appropriate as it would mean people having to take repeated courses of medicine. It is not possible to eliminate the virus using antivirals. The move to using antivirals for treatment only is consistent with the approach being taken in other countries across the world including the USA, Canada, Australia, New Zealand, Chile and Mexico.
A vaccine to protect against swine flu is being developed but it is not available yet. The first batches of vaccine are expected to arrive in late August, and 30m double doses – enough for half the population – are expected to be available by the end of the year. The government has ordered enough vaccine for the whole population and, when it becomes available, will focus on those at the greatest risk first. The government has also ordered 226m face masks, 34m respirators and 15.2m courses of antibiotics. Reports of resistance to Antiviral Oseltamivir Following testing in Denmark, resistance was been confirmed by the WHO Collaborating Centre at the Medical Research Council (MRC) National Institute for Medical Research (NIMR) in the UK. However, the virus remained susceptible to the antiviral zanamivir. In the UK the Health Protection Agency's Centre for Infections has confirmed they have been monitoring antiviral drug resistance since the beginning of this outbreak. Routine sampling in the UK has shown that there is currently no resistance to either oseltamivir or zanamivir. HPA will continue to watch for antiviral resistance and will be carrying out regular sample testing throughout this outbreak. To help the Health Protection Agency identify cases of swine flu in the community, regular flu surveillance work is continuing throughout the summer, at the same pace that is applied during the normal "flu season" (October to May). This includes the routine sampling of swine flu samples for antiviral resistance.