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Weekly pandemic flu media update

31 December 2009

KEY POINTS

  • Most indicators show that flu activity is continuing to decrease across the UK. Some caution must be exercised, however, as the indicators may be influenced by the holiday period.
  • The consultation rate for flu-like illness in England from the Royal College of General Practitioners (RCGP) scheme has decreased to 12.7 per 100,000 in week 52 compared to 24.7 in week 51. This is below the English baseline threshold of 30/100,000.
  • The estimated cases self referring to the National Pandemic Flu Service have shown decreases in all areas of assessments, authorisations and collections. This is across all regions and all age groups. 

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 52 (ending 27 December) GP consultation rates for flu-like illness in England have shown a decrease compared to the previous week (24.7 per 100,000 in week 51 to 12.7per 100,000 in week 52) which is below the English baseline threshold of 30/100,000.

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

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 a continued decrease from 29.3 per 100,000 in week 51 to 16.4 per 100,000 in week 52. The weekly rates for flu-like illness in all SHA regions show general decreasing trends and a decrease is also seen in all age groups. 

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 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 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 52 (ending 27 December)

Figure 4: QSurveillance influenza-like illness rate by age band in week 52 (ending 27 December)

The latest weekly flu-like illness rates show that the highest flu-like illness consultation rates remain in the <1 and 1-4 year-old age bands. Compared with week 51, rates have decreased in all age bands.

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 30 December 2009) 4,563 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). 31 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 17 cases, all of whom had an underlying medical condition: 14 were immunosuppressed and three had chronic respiratory or neurological illnesses.

Testing of samples, taken before and after treatment with oseltamivir, show that the antiviral resistance in 14 of the cases was treatment-induced, four are probably acquired through person to person transmission, and in four cases the origin of the resistant virus is still under investigation.

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: 496 patients (currently hospitalised as of 8am on 30 December). 

Deaths - the number of deaths related to swine flu in England as of 17 December is 203 (This figure represents the number of deaths in individuals with swine flu but does not represent the number of deaths that can be attributed to swine flu). There will be an updated deaths figure in the next briefing on Thursday 7 January 2010.

INTERNATIONAL SUMMARY

Confirmed global deaths reported by ECDC (Update 14:00 CEST 30 December 2009)

 Total deaths reported 12,866

In the last 7 days, the total number of deaths reported globally has increased by 5% 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 23 December that for:

  • North America and Europe:  pandemic flu activity has recently peaked in much of the temperate zone of the northern hemisphere, although activity continues to increase in the later affected areas of central and south-eastern Europe.
  • Central and western Asia: limited data suggest flu transmission remains active, although disease trends remain variable. Increasing activity continued to be reported in Kazakhstan and Egypt, while several other countries including Oman and Israel are reporting declining activity following a peak approximately one month ago.
  • Eastern and southern Asia:  In East Asia, flu transmission remains active but appears to be declining overall. Flu activity has recently peaked and continues to decline in Japan, in northern and southern China, Chinese Taipei and in Mongolia. In southern Asia, flu activity continues to increase in the northern parts of India, Nepal and Sri Lanka.
  • Tropical regions: In the tropical region of Central and South America and the Caribbean, flu transmission remains geographically widespread but overall disease activity has been declining or remains unchanged, apart from Barbados and Ecuador where recent increases in respiratory diseases activity have been reported.
  • Temperate southern hemisphere region: sporadic cases of pandemic flu continue 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/disease/swineflu/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: 8 January 2010