Seasonal Influenza Update

Lord Lansley Excerpts

Monday 10th January 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Seasonal flu virus circulates each year and this year is no exception. This statement is to update Parliament following developments during recess.

Seasonal flu is different from the outbreak of pandemic flu in 2009, when a new flu virus emerged (H1N1, or “swine flu”) against which humans (particularly those aged under 65) had little or no natural immunity. When the pandemic flu virus emerged in 2009, our pandemic preparedness plans were triggered. These plans entailed the mass distribution of “antiviral” drugs, the launch of the “National Flu Line”, and a “Catch it. Bin it, Kill it” advertising campaign designed to help members of the public understand how they could limit the spread of flu.

There is no flu pandemic this year, so these plans have not been triggered. Although the H1N1 virus is circulating, it is now one of the seasonal flu strains. This is because when it circulated in 2009-10, it helped to establish a residual level of immunity in people exposed to it, which means that H1N1 now circulates like other seasonal flu viruses.

In the United Kingdom, the H1N1 and influenza B viruses are the strains of flu that are circulating widely. H1N1 is the predominant virus, and is behaving—as expected—as it did in 2009-10. This means that H1N1 is likely to infect younger people—particularly those with underlying disease—and pregnant women.

A seasonal flu vaccine is available this year, as in previous years. This vaccine protects against all three strains of flu which the World Health Organisation identified would be most likely to circulate this year. Surveillance data show that these strains are circulating and that the vaccine is a good match.

General practitioners (GPs) order seasonal flu vaccine direct from the manufacturers according to their needs. This system is different from the childhood vaccination programme where the Department procures vaccine centrally and distributes it free of charge to the NHS.

We are aware of some reports of flu vaccine supply issues in some areas in England. We are working with NHS at the local level to ensure available supplies of surplus vaccine are moved to where they are needed. If efforts to source seasonal flu vaccine locally are not successful, the H1N1 monovalent vaccine (Pandemrix) is now available to GPs, for patients who are eligible for the seasonal flu vaccine.

I have already agreed for a review of procurement options of the seasonal flu vaccine to be undertaken, including central procurement, although no decisions have yet been made.

As in previous years, and on the basis of procedures which have existed for decades, the Government take expert advice from the Joint Committee on Vaccination and Immunisation (JCVI). This year, as last year, the JCVI advised that those aged 65 and over, and those in clinical at-risk groups, should be vaccinated. Because of the specific characteristic of the H1N1 virus, the JCVI also advised for the first time that healthy, pregnant women should be vaccinated with seasonal flu vaccine. The JCVI has recently assured me that this advice is appropriate for this year’s flu season.

As in previous years, only certain groups are being targeted for vaccination. We have therefore focused our efforts on ensuring that these groups are vaccinated. Current information for vaccinations given up to 2 January 2011 shows that 70.0% of over 65s have been vaccinated and 45.4% of those in clinical at-risk groups have been vaccinated, which is broadly in line with previous years.

The latest data indicate that the rate of GP consultations for influenza-like illness (ILI) is currently 98 per 100,000 people but we need to be cautious about interpreting the data due to the holiday period. The highest recorded level this year was 124 per 100,000, which is lower than that recorded during the pandemic in 2009-10 and below the epidemic level of 200 per 100,000 people. Nevertheless, given that they reached these levels I have taken the decision to reinstate the “Catch it, Bin it. Kill it” campaign.

Data indicate that this year’s flu has resulted in greater than usual numbers of patients requiring critical care. These patients have largely been infected with H1N1, and the pattern is consistent with H1N1’s characteristics last year. As a result, where necessary, local NHS organisations have increased their critical care capacity, in part by delaying routine operations requiring critical care back-up. This is a normal operational process which is initiated by NHS organisations at the local level; critical care capacity is not “fixed” but is always able to flex in this way according to local need.

In addition, over the last month we have increased the number of so-called “ECMO” beds—for patients with the most severe disease—from 5 to 22.

The number of deaths this winter from flu verified by the Health Protection Agency currently is 50, with 45 of these being associated with the H1N1 infection. The number of deaths from seasonal flu varies each year, with over 10,000 deaths from seasonal flu estimated in the winter of 2008-09.

Some have queried why statistics for the number of deaths in pregnant women are not available. The only reason the Health Protection Agency has not published the breakdown is to protect those individuals from being personally identifiable, the number of such cases being small.

When influenza is circulating, antiviral medicines can also help clinical at-risk groups who have either been exposed to or have contracted a flu-like illness. This season we notified clinicians that the use of antiviral medicines in these groups was justified, but also, as a higher than normal number of patients outside the clinical at-risk groups were becoming seriously ill with flu, general practitioners (and other prescribers) were recommended to exercise their clinical discretion so that any patient who they feel is at serious risk of developing complications from influenza may receive antiviral treatments on the NHS. In response, demand for these medicines continued to rise.

We have taken prompt action to ensure that all patients have access to appropriate antiviral medicines when they need them, and there is no shortage of antiviral medicines in the country.

There is always more pressure on the NHS during the winter, but the NHS is well-prepared and is coping well. In summary, we are taking the following action:

the first line of defence against flu is vaccination, and we want to see vaccination rates increase still further. That is why we are currently working with the BMA and RCGP to ensure everyone in an at-risk group who has not been vaccinated contacts their GP and books an appointment;

the second line of defence is to practice good respiratory and hand hygiene. That is why we reinstated the Catch it, Bin it, Kill it campaign. In addition, and in advance of the new school term, we are encouraging parents to educate their children to use good hand and respiratory hygiene; and

the third line of defence is a well-prepared NHS with the ability to treat those who do need help. That is why we are working with local NHS organisation to help them escalate critical care capacity where necessary, and have increased the number of ECMO beds available for patients.

We are making available a range of winter performance information publicly available. This is published on the Winterwatch section of the Department’s website at: http://winterwatch.dh.gov.uk/.