Swine Flu Pandemic Weekly Report, Wales

Main Category: Swine Flu
Also Included In: Flu / Cold / SARS;  Public Health;  Respiratory / Asthma
Article Date: 31 Jul 2009 - 3:00 PDT


Levels of flu in Wales increased sharply in the week ending 26 July. Current levels of flu in Wales would be considered normal in the winter. Swine flu usually leads to a mild illness although in a minority of cases it can be severe

Summary

- The clinical consultation rate for influenza in Wales increased sharply during the week ending 26 July to 78.6 cases of flu like illness diagnosed by GPs out of every 100,000 people in Wales. It was 36.0 per 100,000 in the previous week. This is above the baseline level threshold of 25 consultations per 100,000 practice population and would be considered to be normal seasonal activity for the winter period.

- 87 laboratory confirmed cases of swine flu have been reported by NPHS Health Protection Teams in 20 LHB areas (as at 10am on 29 July).

- Of the laboratory confirmed cases, 23 people confirmed with swine flu in Wales have been admitted to hospital. All of these have now been discharged (as at 10am on 29July).

- According to the NPHS daily GP surveillance scheme, as at 28 July, the influenza consultation rate in Wales as a whole was 147.0 cases of flu like illness diagnosed by GPs in the previous seven days out of every 100,000 people in Wales.

- Consultation rates in 20 LHB areas now exceed 100 cases of flu like illness diagnosed by GPs in the previous seven days out of every 100,000 people in Wales. In four LHB areas, the rates exceed 200 per 100,000. Consultation rates appear highest in southern and north eastern areas of Wales.

- Consultation rates appear highest in children aged less than 4 years and in those aged 15 - 24 years,

- Latest figures for yesterday [Wednesday, 29 July] show NHS Direct Wales received 285 swine flu-related calls. Of those, 265 people were symptomatic and 20 were from the 'worried well'.

1. GP Surveillance of Infections Scheme
During the flu season (October to March), the NPHS releases weekly influenza data which is available for both health professionals and the public and is posted on the NPHS Health Protection website. Due to the ongoing swine flu pandemic this weekly reporting has been extended until further notice.

The data detail rates of influenza circulating in Wales including geographical and age range distributions and results of virological testing of submitted swab samples.

2. Enhanced virological surveillance for influenza and respiratory viruses
During the week ending 26 July (week 30) one sample was submitted for testing by sentinel GPs, which tested negative for influenza.
Since week 26 (22 June), 30 samples have been received and tested from sentinel GPs (including one Out of Hours GP Service sample). Two samples have tested positive for influenza A and were further identified as swine influenza A(H1N1)v and one sample has tested positive for rhinovirus..

3. Laboratory confirmed swine flu cases
As at 29 July, there have been 87 laboratory confirmed cases in Wales, The age group currently with the highest numbers of cases are 15 to 24 year olds (Table 5). Confirmed cases have been reported in 20 out of 22 LHB areas in Wales (Table 3). Of the 87 laboratory confirmed cases, 23 have been admitted to hospital. All of these have been subsequently discharged.

4. Rapid Surveillance of Influenza
The NPHS influenza rapid surveillance scheme, which records reports of diagnoses of flu from more than 300 GP practices across Wales, shows increasing levels of influenza activity across Wales. Further detail can be found on the NPHS website: http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=38241

As at 29 July the consultation rate for Wales as a whole was 147.0 per 100,000. Consultation rates in all LHB areas exceed 25 per 100,000 (see figure 4), with consultation rates in 20 LHB areas now exceeding 100 per 100,000, and consultation rates in four LHB areas now exceeding 200 per 100,000. Consultation rates appear highest in southern and north eastern areas of Wales

Consultation rates appear highest in children aged 1 - 4 years and lowest in those aged 65 years and over (figure 5).

County Influenza consultation rate (per 100,000 population) at 28 July Estimated number of GP consultations within LA for previous seven days

Carmarthenshire 101.8 183
Ceredigion 71.3 55
Pembrokeshire 88.4 104
Powys 127.7 168
Dyfed Powys 100.3 509
Blaenau Gwent 207.2 143
Caerphilly 182.4 313
Monmouthshire 121.9 108
Newport 190.7 267
Torfaen 264.0 240
Gwent 194.2 1,089
Anglesey 130.4 90
Conwy 132.7 148
Denbighshire 123.6 120
Flintshire 138.7 209
Gwynedd 206.4 244
Wrexham 161.4 213
North Wales 152.2 1,032
Bridgend 198.4 266
Cardiff 158.1 508
Merthyr Tydfil 146.4 81
Neath Port Talbot 134.8 185
Rhondda Cynon Taf 107.1 250
Swansea 96.6 220
Vale of Glamorgan 213.3 264
South Wales 140.2 1,729
WALES 147.0 4,410

5. NHS Direct Wales calls
Latest figures for yesterday [Wednesday, 29 July] show NHS Direct Wales received 285 swine flu-related calls. Of those, 265 people were symptomatic and 20 were from the 'worried well'.

6. Comment from the Chief Medical Officer and National Public Health Service for Wales Chief Medical Officer for Wales, Dr Tony Jewell, said:
"While there has been another sharp rise in the number of swine flu cases in Wales over the last week, which we have expected and been planning for, we are still seeing levels we typically experience with seasonal flu in the winter.

"I want to thank the staff of the NHS for their hard work in recent weeks.
"Wales - along with Scotland and Northern Ireland - have decided not to join the interim National Pandemic Flu Service (NPFS) that has been launched in England as we believe that people prefer to deal with the NHS services that they know and are comfortable with. Therefore, we are continuing to strengthen existing services in the same way as Scotland did to manage the increase they have already seen, such as training more call handlers for NHS Direct Wales.

"Arrangements will also be made to filter calls quickly when patients ring NHS Direct Wales so that people with swine flu symptoms - as well as those phoning in with other calls are dealt with as effectively as possible.
"We continually monitor the situation, and should the need arise, like Scotland and Northern Ireland, we are still able to plug into the NPFS if and when it is required.
"People should to stay at home if they have flu-like symptoms and check their symptoms on the NHS Direct Wales website at http://www.nhsdirect.wales.nhs.uk or by phoning the swine flu information line on 0800 1 513 513. If you have these symptoms, remember coughs and sneezes spread diseases so if you do, you must catch it, bin it, kill it.

"If the symptoms are causing concern people can phone NHS Direct Wales on 0845 46 47. People in an at-risk groups such as those with a chronic condition, children under 5 or pregnant women, should phone their GP. as they are a priority for early antiviral treatment.

"People with flu-like symptoms should NOT go to their A&E, local GP or pharmacy in case they spread the virus to others. Such visits cause undue pressure and potential delay for other patients who are in need of emergency services.

"If we all play our part, we will be able to manage swine flu without causing undue pressure on the NHS."

Dr Roland Salmon, Director of the Communicable Disease Surveillance Centre, National Public Health Service for Wales, said:

"The rise in numbers of people contacting their GP with flu like symptoms illustrates the spread of the disease across Wales. Not everyone however who has contacted their GP with flu like symptoms will have swine flu and not everyone with swine flu contacts their GP so it is difficult to accurately record the spread of the virus across Wales.

"Over the last three months we have learnt that in the majority of cases swine flu is mild although proving severe for a small minority. Most people recover from infection without the need for hospitalisation or medical care.

"As the disease becomes more widespread in the UK we have changed our approach to focus on treatment, emphasising those people most at risk - people more likely to develop serious illness or complications. These are, particularly, the groups that we encourage to get vaccinated each winter, because they are at risk from seasonal influenza, together with pregnant women and children under 5.

"We advise people to practice good respiratory and hand hygiene to reduce the chance of catching or spreading the virus. If people think they may have flu and want to check their symptoms they can call the Swine Flu Information Line on 0800 1 513 513. If they are still concerned they should contact NHS Direct Wales on 0845 4647.

"People should not go to Accident and Emergency Departments or to their GP surgery as this may risk spreading the infection. It also places undue pressure on the emergency services."

Public health advice and messages

-- If you have flu-like symptoms stay at home. You can check your symptoms by visiting the NHS Direct Wales website on www.nhsdirect.wales.nhs.uk or by calling the Swine Flu Information Line on 0800 1 513 513. If you are still concerned contact NHS Direct Wales on 0845 4647. Do not go into your GP surgery or Accident and Emergency department unless you are advised to do so or are seriously ill, as you may spread the illness to others.

-- Further information including health advice can be found at http://www.nhsdirect.wales.nhs.uk, http://www.wales.gov.uk and http://www.nphs.wales.nhs.uk. You can also call the Swine Flu Information line on 0800 1 513 513 for recorded information, or NHS Direct Wales on 0845 46 47 for health advice.

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

Control measures

-- Agreements have been signed between the UK Government and vaccine manufacturers to secure enough vaccine for the whole population. The first batches are expected in August with around 60 million doses by the end of the year - enough for 30 million people to be vaccinated - with more following after that. The European Medicines Agency has strict processes in place for licensing pandemic vaccines. In preparing for a pandemic, appropriate trials to assess the safety and the immune responses have been carried out on vaccines very similar to the swine flu vaccine.

-- The Welsh Assembly Government's Health Emergency Preparedness Unit has issued guidance to Local Health Boards on anti-viral distribution. The unit is co-ordinating work on identifying appropriate collection points and the necessary arrangements to support this process.

Features of the outbreak

-- Based on assessment of all available information and following several expert consultations, the World Health Organization (WHO) declared the level of influenza pandemic alert at phase six on 11 June 2009.

-- Phase six indicates there is human-to-human spread of the virus in at least two countries in one World Health Organization region, with community level outbreaks in at least one other country in a different WHO region.

-- On 2 July the four UK nations agreed to move to the treatment phase in their response to the pandemic - treating people most at risk. Contact tracing and the use of antivirals preventively have been ended. GPs will now provide clinical diagnosis of swine flu cases rather than awaiting laboratory test results.

Further information

-- Further health information for the public on swine flu is available bilingually from http://www.nhsdirect.wales.nhs.uk
-- Further public health information on swine flu and Pandemic Flu is available bilingually from http://www.nphs.wales.nhs.uk
-- Further information from the Welsh Assembly Government response is available bilingually at http://www.wales.gov.uk

Source
Welsh Assembly Government

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