Swine Flu Pandemic Weekly Report, Wales
-- Levels of flu in Wales are low but increasing
-- Swine flu usually leads to a mild illness although in a minority of cases it can be severe
-- The clinical consultation rate for influenza in Wales increased during the week ending 12 July to 15.76 cases of flu like illness diagnosed by GPs out of every 100,000 people in Wales. It was 5.1 per 100,000 in the previous week. This is within baseline levels (less than 25 consultations per 100,000 practice population).
-- 67 laboratory confirmed cases of swine flu have been reported by NPHS Health Protection Teams in 18 LHB areas (as at 12 noon on 15 July).
-- Ten people confirmed with swine flu in Wales have been admitted to hospital. Nine of these have now been discharged (as at 12 noon on 15 July).
-- According to the NPHS daily GP surveillance scheme, as at 15 July, the influenza consultation rate in Wales as a whole was 26.6 cases of flu like illness diagnosed by GPs in the previous seven days out of every 100,000 people in Wales.
-- Consultation rates in 11 LHB areas now exceed 25 cases of flu like illness diagnosed by GPs in the previous seven days out of every 100,000 people in Wales, with the Gwent and South Wales areas mostly affected.
-- Consultation rates appear highest in children aged less than 4 years and in those aged 15 - 44 years.
-- During the week ending 12 July, the percentage of total calls to NHS Direct Wales which were influenza related increased to 23.3 per cent from 20.6 per cent two weeks before.
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 12 July (week 28) nine samples were submitted for testing by sentinel GPs, none of which tested positive for influenza.
Since week 26 (22 June), 16 samples have been received and tested from sentinel GPs (including one Out of Hours GP Service sample). One sample has tested positive for influenza A and was further identified as swine influenza A(H1N1)v. This was from a patient from the Cardiff area, aged 25 - 34yrs with a recent history of travel to Spain.
3. Laboratory confirmed swine flu cases
As at 15 July there have been 67 laboratory confirmed cases in Wales, ten of which have been hospitalised (Table 4). The age group currently with the highest numbers of cases are 15 to 24 year olds (Table 5). Confirmed cases have been reported in 18 out 22 LHB areas in Wales (Table 3).
Of the 67 laboratory confirmed cases, 10 have been admitted to hospital. Nine 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 low but increasing levels of influenza activity across Wales.
Further detail can be found on the NPHS website
As at 15 July the consultation rate for Wales as a whole was 26.6 per 100,000, consultation rates in 11 LHB areas now exceed 25 per 100,000 (see figure 4 and Table 6), with the Gwent and South Wales areas mostly affected.
Consultation rates appear highest in children aged less than 4 years and in those aged 15 - 44 years (figure 5).
County Influenza consultation rate (per 100,000 population) at 14 July Estimated number of GP consultations within LA for previous seven days
Carmarthenshire 9.3 17
Ceredigion 24.2 19
Pembrokeshire 26.6 31
Powys 20.0 26
Dyfed Powys 17.7 90
Blaenau Gwent 44.6 31
Caerphilly 37.4 64
Monmouthshire 56.3 50
Newport 65.5 92
Torfaen 27.7 25
Gwent 45.0 252
Anglesey 21.4 15
Conwy 14.9 17
Denbighshire 15.4 15
Flintshire 16.0 24
Gwynedd 21.1 25
Wrexham 27.4 36
North Wales 19.9 135
Bridgend 21.6 29
Cardiff 37.5 120
Merthyr Tydfil 26.2 15
Neath Port Talbot 10.9 15
Rhondda Cynon Taf 26.5 62
Swansea 9.7 22
Vale of Glamorgan 49.4 61
South Wales 25.6 316
WALES 26.6 798
5. NHS Direct Wales calls During week 28 (latest data), the percentage of total calls to NHS Direct Wales which were influenza related increased to 23.3% from 20.6 % in week 26 (figure 7). Flu related calls are the sum of calls recorded as 'cold/flu', 'cough', 'headache', 'fever' and 'sore throat'.
1 Data supplied by Health Statistics and Analysis Unit, Welsh Assembly Government.
6. Comment from the Chief Medical Officer and National Public Health Service for Wales Chief Medical Officer for Wales, Dr Tony Jewell, said: "We are seeing an increase in the number of cases in Wales as we would expect given the community spread in other parts of the UK. We estimate that up to 30 per cent of the population could catch swine flu at some point over the next 12-18 months. However, we have antivirals to reduce the symptoms should people catch it, and we have ordered vaccines to cover the whole population. Both of these measures will help reduce the potential impact on individuals, communities and the economy.
"In an effort to reduce spread of infection, we have also been stressing that if people have flu-like symptoms, they should stay at home and check their symptoms on the NHS website at www.nhs.uk or phone the swine flu information line on 0800 1 513 513. If the symptoms are causing concern, or people are in an at risk group such as those with heart and lung disease, children under 5 or pregnant women, they should phone NHS Direct on 0845 46 47 or phone their GP. People in the high risk groups will benefit from antivirals most if taken within the first 48 hours of the onset of symptoms.
"People with flu-like symptoms should not go to their local surgery, A&E or pharmacy in case they spread the virus to others, especially at-risk groups.
"While we have been planning for this for some time and are prepared for this, we are not complacent and people must be vigilant. Our advice to the public remains the same and that is to follow good respiratory and hand hygiene - in short, catch it, bin it, kill it - to help prevent the spread of influenza."
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.
"Previously, we have been investigating and responding to individual cases. This has allowed us to learn about the virus, how it spreads and how it affects people. We have learnt that, in the majority of cases it 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.
"As the virus seems to predominantly affect younger age groups, it is expected that we will see more cases in schools. As with any feverish illness, children who are displaying flu-like symptoms, particularly if their temperature is raised, should not attend school.
"If a child has had contact with someone diagnosed with swine flu and does not display any flu-like symptoms there is no reason for this child to be kept away from school.
"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 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.
-- 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.
-- 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 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 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
Welsh Assembly Government