As at 17:00 on the 18th August 2009 the total number of A/H1N1 ('Swine flu') cases confirmed worldwide is estimated at 237,129.  Associated deaths are reported as 2,144, a mortality rate of 0.9%, still significantly below the mortality rate associated with seasonal flu.

There are currently 263 patients hospitalised with A/H1N1 in the UK (Source: Health Protection Agency).  The number of deaths related to swine flu in England is 54 (which represents the number of deaths in individuals with swine flu, however, does not represent the number of deaths that can be attributed to swine flu).

In the last week or so, cases reported globally have increased by 10% and the number of deaths by 24%, although in the UK there has been a further reduction in the rates of flu-like illness and related activity.

HPA modelling gives an estimate of 11,000 new cases in England last week (although the modelling range is between 6,000 to 25,000 cases).  The highest flu-like illness consultation rates are in the infant group, who are always referred to a GP by the National Pandemic Flu Service and the 1-4 year age groups.

There has been a decrease in estimated number of cases in all regions of the UK, so far with a generally low impact on health services.  The majority of cases continue to be mild.  There is no sign that the virus is changing.

Possible resistance to anti-virals is constantly monitored by the Centre for Infections, in Colindale, London.  So far, over 700 viruses have been analysed and nearly 200 specimens fully tested for resistance and all were found to be sensitive to the main anti-virals, which means resistance to the drugs is not developing.

The UK Medicines and Healthcare Products Regulatory Agency (MHRA) has found a possible interaction between 'Tamiflu' and Warfarin, which is an anti-coagulant used by many people with heart and circulation problems.  Current professional advice, including from the MHRA, maintains that the benefits of taking 'Tamiflu' outweigh the risks and patients should continue to take it as advised by their healthcare provider.

Several countries, including the United States, Canada, Australia, Hong Kong and some European Union countries are progressively introducing a shelf-life extension program for 'Tamiflu' from five to seven years.  The WHO has indicated it should be up to national regulatory authorities to grant any shelf-life extensions.  Blossoms is still attempting to ascertain the UK Government position regarding any shelf-life extension.

In Europe, all countries are reporting low or moderate intensity of cases indicating a normal or slightly increased proportion of populations being affected by respiratory illness.  The majority of new confirmed cases are being reported from Germany (Source: European Centre for Disease Control).

The WHO reports an overall decline in the Americas.  Activity is widespread in the general community in Australia and South Africa, Thailand, Hong Kong and Taiwan.  India and China are both experiencing outbreaks with significant local transmission.

The number of people presenting to GPs with influenza like illness continues to fall in New Zealand, along with fewer hospital admissions and reduced demand for intensive care beds, which is a good indicator that the pandemic is on a downward trend in areas currently within their traditional flu season.

Vaccine production is continuing and the first European clinical trial, being conducted in Germany, has started this week.  The trial will assess the use of the vaccine given as 2 doses, 21 days apart in 128 healthy adults, aged between 18 and 60, which means early results from the trial should be available in mid-September.

Additional trials planned in the manufacturers' clinical development programmes are expected to commence shortly and will include more trials in healthy adults, trials in children (including infants) and in the elderly.

More testing of vaccines will be required before any conclusion (or distribution) will be made and Blossoms anticipates that as clinical trial data must be submitted to regulators, a licensed vaccine is still unlikely to be available for distribution before the end of September at the earliest.

It's also of note that in July the National Biodefense Safety Board in the United States anticipated 120 million vaccine doses would be available in October, however, stated last week that 45 million doses will be delivered, approximately 60% below expectations.

Blossoms will continue to monitor the situation and provide updates accordingly.  Please don't hesitate to contact our occupational health team if we can be of any assistance.