As at 17:00 on 8th September 2009 the total number of A/H1N1 ('Swine flu') associated deaths worldwide are reported as 3,491, with the mortality rate remaining at 0.9%, significantly below the mortality rate associated with seasonal flu.

Health Protection Agency (HPA) modelling gives an estimate of 3,000 new cases in England last week, reduced from 4,500 the week before (the modelling range is 1,500 to 6,600).  In the last week, the total number of deaths reported globally has increased by 19%, compared with 13% and 21% in each of the last two weeks.

There are currently 132 patients hospitalised with A/H1N1 in England (currently hospitalised at 08:00 on September 9th, source: HPA).  The number of deaths related to swine flu in England is 66 (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).

The highest flu like illness consultation rates are in the 15-24 year age group followed by the 25-44 year age group.  The trend in the <1 year age group is decreasing more than in other age groups.

The majority of cases continue to be mild and there is no sign that the virus is changing or that it is becoming resistant to anti-virals, although the US Centre for Disease Control (CDC) has documented a potential case of person-to-person transmission of a Tamiflu-resistant version.  The Centre for Infections in London has found no sign that resistance is developing.

The CDC says the potential case of resistance supports its position that antiviral drugs should not be used preventatively in otherwise healthy people, rather should only be used for treatment and prevention in high-risk cases, which is intended to preserve the benefits of Tamiflu and Relenza for as long as possible during the pandemic.

The US Department of Health has also revised it's guidance regarding anti-virals to restrict usage to patients who show warning signs of severe illness, who are already severely ill or who have signs of lower respiratory tract infection.  Immediate treatment is still recommended at-risk groups, including young children, pregnant women and people with underlying chronic health conditions.

The Department of Health is also planning to stockpile a number of other important medicines such as aspirin, warfarin and paracetamol, in anticipation of the next pandemic wave, although the downward trend in the number of newly reported cases has brought current flu levels back to the seasonal norm.  it is likely to be early October before case begin to rise again, in line with normal seasonal flu patterns.

In Europe, although little flu activity is being reported, a few countries are reporting geographically widespread flu activity (Austria and Israel) or an increasing trend in respiratory disease (Netherlands) (source: WHO).

Most Southern hemisphere countries have passed the peak of their winter flu epidemic.  Flu activity in Australia is now generally returning to normal levels, although there is still sustained flu activity in South Africa and some parts of Australia (Western and Southern).

There are wide variations in flu activity reported in the Northern hemisphere, with an early increase past the seasonal epidemic threshold in Japan.  Flu activity in Canada and the United States remains normal, although with some regional increases in the South Eastern United States.

Vaccine production continues quietly with no significant news from the main manufacturers, although a US provider MedImmune (a division of AstraZeneca) reports that (regulatory hurdles aside) the company expects to have 5 million doses of a nasal-spray vaccine available by the end of September.

The European Medicines Agency (EMEA) has said initial data from clinical trials indicate that pandemic vaccines create a strong immune response and called the products "promising".  Some European governments have begun receiving pandemic vaccine, however, must receive licensing approval before usage.  EMEA will make a recommendation to the European Commission, anticipated before the end of September, which is the final approving body.

EMEA is still working to determine whether one vaccine dose or two will be needed, and whether vaccines should be recommended for pregnant women and young children, although CSL, an Australian firm, has just announced it's vaccine is effective with one dose.  CSL are the third company, alongside Sinovac and Novartis, to find the one dose may be adequate for protection.

Studies conducted by the WH) also confirm that a proportion of older adults have some level of natural immunity to the virus.

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.