Swine flu outbreak – latest news

 

LATEST NEWS (23 December 2009):

 

Department of Health swine flu newsletter (pdf).

 

Other news (22 December 2009):

 

Important Londonwide CEO message, volume 2, number 14 - 22 December 2009 - The latest update on the swine flu outbreak from Londonwide LMCs which includes key points for GPs and practice nurses on Patient Group Directions (PGDs).

 

16 December 2009:

 

Important Londonwide CEO message, volume 2, number 13 - 16 December 2009 (16 December 2009) - The latest update on the swine flu outbreak from Londonwide LMCs which covers the swine flu children’s Patient Group Direction (PGD).

 

11 December 2009:

 

 

9 December 2009:

 

  • Important Londonwide CEO message, volume 2, number 11 - 9 December 2009 - The latest update on the swine flu outbreak from Londonwide LMCs which covers the very latest news on vaccination of the under 5s

  • Flowchart for triage of swine flu patients for practice managers and receptionists

    The Department of Health and the Royal College of General Practitioners (RCGP) have produced a flowchart to assist GP receptionists to determine which symptomatic swine flu patients should be seen most urgently - particularly in the case of patients referred by the National Pandemic Flu Service (NPFS).

 

8 December 2009:

 

 

30 November 2009:

 

Second phase vaccinations update

 

25 November 2009:

 

Department of Health Vaccines Phase Two Q&A

 

20 November 2009:

 

Important Londonwide CEO message, volume 2, number 9 - 20 November 2009

 

17 November 2009:

 

Department of Health swine flu newsletter (pdf).

 

16 November 2009:

 

Important Londonwide CEO message, volume 2, number 8 - 16 November 2009

 

13 November 2009:

 

Important Londonwide CEO message, volume 2, number 7 - 13 November 2009

 

4 November 2009:

 

Questions and answers guidance on the swine flu vaccination agreement has now been published. There is also new guidance on JCVI priority groups for the vaccination programme.

 

 

Other news (3 November 2009):

 

Swine flu vaccinations - briefing for clinical professionals (pdf) - The Department of Health (DH) document provides details of the swine flu vaccines, as well as the vaccination programme and explores some of the surrounding issues which may be of particular interest to clinicians.

 

Important Londonwide CEO message, volume 2, number 6 - 3 November 2009

 

29 October 2009:

 

Important Londonwide CEO message, volume 2, number 5 - 29 October 2009

 

22 October 2009:

 

Important Londonwide CEO message, volume 2, number 4 - 22 October 2009

 

20 October 2009:

 

Important Londonwide CEO message, volume 2, number 3 - 20 October 2009

 

16 October 2009:

 

Important Londonwide CEO message, volume 2, number 2 - 16 October 2009

 

9 October 2009:

 

Important Londonwide CEO message, volume 2, number 1 - 9 October 2009

 

28 September 2009:

 

The Department of Health (DH) has written to Dr Laurence Buckman and all PCTs clarifying the vaccination arrangements in relation to the swine flu influenza outbreak.

 

The letter confirms that district nurses will vaccinate housebound patients in the priority groups and that GP practices will not be charged for this service.

 

The letter also confirms that it is the responsibility of GPs as employers to make arrangements for the vaccination of themselves and their staff. Vaccinating staff will not attract a payment.

 

We are still awaiting information on the vaccine release date as well as further details on the flu vaccination DES (Directed Enhanced Service). As soon as we have any information we will of course let you know.

 

15 September 2009:

 

Agreement reached on the H1N1 vaccination arrangements - Important letter from the GPC – please read!

 

8 September 2009:

 

Important Londonwide CEO message number 20 - 8 September 2009

 

27 August 2009:

 

Chief Medical Officer's Pandemic Influenza Weekly Situation Report (pdf)

 

Important Londonwide CEO message number 19 - 24 August 2009

 

Important Londonwide CEO message number 18 - 11 August 2009

 

Important Londonwide CEO message number 17 - 4 August 2009

 

Important Londonwide CEO message number 16 - 28 July 2009

 

Important Londonwide CEO message number 15 - 24 July 2009

 

Important Londonwide CEO message number 14 - 21 July 2009

 

Important Londonwide CEO message number 13 - 20 July 2009

 

Important Londonwide CEO message number 12 - 14 July 2009

 

Important Londonwide CEO message number 11 - 13 July 2009

 

Important Londonwide CEO message number 10 - 10 July 2009

 

9 July 2009:

 

Dr Michelle Drage, joint Chief Executive Officer at Londonwide LMCs, is quoted in today's Daily Telegraph in an article on the swine flu outbreak.

 

Swine flu: Government is scaremongering say leading GPs (Daily Telegraph)

 

8 July 2009:

 

Don't forget to download our poster for you to use in your surgery. The poster can be printed in black and white as well as colour and contains information for patients on what to do if they suspect that they might have the swine flu A(H1N1) virus.

 

Londonwide LMCs advice poster on swine flu (pdf)

 

Important Londonwide CEO message number 9 - 7 July 2009

 

Important Londonwide CEO message number 8 - 3 July 2009

 

Important Londonwide CEO message number 7 - 2 July 2009

 

1 July 2009:

 

There has been no new information has been produced on the swine flu outbreak since the last Londonwide CEO message number 6, on 29 June 2009.

 

We are in daily contact with NHS London about the changing situation and if there is anything new to report we will let you know immediately.

 

For those of you who have contacted our flu line (flu@lmc.org.uk), please be assured that all queries and local intelligence are read and fed back to NHS London. If you do not receive a further email from our flu line, this is because we are prioritising the queries that we can deal with.

 

Remember, for urgent clinical advice please contact the London Flu Response Centre.

 

Important Londonwide CEO message number 6 - 29 June 2009

 

Important Londonwide CEO message number 5 - 26 June 2009

 

26 June 2009:

 

Our thanks to all of you who have contacted our flu line email address.

 

Please note that email address is not an emergency helpline. However, please be assured that all queries/local intelligence are read. They are also fed back to NHS London on your behalf which helps us to raise the reality that you are facing with those organisations leading on flu.

 

If you do not receive an email response from the flu account, this is because we are prioritising the queries that we can deal with.

 

Don’t forget to also contact your local health protection unit (HPU) or PCT Medical Director if necessary.

 

Important Londonwide CEO message number 4 - 25 June 2009

 

Important Londonwide CEO message number 3 - 24 June 2009

 

Important Londonwide CEO message number 2 - 23 June 2009

 

Important Londonwide CEO message number 1 - 22 June 2009

 

16 June 2009:

 

 

15 June 2009:

 

  • GPs must not issue private prescriptions for Tamiflu outside the HPA algorithm (eg as a prophylactic measure for people going on holiday). Please remember that Tamiflu should only be prescribed in line with the HPA algorithms.

 

12 June 2009:

 

The Department of Health (DH) has published a supplement to its maternity guidance, including recommendations on the use of antiviral medicines for pregnant women, women who are breastfeeding and children under the age of one year.

 

11 June 2009:

 

The World Health Organisation (WHO) has announced that the swine flu A(H1N1) outbreak is now a Phase 6 pandemic.

 

NHS London has issued a briefing for GPs and community nurses as well as a briefing from the Department of Health (DH) on the implications of WHO moving to level 6 pandemic.

 

8 June 2009:

 

London Flu Response Centre (FRC) update to NHS London

 

The FRC briefing explains the latest information available on the new HPA (Health Protection Agency) algorithms. There is also a questions and answers section at the end of the briefing which explains issues around swabbing, antivirals and the 48 hours rule.

 

London Flu Response Centre (FRC) update to NHS London (pdf)

 

5 June 2009:

 

Changes to the algorithm for the management of suspected cases of swine influenza – update from the HPA

 

The HPA has now produced two algorithms to simplify and address the need for case management for clinical and public health purposes and surveillance.

 

The two groups of patient presenting with I-LI should be considered separately:

 

  1. patients with I-LI who have travelled to an affected area or have had contact with a probable or confirmed case of swine influenza. Patients in this group should continue to be managed as indicated in the S5a algorithm.


  2. patients with I-LII who have not travelled to an affected area and have not had contact with a probable or confirmed case of swine influenza. Patients in this group should be managed through the use of the S5b algorithm. This algorithm encourages the collection and submission of samples for testing from relevant patients for the purpose of enhancing surveillance for sporadic cases, and from others when clinically indicated. It also recommends an approach to management of these cases that is appropriate to their clinical condition and to their likelihood of being due to swine influenza.

 

4 June 2009:

 

Provision of swab kits for testing swine flu cases – update from the HPA

 

As part of the national response to the first 3000 swine flu cases, a supply of swab kits are to be provided via the NHS Supply Chain direct to clinicians who will carry out the collection of the specimen.

 

Deliveries to GPs of ten swab kits per practice began on 4 June 2009. The delivery process will run until mid July and will take place in normal working hours. A new HPA algorithm S5b regarding swabbing community cases of influenza like illness where there is no relevant travel history or epidemiological link to a known swine flu case/ contact has also been produced by the HPA.

 

Contents of swab kit packs will include a request form, a kit insert explanation form, a vial of transport medium and integral swab, collection bag (small), swab, HPA label, bio plus packaging material, a surgical mask, an examination glove and a polythene apron.

 

Further information on this can be found on the HPA website.

 

3 June 2009:

 

Latest HPA standard practical advice for investigating individuals with possible swine influenza infection (pdf).

 

 

1 June 2009:

 

HPA letter to all GPs in London concerning the Swine Flu outbreak at Eton College (pdf).

 

This letter has been included as it refers to 'a significant number of students' living in London and so may be of use to London GPs and their practice teams.

 

27 May 2009:

 

Information from the HPA about face mask/FFP3 life extension (pdf).

 

26 May 2009:

 

  • The HPA has produced guidance on case definition and classification of cases of swine influenza.

  • Questions have been asked about the need for healthcare workers to wear goggles when taking swabs from possible/probable swine flu patients. The following advice has been provided by the HPA Centre for Infections.

    In undertaking any procedure, a risk assessment should be undertaken, as part of standard infection control measures. It is known that influenza can be spread by droplets and that there are receptors on the eye, therefore if is considered that there is the likelihood of eye splashes occurring then eye protection should be used.

    When taking a swab each patient needs to be assessed individually taking account of their presenting symptoms and clinical condition and a judgement made on the likelihood of the patient coughing or sneezing during the procedure. If it is felt likely that there may significant coughing or sneezing, then eye protection should be considered. The following two examples may be useful to help decide whether or not eye protection is required.
    1. If people are coughing so frequently and ‘violently’ that there is deemed to be a significant risk of a splash on the face from respiratory secretions then the HCW should wear eye protection to protect themselves.

    2. Alternatively if the person had a sore throat and little cough then it would be less appropriate for the HCW to wear eye protection since it is unlikely that they are going to have a significant splash risk from taking a throat swab.

The HPA does not propose to amend the specification for the swab kits to be provided to GPs by NHS Supply Chain so these will not include goggles.

 

22 May 2009:

 

The London Flu Response Centre (FRC) is now operational for healthcare professionals across London. The Centre can be contacted on 0845 425 1752 from 0900 to 2000.

 

Calls outside of these times should be made to the normal out of hours number for the local Health Protection Unit.

 

20 May 2009:

 

NHS London's advice on pregnancy, breastfeeding and swine flu is now available.

 

19 May 2009:

 

London’s Flu Response Centre has been launched and will be operational for all London areas by tomorrow. A summary of this update is outlined below. This information has been provided by NHS London for all GPs and practice teams in London.

 

 

London Flu Response Centre

 

The London Flu Response Centre (0845 425 1752) will be operational for healthcare professional in primary care, Acute Trusts and Mental Health Trusts served by North East and Central London HPU from 1500 this afternoon.

 

Healthcare professionals in other HPU areas should contact the new Centre following the timetable below:

 

  • North East and Central London HPU from 18 May
  • South East London HPU from 19 May
  • South West London HPU from 19 May
  • North West London HPU from 20 May

 

All healthcare professionals should call this centre to discuss possible cases of swine influenza and for all queries relating to swine influenza.

 

Calls to the Centre will be handled by NHS staff, supervised by HPA health protection staff. Many NHS organisations have identified staff for the Centre, however further volunteers are still being sought. Please contact nicki.smith@london.nhs.uk for more information.

 

The new Centre will provide the same, comprehensive service that has to date been provided by the individuals local Health Protection Units.

 

NHS organisations will receive correspondence from their local HPU explaining the above. Please continue with your current local arrangements until your HPU has moved into the centre.

 

15 May 2009:

 

HPA standard practical advice for investigating individuals with possible swine influenza infection (pdf).

 

13 May 2009:

 

The HPA’s algorithm S5 for the management of suspected cases (returning travellers and visitors from countries affected by swine influenza A/H1N1 or contacts) for phase 5 has been updated.

 

12 May 2009:

 

The latest edition of the BMJ includes a very helpful questions and answers section on swine influenza A/H1N1.

 

11 May 2009:

 

The latest briefing from the Chief Medical Officer (CMO) is now available.

 

6 May 2009:

 

The Department of Health is currently sending out leaflets about the swine flu outbreak and how to prevent its spread to every household in the UK.

 

5 May 2009:

 

The HPA’s algorithm S5 for the management of suspected cases (returning travellers and visitors from countries affected by swine influenza A/H1N1 or contacts) for phase 5 has been updated.

 

30 April 2009:

 

The World Health Organisation (WHO) has raised the alert to level five. A pandemic has not yet been declared.

 

The following update for GPs and their practice teams comes from NHS London.

 

 

  • Currently, suspect cases are being managed by the Health Protection Agency (HPA), including testing, contact tracing and allocation of antivirals where indicated by the HPA algorithm.

  • GPs must inform the HPA via their local Health Protection Unit (HPU) if patients present themselves with symptoms of swine influenza A (H1N1) within seven days of visiting areas where sustained human to human transmission of swine influenza A/H1N1 is occurring. GPs must also inform their HPU if they prescribe antivirals at this time.

  • GPs should not issue private prescriptions for Tamiflu to patients who do not have swine influenza A (H1N1) symptoms as these are unlikely to be filled by community pharmacies. Tamiflu should only be prescribed for patients who fit the HPA algorithm.

  • PCTs should ensure that GPs have relevant personal protective equipment (PPE) available for when taking swabs for influenza A testing. Queries about taking swabs should be referred to the PCT.

  • An influenza A positive result does not mean that the patient has swine influenza A/H1N1. It means that the patient has tested positive for influenza A virus. This could be normal seasonal human influenza A.

  • In order to determine if this is due to swine influenza A/H1N1, a second test needs to be carried out at the Health Protection Agency Centre for Infections to type the virus – ie to determine and detect swine influenza A/H1N1. It can take up to 24 hours to confirm swine influenza A/H1N1. 

 

Further information is available from:

 

 

The Health Protection Agency (HPA) has also produced questions and answers guidance on swine influenza cases.

 

27 April 2009:

 

Please note that the LMC guidance below is only outline guidance and you must be guided by advice from the Chief Medical Officer (CMO), Health Protection Agency (HPA) and the Public Health Department of your PCT.

 

You will be aware from media coverage that human cases of swine influenza A (H1N1) have been reported in Mexico and certain areas of the United States of America. This is an evolving situation and it is likely that more countries will be affected. The Health Protection Agency (HPA) is closely monitoring the situation and is working with the UK Government to review the current incident and any threat it poses to the UK.

 

Cases have presented with symptoms of influenza-like illness: fever, respiratory tract illness, headache and muscle aches. Some have presented with vomiting and diarrhoea.

 

The virus that has been identified is a novel influenza A virus and the US Centre for Disease Control (CDC) suggests human-to-human transmission of swine flu. It is sensitive to oseltamivir and zanamivir, but resistant to amantadine and rimantadine.

 

The HPA recommends that clinicians should consider swine influenza A (H1N1) virus infection in the differential diagnosis of returning travellers and visitors to the UK presenting with:

 

  • Febrile acute respiratory illness AND
  • A history of travel to affected areas of Mexico or the United States in the 7 days preceding illness onset

 

If you suspect a swine influenza case, the HPA swine fever management algorithm for returning travellers should be followed and the local Health Protection Unit should be immediately informed. The algorithm includes guidance on:

 

  • Case investigation including sampling and testing
  • Initial case management including use of anti-virals
  • Infection control measures in community and health care settings
     

 

Please also read the joint GPC/RCGP guidance on dealing with a flu pandemic which is available on this website.

 

This website will be updated on a regular basis and we will keep you informed via regular email alerts.

 

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