swine flu advice
Advice to Asquith regarding (swine) flu H1N1 jab for Under 5s
Prepared by Dr A Raffles, Medical Advisor to Asquith Nurseries
24th November 2009
You may have seen in the news that the H1N1 and seasonal flu vaccine is now being offered to children aged 6 months to 5 years.
The paediatric consultant of Asquith Day Nurseries & Pre-Schools, Dr Raffles recommends children in this age group receive the H1N1 and seasonal flu vaccine, which is available from your GP. Prior possible exposure to the flu virus should not be considered a reason to not vaccinate. If there are pregnant women in your family or amongst your friends, it is even more advisable to vaccinate your child to help prevent spread of infection.
Advice to Asquith regarding current pandemic (swine) flu H1N1
Prepared by Dr A Raffles, Medical Advisor to Asquith Nurseries
8th September 2009
The advice in this article is neither exhaustive nor to be used without professional advice. If you have any concerns, contact your GP or the National Pandemic Flu Service (a dedicated website and call centres that will quickly tell you if you have swine flu, without the need to contact your GP).
swine flu update
The number of new cases of swine flu in England continued to drop last week, with an estimated 4,500 new cases reported. This compares to an estimated 5,000 the week before, and 130,000 at its height. So far, 70 people have died in the UK. Cases in children have generally been mild.
Current advice is for all schools and nurseries to reopen normally. However it is expected that the number of cases of swine flu, as well as seasonal flu, will rise as the autumn and winter progress - this is the usual pattern for viral illnesses in children, with cases generally reducing in number when there is a cold snap.
antivirals
Recent advice and experience suggests that Tamiflu, or Relenza, the antivirals recommended for the flu viruses, should not routinely be given to children who are otherwise well. Even if your child develops flu like symptoms, the best advice is to use your usual treatments for high fever - Paracetamol and Ibuprofen. Only if symptoms do not improve within 48 hours should you need to see a GP, or contact the NHS Flu Line.
vaccination
Vaccination is strongly recommended for all children under 5 years of age. Scientists have now developed a vaccine for swine flu, but it isn't available yet.
The first batches of the vaccine are expected to be available in October, and 30 million double doses (enough for half the population) are expected by the end of the year.
The government has ordered enough vaccine for the whole population. It will focus on those at the greatest risk first. The vaccine will initially be given to people aged between six months and 65 years who usually get the seasonal flu jab.
In addition to the swine flu vaccine, all children will also be recommended to have the seasonal vaccine.
We expect a significant increase in the number of cases of children with flu of both sorts, and we are prepared for many staff members to be off for a few days. Please watch our website for continuous updates.
Advice to Asquith regarding current pandemic (swine) flu H1N1 Prepared by Dr A Raffles, Medical Advisor to Asquith Nurseries 4th August 2009
what is swine flu?
Swine flu is the common name that has been given to a new strain of influenza. It is called swine flu because it is thought to have originated in pigs, and was first detected in a Canadian swineherd, which suggested it may have crossed from an animal to a human.
The most common symptoms are fever greater than 38°C (100°F) over 3 to 4 days, and 2 or more of the following symptoms:
- sore throat
- diarrhoea
- headache
- feeling generally unwell
- dry cough
These are symptoms very similar to seasonal influenza. Most people including children of all ages will recover within a week, even without special treatment.
My own experience has been that I have personally cared for 8 children with confirmed H1N1 influenza in hospital. All of these children had severe underlying health problems, and all have recovered within 7 days. We have seen countless unwell children over the last 4 weeks with a diagnosis of H1N1, but not confirmed by isolating the virus. All these children have also recovered. Most had mild illnesses indistinguishable from a cold.
Taking Tamiflu is also not without problems - in particular tummy pain and diarrhoea are common symptoms. In otherwise well children, who were given Tamiflu when the first cases were appearing in schools some weeks ago there was a very high frequency of tummy pains, diarrhoea and loss of appetite, presumably due to the treatment as the children had no other symptoms suggestible of pandemic flu.
what is a pandemic?
The virus was first identified in Mexico in April and has since become a pandemic, which means it has spread around the globe. It has spread quickly because it is a new type of influenza virus that few, if any, people have full resistance to.
Flu pandemics are natural events that occur from time to time.
Any figures appearing in the press and on the news are almost certainly a large underestimate because only those cases which have been confirmed by laboratory tests are reported.
In the majority of cases the virus has proved relatively mild. However, more than 550 people have died globally and its 'risk profile' is still not fully understood. For this reason, and because all viruses can mutate to become more potent, scientists are advising caution.
the situation in the UK (4th August 2009)
The number of new cases of swine flu in England appears to be levelling off, with an estimated 110,000 new cases reported the week ending July 26th. This compares to an estimated 100,000 cases the week before. There is no sign that the virus is changing, and it is not becoming more severe or developing resistance to anti-virals. The small number of deaths has mainly been in adults and older children with underlying risk factors. There has been a decrease in the estimated number of cases in 5-14 year olds.
Of these many thousands of cases since July, 793 have involved hospitalisation, and 31 people have died. However, the total number of cases is almost certainly a significant underestimate, as the diagnosis no longer needs the virus to be detected, and is made on the symptoms only. Put in context, over the same period 50 children will have died in Road Traffic Accidents.
The UK formally moved from a 'containment' to a 'treatment' phase for swine flu on 2 July 2009. This meant that intensive efforts to contain swine flu, via automatic school closures, for example, ended in order to free up capacity to treat the increasing numbers of people who are contracting swine flu daily.
As in other countries, the majority of cases reported so far in the UK have been mild. Only a small number have led to serious illness, and these have frequently been where patients have had underlying health problems.
There has been an argument put forward that government should restrict antivirals to those groups who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, then the NHS should let the virus run its course, treating it with Paracetamol and bed rest as you would normal flu.
However, the government's Scientific Advisory Group on Emergencies (SAGE) believes that there is still some doubt about the risk profile of the virus. For instance, there are reports of some cases in Argentina where young, healthy adults have apparently become extremely ill from swine flu.
While there is still this doubt, the government has decided to continue offering the antiviral medicines Tamiflu, for children and adults, or Relenza, an antiviral spray for pregnant women, to everyone with symptoms which may suggest swine flu, at their doctor's discretion.
high-risk groups
Some people may be more at risk of serious illness if they catch swine flu, and will need to start taking antivirals as soon as they are confirmed with the illness. This is based on very limited UK experience, and mostly on the pattern of illness reported from countries with very different health care services. On occasion, doctors may advise some high-risk patients to take antivirals before they have symptoms, prophylactic treatment, if someone close to them has swine flu.
The risk profile of the virus is still being studied but it is already known that the following groups appear to be vulnerable:
- children under five years old
- people aged 65 years and older
- pregnant women
- people with:
- chronic lung disease
- chronic heart disease
- chronic kidney disease
- chronic liver disease
- chronic neurological disease (neurological disorders include motor neurone disease multiple sclerosis and Parkinson's disease)
- immunosuppression (whether caused by disease or treatment)
- diabetes mellitus
- patients who have had drug treatment for asthma in the past three years
swine flu vaccine
A vaccine to protect against swine flu is being developed but it is not available yet.
The first batches of vaccine are expected to arrive in the autumn, and 30 million double doses - enough for half the population - are expected to be available by the end of the year.
The government has ordered enough vaccine for the whole population and, when it becomes available, will focus on those at the greatest risk first.
The vaccine will be suitable for babies over 6 months of age, and 2 doses, two weeks apart are required. The immunization takes 2 weeks to become effective once both doses have been given
catch it, bin it, kill it
Although the UK has moved to a treatment phase for swine flu, it is important that people continue to do everything they can to stop the virus from spreading.
The key is to practise good respiratory and hand hygiene. In other words, remember to catch it, bin it, kill it. Catch your sneeze in a tissue, place it quickly in a bin and wash your hands and surfaces regularly to kill the virus.
stay away from hospitals
During the summer holidays many hospitals will be admitting well children for routine surgery. You would be advised to avoid taking other children to visit otherwise well children whilst there is a possibility that children with swine flu (H1N1) will be on the wards as well.
Avoid unnecessary visits to Emergency departments, and use your local GP services, including out of hours services and NHS walk in services, as well as NHS Direct.
nursery precautions
Please do not send unwell children with any fever to nursery, at any time. Wait until the fever has settled for 48 hours before returning your child to nursery.
If any adults in the household have the flu symptoms they should avoid returning to work until they have been free of fever for 48 hours.
At the present time there is no reason to close nurseries where a child has confirmed or suspect Swine flu. A more immediate problem which may result in closure will be staffing as many of the staff, with young children of their own, may be off for a few days if they contract the illness. Nurseries will make contingency plans i.e. extra staff, pooling staff etc. to manage this eventuality should it occur.
travel
It is likely that spread of the virus, and any other viruses, is increased when you travel by air - but this does not mean cancelling any travel plans. Ensure you take adequate Paracetamol or Ibuprofen for temperature control with you when you are travelling. These products are available world wide. It is not necessary to take Tamiflu abroad, as a precaution, if you and your family are fit and well.
pregnancy
Although pregnancy has been suggested to be a risk factor, due to 2 deaths in pregnant women, it should be put into the context that about 100 women a year die in England, out of 750,000 deliveries, of a pregnancy-associated complication. This includes pneumonia in pregnancy as this is can be a more serious disease then in a non-pregnant women. So far it appears that the pregnancy associated risk is solely based on the fact that 2 women have died, and were found to have the H1N1 virus - whether of not it was the cause of death - as both had severe underlying health problems.
vitamins, antibiotics and other health remedies
In the UK a well-nourished parent or child of any age rarely needs to take routine vitamin supplements. As a preventative measure some families take Vitamin C as supplement, and this is unlikely to do any harm. Antibiotics taken without symptoms are entirely unnecessary, and other healthcare self medications, other then Paracetamol or Ibuprofen are unlikely to be of benefit. Asthmatic parents and children should not stop their regular treatments.
what can I do as a parent or staff member?
You can reduce, but not eliminate, the risk of catching or spreading swine flu by:
- Always covering your nose and mouth with a tissue when coughing or sneezing.
- Disposing of dirty tissues promptly and carefully.
- Maintaining good basic hygiene, for example washing hands frequently with soap and warm water to reduce the spread of the virus from your hands to face, or to other people.
- Cleaning hard surfaces, such as door handles, frequently using a normal cleaning product.
You should also prepare now by:
- Confirming a network of 'flu friends' - friends and relatives - who could help you if you fall ill. They could collect medicines and other supplies for you so you do not have to leave home and possibly spread the virus.
- Knowing your NHS number and those of other family members and keeping them in a safe place. It is not essential to have your NHS number in order to receive treatment, but it can help NHS staff to find your health records. You will be able to find your NHS Number on your medical card or other items such as prescribed medication, GP letter or hospital appointment card/letter.
- Making sure you have adequate quantities of cold and cough remedies in your medicine cupboard in case you or your family are affected by swine flu.
- Make sure you have a thermometer - ensure you are familiar with its use, and have used it when your child is well, as they often have a higher then normal reading even when the child is well.
who should be wearing a face mask?
The Health Protection Agency (HPA) recommends that healthcare workers should wear a face mask if they come into close contact with a person with symptoms (within one metre) to reduce their risk of catching the virus from patients.
However, the HPA does not recommend that healthy people wear face masks to go about their everyday business. The commonly used paper face mask is ineffective.
why shouldn't the general public wear face masks?
Because there's no conclusive evidence that face masks will protect healthy people in their day-to-day lives.
The virus is spread by picking up the virus from touching infected surfaces, or by someone coughing or sneezing at very close range - so unless you are standing close to someone with the virus, wearing a face mask will not make a difference.
There are concerns about the risks posed by not using face masks correctly.
Face masks must be changed regularly as they are less effective when dampened by a person's breath. People may infect themselves if they touch the outer surface of their mask, or may infect others by not disposing of old masks safely.
Finally, wearing a face mask may encourage complacency. People need to focus on good hand hygiene, staying at home if they are feeling unwell, and covering their mouth when they cough or sneeze.
National Pandemic Flu Service
The National Pandemic Flu Service is a new online service that will assess your symptoms and, if required, provide an authorisation number that can be used to collect antiviral medication from a local collection point. For those who do not have internet access, the same service can be accessed by telephone on:
Telephone:0800 1 513 1000800 1 513 100
Minicom:0800 1 513 2000800 1 513 200
www.pandemicflu.direct.gov.uk 
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