(DH) Agreements secured for pre-pandemic vaccine for the UK

Agreements have been signed between the UK Government and vaccine manufacturers to secure supplies of up to 90 million doses of pre-pandemic H1N1 vaccine before a pandemic begins, the Department of Health announced today.

The deals signed between Secretary of State for Health, Alan Johnson, GlaxoSmithKline, and Baxter, will enable production of pre-pandemic vaccine to begin as soon as possible.

The agreements could provide enough vaccine to protect the most vulnerable in our population before a pandemic is likely to arrive, without affecting our supply of seasonal flu vaccine.

Secretary of State for Health, Alan Johnson said:

"The localised cases of swine flu found in the UK have so far been mild, and our strategy of containing the spread with anti-virals appears to have been effective in reducing symptoms and preventing further spread of infection.

"Scientists tell us that as yet we don't know enough about this novel strain, or whether it's likely to mutate, but that this virus has the potential to become a pandemic and we can't predict how serious that would be. We have an opportunity to secure vaccine in advance of a pandemic wave. We have Advance Purchase Agreements to provide vaccine for the entire UK population which will take effect when Phase 6 pandemic is declared. It will then take over a year for all the vaccine necessary to be provided.

"These additional arrangements provide the opportunity by December this year to have enough pre-pandemic vaccine to protect at least half of the population from swine flu. This will however depend on when and if the manufacturers switched from seasonal to H1N1 pandemic specific vaccine production at a time after Phase 6 is declared by the World Health Organisation, as this will take precedence over pre-pandemic contracts."

If a pandemic is declared, Advance Supply Agreements signed by the Government with GSK and Baxter in July 2007, will enable the UK to purchase up to 132 million doses of pandemic specific vaccine, when it becomes available.

(DH) New National Director for NHS Flu Resilience appointed

Ian Dalton has been appointed the new National Director for NHS Flu Resilience at the Department of Health, Health Secretary Alan Johnson announced today.

Mr Dalton, currently Chief Executive of NHS North East, will take up this newly created position with immediate effect, reporting to NHS Chief Executive David Nicholson.

The establishment of this new role follows the recent Swine Flu outbreak. Mr Dalton will be responsible for ensuring that all NHS organisations in England build on the robust planning that is already in place to deal with a flu pandemic, that NHS front line organisations are supplied with adequate equipment and drugs, and leading on appropriate vaccination programs.

Health Secretary Alan Johnson said:

"We have been preparing for the possibility of a pandemic for a number of years and the World Health Organisation says we are among the most prepared countries in the world.

"We already have robust arrangements in place that are continuing to ensure we are well-placed to deal with Swine Flu. The appointment of Ian Dalton will support the vital operational side of our plans by ensuring every NHS organisation in England is in the best possible position to protect the population.

"Ian Dalton is highly respected in the NHS and brings a wealth of skills and experience to this challenging role. I am extremely pleased to be welcoming him to the Department."

NHS Chief Executive David Nicholson said:
"The NHS has done a good job so far handling the swine flu challenge and we have clear plans in place for responding to future developments. Ian's many years of senior management experience mean he is well placed to ensure the NHS is prepared and can continue to protect and care for people."

Ian Dalton said:

"Preparing for and dealing with the threat of pandemic flu is extremely important. The NHS is well placed to deal with such an eventuality and I am looking forward to working with colleagues throughout England to ensure the NHS continues to respond appropriately to any developing
situation."

Mr Dalton will remain substantive in his current post as Chief Executive for NHS North East and will return to this role in due course. David Stout, currently Director of Finance and Communications, will be appointed as Acting Chief Executive for NHS North East.

UN Pandemic alert still at phase 5, as influenza A (H1N1) continues to spread

New York, Apr 30 2009 2:00PM
As it continued to intensively monitor the spread of the influenza A (H1N1) virus, the United Nations health agency today held its pandemic alert to Phase 5, put in place yesterday, and reiterated its call for heightened vigilance.

"The situation continues to evolve," Keiji Fukuda, Assistant Director-General of the UN World Health Organization (WHO), said during what has become a daily press teleconference from the agency, adding that there was nothing new today that indicated a move to the highest level of alert, Phase 6.

"We see some countries reporting new cases," Mr. Fukuda said. "We also see some countries, in which infection has been going on, reporting continued cases in their countries. And then we're seeing that, in other countries, cases appear to be holding steady, for example, the United States," he added.

As of 2:50 p.m. Geneva time, lab-confirmed cases of the virus rose to 236 worldwide, up from the148 reported yesterday, he stated.

The largest jump occurred in Mexico, which went up to 97 confirmed cases from 26 reported earlier, including seven deaths. That steep rise, Mr. Fukuda said, probably comes from the backlog of thousands of specimens submitted for testing and for which the laboratory results are just coming in.

In announcing the notching up of the alert level to Phase 5 last night, WHO Director-General Margaret Chan said it was a signal to Governments and to the private sector that preparatory actions should now be undertaken with "extreme urgency."

Alert Phase 5 meant that sustained human to human transmission had been confirmed, with widespread community outbreaks in at least two regions, she said.

On the positive side, she reported that the world is better prepared for an influenza pandemic than at any time in history, because of preparations made for avian flu outbreaks over the past years.

Dr. Chan added that WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels. And the results of these ongoing assessments will be made publicly available. "We do not have all the answers right now, but we will get them."

Today, Mr. Fukuda said that WHO's preparations have included a distribution of antiviral drugs to developing countries, including Mexico, out of 2 million doses donated for that purpose by the Roche pharmaceutical company.

The agency is also working with Roche, which is planning to scale up its production of antivirals, on a framework to replenish its stockpile.

The UN Food and Agriculture Organization (FAO), meanwhile, reiterated that there is no evidence available that the influenza A (H1N1) virus is coming from or circulating in pigs.

It was also announced today that Deputy Secretary-General Asha-Rose Migiro will hold a town hall meeting tomorrow with New York staff to give an overview of the influenza A (H1N1) situation and the UN's preparedness to address a potential pandemic.
________________

Update on confirmed swine flu cases in England

As at 17:00 on 29 April 2009

As at 17:00 on 29 April 2009
Confirmed UK Cases	Cases currently under laboratory investigation
8*	230

*this includes 3 cases confirmed 30/04/09

Testing of the swine flu virus was carried out by the Health Protection Agency's Centre for Infections Virus Reference Department.

Two of the new cases are from the London area and one is from the North East of England. All have mild symptoms and are responding to treatment at home.

The Health Protection Agency is working to ensure that any close contacts of the three patients are offered antivirals as a precautionary measure. At this stage close contacts who should be offered antivirals as a precautionary measure are those individuals who have been exposed to a probable or confirmed case within the previous seven days for longer than one hour and within a distance of one metre or less.

All eight confirmed cases up to now have been associated with travel to Mexico. The Health Protection Agency's advice remains that individuals returning from affected areas who become unwell within seven days of their return should stay at home and contact their GP or NHS Direct. Individuals will be assessed and, if necessary, testing and treatment will be provided.
The Health Protection Agency is continuing to monitor events and work closely alongside the UK government, to review the ongoing events and assess any threat they pose to UK public health. This includes:

• Enhancing the Agency's presence at airports in England to provide all passengers arriving from Mexico with information and advice on swine flu.
• A leaflet produced by the Health Protection Agency, the Department of Health and the UK Borders Agency is being made available at all ports of entry into the UK providing passengers arriving in the UK with information on swine flu.
• Specialist liaison to the UK Embassy in Mexico to aid the UK effort to tackle swine flu.
  

The World Health Organization (WHO) has raised its pandemic alert level to Phase 5. 'This is characterised by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that pandemic is imminent and that the time to finalise the organisation, communication and implementation of the planned mitigation measures is short'. The Agency is well prepared to meet the requirements of phase 5.

Anyone returning from affected areas who becomes unwell with flu-like symptoms within seven days of their return should stay at home and contact their GP by phone or ring NHS Direct on 0845 4647. Individuals will be assessed and, if necessary, testing and treatment will be provided. The Health Protection Agency will identify any close contacts as part of the assessment, and they will be given advice and, if necessary, antiviral drugs.

General infection control practices and good respiratory and hand hygiene can help to reduce transmission of all viruses, including human swine influenza. This includes:

• Covering your nose and mouth when coughing or sneezing, preferably with a tissue;
• Disposing of dirty tissues promptly and carefully;
• Maintaining good basic hygiene - 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;
• Making sure children follow this advice.

Today the Department of Health has set up a swine flu information line for the public on 0800 1 513 513.

Swine influenza - Health Protection Agency update

The first confirmed cases of swine influenza have been seen in Europe – one case in Spain and two in Scotland. The Health Protection Agency is continuing to monitor events and work closely alongside the UK government, to review the ongoing events and assess any threat they pose to UK public health.

The appearance of confirmed cases in the UK and Europe is not unexpected. In addition to the Mexican cases there have been cases reported in various parts of the US, Canada and New Zealand so the likelihood that it would come here was always high.

Outside of Mexico the majority of cases have been mild and cases have responded positively to antiviral treatment. Although there has been a high number of a deaths associated with the Mexican outbreak there have not so far been any deaths reported elsewhere.

Individuals returning from affected areas who become unwell within seven days of their return should stay at home and contact their GP or NHS Direct. They will be assessed and, if necessary, testing and treatment will be provided.

Clinicians have been asked to consider swine influenza A (H1N1) virus infection when assessing returning travellers and visitors to the UK who present with flu-like symptoms AND have a history of travel to affected areas in the 7 days preceding illness onset.

The World Health Organization (WHO) has requested that all countries strengthen their flu surveillance to provide more information on this infection.

There are currently very low levels of flu activity in the UK but the Agency and the NHS have ongoing surveillance systems in place, which will alert public health authorities of any unusual strain circulating in the UK.

Guidance for health professionals
As part of its preparations the Agency has produced and distributed guidance for the NHS (a WHO Pandemic Alert Phase 3 algorithm) on the management of returning travellers and visitors from countries affected by swine influenza A/H1N1 who present with febrile respiratory illness.

This guidance will support health professionals in their recognition, investigation and initial management of patients who have travelled to affected areas and may be at risk.

The UK's detection capability for this virus is already excellent, using the Health Protection Agency's regional laboratory network and the Centre for Infections Virus Reference Department.

Advice for returning travellers
If you have recently visited one of the countries or areas where human cases of influenza have been identified, it is important for you to monitor your health closely for seven days after your visit to the affected area. There is no need for you to isolate yourself from other people as long as you remain well.

If during this period you develop a feverish illness accompanied by one or more of cough, sore throat, headache and muscle aches, you should stay at home and contact your GP by phone or seek advice from NHS Direct (084...). You should make sure that you tell those from whom you are seeking advice about your recent travel to an area affected. Depending on your symptoms you may be advised that further investigations may be necessary.

General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including the human swine influenza. This includes:

• 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 (eg door handles) frequently using a normal cleaning product
• Making sure your children follow this advice

Travel health
There are currently no UK travel restrictions on those who are planning to visit affected areas. However, it is always good practice to follow good respiratory and hand hygiene.

Any passengers arriving in the UK with symptoms of illness are being offered health information and advice by port health representatives.

There are well established guidelines about what happens with people who become unwell in transit and these are governed by international air travel regulations to which the UK is a signatory.

Airlines are required to carry out informal pre-departure screening at the check-in desk for many factors as well as communicable disease. Check-in staff have guidance on the types of health problems that may present travellers with in-flight or other travel problems and are encouraged to use them to screen passengers.

If someone becomes unwell during a flight then cabin crew have to follow the International Air Travel Association (IATA) guidelines. The pilot has a duty to notify the port health staff so that the passenger can be assessed upon arrival.

Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe.

There has at present been no change to the WHO pandemic alert level which is currently at WHO Phase 3, although WHO is keeping the situation under constant review.

World Health Organisation: Swine influenza

The Emergency Committee, established in compliance with the International Health Regulations (2005), held its second meeting on 27 April 2009.

The Committee considered available data on confirmed outbreaks of A/H1N1 swine influenza in the United States of America, Mexico, and Canada. The Committee also considered reports of possible spread to additional countries.

On the advice of the Committee, the WHO Director-General decided on the following.

The Director-General has raised the level of influenza pandemic alert from the current phase 3 to phase 4.

The change to a higher phase of pandemic alert indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable.

As further information becomes available, WHO may decide to either revert to phase 3 or raise the level of alert to another phase.

This decision was based primarily on epidemiological data demonstrating human-to-human transmission and the ability of the virus to cause community-level outbreaks.

Given the widespread presence of the virus, the Director-General considered that containment of the outbreak is not feasible. The current focus should be on mitigation measures.

The Director-General recommended not to close borders and not to restrict international travel. It was considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention.

The Director-General considered that production of seasonal influenza vaccine should continue at this time, subject to re-evaluation as the situation evolves. WHO will facilitate the process needed to develop a vaccine effective against A/H1N1 virus.

The Director-General stressed that all measures should conform with the purpose and scope of the International Health Regulations.