Published 22 July 2009, doi:10.1136/bmj.b2984
Cite this as: BMJ 2009;339:b2984

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Government tries to end confusion over swine flu advice to pregnant women

¹ London

The government has issued new guidance to try to end the confusion over advice to pregnant women on how to avoid the A/H1N1 virus.

The guidance comes after a weekend of conflicting messages from different sources, such as the Department of Health, the National Childbirth Trust, and medical royal colleges.

The National Childbirth Trust issued advice suggesting that women should consider delaying conception. The trust said that the guidance was taken from the health department’s website.

A joint statement from the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives said that current advice was for pregnant women to avoid crowded places whenever possible in times of flu outbreaks.

The health department subsequently posted a new document on its website reiterating previously issued advice but emphasised that it was no longer telling women to delay conception or to stay away from busy workplaces or transport.

A statement from England’s chief medical officer, Liam Donaldson, said that the health department was not advising pregnant women to avoid going to work or busy public places. But it advised that they should observe good hand hygiene, avoid contact wherever possible with someone who is known or suspected to have swine flu, and to contact their GP if they had flu-like symptoms.

Professor Donaldson added, however, that some pregnant women might "exercise their choice now, on a highly precautionary basis," to avoid large, densely populated gatherings. He added that he might make a more specific recommendation later in the year when the pandemic was expected to reach its height.

A department spokeswoman said that the previous guidance to women trying to conceive had been based on predictions for a pandemic involving the more serious avian flu. She said that the advice had now been "refined to reflect current circumstances."

The National Childbirth Trust has now adapted its advice. Mary Newburn, its head of research and information, said, "When a woman is pregnant she is at a slightly greater risk from infection, so she may wish to take some additional precautions. But generally the Department of Health advises that families can continue with normal social activities."

Pregnant healthcare workers should avoid seeing patients with flu-like symptoms if this is possible and practical, the Royal College of General Practitioners says.

So far the UK has had 29 deaths among people infected with the virus, including four children and two mothers who died shortly after giving birth.

The latest figures (20 July) from the European Centre for Disease Prevention and Control show that Europe had 16 969 confirmed cases; and globally there were 139 566 confirmed and reported cases and 781 deaths.

In Australia, where the winter is thought to be helping the spread of the disease, 1130 new cases were reported in just 24 hours from Sunday 19 to Monday 20 July, bringing the total there to 13 178 cases, including 32 deaths.

A national pandemic flu service is being launched this week in England to help take some pressure off "overwhelmed" GPs, who are being swamped with calls from worried patients (BMJ 2009;339:b2932, 20 Jul, doi:10.1136/bmj.b2932).

The health secretary, Andy Burnham, speaking in the House of Commons on 20 July, said that the service would go live later this week, subject to testing.

"The technology to launch the national pandemic flu services has been available for some time, but with the latest Health Protection Agency figures, and drawing on advice from the field, we have now reached a point where the service is required.

"It will be accompanied by a major public information campaign. After the launch, people will no longer need to ring their GP. They can either answer questions online via the new website or ring the call centre service, where trained staff will be able to assess them over the phone.

"If swine flu is confirmed they will then get an authorisation number, which their ‘flu friend’ can use to pick up antivirals from the local antiviral collection point."

Researchers at Imperial College London have proposed that the government consider closing schools later in the year to try to reduce the spread of the virus.

The researchers, writing in Lancet Infectious Diseases (2009;9:473-81, doi:10.1016/S1473-3099(09)70176-8), analysed studies of flu pandemics and epidemics and said that, at peak times, taking such action could reduce the incidence by as much as 45%.

However, such interventions had high social and economical costs, they said, and could potentially disrupt healthcare systems and other key services, so closing schools should be carefully considered and should be based on the pandemic’s severity.

Because the virus continues to spread the QSurveillance primary care tracking database has launched more detailed weekly and daily reports to the government and health authorities.

QSurveillance is a part of the UK pandemic plan. The system, part of a non-profit partnership between the healthcare IT specialist Egton Medical Information Systems (EMIS) and the University of Nottingham, automatically collects anonymised patient data from general practices across the UK on a daily basis and supplies daily analyses to the Health Protection Agency and Department of Health.

Currently 3500 general practices using EMIS computer systems, covering 23 million patients, contribute to the database.

Cite this as: BMJ 2009;339:b2984

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