Published 2 November 2009, doi:10.1136/bmj.b4528
Cite this as: BMJ 2009;339:b4528

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Number of swine flu patients going into intensive care is rising

¹ London

The proportion of patients in hospital with swine flu who have been admitted to intensive care continues to rise in England, said the chief medical officer, Liam Donaldson, last week.

In the week to 28 October 157 of 751 hospitalised patients with the illness (21%) had to go into intensive care, up from 63 of 840 patients (7.5%) in the last week of July, when the epidemic reached a peak before the school holidays began.

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"There is an eerie similarity to what happened in Australia," said Professor Donaldson at a press briefing on 29 October. At one point during Australia’s winter months of June to August 25% of hospitalised patients were in critical care.

Children under the age of 5 years had the highest rate of hospitalisation in the week to 28 October, Professor Donaldson said, and younger patients admitted to critical care were much less likely than older patients to have underlying health conditions.

New data indicate that 65% of the 97 people in England who have died from swine flu during the outbreak would have been in the high priority vaccine groups (pregnant women, people aged over 65 years, and patients with chronic underlying conditions such as diabetes, heart disease, and asthma).

Professor Donaldson expressed hope that the new vaccine programme would reduce the numbers of people dying from the infection.

Ian Dalton, national director of NHS flu resilience, said that the vaccination programme was "on track" and that general practices should expect delivery of their first box of swine flu vaccines in the next three to four weeks if they have not already received one.

The swine flu vaccination programme began on 21 October, with the first vaccines being distributed to primary care trusts across the country for vaccination of healthcare professionals first. Vaccination of "at risk" patients will begin as soon as general practices receive their vaccines.

Five million doses of GlaxoSmithKline’s vaccine, Pandemrix, and one million of Baxter’s Celvapan have been ordered. Celvapan is not egg based and is therefore suitable for patients who have egg allergies.

How the vaccine will be distributed after vaccination of the priority groups has yet to be decided, but Professor Donaldson was keen to emphasise that patients should still continue to use the national pandemic flu service to obtain antiviral drugs when necessary.

"Antivirals still have their part to play [until the vaccine reaches everyone]," he said. "We do have a feeling that [the antivirals] have contained the disease and helped vulnerable groups."

The incidence of swine flu continues to rise but at a slower rate than in the past couple of weeks. The Health Protection Agency estimated that there were 78 000 new cases of swine flu in the week ending 25 October, up from 53 000 in the previous week and 27 000 cases in the week before. The biggest increase in incidence this week was in children, particularly those aged 1-4 years.

Professor Donaldson described this second wave of the virus as being a "slow burn . . . giving us more breathing space."

Cite this as: BMJ 2009;339:b4528

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