Published 19 October 2009, doi:10.1136/bmj.b4291
Cite this as: BMJ 2009;339:b4291

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H1N1 vaccination begins as proportion of cases in hospital admitted to intensive care rises

¹ BMJ

The swine flu vaccination programme will begin on Wednesday 21 October, when the first vaccines are distributed to acute trusts for use in "very high risk" patients and healthcare professionals, the chief medical officer Liam Donaldson has announced.

At the Department of Health briefing of 15 October, Professor Donaldson said that he was worried by the fact that the proportion of patients admitted to hospital who are going into intensive care has risen from one in eight to one in five.

He said that the Pandemrix vaccine (GlaxoSmithKline) will reach acute trusts on 21 October and general practices and mental health trusts on 26 October. Celvapan (Baxter) will be distributed from 26 October and will be reserved for patients in priority groups with anaphylactic reactions to egg.

In hospitals, priority will be given to patients at high risk and front line staff. General practices will target pregnant women and people with chronic disease.

Professor Donaldson said that the department was going "to try extremely hard" to achieve substantial uptake in health workers, where it has traditionally been low, to protect patients and reduce disruption to services.

The Ministry of Defence also announced last week that the vaccination is going to be offered to UK troops deployed in Afghanistan. They said that this will aim to "maintain the numbers of troops available to commanders." The programme will begin only after people at high risk in the United Kingdom have been vaccinated.

There is some concern that the postal strike could pose a problem because GPs send their appointment invitations by post. Professor Donaldson said, "We will be working very hard to mitigate any risks arising from the postal strike, but it is an extremely unwelcome piece of timing."

David Salisbury, the Department of Health director of immunisation, emphasised the need for pregnant women to be vaccinated because they are at particular risk. He said that seasonal flu vaccinations had been safely used in pregnant women and that this group had experienced high case fatality rates in previous pandemics.

Two more deaths in pregnant women were announced last week in the United States, making a total of six deaths in pregnant women there. Overall, the number of people who have had the infection in England rose by 27 000 in the week ending 11 October, compared with a rise of 18 000 in the previous week. The Health Protection Agency estimates that 370 000 people in England have now had the virus.

There had been a further increase in patients admitted to hospital, with a total of 364, 74 of whom went into intensive care, as of 8 am on 14 October. Professor Donaldson said this was a "significant change" and represented "the highest proportion of hospital patients who have been in intensive care since this all began."

Until the last week, the proportion of patients who had been admitted to intensive care was about 12-13%, but it has now reached 20%. Although there has been no change in the virus noted, Professor Donaldson said that "we are seeing more serious cases than we have seen before" and admitted that this was worrying him.

The Health Protection Agency reported that the main burden of flu-like illness nationally was in 5-24 year olds. The United States has reported a rise in paediatric influenza deaths, which is uncharacteristic for this time of year.

Deaths have continued to increase, with the UK total now at 106 (83 in England, 15 in Scotland, 4 in Wales, and 4 in Northern Ireland).

Professor Donaldson said, "While we have got the positive news that we are not yet seeing explosive doubling type increases in the rate of the pandemic in this country, I am concerned about the relatively high proportion of patients who are in the serious category in hospital."

Cite this as: BMJ 2009;339:b4291

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Rise in swine Flu cases admitted to intensive care

CV Praveen, et al.
bmj.com, 24 Oct 2009 [Full text]