Published 26 October 2009, doi:10.1136/bmj.b4415
Cite this as: BMJ 2009;339:b4415

News

Cases of swine flu in England almost double in a week

¹ London

The number of patients with swine flu who required intensive care rose to its highest level so far in the epidemic last week, with 99 patients being admitted compared with 63 at the end of July. "This is the most worrying figure we have had so far," said Liam Donaldson, chief medical officer for England.

At a press conference on 22 October, Professor Donaldson said that the number of hospitalisations has risen sharply compared with the past few weeks, with 506 patients admitted to hospital in the week ending 21 October, compared with 840 in the last week of July.

Professor Donaldson expressed concern about the number of patients going into intensive care, particularly as initial information suggested that a large proportion of these patients did not have underlying conditions. "We are worried about the sustained stress on the NHS," he said.

Professor Donaldson commented that medical scientists did not understand what had caused this change in the impact of the disease. He said that in accordance with this sharp rise in the number of admissions to intensive care, a biological change in the virus would have been expected—but no changes in the virus had been detected.

The incidence of swine flu has almost doubled in the past week, with the number of new cases reaching 53 000 in England in the week ending 18 October, compared with 27 000 in the previous week. The total number of deaths in the UK during the outbreak stands at 122 (93 in England, 15 in Scotland, 6 in Wales, and 8 in Northern Ireland), with 16 of these deaths occurring in the past week.

Professor Donaldson said that they were seeing an "unusual pattern" in the age distribution of deaths, with 84% of these deaths being reported in people aged under 45. He said that it was very "striking and unusual" to have younger age groups dying, whereas typical patterns for seasonal flu showed that the largest proportion of deaths was in people over 65.

The news comes a day after the swine flu vaccination programme began. The first vaccines have been distributed across the country, and vaccination of healthcare professionals began on Wednesday 21 October, with vaccination of "at risk" patient groups to begin next week. How the vaccine will be distributed after these groups have been vaccinated is yet to be decided. "The supply of the vaccine is driving the timeline," said David Salisbury, the Department of Health’s director of immunisation.

The government’s emergency contingency committee, Cobra, met to discuss the development of the disease so far, and in particular to decide whether children in special needs schools should be included in the "high priority" group for vaccination, after two children in the same special needs school in Northern Ireland died within the last week.

Kent Woods, Chief Executive of the Medicines and Healthcare Products Regulatory Agency (MHRA), stated that the side effects of the vaccine were to be closely monitored. He hoped that a new web portal for anyone to report any side effects, which was launched by the agency on 22 October, would show a "real-time analysis" of the vaccine.

Revised guidance for NHS planners issued by the Department of Health suggests that during the peak week, which is expected later this winter, 1.5 million people in the UK could have swine flu, with one in three children becoming infected.

Professor Donaldson said, "We are seeing some very tragic individual cases," and he commented that clinicians he has spoken to have stated that they are "very unnerved by the severity of the illness" and the speed of deterioration in patients.

Cite this as: BMJ 2009;339:b4415

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