Cases of swine flu in England almost double in a weekBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4415 (Published 26 October 2009) Cite this as: BMJ 2009;339:b4415
All rapid responses
With the incidence of swine flu reportedly almost doubling last week
and increasing proportions of those affected becoming critically ill, the
introduction of the swine flu vaccine is timely. It seems appropriate
that it is immediately offered to those caring for swine flu patients.
However, will the vaccine be accepted by those who are perhaps most
sceptical about its evolution and effectiveness? The Nursing Times’
readers poll this month reported that only 23% of nurses intended to be
vaccinated, a substantial fall from 35% in August (1). Similarly, 29% of
216 GPs would refuse the jab; many admitting anxiety about vaccine safety
due to lack of convincing trial data (2).
New York State’s answer to their health professionals’ reluctance to
receive inoculation was to introduce a directive, ordering healthcare
staff to receive vaccination or put their jobs at risk (3,4).
Also worrying is the potential for those unvaccinated health professionals
to be at risk of serious disease or death. The “unusual pattern” of age
distribution of deaths, with 84% of swine flu deaths being reported in
those under 45 years (5), would put the majority of the UK’s healthcare
workforce at risk. 60% of Britain’s GMC-registered doctors are aged under
45 years (6); 68.98% of NMC – registered nurses are under 49 years (7).
Yet, does the published swine flu incidence represent reality?
Emerging numbers of new cases (53,000 week ending 18 October) are only
estimates, based on GP consultations of “flu-like” illness reported by Q
Surveillance (sample of UK practices thought to be representative of its
population) which, combined with the number of patients collecting anti-
viral prescriptions, give us the latest swine flu figures 8.
Nevertheless, only 30% of patients (8), randomly sampled at anti-viral
collection sites, test positive for swine flu (reducing incidence from
53,000 to 15,900).
If the majority of medical professionals remain confused by these
statistics and the vaccine’s questionable effectiveness, it is hard for
them to act as an example and informer to their patients. It perhaps also
indicates how much we as clinicians correctly apply principles of evidence
-based medicine to ourselves as well as to our patients.
Remarkably, the relevant New York State authority is hoping to
achieve inoculation by ordering healthcare professionals to receive
vaccination or risk losing their jobs. An alternative action, with
potentially longer effect, would be to develop more rigorous research
techniques to enable evidence-based decision making. This could, in part,
be achieved through the development of a comprehensive database of
confirmed rather than estimated cases.
1.Nursing Times 6/10/09. Nurses confidence in swine flu vaccine
confidence-in-swine-flu-vaccine-falling/5006950.article Accessed 28/10/09
2. Moberly T One in three GPs reject swine flu jab. Health Care Repulic
reject-swine-flu-jab/ Accessed 28/10/09
3.BBC online 24/10/09. US declares swine flu emergency
http://news.bbc.co.uk/1/hi/world/americas/8324070.stm Accessed 29/10/09
4. Flu. Gov. President Obama signs emergency declaration for H1N1 flu
5. Siva N. Cases of swine flu in England nearly double in a week. BMJ
6 GMC statistics Oct 2009http://www.gmc-
uk.org/doctors/register/search_stats.asp Accessed 28/10/09
7.NMC statistics Mar 2008 http://www.nmc-
uk.org/aArticle.aspx?ArticleID=3857 Accessed 28/10/09
8. Telephone consultations with HPA, D of H (ONS), Flu Surveillance
Competing interests: No competing interests