Written Statement - Seasonal influenza and winter pressures

Before Christmas I wrote to Members about the situation in Wales in respect of seasonal influenza. This statement updates on the latest position and on the demands on the NHS of other winter pressures such as norovirus and the coldest December in Wales for over 100 years.

Influenza activity continues to increase across the UK.  Influenza A H1N1 (2009) and B are the predominant circulating viruses with few, sporadic A (H3N2) viruses detected. The H1N1 (2009) virus strain is virologically and epidemiologically similar to that seen during the pandemic. Seasonal influenza has hit the UK about a month earlier than normal and appears more prevalent than in recent years, although the current rates remain lower than during the 2009 H1N1 pandemic and much lower than the 1999-2000 seasonal flu outbreak.

The consultation rates rose consistently throughout December. The provisional consultation rate for influenza in Wales in week 52 (week ending 2/1/2011) reported through the GP Sentinel Surveillance of Infections Scheme, is 89.2 consultations per 100,000 population, which is within the definition of normal seasonal activity. This represents a slight decrease in the number of consultations, from 92.1 per 100,000 the previous week. Surveillance data from Out of Hours doctors and NHS Direct collected during week 52 suggests that influenza activity in the community may still be increasing. Consultation rates were highest in the 25-34 year age-group (129.2 per 100,000).

Indications from Public Health Wales are that the consultation rates may now be levelling out and will begin to reduce in the next few weeks, although elevated influenza activity is likely for several weeks to come. The situation should become clearer next week as activity up to this week may have been affected by different consultation patterns and by schools being closed for the Christmas holiday.

For the majority, the flu is mild, however, for a small number with pre-existing medical conditions, the symptoms can be more severe and lead to  complications.

Over the Christmas period, the Joint Committee on Vaccination and Immunisation (JCVI) strongly reiterated its previous advice on seasonal influenza vaccination, i.e that all individuals in risk groups should be vaccinated as soon as possible, particularly those aged less than 65 years.  It also considered the issue of offering vaccination to healthy children either 0-4 years and/or 5-15 years of age. It considered that, although there is a high incidence of influenza-like illness currently in these age groups, a significant proportion of this is due to other viruses such Respiratory Syncytial Virus (RSV). Based on previous seasonal influenza epidemiology, the Committee concluded that it did not believe that seasonal or pandemic vaccine should be used for these or other healthy person groups.

Members will be aware of media reports of vaccine shortages in primary care and occupational health units. My officials are working with Local Health Boards in Wales to co-ordinate the redistribution of stocks to cover areas where stocks are low. Given that we have been running a campaign since October to encourage vulnerable groups such as pregnant women and the elderly to get vaccinated, it is natural that stocks will run down over time. The Chief Medical Officer is writing today (6 January) to the Service to support clinicians using the pandemic vaccine Pandemrix as an alternative, with patients’ being informed that they are receiving a vaccine that only protects against the dominant circulating strain.

Clinicians will be reminded it is important to treat people with antivirals in at-risk groups promptly, preferably within 48 hours of symptom onset, regardless of vaccination status, as no vaccine gives full protection against influenza.

In advance of the recent increase in influenza activity, we took steps to raise awareness among the public of the benefits of vaccination to protect against the virus. A substantial seasonal flu publicity campaign was rolled out during the autumn and winter, through channels such as TV and radio, and posters aimed at clinical settings like GP surgeries and for care homes. Materials were produced aimed at pregnant women and charities and organisations related to at-risk groups, such as the British Heart Foundation and Asthma UK Cymru, were supplied with information for their newsletters, bulletins and websites. Information was also sent out through social networking and blogging channels such as YouTube and Twitter. 

Through recent media activity WAG has also continued to promote the need for risk groups (such as pregnant women) to be vaccinated. The Chief Medical Officer’s Department has also issued guidance to GPs encouraging them to vaccinate these groups. It is still not too late for these groups to become vaccinated, although the window of opportunity for vaccination to be effective during this flu season year is now becoming smaller. Antiviral treatment in the early stages of influenza can reduce complications and the length of illness. Antivirals are widely available although liquid doses for under 1 year olds need special preparation and are available through hospital pharmacies.

During the flu season, Public Health Wales publishes a weekly flu report for Wales which is available from the Public Health Wales Health Protection Division website from the link: Seasonal influenza surveillance data for Wales

At this time of year, Norovirus (or winter vomiting disease) also provides challenges to hospitals and schools. Earlier this week, the Chief Medical Officer reiterated advice about how to manage norovirus and how to avoid passing it on. The advice reminded people that if they are unwell, they should avoid coming into hospital or visiting the GP, as the bug will spread quickly to other patients and staff.

Public Health Wales have reported that there is little evidence of a community-wide outbreak of norovirus.

In addition to the seasonal flu and D&V outbreaks, the cold weather with ice and snow has caused an increase in trauma cases and we would expect an increase in cases of heart attacks, stroke and pneumonias. These cases contribute to the pattern of excess winter deaths and we know there is a correlation with prolonged low temperatures.

My officials are holding daily conference calls with Local Health Boards to share information, monitor demand and bed capacity including critical care. Overall, the NHS in Wales is extremely busy but coping well with the increased demands of the winter pressures.

I will provide Members with a further update later this month.